Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- NSAIDs cause 10% of peptic ulcers [5].
- The annual risk of a life-threatening ulcer-related complication is 1-4% in patients who use NSAIDs long-term [8].
- Ulcers and ulcer-related complications increase with older age, concurrent steroid or anticoagulant use, prior ulcer or bleeding, and in those with major organ impairment [8][13].
- The use of NSAIDs in patients with active H. pylori infection increases the risk of PUD and of bleeding [20].
NSAID pathophysiology
- NSAIDs cause mucosal injury through multiple mechanisms.
- The most well-known of these is through inhibition of prostaglandin synthesis by inhibiting cyclo-oxygenase(COX)-1. This reduces mucous and bicarbonate secretion, reduces mucosal blood flow and impairs platelet aggregation, all of which reduce host defences to injury [14].
- NSAIDs also exert a direct local toxic effect to gastric cells through a variety of mechanisms [14].
Learning Bite
NSAIDs cause mucosal damage through local and systemic mechanisms.