[Current state of treatment and prevention of gastroduodenal side effects of non-steroidal antirheumatic drugs].

In spite of optimized antirheumatic treatment, NSAID-related mucosal lesions ranging to bleeding ulcers occur mainly in the stomach and less frequently in the duodenum. With continued NSAID therapy, overt mucosal lesions can be treated with Omeprazol or H2 blockers. The efficacy of these medications may be correlated with their acid-inhibiting potency. Antacids have not as yet been sufficiently tested for this indication. Although prostaglandin derivatives are effective, in high doses they may cause diarrhea. Despite their good efficacy, they should therefore not be employed as a first choice for this indication. NSAID-induced mucosal lesions "owe" their development to local iatrogenic prostaglandin deficiency. Through co-medication with Misoprostol in low dosage, NSAID mucosal lesions and ulcers are prevented without the occurrence of significant undesirable Misoprostol effects. H2 antagonists and Omeprazol have a protective effect on the mucosa solely in the duodenum. Antacids have not as yet been tested successfully for this indication either. Elderly patients with a medical history of ulcers frequently develop silent NSAID ulcers. Any NSAID therapy necessary for these high-risk patients should therefore always be accompanied by at least a sufficient mucosal protection therapy.