[Advances in gastrointestinal disorders associated with non-steroidal antiinflammatory agents and aspirin]

Patients with gastrointestinal (GI) risk factors who require non-steroidal antiinflammatory drugs (NSAIDs) or aspirin must receive gastropreventive therapies. According to some recent surveys, the low prescription rates of these therapies reported some years ago are progressively improving in several European countries, which should be accompanied by a subsequent decrease in the frequency of hospitalizations due to complications of the upper GI tract, but not of those located in the lower GI tract. The most recent data confirm that celecoxib has a better GI safety profile both in the upper and lower GI tract than traditional NSAIDs. The NSAID most frequently involved in admissions for GI complications is aspirin and consequently at-risk patients receiving this drug should also receive antisecretory agents. Cotherapy consisting of proton pump inhibitors with double antiplatelet therapy is highly frequent in Spain, which has been associated with a low incidence of upper GI bleeding, and a growing incidence of patients with lower GI bleeding usually due to pre-existing vascular lesions. Another therapeutic tool that has been proposed to reduce the occurrence of upper GI bleeding in patients taking aspirin is Helicobacter pylori eradication therapy. The most recent data show that eradication of H. pylori infection in patients with a previous peptic ulcer bleeding episode who continue to take aspirin reduces the recurrence rate of this complication to levels observed in patients without a history of ulcer bleeding history who take aspirin for cardiovascular disease.