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Misoprostol and Nonsteroidal Anti-inflammatory Drugs: A Tale of Effects, Outcomes, and Costs

Joel S. Levine, MD
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University of Colorado Health Sciences Center, Denver, CO 80262 Requests for Reprints: Joel S. Levine, MD, University of Colorado Health Sciences Center, B-158, 4200 East Ninth Avenue, Denver, CO 80262.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(4):309-310. doi:10.7326/0003-4819-123-4-199508150-00010
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Nonsteroidal anti-inflammatory drugs (NSAIDs) injure the mucosal lining of the stomach, causing a “gastroduodenopathy” of superficial erosions in the antrum and duodenum with occult gastrointestinal bleeding [1]. Dyspeptic symptoms are of little value in discriminating between patients with and without this gastropathy. Many epidemiologic studies have also documented an increased risk for perforation, obstruction, and overt gastrointestinal bleeding from larger chronic ulcers associated with NSAID use [2]. Physicians have had to balance these known unfavorable consequences of NSAIDs with their utility in treating painful inflammatory conditions.

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