Warding Off Ulcers Due to Painkillers

Heartburn Drug Prevents Ulcers Among Long-Term Users of Painkillers

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Oct. 15, 2003 (Baltimore) -- People who take painkillers regularly to ease arthritis and other painful conditions face the risk of a dangerous bleeding ulcer. But a heartburn pill a day may keep ulcers at bay.

So suggests a new study showing that the prescription heartburn drug Nexium helped prevent ulcers among 573 long-term users of painkillers.

Nexium, a prescription medication, belongs to a class of drugs known as proton-pump inhibitors, which block the production of stomach acid. Other such drugs include Prevacid and Prilosec, which recently went over the counter.

AstraZeneca, which markets Nexium, helped fund the study, which was presented here Tuesday at the 68th Annual Scientific Meeting of the American College of Gastroenterology.

Regular use of anti-inflammatory painkillers such as ibuprofen, naproxen, and Celebrex increases the risk of ulcers up to fivefold, says James Scheiman, MD, professor of internal medicine at the University of Michigan Health System in Ann Arbor.

These common painkillers suppress inflammation by blocking inflammatory substances called prostaglandins. However, these substances also help protect the stomach and intestinal lining from the damaging effects of acid. Thus, without these protective substances, the stomach and intestines become more susceptible to ulcers, Scheiman says.

Don't Trade One Pain for Another

"The results are very encouraging," Scheiman says. "There doesn't have to be a tradeoff between one type of pain and another."

The researchers studied 573 ulcer-free patients who had taken painkillers at least five days a week for four weeks. The painkillers included older anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen as well as newer ones including Celebrex and Vioxx. Each participant was randomly assigned to receive Nexium or placebo daily for six months.

Patients in the study were at particularly high risk of ulcer, Scheiman says. About two-thirds were 60 years or older, one-fourth had previously had an ulcer, and 10% fell into both categories.

By six months later, 12% of patients taking placebo had developed an ulcer, compared with 5% and 4%, respectively, of those on low-dose and high-dose Nexium. "That's nearly a 60% reduction in ulcer development," Scheiman says.

Patients who took Nexium were also less likely to suffer from heartburn and acid reflux, the study showed.

Nexium was well tolerated, he says: Only 6% of patients stopped taking it because of side effects, compared with 13% of patients on placebo.

Some Say Yes, Some Say No

So should all patients taking anti-inflammatory painkillers for long periods of time start popping Nexium or other proton-pump inhibitors such as Prilosec?

Researchers not involved with the study are divided.

"In a word, no," says David Y. Graham, MD, chief of the digestive disease division at Baylor College of Medicine in Houston.

"If they cost 20 cents, yes. But the data that they give a really big benefit to the average person is just not there to support routine use."

The drugs should be taken by certain people, such as those who suffer from indigestion and other symptoms of stomach upset, he says.

But Jay Goldstein, MD, professor of medicine at the University of Illinois in Chicago, says, "In an ideal world, yes. Maybe it's an expensive approach to treating a 25-year-old healthy athlete on [long-term painkillers]. But with increased risk, everyone should be on them."

In addition to long-term use of painkillers, risk factors for the development of ulcers include smoking, heavy coffee drinking, stress, and most strongly, infection with a common bacteria known as Helicobacter pylori.

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SOURCES: 68th Annual Scientific Meeting of the American College of Gastrenterology, Baltimore, Oct. 12-15, 2003. David Y. Graham, MD, chief of the digestive disease division, Baylor College of Medicine, Houston. James Scheiman, MD, professor of internal medicine, University of Michigan Health System, Ann Arbor. Jay Goldstein, MD, professor of medicine, University of Illinois, Chicago.
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