Información de la revista
Vol. 2. Núm. 5.
Páginas 261-271 (Septiembre - Octubre 2006)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 2. Núm. 5.
Páginas 261-271 (Septiembre - Octubre 2006)
Revisiones
Acceso a texto completo
Efectos gastrointestinales graves por antiinflamatorios no esteroideos. Un problema no resuelto
Upper gastrointestinal events associated with nonsteroidal anti-inflammatory drugs usage. An unsolved problem
Visitas
14743
Federico Galván-Villegas
Autor para correspondencia
fegalvi@cybercable.net.mx

Correspondencia: Dr. F. Galván-Villegas. Departamento de Reumatología. Hospital de Especialidades. Centro Médico Nacional de Occidente. Unidad Médica de Alta Especialidad. Avda. Chapalita, 1300. Colonia Chapalita Campo de Polo. CP. 45000 Guadalajara, Jalisco. México.
, Ernesto Neri Navarrete
Departamento de Reumatología. Hospital de Especialidades. Centro Médico Nacional de Occidente. Unidad Médica de Alta Especialidad. IMSS. Guadalajara. Jalisco. México
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas

Antes de indicar un antiinflamatorio no esteroideo (AINE) se debe evaluar cada caso individual en cuanto a factores de riesgo, como edad, uso de otros agentes potencialmente agresivos al tracto gastrointestinal, tabaquismo y uso concomitante de aspirina, para seleccionar la mejor opción de tratamiento para cada paciente en particular y determinar la necesidad de terapia gastroprotectora. Dada la posibilidad de riesgo cardiovascular, de los COX-2 selectivos, también se deben analizar los factores de riesgo cardiovascular que tenga nuestro paciente antes de iniciar un medicamento de este tipo, principalmente teniendo en cuenta que el efecto protector de los COX-2 selectivos disminuye considerablemente en pacientes que reciben terapia con aspirina.

Palabras clave:
Antiinflamatorios no esteroideos (AINE)
COX-1
COX-2
Efectos gastrointestinales
Gastropatía

Before nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated, risk factors such as age, the use of other drugs potentially harmful to the gastrointestinal tract, smoking, and concomitant use of aspirin should be evaluated, to select the most appropriate option for each patient and determine the need for gastroprotective therapy. Because of the possibility of cardiovascular risk posed by COX-2 selective NSAIDs, cardiovascular risk factors should also be analyzed in each patient before starting treatment of this type, mainly bearing in mind that the protective effect of COX-2 selective NSAIDs is substantially reduced in patients taking aspirin.

Key words:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
COX-1
COX-2
Gastrointestinal effects
Gastropathy
El Texto completo está disponible en PDF
Bibliografía
[1.]
M.R. Griffin.
Epidemiology of nonsteroidal-antiinflammmatory drug-associated gastrointestinal injury.
Am J Med, 104 (1998), pp. 23S-29S
[2.]
M.M. Wolfe, D.R. Lichtenstein, G. Singh.
Medical progress: gastrointestinal toxicity of nonsteroidal antiinflammatory drugs.
N Engl J Med, 340 (1999), pp. 1888-1899
[3.]
G. Singh, D.R. Ramey, D. Morfeld, H. Shi, H.T. Hatoum, J.F. Fries.
Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis: a prospective observational cohort study.
Arch Intern Med, 156 (1996), pp. 1530-1536
[4.]
G. Singh, G. Triadafilopoulus.
Epidemiology of NSAID-induced GI complications of peptic ulceration.
Gut, 26 (1999), pp. 18-24
[5.]
C.P. Armstrong, A.L. Blower.
Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration.
Gut, 28 (1987), pp. 527-532
[6.]
G. Singh, D.R. Ramey, R. Ferry, M. Khraishi, G. Triadafilopoulos.
NSAID related effects on the GI tract: an ever widening sprectrum [abstract].
Arthritis Rheum, 40 (1997), pp. S93
[7.]
G. Singh.
Recent considerations in nonsteroidal anti-inflammatory drug gastropathy.
Am J Med, 105 (1998), pp. 31S-38S
[8.]
R.L. Ruffalo, R.L. Jackson, J.J. Ofman.
The impact of NSAID selection on gastrointestinal injury and risk for cardiovascular events: identifying and treating patients at risk.
Pharm Ther J, 27 (2002), pp. 570-576
[9.]
