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Can NSAID-related ulcers and complications be prevented?
NSAIDs are valuable medications for patients with arthritis and other inflammatory conditions. For patients who need long-term NSAID treatment, several steps can be taken to decrease NSAID-related ulcers and complications. The risk of ulcers and complications tend to be dose related. Therefore, the smallest effective dose of NSAIDs is taken to minimize the risk. NSAIDs might be selected that have less effect on the stomach's production of prostaglandins. Some of these NSAIDs are called selective Cox-2 inhibitors. Cox-2 inhibitors block the Cox-2 enzyme that produces prostaglandins of inflammation without blocking the prostaglandin production of Cox-1 in the stomach. Currently in the United States, the only available selective Cox-2 inhibitor is celecoxib (Celebrex).
Taking NSAIDs with meals may minimize stomach upset with NSAIDs but not ulcerations.
A synthetic prostaglandin, misoprostol (Cytotec), can be administered orally along with NSAIDs. Misoprostol has been shown to decrease NSAID-induced ulcers and their complications. The side effects of misoprostol include abdominal cramps and diarrhea. Misoprostol also is avoided in pregnant women because it can cause uterine muscle contractions and miscarriage. Standard doses of H2-blockers and proton pump inhibitors reduce the risk of NSAID-induced ulcers.
Scientists are actively searching for safer NSAIDs that are effective anti-inflammatory agents but are not ulcer producing. In the meantime, patients who need long term NSAID treatment should be closely supervised by a doctor. Patients at risk of NSAID-induced ulcers and complications should consider preventive measures, such as using NSAIDs with less prostaglandin disrupting effects on the stomach and using proton pump inhibitors, H2-blockers, or misoprostol. Stopping smoking, and eradicating H. pylori also may be helpful since both smoking and infection with H. pylori themselves cause ulcers.
Medically reviewed by John A. Daller, MD; American Board of Surgery
Chan F. Primer. Managing NSAID-induced ulcer complications-balancing gastrointestinal and cardiovascular risk. Nature Clinical Practice Gastroenterology & Hepatology (2006) 3, 563-573.