[Digestive complications of non-steroidal anti-inflammatory drugs]

Gastrointestinal complications associated with non-steroidal antiinflammatory drugs (NSAID) represent a frequent and expensive drug side effect. Recent publications have shown that the deleterious effect of NSAID is not limited to the gastroduodenal tract but can involve all segments of the gut. Epidemiological and clinical studies have demonstrated that 20-30% of patients under NSAID develop digestive symptoms. The relative risk of gastric ulceration is 5 times higher and this risk increases in older patients and in those with peptic ulcer history. Bleeding and perforated gastroduodenal ulcer occur more frequently in patients who received NSAID and mortality in these complications seems to be higher than in control groups. Curative and preventive treatments are effective in gastropathy associated with NSAID use, but the indications for prophylactic therapy need to be more precise in the future. The risk of oesophageal stenosis is increased in patients with gastroesophageal reflux taking NSAID. Diarrhea occurs in 5-30% of patients under NSAID. Intestinal perforation and hemorrhage are more frequent in anti-inflammatory drug takers than in control groups. Mild intestinal inflammation had been recently reported under NSAID, marked by ileal dysfunction, blood and protein loss and occasionally diaphragm-like small intestinal stricture. The pathogenesis of the inflammation is uncertain but seems to be related to an increase in mucosal permeability.