[Prophylaxis and treatment of NSAID-related peptic ulceration: present status and prospects]

Non-steroidal anti-inflammatory drugs (NSAIDs) including low dose aspirin have been widely prescribed to elderly patients for treatment of OA and RA as well as for primary and secondary prevention of atherosclerotic thrombotic events. Nonetheless, NSAIDs' effectiveness in the treatment and prophylaxis of such diseases may be limited by the risk of upper gastrointestinal (GI) complications such as ulceration, hemorrhage and perforation. NSAID administration is associated with several-fold increase in the upper GI bleeding in the Japanese general population. Such GI risk is known to increase in patients with a prior history of peptic ulcer disease, advanced age, and concomitant use of corticosteroids, clopidogrel, or anticoagulants with NSAIDs or aspirin. Mechanisms of NSAID-induced GI injury are believed to be through local effects within the GI mucosa that cause topical injury and through systemic inhibition of cyclo-oxygenase (CO) resulting in depletion of mucosal protective prostaglandins. Herein, we focus on the strategy to manage NSAID- or aspirin-induced peptic ulcerations and their complications, based on the scientific evidence.