Prevention and non-invasive therapy of gastrointestinal disorders: saving lives by a science based approach to NSAIDs

ABSTRACT

During the last 15 years management of patients who need to take non-steroidal anti-inflammatory drugs [NSAIDs] has been revolutionised by the availability,for co-prescription of prostaglandin analogues such as misoprostol or proton pump inhibitors and by the emergence of selective inhibitors of the inducible cyclo-oxygenase [COX]-2 enzyme. This paper describes work mainly from the Division of Gastroenterology [now Wolfson Digestive Diseases Centre], that investigated numerous strategies in acute and/or explanatory studies before evaluating their effectiveness in large patient studies with endoscopy or clinical outcome as an endpoint. The data show, contrary to common pre-conception, that acute changes are highly predictive of patient outcomes. It seems likely that some strategies that were never evaluated in patient studies would be effective