Gastro-Intestinal (Stomach) Protection

General Indications

Your stomach is the only organ in your body capable of eating itself, so to speak: Digestive juices contain enough enzymes and hydrochloric acid to burn a hole through your stomach wall. Obviously, human biology has solved the problem. There's a dense layer of mucous lining your stomach and intestines, which forms an effective barrier against corrosion. Under normal conditions, the mucous is renewed faster than it's eaten away by acids and enzymes.

If for some reason the rate of mucous renewal should drop, however, the barrier slowly erodes, exposing the tissues of the stomach wall to injury: an ulcer. If the ulcer occurs at the site of a major blood vessel, it can cause internal bleeding, or if the ulcer perforates the stomach wall, the membrane lining the abdominal cavity (the peritoneum) can become inflamed. Both are very serious medical conditions, requiring emergency medical attention.

The problem is you might not always know you even have an ulcer. You'd think that if a hole were being eaten in your stomach, you'd feel it, but not necessarily. Clinical experience shows that - even as an NSAID causes an ulcer - its analgesic effects may also mask the pain the ulcer is causing. The result is what's known as a 'silent ulcer.' To understand why NSAID's can cause bleeding and ulcers, you need to know about a family of hormones called prostaglandins.

Different prostaglandins undertake different maintenance chores in our bodies, ranging from constricting blood vessels to regulating the blood's clotting ability. One prostaglandin, called PE-1, helps keep the stomach's mucous barrier healthy; a close relative, PE-2, helps promote local inflammation.

NSAIDs inhibit PE-2 production, which is good for treating your inflammatory arthritis; reducing the inflammation in the joints means less chance of disability. Unfortunately NSAIDs also reduce PE-1 levels, and that's not so good for the mucous barrier protecting your stomach. Less PE-1 means you're at higher risk of developing an ulcer. What's more, most NSAIDs are acidic and stimulate the stomach's acid production.

If you cough up material that looks like old coffee grounds or if your stools are black and tar-like, these could be signs of internal bleeding in the stomach or intestines. Alert your doctor immediately.

So, does that mean the moment you swallow an NSAID, it's going to burn a hole in your stomach? No. NSAIDs are relatively safe, and the vast majority of people who take them never develop an ulcer. Nevertheless, NSAIDs must be taken continuously to be effective against inflammatory arthritis and, with time, your risk of ulcers increases, particularly if you have a history of stomach problems or are aged 60 or more. Your doctor will have to decide whether the benefits from continuing your NSAID therapy outweigh the risks of not treating your arthritis or of your developing an ulcer.

In addition to NSAIDs, other strong acid producers (and thus stomach irritants) include caffeine (coffee, tea, cola, chocolate), alcohol and nicotine. If your stomach is bothering you, try reducing your intake of these irritants. Anti-inflammatories are generally taken with food; most people find this helps reduce heartburn and indigestion.

It also helps to take your anti-inflammatory with an eight-ounce glass of water, to dilute the acid produced and help dissolve the tablet. Fluid intake also helps reduce constipation. Stomach pain, heartburn and indigestion should be easily relieved by an antacid (such as Maalox, Mylanta, Gelusil, etc.). If symptoms persist, notify your doctor.

Also, avoid taking extra non-prescription ASA or ibuprofen (Advil, MotrinIB), if you're taking a prescription anti-inflammatory as they increase the risk of stomach upset and gastrointestinal bleeding. For additional pain relief, headaches or fevers, acetaminophen is a safe alternative with a prescription anti-inflammatory.

If your doctor considers increased GI protection necessary, he or she may recommend that you take your NSAID along with a stomach-protecting medication such as a class of drugs called Proton Pump Inhibitors (PPI), or misoprostol or an NSAID with built-in cytoprotection (Arthrotec).

This page was last reviewed/updated on : 02/23/2008