Diagnosis and treatment of nonsteroidal anti-inflammatory drug-associated upper gastrointestinal toxicity

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in the United States to treat pain and reduce inflammation from chronic inflammato ry disorders such as rheumatoid arthritis and osteoarthritis. Approximately 40% of older Americans take NSAIDs. Chronic NSAID use carries a risk of pe ptic ulcer and other gastrointestinal disturbances. This article reviews th e diagnosis of medication-induced ulcers based on clinical presentation, la boratory tests, and endoscopic findings to assist the clinician in early di agnosis and appropriate therapy. Risk factors for NSAID-induced ulcers incl ude old age, poor medical status, prior ulcer, alcoholism, smoking, high NS AID dosage, prolonged NSAID use, and concomitant use of other drugs that ar e gastric irritants, such as alendronate, a bone resorption inhibitor presc ribed for osteoporosis. Appropriate treatment options for patients with med ication-induced ulcers include dosage reduction, medication substitution, m edication withdrawal, antiulcer therapy, and discontinuation of other gastr otoxic drugs.