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Gastroprotective strategies among NSAID users: guidelines for appropriate use in chronic illness Targownik LE; Thomson PACan Fam Physician 2006[Sep]; 52 (9): 1100-5OBJECTIVE: To review proper use of gastroprotective strategies in family medicine for patients requiring chronic nonsteroidal anti-inflammatory drug (NSAID) therapy. QUALITY OF EVIDENCE: Evidence of the efficacy and safety of strategies currently in use (prostaglandin analogues, cyclooxygenase-2 inhibitors, proton pump inhibitors) is derived from randomized controlled trials (level I evidence). The simultaneous use of multiple medications for very high-risk NSAID users is supported only by expert opinion (level III evidence). MAIN MESSAGE: Gastroprotective strategies should be reserved for NSAID users at substantially increased risk of gastrointestinal complications; low-risk patients can safely use NSAIDs alone. Cyclooxygenase-2 inhibitors, prostaglandin analogues, and proton pump inhibitors reduce the risk of NSAID-related gastointestinal complications by 40% to 90%. Cyclooxygenase-2 inhibitors should be avoided by patients who have or are at risk for cardiovascular disease. CONCLUSION: Chronic NSAID use has been implicated in the development of severe and potentially life-threatening gastointestinal complications, though certain strategies are known to decrease the risk of these NSAID-related gastointestinal complications. Prescribing physicians must know which of their patients should be prescribed medications and which strategies are appropriate for particular patients.|*Practice Guidelines as Topic[MESH]|*Proton Pump Inhibitors[MESH]|Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/*therapeutic use[MESH]|Canada[MESH]|Chronic Disease[MESH]|Cyclooxygenase 2 Inhibitors/therapeutic use[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Administration Schedule[MESH]|Drug Therapy, Combination[MESH]|Education, Medical, Continuing[MESH]|Family Practice/standards/trends[MESH]|Female[MESH]|Gastrointestinal Diseases/*chemically induced/*prevention & control[MESH]|Humans[MESH]|Male[MESH]|Prognosis[MESH]|Proton Pumps/therapeutic use[MESH]|Randomized Controlled Trials as Topic[MESH]|Risk Assessment[MESH]|Treatment Outcome[MESH] |
