Subscribe to RSS
DOI: 10.1055/s-2004-824835
© Georg Thieme Verlag Stuttgart · New York
Gastrointestinale Nebenwirkungen von Medikamenten[1]
Gastrointestinal side effects of drugsPublication History
eingereicht: 27.8.2003
akzeptiert: 15.1.2004
Publication Date:
20 July 2004 (online)

Unerwünschte Arzneimittelwirkungen (UAW) können im gesamten Verdauungstrakt auftreten. Wichtige Beispiele im oberen Intestinaltrakt sind Schleimhautschäden durch Bisphosphonate und nichtsteroidale Antirheumatika (NSAR); die letztgenannten schädigen nicht selten auch Dünn- und Dickdarm. Häufige Nebenwirkung einer antibiotischen Behandlung ist die Enterokolitis; zahlreiche Pharmaka wie Diuretika können Ursache einer akuten Pankreatitis sein. In diesem Beitrag sollen die wesentlichen UAW im Gastrointestinaltrakt und ihre Therapie diskutiert werden.
Literatur
- 1 Ablin D S, Ziegler M. Ulcerative type of colitis associated with the use of high strength pancreatic enzyme supplements in cystic fibrosis. Pediatr Radiol. 1995; 25 113-115
- 2 Allen M, Mellow M, Robinson M G, Orr W C. Comparison of calcium channel blocking agents and an anticholinergic agent on oesophageal function. Aliment Pharmacol Ther. 1987; 1 153-159
- 3 Allison M C, Howatson A G, Torrance C J. Gastrointestinal damage associated with the use of nonsteroidal anti-inflammatory drugs. N Engl J Med. 1992; 327 749-754
- 4 Andersen V, Sonne J, Andersen M. Spontaneous reports on drug-induced pancreatitis in Denmark from 1968 to 1999. Eur J Clin Pharmacol. 2001; 57 517-521
- 5 Arzneimittelkommission der Deutschen Ärzteschaft . Zur Sicherheit von COX-2-Inhibitoren. Dtsch Ärztebl. 2002; 99 1291-1292
- 6 Ballinger A B, Smith G. COX-2 vs NSAIDs: gastrointestinal damage and prevention. Exp Opin Pharmacother. 2001; 2 31-40
- 7 Bansi D S, Price A, Russell C, Sarner M. Fibrosing colonopathy in an adult owing to overuse of pancreatic enzyme supplements. Gut. 2000; 46 283-285
- 8 Bombardier C, Laine L, Reicin A. et al. VIGOR study group . Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med. 2000; 343 1520-1528
- 9 Boyce H W. Drug-induced esophageal damage: diseases of medical progress. Gastrointest Endosc. 1998; 47 547-550
- 10 Byrne M F, McGuiness J, Smyth C M. et al . Nonsteroidal anti-inflammatory drug-induced diaphragms and ulceration in the colon. Eur J Gastroenterol Hepatol. 2002; 14 1265-1269
- 11 Chan F KL, Chung S CS, Suen R N. et al . Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med. 2001; 344 967-973
- 12 Chocarro Martinez A, Galindo Tobal F, Ruiz-Irastorza G. et al . Risk factors for esophageal candidiasis. Eur J Clin Microbiol Infect Dis. 2000; 19 96-100
- 13 De Abajo F J, Garcia Rodriguez L A, Montero D. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population-based case-control study. Br Med J. 1999; 319 1106-1109
- 14 El-Serag H B, Sonnenberg A. Association of esophagitis and esophageal strictures with diseases treated with non-steroidal anti-inflammatory drugs. Am J Gastroenterol. 1997; 92 52-56
- 15 De Groen P C, Lubbe D F, Laurence C B. Esophagitis associated with the use of alendronate. N Engl J Med. 1996; 335 1016-1021
- 16 Garcia Rodriguez L A, Hernandez-Diaz S, De Abajo F J. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol. 2001; 52 563-571
- 17 Garcia Rodriguez L A, Hernandez-Diaz S. Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal anti-inflammatory drugs. Epidemiology. 2001; 12 570-576
- 18 Hawkey C J, Langman M JS. Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors. Gut. 2003; 52 600-608
- 19 Ishikawa H, Iwakiri K, Sugiura T, Kobayashi M. Effect of nifedipine administration (10 mg) on esophageal acid exposure. J Gastroenterol. 2000; 35 43-46
