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Gastrointestinal safety of NSAIDs and over-the-counter analgesics?It is well recognised that they may adversely cause damage throughout the gastrointestinal tract and aggravate pre-existing disease.Their side effects on the upper gastrointestinal tract can be assessed by various means; each study type has different clinical connotations.Short-term use (less than 14 days) demonstrates dose-dependent damage of prescribed NSAIDs; the damage is proportional to the acidity of the drugs and not seen with Cyclooxygenase-2 (COX-2) selective inhibitors that have a pKa over 7.0.I Bjarnason?

Gastrointestinal safety of NSAIDs and over‐the‐counter analgesics‏

I Bjarnason‏
International Journal of Clinical Practice
Non‐steroidal anti‐inflammatory drugs (NSAIDs) are widely used. It is well recognised that they may adversely cause damage throughout the gastrointestinal tract and aggravate pre‐existing disease. Their side effects on the upper gastrointestinal tract can be assessed by various means; each study type has different clinical connotations.
Short‐term use (less than 14 days) demonstrates dose‐dependent damage of prescribed NSAIDs; the damage is proportional to the acidity of the drugs and not seen with Cyclooxygenase‐2 (COX‐2) selective inhibitors that have a pKa over 7.0. There have not been any serious outcomes, such as bleeding or perforation in these studies, and Helicobacter pylori (HP) plays no role in this damage. Long‐term (3 months or more) endoscopy studies in patients show ulcer rates from 15%–35% with the various NSAIDs, but serious outcomes are exceedingly rare.
There are recent studies to suggest that OTC NSAIDs should be taken on a fasting stomach, not with food as commonly advocated.