英国胃肠病学会（AGA）有关开据 NSAIDs处方的建议

吲哚类非甾体的系统设计牵动高发消化道癌症技术委员会原则上颁布推荐要求书来减小不确定性据American胃肠病研习推举的多学科技术委员会详述，吲哚类非甾体给有预防性的症状提供了空旷的更进一步，但是医疗保健部门在给症状先以于据这吗啡前，所需仔细选择它的牵动不确定性。消化道病变是可用非类非甾体的最类似的过敏，有数上消化道和下消化道的癌症。导致的消化道癌症，如潜在的致命性病变性肿胀，年频发率为可用者的1－4％。技术委员会的谈论结果“关于颁布吲哚类非甾体有数内侧水解酶－2自生剂和高血压的系统设计要求书学术会议的深思熟虑”刊载在American胃肠病研习出版的9月初的《临床胃肠病学与肝脏病学》时代周刊上。“吲哚类非甾体是世界性系统设计最广泛的类固醇，而且广泛的系统设计断定了它的消炎和相对兼容性” 据霍普金斯大学考文垂分校内现代科学教授，论文的主要创作者C. Mel Wilcox博士详述。“但是，过去虽然充分认识了消化道癌症，而没预见其心脏小心，American胃肠病研习推举一致同意来增高对系统设计该吗啡的更进一步和消化道及全身性毒性的不确定性，从而改进对该吗啡的系统设计。”少于世界性每年耗用500亿高血压片，其中American差不多6000万份处方先以于据了高血压，并主要给老年症状。这吗啡对急、慢性疼痛和头骨肌肉水肿等方面有效。但是，吲哚类非甾体的可用牵动着导致的小心，有数消化道、消化道和全身性癌症，甚至有数尿毒症和心肌梗死。“我们高兴地注意到吲哚类非甾体的消化道癌症和死亡者早就从1992年先以于始下降，我们认为这种境况得益于一下方面：小药物可用吲哚类非甾体；降低了十二指肠索斯尼夫卡的广为人知；增高了质子泵自生剂的系统设计；以及应运而生对消化道更安全的吲哚类非甾体的系统设计，如昔布吗啡。” Wilcox博士知道。“但是，医疗保健部门和症状所需了解该吗啡的系统性不确定性来颁布吲哚类非甾体的最佳系统设计要求书。技术委员会为医疗保健部门颁布了当他们在决定确实给症状先以于吲哚类非甾体时的以下要求：评价放射治疗的预防性和症状频发消化道和全身性癌症的潜在小心因子，并和症状谈论全身性疾病的潜在小心因子。对不确定性和更进一步进行数据分析来衡量个体消化道和全身性小心后，先以于据低不确定性的类固醇。消化道病变频发小心大的症状所需系统设计消化道不确定性低的吲哚类非甾体，例如非软性吲哚类非甾体；全身性事件频发不确定性大的症状所需接受内侧氧酶－2自生剂放射治疗；有已知全身性疾病或全身性病不确定性的症状所需接受小药物高血压。限制所先以于吲哚类非甾体的持续时间和药物，以及征询并要求症状进行吲哚类非甾体的联合放射治疗。在系统设计吲哚类非甾体放射治疗前，先以管控十二指肠索斯尼夫卡的病菌，以致不增高并发消化性肿胀的不确定性。针对消化道癌症不确定性大的症状颁布胃肠维护要求书，如系统设计米索前列羟基或质子泵自生剂。“吲哚类非甾体的系统设计牵动低消化道癌症在诊断和放射治疗上很重要，” Wilcox博士解释知道。“很好地理解低消化道病变频发的不确定性和中间体是减少吲哚类非甾体的可用小心所所需的。”在一致同意期间谈论的解毒剂都亦然类自生水肿反应的类固醇，因此在学术上被认为是吲哚类非甾体。非软性的吲哚类非甾体，有数布洛芬、依托度酸和N-丁美酮，它们比其他吲哚类非甾体，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对消化道较强更高的兼容性。昔布吗啡是软性内侧水解酶－2抑制剂。在标准药物下，扑热息痛不是吲哚类非甾体。American胃肠病研习技术委员会由胃肠病学、风湿病学、心脏病学和内现代科学医师组成，他们在小组谈论后，以现阶段科研报告为基础颁布了这个要求书。American胃肠病研习举办活动的“关于吲哚类非甾体的系统设计的一致同意”由TAP药品公司提供的一项无限教学Fund赞助。与会者的财政先以于销公布包含在原稿内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.主编：bluelove 主编： Zhu