NSAIDsは日常臨床で広く使用される一方，胃・十二指腸を中心とする上部消化管傷害を高頻度に惹起し，その管理は古くから臨床上の重要課題である．これらの傷害はCOX阻害によるプロスタグランジン欠乏と topical effect を主要機序とし，自覚症状に乏しいまま潰瘍や出血を呈することも少なくない．さらに，高齢化や抗血栓薬併用患者の増加により，NSAIDs／低用量アスピリン起因性傷害は複雑化し，重篤化しやすい現状にある．上部消化管においては，PPI／PCAB や H. pylori 除菌の有効性が確立されつつあり，2026年改訂の消化性潰瘍診療ガイドラインでも最新知見が整理され，標準的管理の方向性が示されている．一方，小腸傷害については治療法や管理体系がいまだ確立しておらず，新たな病態理解と戦略構築が求められている．本シンポジウムでは，NSAIDs起因性消化管傷害の疫学・病態・治療・予防の最新知見を整理し，消化管全体を見据えた今後の展望について議論を深めたい．

NSAIDs are widely used in clinical practice, but frequently cause upper gastrointestinal injury, posing an important challenge. These injuries are primarily caused by prostaglandin deficiency and a topical effect, leading to ulcers or bleeding with few symptoms. The increasing number of elderly patients and those receiving antithrombotic therapy further complicates and exacerbates NSAID/low-dose aspirin–induced injury. For the upper gastrointestinal tract, the efficacy of PPIs/PCABs and H. pylori eradication is well established. The Japanese evidence-based clinical practice guidelines for peptic ulcer disease, revised in 2026, will incorporate updated evidence and provide clearer direction for standard management. In contrast, effective therapies and management strategies for NSAID-induced small-bowel injury remain undefined, highlighting the need for new pathophysiological insights and therapeutic approaches. This symposium aims to summarize recent findings on the epidemiology, pathophysiology, treatment, and prevention of NSAID-induced gastrointestinal injury and to discuss future perspectives for the comprehensive management of the entire gastrointestinal tract.