Bulletin Autumn‧Winter 2004

NSAID-induced Ulcer Disease: A Global Health Problem NSA ID or aspirin in any dosage carries an ulcer risk. A m o n g patients t a k i ng a s p i r in at v e ry l ow doses for cardiovascular p r o t e c t i o n, the r i sk of ulcer bleeding is more than t wo times that of non-users. The risk of ulcer bleeding is v e r y h i g h a m o n g p a t i e n ts w h o h a ve a h i s t o r y of u l c er a nd m u l t i p l e m e d i c a l problems. Up to 20 per cent of high-risk patients r e c e i v i n g N S A I D s develop recurrent ulcer b l e e d i n g w i t h i n s i x mon t hs if they have a history of ulcer bleeding. F u r t h e r m o r e , u l c e r bleeding i n old and frail pa t i en ts o f t en carries high mortality. In the US, the n umb er of deaths due to NSA I D - r e l a t ed ulcer complications each year is compa r ab le to t h a t d ue to a c q u i r ed i m m u n o d e f i c i e n c y s ynd r ome (AIDS). The direct med i cal cost for treating NSAID-related ulcer disease exceeds US$4 b i l l i on per annum. I n Ho ng Kong, arthritis, coronary heart disease, peptic ulcer, and stroke are amongst the top 10 m e d i c a l c o n d i t i o ns i n t he e l d e r l y population. These medical problems are closely related to each other because about 50 per cent of pep t ic ulcer disease is associated w i t h N S A I Ds use f or the t r ea tment of a r t h r i t i s, coronary heart disease, or stroke. It has been estimated that over 325,000 people i n Ho ng Kong aged 70 or above are taking NSAIDs. The problem of NSAID-induced ulcer disease is increasing i n our aging population. For years, research on the prevention of N S A I D - i n d u c ed u l c er has b e en d o m i n a t e d b y t he p h a r m a c e u t i c al i ndus t r y. Deve l opment of potent antiulcer drugs and advances i n new anti- inflammatory analgesics and anti-platelet agents have reduced the gastric toxicity of traditional therapies. However, these new treatments are often very expensive, and more importantly, have not been critically evaluated i n high-risk populations. Over the years, Prof. Francis Ch an and his research team have been dedicated to developing novel strategies and critically e v a l u a t i ng c u r r ent strategies f or the prevention of NSAID-induced ulcers. Defining New Strategies for Ulcer Prevention 49 A n n u a l i n c i d e n ce of ulcer bleeding in d e v e l o p ed r e g i o ns /100,000 Major causes of ULCER bleeding in Hong Kong * Statistics based on 977 cases in the cases in the Prince of Wales Hospital during May 1997-April 1998