Gastropathy NSAID

Indomethacin was used traditionally, but its relative cyclooxygenase-1 (COX-1) selectivity theoretically increases its gastropathy risk. Thus other generic NSAIDs may be preferred. Adverse effects of NSAIDs include gastropathy (primarily peptic ulcers), renal dysfunction, and fluid retention. NSAIDs generally should be avoided in patients at risk for peptic ulcers, those taking warfarin, and those with renal insufficiency or uncontrolled hypertension or heart failure. 

Significant mortality is associated with NSAID gastropathy. G. Singh and G. Triadafilopoulos, Epidemiology of NSAID induced gastrointestinal complications, Journal of Rheumatology, 1999, 26, 56,18-24, by permission of Oxford University Press. 

Becker JC, Domschke W, Pohle T. Current approaches to prevent NSAID-induced gastropathy—COX selectivity and beyond. Br J Clin Pharmacol. 2004 58 587-600. 

One of the major problems with use of NSAIDs in elderly patients, especially women, is the increased incidence of gastric mucosal damage (NSAID gastropathy). This condition can lead to significant GI bleeding and... 

Roth SH. New understandings of NSAID gastropathy. Scand J Rheumatol Suppl 1989 78 24-9. 

NSAID gastropathy is the term proposed by Roth and Bennett to describe upper gastrointestinal lesions... 

The role of Helicobacter pylori Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) account for nearly all gastroduodenal ulcers and serious ulcer complications, but the interaction between infection with H. pylori and the use of NSAIDs in the pathogenesis of NSAID-induced gastropathy is controversial. In fact, studies that have examined these two susceptibility factors have yielded conflicting results about whether H. pylori infection increases the risk of toxicity in NSAID users, has no effect, or may even be protective (70-72). 

Piscitelli SC. Zollinger-Ellison disease/NSAID-induced gastropathy/peptic ulcer disease. In Carter BL, Angaran DM, Lake KD, Raebel MA, eds. Pharmacotherapy self-assessment program, 2nd edition. Kansas City American College of Clinical Pharmacy, In press. 

Other agents have been evaluated in attempts to prevent NSAID-induced gastropathy. Among 935 NSAID users with baseline gastric or duodenal erosions, omeprazole and misoprostol were similarly effective in the treatment of ulcers and their symptoms, but omeprazole maintenance therapy conferred a lower rate of relapse. Thus several medications are available for the treatment or prevention of ulcers in high-risk patients. 

Becker, J.C., Domschke, W., and Pohle, T. (2004). Current approaches to prevent Nsaid-Induced gastropathy - Cox selectivity and beyond. Br. J. Clin. Pharmacol. 58,587-600. 

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