[NSAID-induced ulcers--therapy and prevention]

There is a lot of epidemiological information to calculate the risk of developing gastroduodenal lesions during NSAID therapy on a reliable base in an individual patient. In treating NSAID ulcers one has to decide whether the antirheumatic treatment can be stopped or whether one has to continue. In the first mentioned condition all antiulcer drugs can be used safely like in chronic recurrent ulcer disease. However, when NSAID therapy has to be continued proton pump inhibitors are necessary in doubled therapeutic dosage. Prophylaxis should not be made in all patients on NSAIDs, but is only indicated with convincing cost-benefit ratio in high-risk patients. Whereas H2-blockers and proton pump inhibitors seem to protect mainly the duodenal mucosa oral prostaglandins (Misoprostol) are effective in the stomach as well.