[The region of orthopaedic surgery and rheumatology]

NSAIDs can cause serious GI complications such as peptic ulcers, perforations and bleeds and this risk increases with age, concurrent use of other medications, and probably with the duration of therapy. The recommendation that in patients with increased GI risk, either a COX-2 selective agent or a non-selective NSAID with co-prescription of a PPI or misoprostol for gastroprotection should be considered is supported by evidence from a systematic review of RCTs. There was no evidence for similar gastroprotection with H2 receptor antagonists and treatment with misoprostol is associated with an increase risk of diarrhea. The GI protection that is associated with the use of COX-2 selective agents is largely lost when low-dose aspirin is administered concurrently for CV prophylaxis.