[Current issues of NSAID-induced gastrointestinal ulcer in Japan]

Non-steroidal anti-inflammatory drug (NSAID) induced serious gastrointestinal ulcer and its complications are increasing in accord with expanding elderly population in Japan. In particular, bleeding ulcers associated with the use of low-dose aspirin are now the most frequent cause of emergent admission in many institutions. Despite of the evidence-based guidelines to prevent and treat NSAID ulcers, current Japanese health insurance policy does not allow appropriate re-imbursement for internationally acknowledged preventive and therapeutic measures. Recently, however, clinical trials to apply for the prevention of NSAID or low-dose aspirin induced ulcer have begun. In addition, a cyclooxygenase 2 specific inhibitor, celecoxib is introduced after a long process of approval. Taken together, we will be able to prevent and treat these iatrogenic ulcers based not on the dubious medications such as mucosal defense agents but on the drugs such as PPI with scientifically solid evidence.