Management of NSAID-associated peptic ulcer disease

Expert Rev Gastroenterol Hepatol. 2016 Jun;10(6):723-33. doi: 10.1586/17474124.2016.1142872. Epub 2016 Mar 2.


Non-steroidal anti-inflammatory drug (NSAID) use increases the risk of gastrointestinal complications such as ulcers or bleeding. The presence of factors like advanced age, history of peptic ulcer, Helicobacter pylori infection and the use of anticoagulants or antiplatelet agents increase this risk further. COX-2 inhibitors and antisecretory drugs, particularly proton pump inhibitors, help to minimize the risk of gastrointestinal complications in high-risk patients. This review presents a practical approach to the prevention and treatment of NSAID-associated peptic ulcer disease and examines the new advances in the rational use of NSAIDs.

Keywords: COX-2 selective inhibitors; Cardiovascular risk; Gastrointestinal bleeding; Gastrointestinal risk; Gastroprotection; Low dose aspirin; NSAID gastropathy; Non-steroidal anti-inflammatory drugs; Upper gastrointestinal complications.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Ulcer Agents / adverse effects
  • Anti-Ulcer Agents / therapeutic use*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Helicobacter Infections / drug therapy
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / drug effects
  • Helicobacter pylori / pathogenicity
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Peptic Ulcer / chemically induced
  • Peptic Ulcer / diagnosis
  • Peptic Ulcer / drug therapy*
  • Peptic Ulcer / microbiology
  • Peptic Ulcer Hemorrhage / chemically induced
  • Peptic Ulcer Hemorrhage / diagnosis
  • Peptic Ulcer Hemorrhage / drug therapy*
  • Peptic Ulcer Hemorrhage / microbiology
  • Proton Pump Inhibitors / therapeutic use
  • Risk Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors