Adverse effects of conventional non-steroidal anti-inflammatory drugs on the upper gastrointestinal tract

Fundam Clin Pharmacol. 2003 Aug;17(4):393-403. doi: 10.1046/j.1472-8206.2003.00179.x.


This article reviews the clinical and epidemiological features of conventional non-steroidal anti-inflammatory drug (NSAID) related peptic ulcer complications, and the associated risk factors. The degree of gastrointestinal toxicity varies widely between the available drugs and with dose of each. The risk of ulcer complications can however be reduced, and perhaps completely removed, by using the lowest dose of the least toxic member of the class. Enteric coating and other delayed release formulations have not been shown to reduce risk. Estimates of the imposed disease burden have varied widely, in part through assuming that risks in selected patient groups will necessarily translate to the general population. Nevertheless, the imposed disease burden is one of the largest associated with current drug treatment. Associated risk factors such as prior ulcer, corticosteroid use and concurrent aspirin as well as general cardiovascular disease will raise the likelihood of an ulcer complication in NSAID takers and non-takers. Therefore, strategies dependent on substituting COX-selective drugs will then be only partially successful.

Publication types

  • Review

MeSH terms

  • Acetaminophen / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Aspirin / administration & dosage
  • Aspirin / adverse effects
  • Clinical Trials as Topic
  • Drug Interactions
  • Humans
  • Nonprescription Drugs / administration & dosage
  • Nonprescription Drugs / adverse effects
  • Peptic Ulcer / chemically induced*
  • Risk Factors
  • Tablets, Enteric-Coated


  • Anti-Inflammatory Agents, Non-Steroidal
  • Nonprescription Drugs
  • Tablets, Enteric-Coated
  • Acetaminophen
  • Aspirin