Effects of nonsteroidal anti-inflammatory drugs, including COX-2 specific inhibitors, on the GI tract

Commentary

Nonsteroidal anti-inflammatory drugs (NSAIDs) may cause adverse GI effects, e.g., dyspepsia (persistent pain or discomfort in the upper abdomen), and serious complications, e.g., bleeding and perforation. Although the probability is low that any individual user will suffer a complication, the huge patient exposure translates into a major health care problem. Dr. Scheiman presents a thoughtful review on the GI effects of NSAIDs, low-dose aspirin, COX-2 inhibitors, and the combination of more than one of these therapies. The recent withdrawal of rofecoxib from the market because of an increased risk of thrombotic cardiovascular events should lead clinicians to carefully consider whether this class of agents designed to reduce GI adverse events is appropriate for their patients, especially those with underlying cardiovascular risk. Dr. Scheiman emphasizes that because aspirin use substantially reduces the GI benefit of COX-2 inhibitors, alternative strategies to reduce GI toxicity should be used.

Grace Elta, MD

Editor