Gastrointestinal Hepatic System

Perhaps the greatest morbidity from NSAID use is bleeding from the GI tract. At therapeutic doses, NSAIDs inhibition of cytoprotective gastric prostaglandins (PGI 2 and PGE2) increases the risk of gastric erosion, gastritis, and GI bleeding. There is a two- to fivefold increased risk of perforation or hemorrhage in NSAID users over the non-NSAID-using population. Data suggest that the risk for life-threatening bleeding is between 1.3 and 4 percent per year among NSAID users. It is estimated that NSAID-related GI bleeding contributes to 7500 deaths and 75,000 hospitalizations annually in the United States. The prostaglandin analogue misoprostol is effective at preventing NSAID-related gastric erosions at doses of 200 pg qid. Recently, the proton-pump inhibitor omeprazole has been shown to be effective at treating NSAID-related ulcers, but its role in prophylactic therapy is less clear. 7

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