L.J. Crofford.
COX-1 and COX-2 tissue expression: implications and predictions.
J Rheumatol, 24 (1997), pp. 15-19
[10.]
F.L. Lanza, M.F. Rack, T.J. Simon, H. Quan, J.A. Bolognese, M.E. Hoover, et al.
Specific inhibition of cyclooxygenase-2 with MK-0966 is associated with less gastsroduodenal damage than aspirin or ibuprofen.
Aliment Pharmacol Ther, 13 (1999), pp. 761-767
[11.]
J.M. Scheinman.
Outcomes studies of the gastrointestinal safety of cyclo-oxygenase-2 inhibitors.
Cleve Clin J Med, 69 (2002), pp. S140-S146
[12.]
J.J. Deeks, L.A. Smith, M.D. Bradley.
Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomized controlled trials.
BMJ, 325 (2002), pp. 619
[13.]
C. Bombardier, L. Laine, A. Reicin, D. Shapiro, R. Burgos-Vargas, B. Davis, et al.
Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group.
N Engl J Med, 343 (2000), pp. 1520-1528
[14.]
M.J. Langman, D.M. Jensen, D.J. Watson, S.E. Harper, P.L. Zhao, H. Quan, et al.
Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs.
JAMA, 282 (1999), pp. 1929-1933
[15.]
S. Hernández-Díaz, L.A. Rodríguez.
Incidence of serious upper gastrointestinal bleeding/perforation in the general population: review of epidemiologic studies.
J Clin Epidemiol, 55 (2002), pp. 157-163
[16.]
J.H. Kurata, A.N. Nogawa.
Meta-analysis of risk factors for peptic ulcer. Nonsteroidal anti-inflammatory drugs, Helicobacter pylori and smoking.
J Clin Gastroenterol, 24 (1997), pp. 2-17
[17.]
L.A. García Rodríguez, S. Hernández-Díaz, F.J. De Abajo.
Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies.
Br J Clin Pharmacol, 52 (2001), pp. 563-571
[18.]
L.A. García Rodríguez, S. Hernández-Díaz.
Risk of uncomplicaated peptic ulcer among users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs.
Am J Epidemiol, 159 (2004), pp. 23-31
[19.]
S.M. Weisman, D.Y. Graham.
Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events.
Arch Intern Med, 162 (2002), pp. 2197-2202
[20.]
S. Derry, Y.K. Loke.
Risk of gastrointestinal hemorrhage with long term use of aspirin: meta-analysis.
BMJ, 321 (2000), pp. 1183-1187
[21.]
R. Stalnikowitz-Darvasi.
Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive events. A critical analysis.
J Clin Gastroenterol, 21 (1995), pp. 13-16
[22.]
J. Weil, D. Colin-Jones, M. Langman, D. Lawson, R. Logan, M. Murphy, et al.
Prophylactic aspirin and risk of peptic ulcer bleeding.
BMJ, 310 (1995), pp. 827-830
[23.]
H.T. Sorensen, L. Mellemkjaer, W.J. Blot, G.L. Nielsen, F.H. Steffensen, J.K. McLaughlin, et al.
Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin.
Am J Gastroenterol, 95 (2000), pp. 2218-2224
[24.]
V. Bansal, T. Dex, H. Proskin, S. Garreffa.
A look at the safety profile of over-the- counter naproxen sodium: a meta-analysis.
J Clin Pharmacol, 41 (2001), pp. 127-138
[25.]
S.E. Gabriel, L. Jaakkimainen, C. Bombardier.
Risk for serous gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs.
Ann Intern Med, 115 (1991), pp. 787-796
[26.]
S. Hernández-Díaz, L.A. Rodríguez.
Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s.
Arch Intern Med, 160 (2000), pp. 2093-2099
[27.]
J.J. Ofman, C.H. MacLean, W.L. Straus, S.C. Morton, M.L. Berger, E.A. Roth, et al.
A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs.
J Rheumatol, 29 (2002), pp. 804-812
[28.]
L. Laine.
Approaches to nonsteroidal anti-inflammatory drug use in the high risk patients.
Gastroenterology, 120 (2001), pp. 594-606
[29.]
R.W. Dubois, G.Y. Melmed, J.M. Henning, M. Bernal.
Risk of upper gastrointestinal injury and events in patients treated with cyclooxygenase (COX-1/COX-2) nosteroidal antiinflammatory drugs (NSAIDs, COX-2) selective NSAIDs and gastroprotective cotherapy, an appraisal of the literature.
