Aspirin peptic ulcer disease with

Previous peptic ulcer disease or upper gastrointestinal bleeding Cardiovascular disease and other comorbid conditions Multiple NSAID use (e.g., low-dose aspirin in conjunction with another NSAID)... 

Contraindications fc>r nonsalicylate NSAID therapy are the same as those for aspirin (see Box 7-I).The formation of a gastric ulcer or erosion that may bleed profusely is a serious potential problem with NSAIDs. Consequently, the nonsalicylate NSAIDs should be avoided or used with great caution in patients with active peptic ulcer disease. NSAIDs may increase the risk of GI complications even when used in conjunction with low-dose aspirin for cardioprotection. In addition, because of potential crosssensitivity to other NSAIDs, the nonsalicylate NSAIDs should not be given to patients in whom aspirin or other NSAIDs have caused symptoms of asthma, rhinitis, urticaria, angioedema, hypotension, bronchospasm, or of symptoms of hypersensitivity reactions. Opioids, tramadol, or acetaminophen may be suitable alternatives for patients with known or suspected susceptibility. 

Aspirin also places patients at risk for gastrointestinal bleeding, ulceration and perforation. Patients with a history of significant GI bleeding or peptic ulcer disease should not be prescribed aspirin. Patients who are already taking another type of NS AID should not take aspirin, as this increases the risk for upper GI bleeding even more. 

Peptic ulcer disease is one common illness that affects more than 6 million persons in the United States each year (Sandler et al. 2001) and is strongly linked wifii increased rate of cigarette smoking, alcohol intake, psychological stress, regular use of aspirin, and prolonged use of steroids. Infection with Helicobacter pylori also substantially increases the risk for peptic ulcer and its complications (Papatheodo-ridis et al. 2006). Essential oil of Cinnamomum zeylanicum also... 

Levy, M. (1974) Aspirin use in patients with major upper gastrointestinal bleeding and peptic ulcer disease. New Engl J. Med., 290,1158. 

The specific risks of salt and water retention in cardiac and renal disease have already been mentioned. The potential for ulcerogenic activity should be kept in mind if phenylbutazone is given to a patient with a history of peptic ulceration. Patients who are hypersensitive to other drugs (especially aspirin) should be carefully monitored when taking phenylbutazone. 

Do not give if there is a history of active peptic ulcer, other GI ulceration, chronic inflammation of the GI tract, GI bleeding disorders, or a history of hypersensitivity to aspirin and other NSAIDs. Use caution with patients who have kidney, liver, GI tract disease, or a history of fluid retention. 

Naproxen should be given with care to patients with asthma or bronchospasm, bleeding disorders, cardiovascular disease, peptic ulceration or a history of such ulceration, renal failure, and in those who are recieving coumarin anticoagulants. Patients who are sensitive to aspirin should generally not be given naproxen (5). 

Iron deficiency is commonly caused by insufficient dietary intake, excessive menstrual flow, multiple births, and gastrointestinal bleeding (occult or patent) due to medications (aspirin, steroids), hiatal hernia, peptic ulcers, gastritis associated with alcoholism, anemia of chronic disease, geophagia, and tumors. After these patients are carefully diagnosed, iron supplementation is administered using oral ferrous sulfate or by intravenous therapy with an iron-dextran complex (Imferon) [28,29]. 

The complications of acid peptic disease usually represent the sequelae of long-standing or chronic ulceration. Occasionally, such events may occur in an acute setting, but in such circumstances, the acute presentation often represents administration of a drug such as an NSAID, aspirin, or alcohol or exposure to the stress of trauma or major surgery. For the most part, bleeding and perforation are the most dramatic and the most common, with penetration and obstruction being less frequent and far less acute in their presentations. 

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