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Review
. 2023 Apr 3;15(4):e37080.
doi: 10.7759/cureus.37080. eCollection 2023 Apr.

Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review

Rohab Sohail  1 , Midhun Mathew  2 , Khushbu K Patel  3 , Srija A Reddy  4 , Zaroon Haider  5 , Mansi Naria  6 , Ayesha Habib  7 , Zain U Abdin  8 , Waleed Razzaq Chaudhry  9 , Anum Akbar  10
Affiliations
Review

Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review

Rohab Sohail et al. Cureus. .

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their anti-inflammatory, antipyretic, and analgesic properties. However, their use is often associated with gastrointestinal tract (GIT) side effects due to the inhibition of both cyclooxygenase (COX)-1 and COX-2 enzymes, leading to a decrease in gastroprotective prostaglandins (PG). To minimize these adverse effects, various approaches have been explored, including selective COX-2 inhibitors, NO-NSAIDs (nitric oxide-releasing NSAIDs), and dual COX/LOX (lipoxygenase) NSAIDs. However, the effects of these gastroprotective NSAIDs on the GIT and their efficacy remains uncertain. This review aims to provide an overview of the current understanding of the effects of traditional NSAIDs and gastroprotective NSAIDs on GIT. We discuss the underlying mechanisms of GIT damage caused by NSAIDs, including mucosal injury, ulceration, and bleeding, and the potential of gastroprotective NSAIDs to mitigate these effects. We also summarize recent studies on the efficacy and safety of various gastroprotective NSAIDs and highlight the limitations and challenges of these approaches. The review concludes with recommendations for future research in this field.

Keywords: cox enzyme; dual cox/lox; gastroprotective nsaids; no-nsaids; nsaids; prostaglandins.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Mechanism of Action of NSAIDs
NSAIDs: Non-steroidal anti-inflammatory drugs; COX: Cyclooxygenase; PGH2: Prostaglandin H2; TXA2: Thromboxane A2; PGD2: Prostaglandin D2; PGF2α: Prostaglandin F 2α; PGE2: Prostaglandin E2; PGI2: Prostacyclin Source: Reference no. [19] (Created with bioRender.com)
Figure 2
Figure 2. NSAIDs induced GI side effects
NSAIDs: Nonsteroidal anti-inflammatory drugs; GI: Gastrointestinal Source: Reference no. [50] (Created with bioRender.com)
Figure 3
Figure 3. COX-1 inhibition induced stomach ulcer
COX: Cyclooxygenase Source: Reference no. [52] (Created with bioRender.com)
Figure 4
Figure 4. Mechanism of Action of Selective COX-2 inhibitors
COX: Cyclooxygenase Source: Reference no. [49] (Created with bioRender.com)
See this image and copyright information in PMC

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