Abstract
Side effects of the distal gastrointestinal tract after NSAID use are common and more frequent than previously recognized. Increased mucosal permeability and mucosal inflammation are often silent but appear after NSAID treatment with most dual COX inhibitors. Other clinical manifestations include: anemia, occult blood loss, malabsorption, proteinloss, ileal dysfunction, diarrhea, mucosal ulceration and strictures due to diaphragm disease. More common complications are lower gastrointestinal bleeding and perforation, which represent at least one third of all gastrointestinal complications observed with NSAID use. Studies with selective COX-2 inhibitors have shown that, in the short term, these agents do not increase mucosal permeability or induce anemia due to occult bleeding and that, when compared to dual COX inhibitors, lower gastrointestinal complications may be reduced by 50%. In order to minimize the impact of these side effects, it is important to increase the current standards of suspicion by physicians who treat these patients, since drug discontinuation may further reduce damage, and clinical experience with agents that may prevent or treat distal tract damage is very limited. From this perspective, selective COX-2 inhibitors may be the drugs of choice in the high-risk patient that needs NSAIDs. Another important area of uncertainty is the impact of NSAID use in patients with inflammatory bowel diseases. Data from different animal models of inflammatory bowel disease suggest that inhibition of both COX-1 and COX-2 derived prostaglandins affects the severity of the mucosal inflammation. However, current epidemiological and clinical data are contradictory. Since many patients with inflammatory bowel diseases need NSAID treatment, clinicians should be aware of the problem and try to minimize or reduce NSAID exposure. Further studies are needed to define the effect of both non-selective NSAIDs and selective COX-2 inhibitors in these patients.
Keywords: Gastrointestinal, NSAID, COX-2 inhibitors
Current Pharmaceutical Design
Title: Clinical Implications of COX-1 and / or COX-2 Inhibition for the Distal Gastrointestinal Tract
Volume: 9 Issue: 27
Author(s): Angel Lanas, Julian Panes and Josep M. Pique
Affiliation:
Keywords: Gastrointestinal, NSAID, COX-2 inhibitors
Abstract: Side effects of the distal gastrointestinal tract after NSAID use are common and more frequent than previously recognized. Increased mucosal permeability and mucosal inflammation are often silent but appear after NSAID treatment with most dual COX inhibitors. Other clinical manifestations include: anemia, occult blood loss, malabsorption, proteinloss, ileal dysfunction, diarrhea, mucosal ulceration and strictures due to diaphragm disease. More common complications are lower gastrointestinal bleeding and perforation, which represent at least one third of all gastrointestinal complications observed with NSAID use. Studies with selective COX-2 inhibitors have shown that, in the short term, these agents do not increase mucosal permeability or induce anemia due to occult bleeding and that, when compared to dual COX inhibitors, lower gastrointestinal complications may be reduced by 50%. In order to minimize the impact of these side effects, it is important to increase the current standards of suspicion by physicians who treat these patients, since drug discontinuation may further reduce damage, and clinical experience with agents that may prevent or treat distal tract damage is very limited. From this perspective, selective COX-2 inhibitors may be the drugs of choice in the high-risk patient that needs NSAIDs. Another important area of uncertainty is the impact of NSAID use in patients with inflammatory bowel diseases. Data from different animal models of inflammatory bowel disease suggest that inhibition of both COX-1 and COX-2 derived prostaglandins affects the severity of the mucosal inflammation. However, current epidemiological and clinical data are contradictory. Since many patients with inflammatory bowel diseases need NSAID treatment, clinicians should be aware of the problem and try to minimize or reduce NSAID exposure. Further studies are needed to define the effect of both non-selective NSAIDs and selective COX-2 inhibitors in these patients.
Export Options
About this article
Cite this article as:
Lanas Angel, Panes Julian and Pique M. Josep, Clinical Implications of COX-1 and / or COX-2 Inhibition for the Distal Gastrointestinal Tract, Current Pharmaceutical Design 2003; 9 (27) . https://dx.doi.org/10.2174/1381612033453992
DOI https://dx.doi.org/10.2174/1381612033453992 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
FTY720 (Fingolimod) Ameliorates Brain Injury through Multiple Mechanisms and is a Strong Candidate for Stroke Treatment
Current Medicinal Chemistry Effect of Piperine, Quercetin, Polysorbate 80 on the Oral Bioavailability of Losartan in Male Wistar Rats
Pharmaceutical Nanotechnology Gastric Mucosal Protection: From Prostaglandins to Gene-Therapy
Current Medicinal Chemistry An Overview of the Actions of Capsaicin and Its Receptor, TRPV1, and Their Relations to Small Primary Sensory Neurons
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry Effects of ACE-Inhibitors and Angiotensin Receptor Blockers on Inflammation
Current Pharmaceutical Design Synthesis and Biological Activity of 3-(2, 8, 9-trioxa-aza-1-germatricyclo [3. 3. 3. 0] undecane-1-yl)-caffeic Acid
Medicinal Chemistry Seasonal and Perennial Allergic Conjunctivitis
Recent Patents on Inflammation & Allergy Drug Discovery Contrast Media in Cardiovascular Magnetic Resonance
Current Pharmaceutical Design The Role of Coronary Collaterals in Chronic Total Occlusions
Current Cardiology Reviews Purinergic Signalling and Endothelium
Current Vascular Pharmacology Static Cerebral Blood Flow Autoregulation in Humans
Current Hypertension Reviews Radionuclide PET and PET/CT in Coronary Artery Disease
Current Pharmaceutical Design Potassium Channels and Uterine Vascular Adaptation to Pregnancy and Chronic Hypoxia
Current Vascular Pharmacology Seasonal and Perennial Allergic Conjunctivitis
Recent Patents on Inflammation & Allergy Drug Discovery Cardiovascular Complications in Inflammatory Bowel Disease
Current Drug Targets Hypertension Impairs Cerebral Blood Flow in a Mouse Model for Alzheimer’s Disease
Current Alzheimer Research Neuroinflammation and Immunity: A New Pharmacological Target in Depression
CNS & Neurological Disorders - Drug Targets Coronary Artery Disease and Endothelial Dysfunction: Novel Diagnostic and Therapeutic Approaches
Current Medicinal Chemistry Age-Related Changes and Effects of Mild Hypothermia on Carotid Artery Reactivity in Newborn Rats
CNS & Neurological Disorders - Drug Targets Microcirculation in Hypertension: An Update on Clinical Significance and Therapy
Current Vascular Pharmacology