DIAGNOSIS AND TREATMENT OF NONSTEROIDAL ANTI-INFLAMMATORY DRUG-ASSOCIATED UPPER GASTROINTESTINAL TOXICITY

Gastroenterologists and other clinicians need to be informed and vigilant regarding nonsteroidal anti-inflammatory drug (NSAID)–induced gastrotoxicity. NSAID-associated gastropathy is the commonest and most frequently lethal medication toxicity in the United States. 46 NSAID toxicity results in more than 100,000 hospitalizations and 10,000 to 20,000 deaths in the United States each year. 137 To place these statistics in perspective, more Americans die annually from NSAID toxicity than from esophageal, gastric, or hepatic cancer. 92 Gastrotoxicity substantially raises the cost of NSAID therapy: In one study, for every $100 spent on arthritis therapy, approximately $50 was spent on treating adverse gastrointestinal drug reactions. 13 In this study, the total annual cost of treating gastrointestinal side effects from NSAIDs was estimated at about $4 billion. 13 Despite the widespread use of NSAIDs, NSAID-associated peptic ulcer disease (PUD) is frequently overlooked and underdiagnosed because of the asymptomatic presentation of early disease and the underreporting of nonprescription NSAID use. 38