Surgery in the management of the gastric side-effects of NSAIDs

It is now accepted that the administration of non-steroidal anti-inflammatory drugs (NSAIDs) can result in peptic ulceration. Not infrequently, the first presentation of the ulcer is as a life-threatening complication such as a perforation or gastrointestinal bleed. Surgeons often become involved in management when one of these complications occurs. This paper discusses the ways in which NSAID-induced peptic ulceration may present to the surgeon and the special features that distinguish patients with NSAID-induced ulcers from the remainder of patients with peptic ulcer disease. It is pointed out how little has been written on the surgical management of this group of patients. The importance of the overall assessment of these patients, with the correction of nutritional deficiencies and the use of appropriate prophylactic therapeutic measures in their surgical management, is stressed. The criteria for determining what surgical procedure is used and results are described.