NSAID-induced ulcers

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Opinion statement

Nonselective nonsteroidal antiinflammatory drugs (NSAIDs) are used chronically by approximately 13 million to 15 million Americans annually for the treatment of painful and inflammatory conditions. While all these agents are quite effective in reducing inflammation and pain, they are also associated with UGI symptoms and mucosal injury. These include abdominal pain/dyspepsia in the absence of ulcer disease; symptomatic and asymptomatic gastric and duodenal ulcers; and clinically significant upper GI events such as bleeding, gastric outlet obstruction, and perforation.

The clinically relevant treatments related to NSAID-associated symptoms and mucosal injury fall into three major categories: symptomatic treatment of dyspepsia while using NSAIDs; treatment of acute endoscopically proven ulcers and ulcer complications in those using these medications; and prevention (prophylaxis) of ulcer and ulcer complications in patients at high risk for ulcer complications.

The new COX-2 selective inhibitors are likely to be associated with different short- and long-term safety profiles as compared to traditional NSAIDs; the literature and post-marketing data regarding these agents (celecoxib, rofecoxib) are evolving. As such, this article primarily focuses on the approach to patients using traditional, nonselective, nonsteroidal agents.