Influence of Microbiota on NSAID Enteropathy: A Systematic Review of Current Knowledge and the Role of Probiotics
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REVIEW
Influence of Microbiota on NSAID Enteropathy: A Systematic Review of Current Knowledge and the Role of Probiotics Martina Rekatsina . Antonella Paladini . Maria Grazia Cifone . Francesca Lombardi . Joseph V. Pergolizzi . Giustino Varrassi
Received: March 11, 2020 Ó The Author(s) 2020
ABSTRACT Microbiota are increasingly studied, providing more precise information on their important role in physiologic processes. They also influence some pathologic processes, such as NSAIDinduced 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
Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.12063216. M. Rekatsina Anaesthetic Department, Moorfields Eye Hospital, London, UK A. Paladini M. G. Cifone F. Lombardi Department of Life, Health and Environmental Sciences, University of L’Aquila, Building Delta 6, 67100 L’Aquila, Italy J. V. Pergolizzi NEMA Research Group, Inc, Naples, FL, USA G. Varrassi (&) Paolo Procacci Foundation, Via Tacito 7, 00193 Rome, Italy e-mail: [email protected] G. Varrassi World Institute of Pain, Winston Salem, NC, USA
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; NSAIDs; Probiotics
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Key Summary Points NSAIDs may be responsible for gastroenteric side effects. Enteritis of this origin is frequently not diagnosed Microbiota have a crucial role in the homeostasis of the intestinal mucosa and its functionality This systematic review analyzes what has been studied on the interaction between the microbiota and possible NSAIDinduced enteritis Many studies, both experimental and on humans, have investigated the topic Currently, it is clear that the use of probiotics may help in preserving the functionality of the enteral mucosa in patients treated with NSAIDs It would be interesting to have clearer data on the the real relationship between the two. These should be based on clinical trials in humans aiming to clarify which kinds of probiotics are most useful to prevent or treat enteritis due to use of any NSAID, especially in patients using them chronically or in combination with lowdose aspirin for cardiovascular risk prevention
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