NSAID Gastropathy: An Update on Prevention

Correspondence to: Kam-Chuen Lai Abstract: Adverse reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are common. Upper gastrointestinal complications including ulcer bleeding, perforation and obstruction are the most serious complications that can result in substantial morbidity and mortality. Many NSAID-using patients present with complications without any preceding symptoms. Risk factors for NSAID-related gastrointestinal bleeding include advanced age, past history of ulcers and bleeding and concomitant use of anticoagulants or corticosteroids. The role of Helicobacter pylori infection in NSAID-related peptic ulcer is unclear. In high-risk patients who need to continue NSAIDs, prophylactic treatment against ulcer development is required. Options include concomitant use of anti-ulcer drugs, use of selective COX-2 inhibitors and eradication of H. pylori. This review summarizes the current status of these regimens in the prevention of NSAID-related peptic ulcer complications.