[Ulcer prevention during anti-rheumatism therapy and in intensive medicine]

Gastrointestinal side effects are common to all nonsteroidal anti-inflammatory drugs (NSAID). Relevant to the patient are NSAID-induced dyspepsia and ulcer complications such as hemorrhage and perforation. The most important prophylactic means is repeated verification that the NSAID cannot be replaced by other measures, e.g. physical therapy or simple analgesics. If a NSAID is needed, it should be administered at the lowest effective dose. The present drugs used in preventing NSAID-induced ulcers and their complications are far from perfect. Major problems are adverse effects, high costs and insufficient efficacy in the prevention of ulcer complications. Thus, prophylactic antiulcer treatment is recommended in high-risk patients (as a primary prophylaxis) and in patients with previous ulcers (as a secondary prophylaxis). Similar arguments apply for prevention of ulcers in intensive-care patients. Patients at risk are critically ill, those with previous ulcers and in particular those with clotting disorders. Acid-reducing drugs are recommended for nonintubated patients, whereas sucralfate is preferred in patients on artificial ventilation because it is associated with a lower risk for nosocomial pneumonias.