Purpose of review: To better understand the effects of NSAIDs on the colon.
Recent findings: An epidemiological study has confirmed that NSAIDs increase the risk of hospitalizations for lower gastrointestinal complications, though the estimated rate of hospitalization was lower than that for upper gastrointestinal complications. Proton-pump inhibitors were associated with reduction in hospitalizations for upper but not lower gastrointestinal complications. Current research on cyclooxygenase (COX) inhibition in patient and animal models suggests that COX-1 and COX-2 may have different roles in the exacerbation of inflammatory bowel disease. Epidemiological research on the chemoprevention of colorectal cancer with aspirin suggests that the positive effect of risk reduction is only observed after long-term treatment. The search for targets of chemopreventive drugs is ongoing. COX-2 inhibition still seems preferred option, as the effects observed with aspirin (the only chemopreventive agent with some apparent future) are more profound only in tumors and cells expressing COX-2. Other molecules such as nitric oxide NSAIDs, especially nitric oxide aspirin, are under intensive experimental research.
Summary: NSAID use increases the risk of hospitalizations due to complications in the lower gastrointestinal tract. By inhibiting COX-2 or other tumorigenic targets, NSAIDs, especially aspirin or new aspirin derivates, may prevent colon cancer in selected populations.