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Mechanisms of gastrointestinal ulceration from non-steroidal anti-inflammatory drugs: a basis for use and development of protective agents

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Side-Effects of Anti-Inflammatory Drugs 3

Part of the book series: Inflammation and Drug Therapy Series ((IDTH,volume 5))

Abstract

The past decade or so has seen an upsurge in interest on the clinical importance of gastrointestinal (GI) ulceration as a major side-effect of the non-steroidal anti-inflammatory drugs (NSAIDs) and with this research on the mechanisms thereof has also increased. A number of reviews on the clinical importance of GI side-effects from NSAIDs have been published [1–6]. The epidemiological evidence suggests that there is an appreciable risk of NSAID gastropathy in rheumatic patients [3,4], the risk being much greater in the elderly female patient [5].

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References

  1. Doherty C. Non-steroidal anti-inflammatory drugs in patients with peptic ulcer diseases: to be considered in certain circumstances. Br Med J. 1989;298:176–9.

    Article  CAS  Google Scholar 

  2. Hawkey C. Non-steroidal anti-inflammatory drugs in patients with peptic ulcer diseases: rarely justified in terms of cost or benefit. Br Med J. 1989;298:177–8.

    Article  CAS  Google Scholar 

  3. Roth S.H. NSAID gastropathy - the central issue. Drugs. 1990;40:25–28.

    Article  PubMed  Google Scholar 

  4. Fries J.F. NSAID gastropathy; the second most deadly rheumatic disease? Epidemiology and risk appraisal. J Rheumatol. 1991;18 (suppl. 28):6–10.

    Google Scholar 

  5. Griffin M.R., Piper J.M., Daugherty J.R., Snowden M., Ray, W.A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114:257–63.

    PubMed  CAS  Google Scholar 

  6. Soll A.H., Weinstein W.M., Kurata J., McCarthy D. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease. Ann Intern Med. 1991;114:307–19.

    PubMed  CAS  Google Scholar 

  7. Bjamason I., Fehilly B., Smethurst P., Menzies I.S., Levi A.J. Importance of local versus systemic effects of non-steroidal anti-inflammatory drugs in increasing intestinal permeability in man. Gut. 1991;32:275–7.

    Article  Google Scholar 

  8. Jenkins A.P., Trew D.R., Crump B.J., Nukajam W.S., Foley J.A.,. Menzies I.S., Creamer B. Do nonsteroidal anti-inflammatory drugs increase colonic permeability. Gut. 1991;32:66–9.

    Article  PubMed  CAS  Google Scholar 

  9. Rainsford K.D. Mechanisms of gastric contrasted with intestinal damage by non-steroidal anti-inflammatory drugs. In: Rainsford K.D., Velo G.P. (eds.) Side Effects of Anti-inflammatory Drugs. Part 2. Studies in Major Organ Systems. Lancaster, MTP Press;1987:3–26.

    Google Scholar 

  10. Whittle B.J.R., Vane J.R. A biochemical basis for the gastrointestinal toxicity of non-steroidal antirheumatoid drugs. Arch Toxicol. 1984;7 (Suppl.):315–22.

    Article  CAS  Google Scholar 

  11. Rainsford K.D. Toxicity of currently used anti-inflammatory and anti-rheumatic drugs. In: Lewis A.J., Furst D.E. (eds.) Newer Anti-Inflammatory Drugs. New York, Marcel Dekker;1987:215–44.

    Google Scholar 

  12. Rainsford K.D. Side-effects of anti-inflammatory/analgesic and anti-rheumatic drugs. In: Williamson W.R.N. (ed.) Anti-Inflammatory Drugs. New York, Marcel Dekker, New York, 1978:359–406.

    Google Scholar 

  13. Rainsford K.D. Current concepts of the mechanisms of side effects of non-steroidal anti-inflammatory drugs as a basis for establishing research priorities: an experimentalists view. J Rheumatol. 1988;15 (Suppl. 17):63–70.

    Google Scholar 

  14. Rainsford K.D. Mechanisms of NSAID-induced gastrointestinal mucosal injury: a basis for preventing ulceration and symptoms from these agents. Aliment Pharmacol Therap. 1988;2S:43–55.

