Nonsteroid anti-inflammatory drug-induced gastroduodenal injury.
OBJECTIVE
This article reviews selected publications related to nonsteroid anti-inflammatory drug (NSAID)-induced gastroduodenal toxicity in recent years.


RESULTS
This article provides a comprehensive review of the latest evidence on the epidemiology of NSAID-induced gastroduodenal injury, recommendations on optimal gastroprotective regimens among patients in need of NSAID, risk stratification approach by considering gastrointestinal and cardiovascular risks, and negative interaction between proton pump inhibitors (PPIs) and clopidogrel.


CONCLUSIONS
Current evidence indicates that a PPI and a cyclooxygenase (COX)-2-selective NSAID provides the best gastric protection. In light of potential cardiovascular hazard of NSAIDs, physicians should select an NSAID according to individual patients' cardiovascular risk (i.e., naproxen vs. a nonnaproxen NSAID). The choice of gastroprotective therapy depends on the number and nature of gastrointestinal risk factors. PPI co-therapy is recommended in patients with high gastrointestinal risk on aspirin. Whether there is any clinically important interaction between PPIs and clopidogrel remains uncertain.
Lai
Larry H
LH
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
Chan
Francis K L
FK
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004347:Drug Interactions; D004378:Duodenal Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D013272:Stomach Diseases / Q000139:chemically induced* / Q000453:epidemiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin