Non‑steroidal anti‑inflammatory drugs (NSAIDs) markedly increase the risk of ulcer exacerbation, gastrointestinal bleeding, perforation, and obstruction in patients with existing peptic ulcer disease.
NSAIDs can precipitate serious GI complications in ulcer disease.
COX‑2 selective agents reduce but do not eliminate risk; gastro‑protection is still required.
Discontinue NSAIDs promptly at the first sign of GI bleeding.
Regular endoscopic surveillance may be warranted for chronic ulcer patients on any NSAID.
NSAIDs inhibit cyclo‑oxygenase‑1 (COX‑1), reducing prostaglandin synthesis that normally maintains gastric mucosal blood flow, mucus, and bicarbonate secretion. The loss of these protective factors makes the ulcerated mucosa more susceptible to acid injury, impairs healing, and predisposes to bleeding.
Risk of ulcer enlargement, re‑bleeding, perforation, and gastric outlet obstruction. Potential for life‑threatening upper GI hemorrhage. May mask symptoms of ulcer complications, delaying diagnosis.
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