Gastroduodenal Mucosal Injury by Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastric mucosal injury through multiple pharmacological effects (local and systemic) on mucosal defence. Although many factors contribute to mucosal defence, the most consistent and well studied effect of NSAIDs on the mechanisms of mucosal defence is the inhibition of prostaglandin generation. It is known that normal gastric mucosa has the ability to adapt to repeated administration of NSAIDs despite distinct evidence of mucosal injury after single administration. Nevertheless, the high incidence of mucosal injury in patients who are on long term NSAID therapy should not be overlooked, since gastroduodenal injury by long term use is associated with bleeding or perforation, both of which are serious complications. Among several factors responsible for mucosal defence, the role of epithelial renewal is discussed.