Treatment and secondary prevention of NSAID-induced ulcers

To treat a nonsteroidal anti-inflammatory drug (NSAID)-induced ulcer, stop the NSAID (if possible) and give a proton pump inhibitor (PPI) for 8 to 12 weeks. If the NSAID must be continued, PPI therapy will still be effective for healing. Suitable regimens are:

1esomeprazole 20 mg orally, daily esomeprazole esomeprazole esomeprazole

OR

1lansoprazole 30 mg orally, daily lansoprazole lansoprazole lansoprazole

OR

1omeprazole 20 mg orally, daily omeprazole omeprazole omeprazole

OR

1pantoprazole 40 mg orally, daily pantoprazole pantoprazole pantoprazole

OR

1rabeprazole 20 mg orally, daily. rabeprazole rabeprazole rabeprazole

If Helicobacter pylori is detected in a patient with an NSAID-induced ulcer, both risk factors should usually be addressed; see First-line H. pylori eradication therapy in adults for treatment regimens.

For secondary prevention of NSAID-induced ulcers, no strategy adequately prevents ulcer recurrence, so NSAIDs should be avoided wherever possible. If ongoing NSAID therapy is required:

  • for patients with H. pylori infection, H. pylori eradication therapy is appropriate; however, PPIs are still needed thereafter to reduce the risk of recurrent bleeding; see Maintenance therapy after H. pylori eradication therapy in adults
  • the combination of a COX-2–selective NSAID and a PPI appears to give most protection from recurrent ulceration. Other options are a COX-2–selective NSAID alone or a combination of a nonselective NSAID and a PPI
  • for patients taking low-dose aspirin, see Low-dose aspirin and peptic ulcers.