NSAID-associated ulcers: prevention and management in the personalized-medicine era

Non-steroidal anti-inflammatory drugs (NSAID) are a group of medications that provide analgesic effect and decrease inflammatory processes associated with a number of diseases, including rheumatologic, neurologic, musculoskeletal and orthopedic disorders. Traditionally NSAID can be classified according to their mechanism of action into selective cyclooxigenase-2 inhibitors and non-selective inhibitors. Acetylsalicylic acid (ASA) share properties with NSAID, but also exert platelet antiagregant effect, and has been used for many years as prophylactic agents for ischemic heart and cerebral diseases. Their main mechanism of action is by inhibition of prostaglandin synthesis, and both NSAID and ASA are associated with a number of side effects related to their mechanism of action, including liver and renal damage, but mainly gastrointestinal toxicity by a combination of topical effect and diminished production of gastric mucus and bicarbonate, as well as dysbiosis-associated intestinal inflammatory changes. Prevention includes judicious use of low-grade gastrointestinal toxicity agents, at the lowest therapeutic dosage, and in case of overt damage, treatment directed toward involved pathophysiologic mechanism, with gastric antisecretory drugs, or mucosal-protecting agents.