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Varför minska mängden magsyra hos patienter som tar NSAID-preparat?

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Antiinflammatoriska läkemedel av icke-steroid typ har en systemisk effekt på flera delar av slemhinneförsvaret, och sura NSAID-preparat, inklusive acetylsalicylsyra, kan också ha en lokal effekt på magslemhinnan [1].

Dessa systemiska och lokala effekter gör det lättare för magsyra att diffundera till slemhinnans inre, vilket leder till symtom och eventuell utveckling av djupare erosioner och peptisk sårbildning.

Magsyrans centrala roll för NSAID-relaterad gastroduodenal skada framgår av denna studie på råtta [2]. När indometacin gavs parenteralt var omfattningen av skadan på magslemhinnan stor när pH i magen var 2 eller 4, men minskade när pH höjdes till över 4.

En höjning av intragastriskt pH till över 4 är följaktligen nyckeln i behandlingen av NSAID-relaterade biverkningar i övre mag-tarmkanalen. För att effektivt höja intragastriskt pH till över 4 behövs en protonpumpshämmare, eftersom en H2-receptorantagonist endast kan nå detta mål under en mycket kortare tidsperiod.

Diagram: NSAID-associated gatroduodenal damage is pH-dependent

 

Referenser:

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  2. Elliott SL, Ferris RJ, Giraud AS, Cook GA, Skeljo MV, Yeomans ND. Indomethacin damage to rat gastric mucosa is markedly dependent on luminal pH. Clin Exp Pharmacol Physiol 1996;23:432–4.
  3. Laine L. The gastrointestinal effects of nonselective NSAIDs and COX-2 selective inhibitors. Semin Arthritis Rheum 2002;32 Suppl 1:25–32.
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Senast uppdaterad: 2009-04-01

 
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