[Are dyspepsia or gastroesophageal reflux predictive of serious digestive events during treatment with NSAIDs? How should they be treated?].

The prevalence of dyspepsia is high in the general population. Its incidence varies depending on the study and the definition chosen for dyspepsia. Treatment with NSAIDs increases the risk of dyspepsia. The absence of dyspepsia does not eliminate a potential serious GI event during treatment with an NSAID, and patients with dyspepsia do not have an increased risk of GI complications. What about gastro-oesophageal reflux? Symptoms of gastro-oesophageal reflux are frequent during treatment with an NSAID, but the NSAID-related gastro-oesophageal reflux-inducing effect has not been demonstrated. On the contrary, this causal relationship has been established in the occurrence and worsening of lesions of oesophagitis. From the standpoint of management, the existence of dyspepsia or gastro-oesophageal reflux before prescription of an NSAID should be treated and investigated if necessary (patient older than 50). In the event of chronic gastro-oesophageal reflux, endoscopy is necessary to screen for and treat oesophagitis before initiating treatment with NSAID. In case of dyspepsia or gastro-oesophageal reflux developing during treatment with an NSAID, endoscopy is not a systematic procedure to be performed in a first phase. It is indicated in case of non-response to a symptomatic therapy and in case of a GI lesion risk (patient older than 50).