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Review
. 2018 Jul-Dec;8(2):148-160.
doi: 10.5005/jp-journals-10018-1281. Epub 2019 Feb 1.

International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G

Richard Hunt  1 , Leonid B Lazebnik  2 , Yury C Marakhouski  3 , Mircea Manuc  4 , Ramesh Gn  5 , Khin S Aye  6 , Dmitry S Bordin  7 , Natalia V Bakulina  8 , Baurzhan S Iskakov  9 , Abror A Khamraev  10 , Yurii M Stepanov  11 , Reidwaan Ally  12 , Amit Garg  13
Affiliations
Review

International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G

Richard Hunt et al. Euroasian J Hepatogastroenterol. 2018 Jul-Dec.

Abstract

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations.

Methods: A modified 'Delphi' process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists.

Results: The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events.

Conclusion/clinical significance: These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients.How to cite this article: Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160.

Keywords: Gastropathy; Gastroprotective agents; Non-prescription drugs; Nonsteroidal Anti-inflammatory Agents; Proton pump inhibitor..

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Conflict of interest statement

Source of support: Nil Conflict of interest: Richard Hunt has served as a consultant for INSYS, Dr Reddy’s, Takeda, and Novar-tis. He has received an honorarium from Novartis, Danone, Dr Reddy’s, and Takeda. He has been on the speaker’s bureau for Takeda and Dr Reddy’s and on scientific advisory board for INSYS. Dmitry S Bordin has served as a lecturer for Astellas, AstraZeneca, KRKA and Abbott. For the remaining authors, there are no conflicts of interest.

Figures

Fig. 1:
Fig. 1:
Modified Delphi protocol for consensus development
See this image and copyright information in PMC

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