NSAIDs - How to prevent GI bleed?

NSAIDs - How to prevent GI bleed?


I saw a young man today with likely ankylosing spondylitis. I started him on NSAIDs. He told me that he suffers from reflux, this brings up a question, how can I reduce the GI side effect?

How does it work ? (This is to remind myself, I seriously can't remember)

Key points:

1. No one NSAID is safer another. 

2. Use low dose NSAIDs for the shortest time possible. 

3. COX-2 NSAIDs seem to have less GI side-effects

4. Co-infection of H. Pylori and the use of NSAIDs increase the risk of GI ulcer by 60 folds and bleeding by 6 folds. 

5. Other drugs which can increase bleeding risks include: anti platelets, anti coagulants, anti depressants, corticosteroids, cigarette, smoking and excessive ETOH consumption.

6. Some other risk factors of GI bleed: 

7. Consider the use of PPI in high risk groups: 

Reference:

Australian therapeutic guideline