    Google Scholar 

  15. Rainsford K.D. Interplay between anti-inflammatory drugs and eicosanoids in gastrointestinal damage. In: Hillier K. (ed.) Eicosanoids and the Gastrointestinal Tract. Lancaster, MTP Press;1988:111–128.

    Chapter  Google Scholar 

  16. Szabo S., Spill W.F., Rainsford K.D. Nonsteroidal anti-inflammatory drug-induced gastropathy: mechanisms and management. Medical Toxicol. 1989;4:77–94.

    Article  CAS  Google Scholar 

  17. Rainsford K.D. Mechanisms of gastrointestinal damage by non-steroidal anti-inflammatory drugs. In: Szabo S., Pfeiffer C.J. (eds.) Ulcer Disease: New Aspects of Pathogenesis and Pharmacology. Boca Raton (FL), CRC Press;1989:3–13.

    Google Scholar 

  18. Price A.H., Fletcher M. Mechanisms of NSAID-induced gastroenteropathy. Drugs. 1990;40:25–8.

    Article  Google Scholar 

  19. Rainsford K.D. Microvascular injury during gastric mucosal damage by anti-inflammatory drugs in pigs and rats. Agents Actions. 1983;13:457–460.

    Article  PubMed  CAS  Google Scholar 

  20. Rainsford K.D., Willis C.M., Walker S.A., Robins P.G. Electron microscopic observations comparing the gastric mucosal damage induced in rats and pigs by benoxaprofen with aspirin, reflecting their differing actions as prostaglandin synthesis inhibitors. Br J Exp Pathol. 1982;63:25–34.

    PubMed  CAS  Google Scholar 

  21. Rainsford K.D., Willis C. Relationship of gastric mucosal damage induced in pigs by anti-inflammatory drugs to their effects on prostaglandin production. Dig Dis Sci. 1982;27:624–635.

    Article  PubMed  CAS  Google Scholar 

  22. Rainsford K.D. Effects of 5-lipoxygenase inhibitors and leukotriene antagonists on the development of gastric mucosal lesions induced by nonsteroidal anti-inflammatory drugs in cholinomimetic treated mice. Agents Actions. 1987;21:316–319.

    Article  PubMed  CAS  Google Scholar 

  23. Whitehouse M.W., Rainsford K.D. Esterification of acidic anti-inflammatory drugs suppresses their gastro-toxicity without adversely affecting their anti-inflammatory activity in rats. J Pharm Pharmacol. 1980;32:795–796.

    Article  PubMed  CAS  Google Scholar 

  24. Whitehouse M.W., Rainsford K.D. Comparison of the ulcerogenic actions of different salicylates. In: Pfeiffer C.J. (ed.), Boca Raton (Florida), CRC Press;1982;127–141.

    Google Scholar 

  25. Rainsford K.D. Novel non-steroidal anti-inflammatory drugs. In: Brooks P.M. (ed.) Bailliere’s Clinical Rheumatology, vol. 2. London, Bailliere-Tindall;1988;485–511.

    Google Scholar 

  26. Jeremy N., Williams J.D. Drug development report (5): Prodrugs: the answer to NSAIDinduced gastropathy? J Drug Dev 1990;3:93–107.

    Google Scholar 

  27. Rainsford K.D., Fox S.A., Osborne D.J. Comparative effects of some non-steroidal anti-inflammatory drugs on the ultrastructural integrity and prostaglandin levels in the rat gastric mucosa: relationship to drug uptake. Scand J Gastroenterol. 1984:19 (Suppl. 101):55–68.

    CAS  Google Scholar 

  28. Rainsford K.D., Fox S.A., Osborne D.J. Relationship between drug absorption, inhibition of cyclooxygenase and lipoxygenase pathways and the development of gastric mucosal damage by non-steroidal anti-inflammatory drugs in rats and pigs. In: Bailey M.J. (ed.) New York, Plenum Press;1985;639–653.

    Google Scholar 

  29. Rainsford K.D. Comparison of the gastric ulcerogenic activity of new non-steroidal anti-inflammatory drugs in stressed rats. Br J Pharmacol. 1981;73:79c–80c.

