An evidence-based approach to the gastrointestinal safety profile of COX-2-selective anti-inflammatories

Evidence-based medicine (EBM) provides frameworks for the systematic review of study methodology and results. Thus, EBM frameworks facilitate assessing a study's ability to produce unbiased and accurate results and applying the results to the management of individual patients. Using EBM frameworks, published literature about risk factors for serious NSAID-associated gastrointestinal (GI) disorders, GI safety of COX-2 selective NSAIDs, and GI safety of co-therapy of proton pump inhibitors and NSAIDs are reviewed. This article concludes with evidence-based recommendations concerning which patients are at high risk for serious NSAID-associated GI disorders and which therapies are most effective in reducing serious NSAID-associated GI disorders.