Nonsteroidal anti-inflammatory drug toxicity

The nonsteroidal anti-inflammatory drugs continue to be a mainstay of therapy for patients with chronic pain and inflammation. Because large numbers of these drugs are prescribed, even the most unusual adverse reactions are not uncommon. During the past year several reviews have appeared on the problems of nonsteroidal anti-inflammatory drug-induced gastroduodenal erosive disease. Several authors have also grappled with the possible uses of concomitant prophylactic therapy to decrease the possibility of an adverse event. Although several of these reviews are well-done meta-analyses of the available literature, others are more personal reflections on this difficult problem. Colitis and other small- and large-bowel adverse reactions to the nonsteroidal anti-inflammatory drugs have also been addressed this year. Unfortunately, there is not much new information on the interesting problem of small- and large-bowel diaphragm formation, which has been thought to be due to nonsteroidal anti-inflammatory drug therapy in certain patients. There are, however, intriguing data on the effects of indomethacin on rat intestine. There has also been useful work on further defining the renal effects of the nonsteroidal anti-inflammatory drugs. In addition, a syndrome of acute renal failure following binge drinking and therapy with nonsteroidal anti-inflammatory drugs is discussed. There have been significant articles that have improved our understanding of the various and at times confusing clinical problems of nonsteroidal anti-inflammatory drug-induced adverse reactions.