Prophylaxis and treatment of NSAID-induced gastropathy

Because the gastrointestinal complications of nonsteroidal anti-inflammatory drug (NSAID) use may be responsible for over 10,000 deaths each year, clinicians should consider limiting use of these agents. Risk factors such as previous ulcer disease, high dosage, concomitant corticosteroid use, age greater than 60 years and use of more than one NSAID concomitantly should be reviewed. If a patient has two or more risk factors, prophylaxis with misoprostol is indicated. In low-risk patients, prophylaxis with misoprostol is not indicated because of the risk of gastrointestinal side effects and high cost. Although it is common clinical practice to treat NSAID-induced dyspepsia with prophylactic antiulcer therapy, clinical studies do not support this approach. If an ulcer develops during NSAID therapy, treatment with a histamine H2 antagonist should be started. Discontinuation of the NSAID is recommended but is not necessary for ulcer healing. It is recommended that, once the ulcer heals, the patient also take misoprostol if NSAID usage is continued.