Nonsteroidal anti-inflammatory drugs (NSAIDs) and peptic ulcers

It is not entirely clear how nonsteroidal anti-inflammatory drugs (NSAIDs) damage the stomach's lining, sometimes causing an ulcer. The following are the two likely ways this may happen:

• Use of NSAIDs may directly irritate the stomach's lining, making it easier for ulcers to form.
• NSAIDs may interfere with prostaglandins, which are chemicals that may help regulate the protective lining of the stomach.

It is also possible that both of these factors occur at the same time.

About 15 to 20 out of every 100 people who use high doses of NSAIDs, such as people who have rheumatoid arthritis or osteoarthritis, develop sores in the stomach that look like ulcers when examined with endoscopy.¹ But only a small number actually develop symptoms or complications of peptic ulcer disease. Serious complications of peptic ulcer disease caused by NSAID use are higher in people who:¹

• Have a prior history of abdominal (belly) problems, such as an ulcer or bleeding.
• Are older than age 60.
• Need high doses of NSAIDs to control pain and inflammation caused by long-term (chronic) diseases, such as arthritis or headaches.
• Use corticosteroids in addition to NSAIDs.
• Have infection with Helicobacter pylori (H. pylori), especially if they have just started using NSAIDs.
• Use aspirin, even in low daily doses.
• Use blood thinners (anticoagulants) or antiplatelet medicines such as warfarin (Coumadin), clopidogrel (Plavix), or ticlopidine (Ticlid), especially when used in addition to NSAIDs or low dose aspirin.

You can prevent NSAID ulcers and their complications by not taking NSAIDs or by only taking them occasionally and in small doses. When NSAIDs must be used and you have a risk of complications, you can take misoprostol or proton pump inhibitors to reduce your chances of complications.

Citations

1. Lanza FL, et al. (1998). A guideline for the treatment and prevention of NSAID-induced ulcers. American Journal of Gastroenterology, 93(11): 2037–2046.