[Nitric oxide and gastroduodenal damage caused by NSAIDs. Recent findings and clinical implications]

A significant role of nitric oxide (NO) is being acknowledged gastroduodenal mucosa defense mechanism(s) against the injurious effect of NSAIDs. Many of the NO effects recall those of prostaglandins, such as direct protection of epithelial cells, mucus release, repair of mucosal erosions or ulcerations, mast cell degranulation. Other co-effects prove to be the inhibition of neutrophil adherence to the vascular endothelium, also associated with an improved mucosal blood flow. NO may also act by scavenging oxygen-derivedfree radicals. Consequently, in order to reduce the NSAID gastrotoxicity has been proposed: a) the linking of a NO-releasing mojety to these agents (NSAID NO-donors); b) the use of amtolmetin guacyl (AMG), a drug which induces an increase in the gastric mucosa NO concentration via direct stimulation of the local endogenous synthesis of this gas. Clinical studies on the efficacy and tolerability have been carried out with AMG versus other NSAIDs (diclofenac, indomethacin, piroxicam, naproxen) in patients with osteoarthritis, rheumatoid arthritis and a number of post-traumatic arthropathies. As far as clinical symptoms are concerned AMG proves to be equally effective, but significantly better as far as gastroscopic lesions are concerned. NONSAIDs and AMG may play an important role among the long-term treatment of chronic inflammatory osteoarticular and rheumatic diseases.