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| 1 | Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy显示文摘This article reviews the latest developments in understanding the pathogenesis, detection and treatment of small intestinal damage and bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs). With improvements in the detection of NSAID-induced damage in the small intestine, it is now clear that this injury and the associated bleeding occurs more frequently than that occurring in the stomach and duodenum, and can also be regarded as more dangerous. However, there are no proven-effective therapies for NSAID-enteropathy, and detection remains a challenge, particularly because of the poor correlation between tissue injury and symptoms. Moreover, recent studies suggest that commonly used drugs for protecting the upper gastrointestinal tract (i.e., proton pump inhibitors) can significantly worsen NSAID-induced damage in the small intestine. The pathogenesis of NSAID-enteropathy is complex, but studies in animal models are shedding light on the key factors that contribute to ulceration and bleeding, and are providing clues to the development of effective therapies and prevention strategies. Novel NSAIDs that do not cause small intestinal damage in animal models offer hope for a solution to this serious adverse effect of one of the most widely used classes of drugs. | John L Wallace | 2013 | World Journal of Gastroenterology2013，19，12： | 15 |
| 2 | Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease显示文摘The use of non-steroidal anti-inflammatory drugs(NSAIDs) is widespread worldwide thanks to their analgesic, anti-inflammatory and antipyretic effects. However, even more attention is placed upon the recurrence of digestive system complications in the course of their use. Recent data suggests that the complications of the lower gastro-intestinal tract may be as frequent and severe as those of the upper tract. NSAIDs enteropathy is due to enterohepatic recycling of the drugs resulting in a prolonged and repeated exposure of the intestinal mucosa to the compound and its metabolites. Thus leading to so-called topical effects, which, in turn, lead to an impairment of the intestinal barrier. This process determines bacterial translocation and toxic substances of intestinal origin in the portal circulation, leading to an endotoxaemia. This condition could determine a liver inflammatory response and might promote the development of nonalcoholic steatohepatitis, mostly in patients with risk factors such as obesity, metabolic syndrome and a high fat diet, which may induce a small intestinal bacterial overgrowth and