NSAIDs and gastrointestinal complications: new clinical challenges

The use of NSAIDs is associated with significant risk of upper gastrointestinal ulcer, bleeding, perforation and stricture. NSAIDs vary in their analgesic and anti-inflammatory properties; choice of NSAID, dosage and duration are the cornerstone of rationale therapy. Proton pump inhibitors are widely used to reduce the risk of serious events, despite the paucity of data that indicates that they are effective for this indication. The existing recommendations for prevention of gastrointestinal toxicity are reviewed in this article, in light of new clinical challenges posed by the emerging data regarding competing cardiovascular risk. Strategies are proposed for common clinical prescribing dilemmas, new clinical risk groups are identified and preventative strategies for these special populations are recommended.