Non-steroidal anti-inflammatory drugs in patients with peptic ulcer disease: rarely justified in terms of cost or patient benefit.

Although salicylate and non-aspirin, non-steroidal anti-inflammatory drugs cause acute injury to the gastroduodenal mucosa,`~their role during long term treatment in predisposing to peptic ulcer disease and clinically important complications remains uncertain.4'" Common criticisms of existing studies include inadequate design,' investigating young volunteers rather than older patients, examining acute and not chronic injury, and focusing attention on aspirin.-" Interpretation is particularly clouded by the prevalence of unsuspected (clinically irrelevant?) gastroduodenal lesions observed endoscopically in patients who take non-steroidal anti-inflammatory drugs, irrespective of their rheumatic condition."' Well designed case-control studies have nevertheless associated non-steroidal anti-inflammatory drugs with gastroduodenal (and ileal and colonic) bleeding and perforation,'1-2l though ranking of toxicity among such drugs has proved problematic.` Such difficulties, with the need to distinguish clearly individual and population risks, have been extensively reviewed. '-" Against this background, however, it is apparent that nonsteroidal anti-inflammatory drugs can adversely affect the gut, elderly women being particularly at risk of significant complications.1'' While awaiting results of more definitive studies what is the advice to prescribing doctors?