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I read with interest the article on ulcer prevention in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs) by Graham et al.¹ As the authors note, studies are needed to test whether a proton pump inhibitor can prevent life-threatening ulcer complications in long-term users of NSAIDs. They state that the ideal study should compare a proton pump inhibitor with or without low-dose misoprostol vs placebo, although such studies are unlikely to be realized if the cyclooxygenase 2 inhibitors prove to eliminate life-threatening NSAID ulcer complications. In this respect, further studies might be of interest. Aspirin and several other NSAIDs are weak acids that cross the mucosa in their lipid state. The suppression of acid production reduces the lipophilic nature of these drugs and, theoretically, might reduce their absorption and bioavailability. I wonder if there is need for concern that concurrent administration of a proton pump inhibitor with low- or very low-dose . . . [Full Text of this Article]

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RELATED ARTICLE

Ulcer Prevention in Long-term Users of Nonsteroidal Anti-inflammatory Drugs: Results of a Double-blind, Randomized, Multicenter, Active- and Placebo-Controlled Study of Misoprostol vs Lansoprazole
David Y. Graham, Naurang M. Agrawal, Donald R. Campbell, Marian M. Haber, Cyndy Collis, Nancy L. Lukasik, and Bidan Huang
Arch Intern Med. 2002;162(2):169-175.
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