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NSAIDs and the gastrointestinal tract
1Division of Gastroenterology, Digestive Health Center, Center for Health and Healing, 6th Floor, Oregon Health and Science University, Portland, OR 97239, USA.
Current Gastroenterology Reports
|September 22, 2009
Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal issues, especially in older adults or those with ulcers. Risk assessment for cardiovascular and GI health is crucial before NSAID use.
Area of Science:
- Gastroenterology and Internal Medicine
- Pharmacology and Therapeutics
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used but associated with significant gastrointestinal (GI) adverse events.
- Risk factors such as peptic ulcer history, advanced age, Helicobacter pylori infection, and concomitant aspirin use increase NSAID-related complications.
- NSAID enteropathy is an emerging concern, highlighting the need for comprehensive risk assessment.
Purpose of the Study:
- To review the gastrointestinal and cardiovascular risks associated with NSAID use.
- To discuss strategies for risk stratification and prevention of NSAID-induced GI complications.
- To evaluate the chemopreventive potential of NSAIDs and COX-2 inhibitors for colorectal cancer.
Main Methods:
- Literature review of studies on NSAID-related GI and cardiovascular risks.
- Analysis of risk factors and protective strategies, including H. pylori testing and gastroprotective agents.
- Evaluation of evidence for NSAIDs and COX-2 inhibitors in colorectal adenoma prevention.
Main Results:
- NSAID use increases GI risks, particularly in high-risk individuals.
- Combined NSAID and proton pump inhibitor (PPI) therapy is effective for gastroprotection, comparable to cyclooxygenase (COX)-2 inhibitors.
- For high-risk patients, a combination of COX-2 inhibitors and PPIs is recommended.
- Aspirin and COX-2 inhibitors show potential in reducing colon adenoma risk, with higher-dose, longer-duration aspirin being more effective.
Conclusions:
- Before initiating NSAIDs, comprehensive cardiovascular and GI risk stratification, including H. pylori testing, is essential.
- Appropriate gastroprotection strategies, such as NSAID-PPI combinations or COX-2 inhibitors with PPIs for high-risk individuals, should be employed.
- Careful patient selection is necessary when considering NSAIDs or COX-2 inhibitors for chemoprevention of colorectal cancer, balancing benefits against risks.
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