Recent Advances in NSAIDs-Induced Enteropathy Therapeutics: New Options, New Challenges

Table 1

Proposed pathophysiologic mechanism and protection of NSAID-induced small intestinal injuries.

Cause	Protection	Advantages	Weak points
Cyclooxygenase inhibition	COX-II inhibitor	Protection of upper and lower GI complications contrary to PPI + nonselective NSAID	No beneficial effect on user of selective COX-2 inhibitors for over 3 months
Decreased prostaglandin synthesis	Prostaglandins	Preventive effect on clinical studies using capsule endoscopies	Lower compliance due to side effects (diarrhea, abdominal pain, dyspepsia, etc.)
Gram-negative bacteria	Antimicrobials	Strong experimental studies high light that Gram-negative bacteria play an important role in NSAID enteropathy	No well-designed clinical studies
Bile	Phosphatidylcholine-NSAID	Cytotoxic action of NSAID in combination with bile acids in preclinical studies	No well-designed; clinical studies
Dysbiosis	Probiotics	Positive results on preclinical and clinical studies	Optimal dose of each; strains is not determined

COX: cyclooxygenase.