The Dangers of Aspirin & NSAIDS

The second major cause for ulcers is irritation of the stomach arising from regular use of non-steroidal anti-inflammatory drugs, or NSAIDs. NSAIDs are available over-the-counter (OTC) and by prescription.

If you are taking over-the-counter pain medications on a regular basis, you will want to talk with your physician about the potential for ulcers and other GI side effects. NSAID-induced gastrointestinal side effects can be reduced by using alternative therapy. Your doctor may recommend that you change the medication you are using; or add some other medication in conjunction with your pain medication.

Bleeding: Internal bleeding in the stomach or the duodenum.

Perforation: When ulcers are left untreated, digestive juices and stomach acid can literally eat a hole in the intestinal lining, a serious medical problem that requires hospitalization, and often surgery.

Obstruction: Swelling and scarring from an ulcer may close the outlet of the stomach, preventing food to pass and causing vomiting and weight loss.

Endoscopy: This test involves insertion of a small lighted flexible tube through the mouth into the esophagus, stomach, and small intestine (duodenum) to examine for abnormalities and remove small tissue samples (biopsy). The test is usually performed using medicines to temporarily sedate you.

Upper GI Series: Alternately, there is an X-ray test where you are given a chalky material (barium) to drink while X-rays are taken to outline the anatomy of the upper digestive tract.

New NSAID medications became available in prescription form that also offered excellent pain relief, but like aspirin, these new prescription medications also had the potential to promote the development of ulcers and bleeding in the GI tract. Since they were being administered under a doctor's prescription, any such effects could be monitored.

NSAIDs became more popular as prescription remedies, and the FDA has approved several for sale to consumers without a prescription. A partial list of NSAIDs that are available over-the-counter and recommended maximum daily doses is below.

NSAIDS were found to have an additional benefit of reducing inflammation, and so helped alleviate not only the symptom of pain, but also served to reduce the actual cause of the pain, for example, reducing joint inflammation in arthritis.

In this regard, aspirin and NSAIDs have been found to cause damage to the lining (or mucosa) of the digestive tract primarily in the stomach and upper intestine. This damage can result in an ulcer or intestinal bleeding. Although this can happen to an individual who is an infrequent user of aspirin or NSAIDs, it is of a much greater concern in frequent users, and those consuming higher dosages of these medications.

Age: Has been identified as a risk factor in several studies. Older patients also often require pain medications more often or in larger doses, further increasing their risk.

Previous Ulcer: A history of an ulcer or an ulcer complication have been identified in several studies as risk factors for complications due to aspirin or NSAIDs use.

Alcohol: Alcohol, taken alone can cause irritation of the GI tract. There have been some indications that patients who consume alcohol at the same time they are taking aspirin or NSAIDs have an increased risk of damage to the intestinal lining, including ulcers and GI bleeding. There have been some reports that chronic heavy alcohol users may be at increased risk of liver toxicity from excessive acetaminophen use. Individuals who consume large amounts of alcohol should not exceed recommended doses of acetaminophen. In 1993, FDA Advisory Committees recommended that all OTC pain relievers contain an alcohol warning--to date, some, but not all OTC pain relief products have complied with that recommendation. Chronic heavy alcohol users should consult their physician for advice on when and how to take pain relievers.

Steroids: Patients taking NSAIDs who also are taking a prescription corticosteroid, medications like prednisone (in doses over 10 mg), have been found to have a seven fold increased risk of having GI bleeding.

Anti-coagulants: Similarly, patients who are taking NSAIDs at the same time they are taking oral prescription anti-coagulants (for example, medications like coumadin) have been found to have a 12-fold increased risk of bleeding.

The most important ground rule, however, is to follow the instructions on your medication. No medication–whether a prescription or over-the-counter drug–should be taken more frequently than is directed in the labeling.

Most NSAID ulcers heal easily if the NSAIDs are stopped. If the medication cannot be stopped, the dose may often be reduced. Even if your physician determines that continued administration of NSAIDS is needed, healing can still occur.

Of particular concern are patients with arthritic conditions. More than 14 million such patients consume NSAIDs regularly. Up to 60% will have gastrointestinal side effects related to these drugs and more than 10% will cease recommended medications because of troublesome gastrointestinal symptoms.

Another medication, misoprostol, has been used effectively to prevent gastric and duodenal ulcers and has been shown to reduce the risk of bleeding in those that must continue using NSAIDs. As with all instances where patients are taking more than one prescription or over-the-counter medication, patients and their physicians need to evaluate any side effects, potential drug interactions, or other factors, for example limitations on use during pregnancy.

In the case of recurring or more serious problems, you may need to see a gastroenterologist, a physician who specializes in disorders and conditions of the gastrointestinal tract.

NSAIDs and aspirin have some very positive health benefits. Like all medications, care must be taken with their use. For example, they should not be taken with alcohol, as the combination can increase the risk of GI bleeding. Patients who need to use NSAIDs regularly should consult regularly with their physician to be alert for any potential GI effects. Since problems may arise with few, if any, symptoms, ongoing monitoring with your physician is important. If problems do arise, and are recognized early, there are a variety of ways to minimize or reverse any adverse effects, either by using alternatives to NSAIDs, or through your physician prescribing medications that can reduce any adverse effects.