Prevention of NSAID-related Gastrointestinal Complications in the Geriatric Patient

Naveen Arya, MD, FRCP(C), Resident, Gastroenterology sub-specialty training program, Univerity of Toronto, Toronto, ON.
Peter G. Rossos, MD, FRCP(C), Staff Gastroenterologist, University Health Network; Program Director, Division of Gastroenterology, University of Toronto, Toronto, ON.

With advancing age, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of arthritis, pain and headache increases. Although there are many benefits of NSAIDs for their analgesic and anti-inflammatory properties, there are also potential serious side effects. The side-effect profile includes dyspepsia, gastrointestinal mucosal ulceration and bleeding, cardiac dysfunction, renal toxicity and platelet dysfunction (Table 1). Chronic use of NSAIDs is associated with serious gastrointestinal (GI) toxicity, which severely restricts the use of these medications. In the United States, adverse events associated with NSAIDs result in 103,000 hospitalizations and 16,500 deaths per year.1 In the United Kingdom, it is estimated that 1/2000 NSAID prescriptions lasting for two months will result in death.2

The average cost of both over-the-counter and prescription NSAID use in the United States is approximately $5-10 billion dollars (U.S.) per year.3 Despite significantly increased costs of therapy, newer COX-2 inhibitors are frequently prescribed in an effort to reduce complications.