    Google Scholar 

  30. Rainsford K.D. An analysis of the gastrointestinal side-effects of non-steroidal anti-inflammatory drugs, with particular reference to comparative studies in man and laboratory species. Rheumatol Int. 1982;2:1–10.

    Article  PubMed  CAS  Google Scholar 

  31. Rainsford K.D. Gastric ulcerogenicity of non-steroidal anti-inflammatory drugs in mice with mucosa sensitized by cholinomimetic treatment. J Pharm Pharmacol. 1987;39:669–672.

    PubMed  CAS  Google Scholar 

  32. McCormack K., Brune K. The amphiprotic character of azapropazone and its relevance to the gastric mucosa. Arch Toxicol. 1991;64:1–6.

    Article  Google Scholar 

  33. McCormack K. Mathematical model for assessing risk of gastrointestinal reactions to NSAIDs. In: Rainsford K.D. (ed.) Azapropazone. 20 years of clinical use. Lancaster, Kluwer, 1989;81–93.

    Google Scholar 

  34. Rainsford K.D. Structure-activity relationships of non-steroidal anti-inflammatory drugs. I. Gastric ulcerogenic activity. Agents Actions. 1978;8:587–605.

    Article  PubMed  CAS  Google Scholar 

  35. Whittle B.I.R. Protection of the gastric mucosa by prostaglandins and their analogs. ISI Atlas of Science: Pharmacology. 1987;1:168–172.

    CAS  Google Scholar 

  36. Agrawal N.M., Dajani E.Z. Options in the treatment and prevention of NSAID-induced gastroduodenal mucosal damage. J Rheumatol.l990; (suppl. 20) 17:7–11.

    Google Scholar 

  37. Ligumsky M., Golanska E.M., Hansen D.G., Kauffman G.L. Aspirin can inhibit gastric mucosal cyclo-oxygenase without causing lesions in rat. Gastroenterology. 1983;84:756–761.

    PubMed  CAS  Google Scholar 

  38. Goldin E., Stalnikowicz R., Wengrower D., Eliakim R., Fich A., Ligumsky M., Karmeli F., Rachmilewitz D. No correlation between indomethacin-indiced gastrodudenal damage and inhibition of gastric prostanoid synthesis. Aliment Pharmacol Therap. 1988;2:369–375.

    Article  CAS  Google Scholar 

  39. Rainsford K.D. Comparative effects of oxaprozin on the gastrointestinal tract of rats and mice: relationship to drug uptake and effects in vivo on eicosanoid metabolism. Aliment Pharmacol Therap. 1988;2:439–450.

    Article  CAS  Google Scholar 

  40. Tavares I.A., Collins P.O., Bennett A. Inhibition of prostanoid synthesis by human gastric mucosa. Aliment Pharmacol Therap. 1987;1:617–625.

    Article  CAS  Google Scholar 

  41. Carty T.J., Stevens J.S., Lombardino J.G., Parry M.J., Randall M.J. Piroxicam, a structurally novel anti-inflammatory compound. Mode of prostaglandin synthesis inhibition. Prostaglandins 1980;19:671–682.

    Article  PubMed  CAS  Google Scholar 

  42. Dahlen S.E., Bjrk J., Hedqvist P., Arfors K.E., Hammerstrm S., Lindgren J.A., Samuelson B. Leukotrienes promote plasma leakage and leukocyte adhesion in postcapillary venules: In vivo effects with relevance to the acute inflammatory response. Proc Natl Acad Sci USA. 1981;78:3887–3891.

    Article  PubMed  CAS  Google Scholar 

  43. Peskar B.M., Hoppe U., Lange K., Peskar B.A. Effects of non-steroidal anti-inflammatory drugs on rat gastric mucosal leukotriene C4 and prostanoid release-relation to ethanol injury. Br J Pharmacol. 1988;93:937–943.

    Article  PubMed  CAS  Google Scholar 

  44. Pendleton R.G., Stavorski J.R. Evidence for differing leukotriene receptors in gastric mucosa. Europ J Pharmcol. 1986;125:297–299.

