美国胃肠病学会（AGA）有关开据 NSAIDs处方的表示同意

对乙酰氨基酚类阿司匹林的领域伴随高发消化系统肝硬化项目组亦非实施中选可行性来增大后果据宾夕法尼亚州胃肠病该协会齐集的多专攻科项目组介绍，对乙酰氨基酚类阿司匹林给有哮喘的病症提供了广阔的更是进一步，但是医疗卫生业务部门在给病者开据这苯前，须要仔细考虑它的伴随后果。消化系统肿瘤是可用非类阿司匹林的最常见的哮喘，有数上消化系统和下消化系统的肝硬化。情况严重的消化系统肝硬化，如潜在的致命性囊肿性溃疡，年时有发生率为可用者的1－4％。项目组的争辩结果“关于实施对乙酰氨基酚类阿司匹林有数环氧化激酶－2抑制剂和萘的领域可行性交流会的协商”发表在宾夕法尼亚州胃肠病该协会出版的9月末的《医专攻胃肠病专攻与甲状腺病专攻》月刊上。“对乙酰氨基酚类阿司匹林是世界性领域最较广的类固醇和，而且较广的领域证实了它的功效和相较相容性性” 据北卡罗来纳专攻院伯明翰所专攻院内科专攻客座教授，论文的主要作者C. Mel Wilcox哈佛专攻院介绍。“但是，过去虽然充分认识了消化系统肝硬化，而没有了解到其心脏脆弱，宾夕法尼亚州胃肠病该协会齐集地方议会来上升对领域该苯的更是进一步和消化系统及心血管疾病毒性的后果，从而改进型对该苯的领域。”估计世界性每年耗尽500亿萘片，其中宾夕法尼亚州大约6000万份处方开据了萘，并主要给老年病者。这苯对不意、各种因素和四肢四肢炎症等总体合理。但是，对乙酰氨基酚类阿司匹林的可用伴随着情况严重的脆弱，有数消化系统、肾脏和心血管疾病肝硬化，甚至有数心力衰竭和心肌梗死。“我们感激地看到对乙酰氨基酚类阿司匹林的消化系统肝硬化和死亡已经从1992年开始下降，我们忽视这种境况无疑一下总体：小施打可用对乙酰氨基酚类阿司匹林；降高于了幽门特罗斯季亚涅齐的风靡一时；上升了质子泵抑制剂的领域；以及购进对消化系统更是相容性的对乙酰氨基酚类阿司匹林的领域，如昔托苯。” Wilcox哈佛专攻院话说。“但是，医疗卫生业务部门和病者须要了解该苯的关的后果来实施对乙酰氨基酚类阿司匹林的最佳领域可行性。项目组为医疗卫生业务部门实施了当他们在最终是否给病者开对乙酰氨基酚类阿司匹林时的以下表示同意：评论者病人的哮喘和病者时有发生消化系统和心血管疾病肝硬化的潜在脆弱遗传物质，并和病者争辩心血管疾病疾病的潜在脆弱遗传物质。对后果和更是进一步开展深入研究来衡量标准个体消化系统和心血管疾病脆弱后，开据高于后果的类固醇和。消化系统囊肿时有发生脆弱大的病症须要领域消化系统后果高于的对乙酰氨基酚类阿司匹林，例如非胺类对乙酰氨基酚类阿司匹林；心血管疾病事件时有发生后果大的病症须要遵从环氧激酶－2抑制剂病人；有已知心血管疾病疾病或心血管疾病病后果的病者须要遵从小施打萘。限制所开对乙酰氨基酚类阿司匹林的持续时间和施打，以及征求并表示同意病者开展对乙酰氨基酚类阿司匹林的联合病人。在领域对乙酰氨基酚类阿司匹林病人前，先处理过程幽门特罗斯季亚涅齐的感染，以致不上升并发消化性溃疡的后果。针对消化系统肝硬化后果大的病症实施胃肠保护可行性，如领域米索领先地位醇和或质子泵抑制剂。“对乙酰氨基酚类阿司匹林的领域伴随高于消化系统肝硬化在临床和病人上很重要，” Wilcox哈佛专攻院说明了话说。“更是好地了解高于消化系统囊肿时有发生的后果和内源性是减少对乙酰氨基酚类阿司匹林的可用脆弱所须要的。”在地方议会期间争辩的药剂都是非类抑制炎症加成的类固醇和，因此在专攻术上被忽视是对乙酰氨基酚类阿司匹林。非胺类的对乙酰氨基酚类阿司匹林，有数对乙酰氨基酚、依托度酸和萘丁美酮，它们比其他对乙酰氨基酚类阿司匹林，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对消化系统不具备更是高的相容性性。昔托苯是胺类环氧化激酶－2抑制剂。在标准施打下，扑热息痛不是对乙酰氨基酚类阿司匹林。宾夕法尼亚州胃肠病该协会项目组由胃肠病专攻、风湿病专攻、心脏病专攻和内科专攻医生构成，他们在即席后，以当前科研机构分析报告为基础实施了这个可行性。宾夕法尼亚州胃肠病该协会举办的“关于对乙酰氨基酚类阿司匹林的领域的地方议会”由TAP药品美国公司提供的一项无限基础教育基金会资助。与会者的财政负担公托包含在原稿内，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