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Медицинский Совет

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НПВП-повреждения желудочно-кишечного тракта: новые возможности профилактики гастро- и энтеропатий

https://doi.org/10.21518/2079-701X-2019-21-166-174

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Аннотация

Нестероидные противовоспалительные препараты – одни из наиболее часто назначаемых лекарственных средств в клинической практике врачей различных специальностей для лечения воспалительного и болевого синдромов. Популярность данной фармакологической группы возрастает благодаря безрецептурному отпуску, но при этом увеличивается значимость вопросов вероятности, профилактики и лечения тяжелых нежелательных лекарственных реакций при контролируемом и бесконтрольном со стороны медицинского персонала применении. Данный обзор посвящен проблеме повреждений желудочно-кишечного тракта, вызванных приемом нестероидных противовоспалительных средств, а также существующим на сегодняшний день возможностям предотвращения и коррекции этих повреждений. Значительные надежды возлагаются на препараты, способные повышать продукцию простагландинов и слизи в органах пищеварительного тракта, а также оказывать противовоспалительное действие в целом. Особого внимания заслуживает препарат ребамипид, обладающий рядом плейотропных эффектов, в числе которых стимуляция образования простагландинов и гликопротеинов в слизистых оболочках, ингибирование синтеза продуктов окислительного стресса, воспалительных цитокинов и хемокинов эпителиальными клетками желудочно-кишечного тракта. Эффективность профилактического применения ребамипида рассмотрена в сравнительном аспекте с иными стратегиями применения лекарственных препаратов для предотвращения развития язв желудка, двенадцатиперстной кишки и дистальных отделов тонкого кишечника: описаны механизмы профилактического действия и его дискуссионные аспекты для ингибиторов протонной помпы, блокаторов Н2-гистаминовых рецепторов, мизопростола. Клиническая эффективность ребамипида проиллюстрирована клиническим примером. Дополнительным преимуществом ребамипида является отсутствие влияния на активность ферментов системы цитохрома P450, что сводит к минимуму риски развития межлекарственных взаимодействий и изменений биодоступности, биотрансформации и выведения самого препарата при его курсовом применении.

Об авторах

В. Н. Дроздов
Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)
Россия

Дроздов Владимир Николаевич, д.м.н., профессор, профессор кафедры клинической фармакологии и пропедевтики внутренних болезней

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2



Ю. В. Мещеряков
Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)
Россия

Мещеряков Юрий Владимирович, аспирант кафедры клинической фармакологии и пропедевтики внутренних болезней

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2



С. Ю. Сереброва
Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Научный центр экспертизы средств медицинского применения
Россия

Сереброва Светлана Юрьевна, д.м.н., главный научный сотрудник Центра клинической фармакологии; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

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



Е. В. Ших
Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)
Россия

Ших Евгения Валерьевна, д.м.н., профессор, заведующая кафедрой клинической фармакологии и пропедевтики внутренних болезней

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2



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Для цитирования:


Дроздов В.Н., Мещеряков Ю.В., Сереброва С.Ю., Ших Е.В. НПВП-повреждения желудочно-кишечного тракта: новые возможности профилактики гастро- и энтеропатий. Медицинский Совет. 2019;(21):166-174. https://doi.org/10.21518/2079-701X-2019-21-166-174

For citation:


Drozdov V.N., Meshcheryakov Y.V., Serebrova S.Y., Shikh E.V. NSAID-induced damage to the gastrointestinal tract: new opportunities for the prevention of gastro- and enteropathies. Meditsinskiy sovet = Medical Council. 2019;(21):166-174. (In Russ.) https://doi.org/10.21518/2079-701X-2019-21-166-174

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ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)