J Clin Rheumatol, 10 (2004), pp. 178-189
[30.]
D.A. Kujubu, B.S. Fletcher, B.C. Varnum, R.W. Lim, H.R. Herschman.
TIS 10, a phorbol ester tumor promoter-inducible mRNA from Swiss 3T3 cells, encodes novel prostaglandin synthase/cyclo-oxygenase homologue.
J Biol Chem, 266 (1991), pp. 12866-12872
[31.]
D.L. DeWitt, E.A. Meade, W.L. Smith.
Prostaglandin H synthase isoenzyme activity: the potential for safer non-steroidal anti-inflammatory drugs.
Am J Med, 95 (1993), pp. 40S-44S
[32.]
R.I. Russell.
Non-steroidal anti-inflammatory drugs and gastrointewstinal damage-problems and solutions.
Postgrad Med J, 77 (2001), pp. 82-88
[33.]
J.L. Goldstein, F.E. Silverstein, N.M. Agrawal, R.C. Hubbard, J. Kaiser, C.J. Maurath, et al.
Reduced risk of upper gastrointestinal ulcer complications with celecoxib a novel COX-2 inhibitor.
Am J Gastroenterol, 95 (2000), pp. 1681-1690
[34.]
S. Harper, M. Lee, S. Cartis.
A lower incidence of upper-GI perforations, ulcers and bleeds (PUBs) in patients treated with etoricoxib vs. nonselective cyclooxygenase inhibitors.
Arthritis Rheum, Suppl 44 (2001), pp. S318
[35.]
F.E. Silverstein, G. Faich, J.L. Goldstein, L.S. Simon, T. Pincus, A. Whelton, et al.
Gastrointestinal toxicity with celecoxib vs. nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized trial. Celecoxib Long-term Arthritis Safety Study.
JAMA, 284 (2000), pp. 1247-1255
[36.]
J.L. Goldstein, G. Eisen, W. Bensen.
SUCCESS in osteoarthritis (OA) trial: selecoxib significantly reduces the risk of upper gastrointestinal (UGI) hospitalizations compared to diclofenac and naproxen in 13,274 randomized patients with OA [abstract].
European League Against Rheumatism, (2001),
[37.]
T.J. Schnitzer, G.R. Burmester, E. Mysler, M.C. Hochberg, M. Doherty, E. Ehrsam, et al.
Comparison of lumiracoxib with naproxen and ibuprofen in ther therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomized controlled trial.
[38.]
M. Mandani, P.A. Rochon, D.N. Juurlink, A. Kopp, G.M. Anderson, G. Naglie, et al.
Observational study of upper gastrointestinal hemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs.
BMJ, 325 (2002), pp. 624
[39.]
M.E. Winblat.
Nonsteroidal anti-inflammatory drug toxicity: increased risk in the elderly.
Scand J Rheumatol Suppl, 91 (1991), pp. 9-17
[40.]
L. Laine, C. Bombardier, C.J. Hawkey, B. Davis, D. Shapiro, C. Brett, et al.
Stratifying the risk of NSAID-related upper gastrointestinal clinical events: results of a double-blind outcomes study in patients with rheumatoid arthritis.
Gastroenterology, 123 (2002), pp. 1006-1012
[41.]
L.A. García Rodríguez, H. Jick.
Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs.
Lancet, 343 (1994), pp. 769-822
[42.]
P. Serrano, A. Lana, M.T. Arroyo, I.J. Ferreira.
Risk stratification of upper gastrointestinal bleeding in cardiovascular patients on low-dose aspirin. A cohort study [abstract].
Gastroenterology, 118 (2002), pp. A862
[43.]
L.A. García Rodríguez, S. Hernández-Díaz.
The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents.
Arthritis Res, 3 (2001), pp. 98-101
[44.]
R.I. Shorr, W.A. Ray, J.R. Daugherty, M.R. Griffin.
Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease.
Arch Intern Med, 153 (1993), pp. 1665-1670
[45.]
L. Mellemkjaer, W.J. Blot, H.T. Sorensen, L. Thomassen, J.K. McLaughlin, G.L. Nielsen, et al.
Upper gastrointestinal bleeding among users of NSAIDs: a population-based cohort study in Denmark.
