Incidence

Hospitalizations for UGIB increasing
Due to increased NSAID use
- Risk of bleeding and perforation proportional to daily dose of NSAID
Also increases with
- Age > 60
- Prior GI event
- Concurrent use of NSAIDs and steroids or anticoagulants
- 2-10 x increased risk of GI complications

Pathophysiology

NSAIDs absorbed through stomach and small intestine
Action of NSAIDs
- Systemic inhibition of cyclo-oxygenase enzymes
- COX form rate limiting step in prostaglandin synthesis in GIT
- Prostaglandins promote gastric and duodenal mucosal protection via numerous mechanisms
- Risk of mucosal injury and ulceration is proportional to anti-inflammatory effect of each NSAID
Ulcers usually
- Found in stomach (H. pylori higher in duodenum)
- Not associated with gastritis (only 25%, c.f. H. pylori)
- Heal when NSAID discontinued, and do not recur