Nonsteroidal Anti-inflammatory Drug-related Gastrointestinal Bleeding in the Elderly

SUMMARYNonsteroidal anti-inflammatory drug (NSAID) could induce gastrointestinal (GI) injury by way of topical (mucus, gastric acid and drug interaction) and systemic mechanism (decreased prostaglandin synthesis). Compared with non-NSAID users, elderly taking NSAID or aspirin have a higher chance than younger people of developing GI bleeding (5.5-fold vs. 1.65-fold). Endoscopy is the best tool to identify the source and severity of ulcer with bleeding. The use of NSAID or aspirin should be weighed carefully in elderly who have a history of peptic ulcer. If necessary, it is better to choose cyclooxygenase-2 inhibitor since it has been reported that the drug has less than half the risk of non-selective NSAID to ignite GI complications. Eradication of Helicobacter pylori might reduce ulcer risk in new NSAID users, but not in patients with long-term therapy. Proton pump inhibitor is the drug of choice that is effective for both treatment and prevention (taken together with NSAID) of NSAID-related GI bleeding.