Association of nonsteroidal antiinflammatory drugs with upper gastrointestinal disease: epidemiologic and economic considerations.

One of the major concerns regarding the use of nonsteroidal antiinflammatory drugs (NSAID) in the treatment of patients with arthritis is the high incidence of gastrointestinal (GI) side effects. Important issues regarding NSAID and upper GI complications include the following: (1) the magnitude of the association between NSAID therapy and clinically important gastric or duodenal ulcers or upper GI bleeding; (2) the subgroup(s) of patients who are at increased risk for upper GI side effects; and (3) the economic impact of NSAID induced upper GI toxicity. A causal association between NSAID use and the development of clinically important ulcer disease or its complications, including upper GI bleeding, is supported by available epidemiologic data. Furthermore, data suggest that up to one third of all direct costs of care may be attributed to the treatment of NSAID induced GI side effects. Approaches to this problem, such as the development of safer NSAID that are equally effective, need to be pursued.