The gastrointestinal (GI) toxicity of non-steroidal anti-inflammatory drugs (
NSAIDs) is well recognized. Risk factors for
NSAIDs-related GI toxicity includes advanced age, generalized disease, past history of
peptic ulcer, concomitant use of
steroid, duplicated use of various
NSAIDs. The guidelines recommended using a
proton pump inhibitor or a
prostaglandin for the treatment and prevention of
NSAIDs-related GI toxicity. The updated guideline added
cyclooxygenase-2 (COX-2) selective inhibitors, which have demonstrated equivalent efficacy to nonspecific
NSAIDs in the management of
arthritis and
pain, to the prevention strategy. Several large, randomized, clinical trials compared the rates of serious GI events in patients taking COX-2 selective inhibitors and nonspecific
NSAIDs but came to different conclusions. More recently, the overall safety profile of COX-2 selective inhibitors and traditional
NSAIDs has come under intense debate especially due to the recently shown cardiovascular risk of COX-2 selective inhibitors. Therefore, it is essential to determine the actual risk of GI toxicity with COX-2 selective and traditional
NSAIDs alone or combined with other compounds from independent Japan studies.