[What treatments can reduce the digestive complications of NSAIDs]

The aim is to compile a systematic review of literature data on the efficacy of GI protective agents in the prevention of upper GI lesions in a subject receiving long-term therapy with an NSAID.

We have selected solely experimental studies which have received a very high score in terms of methodology, whether in internal validity or clinical significance. Thus, 35 randomized, controlled studies have been reviewed.

Only one large long-term study examined the prevention of serious GI risks and misoprostol (800 micrograms/day) showed that it was capable of reducing the incidence of ulcer complications (perforations and bleeding) by 40% compared to placebo. No such data are available for PPI and H2-receptor antagonists (H2-RA). In summary Controlled endoscopic study results for patients with joint diseases receiving NSAID therapy for a period greater than 3 weeks demonstrated that misoprostol, PPI and H2-RA at double-dose are effective in reducing the risk both of gastric and duodenal ulcer. The standard doses of H2-RA are not effective in reducing the risk of gastric ulcer. There are very few studies comparing two gastro-intestinal protective agents and they seem to indicate that misoprostol and proton pump inhibitors are comparable in reducing the risk of gastric ulcer and are better than standard doses of H2-RA and that omeprazol is better than misoprostol at reducing the risk of duodenal ulcer. Tolerability of PPI and H2-RA are appreciably better than misoprostol which induces intestinal disorders.