    Article  CAS  Google Scholar 

  45. Salvati P., Whittle B.J.R. Investigation of the vascular actions of arachidonate lipoxygenase and cyclooxygenase products. Prostaglandins 1981;22:141–156.

    Article  PubMed  CAS  Google Scholar 

  46. Wallace J.L., Keenan C.M., Granger D.N. Gastric ulceration induced by non-steroidal anti-inflammatory drugs is a neutrophil dependent process. Am J Physiol. 1990;259:G462–G467.

    PubMed  CAS  Google Scholar 

  47. Wallace J.L., Arfors K.E., Webb-McKnight G. A monoclonal antibody against the CDI8 leukocyte adhesion molecule prevents indomethacin-induced gastric damage in the rabbit. Gastroenterology. 1991;100:878–883.

    PubMed  CAS  Google Scholar 

  48. Kuehl F.A. Jr, Dougherty H.W., Ham E.A. Interactions between prostaglandins and leukotrienes. Biochem Pharmacol. 1984;33:1–5.

    Article  PubMed  CAS  Google Scholar 

  49. Waisman Y., Marcus H., Ligumski M., Dinari G. Modulation by opiates of small intestinal prostaglandin E:2 and 3’,5’-cyclic adenosine monophosphate levels and of indomethacininduced ulceration in the rat. Life Sci. 1991;48:2035–2042.

    Article  PubMed  CAS  Google Scholar 

  50. Rainsford K.D., Whitehouse M.W. Biochemical gastro-protection from acute ulceration induced by aspirin and related drugs. Biochem Pharmacol. 1980;29:1281–1289.

    Article  PubMed  CAS  Google Scholar 

  51. Rainsford K.D. Prevention of indomethacin induced gastro-intestinal ulceration in rats by glucose-citrate formulations: role of ATP in mucosal defences. Br J Rheumatol. 1987;26:(Abstr Suppl. 2) 81.

    Article  Google Scholar 

  52. Walker F.S., Pritchard M.H., Jones J.M., Owen G.M., Rainsford K.D. Inhibition of indomethacin-induced gastrointestinal bleeding, both immediate and persistent, in man by citrate-glucose formulations. Br J Rheumatol. 1987;26:(Abstr Suppl. 2) 12.

    Google Scholar 

  53. Whitehouse M.W., Rainsford-Koechli V., Rainsford K.D. Aspirin gastrotoxicity: protection by various strategems. In: Rainsford K.D., Velo G.P. (eds.). Side Effects of Anti-inflammatory/ Analgesic Drugs. New York, Raven Press;1984;77–87.

    Google Scholar 

  54. Rainsford K.D., Dieppe P.A., Pritchard M.H., Rhodes J., Leach H., Russell R.I., Walker F.S., Hort J.F. Protection from gastrointestinal side-effects by azapropazone by its incorporation into a glucose-sodium citrate formulation. Aliment Pharmacol Ther. 1991;5:.

    Google Scholar 

  55. Rainsford K.D., Whitehouse M.W. Anti-ulcer activity of zinc monoglycerolate (Glyzinc (R)): a slow-release zinc formuulation. Clin Expt Physiol Pharmacol. 1987.

    Google Scholar 

  56. Rainsford K.D, Whitehouse M.W. Anti-ulcer activity of a slow-release zinc complex, zinc monoglycerolate [Glyzinc(R)]. J. Pharm. Pharmacol. 1991; accepted.

    Google Scholar 

  57. Rainsford K.D. Mechanisms of gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol. 1989;24:(Suppl. 163) 9–16.

    Article  Google Scholar 

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Rainsford, K.D. (1992). Mechanisms of gastrointestinal ulceration from non-steroidal anti-inflammatory drugs: a basis for use and development of protective agents. In: Rainsford, K.D., Velo, G.P. (eds) Side-Effects of Anti-Inflammatory Drugs 3. Inflammation and Drug Therapy Series, vol 5. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-2982-4_14

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  • DOI: https://doi.org/10.1007/978-94-011-2982-4_14

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5325-9

  • Online ISBN: 978-94-011-2982-4

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