NSAID gastropathy. The central issue.

NSAID gastropathy is a serious, iatrogenic problem of common NSAID usage of major public health dimensions. Since ulcer bleeding and perforations can be disastrous, the issue clearly requires prevention. Various gastroprotective therapies exist, but since symptoms do not predict the evolving pathophysiology in most cases, the problem continues to be underestimated in clinical care. Endoscopy is of definitive value, but not generally thought appropriate for screening purposes. Under these circumstances, not driven by putative symptomatology, a long term basis for compliance with gastroprotective therapies is potentially compromised and always expensive. NSAID treatment strategy based on reducing putative gastrotoxicity is a primary goal. Present encouraging postmarketing surveillance experience, clinical research, and most recently, endoscopy evaluation suggest nabumetone as a potential prototype for a new generation of gastro-sparing NSAID therapies based on desirable pharmacological features.