NSAID-Induced Gastric Ulcers: Exploring the Silent Dilemma

Abstract

T his specia l issue ofTheCanadian}ournalofGastroenrerology is devoted to the proceedings of a sate llite symposium he ld at the t ime of the Fourth International Course in Therapeut ic Endoscopy which took place in Toronto in October 1989. The symposium , spon~ored hy Searle Canada, took advantage of the large gathering of Canadian and overseas gast roemerologists to d iscuss some of the current controversies surrounding NSAIDs and gastroduodenal damage. T he presen tat ions, given by an in ternational panel of experts, focused on the fo llowing issues: the risk of developing gastric and duodenal les ions and the extent of th is risk with regard ro complicatio ns of bleeding and perfora t ion ; how symptoms should be managed and ulcers Lreated depending upon the ir locat ion ; and prophylaxis, particularly regard ing the problems related tO iden tify ing who should receive prophylactic trc;icment and with what medication . Studies reporting symptoms in patients taking NSA IDs show a considerable range from l O to 60% with a mean of about one-third of patien ts experienc ing problems at t hree mon ths. But do all symptomat ic patients require investigation and trcatmem ? In many cases severi ty will decline over the first few weeks as 1o lerance develops, and loss of symptoms may coincide wi th a change in the cho ice of NSAID which is often c redited with the improvement. Other a lternatives inc lude red uc ing the dose or giving the