[Prevention and treatment of non-steroidal anti-inflammatory drug gastroenteropathy]

Nonsteroidal anti-inflammatory drug (NSAID) use is associated with both upper and lower gastrointestinal tract complications in 1 to 2% of patients using these drugs for 6 to 12 months. Gastroduodenal ulcers are also present in 30 to 50% of patients using NSAID. Dyspepsia is another frequent side effect that may or may not be associated with mucosal lesions. Main risk factors for NSAID-associated gastrointestinal complications include age > 60 years, ulcer history, high dose of NSAID, and concomitant use of anticoagulants, aspirin, or corticosteroids. Patients with risk factors that need NSAIDs should receive gastroprotection with proton pump inhibitors or misoprostol. Another gastrointestinal safer option is use of COX-2 selective NSAIDs (coxibs). Increased cardiovascular risk observed with long-term use of rofecoxib should be compared with other COX-2 selective and non-selective NSAID. In patients at very high risk, co-prescription of coxib with proton pump inhibitors has been recommended. In patients at risk, all these strategies are cost-effective.