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Non‐steroidal anti‐inflammatory drugs: who should receive prophylaxis?
Author(s) -
Hawkey C. J.
Publication year - 2004
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 - 10.1111/j.1365-2036.2004.02042.x
Subject(s) - medicine , helicobacter pylori , proton pump inhibitor , risk factor , incidence (geometry) , peptic ulcer , gastroenterology , drug , disease , cox 2 inhibitor , intensive care medicine , pharmacology , biochemistry , chemistry , physics , cyclooxygenase , optics , enzyme
Summary Non‐steroidal anti‐inflammatory drugs (NSAIDs) are the major recognized cause of iatrogenic disease, and may cause 100 000 deaths per annum through peptic ulcer complications. A number of risk factors can be identified that indicate patients at high risk. These patients can be managed by substitution of a COX‐2 inhibitor or by prophylaxis with a proton pump inhibitor (PPI). Because risk factors that render patients at high risk of ulcer complications also act in the absence of NSAID use, PPI prophylaxis (or Helicobacter pylori eradication where H. pylori is the risk factor) have much to offer and controlled studies show that the incidence of recurrent peptic ulcer bleeding can be reduced substantially by PPI co‐administration. Substitution of COX‐2 inhibitors also has much to offer, arguably most in those without risk factors (although regulatory authorities do not accept this argument). Recent data show that PPI and COX‐2 inhibitors can play complementary roles in the management of patients with moderate to severe dyspepsia and at high risk of ulcer complications.