Intended for healthcare professionals

Clinical Review ABC of the upper gastrointestinal tract

Indigestion and non-steroidal anti-inflammatory drugs

BMJ 2001; 323 doi: (Published 24 November 2001) Cite this as: BMJ 2001;323:1236
  1. J M Seager,
  2. C J Hawkey

    Non-steroidal anti-inflammatory drugs (NSAIDs) are usually thought to pose a dilemma for doctors wishing to prescribe them. Their anti-inflammatory and analgesic properties have led to their widespread use for rheumatoid and (much more commonly) other conditions often regarded as more trivial. However they are ulcerogenic to the stomach and duodenum and lead to a threefold to 10-fold increase in ulcer complications, hospitalisation, and death from ulcer disease.1

    Three ulcers (one bleeding) in the gastric antrum caused by NSAIDs. Such ulcer complications are estimated to cause up to 16 500 deaths each year in the United States and 2000 deaths a year in Britain

    In fact, the dilemma is more complex than whether potentially life threatening drugs should be used to manage conditions that are uncomfortable but not in themselves life threatening. There is growing evidence that NSAIDs have other incidental benefits. The only study to investigate overall life expectancy with drug use found non-significant trends towards enhanced rather than reduced life expectancy. Aspirin has benefits in preventing cardiovascular disease and probably cancer that seem to far outweigh the hazards of gastrointestinal ulceration. Limited evidence suggests that these benefits may be shared by other NSAIDs.

    NSAID use

    About 24 million prescriptions a year are written for NSAIDs in the United Kingdom. Half of these are given to patients over the age of 60. At any one time about 15% of elderly people are taking an NSAID. Average prescribing rates are calculated to be 426 scripts per 1000 population per year.

    Hospitalisations due to complications associated with NSAID use are a problem in elderly patients

    Less than 10% of NSAIDs used in the community seem to be for rheumatoid arthritis, and less than half for any form of arthritis. They are widely used for acute soft tissue injury and more chronically for undiagnosed …

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