NSAID GASTROENTEROPATHY - CURRENT THERAPY AND DIAGNOSIS

The gastrointestinal side effects of nonsteroidal antiinflammatory dru gs (NSAIDs) continue to be the major factor limiting the use of these agents. While several strategies are being followed to develop new NSA IDs that spare the gastrointestinal tract, it is as yet unclear if the se will prove to be successful. In the meantime, physicians are faced with the problem of how to prevent the development of gastrointestinal lesions in patients who require NSAIDs to manage their inflammatory d isease (e.g., rheumatoid arthritis). This problem is complicated by th e fact that most NSAID-induced ulcers are ''silent''; that is, the pat ient does not experience symptoms. Widespread screening of NSAID users with radiology or endoscopy is not economically feasible. On the othe r hand, a newly developed noninvasive method for detecting gastric ulc ers, namely the sucrose test, may prove to be very useful for identify ing patients at most risk of NSAID-related gastrointestinal complicati ons. Prophylactic therapy with misoprostol, omeprazole and high doses of H-2 receptor antagonists has been reported to be effective in preve nting NSAID ulcers. However, the cost-effectiveness of widespread prop hylaxis of NSAID users is questionable, once again underscoring the ne ed for inexpensive methods of detecting the patients at highest risk o f developing complications.