What's new in steroid and nonsteroid drug effects on gastroduodenal mucosa?

A survey is given on the damaging effect of acetylsalicylic acid, other nonsteroidal antiinflammatory drugs and corticosteroids on the gastroduodenal mucosa. The results of blood loss studies and endoscopic investigations are reviewed. Also, the histologic aspects of such damage are discussed. Modern concepts of the pathophysiology of these lesions stress the cytoprotective role of endogenous prostaglandins. Epidemiologic data strongly support an association between frequent and heavy intake of acetylsalicylic acid and gastric ulcer as well as gastrointestinal bleeding, whereas the association with duodenal ulcers is far less clearly established. Conclusive evidence is currently unavailable proving the superiority of other nonsteroidal antiinflammatory drugs in this regard. The ulcerogenic potency of corticosteroids at least in the small or medium dose range probably has been overstated in the past. Intensive ulcer therapy making use of H2 receptor antagonists often allows healing of small ulcers with a diameter up to 1 cm despite continued treatment with low dose corticosteroids or nonsteroidal antiinflammatory drugs, whereas continuation of these drugs is associated with very poor healing in ulcers larger than this size. The danger of perforation has to be taken into consideration.