OBJECTIVES: To calculate the dimension of NSAID induced GI complications in Europe because few epidemiologic data exist. To find evidence of treatment patterns and analyse data on the economic burden of NSAID induced GI complications. To assess the economic benefit of ulcer prophylaxis with proton pump inhibitors (PPI). METHODS: Pub Med and Cochrane Library literature research was conducted with defined MESH terms. An epidemological extrapolation was done to estimate hospitalisation and death cases due to NSAID use in Europe, limited to rheumatoid arthritis (RA) and osteoarthritis (OA) patients. Economic benefit of ulcer prophylaxis was examined on the basis of international cost of illness and cost effectiveness studies. RESULTS: Eighty-three studies were analysed. Approximately 3 million patients with RA and 17.3 million patients with OA were calculated for Europe. Potential incidence of hospitalisation due to NSAID use was 157933 patients annually with estimated 25222 cases of death. In the UK, total costs for inpatient stay and treatment of complications were about 367.5 million Euros per year. Data from The Netherlands showed that 14% of the costs of all GI complications were due to NSAID use. Across Europe, co-medication studies are rare; in France, co-medication was prescribed in 29.5%, in Spain in 41.6%, and in The Netherlands in 43% of NSAID users. Indirect costs (e.g. loss of productivity) ranged from 20-50% of total costs. CONCLUSION: Compared to our epidemiological extrapolation, much higher hospitalisation and death rates in Europe must be expected because of the wide range of NSAID indications. A lack of outpatient data limits a differentiated calculation of costs for NSAID induced complications. Although guidelines for ulcer prophylaxis do exist in many European countries, daily routine shows an inconsequent application of gastro protective agents. Given the calculated prevalences, prophylactic ulcer care with PPI should receive more attention in Europe.