Management of NSAID-associated upper gastrointestinal problems.

To describe risk factors and review appropriate management strategies for patients who experience nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) adverse events. NSAIDs are the most heavily prescribed class of drugs. Their association with gastrointestinal events has been known for many years. Often presenting with little warning, serious GI events can be life-threatening. Primary care clinicians can and should prevent these events and manage symptoms before they progress to serious problems. Risk factors, including increasing age, presence or history of GI ulceration/bleed, and concomitant medications, are well known. Clinicians may be less familiar with the impact of multiple NSAID use (including low-dose aspirin), or Helicobacter pylori infection. Use of gastroprotective agents can prevent serious complications. Familiarity with risk factors, use of appropriate interventions, and careful monitoring can prevent serious, life-threatening GI problems.