美国胃肠病学会（AGA）有关开据 NSAIDs处方的表示同意

吲哚类抗病毒的领域相关联高发肠胃比方说症初步合意拟定推荐建议书来减小安全和性据新泽西州胃肠病该协会召集的多学科初步介绍，吲哚类抗病毒给有适应症的炎症备有了广阔的某种程度，但是保健业务部门在给病症开据这类制剂同一时间，能够仔细重新考虑它的相关联安全和性。肠胃炎症是常用非类抗病毒的最罕见的不良反应，除此以外上消化道和下消化道的比方说症。严重的肠胃比方说症，如潜在的致命性病毒性出血，年心血管疾病为常用者的1－4％。初步的讨论结果“关于拟定吲哚类抗病毒除此以外环氧化肽－2诱导剂和布洛芬的领域建议书讲演的互信”发表在新泽西州胃肠病该协会再版的9一月的《病理胃肠病学与血液病学》周报上。“吲哚类抗病毒是全世界领域最最常的制剂，而且最常的领域证实了它的解毒和相对来说安全和性” 据阿拉巴马大学伯明翰分校内科学名誉教授，篇文章的主要作者C. Mel Wilcox名誉教授介绍。“但是，只不过虽然充分认识了肠胃比方说症，而没有确信其心脏脆弱，新泽西州胃肠病该协会召集议会党团来提高对领域该类制剂的某种程度和肠胃及心血管毒性的安全和性，从而改进对该类制剂的领域。”估计全世界每年损耗500亿布洛芬片，其中新泽西州大约6000万份药物开据了布洛芬，并主要给老年病症。这类制剂对急、慢性疼痛和股骨肌肉瘙痒等上都理论上。但是，吲哚类抗病毒的常用相关联着严重的脆弱，除此以外肠胃、消化道和心血管比方说症，甚至除此以外心力衰竭和败血症。“我们高兴地看到吲哚类抗病毒的肠胃比方说症和失踪现在从1992年开始下降，我们相信这种状况便是一下上都：小副作用常用吲哚类抗病毒；降很低了幽门狂犬病的广为人知；提高了质子泵诱导剂的领域；以及引进对肠胃更为安全和的吲哚类抗病毒的领域，如昔布类制剂。” Wilcox名誉教授说。“但是，保健业务部门和病症能够了解该类制剂的涉及安全和性来拟定吲哚类抗病毒的最佳领域建议书。初步为保健业务部门拟定了当他们在决定是否给病症开吲哚类抗病毒时的以下建议：赞扬病人的适应症和病症频发肠胃和心血管比方说症的潜在脆弱表征，并和病症讨论心血管疾病的潜在脆弱表征。对安全和性和某种程度进行分析方法来衡量个体肠胃和心血管脆弱后，开据很低安全和性的制剂。肠胃出血频发脆弱大的炎症能够领域肠胃安全和性很低的吲哚类抗病毒，例如非丝氨酸吲哚类抗病毒；心血管暴力事件频发安全和性大的炎症能够接受环氧肽－2诱导剂病人；有可知心血管疾病或心血管病安全和性的病症能够接受小副作用布洛芬。限制所开吲哚类抗病毒的周期和副作用，以及征询并建议病症进行吲哚类抗病毒的联合病人。在领域吲哚类抗病毒病人同一时间，先处理幽门狂犬病的受到感染，以致不提高比方说消化性出血的安全和性。针对肠胃比方说症安全和性大的炎症拟定胃肠保护建议书，如领域米索同一时间列醇或质子泵诱导剂。“吲哚类抗病毒的领域相关联很低肠胃比方说症在诊断和病人上很重要，” Wilcox名誉教授说明了说。“更为好地明白很低肠胃出血频发的安全和性和机理是减少吲哚类抗病毒的常用脆弱所能够的。”在议会党团期间讨论的药剂都认类诱导瘙痒反应的制剂，因此在学术上被相信是吲哚类抗病毒。非丝氨酸的吲哚类抗病毒，除此以外布洛芬、逐步形成度酸和萘丁美酮，它们比其他吲哚类抗病毒，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对肠胃具有更为高的安全和性。昔布类制剂是丝氨酸环氧化肽－2抑制剂。在规范副作用下，扑热息痛不是吲哚类抗病毒。新泽西州胃肠病该协会初步由胃肠病学、风湿病学、心脏病学和内科学医师组成，他们在小组讨论后，以当同一时间研究机构报告相结合拟定了这个建议书。新泽西州胃肠病该协会举办的“关于吲哚类抗病毒的领域的议会党团”由TAP药品日本公司备有的一项无限英语教育投资基金捐献。与会者的财政开销公布构成在原稿内，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.校对：bluelove 校对： Zhu