- NPVP-gastropathy symptoms
- NPVP-gastropathy reasons
- Treatment of the NPVP-gastropathy
The term "NPVP-gastropathies" was offered in 1986 to distinguish the specific damage of a mucous membrane of a stomach arising at the long use of NPVP from a classical peptic ulcer. The NPVP-gastropathy can be shown not only dyspepsia and painful symptoms, but also the hidden, potentially deadly phenomena – perforation, ulcers, bleedings. Unlike a classical peptic ulcer the NPVP-gastropathy affects not a duodenum, but an upper part of the digestive tract (DT) more often and usually develops at elderly, but not at young patients. At gastroscopy diffusion erosion and microbleedings, and also the crateriform ulcers come to light an erythema.
The clinical picture at NPVP-indutsirovannykh gastropathies is characterized by an imbalance between symptomatology and expressiveness of endoscopic changes. So, at a number of the patients noting pains or feeling of weight in epigastric area, nausea, sometimes vomiting, heartburn and other dispepsichesky frustration at an endoscopic research the minimum changes of a mucous membrane come to light. On the contrary, in the presence of multiple erosion and stomach ulcers and a bulb of a duodenum often NPVP-gastropathies proceed asymptomatically in this connection there is a risk of development of such serious complications as bleeding and perforation, quite often leading by a lethal outcome. At any patient accepting NPVP gastroduodenal complications can develop. Existence of complaints from a GIT not always allows to speak about development of erosive and ulcer changes of a mucous membrane. Approximately at 30–40% of the patients receiving long (more than 6 weeks) therapy of NPVP, dyspepsia symptoms which do not correlate with the data obtained at endoscopic inspection are noted: to 40% of patients with erosive and ulcer changes of a mucous membrane of upper parts of a GIT do not show complaints and, on the contrary, to 50% of patients with dyspepsia have a normal mucous membrane.
At any patient accepting NPVP gastroduodenal complications can develop. Existence of complaints from a GIT not always allows to speak about development of erosive and ulcer changes of mucous. Approximately at 30 – 40% of the patients receiving long (more than 6 weeks) therapy of NPVP, dyspepsia symptoms which do not correlate with the data obtained at endoscopic inspection are noted: to 40% of patients with erosive and ulcer changes mucous upper parts of a GIT do not show complaints and, on the contrary, to 50% of patients with dyspepsia have a normal mucous membrane.
There are several factors which increase risk of development of gastric ulcers and their complications at purpose of NPVP. Treat them: the age is more senior than 65 years; a peptic ulcer in the anamnesis; high doses and/or concomitant use of several NPVP; the accompanying therapy by glucocorticosteroids (GKS); therapy duration; existence of the disease demanding long reception of NPVP; female; smoking; alcohol intake; existence of H. pylori.
The female is one of risk factors as hypersensitivity of women to NPVP was found. The high risk of development of complications in women can be also connected with increased, but not always the justified use of NPVP (headaches, a premenstrual syndrome, etc.).
At the combined reception of NPVP and GKS the risk of development of erosive cankers of a GIT increases by 10 times. Increase in risk of development of complications can be explained with systemic action of GKS: blocking enzyme A2 phospholipase, they slow down release of arachidonic acid from phospholipids of cellular membranes that leads to reduction of formation of prostaglandins.
The dose and duration of reception of NPVP are one of determinal factors of risk of development of gastroduodenal ulcers and their complications. The high risk of developing of an ulcer is noted at long therapy, but is maximum in the first month of administration of drug. Decrease in risk is explained further, apparently, by adaptable mechanisms thanks to which gastroduodenal mucous gains ability to resist to the damaging action of NPVP. Unfortunately, adaptation mechanisms are up to the end not studied, perhaps, they are connected with increase in speed of production of slime and emergence of population of young epithelial cells.
Any NPVP can cause damage mucous, however the relative risk of development of complications in different groups of drugs varies. According to some authors, the risk of complications at reception of piroxicam is highest and consistently decreases for indometacin, Naproxenum, an ibuprofen. At the combined use of the NPVP various groups their side effects are summed up.
The dose of the accepted drug also plays not the last role in development NPVP-indutsirovannykh of gastropathies. So, at exceeding of a usual daily dose the risk of development of complications increases by 4 times.
Factors of development of the NPVP-gastropathy
Treatment of the NPVP-gastropathy:
Now three groups of drugs are applied to prevention and treatment NPVP-indutsirovannykh of gastropathies: blockers of H2 receptors of the second (ranitidine) and the third (famotidine) of generations (1st group); blockers of H+, K +-Atfazy (омепразол, etc.; 2nd group); synthetic analog of E1 prostaglandins мизопростол.
Justification for purpose of the drugs blocking production of hydrochloric acid (the 1 and 2 groups) is, first, decrease in the return diffusion of H+ and their damaging action on a mucous membrane, secondly, decrease of the activity of pepsin or its inactivation at increase intragastralny рН to 4,0 and above that leads to decrease in aggressive action of a gastric juice. Thirdly, at high intragastric рН diffusion of NPVP in a mucous membrane and consequently, and their damaging action sharply decreases.
Thus, long suppression of acid products of a stomach with maintenance intragastralny рН higher than 4,0 and especially at the level of 6,0 is one of the main tasks at treatment NPVP-indutsirovannykh of gastropathies. It is established that suppression of acid products leads to scarring of ulcers and epithelization of erosion even at the continuing reception of NPVP that is especially important for patients with rheumatic diseases which are forced to accept them for years.
Efficiency of a mizoprostol in treatment of gastropathies is lower, than blockers of H2 receptors and a proton pomp. However the main drug for prevention NPVP-indutsirovannykh gastro-and duodenopatiya is considered мизопоростол – a synthetic analog of E1 prostaglandin. Besides, мизопростол reduces risk of development of heavy complications in the patients accepting NPVP and entering into risk group.
At detection at patients with NPVP-indutsirovannymi gastro-and duodenopatiya in a mucous infection of antral department of H. pylori reasonablly additional purpose of antibacterial drugs.