Management of nonsteroidal anti-inflammatory drug-induced upper gastrointestinal bleeding and perforation

The risk of gastrointestinal bleeding or perforation during NSAID use is unquestionably increased. The need for emergency surgery as well as mortality is also increased in NSAID users as compared to nonusers. However, the magnitude of these risks still remains imprecise. There is a lot of controversy about the role of predisposing factors such as age, sex, past history of peptic ulcer disease, dyspepsia or infection by Helicobacter pylori. The bleeding risk seems to be related to NSAID dosage, but not to the duration of treatment. The location most at risk varies from one study to another with no significant difference between gastric and duodenal ulcers. Bleeding severity or mortality rate do not differ according to whether NSAIDs are used or not. General treatment principles of peptic ulcer bleeding as well as the role of endoscopic hemostasis, drug therapy or surgery are emphasized. The role of subsequent treatment after hemostasis and the rules for prophylaxis are also discussed.