Practical management of NSAID gastropathy in rheumatic patients

Gastropathy is a relatively common complication of treatment with a non-steroidal anti-inflammatory drug (NSAID). Pre-treatment evaluation of patients is therefore of key importance. Contraindications for NSAID treatment may include a history of gastroduodenal ulcer or of NSAID gastropathy, simultaneous administration of anticoagulant therapy and the existence of risk factors for ulcer disease. After NSAID treatment has begun, clinical follow-up is highly desirable. NSAID gastropathy can be asymptomatic despite the presence of a broad spectrum of gastrointestinal mucosal changes on endoscopy, but in the majority of cases there are clinical symptoms. Management of gastropathy may involve withdrawal of NSAID treatment, replacement therapy with a different type of drug or post hoc treatment of the gastropathy with anti-ulcer compounds.