Drug Safety

, Volume 10, Issue 2, pp 170–181 | Cite as

Epidemiology of Gastrointestinal Damage Associated with Nonsteroidal Anti-Inflammatory Drugs

  • Laura Rees Willett
  • Jeffrey L. Carson
  • Brian L. Strom
Review Article Pharmacoepidemiology


Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with significant upper gastrointestinal (GI) toxicity, with a relative risk of approximately 3. This is supported by evidence drawn from randomised controlled trials [of aspirin (acetylsalicylic acid)], cohort studies and case-control studies. The risk is increased with higher doses of medication, shorter treatment duration and concomitant corticosteroid use. Elderly patients and those with a history of GI illness are also at increased risk. Ibuprofen may be associated with a lower, and piroxicam with a higher, risk of complications. There are only preliminary data regarding an association between NSAIDs and small and large intestinal complications.

Therapeutic alternatives which may confer a lower risk of significant GI toxicity include enteric-coated preparations, non-acetylated salicylates, and NSAIDs taken in conjunction with misoprostol. Epidemiological data regarding these alternatives are sparse.


Aspirin Misoprostol Nsaid User Gastrointestinal Damage Salsalate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • Laura Rees Willett
    • 1
  • Jeffrey L. Carson
    • 1
  • Brian L. Strom
    • 2
  1. 1.Division of General Internal MedicineUniversity of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical SchoolNew BrunswickUSA
  2. 2.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA

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