[NSAID-induced ulcer and its complications]

The past two decades have seen a dramatic increase in the consumption of NSAIDs, despite their notorious association with serious gastrointestinal side effects. Of NSAID users, 20-50 per cent have an ulcer at some time; and 1-2 per cent of those on continuous NSAID treatment are hospitalised annually for ulcer complications, causing death in 10 per cent of cases, or total of 450 deaths annually in the Nordic countries. The risk factors are advanced age, a history of peptic ulcer or NSAID-induced gastrointestinal complications, high-dose NSAID treatment and concomitant cardiovascular disease. Ulcers can be healed with routine treatment, and Heliobacter pylori infection does not seem to be an aggravating factor. As ulcerous complications often appear without prodromal symptoms, prophylaxis should be considered for high-risk patients. Whereas histamine H2-antagonists prevent only duodenal ulcers, omeprazole seems to be effective against gastric and ulcers as well. The prostaglandin E1 analogue misoprostol protects against both gastric and duodenal ulcers, and reduces the risk of serious complications by 40 per cent. Newly developed NSAIDs, highly selective for cyclo-oxygenase 2 (COX-2), may exert potent anti-inflammatory effects without affecting COX-1 or the gastrointestinal mucosa.