Epidemiology of NSAID-related gastroduodenal mucosal injury

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the agents most fr equently used against musculoskeletal and rheumatic disorders throughout th e world. The gastroduodenal adverse effects include dyspepsia without endos copically proven damage, asymptomatic endoscopic lesions of submucosal haem orrhage, erosions and ulcers, and-most important-ulcer complications. Estab lished risk factors for NSAID-associated ulcer complications include patien t-specific factors such as advanced age, female gender, a history of peptic ulcer, and drug-specific factors such as the use of non-selective NSAIDs ( type, dose, duration, multiple use) and concomitant anticoagulant drugs or corticosteroids. Probable risk factors comprise Helicobacter pylori infecti on and heavy consumption of alcohol, whereas use of selective serotonin re- uptake inhibitors, smoking and a number of other factors have also been pro posed to contribute. Knowledge of absolute risk estimates is important for clinical decision making. The aim of this chapter is to summarize the epide miological data related to the broad spectrum of iatrogenic gastroduodenal mucosal injury.