Prevention and treatment of nonsteroidal anti-inflammatory drug-induced gastropathy

Numerous human studies have shown that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with various gastroduodenal mucosal lesions, collectively referred to as NSAID gastropathy. NSAIDs should not be prescribed unless there is a clear-cut indication for them. Acetaminophen should be used initially to treat most patients with osteoarthritis. If NSAID therapy is required, the lowest possible NSAID dose should be prescribed, and the patient should be advised to reduce any modifiable risk factors. In patients who take NSAIDs occasionally and are at low risk for NSAID gastropathy, no specific prophylactic measures seem justified. In high-risk NSAID users, risk reduction and prophylaxis with misoprostol would be appropriate. If an ulcer is documented during NSAID treatment, NSAID therapy should be discontinued if possible. However, NSAID therapy need not be discontinued if it is therapeutically justifiable and if appropriate antiulcer treatment is initiated.