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Canadian Journal of Gastroenterology
Volume 16, Issue 4, Pages 231-240
Hot Topics in Gastroenterology

Recommendations for the Appropriate Use of Anti-Inflammatory Drugs in the Era of the Coxibs: Defining the Role of Gastroprotective Agents

Richard H Hunt,1 Alan N Barkun,2 David Baron,3 Claire Bombardier,4 Ford R Bursey,5 John R Marshall,1 David G Morgan,6 Pierre Paré,7 Alan BR Thomson,8 and J Scott Whittaker9

1Division of Gastroenterology, Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada
2Division of Gastroenterology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
3Division of Gastroenterology, Department of Medicine, North York General Hospital, Toronto, Ontario, Canada
4Toronto General Hospital Research Institute, Toronto, Ontario, Canada
5Division of Gastroenterology, Department of Medicine, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada
6Division of Gastroenterology, Department of Medicine, Hamilton Health Sciences Corporation – Henderson Hospital, Hamilton, Ontario, Canada
7Division of Gastroenterology, Department of Medicine, Centre Hospitalier Affiliated Universitaire of Quebec, Laval University, Quebec, Quebec, Canada
8Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
9Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada

Received 23 October 2001; Accepted 20 February 2002

Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Treatment with anti-inflammatory drugs and the analgesic efficacy of conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are compromised by a two- to fourfold increased risk of gastrointestinal complications. This increased risk has resulted in an increasing use of the new selective cyclooxygenase-2 inhibitors or coxibs, which, in clinical trials and outcomes studies, reduced gastrointestinal adverse events by 50% to 65% compared with conventional NSAIDs. However, the coxibs are not available to all patients who need them, and NSAIDs are still widely used. Moreover, treatment with a coxib cannot heal pre-existing gastrointestinal lesions, and cotherapy with an anti-secretory drug or mucosal protective agent may be required.

This paper addresses the management of patients with risk factors for gastrointestinal complications who are taking NSAIDs and makes recommendations for the appropriate use of ‘gastroprotective’ agents (GPAs) in patients who need to take an NSAID or a coxib. When economically possible, a coxib alone is preferable to a conventional NSAID plus a GPA to minimize exposure to potential gastrointestinal damage and avoid unnecessary dual therapy. Patients at high risk require a GPA in addition to a coxib.