A guideline for the treatment and prevention of NSAID-induced ulcers

Abstract

Guidelines for clinical practice are intended to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind, placebo-controlled studies are preferable, but compassionate use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject without regard to specialty training or interests and are intended to indicate the preferable, but not necessarily the only, acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been intensely reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of their production based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity.

In vivo anti-ulcer, anti-stress, anti-allergic, and functional properties of Gymnemic Acid Isolated from Gymnema sylvestre R Br

“…The negative control group showed a 9.7 ± 0.03 ulcer index, which happened due to the inhibition of prostaglandin synthesis, which is essential for mucosal integrity and regeneration, followed by reduction in mucosal blood flow and a consequent generation of ulcer [50]. The aqueous extract at all doses provided dose dependent protection and doses of 150 mg/kg and 200 mg/kg provided significant protection (89% and 100%, p < 0.05) when compared with the negative control (Table 5).…”

Potential drug interactions and duplicate prescriptions among ambulatory cancer patients: a prevalence study using an advanced screening method

“…These combinations are known to increase the gastrointestinal bleeding risks [16,17]. Because of the potentially severe consequences we classify all GI-interactions as major.…”

Non-Steroidal Anti-Inflammatory Drugs: An Overview of Cardiovascular Risks

“…With this low absolute risk increase, the number needed to treat with aspirin to cause one major gastrointestinal bleeding is 833. Strategies for the prevention of aspirin associated gastrointestinal bleeding should therefore be targeted at high-risk patients, such as patients with previous gastro-intestinal bleeding, age over 60 years, concomitant use of corticosteroids, non-aspirin NSAIDs, anticoagulants, other platelet inhibitors and serotonin reuptake inhibitors, infection with Helicobacter pylori , and co morbid conditions such as diabetes mellitus, heart failure, and rheumatoid arthritis [14,15]. …”

“…Most NSAID users with subjective symptoms show no endoscopic gastro duodenal damage, while up to 58% of patients who present with life threatening NSAID ulcer complications did not have prodromal symptoms [28]. Risk factors for the development of gastro duodenal ulcers are the same as for aspirin, the risk being higher with higher dosage of NSAIDs [14,15]. Much research has been done on preventive strategies for the development of NSAID related gastro duodenal toxicity.…”