Strategies for preventing NSAID-induced ulcers

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce gastroduodenal prostaglandin mucosal concentrations, resulting in the loss of a major mechanism for protection against mucosal injury. In endoscopic clinical research studies of patients who take NSAIDs, the incidence of new gastric ulcers ranges from 10% to 20% and the incidence of duodenal ulcers ranges from 4% to 10% during the first 3 months of NSAID use. Misoprostol appears to be superior to both ranitidine and sucralfate for the prevention of gastric ulcers and as effective as ranitidine and sucralfate in preventing duodenal ulcers. In patients with NSAID-induced gastric ulcers in whom NSAIDs cannot be stopped, omeprazole is considerably more effective than ranitidine for ulcer healing.