Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) are the most frequently prescribed medication for chronic pain. Gastrointestinal complications from NSAID treatment are a major cause of morbidity and mortality. In the majority of patients, NSAID induced gastropathy is superficial and self-limiting. However, peptic ulcers develop in some patients and may lead to hemorrhage, perforation, or death. NSAIDs can cause gastrointestinal damage via topical injury of the mucosal barrier, systemic inhibition of prostaglandin synthesis or a combination of both. Risk factors for NSAID related complications include age >s 60 years, history of ulcer disease, concomitant corticosteroid or anticoagulant use, high dose therapy, and multiple NSAID use. Identifying high-risk patients is critical in order to minimize risk. Factors suggested to predict the safety of NSAIDs include selective COX-2 inhibition, absence of enterohepatic circulation, shorter half-life, and nonacidic pro-drug formulations. The COX-2 selective NSAIDs, celecoxib and rofecoxib, have been recently marketed and appear to have less GI toxicity. Long-term studies and post marketing surveillance are needed to confirm the safety of the COX-2 inhibitors. Proton pump inhibitors and misoprostol are the only agents proven beneficial in preventing GI adverse effects from NSAIDs.