ManagementofNSAIDinduced gastrointestinal disturbance

Thevalueoftreatment withnon-steroidal antiinflammatory drugs(NSAIDs) issuggested bytheir widespread use,over22million prescriptions being issued eachyear.' Patients commonlysuffer from adverse gastrointestinal effects, however. Avoidanceofthese wouldbeeasedifwe hada fuller understanding ofbasic mechanisms andpredisposingfactors. Assessment isfurther hindered because peptic ulcer iscommonintheelderly evenwithout NSAIDtreatment, there arenocharacteristic symptompatterns, patients withconnective tissue diseasesmaybeinherently morepronetogastrointestinal damage,2 there isawiderangeofdisorders forwhichNSAIDsareindicated, beitlongterm (rheumatoid arthritis, osteoarthritis) oracutely (soft tissue injuries), andthere areatleast 18available generic NSAIDs. Ulcerfrequency Duodenal ulcer hasbeenaccepted asadisease ofthe youngormiddle aged, butrecent datasuggest that theincidence ofbothgastric andduodenal ulcer, at least asjudged byperforation rates, hasincreased markedly intheUnited Kingdomintheelderly over thepast25years, whereas ithasfallen substantially inyounger people.' Thereasons forthis change are notclear, andweareleft withtheimpression that there arespecific factors whichhavemadeelderly people morepronetopeptic ulceration andits