Risk Factors and Prevention of Upper Gastrointestinal Complications Associated with Nonsteroidal Anti-Inflammatory Drugs

Aim: to present current data about the frequency and risk factors of upper gastrointestinal complications associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the possibilities of preventing these complications.
Key points. The incidence of gastrointestinal complications associated with NSAIDs is 14.7–30.1 %, with the maximum risk noted in the first two weeks of their administration. The use of selective cyclooxygenase-2 inhibitors is associated with a reduced risk of gastrointestinal complications. All patients who are going to receive NSAIDs should be diagnosed with H. pylori and treated with eradication therapy if this infection is detected. Even in patients without risk factors for gastrointestinal complications and with short courses of therapy, coxibs or a combination of NSAIDs and proton pump inhibitors may be considered. Prevention of NSAID-associated lesions of the upper gastrointestinal tract is an indication for the appointment of omeprazole and esomeprazole in accordance with the instructions for medical use. Esomeprazole has a number of pharmacokinetic advantages — a large area under the pharmacokinetic curve, the ability to inhibit CYP4502C19, which determines the high efficiency of therapy in fast and ultrafast metabolizers. Previous clinical studies of esomeprazole for the prevention of NSAID-associated lesions of the upper gastrointestinal tract demonstrate high efficacy. In the randomized OBERON study the risk of gastric and duodenal ulcers after 3 months of low-dose acetylsalicylic acid treatment in the esomeprazole group was 7 times lower.
Conclusion. Assessment of risk factors, correction of modifiable risk factors, selection of safer NSAIDs and simultaneous administration of proton pump inhibitors (including esomeprazole) are effective prevention of NSAID-associated upper gastrointestinal lesions.

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