NSAIDs and GI Side Effects

NSAID-related GI side effects result from inhibition of prostaglandins, which play a key role in maintaining the integrity of the gastric mucosa. The non-selective inhibition of the Cox enzymes result in an inhibition of systemic prostaglandin synthesis, which leads to an impairment of the GI mucosa, often resulting in ulceration and irritation. This places patients at increased risk for upper GI irritation, gastritis, GI bleeding and ultimately, duodenal and gastric ulcers.


	In more than 80% of patients with serious GI complications, there are no prior symptoms of warning signals

Patient Need – Production of Prostaglandins

NSAID Induced GI Side Effects

Although NSAID use is associated primarily with upper GI events and gastric ulcers, lower GI problems can also occur, including (1) inflammation and permeability changes of the intestine and lower bowel; (2) hemorrhage of the ileum, duodenum, and colon; (3) perforation; and (4) stricture formation.

The adverse GI events associated with NSAID use can be broadly categorized into 3 groups: (1) "nuisance symptoms" (heartburn, nausea, dyspepsia, vomiting, abdominal pain); (2) mucosal lesions as seen on endoscopy or x-rays; and (3) serious GI complications (perforated ulcers, catastrophic bleeding that requires hospitalization).

Patients taking NSAID's for prolonged periods are at risk for both mild and severe side effects including:

Upper GI irritation
Gastritis
Bleeding
Duodenal and Gastric Ulceration

Risk Factors

Clinical studies have shown that GI ulcers afflict 10-25% of chronic arthritis patients treated with NSAIDs, and arthritis patients are 2.5-5 times more likely to be hospitalized for NSAID related GI complications than the general population. In more than 80% of patients with these serious GI complications, there are no prior symptoms or warning signals.

Patients at Higher Risk for NSAID Related GI Complications

Source:
Gabriel, et al. Annals Internal Medicine. 1991; 115-787.
Garcia, R. et al. Lancet. 1994; 343-769.
Silverstein et al. Annals Internal Medicine. 1995 ; 123-241.
Sorensen et al. Am J Gastroenterol. 2000;95:2218.