rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2011-58rsp-342Research ArticleСтатьиArticlesПРИМЕНЕНИЕ КАПСУЛЬНОЙ ЭНДОСКОПИИ ДЛЯ ОЦЕНКИ ВЛИЯНИЯ МЕЛОКСИКАМА И ДИКЛОФЕНАКА НА СЛИЗИСТУЮ ОБОЛОЧКУ ТОНКОЙ КИШКИ У ПАЦИЕНТОВ С АНКИЛОЗИРУЮЩИМ СПОНДИЛИТОМ: ПЕРВЫЙ ОПЫТUSE OF CAPSULE ENDOSCOPY TO EVALUATE THE EFFECTS OF MELOXICAM AND DICLOFENAC ON THE SMALL BOWEL MUCOSA IN PATIENTS WITH ANKYLOSING SPONDYLITIS: THE FIRST EXPERIENCEКаратеевАндрей ЕвгеньевичKarateevA Eaekarateev@yandex.ruБочковаА. Г.BochkovaA G-RumyantsevaO ARumyantsevaO A-TyukhovaE YuTyukhovaE Yu-НасоновЕвгений ЛьвовичNasonovE L-201115082011494№4 (2011)3135Copyright © Каратеев А.Е., Бочкова А.Г., Rumyantseva O.A., Tyukhova E.Y., Насонов Е.Л., 20112011Каратеев А.Е., Бочкова А.Г., Rumyantseva O.A., Tyukhova E.Y., Насонов Е.Л.Karateev A.E., Bochkova A.G., Rumyantseva O.A., Tyukhova E.Y., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/342

Поражение тонкой кишки (ТК) - нередкое осложнение, возникающее на фоне приема нестероидных противовоспалительных препаратов (НПВП). По данным клинических исследований, селективные ингибиторы циклооксигеназы (ЦОГ) 2 в этом плане более безопасны. Мелоксикам относится к селективным НПВП, однако его влияние на ТК изучено недостаточно. Цель - сравнить влияние мелоксикама 15 мг/сут и диклофенака 150 мг/сут на слизистую оболочку ТК. Материал и методы. Исследуемую группу составили 15 больных анкилозирующим спондилоартритом (АС): 6 мужчин и 9 женщин, средний возраст - 42,3±17,1 года; 7 из них не менее 1 мес принимали мелоксикам 15 мг/сут, а 8 - диклофенак 100-150 мг/сут. Состояние ТК оценивалось по данным капсульной эндоскопии (КЭ). Результаты. Эрозии ТК (от 3 до 20 и более) были выявлены у 11 больных - у 5 (71,3%) принимавших мелоксикам и 6 (75,0%) - диклофенак (р=0,82). Среднее число эрозий у получавших мелоксикам (6,2±4,7) было меньше, чем у тех, кто принимал диклофенак (9,4±7,3;р=0,13). У одной пациентки, получавшей диклофенак, по данным КЭ была заподозрена болезнь Крона, впоследствии подтвержденная при колоноскопии. Заключение. Мелоксикам демонстрировал меньшее негативное влияние на ТК в сравнении с диклофенаком, хотя это отличие было статистически недостоверно. Патология тонкой и толстой кишки часто возникает у больных АС и может быть связана не только с негативным действием лекарств, но и с коморбидными воспалительными заболеваниями кишечника. Требуются дальнейшие

Small bowel (SB) injury is a common complication from the use of nonsteroidal anti-inflammatory drugs (NSAIDs). According to clinical trials, selective cyclooxygenase-2 inhibitors are safer in this respect. Meloxicam belongs to selective NSAIDs; however, its effect on the SB has been inadequately investigated. Objective: to compare the effects of meloxicam 15 mg/day and diclofenac 150 mg/day on the SB mucosa. Subjects and methods. A study group comprised 15 patients, including 6 men and 9 women (mean age 42.3+17.1 years), with ankylosing spondylarthritis (AS); 7 of them took meloxicam 15 mg/day for at least one month and 8 had diclofenac 100-150 mg/day. The SB was evaluated from capsule endocopy (CE) readings. Results. SB erosions (n = 3 to 20 or more) were found in 11 patients: 5 (71.3%) and 6 (75.0%) subjects taking meloxicam and diclofenac, respectively (p = 0.82). The average amount of erosions in those receiving meloxicam (6.2+4.7) was less than in those having diclofenac (9.4+7.3; p = 0.13). One patient taking diclofenac was suspected of having Crohn's disease shown by CE and then confirmed by colonoscopy. Conclusion. Meloxicam has demonstrated a less negative effect than diclofenac on SB, although this difference was statistically insignificant. Small and bowel pathology frequently occurs in patients with AS and may be associated not only with the negative effect of the drugs, but also with comorbid inflammatory bowel diseases. There is a need for further studies of the distal gastrointestinal tract and for those of the effect of NSAIDs on the SB.

