Epidemiology and economics of NSAID-induced gastropathy

Nonsteroidal anti-inflammatory drug (NSAID) use and gastrointestinal (GI) injury and symptoms are associated in clinical practice, but the importance of this injury is debatable. Most rheumatologists and general practitioners view NSAIDs as extremely valuable and generally well-tolerated first-line agents in the treatment of arthritis and musculoskeletal disorders. Generally, gastroenterologists and surgeons, on the other hand, insist that NSAIDs are dangerous and potentially lethal irritants to the GI mucosa. More frequent NSAID-induced gastropathy may be related to general epidemiological trends in NSAID-using populations: longer life expectancy, multiple risk co-factors for peptic ulcer disease (ie, smoking, alcohol, diet, comedication), and the increased availability of endoscopic examinations. Based on endoscopic studies, the prevalence of NSAID-induced adverse GI events has been documented in published reports. The frequency of bleeding is related to dose and duration of NSAID therapy. Overall, the prevalence of ulcer complications is higher in patients who consume NSAIDs. Cost-benefit analyses indicate that preventing potential GI damage with agents such as misoprostol may reduce the expense of treating the GI side effects associated with NSAID therapy.