For a patient on chronic NSAID therapy with epigastric pain, what is a major risk and a preventive measure?

• A. GI bleeding risk; take with food and consider proton pump inhibitor prophylaxis
• B. Kidney failure; limit fluids
• C. Hypertension; stop NSAIDs
• D. Liver toxicity; take on empty stomach

Answer: (A)

Chronic NSAID use harms the stomach lining because these drugs inhibit COX-1 and reduce protective prostaglandins, making the gastric mucosa more vulnerable to irritation and bleeding. When someone has epigastric pain while on NSAIDs, the major risk to address is gastrointestinal bleeding and peptic ulcers stemming from this mucosal damage. The best preventive approach is to reduce gastric irritation and protect the mucosa: take the NSAID with food to lessen direct gastric irritation, and, given long-term use, consider adding a proton pump inhibitor to suppress acid production and promote mucosal healing. This combination lowers the likelihood of ulcers and bleeding more effectively than other simple measures.