нестероидные противовоспалительные препаратыкапсульная эндоскопияэнтеропатияnonsteroidal anti-inflammatory drugscapsule endoscopyenteropathyReferences<div><p>Насонов Е.Л. Нестероидные противовоспалительные препараты (Перспективы применения в медицине). М.: Анко, 2000;142 с.</p><p>Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМА-ПРЕСС, 2009;167 с.</p><p>Каратеев А.Е., Насонова В.А. Энтеропатия, индуцированная нестероидными противовоспалительными препаратами. Тер арх 2003;5:74-8.</p><p>Allison M., Howatson A., Torrance C. et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drags. N Engl J Med 1992;327:749-54.</p><p>Davies N., Saleh J., Skjodt N. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci 2000; 3:137-55</p><p>Lang J., Price A., Levi A. et al. Diaphragm disease: the pathology of non-steroidal anti-inflammatory drug induced small intestinal strictures. J Clin Pathol 1988;41:516-26.</p><p>Adebayo D., Bjarnason I. Is non-steroidal anti-inflammaory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Postgrad Med J 2006; 82(965):186-91</p><p>Laine L., Curtis S.P., Cryer B. et al. Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Lancet 2007; 369:465-73.</p><p>Chan F., Lanas A., Scheiman J. et al. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 2010;376:173-9.</p><p>Delvaux M., Gay G. Capsule endoscopy: technique and indications. Best Pract Res Clin Gastroenterol 2008;22(5):813-37.</p><p>Qvigstad G., Hatlen-Rebhan P., Brenna E., Waldum H. Capsule endoscopy in clinical routine in patients with suspected disease of the small intestine: a 2-year prospective study. Scand J Gastroenterol 2006; 41(5):614-8.</p><p>Imaeda H., Ogata H., Iwao Y. et al. Expectation of video capsule endoscopy for diagnosis of NSAID induced enteropathy. Nippon Rinsho 2007;65(10):1896-901. '</p><p>Maiden L., Thjodleifsson B., Seigal A. et al. Long-term effects of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 selective agents on the small bowel: a cross-sectional capsule enteroscopy study. Clin Gastroenterol Hepatol 2007;5(9):1040-5.</p><p>Goldstein J., Eisen G., Lewis B. et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 2005;3:133-41.</p><p>Hawkey C., Ell C., Simon B. et al. Less small-bowel injury with lumiracoxib compared with naproxen plus omeprazole. Clin Gastroenterol Hepatol 2008;6(5):536-44.</p><p>Dougados M., Simon P., Braun J. et al. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis 2011;70(2):249-51.</p><p>Singh G., Lanes S., Triadafilopoulos G. Risk of serious upper gastrointestinal and cardiovascular tromboembolic complications with meloxicam. Am J Med 2004; 117:100-6.</p><p>Bernstein C., Blanchard J., Rawsthorne P., Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 2001;96(4):1116-22.</p><p>Larsen S., Bendtzen K., Nielsen O. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med 2010; 42(2):97-114.</p><p>M., Gueguen A., Nakache J. et al. Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology (Oxford) 1999;38(3):235-44.</p><p>Mielants H., Veys E., Cuvelier C., de Vos M. Ileocolonoscopic findings in seronegative spondylarthropathies. Br J Rheumatol 1988;27(Suppl. 2):95-105.</p><p>Mielants H., Veys E. Significance of intestinal inflammation in the pathogenesis of spondylarthropathies. Verh K Acad Geneeskd Belg 1996;58(2):93-116.</p><p>Grandbois L., Lomasney L., Demos T., Tehrani R. Radiologic case study. Seronegative spondyloarthropathy associated with Crohn's disease. Orthopedics 2005; 28(11):1296;1375-9.</p><p>Rudwaleit M., Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol 2006;20(3):451-71.</p><p>Turkcapar N., Toruner M., Soykan I. et al. The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int 2006;26(7):663-8.