medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-398medsovet-9465Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESФармакологическая гастропротекция: показания, возможности и рискиPharmacological gastroprotection: Indications, possibilities and riskshttps://orcid.org/0000-0002-7163-7119СереброваС. Ю.SerebrovaS. Yu.

Сереброва Светлана Юрьевна - д.м.н., ведущий научный сотрудник, НЦЭСМП; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

127051, Москва, Петровский бульвар, д. 8, стр. 2; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Svetlana Yu. Serebrova - Dr. Sci. (Med.), Chief Scientific Researcher, Scientific Centre for Expert Evaluation of Medicinal Products; Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

serebrova@expmed.ruhttps://orcid.org/0000-0001-7024-5546ПрокофьевА. Б.ProkofievA. B.

Прокофьев Алексей Борисович - д.м.н., профессор, начальник Научного отдела клинической фармакологии, НЦЭСМП; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

127051, Москва, Петровский бульвар, д. 8, стр. 2; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Alexey B. Prokofiev - Dr. Sci. (Med.), Professor, Head of the Scientific Department of Clinical Pharmacology, Scientific Centre for Expert Evaluation of Medicinal Products; Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

prokofiev@expmed.ruЕсаковаЕ. Ю.EsakovaE. Yu.

Есакова Елена Юрьевна - к.фарм.н., ведущий аналитик Научного отдела клинической фармакологии, НЦЭСМП; ассистент кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

127051, Москва, Петровский бульвар, д. 8, стр. 2; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Elena Yu. Esakova - Cand. Sci. (Pharm.), Leading Analyst of the Scientific Department of Clinical Pharmacology, Scientific Centre for Expert Evaluation of Medicinal Products; Assistant Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

demchenkova@expmed.ruhttps://orcid.org/0000-0002-9198-8661ЖуравлеваМ. В.ZhuravlevaM. V.

Журавлева Марина Владимировна - д.м.н., заместитель начальника Научного отдела клинической фармакологии, НЦЭСМП; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

127051, Москва, Петровский бульвар, д. 8, стр. 2; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Marina V. Zhuravleva - Dr. Sci. (Med.), Deputy Head of the Scientific Department of Clinical Pharmacology, Scientific Centre for Expert Evaluation of Medicinal Products; Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051; 8, Bldg. 2,Trubetskaya St., Moscow, 119991

zhuravleva@expmed.ruhttps://orcid.org/0000-0003-2385-7114ЕременкоН. Н.EremenkoN. N.

Еременко Наталья Николаевна - к.м.н., главный эксперт управления №1 по эффективности и безопасности лекарственных средств Центра экспертизы и контроля готовых лекарственных средств, НЦЭСМП; доцент кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

127051, Москва, Петровский бульвар, д. 8, стр. 2; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Natalia N. Eremenko - Cand. Sci. (Med.), Associate Professor, Chief Expert of the Administration No. 1 on the Effectiveness and Safety of Medicines, Scientific Centre for Expert Evaluation of Medicinal Products; Associate Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

eremenko@expmed.ruhttps://orcid.org/0000-0003-0802-4229КазаковР. Е.KazakovR. E.

Казаков Руслан Евгеньевич - к.б.н., ведущий научный сотрудник Научного отдела клинической фармакологии.

127051, Москва, Петровский бульвар, д. 8, стр. 2

Ruslan E. Kazakov - Cand. Sci. (Biol.), Chief Scientific Researcher, Scientific Centre for Expert Evaluation of Medicinal Products.

8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051

kazakov@expmed.ruНаучный центр экспертизы средств медицинского применения; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияScientific Centre for Expert Evaluation of Medicinal Products; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationНаучный центр экспертизы средств медицинского примененияРоссияScientific Centre for Expert Evaluation of Medicinal ProductsRussian Federation2025171020250157484Copyright © Сереброва С.Ю., Прокофьев А.Б., Есакова Е.Ю., Журавлева М.В., Еременко Н.Н., Казаков Р.Е., 20252025Сереброва С.Ю., Прокофьев А.Б., Есакова Е.Ю., Журавлева М.В., Еременко Н.Н., Казаков Р.Е.Serebrova S.Y., Prokofiev A.B., Esakova E.Y., Zhuravleva M.V., Eremenko N.N., Kazakov R.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9465

