Some of the factors that may mediate or modify the gastrointestinal mucosal damage induced by non-steroidal anti-inflammatory drugs

Abstract

Numerous factors are involved in the gastrointestinal mucosal damage induced by non-steroidal anti-inflammatory drugs. The physico-chemical-acidic-property of the drugs is responsible partly for the rapid absorption, mucosal accumulation and barrier breaking effect, partly for the topical irritant action. The drugs decrease the defensive mechanisms of the stomach at different level, destroy the mucosal barrier, decrease the surface hydrophobicity, the mucosal blood flow, and inhibit the prostaglandin synthesis. Exogenous sulfhydryls and interleukin-1 inhibit the NSAID-induced mucosal damage, whether they are also involved in the ulcerogenic action has not been clearly determined. On the other hand, injurious factors are also stimulated; enhanced gastric acid secretion, increased pepsin activity, enhanced formation of free radicals and leukotrienes, as well as activation of leukocyte can also contribute to the mucosal lesions induced by NSAIDs. Prior Campylobacter pylori infection may make the mucosa more susceptible to NSAID-associated injury.