Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

NSAIDs 1067

gastroduodenal ulcers and their complications, including bleed-

ing and perforation

➣some NSAIDs have relatively less COX-1 inhibition and may

have lower risks of GI complications (etodolac, nabumetone, and

meloxicam)

➣COX-2 specific NSAIDs (celecoxib and rofecoxib) do not cause

gastroduodenal ulcers and have been shown in prospective ran-

domized studies to cause 60% fewer GI bleeds and perforations

than nonselective NSAIDs; these drugs do not have effects on

platelet function and are therefore not effective for cardiovascu-

lar prophylaxis

➣aspirin is a nonselective NSAID and is associated with GI bleeds

and perforations even when used in low doses for cardiovascular

prophylaxis; enteric-coating and buffering with antacids do not

protect against the GI complications

Signs & Symptoms

■dyspepsia

■upper GI bleeding

■chronic iron deficiency anemia

tests

Laboratory Tests

■laboratory tests in dyspeptic patients are usually normal

■patients with GI bleeding may have anemia and/or iron defici-

ency

■patients with ulcers should be tested by serology for H pylori infec-

tion, although this infection neither enhances or reduces the risk of

NSAID associated ulcers

Imaging Tests

■Endoscopy

➣upper GI endoscopy is the most sensitive and specific test for

the diagnosis of NSAID related ulcers and associated mucosal

damage

➣gastric ulcers are found in 15% and duodenal ulcers in 5% of

chronic NSAID users

➣erosions are more common, but are superficial and rarely cause

clinical problems

➣endoscopic treatment of bleeding ulcers is effective in over 90%

of patients and reduces mortality and the need for surgery