Do NSAIDs increase the risk of Lower Gastrointestinal Bleeding?
Several case-control studies show a two- to threefold increase in LGIB with a variety of different NSAIDs.
One large study in patients with rheumatoid arthritis comparing naproxen with rofecoxib demonstrated that the use of COX-2–selective inhibitors may decrease this rate by 54%. However more recent analysis of unpublished data directly challenges this optimistic result. In fact any risk reduction seen with various NSAIDs may be entirely dose related.
In contrast to UGIB, there does not seem to be any risk reduction in LGIB with concomitant proton pump inhibitor use.