NSAIDs, Antibiotics, Infections, and Stress -- Oh My!
Friday July 10, 2009
A new article in The American Journal of Gastroenterology looks at the effect that NSAIDs, antibiotics, infections, and stress have on IBD. The authors looked at available research on all these topics to make some conclusions about the associated with IBD. They conclude that NSAIDs might cause a flare, but that there isn't much research that points to antibiotics as a cause for flare-ups. In the case of intestinal infections, it's unclear if IBD symptoms are triggered because of the infection, clear up when the infection clears up, or continue after the infection resolves. As far as stress, there is some evidence that IBD flare-ups occur in patients who report that they're stressed. Yet IBD flare-ups and stressful life events are not necessarily associated.
The authors point out that many of the studies used to write their review were lacking in one way or another, such as not using control groups, or not providing baseline population data for comparison. In light of that, they conclude that larger and better studies would help understand how NSAIDs, antibiotics, infections, and stress affect IBD.
I know many of you reading this probably have a story about how one of these things affected your IBD. Why don't you click on "comments" below, and tell me about it?
Source: Singh S, Graff LA, Bernstein CN. "Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?" Am J Gastroenterol 2009; 104:1298–1313; published online 31 March 2009. 10 Jul 2009.
Comments
I must be the odd man out in these tests. When I was first diagnosed with “patchy ulcers in the small intestine” back in 1973, this was considered to be a stress-related disease, plain and simple. Like gastric ulcers, it was treated with lots of milk and bananas, Valium, Maalox, and more Valium. I wasn’t a stressed-out person when I entered this Carnival of Care, but I was after 10 years of being told that all my flares and symptoms were the result of stress (or Type-A behavior, or worry, or some variation). The logic was crystal clear: if my gut went bonkers on a more or less constant basis, I must be one heck of an uptight guy. I have come to realize that in my case, I have both IBS that reacts to stress, nerves, and worry, and IBD that flares more-or-less when it wants to.
Antibiotics tear me up. I can almost never complete an entire 5-day or 10-day course. This is very frustrating, considering I have chronic pleurisy and all sorts of lung problems that need frequent antibiotic therapy. I have learned to keep lots of reading materials handy, and trust the doctors to weigh the costs against the benefits.
NSAIDs have never caused me any trouble. No flares, no extra runs to the bano, nothing. I have to take them for the pleurisy and lung problems (pulmonary fibrosis, bronchiectasis). It’s either that, or prednisone, which I hope to never put in my body in any form again. Seriously.
Infections? I really don’t know. I could have a 48-hour diarrhea bug and chalk it up to a mild flare, especially now that I’ve had two surgeries for CD that left me with “short bowel syndrome,” a condition for which somebody really needs to find another name. Like Ray Romano, the comedian, one of my life goals is to never throw up again, and fortunately I am having a good run of luck.
Hope this helps. I sometimes wonder why high-falutin’ studies and surveys fail to match my own experience. I guess this is a disease that affects everyone differently. Here’s hoping someone finds a common denominator and an across-the-board treatment soon. After 35 years, I’m tired of it!
Thanks for your web site. I think you’ve done a great job with a tough subject….
Thanks David!
It is a tough subject! I often wonder if there should be even more categories of IBD — subcategories that could explain these differences. I also was told that UC was a stress-related problem and that it was my uptight personality that was causing it. But I was 16 when I was diagnosed — I remember being much more easygoing then. The UC caused my stress which caused my “type-A” personality. Someone should do a study on that!