Epidemiology of gastrointestinal damage associated with nonsteroidal anti-inflammatory drugs.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with significant upper gastrointestinal (GI) toxicity, with a relative risk of approximately 3. This is supported by evidence drawn from randomised controlled trials [of aspirin (acetylsalicylic acid)], cohort studies and case-control studies. The risk is increased with higher doses of medication, shorter treatment duration and concomitant corticosteroid use. Elderly patients and those with a history of GI illness are also at increased risk. Ibuprofen may be associated with a lower, and piroxicam with a higher, risk of complications. There are only preliminary data regarding an association between NSAIDs and small and large intestinal complications. Therapeutic alternatives which may confer a lower risk of significant GI toxicity include enteric-coated preparations, non-acetylated salicylates, and NSAIDs taken in conjunction with misoprostol. Epidemiological data regarding these alternatives are sparse.
Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick.
L R
LR
Willett
J L
JL
Carson
B L
BL
Strom
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D000894:Anti-Inflammatory Agents, Non-Steroidal