Ulcerogenic drugs and upper gastrointestinal bleeding

Aspirin and other NSAIDs are drugs for which the causal association with major gastrointestinal bleeding has not been adequately or conclusively demonstrated, although a certain degree of correlation is very likely. For aspirin ingestion in particular the increased risk is confined to patients taking the drug at heavy and regular dosages (less than 1% of users), and can be reduced further by the use of enteric-coated formulations. For non-aspirin NSAIDs, the relative risk of GI bleeding after repeated and prolonged exposure (in comparison to controls) has been quantified between 1.5 and 2.7, which is a small but significant figure, and it is increased by the age of the patients, by the duration of treatment and by the dose of drug. No consistent causal relationship can be found between major GI bleeding (or other major peptic ulcer complications) and steroids or other 'ulcerogenic' drugs. The therapy of drug-induced (or drug-associated) GI bleeding is probably not different from the usual treatment of upper GI haemorrhage. As far as the treatment of drug-associated gastroduodenal mucosal damage is concerned, it appears that with mucoprotective agents or H2 antagonists the healing rates of peptic ulcers is slower than observed in non-drug-associated disease. Prophylactic treatment with prostaglandins has only been proposed; and prophylactic treatment with H2 antagonists has been disappointing.