Premium
Review article: nonsteroidal anti‐inflammatory drug‐associated gastrointestinal complications—guidelines for prevention and treatment [Note 1. The opinions and assertions contained herein are the private ...]
Author(s) -
Philip Schoenfeld,
Michael B. Kimmey,
James M. Scheiman,
David J. Bjorkman,
Loren Laine
Publication year - 1999
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1999.00617.x
Subject(s) - medicine , misoprostol , concomitant , gastroenterology , perforation , analgesic , drug , gastrointestinal bleeding , helicobacter pylori , gastritis , proton pump inhibitor , antiinflammatory drug , ingestion , gastrointestinal disease , pharmacotherapy , nonsteroidal , disease , anesthesia , pharmacology , pregnancy , genetics , materials science , abortion , metallurgy , punching , biology
Chronic ingestion of NSAIDs increases the risk for gastrointestinal complications, which range from dyspepsia to gastrointestinal bleeding, obstruction, and perforation. Among patients using NSAIDs, 0.1 to 2.0% per year suffer serious gastrointestinal complications. Patients who require analgesic therapy should be carefully assessed for the lowest possible dosage and shortest duration of NSAID use and for the potential of treatment with a non‐NSAID pain reliever. These patients should also be assessed for factors that increase their risk of gastrointestinal complications, including increased age, concomitant anticoagulant or corticosteroid use, and past history of NSAID‐associated gastrointestinal complications. The exact association between Helicobacter pylori infection and NSAID‐related ulcer disease is unclear, and the routine testing and treatment of all NSAID using patients for H. pylori infection is not recommended at this time. NSAID‐using patients who suffer from dyspepsia should have NSAIDs discontinued, the dosage changed, or be changed to a different class of NSAID. If NSAIDs cannot be discontinued, then an antisecretory agent should be initiated. Misoprostol prevents NSAID‐associated gastrointestinal complications. Proton pump inhibitors are the most effective at healing NSAID‐associated ulcers among patients who cannot discontinue NSAID therapy.