美国胃肠病学会（AGA）有关开据 NSAIDs药品的建议

咪唑类组胺的广泛应用有如高发消化道道癌症国家科委合意拟订录用表示同意来增高可能会据旧金山消化道病物理精研会召集的多精研科国家科委介绍，咪唑类组胺给有结核病的患者提供了广阔的有益，但是医疗管理机构在给病者开据这类本品前，需仔细权衡它的有如可能会。消化道道水肿是适用非类组胺的最常见于的征状，包含上消化道和下消化道的癌症。相当严重的消化道道癌症，如潜在的有可能即刻症性息肉，年频发率为适用者的1－4％。国家科委的讨论结果“关于拟订咪唑类组胺包含马蹄形氧化酶－2抑制剂和极低极低剂量的广泛应用表示同意讨论会的共识”发表在旧金山消化道病物理精研会出版的9月份的《诊断消化道病精研与肝脏病精研》新闻周刊上。“咪唑类组胺是全世界广泛应用最广泛的本品，而且广泛的广泛应用证实了它的功效和比较可靠性” 据阿拉巴马大精研格拉斯哥分校内科精研教授，期刊的主要编者C. Mel Wilcox教授介绍。“但是，过去虽然充分认识了消化道道癌症，而没有注意到其肺部致命，旧金山消化道病物理精研会召集立法机构来增加对广泛应用该类本品的有益和消化道道及缺血性毒性的可能会，从而改进对该类本品的广泛应用。”估计值全世界每年消耗500亿极低极低剂量片，其中旧金山大约6000万份处方开据了极低极低剂量，并主要给老年病者。这类本品对急、暂时性和骨骼四肢炎症等方面有效。但是，咪唑类组胺的适用有如着相当严重的致命，包含消化道道、胰脏和缺血性癌症，甚至包含心力衰竭和败血症。“我们欣喜地注意到咪唑类组胺的消化道道癌症和死亡并未从1992年开始下降，我们显然这种状况归功于一下方面：小极低剂量适用咪唑类组胺；降极低了大肠索科利夫卡的盛行；增加了质子泵抑制剂的广泛应用；以及引进对消化道道更安全的咪唑类组胺的广泛应用，如昔昂类本品。” Wilcox教授说是。“但是，医疗管理机构和病者需了解该类本品的相关可能会来拟订咪唑类组胺的最佳广泛应用表示同意。国家科委为医疗管理机构拟订了当他们在决定是否给病者开咪唑类组胺时的表列出表示同意：评价治疗的结核病和病者频发消化道道和缺血性癌症的潜在致命生物体，并和病者讨论缺血性疾病的潜在致命生物体。对可能会和有益开展分析来加权有机体消化道道和缺血性致命后，开据极低可能会的本品。消化道道即刻症频发致命大的患者需广泛应用消化道道可能会极低的咪唑类组胺，例如非功能性咪唑类组胺；缺血性事件频发可能会大的患者需接受马蹄形氧酶－2抑制剂治疗；有已知缺血性疾病或缺血性病可能会的病者需接受小极低剂量极低极低剂量。限制所开咪唑类组胺的持续时间和极低剂量，以及征询并表示同意病者开展咪唑类组胺的联合治疗。在广泛应用咪唑类组胺治疗前，先处理大肠索科利夫卡的感染者，以致不增加即刻消化性息肉的可能会。针对消化道道癌症可能会大的患者拟订消化道保护表示同意，如广泛应用米索前列醛或质子泵抑制剂。“咪唑类组胺的广泛应用有如极低消化道道癌症在诊断和治疗上很重要，” Wilcox教授解释说是。“很好地阐释极低消化道道即刻症频发的可能会和机理是增加咪唑类组胺的适用致命所需的。”在立法机构过后讨论的药剂都是非类抑制炎症加成的本品，因此在精研术上被显然是咪唑类组胺。非功能性的咪唑类组胺，包含昂洛芬、依托度酸和咪唑丁美酮，它们比其他咪唑类组胺，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对消化道道不具更高的可靠性。昔昂类本品是功能性马蹄形氧化酶－2抑制剂。在标准极低剂量下，扑热息痛不是咪唑类组胺。旧金山消化道病物理精研会国家科委由消化道病精研、风湿病精研、肺部病精研和内科精研医师组成，他们在小组讨论后，以当前科研报告基础上拟订了这个表示同意。旧金山消化道病物理精研会举办的“关于咪唑类组胺的广泛应用的立法机构”由TAP药品Corporation提供的一项无限教育投资Corporation筹集资金。与会者的税制开销公昂包含在原稿内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.编辑：bluelove 编辑： Zhu