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Nonsteroidal Anti-inflammatory Drugs and Peptic Ulcer Disease
- Andrew H. Soll, MD;
- Wilfred M. Weinstein, MD;
- John Kurata, PhD; and
- Denis McCarthy, MD
Abstract
Evidence has accumulated that nonsteroidal anti-inflammatory drugs (NSAIDs) cause clinically important gastroduodenal ulcers. The pathogenesis, which involves the impairment of mucosal resistance to injury in an acid-peptic environment, is multi-actorial and controversial. Ulcers caused by NSAIDs can occur either in mucosa inflamed because of infection with Helicobacter pylori or in histologically normal mucosa. The use of these drugs has been linked to an unexpectedly high incidence of ulcer complications, and a history of peptic ulcer disease is common in such cases. Nonsteroidal anti-inflammatory drugs thus appear both to exacerbate an underlying peptic diathesis and to cause de novo ulcers. The association between the use of these drugs and ulcer complications is supported by ulcer prevalence data from cross-sectional studies, and by data from case-controlled and cohort studies, and from randomized, experimental trials. Drug-induced gastric ulcers have been prevented by misoprostol, but not by H2 blocker therapy. Several therapies have been reported to promote ulcer healing despite continued use of NSAIDs, but adequate controlled trials have not been done. Small gastric and duodenal ulcers readily heal, whereas larger gastric ulcers require vigorous and prolonged therapy. The relative efficacies of various therapies in preventing ulcers, healing ulcers, or preventing complications remain to be established.
Article and Author Information
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An edited summary of an Interdepartmental Conference arrangedby the Department of Medicine of the UCLA School of Medicine, Los Angeles, California. William M. Pardridge, MD, Professor of Medicine, is Director of Conferences.
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Authors who wish to cite a section of the conference and specifically indicate its author can use this example as the form of reference:
Weinstein WM. Differentiation of nonsteroidal anti-inflammatory drug-associated and "ordinary" peptic ulcers, pp 309-311. In: Soil AH, moderator. Nonsteroidal anti-inflammatorydrugs and peptic ulcer disease. Ann Intern Med. 1991;114:307-319.
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Grant Support: Grant DK 17328 from the National Institutes of Health to the Center for Ulcer Research and Education and by the Medical and Research Services of the Veterans Administration.
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Requests for Reprints: Andrew H. Soll, MD, CURE, Wadsworth Veterans Affairs Medical Center, Building 115, Room 203, Los Angeles, CA 90073.
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Current Author Addresses: Dr. Soll: CURE, Wadsworth Veterans Affairs Medical Center, Building 115, Room 203, Los Angeles, CA 90073.
Dr. Weinstein: Department of Medicine, UCLA Medical Center, Room 44-139 CHS, Los Angeles, CA 90024.
Dr. Kurata: San Bernardino County Medical Center, Department of Family Practice, 780 East Gilbert Street, San Bernardino, CA 92415.
Dr. McCarthy: VA Medical Center-111, 2100 Ridgecrest Drive Southeast, Albuquerque, NM 87108.
- © 1991 American College of Physicians