dysbiosis. This alteration of gut microbiota may contribute to nonalcoholic fatty liver disease and its related disorders in two ways: firstly causing a malfunction of the tight junctions that play a critical role in the increase of intestinal permeability, and then secondly leading to the development of insulin resistance, body weight gain, lipogenesis, fibrogenesis and hepatic oxidative stress. | erika utzeri paolo usai | 2017 | World Journal of Gastroenterology2017，23，22： | 12 |
| 3 | 安全性高的非甾体抗炎药的研究进展显示文摘非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)广泛用于多种关节炎的治疗,然而临床使用中发现,传统的非甾体抗炎药缺乏靶点选择性,胃肠道(gastrointestinal,GI)不良反应严重。选择性COX-2抑制剂如罗非昔布等尽管可能降低GI不良反应,但其心血管毒性风险增加。最新研究表明,选择性COX-2抑制剂并没有显著改善传统NSAIDs的GI损伤。近几年,NSAIDs引发的小肠黏膜损伤引起了广泛的关注,且至今还无有效方法消除这一损伤。因此,现有NSAIDs的安全性问题仍然突出。为提高现有NSAIDs的安全性,研究者开始着眼于研发新型安全性更高的非甾体抗炎药。本文主要介绍目前最新的安全性高的NSAIDs,并对其研究进行了展望。 | 吕田 叶海 张灿 | 2016 | 中国新药杂志2016，25，11： | 10 |
| 4 | 胶囊内镜对非甾体类抗炎药致小肠黏膜损伤的诊断价值研究显示文摘目的探讨胶囊内镜对无典型临床表现的非甾体类抗炎药(NSAID)致小肠黏膜损伤的诊断价值。方法纳入2006年10月至2013年12月进行胶囊内镜检查患者110例,其中服用NSAID者38例,比较NSAID服用者与不服用者、服药持续时间≥3个月者与〈3个月者、服用低剂量阿司匹林者与服用非阿司匹林NSAID者的小肠黏膜损伤的发现率,以及小肠黏膜损伤发生的部位和随访情况。结果小肠黏膜损伤发现率服药组为55.3%(21/38),未服药组为5.6%(4/72),2组差异有统计学意义(P〈0.01);服药持续时间≥3个月者小肠黏膜损伤发现率显著高于服药持续时间〈3个月者(7/24比4/14,P=0.01);服用非阿司匹林NSAID者小肠黏膜损伤发现率显著高于服用低剂量阿司匹林者(11/14比10/24,P〈0.05)。在服用低剂量阿司匹林的患者中,服药持续时间≥3个月者小肠黏膜损伤发现率显著高于服药持续时间〈3个月者(10/16比0/8,P=0.00)。服用NSAID者小肠黏膜溃疡主要发生在回肠(10/11),而小肠黏膜糜烂主要发生在空肠(8/10)。8例小肠溃疡患者在停服NSAID或加用黏膜保护剂后,复查胶囊内镜显示小肠溃疡明显改善;4例小肠黏膜糜烂患者加用黏膜保护剂后,复查胶囊内镜显示小肠黏膜糜烂基本消失。结论胶囊内镜对无典型临床表现的NSAID致小肠黏膜损伤具有较好的诊断及指导治疗的作用。 | 薄陆敏 杨俊驰 廖专 徐灿 辛磊 陈洁 方艾乔 李兆申 | 2015 | 中华消化内镜杂志2015，32，1： | 9 |
| 5 | 瑞巴派特对阿司匹林损伤大鼠小肠黏膜通透性的保护作用显示文摘目的探讨瑞巴派特对阿司匹林致大鼠小肠黏膜损伤的保护作用及其可能的机制。方法将30只Wistar大鼠随机平均分为空白对照组、阿司匹林损伤组和低、中、高剂量瑞巴派特保护组。采用阿司匹林150 mg·kg^(-1)·d^(-1)灌胃,连续14 d,瑞巴派特组在每次造模前30 min给予保护。观察小肠黏膜组织病理和超微结构改变,检测黏膜髓过氧化物酶(MPO)、黏蛋白2(MUC2)水平,采用免疫组织化学方法检测紧密连接蛋白ZO-1和Occludin表达,检测血清D-乳酸水平。结果阿司匹林组小肠黏膜损伤,黏膜MPO、血清D-乳酸增加(P<0.05),MUC2、ZO-1和Occludin表达量减少(P<0.05),瑞巴派特可不同程度缓解以上改变。结论瑞巴派特对阿司匹林损伤小肠黏膜通透性具有保护作用,其机制可能包括减轻炎症、增加MUC2的分泌、保护细胞紧密连接蛋白ZO-1和Occludin。 | 杨成 崔梅花 梁君 李静 | 2017 | 胃肠病学和肝病学杂志2017，26，11： | 8 |
| 6 | 非甾体消炎药物致小肠黏膜损伤的研究进展显示文摘非甾体消炎药物(NSAIDs)具有抗炎、解热、镇痛作用,被广泛运用于临床,成为全球使用最多的药物之一。随着NSAIDs的广泛应用,其胃肠道不良事件发生率显著增加,长期以来人们比较重视NSAIDs导致的胃黏膜损伤,而忽略了其对肠道损伤的临床问题。随着胶囊内镜和小肠镜技术的发展,国内外的大量研究表明NSAIDs致小肠黏膜损伤的情况也很常见,针对此类疾病的发生机制进行深入研究并寻找相应的防治方法十分重要。 | 唐雯 张大宽 陈东风 | 2013 | 医学综述2013，19，17： | 7 |
| 7 | 质子泵抑制药加重非甾体抗炎药所致小肠损伤及其防治措施的文献综述显示文摘质子泵抑制药(PPIs)可有效治疗胃和十二指肠的损伤出血,但对非甾体抗炎药(NSAIDs)所致小肠损伤效果不佳,甚至加重损伤的程度。PPIs通过改变肠道菌群和增加胆汁酸的细胞毒性等机制加重NSAIDs药物引起的小肠损伤,联合用药前应充分评估患者的获益及风险,治疗时需兼顾上下消化道,可选用具消化道黏膜保护功能的特殊组胺H2受体拮抗药如拉呋替丁;尽可能选用对消化道影响较小的NSAIDs药物如选择性COX-2抑制药;补充肠道益生菌,纠正肠道微生态;使用消化道黏膜保护药物;必要时使用肠道的局部抗菌药。考虑到COX-2抑制药和PPIs的心血管风险,对于患有心脑血管疾病和存在心脑血管疾病风险的患者,应慎用此两类药物。 | 金晶 谭诗云 方向明 | 2019 | 药物流行病学杂志2019，28，7： | 4 |
