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MR Vol.10 No.1 indexに戻る
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MODERN RHEUMATOLOGY
Vol.10 No.1 |
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NSAID ulcers: prevalence and prevention
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| D. Y. Graham |
| (1) Rm 3A-320 (111D), Veterans Affairs Medical
Center, 2002 Holcombe Blvd., Houston, TX 77030, USA |
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| Abstract |
| Abstract The epidemic of life-threatening
complications of nonsteroidal anti-inflammatory drug (NSAID) use
has prompted the development of prevention strategies. Recent clinical
trials of endoscopic ulcer prevention are critiqued regarding their
results in relation to doses and outcome measures as well as H.
pylori status. Misoprostol is the only agent proven to prevent
life-threatening ulcer complication in NSAID users. Proton pump
inhibitor therapy was not significantly better than the minimally
effective dose of misoprostol for prevention of gastroduodenal
ulcers in chronic NSAID users, and was significantly inferior to
misoprostol in those with "true" NSAID ulcers (i.e.,
without complicating H. pylori infection). Antisecretory therapy
accelerates corpus gastritis in those with H. pylori infection,
suggesting it is prudent to consider H. pylori eradication in those
in whom long term co-therapy with anti-secretory therapy is contemplated.
H. pylori status is a critical variable with regard to endoscopic
ulcers in NSAID users. The data suggest that if full-dose misoprostol
cannot be given, the combination of an antisecretory drug (e.g.,
either ranitidine or omeprazole) plus low-dose misoprostol may
be better than either alone for the prevention of NSAID ulcer complications.
The use of omeprazole alone likely results in a false sense of
security. |
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| Key words |
| Key words Misoprostol ・ Omeprazole ・ Ulcers
・ Bleeding ・ Nonsteroidal anti-inflammatory drug |
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