Br J Clin Pharmacol, 53 (2003), pp. 173-181
[46.]
L. Laine.
Gastrointestinal safety of coxibs and outcomes studies what's the verdict?.
J Pain Symptom Manage, 23 (2002), pp. S5-S10
[47.]
C.J. Hawkey.
Gastrointestinal safety of COX-2 specific inhibition.
Gastroenterol Clin North Am, 30 (2001), pp. 921-936
[48.]
J.L. Goldstein.
Influence of HP infection and/or low dose aspirin on gastroduodenal ulceration in patients treated with placebo, celecoxib or NSAIDs [abstract].
Gastroenterology, (2001),
[49.]
B.M. Spiegel, L. Targownik, G.S. Dubai, I.M. Grainek.
The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis.
Ann Intern Med, 138 (2003), pp. 795-806
[50.]
J.M. Álvaro-Gracia.
Licofelone-clinical update on a novel LOX-COX inhibitor for the treatment of osteoarthritis.
Rheumatology (Oxford), 43 (2004), pp. i21-i25
[51.]
F.E. Silverstein, D.Y. Graham, J.R. Senior, H.W. Davies, B.J. Struthers, R.M. Bittman, et al.
Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nosteroidal anti-inflammatory dugs.
Ann Intern Med, 123 (1995), pp. 241-249
[52.]
A. Rostom, G. Wells, P. Tugwell, V. Welch, C. Dube, J. McGowan.
Prevention of NSAID-induced gastroduodenal ulcers.
Cochrane Database Syst Rev, (2000),
[53.]
D.Y. Graham, N.M. Agrawal, D.R. Campbell, M.M. Haber, C. Collis, N.L. Lukasik, et al.
Ulcer prevention in long-term users of nonsteroidal anti-inflammatory drugs: results of a double-blind, randomized, multicenter, active-and placebo-controlled study of misoprostol vs lansoprazole.
Arch Intern Med, 162 (2002), pp. 169-175
[54.]
C.J. Hawkey, J.A. Karrasch, L. Szczepanski, D.G. Walker, A. Barkun, A.J. Swannell, et al.
Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazol versus Misoprostol for NSAID-induce Ulcer Management (OMNIUM) Study Group.
N Engl J Med, 338 (1998), pp. 727-734
[55.]
D. Cullen, K.D. Bardhan, M. Eisner, D.G. Kogut, R.A. Peacock, J.M. Thomson, et al.
Primary gastroduodenal prophylaxis with omeprazole for nonsteroidal anti-inflammatory drug users.
Aliment Pharmacol Ther, 12 (1998), pp. 135-140
[56.]
P. Ekstrom, L. Carling, S. Wetterhus, P.E. Wingren, O. Anker-Hansen, G. Lundegardh, et al.
Prevention of peptic ulcer and dyspeptic symptoms with omeprazole in patients receiving continuous non-sterol anti-inflammatory drug therapy. A Nordic multicentre study.
Sand J Gastroenterol, 31 (1996), pp. 753-758
[57.]
N.D. Yeomans, Z. Tulassay, L. Juhasz, I. Racz, J.M. Howard, C.J. van Rensburg, et al.
A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Supression Trial: Ranitidine versus Omeprazole for NSAID-associated Ulcer Treatment (ASTRONAUT) Study Group.
N Engl J Med, 338 (1998), pp. 719-726
[58.]
K.C. Lai, S.K. Lam, K.M. Chu, B.C. Wong, W.M. Hui, W.H. Hu, et al.
Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use.
N Engl J Med, 346 (2002), pp. 2033-2038
[59.]
F.K. Chan, L.C. Hung, B.Y. Suen, J.C. Wu, K.C. Lee, V.K. Leung, et al.
Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent uler bleeding in patients with arthritis.
N Engl J Med, 347 (2002), pp. 2104-2110
[60.]
L.S. Simon, J.S. Smolen, S.B. Abramson, G. Appel, C. Bombardier, D.C. Brater, et al.
Controversies in COX-2 selective inhibition.
J Rheumatol, 29 (2002), pp. 1501-1510
[61.]
A.M. Fendrick, S.M. Garabedian-Ruffalo.
A clinician's guide to the selection of NSAID therapy.
Pharmacol Ther, 27 (2002), pp. 579-582
Copyright © 2006. Elsevier España S.L. Barcelona
Idiomas
Reumatología Clínica
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?