| 8 | 非甾体类抗炎药相关小肠损伤的研究进展显示文摘非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)是一种抗炎镇痛及抗血小板药物,在全世界被广泛使用.但随着NSAIDs的长期应用,其并发症逐渐受到人们的关注.以往在临床上关注较多的是其导致的上消化道并发症,但随着内窥镜如胶囊内镜和双气囊小肠镜等的普及,人们发现NSAIDs引起的小肠损伤也并不少见.虽然大部分患者并无明显症状,但仍有部分患者出现了明显的症状或复杂的溃疡,需要进行治疗干预.然而,针对NSAIDs相关性肠病的药物尚未被研发,因此,进一步研究NSAIDs相关肠病的发病机制并制定合适的防治策略是有必要的.本文对NSAIDs所致小肠损伤的流行病学、临床表现、诊断、危险因素、发病机制和治疗进行了归纳总结,为NSAIDs的使用及其并发症的防治提供参考. | 罗洋 朱兰平 雷月 赵经文 王邦茂 陈鑫 | 2021 | 世界华人消化杂志2021，29，20： | 4 |
| 9 | Non-steroidal anti-inflammatory drugs-induced small intestinal injury and probiotic agents显示文摘Intestinal bacteria play a role in the development of non-steroidal anti-inflammatory drugs(NSAID)-induced small intestinal injury.Agents such as probiotics,able to modify the gut ecology,might theoretically be useful in preventing small intestinal damage induced by NSAIDs.The clinical studies available so far do suggest that some probiotic agents can be effective in this respect. | Mario Guslandi | 2012 | World Journal of Gastroenterology2012，18，31： | 3 |
| 10 | 胶囊内镜在92例消化道出血诊断中的应用体会显示文摘目的探讨胶囊内镜在消化道出血的诊断价值。方法回顾性分析92例消化道出血行胶囊内镜检查的结果,分析其阳性检出结果及随访情况。结论 92例检查均顺利完成。共检出病灶69例(检出率75%),其中能解释出血病因的48例(阳性率52.2%),包括十二指肠溃疡2例,小肠血管畸形25例,小肠溃疡14例,小肠过敏性紫癜3例,寄生虫2例,小肠憩室1例,小肠占位性病变(间质瘤)1例;疑诊21例(疑诊率22.8%),包括胃糜烂3例,小肠糜烂13例,小肠息肉4例,小肠静脉显露1例;未检出病灶共23例(未检出率25%)。结果胶囊内镜在消化道出血检查安全性高,有较高的检出率,可成为不明原因消化道出血的一线检查手段。 | 刘应玲 张开光 | 2015 | 安徽医药2015，19，11： | 3 |
| 11 | 抗血小板药物与胃肠黏膜损伤的研究进展显示文摘膳食结构不合理、社会人口老龄化均使得心脑血管疾病高发,服用抗血小板药物者骤增,其中氯吡格雷和阿司匹林使用率最高。虽然有很多研究表明服用抗血小板药物后会出现胃肠黏膜损伤的症状,但是很少有报道分别阐明服用抗血小板药物后出现消化系症状和未出现消化系症状的患者其胃肠黏膜损伤的情况,这对未病先防有很大贡献。 | 刘宇超 郭春林 丁瑞峰 | 2017 | 中外医学研究2017，15，5： | 2 |
| 12 | 非甾体类抗炎药相关性小肠损伤研究进展显示文摘非甾体类抗炎药(non-ste roidal antiinflammatory drugs,NSAIDs)具有良好的解热、镇痛、抗炎、抗血小板疗效而广泛应用于临床,但NSAIDs有一定的消化系毒性,尤其会引起NSAIDs相关性小肠损伤.NSAIDs相关性小肠损伤发病率高、临床后果严重,是一个多因素导致的过程.近来,研究显示环氧合酶、肠道菌群、炎症细胞、NSAIDs的肝肠循环、胆汁及线粒体损伤均参与了NSAIDs相关性小肠损伤的发病.本文就NSAIDs相关性小肠损伤的机制及防治等进展作一综述. | 刘晨晨 樊叶 张振玉 | 2015 | 世界华人消化杂志2015，23，32： | 2 |
| 13 | 胶囊内镜诊断不明原因消化道出血的价值显示文摘目的探讨胶囊内镜对不明原因消化道出血的诊断价值。方法回顾性分析2008年9月~2016年5月在温州市中心医院行胶囊内镜检查的112例不明原因消化道出血患者,分析其病变检查率、诊断率、病因分类。结果检查过程中无明显不适及并发症,全小肠检查成功率92.0%(103/112),胶囊内镜总病变检出率为84.8%(95/112),诊断率为70.5%(79/112);其中显性出血组病变检出率87.5%(70/80),诊断率为71.3%(57/80),隐形出血组病变检出率78.1%(25/32),诊断率为68.8%(22/32),两组检出率及诊断率比较差异无统计学意义(P〉0.05)。近期出血组检出率89.3%(77/86),阳性率77.9%(67/86);既往出血组检出率73.1%(19/26),阳性率46.2%(12/26)。比较近期出血组及既往出血组患者阳性率差异有统计学意义(P〈0.05)。血管性病变是OGIB的主要病因,其次是非特异性小肠炎、小肠溃疡、小肠占位、NSAIDs相关性肠病、Crohn’s病等。结论胶囊内镜是诊断不明原因消化道出血的非常重要的检查手段。胶囊内镜检查时机的选择对结果有重要影响。 | 蔡静 宋丽 潘杰 周乐盈 俞海波 | 2016 | 浙江实用医学2016，21，5： | 1 |
