Introduction In part 2 of this Non-Steroidal Antiinflammatory Drugs (NSAIDS) review, we’ll review the risk of gastrointestinal complications.
In part 2 of this Non-Steroidal Antiinflammatory Drugs (NSAIDS) review, we’ll review the risk of gastrointestinal complications. In our previous article , we discussed cardiovascular disease and NSAID use. Here we will review gastrointestinal complications.
As discussed previously, NSAIDS are one of the most commonly used drugs in the world and their use is increasing in the US and globally. In 2013, NSAIDs had accounted for more than 70 million prescriptions and 30 billion over-the-counter purchases [ 1 ]. Sports medicine physicians should be cognizant of potential complications, especially gastrointestinal toxicity.
Awareness can lead to better prescribing practices and increased safety for at-risk patients.NSAIDS cause gastrointestinal injury by reducing availability of the prostaglandin substrates leading to mucosal injury. Inhibiting COX-1 blocks “production of prostaglandins that play an important protective role in the stomach by increasing mucosal blood flow and stimulating the synthesis and secretion of mucus and bicarbonate, as well as promoting epithelial proliferation” [ 2 ]. This leaves the gastrointestinal mucosa vulnerable to acid secretion, digestive enzymes and acidic diet which all contribute the development of gastrointestinal complications from NSAID use.
COX-2 mediated prostaglandin inhibition primarily targets the anti-inflammatory cascade of the prostaglandin cycle, sparing COX-1 inhibition and reducing the risk of GI toxicity. This lead to the development of selective COX-2 inhibitors such as celecoxib. Although many athletes may not be at high risk of GI complications, many patients with orthopedic injuries or illness are.
In one study of patients with osteoarthritis, 86.6% were at increased risk of GI toxicity and 22.3% were at high risk. Evaluation of GI risk includes determination of the presence of well-known risk factors such as age greater than 60, severe illness, H. Pylori infection, previous history of GI bleeding, complicated or uncomplicated peptic ulcer and/or GI symptoms (dyspepsia), high risk surgical history including bariatric procedures, the use of high-dose NSAIDs, the combination of two NSAIDs including low-dose aspirin, or the concomitant use of NSAIDs and anticoagulants or corticosteroids [ 3 , 4 ].
If you are experiencing symptoms that may be related to nsaids and gastrointestinal complications, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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