NSAID Induced Ulcer

Risk factors for NSAID ulcer:

  • – H/o complicated ulcer
  • – Use of multiple NSAID (including aspirin,cox-2 inhibitor)
  • – High dose NSAID
  • – Concomitant anticoagulant use
  • – H/O uncomplicated ulcer
  • – Age >70 years
  • – H.pylori infection
  • – Use of glucocorticoid

Patients receiving NSAID can be stratified according to their level of GI risk

          Low ulcer risk : If there is no risk mentioned above

          Moderate ulcer risk: If there is 1-2 risk mentioned above

          High ulcer risk:

  •       – > 3 risk factors
  •       – Prior complicated ulcer
  •       – Concomitant use of low dose aspirin/anticoagulant
  • High cardiovascular risk:
  •       – Denotes the requirement for prophylactic low dose aspirin for primary/secondary prevention of serious CV events
  • Endoscopic Ulcer:
  • Circumscribed mucosal defect having a diameter of 5 mm or more with a perceivable depth
  •     – H.pylori ulcer do not need prophylaxis if the organism can be eradicated from the stomach
  •     – Most use of ulcer prophylaxis regimen is related to prevention of NSAID ulcer in patients at moderate to high ulcer risk
  •    – Patients taking low dose aspirin as primary/secondary cardiovascular prophylaxis should not take ibuprofen as ibuprofen attenuate action of aspirin. These patients should be treated by Naproxen with PPI. Aspirin should be continued.


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