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|Type:||Artigo de periódico|
|Title:||Induced Lesions By Nonsteroidal Anti-inflammatory Drugs [lesoes Induzidas Por Aines No Sistema Digestorio]|
|Abstract:||The COX-1-inhibitors nonsteroids anti-inflammatory drugs (NOSAID's) are responsible for important adverse effects in the digestive tract, being those observed in the stomach and duodenum the most important. About 100 million prescriptions of NOSAID's are annually made in USA and roughly 40 billion tablets (aspirin and ibuprofen) are consumed over the counter. Although adverse effects are not that frequent, the huge consumption of NOSAID's, particularly in the population over 60 years, make side effects a fatal risk. The number of patients that develop ulcers because of NOSAID's use range from 10% o to 30%. In About 50% the first symptom is usually a complication (hemorrhage). The risk factors for NOSAID's-induced ulcer and complications are: age> 65 years, type of NOSAID's, association with corticosteroids or other NOSAID's, higher dose of NOSAID's, association with anticoagulants, past history of ulcer or hemorrhage. When 3 or more of those risk factors are present, prophilatic treatment should be done, being proton pump inhibitors the best choice. Enteropathy is frequent in NOSAID's chronic users but, they usually don't call the doctor's attention because they don't result in fife risk for the patient. Nevertheless it should be remembered that enteritis is an important cause of distress. 60% to 70% of patients using NOSAID's for more than 6 months can present anemia and hipoalbuminemia responsible for symptoms like fatigue, indisposition, weakness and loss of appetite. The most promising treatment is metronidazol administration. Small bowell ulcer and perforation, although rare, can occur. A new entity related to the chronic use of NOSAID's is represented by thin smallbowell mucosal diaphragms which results in constrictions and sometimes, sub-oclusion. NOSAID's eventually can cause acute colitis, diverticulitis and diverticulum perforation. The reactivation of Acute Proctocolitisl and Crohn's disease has been observed with NOSAID's. The discovery of selective COX-2 inhibitors brought a new hope to patients with bone diseases. Gastroduodenal complications with these drugs are not different to the observed with placebo, significantly less when compared to diclofenat, considered to be one of the less ulcerogenic NOSAID's. However, more experience is needed to evaluate the safety of long-term use of COX-2 inhibitors, specially in high risk population. The possibility of enterocolic complications have not been properly studied. Some observations recently published in the literature deserve to be pointed out: 1- The creation of a COXIB category in substitution to selective COX-2 inhibitors 'by the World Health Organization. 2- Investigations comparing the safety of specific COX-2 inhibitors, celecoxib and rofecoxib with others COX-1 inhibitors NOSAID's in an expressive number of patients showed the safety of COX-2 inhibitors paticularly in relation to gastrointestinal toxicity. 3- The promising use of COX-2 inhitors in cancer of the colon.|
|Appears in Collections:||Unicamp - Artigos e Outros Documentos|
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