Medikamentöse Prophylaxe bei Gabe nichtsteroidaler-antientzündlicher Pharmaka - Gastrointestinale Effekte einer NSAID-Therapie

Nichtsteroidale antientzündliche Pharmaka (NSAID) verfügen über analgetische, antipyretische und/oder antiphlogistische Eigenschaften. NSAID verursachen jedoch auch Schädigungen des GI-Traktes. Zur Verhinderung dieser gastrointestinalen Effekte sollten die Patienten daher routinemäßig einen Mukosaschutz erhalten. Zurzeit ist die Blockade der Protonenpumpen - (H⁺/K⁺-ATPase) - in Parietalzellen durch Protonenpumpeninhibitoren (PPI) die wirksamste Methode zur Hemmung der Säuresekretion. PPI sind allgemein wirksamer als H₂-Blocker und verhinderten sowohl duodenale als auch gastrale Ulzera bei Risiko-Patienten. Die Häufigkeitsrate der unerwünschten Wirkungen der PPI liegt im Bereich der Anwendung der H₂-Blocker oder eines Placebos. Bei Patienten ohne erhöhtes Risiko für das Auftreten gastroduodenaler Komplikation ist zur Prävention kardiovaskulärer und/oder zerebrovaskulärer Ereignisse auch die Anwendung niedrig dosierter ASS in einer magensaftresistenten, dünndarmlöslichen Darreichungsform in Betracht zu ziehen.

Non-steroidal anti-inflammatory drugs (NSAID) have analgesic, antipyretic and/or antiphlogistic properties. However, they may also damage the GI tract. Hence, patients should also be given mucosal protection as a matter of routine. Presently, the most effective inhibition of acid secretion is blocking of the proton pumps - (H⁺/K⁺-ATPase) in parietal cells by means of proton pump inhibitors (PPI). PPIs are generally more effective than H₂ blockers; in high-risk patients, they prevent both duodenal and gastric ulcers. Frequency rate of undesirable side effects of PPI is within the range of application of H₂ blockers or placebos. In case of patients without enhanced risk of gastroduodenal complications it may also be considered using low-dosage ASA in gastric juice-resistant and enterosoluble preparations to prevent cardiovascular and/or cerebrovascular incidents.

Key words

NSAID therapy - gastrointestinal effects - mucosal protection - proton pump inhibitors (PPI) - acetylsalicylic acid (ASA)

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