GI-bleeding and ulceration can occur with NSAID use. The risk of serious upper GI side-effects varies between individual NSAIDs. Whenever possible, the NSAID should be withdrawn if an ulcer occurs.
Patients at high risk of developing GI complications with a NSAID include those over 65 years, those with a history of peptic ulcer disease or serious GI complication, those taking other medicines athat increase the risk GI side-effects, or those with serious co-morbidity (e.g. cardiovascular disease, diabetes, renal or hepatic impairment).
In a patient who has developed an ulcer, if the NSAID can be discontinued, a proton pump inhibitor usually produces the most rapid healing. On healing, patients should be tested for H.pylori and given eradication therapy if indicated.