2.4. NSAID Use and Gastrointestinal Risk

All NSAIDs may be associated with an increased risk of serious gastrointestinal (GI) adverse events, including potentially fatal GI bleeding, ulceration, or gastric/intestinal perforation. The risk of NSAID-associated severe GI adverse events increases in patients with a history of peptic ulcer disease, GI bleeding, smoking, alcohol use, concurrent use of anticoagulants or oral corticosteroids, advanced age, poor health and prolonged NSAID use. However, COX-2 inhibitors like celecoxib may be associated with fewer GI adverse events due to selective COX-2 inhibition. Some trials have shown reduced ulcer complications and lower GI bleeding rates with celecoxib compared to nonselective NSAIDs. Further long-term studies are necessary to substantiate the perceived lower GI risk associated with COX-2 inhibitors^47,48<./p>