International Journal of Gerontology
Volume 1, Issue 1 , Pages 40-45, March 2007

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

  • Shou-Chuan Shih

      Affiliations

    • Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Shou-Chuan Shih, Division of Gastro-enterology, Department of Internal Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan
    • ,
  • Chen-Wang Chang

      Affiliations

    • Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

Accepted 12 December 2006.

Article Outline

SUMMARY 

Nonsteroidal 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.

Key Words:  elderly , GI bleeding , NSAID

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PII: S1873-9598(08)70022-X

doi:10.1016/S1873-9598(08)70022-X

International Journal of Gerontology
Volume 1, Issue 1 , Pages 40-45, March 2007

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