The two most common causes of stomach and duodenal ulcers are a bacteria called Helicobacter pylori (H pylori) and the use of nonsteroidal anti-inflammatory medications (NSAIDs), which include aspirin. Let’s look at the use of NSAIDs and how to protect your stomach from their harmful effects.
- NSAIDs are medications used to relieve pain and reduce inflammation. More than 17 million Americans use various NSAIDs on a daily basis.
- NSAIDs include medications such as:
– aspirin (Bayer, Bufferin, Ecotrin)
– ibuprofen (Motrin, Advil)
– naproxen (Aleve, Anaprox, Naprosyn)
– indomethacin (Indocin)
– diclofenac (Voltaren)
– piroxicam (Feldene)
– meloxicam (Mobic)
– celecoxib (Celebrex) - All NSAIDs, including aspirin, may cause ulcers, but there are some important things to know:
The risk of ulcers and their complications varies among the different NSAIDs. The risk is probably highest with indomethacin. Lowest risk may be Ibuprofen, meloxicam and celecoxib.
The risk of ulcers is related to the duration of treatment with NSAIDs. The longer you are on them, the higher the risk. It usually takes a few weeks for ulcers to form after starting an NSAID, but they may occur as early as 7 days.
The dose of the NSAID is also important. Usually, the higher the dose of the NSAID, the higher the risk of causing an ulcer. But even one baby aspirin per day can cause an ulcer for some people.
- Other factors that increase the risk of someone developing an ulcer complication while taking an NSAID include:
– a prior history of an ulcer- use of blood thinners such as
– Coumadin
– use of anti-platelet medications such as Plavix
– age greater than 60
– use of steroids such as prednisone
– current ulcer symptoms such as indigestion
If you have any of the above risk factors, you should talk to your doctor about protecting your stomach from ulcers before starting long-term therapy with an NSAID. Depending on your condition and what NSAID you are taking, your doctor may suggest a limited course of medication called a proton pump inhibitor (PPI) such as Prilosec, Prevacid or Nexium while you are taking the NSAID.
Your doctor may consider testing you for the bacteria H pylori before beginning NSAIDs and, if positive, treating you for that.
In summary, if you need to take an NSAID long term, use one that is relatively safe (such as ibuprofen) at the lowest dose needed to control your symptoms, for the shortest duration possible. If you have any of the risk factors listed above, talk to your doctor about taking a PPI during the duration of NSAID therapy to decrease your risk of developing an ulcer complication.