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