New Research Questions Use of NSAIDs in IBD

For many years it has been generally accepted that people with inflammatory bowel disease IBD should avoid non-steroidal anti-inflammatory drugs (NSAIDs) because these drugs may result in a flare-up of IBD symptoms. Two studies published in the February 2006 issue of Clinical Gastroenterology and Hepatology may provide good news for person with IBD who suffer from normal aches, pains, and headaches.

It may be possible to take NSAIDs, including COX-2 inhibitors, while the IBD is in remission. The authors of these studies are optimistic that the COX-2 inhibitors may be a short-term option for people with IBD who need pain relief.

Do these studies mean that people with IBD can take NSAIDs (ibuprofen, naproxen, aspirin, etc.) or COX-2 inhibitors?

People with IBD should still consult with their gastroenterologist before taking NSAIDs—even those available over the counter, such as Advil, Aleve, or Bayer. These studies are a start, but more research is necessary before any kind of a blanket statement regarding the use of NSAIDs can be made.

Only your gastroenterologist, who is familiar with your IBD history and any other medical conditions you may have, can advise you on the use of NSAIDs for pain relief.

What do these studies show?

In the first study, 209 patients in remission for at least 6 weeks were given the non-NSAID pain reliever, acetaminophen, along with NSAIDs naproxen, diclofenac, indomethacin, and a COX-2 inhibitor, nimesulide, for a time period of 4 weeks. Other groups of patients were given acetaminophen, naproxen (a COX-1 and -2 inhibitor), nabumetone (a COX-1 and -2 inhibitor), nimesulide (a selective COX-2 inhibitor), or low-dose aspirin. Between 17% and 28% of patients given NSAIDs experienced a relapse within 9 days. The COX-1 and COX-2 inhibitors, however, did not cause a relapse.

In the second study, 222 patients with ulcerative colitis (UC) and a history of nonspecific arthritis, arthralgia, or another condition that is normally treated with NSAIDs were given either the COX-2 inhibitor celecoxib (Celebrex) or a placebo for 2 weeks. Patients who received the drug were not any more likely to experience a relapse in symptoms than those patients with UC who received a placebo (3% versus 4%).

Why were people with IBD advised against taking NSAIDs in the past?

NSAIDs are drugs that are available over-the-counter and by prescription, and many people take them every day for common aches and pains, headaches, and fevers. However, NSAIDs are also known to irritate the stomach by weakening the lining and making it less able to resist stomach acids. This in turn may cause irritation, or more serious conditions such as ulcers, bleeding, or perforation of the stomach lining.

In IBD, the lining of the intestine is already inflamed by the disease process. It was generally thought that taking an NSAID could exacerbate this effect, causing a relapse or a worsening of symptoms.