Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal intolerance and major bleeding--or do they?

Non-steroidal anti-inflammatory drugs are a mainstay of treatment of the inflammatory arthritides. Unfortunately, they are often associated with dyspepsia, and this troublesome side-effect is a limitation to their chronic use by many patients. The use of enteric-coated preparations has improved the ability of this large group of patients to use these drugs. The appearance of suppository preparations has further improved tolerability of these medications. Though dyspepsia is a common adverse effect, there is little correlation between this side-effect and the prevalence of relevant gastrointestinal bleeding in practice. The latter is an uncommon event, but is of particular concern in the elderly. The introduction of concomitant use of a number of gastroenterologic medications has improved the rheumatologist's ability to give non-steroidal anti-inflammatory drugs to these patients. Despite this, no combination has been proven to be absolutely safe. Cytoprotection by a number of gastroenterologic preparations offers a means of avoiding, or decreasing, troublesome gastritis, and reducing the risk of relevant bleeding. Non-steroidal anti-inflammatory drugs must be used in this (elderly) population with caution, and prospective studies are needed to confirm the role of potential cytoprotective therapy in clinical practice.