[Corticosteroids, non-steroidal antirheumatic agents and the gastroduodenum]

A survey is given on the damaging effect of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs (NSAID) and corticosteroids on the gastroduodenal mucosa. Especially the results of blood loss studies and endoscopic investigations are reviewed in detail. Epidemiologic data strongly support an association between frequent and heavy intake of acetylsalicylic acid and gastric ulcer as well as gastrointestinal bleeding, whereas the association with duodenal ulcers is far less clearly established. Conclusive evidence proving the superiority of other NSAID in this regard is currently unavailable. Intensive ulcer therapy making use of H2 receptor antagonists often allows healing of small ulcers with a diameter less than 1 cm despite continued treatment with low dose corticosteroids or NSAID, whereas continuation of these drugs is associated with very poor healing in ulcers larger than this size. The danger of perforation has to be taken into consideration.