Sitemap

NSAIDs and the Gastrointestinal Tract

Patients who take standard non-steroidal anti-inflammatory drugs (NSAIDs) may develop serious gastrointestinal (GI) side effects in both the upper and lower GI tract.

While the newer classes of NSAIDs (coxibs) have been evaluated in endoscopic ulcer studies and clinical outcome trials, and shown to significantly reduce the risk of upper GI ulcer and complications, they do not eliminate GI complications in at-risk patients.

Low-dose aspirin, widely used for cardioprotection, is also not free from GI adverse effects. When low-dose aspirin is taken in combination with an NSAID or a coxib the risk of developing a serious GI event increases significantly. Current guidance on NSAID use suggests a number of factors put patients at higher risk of an NSAID-induced GI adverse event. These include age over 65 years, previous history, co-morbidity, prolonged use, high doses, and other drugs, like aspirin or anticoagulants.

If people have at least one of these risk factors, and have to take an NSAID for more than a short period, it is recommended they be prescribed some form of gastroprotection- principally a proton pump inhibitor (PPI), misoprostol or higher dose histamine antagonist (H2RA). PPIs are the most effective in the prevention of upper GI events in endoscopy trials and in a few, small, outcome trials in patients at risk. Current prevention strategies with an NSAID+PPI, misoprostol or a coxib must be considered in the individual patient with GI and cardiovascular (CV) risk factors.

A PPI+coxib is indicated in those at highest risk (e.g. previous ulcer bleeding). PPI therapy must be considered for the treatment and prevention of NSAID-induced dyspepsia. Especially in patients with a previous duodenal ulcer, testing and treating for H. pylori may be advisable.