Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)111810.18786/2072-0505-2019-47-048REVIEW ARTICLEОБЗОРSmall intestinal damage associated with the use of nonsteroidal anti-inflammatory drugsПоражение тонкой кишки, ассоциированное с приемом нестероидных противовоспалительных препаратовhttps://orcid.org/0000-0002-1391-0711KarateevA. E.КаратеевА. Е.
Russian Federation

Andrei E. Karateev – MD, PhD, Head of the Laboratory of the Pathophysiology of Pain and Polymorphism of Musculoskeletal Diseases

34A Kashirskoe shosse, Moscow, 115522

Каратеев Андрей Евгеньевич – доктор медицинских наук, заведующий лабораторией патофизиологии боли и полиморфизма скелетно-мышечных заболеваний

115522, г. Москва, Каширское шоссе, 34A

aekarat@yandex.ruMorozE. V.МорозЕ. В.
Russian Federation

Elena V. Moroz – MD, PhD, Head of the Gastroenterology Department2

3 Gospital'naya ploshchad', Moscow, 105094

Мороз Елена Викторовна – кандидат медицинских наук, заведующая гастроэнтерологическим отделением

105094, г. Москва, Госпитальная пл., 3

KryukovE. V.КрюковЕ. В.
Russian Federation

Evgenii V. Kryukov – MD, PhD, Professor, Corresponding Member of Russian Academy of Sciences, Head of the Hospital2

3 Gospital'naya ploshchad', Moscow, 105094

Крюков Евгений Владимирович – доктор медицинских наук, профессор, член-корреспондент РАН, начальник госпиталя

105094, г. Москва, Госпитальная пл., 3

V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical SciencesФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»N.N. Burdenko Main Military Clinical HospitalФГБУ «Главный военный клинический госпиталь имени академика Н.Н. Бурденко»221220194765595672509201925092019Copyright ©; 2019, Karateev A.E., Moroz E.V., Kryukov E.V.Copyright ©; 2019, Каратеев А.Е., Мороз Е.В., Крюков Е.В.2019Karateev A.E., Moroz E.V., Kryukov E.V.Каратеев А.Е., Мороз Е.В., Крюков Е.В.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/1118

The use of nonsteroidal anti-inflammatory drugs (NSAID), even if short-term, may be associated to small intestinal complications, such as erosions, ulcers and chronic mucosal inflammation. Video capsule endoscopy allows for identification of such lesions in 20 to 55% of the patients who have taken nonselective NSAID for 2 to 4  weeks. The pathophysiology of NSAID-induced enteropathy is related to a reduced reparative potential of the mucosa and abnormalities of the microbial balance in the small intestine. In real world practice, NSAID enteropathy is commonly asymptomatic, and its manifestations, such as bleeding, perforation and ileus, are quite rare (about 0.3 episodes per 100  patient-years). The main manifestation of NSAID enteropathy is chronic iron deficient anemia. The use of rebamipide, sulfasalazine, mesalazine, and rifaximin has been discussed in the treatment of NSAID enteropathy, whereas its prevention implies preferential administration of coxibs, the use of rebamipide and probiotics.

Нестероидные противовоспалительные препараты (НПВП) даже при кратковременном использовании способны вызывать осложнения со стороны тонкой кишки с развитием эрозий, язв и хронического воспаления слизистой оболочки. Видеокапсульная эндоскопия позволяет выявлять такие изменения у  20–55%  принимавших неселективные НПВП в  течение 2–4 недель. Патогенез НПВП-энтеропатии связан со снижением репаративного потенциала слизистой оболочки и  нарушениями микробного равновесия тонкой кишки. В  реальной практике НПВП-энтеропатия обычно протекает бессимптомно, манифестные формы  – кровотечения, перфорации и  кишечная непроходимость  – отмечаются довольно редко (примерно 0,3  эпизода на 100  пациентов/лет). Основным проявлением НПВП-энтеропатии становится хроническая железодефицитная анемия. Для лечения НПВП-энтеропатии обсуждается использование ребамипида, сульфасалазина, месалазина и  рифаксимина, для профилактики  – преимущественное использование коксибов, применение ребамипида и пробиотиков.

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