RISK REDUCTION AND STRATEGIES TO PREVENT GI COMPLICATIONS OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drug class in the world. Low-dose aspirin (ASA) is widely used for cardiovascular and cerebrovascular prevention. Their use is limited by GI side effects. These side effects include dyspepsia, gastroduodenal ulcers and complications, such as bleeding or perforation, in 1–4% of patients per year. The side effects occur also in lower part of GI tract behind duodenum.

The risk of GI complication associated with NSAID therapy or ASA prevention is not the same for all patients. Factors associated with an increased risk include a past history of ulcer disease and complications, the concomitant use of multiple NSAIDs or high doses of NSAIDs, concurrent use of anticoagulants or corticosteroids, and advanced age. NSAIDs available over the counter also carry a significant risk of GI complications, as well as uncoordinated treatment of two and more doctors. It appears that smoking and alcohol consumption may also aggravate the risk. Whether Helicobacter pylori is a risk factor in patients taking NSAIDs or ASA is uncertain.

The best approach to the prevention of NSAID-associated GI complication is to avoid the use of these drugs in patients who have the risk factors noted above. In situations where NSAID therapy is required in high risk patients, one may consider using prophylactic co-therapy with proton pump inhibitors, using coxib that has a lower risk of complications, or both.

It is important to note that the risk of a complication is not reduced to zero by any therapeutic approach. The clinical goal is to reduce the risk of an NSAID and ASA associated complication, recognising that the risk will vary with the characteristics of the patient, the drugs used and the clinical situation. This is a core message of the guideline recently published by working group organized by Czech Society of Gastroenterology and Czech Society of General Practice of the Czech Medical Association Jan Evangelista Purkyne.

Keywords: Key words: nonsteroidal anti-inflammatory drugs, low-dose aspirin, Helicobacter pylori, upper gastrointestinal complication, general practitioner.