Nonsteroidal anti-inflammatory drugs and the gut

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for analgesic, anti-inflammatory, and antithrombotic indications. Such use carries the risk of significant side effects on nontarget organs, especially the gut. Some of these effects may be serious, especially among the elderly, whose NSAID use is proportionately greatest. Upper gastrointestinal mucosal lesions range from trivial (petechiae and superficial erosions) to significant and potentially serious (chronic peptic ulcers, esophagitis, and small and large gut ulcers). The most serious side effects are perforation of peptic or gut ulcers and gastrointestinal bleeding, which NSAIDs may promote from both ulcerous and nonulcerous lesions of both the upper and lower gastrointestinal tract, ie, both acid-dependent and non-acid-dependent. Symptoms may be independent of observable lesions, and serious lesions may occur without previous symptoms. NSAIDs may also delay healing of peptic ulcers, even to the extent of intractability, and may cause recurrence after gastric surgery. Until we can separate the mechanisms whereby NSAIDs both cause injury and provide therapeutic benefits, the problem of side effects and their prevention or treatment remains unresolvable.