NSAIDs: New Approaches to Limiting Gastropathy

An extensive literature search on non-steroidal anti-inflammatory drug (NSAID)-induced gastropathy in rheumatic conditions has been carried out. A reduced incidence of gastropathy has been observed among newly developed NSAIDs such as etodolac and the non-acidic nabumetone. An alternative prophylactic therapy to avoid NSAID-induced gastroduodenal mucosal damage which has been successfully tested in several trials is co-medication with the prostaglandin analogue misoprostol. The cytoprotective agent sucralfate also appears to be effective. Recent observations of Campylobacter pylori infections in NSAID-induced gastropathy introduces the question as to whether simultaneous antibacterial medication should be routinely administered during NSAID therapy. At present the invasive technique of endoscopy is used to ascertain gastroduodenal mucosal damage. However, a new technique which merely requires blood sampling is being investigated. This involves measurement of serum levels of the precursor molecules for the gastric enzyme pepsin, pepsinogen I and II. In future this assay could constitute a non-invasive method for detecting gastroduodenal mucosal damage.