Gastrointestinal effects of NSAIDs. Difficulties in detection and management

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid are effective analgesic agents, but their use carries a significant potential for gastrointestinal side effects. Because many persons who have serious adverse effects from NSAIDs are asymptomatic, the decision to use these drugs must be tempered by an understanding of the side-effect profile and knowledge of who constitutes the high-risk population. Patients must be vigilantly monitored for signs and symptoms of reactions to the drugs, which should be discontinued when injury is suspected if at all possible. Diagnostic endoscopy should be the mainstay of further evaluation. Treatment of NSAID-induced gastrointestinal disease parallels that of non-NSAID-related reactions. This includes use of histamine2 receptor antagonists or proton pump inhibitors. Although NSAID-induced ulcers can heal while the drugs are continued, only omeprazole (Prilosec) has been shown to speed healing during NSAID use. For persons at highest risk, consideration must be given to prophylaxis against peptic ulcer disease. Misoprostol (Cytotec) has been clearly shown to offer the best protection against gastroduodenal ulceration.