</p></div><br /><div><p>Насонов Е.Л. Нестероидные противовоспалительные препараты (Перспективы применения в медицине). М.: Анко, 2000;142 с.</p><p>Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМА-ПРЕСС, 2009;167 с.</p><p>Каратеев А.Е., Насонова В.А. Энтеропатия, индуцированная нестероидными противовоспалительными препаратами. Тер арх 2003;5:74-8.</p><p>Allison M., Howatson A., Torrance C. et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drags. N Engl J Med 1992;327:749-54.</p><p>Davies N., Saleh J., Skjodt N. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci 2000; 3:137-55</p><p>Lang J., Price A., Levi A. et al. Diaphragm disease: the pathology of non-steroidal anti-inflammatory drug induced small intestinal strictures. J Clin Pathol 1988;41:516-26.</p><p>Adebayo D., Bjarnason I. Is non-steroidal anti-inflammaory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Postgrad Med J 2006; 82(965):186-91</p><p>Laine L., Curtis S.P., Cryer B. et al. Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Lancet 2007; 369:465-73.</p><p>Chan F., Lanas A., Scheiman J. et al. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 2010;376:173-9.</p><p>Delvaux M., Gay G. Capsule endoscopy: technique and indications. Best Pract Res Clin Gastroenterol 2008;22(5):813-37.</p><p>Qvigstad G., Hatlen-Rebhan P., Brenna E., Waldum H. Capsule endoscopy in clinical routine in patients with suspected disease of the small intestine: a 2-year prospective study. Scand J Gastroenterol 2006; 41(5):614-8.</p><p>Imaeda H., Ogata H., Iwao Y. et al. Expectation of video capsule endoscopy for diagnosis of NSAID induced enteropathy. Nippon Rinsho 2007;65(10):1896-901. '</p><p>Maiden L., Thjodleifsson B., Seigal A. et al. Long-term effects of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 selective agents on the small bowel: a cross-sectional capsule enteroscopy study. Clin Gastroenterol Hepatol 2007;5(9):1040-5.</p><p>Goldstein J., Eisen G., Lewis B. et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 2005;3:133-41.</p><p>Hawkey C., Ell C., Simon B. et al. Less small-bowel injury with lumiracoxib compared with naproxen plus omeprazole. Clin Gastroenterol Hepatol 2008;6(5):536-44.</p><p>Dougados M., Simon P., Braun J. et al. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis 2011;70(2):249-51.</p><p>Singh G., Lanes S., Triadafilopoulos G. Risk of serious upper gastrointestinal and cardiovascular tromboembolic complications with meloxicam. Am J Med 2004; 117:100-6.</p><p>Bernstein C., Blanchard J., Rawsthorne P., Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 2001;96(4):1116-22.</p><p>Larsen S., Bendtzen K., Nielsen O. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med 2010; 42(2):97-114.</p><p>M., Gueguen A., Nakache J. et al. Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology (Oxford) 1999;38(3):235-44.</p><p>Mielants H., Veys E., Cuvelier C., de Vos M. Ileocolonoscopic findings in seronegative spondylarthropathies. Br J Rheumatol 1988;27(Suppl. 2):95-105.</p><p>Mielants H., Veys E. Significance of intestinal inflammation in the pathogenesis of spondylarthropathies. Verh K Acad Geneeskd Belg 1996;58(2):93-116.</p><p>Grandbois L., Lomasney L., Demos T., Tehrani R. Radiologic case study. Seronegative spondyloarthropathy associated with Crohn's disease. Orthopedics 2005; 28(11):1296;1375-9.</p><p>Rudwaleit M., Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol 2006;20(3):451-71.</p><p>Turkcapar N., Toruner M., Soykan I. et al. The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int 2006;26(7):663-8.</p></div><br />

The authors declare that there are no conflicts of interest present.