The correlation between prolonged NSAID use and the incidence of acute digestive complications

Abstract

Background. Long-term administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the most frequent medication-related causes of upper gastrointestinal pathology, with a significant impact on population health and on emergency medical services, increasing their burden in the last 10 years. Objective(s). The aim of this paper is to highlight the correlation between prolonged NSAID use, the onset of gastrointestinal emergencies, by analyzing frequency, underlying mechanisms, and clinical implications. Materials and methods. A systematic review of the scientific literature was conducted using the PubMed, Web of Science, Scopus, UpToDate, and Google Scholar databases, covering the period from January 2020 to May 2025.Original studies and reviews were included based on the Keywords: "NSAIDs", "upper gastrointestinal emergencies", "upper gastrointestinal bleeding (UGIB)". Results. The literature review reveals that over 30% of upper gastrointestinal bleeding (UGIB) cases presenting to emergency departments are associated with NSAID use. Mortality among these patients, particularly the elderly or those with comorbidities, is estimated to range between 6–10%. Approximately 25–30% of chronic NSAID users develop mucosal lesions, and 15–20% develop peptic ulcers. The annual incidence of complicated ulcers (e.g., bleeding, perforation) is estimated at 0.8–2.0%. These complications often require endoscopic or surgical intervention, significantly increasing both morbidity and hospital stay duration. Conclusion(s). Long-term use of NSAIDs represents a major risk factor for upper gastrointestinal emergencies, particularly bleeding and complicated ulcers. Identifying vulnerable patients and ensuring careful monitoring can significantly reduce associated morbidity and mortality across worldwide.