Update on NSAIDs Related Peptic Ulcers

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic, antipyretic, and anti-inflammatory properties and are widely used for treating musculoskeletal and cardiovascular diseases. Notwithstanding these therapeutic efficacies, gastrointestinal toxicity is the major health problem associated with NSAID use. NSAID-related peptic ulcers are a well known complication due to direct mucosal injury and cyclooxygenase inhibition. Risk factors for NSAID-related peptic ulcers include a prior history of peptic ulcer; age > 65 years; high-dose NSAID therapy; and concurrent use of aspirin (including low dose), corticosteroids, or anticoagulants. In addition, Helicobacter pylori infection is an independent risk factor; therefore, eradication therapy is recommended in high-risk patients using NSAIDs. Currently, misoprostol, H2-receptor antagonists, proton pump inhibitors, and COX-2 selective inhibitors are used to prevent and treat NSAID-related peptic ulcers. Further, strategic approaches are required through appropriate NSAID use and risk factor stratification to prevent NSAID-related peptic ulcers and associated complications. (Korean J Med 2014;86:664-672)