In the USA, gastrointestinal complications caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are thought to cause approximately the same number of deaths each year as HIV. Here, Jason Grant presents his approach to minimising peptic ulceration, perforation and haemorrhage.
- A previous gastric ulcer doubles the risk of serious NSAID gastrotoxicity.
- In patients taking NSAIDs, most developing ulcers (but not all) are gastric.
- Older patients are at greater risk of an NSAID complication, especially beyond the age of 65 years.
- Concomitant oral corticosteroids, oral anticoagulants and cigarette smoking potentiate the toxic effects of NSAIDs.