What is the most effective therapy for preventing NSAID-induced gastropathy?

Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity is associated with morbidity and mortality, and given the very wide use of NSAIDs, is problematic and costly to society. Several options are now available to minimize gastrointestinal toxicity from NSAIDs. These options include the proton pump inhibitors, misoprostil, double-dose H2-receptor blockers and the COX-2 selective NSAIDs. No head-to-head clinical trials have compared these options. The effectiveness of these strategies to minimize NSAID-induced gastrointestinal toxicity is summarized. In addition, their associated adverse effect profiles and costs are compared.