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Endoskopie heute 2010; 23(1): 59-65
DOI: 10.1055/s-0030-1247259
Übersicht

© Georg Thieme Verlag Stuttgart ˙ New York

NSAR-Wirkungen auf den Gastrointestinaltrakt

Impact of NSAIDs on the Gastrointestinal TractV. Schick1 , H.-J. Schulz1
  • 1Klinik für Innere Medizin I, Sana Klinikum Lichtenberg, Berlin
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Publication History

Publication Date:
12 March 2010 (online)

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Zusammenfassung

Der häufige Einsatz von nichtsteroidalen Antirheumatika (NSAR) vor allem zur Schmerzbekämpfung ist weltweit verbreitet. Die Einnahme von NSAR ist jedoch mit einer erheblichen Anzahl von Nebenwirkungen verbunden. Die Risiken von NSAR bestehen vor allem in Schleimhautläsio­nen, Dyspepsie, gastrointestinalen Blutungen, Ulze­rationen, Perforationen und Stenosen. NSAR können in sogenannte traditionelle und selektive NSAR (Zyklooxygenase-Hemmer, COX-1- und COX-2-Inhibitoren) sowie Aspirin unterteilt werden. Die Einführung von COX-2-Inhibitoren wurde kurzzeitig als ersehnte Besserung des Nebenwirkungsprofils gesehen, jedoch zeigten große Studien eine zu hohe Anzahl von kardiovaskulären Ereignissen, was den viel versprechenden Einsatz mit der Rücknahme einiger Präparaten vom Markt überschattete. Zunächst lag der Fokus der Nebenwirkungen von NSAR auf Läsionen im oberen Gastrointestinaltrakt. Mit der ­Einführung der Kapselendoskopie, der Ballon­ente­roskopie und der stärkeren Beachtung von Kolonläsionen zeigte sich ein ähnlich häufiges Auftreten von Neben­wirkungen von NSAR im unte­ren Gastro­intestinaltrakt. In diesem Artikel werden die ­gastrointestinalen Risiken vom Ösophagus bis zum Kolon erörtert und die Praxis der Gegenwart und der möglichen Zukunftsperspektiven dargestellt.

Abstract

The application of nonsteroidal antiinflammatory drugs (NSAID) against pain is worldwide ac­cept­ed, although NSAIDs are well known to cause ­potentially serious adverse effects. The risk of NSAIDs consists of mucosal lesions in the gastrointestinal (GI) tract, dyspepsia, gastrointestinal bleeding, ulcera, perforation and stenosis. NSAIDs can be classified in traditional and selective in­hib­itors of cyclooxygenase (COX-1 and COX-2 inhibitor, respectively) and aspirin. The discovery of COX-2 inhibitors was celebrated as a new desired improvement for adverse events for a short time period. But large studies revealed a significant inci­dence of cardiovascular events in combination with COX-2 inhibitors, which ended in a partial withdrawal from COX-2 inhibitors from the market. Adverse events were first only registered in the upper GI-tract, but with the introduction of ballon enteroscopy and capsule endoscopy and the intensified view on detected lesions in the ­colon, a similar number of adverse events from NSAIDs could be registered in the lower GI-tract. In this article gastrointestinal adverse events from the oesophagus up to the colon will be discussed. Finally an overview about the present ­recommendations and possible features in the ­future is given.

Schlüsselwörter

NSAR - Ulzera - Ösophagitis - Perforationsblutung - Diaphragma - Magenausgangsstenose - singuläres Ulkus - Kolopathie - Enteropathie

Key words

NSAIDs - ulcer - oesophagitis - GI tract bleeding - perforation - diaphragm - gastric outlet syndrome - singular ulcer - colonopathie - enteropathie

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Prof. Dr. med. H.-J. Schulz

Klinik für Innere Medizin I · Sana Klinikum Lichtenberg

Fanninger Str. 32

10365 Berlin

Phone: +0 30 / 55 18 22 10

Fax: +0 30 / 55 18 22 50

Email: hj.schulz@sana-kl.de

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