Article information
Resumen
Siguiendo la tendencia de los últimos 2-3 años, los avances recientes más relevantes en el área de las lesiones GI asociadas a antiinflamatorios no esteroideos (AINE) se han centrado en los efectos secundarios en el intestino distal, más allá del duodeno, y en aspectos relacionados con la toxicidad asociada al tratamiento con antiplaquetarios (AP). Nuevos datos refuerzan que AINE y AP se asocian a incremento del riesgo de complicaciones graves, tanto en el tracto gastrointestinal superior como inferior, abriéndose varias líneas de investigación en prevención y terapia basadas en probióticos, antibióticos y agentes mucoprotectores. La interacción entre la infección por Helicobacter pylori, AINE y ácido acetilsalicílico sigue generando controversia, pero la interacción positiva con AINE parece reforzarse. Varias revisiones sistemáticas confirman que la combinación de varios fármacos gastrotóxicos potencia de manera notable el riesgo de hemorragia gastrointestinal, lo cual debe reforzar las actuales consideraciones en gastroprotección, y que los nuevos agentes anticoagulantes no parecen reducir el riesgo de hemorragia digestiva. Una vez que la hemorragia gastrointestinal se ha producido, varios estudios han señalado la necesidad de implementar escalas pronósticas más sencillas que las actuales. En el campo de la innovación destaca el diseño de un endoscopio desechable para estos casos y un nuevo material hemostático prometedor que se aplica localmente sobre la lesión sangrante.
Palabras clave:
Antiinflamatorios no esteroideos
Ácido acetilsalicílico
Clopidogrel
Anticoagulantes
Hemorragia gastrointestinal
Abstract
Following the trends observed for the last 2–3 years, the most significant and recent advances in the area of gastrointestinal lesions associated with anti-inflammatory drugs (NSAIDs) have focused on adverse effects in the distal intestine and on issues related to the toxicity associated with antiplatelet therapy. New data reinforce evidence that NSAIDs and antiplatelet therapy are associated with an increased risk of serious complications in both the upper and lower gastrointestinal tract, opening up several lines of research in prevention and therapy based on probiotics, antibiotics and mucosal protectants. The interaction between Helicobacter pylori infection and NSAIDs or aspirin remains controversial but a positive interaction between this bacterium and NSAIDs seems to be reinforced. Several systematic reviews confirm that the combination of gastrotoxic drugs significantly increases the risk of gastrointestinal bleeding, which should reinforce existing prevention strategies, and that new anticoagulant agents do not appear to reduce the risk of gastrointestinal bleeding. Once gastrointestinal hemorrhage has occurred, several studies have indicated the need to implement simpler prognostic scales than those used today. Notable innovations are the development of a disposable endoscope for acute upper gastrointestinal bleeding events and a promising new hemostatic technique, hemospray, applied locally over the bleeding lesion.
Keywords:
Non-steroidal antiinflammatory drugs
Aspirin
Clopidogrel
Anticoagulants
Gastrointestinal bleeding
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