NSAIDs and Gl mucosal integrity: what holds up?

摘要

The debate over nonsteroidal anti-inflammatory drugs (NSAIDs) and the level of gastrointestinal (Gl) side effects is not new, but has recently been intensified by the finding that horses with small intestinal strangulating obstruction treated with flunixin meglumine have delayed recovery of mucosal integrity. Although this would seem to be a logical extension of what we already know about NSAIDs and Gl function, it has taken the equine community somewhat by surprise because of the well-known association between colic and administration of flunixin meglumine. Importantly, flunixin is simply representative of a dass of drugs that inhibit cyclooxygenase (COX), also including phenylbutazone. However, flunixin has been repeatedly tested because of its frequent use in colic patients. To date, there have been preclinical trials examining the effects of NSAIDs on strangulated bowel, and at least one clinical trial with the same goal. The question 'what holds up' indicates an appraisal of the evidence is needed, so that sensible recommendations can be made.