[Update on gastrointestinal disorders associated with non-steroidal anti-inflammatory drugs]

The most recent studies presented at Digestive Disease Week 2008 on non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin have revealed the growing interest of investigators in the adverse effects of these drugs in the lower gastrointestinal (GI) tract. Some studies have shown that there is an increasing time trend of lower GI events and a decreasing time trend of upper GI events, and that the number of events associated with NSAIDs and/or aspirin located in the lower GI tract is approaching that of events located in the upper GI tract. Another area of growing research interest is the lack of appropriate gastroprotective therapy in patients with risk factors who received NSAIDS or aspirin. Several studies have investigated diverse aspects related to this area and most indicate that at least 50% of at-risk patients treated with NSAIDs (or aspirin) do not receive appropriate gastroprotective therapy. A personal analysis of the data suggests that the risk factor most frequently associated with lack of gastroprotection is age. Knowledge of risk factors and potential therapeutic measures are appropriate among senior residents, but is not subsequently translated into clinical practice. There is no easy solution to this problem since, even within the best conditions of a mega-trial (MEDAL trial) with free available gastroprotection and intervention during the trial, investigators could not reach reasonable gastroprotection rates in at-risk patients.One potential solution may come from combination pills (e.g., NSAID+proton pump inhibitor). One study showed that this combination was associated with fewer gastroduodenal lesions and could avoid the need to prescribe a gastroprotective agent and poor compliance.