Non-steroidal anti-inflammatory drugs: Deleterious effect on the gastric mucosa and protection against ulcerogenic effects
DOI:
https://doi.org/10.33910/2687-1270-2021-2-4-390-398Keywords:
non-steroidal anti-inflammatory drugs, gastrointestinal tract, mucosal damage, prostaglandins, glucocorticoid hormones, gastroprotectionAbstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are used for various diseases to relieve pain and reduce inflammation. However, the use of NSAIDs can lead to adverse side effects on the kidneys, heart, gastrointestinal tract (GIT) and the central nervous system, which complicates the use of NSAIDs in medicine. The review analyses literature on the anti-inflammatory action of NSAIDs and their adverse side effects. A special focus is given to the side effects of NSAIDs on the gastrointestinal tract. Taking NSAIDs can lead to pathological changes in the GIT: dyspeptic symptoms, gastropathy, gastrointestinal mucosal damage, including erosion and ulcers, which can be accompanied by serious complications such as gastrointestinal bleeding and perforations. The main mechanisms of the damaging effect of NSAIDs on the gastric mucosa include a slowdown in the blood flow rate in the stomach microvessels, which leads to an increase in their permeability, as well as an increase in gastric motility, a decrease in the secretion of mucus and bicarbonates in the stomach, a change in lipid peroxidation with the formation of free radicals that destroy the structure of cell membranes. Nonselective NSAIDs, including the well-known and popular indomethacin and aspirin, have a pronounced deleterious effect on the GIT. The selective NSAIDs are safer regarding the gastrointestinal side effects compared with nonselective ones, however, they can lead to serious cardiac problems. To mitigate the ulcerogenic effect of NSAIDs, antacids and proton pump inhibitors are used. They reduce the secretion of hydrochloric acid in the stomach. Another solution are drugs associated with membrane phospholipids. These drugs contain nitric oxide and hydrogen sulfide. Taking NSAIDs increases the level of glucocorticoid hormones in the blood, which compensate for the absence of prostaglandins and have a gastroprotective effect. Physical exercise stimulates the body’s natural defenses and protects the gastric mucosa from the negative effects of NSAIDs. In this regard, it is crucial for physiology to conduct more studies focusing on the mechanisms of NSAID-induced deleterious influence on the GIT, gastroprotective mechanisms and the development of evidence-based approaches to reduce the adverse effects of NSAIDs.
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