Can NSAIDs Cause Peptic Ulcer Disease?
It is well known that Nonsteroidal Antiinflammatory Drugs also known as NSAIDs are frequently prescribed for effective control of pain and inflammation but also known is the fact that these NSAIDs when used frequently and in an uncontrolled manner can cause a medical condition called as Peptic Ulcer Disease. To find out how NSAIDs cause this condition, it is important to understand the functioning of NSAIDs. Normally the body produces two enzymes called COX-1 and COX-2. These enzymes are responsible for pain, inflammation, and fever. NSAIDs work by reducing or blocking the production of these enzymes. Another function of the COX-1 and COX-2 enzymes is that it protects the lining of the stomach from stomach acids. When there is reduced production of these enzymes due to NSAID use, then the stomach lining becomes vulnerable to stomach acids thus causing development of ulcers in the stomach resulting in Peptic Ulcer Disease.
Who Is At Risk For Developing Peptic Ulcer Disease Due To NSAIDs?
Individuals who use NSAIDs frequently for pain control are at maximum risk for developing Peptic Ulcer Disease. This is more frequent in individuals with conditions like arthritis who require regular use of NSAIDs. The vulnerability of an individual developing Peptic Ulcer Disease due to NSAID use increases with:
- Dosage of NSAIDs
- Frequency of use of NSAIDs
- Using multiple NSAIDs
- Duration of taking NSAIDs
- Age of the individual; peptic ulcer disease is more frequent in the elderly population
- Female gender
- Having a prior history of peptic ulcer disease
- Consuming alcohol.
What Are The Symptoms Of Peptic Ulcer Disease Caused By NSAIDs?
The most common symptom of Peptic Ulcer Disease use to NSAIDs is a dull burning pain in stomach. This pain usually occurs when the stomach is empty. This pain calms down after taking antacids or after meals. This pain may last for minutes to may be even hours. This pain may persist for months unending. Some of the other symptoms of Peptic Ulcer Disease are:
- Frequent bloating
- Frequent burping
- Appetite changes
- Weight loss.
How Is Peptic Ulcer Disease Diagnosed?
In order to diagnose Peptic Ulcer Disease, the treating physician will take a history and perform a detailed physical examination and inquire about the symptoms experienced by the individual. If Peptic Ulcer Disease is suspected, the physician will order certain lab tests. The physician may also perform an upper endoscopy to look for presence of ulcers. A CT scan of the stomach may also be performed to look at the internal structures of the stomach to identify presence of ulcers.
What Are Treatments For Peptic Ulcer Disease Caused By NSAIDs?
There are two approaches for treating Peptic Ulcer Disease caused by NSAIDs which depends on the presence or absence of bacteria H. Pylori.
Treatment for Peptic Ulcer Disease Due To NSAIDs Without H. Pylori: If H. Pylori is absent in the individual and it is confirmed that taking NSAIDs has caused Peptic Ulcer Disease then the physician will prescribe medications that will reduce production of stomach acids. Some of the medications used to reduce production of stomach acids are:
Proton Pump Inhibitors: These medications curtail acid production by obstructing the mechanism which passes acid into the stomach. Some of the common medications under this category are:
Histamine Receptor Blockers: This category of medications work by blocking histamine which facilitates acid production. Some of the medications in this category are:
Treatment For NSAIDs-Induced Peptic Ulcer Disease With H. Pylori Present:
In case H. Pylori is present then the treating physician will prescribe PPIs and histamine receptor blockers but prescribe along with it antibiotics and other medications to kill the bacteria.
What Happens If NSAIDs Are Still Required?
The question now arises that despite knowing the risks of taking NSAIDs if a person still requires these medications to control pain and inflammation then what happens. The answer is to consult the physician before starting any NSAIDs to discuss the risks versus benefits of taking these medications. There may be cases when an individual may have developed an ulcer due to NSAIDs and then stopped it but then may want to restart it again after getting treatment then the physician is the best person to advise whether to resume taking NSAIDs or not.
It is also imperative that people inform their treating physicians about all the medications that they take. It is then left to the discretion of the treating physician whether NSAIDs can be safely used in that individual or not. In both cases, the physician will definitely prescribe PPIs or histamine receptor blockers for stomach protection.
Measures To Reduce Risk Of Peptic Ulcer Disease Despite Taking NSAIDs:
- Taking NSAIDs with meals
- Use the lowest dose possible
- Abstinence from smoking and alcohol.