The three therapeutic goals in patients with
NSAID-induced gastroduodenopathy are treatment of dyspeptic symptoms, management of
NSAID-related
ulcers and their complications, and prophylaxis against recurrent gastrointestinal toxicity. Both H(2)-receptor antagonists and
proton pump inhibitors (PPIs) appear to be helpful in relieving the symptoms associated with
NSAID use, while treatment of
NSAID-induced
gastroduodenal ulcers, whether the
NSAID is continued or not, is best achieved by the use of PPIs. However, because symptoms do not often predict the presence of
gastroduodenal ulcers, the goal of prevention has become paramount in the treatment of patients with an increased likelihood of gastrointestinal toxicity. The best prophylaxis against
NSAID-related toxicity is the use of an alternative agent such as
salsalate or
paracetamol (
acetaminophen). However, if an
NSAID is to be used, prophylaxis is best accomplished with a PPI or
misoprostol, a
prostaglandin E1 analogue. The use of
misoprostol is limited by its frequent dosing, at least 200 microg three times a day, and its own gastrointestinal side effects. Future
therapy will include
NSAIDs that maintain their antiinflammatory effects, while possessing superior safety profiles, and include preferential and highly selective
COX-2 inhibitors and
nitric oxide releasing compounds.