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Although traditional non-steroidal anti-inflammatory drugs (tNSAIDs) have been recognised to have adverse effects throughout the gastrointestinal (GI) tract, emphasis has historically centred on reducing their upper GI ulcerogenic effects.1 Randomised trials and systematic reviews have shown that misoprostol and proton pump inhibitors (PPIs) are effective at reducing the risk of tNSAID-related upper GI toxicity. The tNSAID+PPI strategy emerged as the preferred strategy for several reasons including a favourable side effect profile. Over the last 10 years, the focus has shifted towards using cyclooxygenase-2 (COX-2) inhibitors alone as another effective strategy to reduce upper GI toxicity. COX-2 inhibitors, however, have been associated with other adverse effects, and many have been withdrawn from various markets.1 Chan …
Competing interests AR has participated in an Ad board for Astra Zeneca.