ABSTRACT
As, combination of misoprostol or PPIs plus NSAIDs or use of safer NSAIDs, including COX-2 inhibitors, may reduce the gastrointestinal complication associated with NSAIDs therapy. We aimed to demonstrate: the safest drug, risk factors, and plan of avoidance Fifty patients with rheumatological and cardiovascular indications for NSAIDs classified into: twenty patients treated by NSAIDs alone, fifteen patients treated by NSAIDs and proton pump inhibitors [used for a week every month of treatment course], and fifteen patients treated by anti COX2. Involved in this study, subjected to careful clinical examinations, upper endoscopies, with stress on the possible risk factors exaggerate gastrointestinal complication of NSAIDs. In hypertension, bronchospasm, and allergies there were no significant difference between patients treated by NSAIDs, NSAIDs plus PPIs, or Anti COX2. Heartburn was; 50%, 26.6%, and 33.3% in group 1, 2, and 3 respectively, GIT hemorrhage; 25%, 13%, and 6.6 for group 1, 2, and 3 respectively. With observation of higher percentage of heartburn, and GIT hemorrhage among patients treated by NSAIDs alone which was double this percentages observed among group treated by NSAIDs plus PPIs [addition of PPIs reduce GIT complications to the half]. However patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Only one case of death among group 1. In endoscopic examination there were noticed higher percentages of oesophagitis, gastritis, and peptic ulcer among patients treated by NSAIDs alone which were double this percentages noticed among group treated by NSAIDs plus PPIs [addition of PPIs reduce HCL related complications to the half]. However, deudenitis, cardiac incompetent, congestive gastropathy, and abnormal pylorus shown no significant difference between group 1, and 2. Patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Addition of PPIs with NSAIDs reduces GIT complications to the half as PPIs reduce HCL related complications. However, Patients treated by Anti COX2 shown reduction in GIT manifestation and HCL related complications by three folds. By further economical study for cost benefit from combined therapy versus Anti COX2