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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 11 REVIEW Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics worldwide 1 , and in contrast with other analgesic drug classes, NSAIDs are increasingly available as an expanding range of over the counter (OTC) and prescription formulations 2 . NSAIDs are perceived to be safe drugs and consequently OTC NSAID use is seven-times greater than that of prescribed NSAIDs 3 , however their use is associated with significant gastrointestinal tract complications of which upper gastrointestinal tract (UGIT) bleeding is the most common. The aggregate risk of UGIT bleeding among NSAID users is 2.7 to 3 times that of non-users 4 . In 2009, in an attempt to improve public awareness, the United States Food and Drug Administration issued a ruling requiring all NSAID manufacturers list comprehensive warnings on all NSAID packaging, especially UGIT bleeding, the most commonly reported adverse drug event in the country 5 . Similar legislation does not exist in South Africa where non-selective NSAID preparations are readily available in pharmacies, grocery stores and a myriad of other formal and informal outlets with limited if any accompanying patient information. The direct financial implications to the public healthcare system of treating potentially preventable UGIT bleeding complications attributed to the consumption of OTC NSAIDs have to our knowledge not been quantified. Methods A prospective cohort study was conducted in the surgical wards of Chris Hani Baragwanath Academic Hospital (CHBAH) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a six-month period. Ethics approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (M110652). All study participants provided informed consent. An anonymous questionnaire including demographic information, medical history and details of analgesic use was completed with the assistance of a research nurse fluent in the commonly used languages. Upon discharge clinical, radiological, pharmacological, endoscopic and surgical information was collected from the patient’s clinical notes in their hospital file. Study population Consecutive patients older than 12 years admitted with signs and symptoms of an acute UGIT bleed, confirmed by oesophagogastroduodenoscopy were included. Patients with pathology secondary to portal hypertension, Mallory-Weiss tears, oncological lesions, arteriovenous malformations, and incomplete questionnaires were excluded. Data capture and analysis The data from both hospitals were combined and entered into a master Microsoft Excel spreadsheet. Patients were categorised based on their proclivity to use NSAIDs into two groups, ‘NSAID’ and ‘no NSAID’ use. Subgroup analysis was performed for patients who obtained their NSAIDs OTC or with a prescription. SAS 9.3 was used for statistical analyses. Where parametric T-Tests could not be used due to unequal variance, non- parametric Wilcoxon tests were used. Categorical data was analysed using the Pearson’s Chi Squared test. UGIT bleed treatment cost calculation The cost of UGIT bleeds was estimated by aggregating the cost of procedures performed to treat the UGIT bleed, medications, blood products and ward fees for each patient. The cost structure was based on unit costs of procedures, admissions, consultations, medications, blood products and imaging at a university-affiliated hospital (Appendix 1). Resuscitation measures, acute management and laboratory tests as well as the use of disposable materials and equipment initiated in the emergency department and continued in the ward are standardised for all patients in these hospitals and hence were not included in these calculations. Results During the study period, 321 patients were admitted for treatment of an UGIT bleed of which 68 were excluded from analysis (Figure 1). Table 1 illustrates the demographic and clinical characteristics of the study participants, and Table 2 their pattern of NSAID use. No patient used a cyclo-oxygenase inhibitor. The relationships between NSAID use and non-use as well Adverse gastrointestinal bleeding associated with over the counter non-steroidal anti-inflammatory drug use: A cost study in two Gauteng public hospitals Correspondence M Brand email: martin.brand@up.ac.za T Govener, M Brand HPB Surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa GPA’s Non-PPI (Antacids, H2 blockers) PPI Habits Smoker Alcohol use Indication Headache Musculoskelet Gastrointestin Other Pattern of use General advic Take with mea Frequency Daily Twice daily Three times d Four times dai >Four times daily NSAID non-steroidal the counter; GPA’s ga pump inhibitors; H2 h Discussion The South African Ess ibuprofen as an altern first line management for ibuprofen, and co common in South Afri tertiary hospitals in th where patterns of OT UGIT bleeds have not During the study p who were admitted w 85% (n=183) of who prescription. This is fa groups in first world c admitted for UGIT ha The implication is that particular low socioec obtained and users ar information to guide t In this study the thr UGIT bleeds requirin age, multiple medical Age Advanced age itself h risk factor for UGIT bl reported risk factor fo Approximately 40-60 years of age 8 , and up NSAID’s may obtain t individuals in this stu (n=72) used NSAIDS them OTC. In the We patients suffering fro recent years, mostly widespread NSAID u than 60 years of age h to 4.1 million (2011) w Current socio-econo the elderly population medication and 28 % of the fact that the risk 1.65 per 100 000 in p those >65 years and REVIEW