For patients with a history of gastric or duodenal ulcers, which statement about NSAID use is recommended?

• A. Acetaminophen
• B. Celecoxib
• C. Avoid NSAIDs unless other alternatives are not effective and the patient can take a gastroprotective agent (PPI or misoprostol)
• D. Aspirin

Answer: (C)

When someone has a history of gastric or duodenal ulcers, NSAIDs raise the risk of ulcer recurrence and serious GI bleeding because they inhibit COX enzymes and reduce protective prostaglandins in the stomach. The safest approach is to avoid NSAIDs if possible. If pain relief truly requires an NSAID and there are no effective alternatives, use the NSAID only with gastroprotection—such as a proton pump inhibitor or misoprostol—and at the lowest effective dose for the shortest duration. This balance minimizes GI risk while still allowing necessary pain management. Other options like acetaminophen avoid NSAID-related GI harm and are often preferred first; NSAIDs like celecoxib still carry GI risk (even if somewhat reduced) and aspirin also increases GI risk, so they’re not preferred in ulcer history unless a specific indication justifies them with protective measures.