Duodenal perforation in women 60years of age following receipt of a non-steroidal anti-inflammatory drug

such as misoprostol, and the use of paracetamol as an alternative analgesic.1,2 Another approach is to prescribe a drug associated with a comparatively low risk of gastrointestinal toxicity and use more toxic compounds only in the event of a poor clinical response to the first line drug.3,4 However, evaluation of the data on comparative risk is difficult. Published epidemiological studies have provided variable coverage of individual drugs, making them unsuitable for metaanalytical approaches that attempt to pool data across all studies.3