Inappropriate Prevention of NSAID-Induced Gastrointestinal Events Among Long-Term Users in the Elderly
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REVIEW ARTICLE
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Inappropriate Prevention of NSAID-Induced Gastrointestinal Events Among Long-Term Users in the Elderly Angel Lanas and Angel Ferrandez Service of Digestive Diseases, University Hospital, Instituto Aragones de Ciencias de la Salud (CIBER HEPAD), University of Zaragoza, Zaragoza, Spain
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 2. Gastrointestinal (GI) Symptoms and Lesions Related to NSAID Use in the Elderly . . . . . . . . . . . . . . . . 123 3. Prevention of NSAID-Induced GI Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 3.1 Prevention of GI Bleeding Induced by Short-Term versus Long-Term NSAID Use . . . . . . . . . . . . . 126 4. Inappropriate Prevention of NSAID-Induced GI Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 4.1 Unnecessary Prevention of NSAID-Induced GI Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 4.2 Inadequate Prevention of NSAID-Induced GI Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Abstract
Although use of NSAIDs and aspirin (acetylsalicylic acid) is well known to be associated with gastrointestinal (GI) complications and potential mortality, these medications continue to be widely prescribed in the elderly. Age is a significant risk factor for NSAID-induced GI events; indeed, patients >75 years of age carry the highest risk and are similar in this respect to patients with a history of peptic ulcer. Prevention of NSAID-induced gastropathy is indicated in patients at risk. It is accepted that patients >60 years of age taking NSAIDs should participate in prevention strategies such as co-therapy with proton pump inhibitors (PPIs) or misoprostol, or use of cyclo-oxygenase (COX)-2 selective NSAIDs (also called coxibs). Although up to 33% of subjects with no risk factors who receive NSAIDs over-utilise GI preventive therapies, under-utilisation of gastroprotective therapy is more prevalent among those with risk factors, of which the most frequent is age. At least half of those at risk do not receive appropriate preventive therapy, either because they do not receive co-therapy with PPIs or misoprostol or are not treated with COX-2 selective NSAIDs, or because they receive co-therapy with antacids or histamine H2 receptor antagonists, which are not effective. Adherence to the prescribed preventive therapy is an additional problem for those who are prescribed a P
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