Is no NSAID a good NSAID? Approaches to NSAID-associated upper gastrointestinal disease.
Upper gastrointestinal disease induced by use of nonsteroidal anti-inflammatory drugs (NSAIDs) remains a major problem that affects a broad segment of the population, given the frequent use of these drugs by prescription and over the counter. The emergence of the cyclooxygenase (COX)-2 selective inhibitors (coxibs) has introduced a new option that may result in less upper gastrointestinal disease. Recent large studies have demonstrated this advantage, with the caveat that concurrent use of low-dose aspirin may mitigate this benefit. Unfortunately, the relatively high cost of the coxibs makes them not cost-effective unless confined to certain higher-risk populations. Finally, even newer versions of NSAIDs, such as nitric oxide (NO)-releasing aspirin and the COX-inhibiting NO donors, are potential alternatives to traditional NSAIDs with less upper gastrointestinal toxicity.
Chang
Stephen Y
SY
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1400, Chicago, IL 60611, USA.
Howden
Colin W
CW
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D016861:Cyclooxygenase Inhibitors / Q000191:economics / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007783:Lactones / Q000008:administration & dosage / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000139:chemically induced; D054328:Proton Pump Inhibitors; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D054328:Proton Pump Inhibitors; D013450:Sulfones; C116926:rofecoxib