FROM PEPTIC-ULCER DISEASE TO NSAID GASTROPATHY - AN EVOLVING NOSOLOGY

Nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy is an important clinical entity, most commonly encountered in elderly female patients. The expanding use of NSAIDs in the elderly population has l ed to an increased incidence of NSAID-induced gastropathy, The risk of gastric bleeding in these patients is 7-fold higher than in the young er population. Long term NSAID therapy in the elderly is apparently as sociated with failure of normal gastric mucosal adaptation. Silent uni dentified gastric lesions are likely to be common with long term NSAID therapy, as symptomatology does not parallel pathological progression . This gastropathy, in contrast to peptic ulcer disease, is responsive to prostaglandins and other cytoprotective agents, A new generation o f prostaglandin-sparing NSAIDs (e,g. nabumetone), in addition to the o lder nonacetylated salicylates, may represent less gastrotoxic alterna tives. Therefore, these agents may substantially reduce the risk of NS AID-induced gastropathy.