Esomeprazole – effective protection of gastrointestinal tract during nonsteroidal anti-inflammatory drugs therapy Review article
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) use is associated with the risk of relevant upper gastrointestinal tract complications that include gastric ulcers and hemorrhage. In patients without other risk factors predicting serious gastroduodenal damage, protective use of esomeprazole is indicated when dyspeptic symptoms occur, which are the most common reason of NSAIDs discontinuation. Esomeprazole, biologically more active S-isomer of omeprazole, relieves gastrointestinal symptoms in more than 80% of dyspeptic patients who are continuing NSAIDs long-term therapy and is effective in both daily doses (40 mg or 20 mg). In high risk patients (age 65 years or older, history of gastroduodenal ulcers, use of more than one or highdose NSAIDs, concomitant use of glicocorticosteroids, anticoagulant or clopidogrel and the presence of serious comorbidities) protective therapy depends on cardiovascular risk. If they do not use acetylsalicylic acid for primary or secondary prevention, only cyclooxygenase-2-selective inhibitors are recommended, and fixed combination with esomeprazole depends on the onset of dyspeptic symptoms. For patients at increased cardiovascular risk, who are continuing low-dose of acetylsalicylic acid, esomeprazole is a mainstay of protective treatment from the beginning of NSAIDs therapy. It has been shown that esomeprazole 40 mg or 20 mg once daily significantly lowers the incidence of gastric ulcers in patients at risk and after 8 week of treatment healing rates are 92% and 88%, respectively. Among patients who only take low-dose acetylsalicylic acid relative risk reduction of peptic ulcers incidence was 80% in esomeprazole 40 mg recipients and 85% in esomeprazole 20 mg recipients.
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