- 20 Jaspersen D. Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management. Drug Saf. 2000; 22 237-249
- 21 Jaspersen D. Extragastrale Nebenwirkungen nicht steroidaler Antirheumatika. Dtsch Med Wochenschr. 1998; 132 669-673
- 22 Kikendall J W, Mellow M H. Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility. Gastroenterology. 1980; 79 703-706
- 23 Kikendall J W. Pill esophagitis. J Clin Gastroenterol. 1999; 28 298-305
- 24 Langman M J, Weil J, Wainwright G HT P. et al . Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994; 343 1075-1078
- 25 Lankisch P G, Droege M, Gottesleben F. Drug-induced acute pancreatitis: incidence and severity. Gut. 1995; 37 565-567
- 26 Larkai E N, Smith J L, Lidsky M D, Graham D Y. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987; 82 1153-1158
- 27 Lewis S C, Langman M J, Laporte J R, Matthews J N, Rawlins M D, Wiholm B E. Dose-response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol. 2002; 54 320-326
- 28 Limmer S, Ittel T H, Wietholz H. Sekundär- und Primärprophylaxe der ASS-/NSAR-Gastropathie: Eine Übersicht anhand vier klinischer Szenarien. Z Gastroenterol. 2003; 41 719-728
- 29 Lloyd-Still J D. Cystic fibrosis and colonic strictures: a new ‘iatrogenic’ disease. J Clin Gastroenterol. 1995; 21 2-5
- 30 Mallory A, Kern F. Drug-induced pancreatitis: a critical review. Gastroenterology. 1980; 78 813-820
- 31 Makins R, Ballinger A. Gastrointestinal side effects of drugs. Expert Opin. Drug Saf. 2003; 2 421-429
- 32 McArthur K E. Drug-induced pancreatitis. Aliment Pharmacol Ther. 1996; 10 23-27
- 33 Milminick T, Frick T W. Drug-induced pancreatitis. Drug Saf. 1996; 14 406-409
- 34 Nassar N N, Gregg C R. Oesophageal infections. Curr Treat Options Gastroenterol. 1998; 1 56-63
- 35 Pemberton J. Oesophageal obstruction and ulceration caused by oral potassium therapy. Br Heart J. 1970; 32 267-268
- 36 Petersen K U, Jaspersen D. Medication-induced esophageal disorders. Expert Opin. Drug Saf. 2003; 5 1-13
- 37 Ratnaike R N, Jones T E. Mechanisms of drug-induced diarrhoea in the elderly. Drugs Aging. 1998; 13 245-253
- 38 Rünzi M, Layer P. Drug-associated pancreatitis: facts and fiction. Pancreas. 1996; 13 100-109
- 39 Simon L S, Weaver A L, Graham D Y. et al . Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial. JAMA. 1999; 282 1921-1928
- 40 Silverstein F E, Faich G, Goldstein. et al . Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA. 2000; 284 1247-1255
- 41 Smale S, Tibble J, Sigthorsson G, Bjarnason I. Epidemiology and differential diagnosis of NSAID-induced injury to the mucosa of the small intestine. Best Pract Res Clin Gastroenterol. 2001; 15 723-738
- 42 Smyth R L, van Velzen D, Smyth R A. et al . Strictures of the ascending colon in cystic fibrosis and high-strength pancreatic enzyme supplements. Lancet. 1994; 343 85-86
- 43 Stein J, Schröder O. Antibiotikaassoziierte Kolitis - Eine relevante Krankheit?. Urban und Schwarzenberg, München In: Klinik der Gegenwart, Gerock W, Schöllermich J (HRSG) 1997: 1-26
- 44 Thumshirn M, Fried M. Prophylaxe und Therapie NSAR-induzierter Ulzera: ein Update. Dtsch med Wochenschr. 2000; 125 975-978
- 45 Vanek V W, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986; 29 203-210
- 46 Van Velzen D, Ball L M, Dezfulian A R, Southgate A, Howard C V. Comparative and experimental pathology of fibrosing colonopathy. Postgrad Med J. 1996; 72 S39-S48
- 47 Wolfe M M, Lichtenstein D R, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med. 1999; 340 1888-1899
- 48 Wright J M. The double-edged sword of COX-2 selective NSAIDs. Can Med Assoc J. 2002; 167 1131-1137
1 Herrn Prof. Dr. J. F. Riemann gewidmet
Prof. Dr. Daniel Jaspersen
Klinikum Fulda gAG, Med. Klinik II
Pacelliallee 4
36043 Fulda
Email: d.jaspersen.medII@klinikum-fulda.de