| 14 | 非甾体抗炎药相关性肠病的临床诊断及药物治疗进展显示文摘随着抑酸治疗与小肠影像技术的进步,非甾体抗炎药(NSAIDs)损伤风险的研究已从胃十二指肠转移到小肠,但目前NSAIDs相关性肠病仍未得到充分认识。尽管NSAIDs的胃十二指肠与小肠并发症发病机制不同,但两者有一些相同的危险因素。NSAIDs相关性肠病临床并发症的发病率很高且不可逆转。在使用短期、大剂量NSAIDs的无症状患者中,预防措施已被证明效果不佳。与非选择性NSAIDs相比,选择性环加氧酶-2抑制剂与胃-十二指肠并发症较少相关。针对发病率高的小肠并发症,临床医师在使用NSAIDs时应予以重视。 | 徐家桥 王景杰 | 2020 | 医学综述2020，26，9： | 1 |
| 15 | 阿司匹林联合替格瑞洛致严重下消化道出血显示文摘1例66岁男性患者PCI术后服用阿司匹林肠溶片(100 mg、1次/d)和替格瑞洛片(90 mg, 2次/d),约2周后出现黑便,初期量少但逐渐加重,伴头晕、乏力等不适,给予抑酸、护胃、止血、反复输血等治疗2周,症状无明显缓解.停用阿司匹林肠溶片和替格瑞洛片,禁食,给予悬浮红细胞输注,艾司奥美拉唑(80 mg,1次/8 h)静脉泵入,铝镁加混悬液(1.5 g,3次/d)口服及营养支持治疗.第4天,患者症状无改善,加用奥曲肽(0.6 g,1次/12 h)静脉泵入;第8天,患者间断解柏油样大便约1 000 g,血压92/62 mmHg(1 mmHg=0.133 kPa),Hb 43 g/L,胃镜检查示浅表性胃炎,肠镜检查因直肠被柏油样物质覆盖未能完成,考虑消化道仍持续出血,加服云南白药和凝血酶;第13天,患者Hb降至37 g/L,血压降至85/59 mmHg,呈重度贫血貌;第25天,行剖腹探查术,术中见小肠明显扩张,肠腔呈暗黑色,黏膜上有大量弥漫性出血点,以距Treitz韧带100-200 cm处为重,切除小肠出血肠段,并给予抑酸止血、营养补液支持治疗.其后患者未再出现黑便,贫血逐渐好转.小肠部分切除术后第16天,患者腹部切口愈合佳,RBC 2.7×10^12/L,Hb 88 g/L. | 杜青青 王娜 刘蕊 赵春景 钱妍 赵莉 | 2018 | 药物不良反应杂志2018，20，4： | 1 |
| 16 | Spontaneous free perforation of the small intestine in adults显示文摘Spontaneous free perforation of the small intestine is uncommon,especially if there is no prior history of visceral trauma.However,free,even recurrent,perforation may complicate a defined and established clinical disorder,such as Crohn’s disease.In addition,free perforation may be the initial clinical presentation of an occult intestinal disorder,such as a lymphoma complicating celiac disease,causing diffuse peritonitis and an acute abdomen.Initial diagnosis of the precise cause may be difficult,but now has been aided by computerized tomographic imaging.The site of perforation may be helpful in defining a cause(e.g.,ileal perforation in Crohn’s disease,jejunal perforation in celiac disease,complicated by lymphoma or collagenous sprue).Urgent surgical intervention,however,is usually required for precise diagnosis and treatment.During evaluation,an expanding list of other possible causes should be considered,even after surgery,as subsequent management may be affected.Free perforation may not only complicate an established intestinal disorder,but also a new acute process(e.g.,caused by different infectious agents)or a longstanding and unrecognized disorder(e.g.,congenital,metabolic and vascular causes).Moreover,new endoscopic therapeutic and medical therapies,including use of emerging novel biological agents,have been complicated by intestinal perforation.Recent studies also support the hypothesis that perforation of the small intestine may be genetically-based with different mutations causing altered connective tissue structure,synthesis and repair. | Hugh James Freeman | 2014 | World Journal of Gastroenterology2014，20，29： | 1 |
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