THERAPY OF NSAIDS-INDUCED GASTROPATHY

NSAID-induced gastropathy is the most frequent side effect due to NSAI D use, The resulting clinical event is usually of little significance and only in a small percentage of cases results in serious side effect s, Nevertheless, the large worldwide use of NSAIDs makes, even a rare side effect, numerically consistent, The pathogenesis of NSAID-induced gastropathy is related to two main mechanisms: an initial topical eff ect which is pH dependent and a systemic effect which is, more slowly developing, and mainly to the inhibition of prostaglandin The therapy of NSAID-gastropathy is almost completely identified with the therapy of NSAID ulceration because of its frequent relation to the developmen t of potentially serious complications, In the case of symptomatic ulc er development the first therapeutic step is NSAID suspension and, in such a case all ''antiulcer'' drugs are efficient, When the NSAID can not be discontinued, omeprazole seems to be the most efficient drug; H -2 blockers can promote ulcer healing but at a slower rate; sucralfate shows an efficacy similar to H-2 blockers; misoprostol is useful in t he prevention of NSAID-gastropathy, However, it is not so efficient in the treatment of established lesions and shows poor efficacy in the r eduction of dyspeptic symptoms, For each one of these drugs it is nece ssary to obtain further data.