Review: misoprostol or COX-2-specific or selective NSAIDs reduce gastrointestinal complications and symptomatic ulcers.

M e t h o d s Data sources: 5 databases, bibliographies of relevant studies, and contacting authors. Study selection and assessment: Randomized controlled trials (RCTs) ≥ 21 days in duration comparing 1 of the 5 gastroprotective strategies with nonselective NSAIDs alone on outcomes of GI toxicity. Quality assessment included randomization procedures, allocation concealment, blinding, and follow-up. Outcomes: Primary outcomes included serious GI complications (e.g., hemorrhage, hemorrhagic erosions, recurrent upper GI bleeding, perforation, and pyloric obstruction) and symptomatic ulcers.