Non-steroidal anti-inflammatory drugs: who should receive prophylaxis?

Alimentary Pharmacology & Therapeutics
C Hawkey

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are the major recognized cause of iatrogenic disease, and may cause 100 000 deaths per annum through peptic ulcer complications. A number of risk factors can be identified that indicate patients at high risk. These patients can be managed by substitution of a COX-2 inhibitor or by prophylaxis with a proton pump inhibitor (PPI). Because risk factors that render patients at high risk of ulcer complications also act in the absence of NSAID use, PPI prophylaxis (or Helicobacter pylori eradication where H. pylori is the risk factor) have much to offer and controlled studies show that the incidence of recurrent peptic ulcer bleeding can be reduced substantially by PPI co-administration. Substitution of COX-2 inhibitors also has much to offer, arguably most in those without risk factors (although regulatory authorities do not accept this argument). Recent data show that PPI and COX-2 inhibitors can play complementary roles in the management of patients with moderate to severe dyspepsia and at high risk of ulcer complications.

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Citations

Sep 28, 2010·Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association·Mohammad J KavianiMehdi Saberifiroozi
Jan 23, 2010·Digestive Diseases and Sciences·Aleksandra Sokic-MilutinovicTamara Alempijevic
Jul 16, 2008·The American Journal of the Medical Sciences·Stelios F AssimakopoulosVassiliki N Nikolopoulou
Jul 4, 2007·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·M CaselliUNKNOWN Working Group of the Cervia II Meeting
Nov 10, 2009·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Antoine GosselinMei Sheng Duh
Feb 19, 2008·Journal of Clinical Gastroenterology·Giorgio TalaminiItalo Vantini

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