[Risk factors for upper digestive tract toxicity with NSAIDs (excluding Helicobacter pylori)]

AN ABSOLUTELY CERTAIN RISK: The non-selective non-steroidal anti-inflammatory drugs increase the risk of gastro-duodenal ulcer by 3 to 5 and the incidence of the symptomatic ulcers is 1 per 100 patients treated per year History before anti Cox-2. HISTORY BEFORE ANTI COX-2: The past history of ulcer increases the risk of relapse by 14 to 17 with non-steroidal anti-inflammatory drugs intake compared to patients without previous ulcer. The severity of the ulcers induced by non-steroidal anti-inflammatory drugs increases with the age. The ulcer risk is constant with the time and thus the prevalence increases with the duration of the treatment. The concomitant treatments by anticoagulants or aspirin increase the risk of digestive events by 2 to 3. A heavy consumption of alcohol is a factor of risk. Smoking is a minor factor. WITH ANTI COX-2: The incidence of the symptomatic ulcers is reduced by 60% among patients treated by Cox-2 specific antagonists. This reduction is identical that the patients have or not risk factors, and thus, the digestive complications are not suppressed when giving non-specific antagonists to the patients with risk factors. Their incidence cannot be negligible among patients cumulating at least two factors and treated by Cox-2 specific antagonists (from 5 to 16% per year). The benefit related to the

Cox-2 specific antagonists seems dramatically reduced by the concomitant aspirin intake. Among the patients who have a symptomatic ulcer induced by non-steroidal anti-inflammatory drugs, 81% did not have previous symptoms or risk factors.