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NSAIDs and ulcers

UTRECHT, THE NETHERLANDS. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of inflammation and pain. These drugs, unfortunately, are very hard on the stomach lining and often cause serious ulcers and gastrointestinal bleeding. It is estimated that 2200 patients die each year in the UK alone from bleeding caused by NSAIDs. Treating NSAID-related bleeding events is also costly. It is estimated that, for every dollar spent on purchasing NSAIDs, another 55-70 cents is spent on treating their side effects. It is possible to, at least partially, protect patients taking NSAIDs by also giving them a proton inhibitor (omeprazole, pantoprazole, lansoprazole), histamine (H)2-antagonist (cimetidine, ranitidine, nizatidine) or misoprostol (Cytotec). Another approach is to switch to a COX-2 inhibitor such as rofecoxib (Vioxx) or celecoxib (Celebrex). Protection against gastrointestinal bleeding is particularly important for patients who are also taking aspirin, warfarin or corticoids (prednisone) or who have special risk factors such as a history of stomach ulcers, age over 59 years or a Helicobacter pylori infection.

Dutch physicians recently conducted a survey to determine how often adequate measures were prescribed to prevent serious adverse effects of long-term NSAID therapy. Their survey included over 10,000 patients (70% women) who had been taking NSAIDs for 100 or more consecutive days. They found that preventive strategies had only been prescribed for 43% of the study participants and that the measures were inadequate in 36% of cases. The frequency of prescriptions for preventive strategies was 24% in patients with no additional risk factors and 80% for those with 4 or more risk factors for gastrointestinal bleeding. The researchers conclude that a large proportion of Dutch NSAID users are not adequately protected against serious side effects.
Herings, RMC and Goettsch, WG. Inadequate prevention of NSAID-induced gastrointestinal events. The Annals of Pharmacotherapy, Vol. 38, May 2004, pp. 760-63

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