Gastropathy

Description:

The term "medicamentous gastropathy" used in a lexicon of modern medicine - a collective concept which includes a dispepsichesky syndrome, and also erosive cankers of upper parts of the digestive tract (DT) which develop at reception of the medicines possessing the irritating and damaging action on the mucous membranes (MM) of a stomach and, more rare, a duodenum.

In a habit view of change at reception of similar medicines can be determined as chemical gastritis (by the Sydney classification), but morphological changes WITH, the ulcerations and erosion defined at light microscopy of biopsy material it is impossible to characterize strictly as chemical. Inflammatory changes FROM a stomach come to light practically in 100% of observations at the patients accepting medicines with ulcerogenic action and differ only in degree of manifestation and frequency of development of erosive and ulcer defects of a mucous membrane.

The most widely used group of the medicines having the damaging effect on FROM upper parts of a GIT are non-steroidal anti-inflammatory drugs (NPVP). Emergence of the term "NPVP-gastropathies" is connected with identification of the changes of structure of a mucous membrane of a stomach caused by reception of NPVP.

The second significant factor which the specialists using in medical practice of NPVP are obliged to consider is the high frequency of the zhizneugrozhayushchy complications developing against the background of erosive cankers WITH, first of all bleedings.

Relevance of a problem of prevention and treatment of NPVP-gastropathies does not raise doubts. The group of non-steroidal anti-inflammatory drugs is extremely widely demanded in rheumatological, cardiological clinic, for treatment of pain and nonspecific inflammatory processes. In the last decade purpose of NPVP for decrease in risk of development of cancer in patients is actively discussed with the precancerous processes of colorectal area as which are genetically determined, and arose against the background of diseases of this area. From year to year indications to appointment extend, the number of the medicines from the NPVP group blocking "inflammatory" enzyme - cyclic oxygenase of the 2nd type (TsOG-2) increases.

Thus, the prevention and the correct therapy of the gastroenterological side effects and complications connected with reception of NPVP have the big practical importance for specialists of various profile.

Gastropathy symptoms:

NPVS symptoms - gastropathies is pain and a sensation of discomfort in an anticardium, weight after meal, nausea, an eructation, heartburn, vomiting. The main diagnostic method is FGDS (fibrogastroduodenoskopiya) allowing to estimate visually a state mucous a gullet, a stomach and, partially, a duodenum.

Gastropathy reasons:

Inhibition of products of enzyme of cyclooxygenase (prostaglandinsintetaza). TsOG represents the enzyme catalyzing synthesis in an organism of biologically active substances - prostanoid, prostaglandins, thromboxane and prostacyclin are among the most important of them. The group of prostanoid performs functions of mediators of pain, implementation of a fabric inflammation, regulation of an adequate otshnurovka of thrombocytes. For digestive tract functional activity of one of isoenzymes of TsOG, cyclic oxygenase of the 1st type (TsOG-1), physiological, normal constantly present at fabrics of a live organism and providing regulation of the functions described above has the greatest value. The TsOG-2 isoform is not defined in normal fabrics. The expression of TsOG-2 is induced by inflammation mediators (lipopolisakharida, interleykinom-1, a factor of a necrosis of tumors an alpha) from cellular substances of an organism (macrophages, monocytes, endothelial cells of vessels, etc.) also causes all clinical manifestations of inflammatory processes - morbidity, fervescence, puffiness, dysfunction of body.

Direct toxic effect. On molecular structure the majority of NPVP are weak acids. At oral administration in gastric contents they are easily ionized, diffuse in cells FROM a stomach and at achievement of a certain concentration in epithelial cells have the direct damaging effect on intracellular organellas and destroy epithelial cells.

System toxic effect. NPVP irrespective of a use form (peroral, injection, rectal, local) get to a system blood stream and inhibit products of mucins, worsen microcirculation in WITH, reducing its trophic and reparative properties and by that reducing proliferation of epithelial cells FROM a stomach and consequently, reducing protective factors of a mucous membrane.

There is also a number of the accessory factors increasing risk of development of NPVP-gastropathies and more significant complications (erosion and stomach ulcers, bleedings). 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;
- concomitant use of anticoagulants;
- the accompanying therapy by glucocorticosteroids;
- duration of therapy of NPVP;
- existence of the disease demanding long reception of NPVP;
- female;
- smoking;
- alcohol intake;
- existence of a helikobakterny infection.

Treatment of the Gastropathy:

Treatment of NPVS - gastropathies consists, first of all, in the solution of a question of drug withdrawal or its replacement on similar, but safer. From medicines H2-histamine blockers, мизопростол and blockers of a proton pomp are used. Most pathogenetic purpose of a mizoprostol is reasonable, but its mass prescription is limited, in connection with the high cost of therapy. H2-histamine blockers are insufficiently effective at this pathology therefore blockers of a proton pomp are the most appointed (пантопразол, омепразол, esomeprazole (Neksium), ланзопразол). Neksium is the most effective representative of group of blockers of a proton pomp who is often used at this pathology. For treatment of the damages of a GIT caused by use of NPVS Neksium's reception in a dose 0.02g (1 tab.), for 1-2 months is recommended, in the same dosage it is possible to apply Neksium and to prevention of pathology of a GIT at prolonged use of NPVS.

Neksium - choice drug for treatment of the pathologies of a GIT connected using NPVS that is confirmed by data of evidential medicine. The blind randomized research which proved higher performance of Neksium in treatment of NPVS – gastropathies, in comparison with reference drug of the H2 group – histamine blockers – ranitidine was conducted. The research was conducted on a large number of patients, including elderly patients (60 years are more senior) and patients with a round ulcer in the anamnesis.