Goldstein, Jay L & Cryer, Byron. “Gastrointestinal Injury Associated with NSAID Use: A Case Study and Review of Risk Factors and Preventive Strategies,” Drug, Healthcare, and Patient Safety, 22 January, 2015 ,1–36


The proliferations or the increase in pain management in the clinical scenario in the real life situation in the United States of America is the result in increased use of nonsteroidal anti-inflammatory drugs to manage pain. Most adults in the United States take NSAID at least three times a week for three months period. Its use has increased by 2010 according to the National Health Interview Survey (NHIS) conducted that found 12.8% of adults in the United States taking NSAID at least three times a week for three months that represents an increase  of over 40% compared with the results of similar interview conducted in 2005. In the telephone interview conducted by survey, 26% of OTC NSAID users take more than the recommended dose for these drugs.

            The use of NSAID has been associated with cardiovascular (CV), renal, and gastrointestinal (GI) complications. Due to individual’s medical condition or resistance, certain patients are at increased risk of the above phenomena. Its use results in small, but its consistent use has increased in cardiovascular events such as the myocardial infarction, affected in part by dose and potency of cyclooxygenase-2 (COS-2) inhibition. Its use has also long been associated with kidney disease resulting in both acute and chronic impairment of kidney function. These complications prompted the U.S Food and Drug Administration (FDA) to release a scientific statement in 2005 emphasizing the importance of using the lowest effective dose for the shortest duration possible if treatment with NSAID is warranted for an individual patient. People who use NSAID drugs have various symptoms such as reflux, belching, bloating, and /or nausea compared with nonusers; however, these symptoms do not reliably indicate the presence of significant upper GI mucosal injury which includes ulcers, bleeding, and perforation, obstruction, and extension erosions. GI complications commonly develop with no clinical warning symptoms suggestive of ulcers or bleeding. NSAID users with upper GI bleeding or perforation exhibit a high mortality rate from these injuries compared with nonusers with comparable clinical scenarios.

            The rate of lower GI complications resulting from NSAID use has not been as widely documented as that of upper GI damage, but such complications have been recognized for decades. The injuries include bleeding in the large and small bowel, or exacerbation of existing illnesses such as inflammatory bowel disease. While the incidence of lower GI injury associated with NSAID is somewhat lower than that of upper GI injury, results from a 2003 perspective study of rheumatoid arthritis patients found that 0.9% of patients taking naproxen 500 mg twice daily developed serious lower GI complications over a year period. In conclusion, the risk of NSAID-associated GI complications is dose dependent and remains linear over time, based on the results of randomized controlled trials.


The issue of pain management in the United States and around the world by patients who have pre-medical conditions or who might have gotten injured in the workplace as the result of an accident has influenced the periodical overdose of nonsteriodal anti-inflammatory drugs both prescriptive or over the counter. The periodical intake and overdoses of these medications is due to the pain experienced by these patients; however, the pain experienced by patients does not warrant the patients to overdose themselves as the result of its adverse effects it has on patients who take them periodically or abuse them. The fact that the drugs have fatal or mortality effects as the result of the upper and lower gastrointestinal effects the drugs cause on the human body, warns patients to be mindful how these drugs are taking with respect to frequency and quantity. Cardiovascular, renal, and gastrointestinal conditions are not cheap to treat medically because it costs the individual finance, pain, and even death.


The case study conducted by the medical community of the United States through telephone survey and interview to find out the side or adverse effects of nonsteriodal anti-inflammatory drugs have on the human body is the preventive step taken to save people from death. Has not the medical community done this survey and case study, these factors of the drugs would not have been discovered; therefore, people would overdose themselves with such drugs because they want their pain to go away not knowing the fatal effects of the drugs when overdose is imminent. Unfortunately, some people have not gotten this information; therefore, they are at risk to develop these conditions due to frequent taking and overdose these medications.