Coming to Terms with Nonsteroidal Anti-Inflammatory Drug Gastropathy

Abstract

Despite well known complications, oral nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most commonly prescribed medications in the US for musculoskeletal disorders such as osteoarthritis. Although there has been a recent focus on the cardiovascular and renal complications associated with these agents, NSAID gastropathy continues to be a particular concern in many patients, especially those at increased risk for serious adverse events, including the elderly. Complicating the diagnosis of NSAID gastropathy is its silent course, which, up to half of the time, is asymptomatic. Several strategies are currently employed by physicians to mitigate the risk of serious gastrointestinal events. These include either addition of a proton pump inhibitor to current nonselective NSAID therapy or the use of a cyclo-oxygenase-2—selective NSAID. Although these agents are effective at mitigating the overall risk of gastrointestinal adverse events, they fail to address NSAID-related cardiovascular and renal risks. Due to their reduced systemic absorption, topical NSAIDs may present a viable option for patients at increased risk for serious NSAID-related adverse events, including gastropathy.

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Table I

Notes

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    1 Roth and Bennett[3] were the first to distinguish ‘NSAID gastropathy’ from the global mid-century descriptor, ‘peptic ulcer disease’. The new nomenclature was directly inspired by a seminal literature report on unique NSAID-associated outcomes and host risk factors by Sun et al.[4]

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Acknowledgements

Technical editorial and medical writing assistance for the preparation of this manuscript was provided by Lauren Burawski, MA, Synchrony Medical LLC, West Chester, PA, USA. Funding for this support was provided by Mallinckrodt Inc., a Covidien company, Hazelwood, MO, USA.

Dr Roth is a current stakeholder in Transdel Pharmaceuticals and serves as a consultant and speaker for Covidien.

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Correspondence to Dr Sanford H. Roth MD.

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Roth, S.H. Coming to Terms with Nonsteroidal Anti-Inflammatory Drug Gastropathy. Drugs 72, 873–879 (2012). https://doi.org/10.2165/11633740-000000000-00000

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Keywords

  • Celecoxib
  • Peptic Ulcer Disease
  • Esomeprazole
  • Gastrointestinal Adverse Event
  • Boxed Warning