NSAID GI complication management: best strategy.

• A. COX-1 selective NSAID
• B. Nonselective NSAID without PPI
• C. COX-2 selective NSAID with PPI
• D. Avoid NSAIDs entirely

Answer: (C)

The main concept is reducing NSAID-related GI injury while preserving pain control by using a COX-2–selective NSAID together with stomach protection. COX-1 helps protect the gastric mucosa and supports normal platelets, so nonselective NSAIDs that block both COX-1 and COX-2 increase the risk of ulcers and bleeding. A COX-2–selective NSAID largely avoids this mucosal damage because it spares COX-1, lowering GI toxicity. However, even COX-2 inhibitors aren’t entirely risk-free for the GI tract, so adding a proton pump inhibitor decreases gastric acid secretion, further protecting the mucosa and reducing ulcer and bleeding risk. This combination thus offers the best balance for someone needing NSAID therapy who has a history of GI complications.

Avoiding NSAIDs entirely removes the analgesic benefit; nonselective NSAIDs without a PPI keep higher GI risk; and using a COX-2 inhibitor without gastroprotection may still leave some GI risk in susceptible individuals.