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.