Roles of NSAIDs and aspirin in bleeding peptic ulcers : NSAIDs, aspirin and peptic ulcers.

Upper gastrointestinal bleeding is one of the most common complications associated with peptic ulcer disease. In Japan, most patients were infected by Helicobacter pylori and the infection was considered to be one of the major causes of bleeding ulcers. Exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and low dose aspirin are known to be other important risk factors of upper gastrointestinal bleeding. NSAIDs including aspirin are widely used for their anti-inflammatory and analgesic effect. In addition, low-dose aspirin reduces the risk of vascular death. H. pylori infected population is decreasing and the use of NSAIDs and low-dose aspirin are increasing year by year. NSAIDs and low-dose aspirin are expected to become more contributable factors to upper gastrointestinal bleeding in Japan in the future. On the other hand, the H. pylori infection ratio is still very high, especially among the aged population, compared to foreign countries. The nature of the disease characteristics may differ from those of other countries. In addition, the usual prescriptive dosages of non-selective NSAIDs in Japan are smaller than those in Western countries. In Japan, cytoprotective agents are widely used to treat and prevent peptic ulcer diseases. The Japanese situation is therefore unique in many points, and we need to learn more about the Japanese disease characteristics.