gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2024-34-6-7-19gastro-j-1466Research ArticleОБЗОРЫREVIEWSФакторы риска и профилактика осложнений со стороны верхних отделов желудочнокишечного тракта, ассоциированных с приемом нестероидных противовоспалительных препаратовRisk Factors and Prevention of Upper Gastrointestinal Complications Associated with Nonsteroidal Anti-Inflammatory Drugshttps://orcid.org/0000-0003-4075-4096БакулинаН. В.BakulinaN. V.

Бакулина Наталья Валерьевна — доктор медицинских наук, профессор, заведующая кафедрой внутренних болезней, нефрологии, общей и клинической фармакологии с курсом фармации

195067, г. Санкт-Петербург, Пискаревский просп., 47

Natalia V. Bakulina — Dr. Sci. (Med.), Professor, Head of the Department of Internal Medicine, Nephrology, General and Clinical Pharmacology with a Pharmacy Course 

195067, Saint Petersburg, Piskarevsky ave., 47 

natalya.bakulina@szgmu.ruhttps://orcid.org/0000-0001-5720-3528ТихоновС. В.TikhonovS. V.

Тихонов Сергей Викторович — доктор медицинских наук, доцент кафедры внутренних болезней, нефрологии, общей и клинической фармакологии с курсом фармации 

195067, г. Санкт-Петербург, Пискаревский просп., 47

Sergey V. Tikhonov — Dr. Sci. (Med.), Associate Professor of the Department of Internal Medicine, Nephrology, General and Clinical Pharmacology with a Pharmacy Course 

195067, Saint Petersburg, Piskarevsky ave., 47 

sergeyvt2702@gmail.comhttps://orcid.org/0000-0002-9224-6643НагорноваК. А.NagornovaK. A.

Нагорнова Ксения Александровна — кандидат медицинских наук, доцент кафедры внутренних болезней, нефрологии, общей и клинической  фармакологии с курсом фармации 

195067, г. Санкт-Петербург, Пискаревский просп., 47

Kseniia A. Nagornova — Cand. Sci. (Med.), Associate Professor of the Department of Internal Medicine, Nephrology, General and Clinical Pharmacology with a Pharmacy Course 

195067, Saint Petersburg, Piskarevsky ave., 47 

kseniia.nagornova@yandex.ruФГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Министерства здравоохранения Российской ФедерацииРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation202430122024346719Copyright © Бакулина Н.В., Тихонов С.В., Нагорнова К.А., 20252025Бакулина Н.В., Тихонов С.В., Нагорнова К.А.Bakulina N.V., Tikhonov S.V., Nagornova K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1466

Цель обзора: представить актуальные данные о частоте и факторах риска осложнений со стороны верхних отделов желудочно-кишечного тракта (ЖКТ), ассоциированных с приемом нестероидных противовоспалительных препаратов (НПВП), и возможностях профилактики данных осложнений.Основные положения. Частота развития осложнений со стороны ЖКТ на фоне НПВП составляет 14,7– 30,1 %, при этом максимальный риск отмечается в первые две недели их назначения. Применение селективных ингибиторов циклооксигеназы-2, включая коксибы, ассоциируется с уменьшением риска желудочно-кишечных осложнений. Всем пациентам, которым планируется назначение НПВП, необходима диагностика H. Pylori и эрадикационная терапия при выявлении этой инфекции. Даже у пациентов без факторов риска желудочнокишечных осложнений и при коротких курсах терапии может быть рассмотрен вопрос о назначении коксибов или комбинации НПВП и ингибиторов протонной помпы. Профилактика НПВП-ассоциированных поражений верхних отделов ЖКТ является показанием для назначения омепразола и эзомепразола в соответствии с инструкцией по медицинскому применению. Эзомепразол обладает рядом фармакокинетических преимуществ: большая площадь под фармакокинетической кривой, способность ингибировать CYP4502C19, что обуславливает высокую эффективность терапии у быстрых и ультрабыстрых метаболизаторов. Проведенные клинические исследования эзомепразола для профилактики НПВП-ассоциированных поражений верхних отделов ЖКТ демонстрируют высокую эффективность: например, в рандомизированном исследовании на фоне 3-месячной терапии малыми дозами ацетилсалициловой кислоты риск возникновения язв желудка и двенадцатиперстной кишки в группе эзомепразола был в 7 раз ниже.Заключение. Оценка факторов риска, коррекция модифицируемых факторов риска, выбор более безопасных НПВП, одновременное назначение ингибиторов протонной помпы, в том числе эзомепразола, позволяют проводить действенную профилактику НПВП-ассоциированных поражений верхних отделов ЖКТ.

Aim: to present current data about the frequency and risk factors of upper gastrointestinal complications associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the possibilities of preventing these complications.Key points. The incidence of gastrointestinal complications associated with NSAIDs is 14.7–30.1 %, with the maximum risk noted in the first two weeks of their administration. The use of selective cyclooxygenase-2 inhibitors is associated with a reduced risk of gastrointestinal complications. All patients who are going to receive NSAIDs should be diagnosed with H. pylori and treated with eradication therapy if this infection is detected. Even in patients without risk factors for gastrointestinal complications and with short courses of therapy, coxibs or a combination of NSAIDs and proton pump inhibitors may be considered. Prevention of NSAID-associated lesions of the upper gastrointestinal tract is an indication for the appointment of omeprazole and esomeprazole in accordance with the instructions for medical use. Esomeprazole has a number of pharmacokinetic advantages — a large area under the pharmacokinetic curve, the ability to inhibit CYP4502C19, which determines the high efficiency of therapy in fast and ultrafast metabolizers. Previous clinical studies of esomeprazole for the prevention of NSAID-associated lesions of the upper gastrointestinal tract demonstrate high efficacy. In the randomized OBERON study the risk of gastric and duodenal ulcers after 3 months of low-dose acetylsalicylic acid treatment in the esomeprazole group was 7 times lower.Conclusion. Assessment of risk factors, correction of modifiable risk factors, selection of safer NSAIDs and simultaneous administration of proton pump inhibitors (including esomeprazole) are effective prevention of NSAID-associated upper gastrointestinal lesions.

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The authors declare that there are no conflicts of interest present.