Статья представляет собой аналитический обзор концепции фармакологической гастропротекции. Авторы подчеркивают, что целостность слизистой оболочки желудка поддерживается за счет сложного баланса между факторами агрессии (соляная кислота, пепсин, НПВП, H. pylori) и защиты (слизь, бикарбонаты, простагландины, адекватная микроциркуляция, регенерация слизистой оболочки). Перечислены основные механизмы повреждения слизистой оболочки желудка и приведена классификация факторов защиты. Рассмотрены термины «цитопротекция» и «гастропротекция». Обосновано, что истинная гастропротекция определяется как фармакологическое усиление именно защитных свойств слизистой, а не подавление кислотной агрессии. В связи с этим ингибиторы протонной помпы (ИПП), остающиеся золотым стандартом для профилактики опасных осложнений (кровотечений, перфораций), не относятся к истинным гастропротекторам, поскольку действуют на фактор агрессии. Приведены критерии оценки риска желудочно-кишечного кровотечения и подход к назначению гастропротекторов. К истинным препаратам с доказанными гастропротективными свойствами авторы относят препараты висмута, мизопростол и ребамипид. Однако каждый из них имеет серьезные ограничения: риск кумуляции висмута при длительном приеме, выраженные побочные эффекты мизопростола (диарея, абортивное действие) и недостаточно мощную доказательную базу у ребамипида для широкого применения. Ключевой проблемой клинической практики является низкая частота применения гастропротекции даже среди пациентов высокого риска (пожилой возраст, прием антикоагулянтов и НПВП, язвенный анамнез), которым она показана в первую очередь. Основной вывод работы заключается в том, что классическая гастропротекция уступила место антисекреторной терапии не из-за неэффективности, а из-за простоты, предсказуемости и мощной доказательной базы ИПП в предотвращении жизнеугрожающих осложнений. Смещение парадигмы потребует создания нового препарата с неоспоримыми преимуществами перед существующей стандартной терапией.

The article is an analytical review of the concept of pharmacological gastroprotection. The authors emphasize that the integrity of the gastric mucosa is maintained due to a complex balance between the factors of aggression (hydrochloric acid, pepsin, NSAIDs, H. pylori) and protection (mucus, bicarbonates, prostaglandins, adequate microcirculation, mucosal regeneration). The main mechanisms of damage to the gastric mucosa are listed and a classification of protective factors is given. The terms “cytoprotection” and “gastroprotection” are considered. It is substantiated that true gastroprotection is defined as a pharmacological enhancement of the protective properties of the mucosa, and not the suppression of acid aggression. In this regard, proton pump inhibitors (PPIs), which remain the “gold standard” for the prevention of dangerous complications (bleeding, perforation), do not belong to true gastroprotectors, since they act on the aggression factor. The criteria for assessing the risk of gastrointestinal bleeding and the approach to prescribing gastroprotectors are presented. The authors classify bismuth preparations, misoprostol and rebamipide as true drugs with proven gastroprotective properties. However, each of them has serious limitations: the risk of bismuth accumulation with long-term use, pronounced side effects of misoprostol (diarrhea, abortive effect) and an insufficiently strong evidence base for rebamipide for widespread use. The key problem of clinical practice is the low frequency of gastroprotection use even among high-risk patients (elderly age, taking anticoagulants and NSAIDs, ulcer history), for whom it is indicated first and foremost. The main conclusion of the work is that classical gastroprotection has given way to antisecretory therapy not because of inefficiency, but because of the simplicity, predictability and strong evidence base of PPIs in preventing life-threatening complications. A paradigm shift will require the development of a new drug with clear advantages over existing standard therapy.

цитопротекцияфакторы агрессиифакторы защитыингибиторы протонной помпыпрепараты висмутаНПВП-гастропатияжелудочно-кишечное кровотечениеgastroprotectioncytoprotectionaggression factorsprotective factorsproton pump inhibitorsbismuth preparationsNSAID-gastropathygastrointestinal bleedingРабота выполнена в рамках государственного задания ФГБУ «НЦЭСМП» Минздрава России №056-00026-24-00 на проведение прикладных научных исследований (номер государственного учета НИР 124022200076-2).The work was carried out within the framework of state assignment No. 056-00026-24-00 of the Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of Russia to conduct applied scientific research (state R&D registration No. 124022200076-2).ReferencesКолотилова МЛ, Иванов ЛН. Нейрогенно-генетическая теория этиологии и патогенеза язвенной болезни. 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The authors declare that there are no conflicts of interest present.