[The safety of COX-2 inhibitors]

[Adverse effects of non-steroidal anti-inflammatory drugs in the lower gastrointestinal tract]

Non-steroidal antiinflammatory drugs (NSAID) are among the most commonly used drugs worldwide. Together with the beneficial effects, several adverse effects have become evident in the past decades. NSAIDs may damage any part of the gastrointestinal (GI) tract. The adverse effect in the lower GI tract was thought to be less important, but more and more data confirm that NSAIDs can cause equally severe lesions in the lower GI tract as well, only the diagnostic procedures are limited. NSAIDs may damage the intact mucosa, and they also may cause flare-up of a preexisting disease. Adverse events in the lower GI tract are caused mainly by the dual (COX-1 and COX-2) inhibitors. Besides the inhibiting of the cyclooxygenase enzymes, an important step is the local effect of the drug that initiates the chain reaction with the damage of the epithelial cells (increase of mucosal permeability, influx of luminal factors, produce of inflammatory mediators etc.). The spectrum of adverse effects of NSAIDs on the lower GI are reviewed according to the latest literature and the available prevention and therapeutic strategies.