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NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention.
Chin J Dig Dis. 2006; 7(3):127-33.CJ

Abstract

Gastrointestinal toxicity is a common adverse effect of traditional non-steroidal anti-inflammatory drugs (NSAIDs) and patients at risk should receive prevention therapies. Selective cyclooxygenase-2 (COX-2) inhibitors (coxibs) are safer to the gastrointestinal tract than traditional NSAIDs. Current prevention strategies in patients who need NSAIDs should also take into account the presence of cardiovascular risk factors, as coxibs and probably most traditional NSAIDs increase the incidence of serious cardiovascular events. Patients without risk factors should be treated with traditional NSAIDs, whereas patients at risk may receive cotherapy with a proton pump inhibitor (PPI) or misoprostol, or a coxib alone. However, patients with a previous bleeding ulcer should receive the combination of a coxib plus a PPI, and Helicobacter pylori should be tested for and treated if present. Coxib and NSAID therapy should be prescribed with caution in patients with increased cardiovascular risk and should be prescribed at the lowest possible dose and for the shortest period of time. These patients will probably be treated with low-dose aspirin or other antiplatelet agents, which puts them at increased risk of upper gastrointestinal complications. The risk of gastrointestinal toxicity with combined therapy of aspirin and coxib may be lower than that with traditional NSAIDs plus aspirin, but all these patients may benefit from PPI cotherapy. When the lower gastrointestinal tract is of concern, coxib instead of NSAID therapy should be considered. Coxib therapy has better gastrointestinal tolerance than traditional NSAIDs and PPI therapy is effective both in the treatment and prevention of NSAID-induced dyspepsia and should be considered in patients who develop dyspepsia during NSAID or coxib therapy.

Authors+Show Affiliations

Service of Gastroenterology, University Hospital of Zaragoza, Spain. alanas@unizar.esNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16808792

Citation

Lanas, Angel, and Angel Ferrandez. "NSAID-induced Gastrointestinal Damage: Current Clinical Management and Recommendations for Prevention." Chinese Journal of Digestive Diseases, vol. 7, no. 3, 2006, pp. 127-33.
Lanas A, Ferrandez A. NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention. Chin J Dig Dis. 2006;7(3):127-33.
Lanas, A., & Ferrandez, A. (2006). NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention. Chinese Journal of Digestive Diseases, 7(3), 127-33.
Lanas A, Ferrandez A. NSAID-induced Gastrointestinal Damage: Current Clinical Management and Recommendations for Prevention. Chin J Dig Dis. 2006;7(3):127-33. PubMed PMID: 16808792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention. AU - Lanas,Angel, AU - Ferrandez,Angel, PY - 2006/7/1/pubmed PY - 2006/12/9/medline PY - 2006/7/1/entrez SP - 127 EP - 33 JF - Chinese journal of digestive diseases JO - Chin J Dig Dis VL - 7 IS - 3 N2 - Gastrointestinal toxicity is a common adverse effect of traditional non-steroidal anti-inflammatory drugs (NSAIDs) and patients at risk should receive prevention therapies. Selective cyclooxygenase-2 (COX-2) inhibitors (coxibs) are safer to the gastrointestinal tract than traditional NSAIDs. Current prevention strategies in patients who need NSAIDs should also take into account the presence of cardiovascular risk factors, as coxibs and probably most traditional NSAIDs increase the incidence of serious cardiovascular events. Patients without risk factors should be treated with traditional NSAIDs, whereas patients at risk may receive cotherapy with a proton pump inhibitor (PPI) or misoprostol, or a coxib alone. However, patients with a previous bleeding ulcer should receive the combination of a coxib plus a PPI, and Helicobacter pylori should be tested for and treated if present. Coxib and NSAID therapy should be prescribed with caution in patients with increased cardiovascular risk and should be prescribed at the lowest possible dose and for the shortest period of time. These patients will probably be treated with low-dose aspirin or other antiplatelet agents, which puts them at increased risk of upper gastrointestinal complications. The risk of gastrointestinal toxicity with combined therapy of aspirin and coxib may be lower than that with traditional NSAIDs plus aspirin, but all these patients may benefit from PPI cotherapy. When the lower gastrointestinal tract is of concern, coxib instead of NSAID therapy should be considered. Coxib therapy has better gastrointestinal tolerance than traditional NSAIDs and PPI therapy is effective both in the treatment and prevention of NSAID-induced dyspepsia and should be considered in patients who develop dyspepsia during NSAID or coxib therapy. SN - 1443-9611 UR - https://www.unboundmedicine.com/medline/citation/16808792/NSAID_induced_gastrointestinal_damage:_current_clinical_management_and_recommendations_for_prevention_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1443-9611&date=2006&volume=7&issue=3&spage=127 DB - PRIME DP - Unbound Medicine ER -