Non-Steroidal Anti-Inflammatory Drugs and Gastrointestinal Risk

Non-steroidal anti-inflammatory drugs (NSAIDs) are used successfully to alleviate pain and inflammation in somatic musculoskeletal pain disorders. To this end, they inhibit the paracrine synthesis of prostaglandins (PGs), which induce pain while also having house-keeping effects. The COX-1 isoenzymes and the inducible COX-2 enzyme are available for PG synthesis in an organism. Inhibition of COX-1, followed by decreasing PG levels, leads to gastrointestinal side-effects affecting the GI mucosa. Unlike traditional NSAIDs, coxibs selectively inhibit COX-2, thereby causing fewer gastrointestinal problems. Co-medication with proton-pump inhibitors or a synthetic PG analogue also leads to a lower ulcer rate. Other non-PG-dependent mechanisms protect the mucosa. They also may be disrupted by NSAIDs.