Prevalence of NSAID-induced gastrointestinal morbidity and mortality

Nonsteroidal antiinflammatory drugs (NSAID) are prescribed to tens of millions of patients worldwide, usually for the treatment of rheumatic symptoms. Rheumatologists consider them to be safe and effective drugs, whereas gastroenterologists have increasing concern regarding their gut toxicity. Although dyspepsia may be overcome by a variety of methods, major gut hemorrhage and perforation often occur in the absence of symptoms. It has been estimated that as many as one third of such events in people over age 60 years may be attributable to NSAID. We need, therefore, to devise strategies to cope with this problem. The goals of such strategies must include minimizing inappropriate NSAID prescribing and identifying particularly vulnerable patients among those who need such drugs so that prophylactic coprescription can be effectively and economically targeted.