Nonsteroidal Anti-inflammatory Drugs
and Ulcers
What are nonsteroidal anti-inflammatory drugs?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed
medications for the inflammation of arthritis and other body tissues,
such as in tendinitis and bursitis. Examples of NSAIDs include
aspirin, indomethacin (Indocin), ibuprofen (Motrin), naproxen
(Naprosyn), piroxicam (Feldene), and nabumetone (Relafen).
NSAIDs are taken regularly by approximately 33 million Americans!
What are side effects of NSAIDs?
The
major side effects of NSAIDs are related to their effects on the stomach and bowels
(gastrointestinal system). Some 10%-50% of patients are unable to tolerate
NSAID treatment because of side effects, including abdominal
pain, diarrhea, and upset stomach. Approximately 15% of patients
on long-term NSAID treatment develop ulceration of the stomach and
duodenum. Even though many of these patients with ulcers do not have
symptoms and are unaware of their ulcers, they are at risk of
developing serious ulcer complications such as bleeding or
perforation of the stomach.
The
annual risk of serious complications is 1%-4% with chronic NSAID treatment.
The risk of complications is higher in elderly patients, in
those with rheumatoid arthritis, patients taking blood thinning medications
(anticoagulants such as Coumadin and heparin) or cotisone-containing
medications (e.g., prednisone), and patients with heart disease or
a prior history of bleeding ulcers.
How do NSAIDs work and how do they cause stomach problems?
Prostaglandins are natural chemicals that serve as messengers
to promote inflammation. By inhibiting the body's production of prostaglandins,
NSAIDs decrease inflammation. However, certain prostaglandins
also are important in protecting the stomach lining from
the corrosive effects of stomach acid as well as playing a role
in maintaining the natural, healthy condition of the stomach lining. These
protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach,
NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect
prostaglandins in the stomach than others, and, therefore, have
a lower risk of causing ulcers.
If a stomach ulcer is detected, how is it treated?
Treatment of NSAID-induced ulcers involves discontinuing
the NSAID,
reducing stomach acid with H2-blockers (e.g.
Zantac, Tagamet, Pepcid, Axid) or, more effectively, with proton pump
inhibitors, such as omeprazole (Prilosec) or synthetic prostaglandins (misoprostil or
Cytotec). Since H. pylori bacteria is a common cause of ulcers,
eradication of the bacteria with a combination of antibiotics
may also promote ulcer healing.
For further information, please read
the Peptic Ulcer and
H. Pylori articles.
Can NSAID-related ulcers and complications be prevented?
NSAIDs are valuable medications for patients with
inflammatory arthritis and other inflammation of body tissues.
For patients who need long-term NSAID treatment, several steps
can be taken to decrease NSAID-related ulcers and complications.
The risk of ulcers and complications tend to be dose related.
Therefore, the smallest effective dose of NSAIDs is taken to minimize
the risk. NSAIDs might be selected that have less effect on the
stomach production of prostaglandins. Some of these NSAIDs are called selective Cox-2 inhibitors. Cox-2 inhibitors block the Cox-2 enzyme that produces prostaglandins of inflammation without blocking the natural prostaglandin production of Cox-1 in the stomach. Taking NSAIDs with meals
may minimize stomach upset with NSAIDs but not ulcerations.
A synthetic prostaglandin, misoprostol (Cytotec),
can be administered orally along with NSAIDs. Misoprostol has
been shown to decrease NSAID-induced ulcers and their complications.
The side effects of misoprostol include abdominal cramps and diarrhea.
Misoprostol is also avoided in childbearing women because it can
cause uterine muscle contractions and miscarriage. H2-blockers
and proton pump inhibitors have sometimes been used in reducing
the risk of NSAID-induced ulcers. Their effectiveness is still
under study.
Scientists are actively searching for safer NSAIDs
that are effective anti-inflammatory agents but are not ulcer
producing. In the meantime, patients who need long term NSAID
treatment should be closely supervised by a doctor. Patients at
risk of NSAID-induced ulcers and complications should consider
preventive measures, such as using NSAIDs with less stomach
prostaglandin
disrupting effects, or misoprostol. Stopping smoking, and eradicating
H. pylori may also be helpful. A variety of safer and more effective NSAIDs
are available.
Last Editorial Review: 1/30/2007
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From the Doctors at MedicineNet.com  |
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- ibuprofen, Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc. - Explains the medication ibuprofen (Advil, Motrin, Nuprin, Medipren) a drug used for the management of mild to moderate pain, fever, and inflammation. Article includes descriptions, uses, drug interactions, and side effects. Source:MedicineNet
- naproxen, Naprosyn, Naprelan, Anaprox, Aleve - Explains the medication naproxen (Aleve, Naprosyn, Anaprox, Naprelan) a drug used for the management of mild to moderate pain, fever, and inflammation. Article includes descriptions, uses, drug interactions, and side effects. Source:MedicineNet
- Upper Endoscopy (EGD) - Learn about the endoscopy procedure which examines the esophagus, stomach and duodenum to detect gastrointestinal and digestive disorders on MedicineNet.com Source:MedicineNet
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