Elsevier

Medical Clinics of North America

Volume 84, Issue 5, 1 September 2000, Pages 1329-1344
Medical Clinics of North America

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

https://doi.org/10.1016/S0025-7125(05)70289-3Get rights and content
Under a Creative Commons license
open archive

Nonsteroidal anti-inflammatory drugs (NSAIDs) have become one of the most commonly used medications in Western nations since the introduction of the first NSAID, aspirin, about 1 century ago. It is estimated that more than 70 million NSAID prescriptions and more than 30 billion of over-the-counter aspirin, ibuprofen, ketoprofen, and naproxen preparations are sold annually in the United States.38, 44 NSAIDs are generally well tolerated; however, their use frequently is limited by adverse gastrointestinal effects ranging from dyspepsia to serious complications, such as bleeding or perforation from gastric or duodenal ulcers.

Although adverse effects of NSAIDs occur only in a few individuals, the widespread use of NSAIDs has resulted in a substantial number of affected persons who experience serious gastrointestinal complications. It is estimated that 10% to 20% of NSAID users report dyspeptic symptoms, and 5% to 15% of rheumatoid arthritis patients taking NSAIDs are expected to discontinue medications because of dyspepsia.36, 59 A prospective study from the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) has showed that the rate of NSAID-related gastrointestinal complications requiring hospitalization was 6 times higher in patients with rheumatoid arthritis who were taking NSAIDs than in those who were not.61 Despite a decline in the rate of hospitalization from NSAID-related gastrointestinal disorders, the mortality of hospitalized patients remains about 5% to 10%.2, 60 In 1997, the estimated death rate from NSAID-related complications in patients with arthritis was equivalent to that from acquired immunodeficiency syndrome (AIDS).58, 61 The medical costs related to NSAID-associated gastrointestinal complications have been reported to exceed $2 billion annually.69

Cited by (0)

Address reprint requests to M. Michael Wolfe, MD, Boston Medical Center, Section of Gastroenterology, EBRC #507, 650 Albany Street, Boston, MA 02118–2393, e-mail: [email protected]

*

Section of Gastroenterology, Boston University School of Medicine; and Department of Medicine, Boston Medical Center, Boston, Massachusetts