The pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced mucosal injuries in stomach and small intestine

TLDR

NSAIDs are widely prescribed for arthritis, inflammation, and cardiovascular protection, yet they cause gastrointestinal complications that have traditionally been attributed to COX inhibition and prostaglandin deficiency, with recent clinical evidence indicating that small‑intestinal mucosal injury is more common than previously thought. This review examines the defense mechanisms of the stomach and the pathophysiology of NSAID‑induced injury to the stomach and small intestine. It emphasizes NSAID‑induced mitochondrial dysfunction as a key mechanism underlying mucosal injury.

Abstract

Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for arthritis, inflammation, and cardiovascular protection. However, they cause gastrointestinal complications. The pathophysiology of these complications has mostly been ascribed to non-steroidal anti-inflammatory drugs' action on the cyclooxygenase inhibition and the subsequent prostaglandin deficiency. However, recent clinical demonstrated the prevalence of non-steroidal anti-inflammatory drugs-induced small intestinal mucosal injury is more often than previously expected. In this review, we discuss the defense mechanisms of stomach, and the pathophysiology of non-steroidal anti-inflammatory drugs-induced injury of stomach and small intestine, especially focused on non-steroidal anti-inflammatory drugs' action on mitochondria.