CLINICAL-SIGNIFICANCE OF THE UNDESIRABLE GASTROINTESTINAL EFFECTS OF NONSTEROID ANTIRHEUMATICS

Present non-steroid antirheumatics (NSAR) have a lower local toxicity at the gastric and duodenal mucosa than the salicylate derivatives. The incidence of gastric or intestinal side effects that are mediated systemically or by enterohepatic recirculation, however, is on the increase. This is ascribed to patient-immanent factors and changed intake habits in elderly patients. The varying average gastrointestinal side-effect potency of individual NSAR is of secondary importance. For each individual patient it will be necessary to find that NSAR that ensures maximum effect and minimum side effects, and this requires trials with probationers. It is only in recent years that we have come to know of NSAR-associated severe gastrointestinal ulcers and haemorrhages of partly lethal outcome, by means of epidemiology studies. Hence, when NSAR are prescribed for the first time or in repeat prescription, risk patients must be identified and, if necessary, treated prophylactically to protect their mucosa, or submitted to additional curative therapy.