Management of gastroduodenopathy associated with use of nonsteroidal anti-inflammatory drugs.

Adverse events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are reported more frequently to the Food and Drug Administration than are those associated with any other group of drugs. The absolute risk for serious gastrointestinal events--in particular, ulcer bleeding, perforation, and death--is controversial; some investigators believe that an epidemic of NSAID-related complications is being experienced, whereas others suggest that the risks are being overemphasized. The management of patients who take NSAIDs regularly also remains controversial. Key unresolved issues include how best to identify those patients at particularly high risk for the development of ulcer complications and whether such patients should receive prophylactic therapy in an attempt to prevent such problems. In this review, we critically evaluate the currently available literature and present a management algorithm for the treatment and prevention of NSAID-associated gastroduodenopathy.