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This article is part of the supplement: Gastroprotection: the role of proton pump inhibitors

Review

Balancing the gastrointestinal benefits and risks of nonselective NSAIDs

David A Peura1* and Lawrence Goldkind2

Author Affiliations

1 Professor of Medicine and Associate Chief of Gastroenterology and Hepatology at the University of Virginia Health System, Charlottesville, Virginia, USA

2 Division of Gastroenterology at the National Naval Medical Center, and Assistant Professor of Medicine at the F Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

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Arthritis Research & Therapy 2005, 7(Suppl 4):S7-S13  doi:10.1186/ar1793

Published: 15 September 2005

Abstract

Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of medications to treat pain and inflammation. However, gastrointestinal complications associated with NSAIDs are prevalent, largely due to the frequent use of these agents. Adverse events associated with NSAIDs include minor side effects, such as dyspepsia, as well as serious complications, such as bleeding and perforation. Although the probability that any given individual user of an NSAID will suffer a serious gastrointestinal complication is fairly low, widespread patient exposure can translate into a major national health burden. The increasing use of aspirin in the prevention of cardiovascular events and the availability of select over-the-counter NSAIDs represent additional challenges to clinicians in their efforts to make the most appropriate therapeutic decisions while minimizing the potential gastrointestinal risks associated with the use of these agents. Side effects such as dyspepsia do not provide adequate warning of gastrointestinal complications, because most complications occur without the presence of antecedent symptoms. Therefore, accurate risk assessment and the management of controllable risk factors are crucial to the safe administration of NSAIDs. This review focuses on the gastrointestinal effects of aspirin, acetaminophen, and other nonselective NSAIDs, and discusses those factors that are associated with increased risk for adverse gastrointestinal events in certain individuals.