Curriculum · Gastroenterology
Gastroprotection with NSAID therapy
What it is
The question in a patient taking aspirin or an NSAID is whether a proton pump inhibitor is needed, and what to do once an ulcer has already appeared or bled.
Causes and risk
High risk means a history of PUD or UGI bleeding; dual antiplatelet therapy, anticoagulation, or glucocorticoid therapy; or age 60 years and above. Counted another way, the risk factors for peptic ulcers from NSAID use are older age, use of high-dose NSAID, use of aspirin, anticoagulants or corticosteroids, and a history of ulcer. No risk factors is low risk, 1 or 2 risk factors is moderate risk, and more than 2 risk factors, or a history of previous complicated ulcer, is high risk.
How it is diagnosed
Test for H. pylori and stop NSAIDs. Duodenal ulcers carry little risk of malignancy and do not require biopsy unless they are refractory to therapy.