For many years it has been generally accepted that people with IBD should avoid NSAIDs because it may precipitate a relapse. It has also been speculated that the newer COX-2 inhibitor class of drugs (mainly used for the treatment of arthritis) may also cause increased disease activity.
The Crohn’s and Colitis Foundation of America (CCFA) and the Crohn's and Colitis Foundation of Canada recommend that people with Crohn’s disease and ulcerative colitis avoid taking NSAIDs. The CCFA also recommends that patients with IBD question a physician who prescribes an NSAID drug.
A study published in the November 2004 issue of Alimentary Pharmacology and Therapeutics contends that NSAIDs do not necessarily cause relapse in all patients with IBD.
Researchers searched the medical literature for instances of IBD relapse caused by NSAIDs. They found 22 such instances described in various case reports (2 of which were relapses after the use of a COX-2 inhibitor). The authors also found 15 epidemiological studies, all of which had small sample sizes, and many with “methodological problems.” Of these studies, 6 showed evidence of a relationship between NSAIDs and IBD relapse. Of the 6, only 2 showed a statistically significant result and 3 indicated there may be a relationship between acetaminophen (a non-NSAID painkiller) and relapse of IBD.
The study authors conclude that NSAIDs may cause a relapse of IBD symptoms, but it may be an unusual reaction that only occurs in some people. They also indicate that the current evidence connecting IBD relapse and acetaminophen is weak, but it may be important.
It is clear that NSAIDs may cause a relapse in some people with IBD. What is not clear is whether this is a common occurrence, or if it only happens in a small number of individuals. A clear answer may not be possible: case-control studies may be prone to bias, and a clinical trial to test the effects of NSAIDs on people with IBD would be unethical by most standards.
Like so many other facets of treatment for IBD, the decision of whether or not to take NSAIDs will continue to be one that lies with the individual physician and patient. The cost to benefit ratio must be weighed: taking an NSAID to relieve minor discomfort may not be an acceptable risk.
People with IBD should still consult with their gastroenterologist before taking NSAIDs, even those available over the counter. It is also extremely important to make all members of a healthcare team aware of the effect NSAIDs may have on IBD.
