| Theme |
Treatment of Acid‒related Diseases -- the Past, Present and Future |
| Title |
Prophylaxis and Treatment of NSAIDs—related Peptic Ulceration -- Present Status and Prospects |
| Author |
Hideyuki Hiraishi |
Department of Gastroenterology, Dokkyo Medical University |
| Author |
Kou Fukushi |
Department of Gastroenterology, Dokkyo Medical University |
| Author |
Kazunori Nagashima |
Department of Gastroenterology, Dokkyo Medical University |
| Author |
Akira Kanamori |
Department of Gastroenterology, Dokkyo Medical University |
| Author |
Fumiaki Takahashi |
Department of Gastroenterology, Dokkyo Medical University |
| Author |
Keiichi Tominaga |
Department of Gastroenterology, Dokkyo Medical University |
| [ Summary ] |
Non‒steroidal anti‒inflammatory drugs (NSAIDs) including low‒dose aspirin, have been widely prescribed for the treatment of osteoarthritis and rheumatoid arthritis, as well as for the secondary prevention of atherosclerotic thrombotic events in elderly patients. Nonetheless, the effectiveness of NSAIDs in the treatment and prophylaxis of such diseases may be limited by the risk of upper gastrointestinal (GI) complications such as ulceration, hemorrhage, and perforation. NSAID administration is associated with a several‒fold increase in upper GI bleeding in the Japanese general population. Such GI risk is known to increase in patients with a prior history of peptic ulcer disease, advanced age, and concomitant use of corticosteroids, clopidogrel, or anticoagulants containing NSAIDs or aspirin. Mechanisms of NSAID‒induced GI injury are believed to be through local effects within the GI mucosa that cause topical injury and through systemic inhibition of cyclo‒oxygenase (CO), resulting in the depletion of mucosa-protective prostaglandins. Here, we focus on the strategy of managing NSAID‒ or aspirin‒induced peptic ulcerations and their complications, mainly by the administration of anti‒secretory agents such as proton pump inhibitor, based on scientific evidence. |