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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 14 this is followed by several NSAID preparations including Grand-Pa™ (asprin-paracetamol-caffeine) with 15% market share (2013) up from 13% (2009) and Disprin™ (aspirin) with 13% market share (2013) up from 8% (2009). These brands are household names with a historical role in influencing customer choice, are widely available in both formal and informal retailers, are trusted and supported by strong marketing campaigns 21 . NSAID use in the South African public healthcare system does not mirror that of the private healthcare sector. Selective cyclo-oxygenase inhibitors are a group of NSAID’s which have a significantly lower incidence of UGIT side effects, in addition gastroprotective proton pump inhibitors are costly and available by prescription only. Both drug classes are not included in the SA EDL, consequently they are not easily available and financially out of reach of the majority of South Africans. Study Limitations Economic assessments to determine overall cost include evaluation of direct, indirect (productivity losses) and intangible (impaired quality of life) costs. Our study considered direct monetary costs hence it underestimates the actual cost to individual as well as to society. We excluded all 12 patients that died during their admission of whom seven were OTC NSAID users and the remaining five we were not able to determine whether or not they used NSAID’s. This may further underestimate the cost of NSAID related complications. NSAID use (including low dose aspirin) and H.pylori infection with are among the most common independent risk factors for UGIB 22 . At the time of the study CLO (Campylobacter-like organism) tests were not available during endoscopy, hence the synergistic and additive effect H.pylori infection with NSAID’s could not be assessed. Lastly, this study was conducted in two of Gauteng’s tertiary public hospitals; the population served by these hospitals may not fully represent the spectrum of NSAID use from all parts of the country. Conclusion NSAID use is common in South Africa and upper gastrointestinal tract bleeds resulting from OTC NSAID use are not infrequent. The South African Medicines Control Council should enforce the already existing legal parameters that require medication to be sold or distributed with their correct labeling, a package insert and a straightforward patient information leaflet. Regulation of the sale, advertising and marketing of OTC NSAID’s in South Africa may decrease the risk of UGIT bleeds as well as reduce the substantial cost to the public healthcare system. Furthermore GPA’s have been proven to be cost-effective UGIT bleeding prophylaxis in patients taking chronic non-selective NSAIDs 17 . The cost of an annual prescription of 20mg omeprazole per day is approximately R1600 compared to approximately R41 000 for a single admission including a diagnostic endoscopy without surgery or special investigations to treat an NSAID induced UGIT bleed. Hence the SA EDL should be updated to include GPA’s with NSAID use. References 1. Bidaut-Russell M, Gabriel SE. Adverse gastrointestinal effects of NSAIDs: consequences and costs. Best Practice & Research Clinical Gastroenterology. 2001; 15(5): 739-753. Available from http://www.idealibrary.com doi:10.1053/bega.2001.0232 2. Ajouga E, Sansgiry SS, Ngo C et al. Use/misuse of over-the- counter medications and associated adverse drug events among HIV-infected patients. Research in social and adminis- trative pharmacy. 2008; 4: 292-301 3. Wilcox CM, Shalek KA & Cotsonis G. Striking prevalence of over-the-counter nonsteroidal anti-inflammatory drug use in patients with upper gastrointestinal haemorrhage. 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