NSAID-enteropathy and intestinal microbes

It is ironic as the financial support for research into the gastrointestinal side effects of NSAIDs has declined with a noticeable decrease in the number of original research studies being published that the pathogenesis and pathophysiological effects of NSAIDs are now increasingly understood. Independent research workers have formulated a comprehensive framework for the gastrointestinal damage, largely based on “older” studies that the more forceful “opinion leaders” at the time ignored in their persistent, single minded attempt to keep the message simple, namely the misleading message that Cox-1 and Cox-2 inhibition accounts for all the side effects and therapeutic effects of NSAIDs, respectively. This view was largely market driven, simple and easily understood which is important for the uninitiated prescribers. It is, however, an important reminder that much of what is accepted in science is still personality driven and the facts are not widely voiced until the “opinion leaders” retire from the field. Big Pharma, their servants and collaborators highlighted the gastric side effects, at the exclusion of other gastrointestinal sites, because of the potential use of their drugs that could prevent and treat the gastro-duodenal side effects alone. Nevertheless, the adverse effects of NSAIDs were much more prevalent in the small bowel that the stomach (Bjarnason et al. 1993) and the pathogenesis much more interesting (Bjarnason et al. 2018). …