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NSAIDs and Ulcers

Non-steroidal anti-inflammatory drugs, or NSAIDs, can cause peptic ulcer disease and make ulcer symptoms worse.

Pain relief medicines like ibuprofen, naproxen, and aspirin are popular because they work to reduce inflammation and pain. But while they do that very well, they can also have a negative effect on the protective lining of the stomach. 

How NSAIDs Affect the Stomach Lining

NSAIDs work by lowering the levels of enzymes called cyclooxygenases (abbreviated as COX), which in turn lowers the production of another substance called prostaglandin. Decreasing COX and prostaglandin helps in controlling inflammation, but is not so good when it comes to keeping the stomach lining healthy. This makes it harder for the body to maintain the stomach’s protective mucous lining, control the amount of blood flow in the stomach lining, and control how acidic or alkaline it is inside the stomach. 

Different NSAIDs cause different levels of gastrointestinal damage. It is difficult to rank them because dosages differ, but in general indomethacin (Indocin) appears to have a higher risk, while naproxen (Aleve, Anaprox), ibuprofen (Advil, Motrin), diclofenac (Voltaren), and aspirin are considered medium-risk. 

Ulcer Symptoms: Treating Ulcer Pain

People who have pain because of an ulcer do not necessarily need pain medication and should certainly not use an NSAID for ulcer pain. Christian Mathy, MD, assistant clinical professor of medicine in the division of gastroenterology at the University of California, San Francisco, says, “Usually, once you block the acid irritating the ulcer, people feel better quite rapidly.” 

So, along with prescribing antibiotics if someone is infected with Helicobacter pylori(H. pylori), the bacterium that is the main cause of ulcers, Dr. Mathy says he normally prescribes a proton pump inhibitor (Prevacid, Nexium, Protonix), a type of drug that blocks the secretion of gastric acid. This will reduce the pain level. 

If that doesn’t work, Mathy says, “I use an [acid buffer] as it provides a second barrier to irritation which supplements the mucous barrier.” 

Mathy also talks to his patients about cutting back on foods that can aggravate ulcers and cause more pain, and recommends eating frequent small meals. He also cautions smokers that smoking can delay ulcer healing and suggests at the very least cutting back, if not quitting. 

Ulcer Symptoms: Treating Non-Ulcer Pain

Those most likely to take NSAIDs long-term are people with chronic pain conditions such as arthritis. There are also a number of people who use low-dose aspirin to help prevent heart attack and stroke. 

Mathy says for people starting on long-term NSAID therapy, “I always counsel them about the risks.” For those who are at high risk of developing an ulcer, including those who have already had one, people over 75, and patients on [or who will likely be on] a high dose of NSAIDs, “I recommend that as long as they are on the NSAID they should be taking a proton pump inhibitor once a day.” Studies have shown that people who take proton pump inhibitors while on NSAIDS can avoid developing ulcers. 

Mathy also says that patients starting on long-term NSAIDs should be checked for H. pylori because these two risk factors together really raise the odds that someone will develop an ulcer. 

Getting rid of this bug can significantly lower your risk of developing an ulcer if you are taking NSAIDS. In a study of people with H. pylori who also had arthritis and were started on an NSAID, 34 percent of those who didn’t receive treatment for the bacteria developed an ulcer after six months, compared with 12 percent who did have treatment.

Article Source: Everyday Health

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