Review article: controversies in NSAID‐induced gastroduodenal damage‐do they matter?

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Abstract
SUMMARY: Background. This article reviews various issues surrounding NSAID‐induced gastroduodenal ulceration, about which there appear to be conflicting views and data in the literature. These issues include the size, clinical relevance and main site of the problem; when complications occur (early or late?); the relevance of non‐ulcer lesions and whether adaptation is a clinically relevant phenomenon. Method. A comprehensive literature search was carried out to identify relevant new data published since 1987. Results. NSAIDs are causally associated with more gastric than duodenal ulcers but their use may be associated with duodenal ulcers or complications. Erosive lesions may progress to more severe damage. The theories of early or late onset of complications during a course of NSAID therapy may not be mutually exclusive. Conclusions. Available data indicate that NSAID ulcers are at least as dangerous as classic peptic ulcers, and result in significant morbidity and mortality which in the patient population does not appear to be significantly reduced by processes such as adaptation.