Histopathological aspects of mucosal injury related to non-steroidal anti-inflammatory drugs.

A S Taha
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Abstract

As the majority of patients with chronic arthritis are treated, for many years, with non-steroidal anti-inflammatory drugs (NSAID), it is only natural to expect the long-term use of these agents to be associated with a range of oesophago-gastro-duodenal histopathological changes. We have demonstrated that oesophagitis (defined as basis of papillary length, basal cell hyperplasia and inflammatory cell infiltration) is less prevalent in patients taking NSAID. This phenomenon can be utilised in the treatment of certain conditions such as post-irradiation oesophagitis and Barrett's oesophagitis. It also implies that NSAID-related oesophageal ulceration is due to lodging of tablets in the oesophagus and is, in turn, preventable by swallowing of some fluids or solids after taking NSAID. In the stomach, long-term use of NSAID is associated with a specific entity known as chemical or reactive gastritis in about 25% of cases. This is frequently associated with ulceration. Chronic active superficial gastritis, in the presence of Helicobacter pylori, can be found in about 70% of cases. Not unlike oesophagitis, the prevalence of active duodenitis is low in chronic NSAID users. Local ulceration still takes place. This implies that duodenitis is not required in at least some cases of NSAID-related duodenal ulcers, and demonstrates the multi-factorial nature of the pathogenesis of mucosal damage in long-term users of a NSAID.

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与非甾体抗炎药相关的粘膜损伤的组织病理学方面。
由于大多数慢性关节炎患者多年来一直使用非甾体抗炎药(NSAID)治疗,因此预期这些药物的长期使用与一系列食管-胃-十二指肠的组织病理学改变有关是很自然的。我们已经证明,食管炎(定义为乳头长度、基底细胞增生和炎症细胞浸润的基础)在服用非甾体抗炎药的患者中发病率较低。这种现象可用于治疗某些情况,如辐照后食管炎和巴雷特食管炎。这也表明,非甾体抗炎药相关的食道溃疡是由于片剂在食道内倒落,反过来,服用非甾体抗炎药后通过吞咽一些液体或固体可以预防。在胃中,长期使用非甾体抗炎药会导致大约25%的病例出现化学或反应性胃炎。这通常与溃疡有关。慢性活动性浅表性胃炎,在幽门螺杆菌存在下,可在约70%的病例中发现。与食管炎不同,慢性非甾体抗炎药使用者的活动性十二指肠炎患病率较低。局部溃疡仍会发生。这表明至少在一些非甾体抗炎药相关的十二指肠溃疡病例中不需要十二指肠炎,并表明长期使用非甾体抗炎药的粘膜损伤的发病机制是多因素的。
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NSAID gastropathy: state of the art. Epidemiological aspects of NSAID gastropathy. Therapy of NSAIDs-induced gastropathy. Endoscopic aspects of gastroduodenal mucosa due to NSAIDs. Histopathological aspects of mucosal injury related to non-steroidal anti-inflammatory drugs.
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