[Gastrointestinal side effects of non-steroidal anti-inflammatory drugs in high-risk patients--role of selective cyclooxygenase inhibitors].

Non-steroidal anti-inflammatory drugs (NSAID) are the most widely used drugs in the world. Gastrointestinal (GI) side effects of NSAID have a significant economical impact (3-4% clinical GI event, and 1.5% serious/life threatening GI event/year). Selective cyclooxigenase-2 inhibitors (coxibs) are equally effective as non-selective NSAID with about 50% reduction of serious/life threatening GI events. Serious GI events are significantly less in high-risk patients (history of peptic ulcer disease, age over 65 years, treatment with anticoagulants), therefore the use of coxibs is cost-effective in these population. Most of patients with long-term NSAID therapy also require co-therapy with acid suppression or prostaglandin analogue, but coxibs may replace both. The treatment with coxibs in long-term NSAID users thus is cheaper then non-selective NSAID + co-therapy. Patients with GI adverse events during coxib therapy require co-therapy with acid suppression or prostaglandin analogue.