*Corresponding Author: Dr. Santosh Kumar Yadav , Email: drsky.omfs@gmail.com ISSN 0976 – 3333 REVIEW ARTICLE Available Online at www.ijpba.info International Journal of Pharmaceutical & Biological Archives 2012; 3(3):411-414 Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs in Maxillofacial Trauma Patients: A Review Santosh Kumar Yadav* 1, Ajit Kumar Sah 2 , Phoolgen Sah 2 , Rajesh Kumar Jha 2 1 Dept of Oral & Maxillofacial Surgery, Chitwan School of Medical Sciences, Bharatpur-10, Chitwan, Nepal 2 Dept of Pharmacology, Chitwan School of Medical Sciences, Bharatpur-10, Chitwan, Nepal Received 19 Mar 2012; Revised 24 May 2012; Accepted 30 May 2012 ABSTRACT NSAIDs are widely prescribed for the treatment of pain and inflammation and is well accepted and recommended by World Health Organization (WHO), but their use is associated with adverse gastrointestinal effects, ranging from dyspeptic symptoms and peptic ulcers to more serious complications. Elderly patients are at high risk of experiencing NSAID-induced gastrointestinal tract injury and should be considered candidates for prophylactic pharmacological therapy. NSAIDs cause damage in the upper gastrointestinal (GI) tract by impairing the ability of the mucosa to resist and respond to injury. Many of these effects of NSAIDs can be attributed to their ability to suppress mucosal prostaglandin synthesis. This review focuses on several of the important recent observations that have improved our understanding and the safety of NSAIDs in the gastrointestinal tract. Keywords: NSAIDs, Gastrointestinal toxicity, Maxillofacial trauma. INTRODUCTION The use of non-steroidal anti-inflammatory drugs (NSAIDs) as a first-line therapy for pain and inflammation is well accepted and recommended by World Health Organization (WHO) [1] . NSAIDs are one of the most widely used drugs over the world. It is estimated that everyday 30 million people worldwide use NSAIDs for anti- inflammatory and analgesic effects [2] . In maxillofacial settings, NSAIDs are recommended for pain relief in case of accidents/trauma [3] NSAIDs are beneficial in relieving the pain associated with soft-tissue injuries. In severe pain associated with muscle spasms, NSAIDs are generally used in combination with skeletal muscle relaxants . [4] . Moreover; these medications do not alter the perception of sensory modalities other than pain. Hence, they are free from the issues of drug dependence and CNS side-effects unlike opioids [4] . The beneficial effect of NSAIDs is masked by its gastrointestinal (GI) side-effects [3] . Patients on NSAIDs are at increased risk of upper GI complications that range from dyspepsia to peptic ulcers and GI bleeding. Approximately 60% of NSAIDs users at high-risk of NSAIDs complications, fail to receive adequate gastroprotection [5] GI complications: ‘Silent epidemic’ . Gastroprotective strategies are effective in reducing the risk of GI complications in chronic NSAIDs users. Proton pump inhibitors (PPIs) are likely to prevent the development of peptic ulcer disease in patients using NSAIDs. NSAIDs are the choice of drugs in musculoskeletal injuries as these conditions are considered to be inflammatory in nature [3] . The most important mechanism of the anti- inflammatory action of NSAIDs; is inhibition of the cyclooxygenase (COX) enzymes that catalyze the biosynthesis of prostaglandins (PGs) and arachidonic acid. PGs are mediators of inflammation. COX-1 being a constitutive enzyme plays a role in ‘housekeeping’ processes, such as the protection of mucosa in the GI tract and vasodilatation in the kidney. On the contrary, COX-2 is an inducible enzyme that is up- regulated only in inflammatory conditions [6] . Consequently, one of the serious drawbacks of NSAIDs is GI toxicity that is widely associated with traditional NSAIDs. The GI complications range from gastric pain, dyspepsia development and drug intolerance to clinically significant gastroduodenal ulcer complications; such as bleeding, obstruction and perforations. The pathogenesis of the mucosal injury and bleeding is depicted in Figure 1 [7] . Complications related to