Risks of anti-inflammatory drug-associated damage

Non-steroidal anti-inflammatory drug toxicity to the upper gastrointestinal tract differs consistently and strongly between the individual agents. Exact measures of the difference are not yet available because meta-analyses combining individual data sets from a sufficiently large number of subjects and incorporating dosage information are not available. The importance of obtaining such information is emphasised by simple modelling based upon expected usage patterns and disease risks. The adverse effects of the non-steroidal anti-inflammatory drugs (NSAIDs) are, in terms of general population impact, the most common and important of all adverse effects of pharmaceuticals in any group. This is because they are widely used, and the adverse effects are common. Amongst these adverse effects, gastrointestinal problems, manifested by peptic ulceration and its complications, are by far the most frequent. Approaches to prevention can be of three general types. The first is the characterisation and mitigation of the circumstances under which the effects occur, the second the use of preventative treatments, and the third the introduction of selective agents by which therapeutic properties are retained and adverse effects minimised. This commentary concentrates on characterising the extent of risks. However, a good understanding will not be achieved without knowledge of the general epidemiology of peptic ulceration.