Influence of Microbiota on NSAID Enteropathy: A Systematic Review of Current Knowledge and the Role of Probiotics

Abstract

Microbiota are increasingly studied, providing more precise information on their important role in physiologic processes. They also influence some pathologic processes, such as NSAID-induced enteropathy. This side effect is much more diffuse than it has been described in the past. It derives mainly from the local action of the medicines and is caused by the local binding of gram-negative bacterial lipopolysaccharides and infiltration of neutrophils into the intestinal mucosa. The initial interest in the interaction between these damages and microbiota is very old, but new and interesting data are available. This review aims to focus on recent studies on NSAID-induced enteropathy, an often-underestimated medical condition, and on the influence of microbiota on this condition. Apart from the broadly investigated use of antibiotics and other mucosal protective solutions, this systematic review focuses mostly on the use of probiotics, which directly influence intestinal microflora. Other important factors influencing NSAID-induced enteropathy, such as sex, advanced age, infection and use of proton pump inhibitors, are also discussed.

Keywords: Enteropathy; Gut microbiota; NSAIDs; Probiotics.

Fig. 1

Mechanism underlying the pathophysiology of NSAID-induced intestinal damage. PG prostaglandins, HO-1 heme oxygenase-1, ONOO- peroxynitrite, NO nitric oxide, iNOS inducible nitric oxide synthase, NF-κΒ nuclear factor-κB, NLRP3 pyrin domain-containing 3, TLR4 Toll-like receptor 4, LPS lipopolysaccharide, TNFα tumor necrosis factor α, IL-1β interleukin-1β

Fig. 2

PRISMA flow diagram