Nonsteroidal antiinflammatory drugs NSAIDs

NSAIDs, such as indomethacin and ibuprofen, are effective anti-inflammatory agents which damage the gastric mucosal barrier and are important causal factors in gastric ulcers (Misiewicz and Punder 2000). These drugs also reduce the integrity of the duodenal mucosa but are probably responsible for only a small proportion of duodenal ulcers. They greatly increase the risk of bleeding or perforation from pre-existing gastric and duodenal ulcers.

Risk factors for NSAID-induced ulcers have been identified and should be considered when reviewing a patient's medication, although the availibility of over-the-counter NSAID preparations should be recognised. Risk factors for NSAID-induced ulcers include:

• past history of peptic ulcer

• past history of adverse event with NSAIDs

• concurrent use of corticosteroids

• high-dose or multiple NSAIDs

Management of NSAID ulcers

If possible the offending NSAID drug should be discontinued. If an NSAID must be used then one with a lower risk of complications, e.g. ibuprofen, should be used at the lowest effective dose. Co-prescription of a proton pump inhibitor will heal most, but not all, ulcers.

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