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Pathophysiology of NSAID‐induced gastroduodenal damage: epidemiology and mechanisms of action of therapeutic agents

All NSAIDs cause gastroduodenal mucosal damage. The mechanisms by which NSAIDs damage the mucosa are not fully understood. Peptic ulcers appear to be caused by an imbalance between acid output and mucosal resistance; therapeutic agents that act favourably on either variable will heal NSAID‐induced ulcers, particularly if the NSAID is discontinued. Inhibition of acid secretion and/or stimulation of prostaglandin secretion are also believed to have a protective effect against NSAID‐induced mucosal damage. Thus, antisecretory agents, such as the H2 blockers, and prostaglandin analogues, such as misoprostol, can provide protection against NSAID‐induced gastroduodenal damage.