GASTROINTESTINAL TOXICITY OF NEWER NSAIDS

The linkage between gastroduodenal mucosal injury and nonsteroidal ant i-inflammatory drugs (NSAIDs) is now well established. Fifteen percent to 20% of patients taking these agents develop gastric or duodenal ul cer, and about 3% of this group goes on to experience hemorrhage or pe rforation. Gastrointestinal (GI) complications occur primarily in cert ain high risk groups, notably elderly female patients and patients wit h a prior history of peptic ulcer or GI bleeding. Recently, two new NS AIDs, nabumetone and etodolac, which are reportedly safer because they selectively inhibit prostaglandin synthesis in target tissues but spa re that in the stomach, have been introduced in the United States. Fur ther, data from clinical trials of oxaprozin, an NSAID not yet availab le in the United States, indicate that this agent may have a better sa fety profile than older NSAIDs. A review of the literature concerning the mucosal toxicity of these three agents reveals that the overall ul ceration and major complication rate is low. However, a direct compari son with older NSAIDS in a large group of patients in a dose with simi lar efficacy is lacking.