Recently, H. pylori infection rate has decreased and non-steroidal anti-inflammatory drugs(NSAIDs including aspirin) induced ulcers have increased more and more with aging in Japan. Pathological and clinical conditions of NSAIDs ulcer are different from that of H. pylori-related peptic ulcer. In other words, main pathologic condition of NSAIDs ulcer is not only gastric acid secretion but also destruction of defense mechanisms of upper gastrointestinal mucosa, because NSAIDs inhibit both cyclooxygenase (COX)-1 and COX-2 which block production of prostaglandins, consequently resulting in impairing gastroduodenal protective factors. Moreover, it is not rare that NSAIDs ulcer has serious complications such as bleeding and/or perforation. These should be paid attention in NSAIDs users in routine practice.
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