Population impact of strategies designed to reduce peptic ulcer risks associated with NSAID use

The risk of ulcer complications rises steeply with dose for aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) but estimates of the overall incidence of bleeding ulcer are unreliable. Drug utilisation data, epidemiological data on the frequency of bleeding ulcer and death, and the relative risks associated with different NSAIDs, indicate that the number of cases of bleeding ulcer attributable to NSAIDs in the United Kingdom is approximately 2,400. Substitution of ibuprofen at a dose of 2.4 g/day for all other NSAIDs would reduce the number of events attributable to NSAIDs from 2,431 to 695 annually. At a dose of 1200 mg/day, substituting ibuprofen or another safe NSAID would be likely to reduce events to zero. Similarly, substitution of ibuprofen 2.4 g/day for all other NSAIDs would reduce attributable ulcer mortality to 80. The total number of excess cases attributable to aspirin is 753 annually. If prophylactic aspirin was prescribed solely at a dose of 75 mg/day, the number of cases would fall to 445 annually and the number of related deaths from 87 to 51 annually. NSAIDs and aspirin account for approximately one-third and previous ulcer for about one-fifth of the overall risk of bleeding ulcer and its complications.