Indigestion and non-steroidal anti-inflammatory drugsBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7323.1236 (Published 24 November 2001) Cite this as: BMJ 2001;323:1236
- J M Seager,
- 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
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.
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.
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 …