Misoprostol and Nonsteroidal Anti-inflammatory Drugs: A Tale of Effects, Outcomes, and Costs
Authors: Joel S. Levine
Journal: Annals of Internal Medicine (1995)

Editorials15 August 1995Misoprostol and Nonsteroidal Anti-inflammatory Drugs: A Tale of Effects, Outcomes, and CostsJoel S. Levine, MDJoel S. Levine, MDUniversity of Colorado Health Sciences Center, Denver, CO 80262Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-4-199508150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Nonsteroidal anti-inflammatory drugs (NSAIDs) injure the mucosal lining of the stomach, causing a "gastroduodenopathy" of superficial erosions in the antrum and duodenum with occult gastrointestinal bleeding [1]. Dyspeptic symptoms are of little value in discriminating between patients with and without this gastropathy. Many epidemiologic studies have also documented an increased risk for perforation, obstruction, and overt gastrointestinal bleeding from larger chronic ulcers associated with NSAID use [2]. Physicians have had to balance these known unfavorable consequences of NSAIDs with their utility in treating painful inflammatory conditions.Casual observation suggests that many physicians and patients have concluded that the adverse outcomes ...References1. Weinstein WM. Differentiation of nonsteroidal anti-inflammatory drug-associated and "ordinary" peptic ulcers, pp 309-311. In: Soll AH, moderator. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease. Ann Intern Med. 1991; 114:307-19. Google Scholar2. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991; 115:787-96. Google Scholar3. Langman MJ. Ulcer complications and nonsteroidal anti-inflammatory drugs. Am J Med. 1988; 84(Suppl 2A):15-8. Google Scholar4. Arky R. Misoprostol—indications. Physician's Desk Reference. 49th ed. Montvale, NJ: Medical Economics Pr; 1995:2313. Google Scholar5. 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Roth SH, Tindall EA, Jain AK, McMahon FG, April PA, Bockow BI, et al. A controlled study comparing the effects of nabumetone, ibuprofen, and ibuprofen plus misoprostol on the upper gastrointestinal tract mucosa. Arch Intern Med. 1993; 153:2565-71. Google Scholar Author, Article, and Disclosure InformationAuthors: Joel S. Levine, MDAffiliations: University of Colorado Health Sciences Center, Denver, CO 80262Corresponding Author: Joel S. Levine, MD, University of Colorado Health Sciences Center, B-158, 4200 East Ninth Avenue, Denver, CO 80262. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMisoprostol Reduces Serious Gastrointestinal Complications in Patients with Rheumatoid Arthritis Receiving Nonsteroidal Anti-Inflammatory Drugs Fred E. Silverstein , David Y. Graham , John R. Senior , Helen Wyn Davies , Barbara J. Struthers , Richard M. Bittman , and G. 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