Executive Summary
NSAIDs are a class of medicines that reduce pain, inflammation and fever. They inhibit the production of chemicals called prostaglandins at the injury site. However, the same chemicals also help protect the stomach cells from getting harmed by the strong stomach acid.
Do not consume NSAIDs unless prescribed, as their long-term use causes stomach ulcers. Consider alternate options to reduce inflammation.
Some popular painkiller medicines can cause gastrointestinal ulcers if used for long periods. However, many people take them even for minor aches and pains, without consulting a doctor. This may be due to ignorance about how they work, making one assume that any pain is bad and so getting rid of it must be good. This article will help you understand why a few seemingly bad things are good and vice versa.
What Are NSAIDs?
Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medicines used for reducing pain, inflammation and fever. Commonly used NSAIDs are aspirin, ibuprofen, diclofenac and celecoxib.
NSAIDs are used against pain in musculoskeletal disorders such as arthritis, tendonitis and bursitis, fever, migraine and post-operative pain. Aspirin can reduce the risk of heart attack and stroke due to its ‘blood thinning’ properties, though doctors recommend it mainly in high-risk patients in low doses.
How Do NSAIDs Work?
Your body systems primarily communicate with one another through chemicals as messengers. A region secretes certain compounds that flow through the blood or other body fluids to another part, which senses their presence. Depending on the chemical concentrations detected, the other system activates different processes.
When you get an injury or infection, the body makes certain hormone-like lipids called prostaglandins at the site. They may raise body temperature causing fever. By dilating blood vessels at the injury location, they increase blood flow, swelling and redness locally and trigger inflammation and pain. While unpleasant, these are signals for the body’s repair system to initiate the healing process and are desirable.
Many people find such pain or fever insufferable, partly out of ignorance about their purpose. They take NSAID medicines that block a specific enzyme called COX (cyclooxygenase) needed for producing prostaglandins, bringing down fever, inflammation and pain.
However, NSAIDs can cause many side effects, including some serious ones. For example, if prostaglandins dilate blood vessels, you can imagine that NSAIDs will raise blood pressure by constricting them. Besides high blood pressure, heart disease, kidney problems, headache, dizziness, nausea and diarrhoea, NSAIDs may lead to gastrointestinal bleeding and peptic ulcers.
Stomach Acid
Certain cells in the stomach secrete concentrated hydrochloric acid, which plays multiple beneficial roles in your health. It kills most pathogens in your food and breaks it down so that its nutrients can be absorbed better—strong reasons not to consume anti-acidity medicines at the drop of a hat. Read on this website: Do I Need To Worry About Using Acidity Medicines?
How Stomach Cells Are Protected From Stomach Acid
If stomach acid is so strong, why does it not destroy stomach cells? Multiple defence mechanisms ensure that highly acidic stomach contents do not damage stomach cells. The three main ones are:
- Stomach cells produce a thick layer of mucus that acts as a barrier between them and the acid.
- Stomach cells secrete a chemical ion called bicarbonate (IUPAC name: hydrogencarbonate) that neutralises stomach acid in their close vicinity.
- Blood supply to the stomach cells takes away hydrogen ions, a high concentration of which is needed for an acidic environment, and other toxic substances from the cell neighbourhood.
Interestingly, certain chemicals play a pivotal role in producing mucus and bicarbonate, maintaining stomach blood flow and regulating stomach acid production. They are found in abundance in stomach acid and mucus. You have heard their name: Prostaglandins.
By blocking prostaglandin production, NSAIDs weaken stomach cell protection—mucus and bicarbonate productions fall and stomach blood flow is less effective. As the stomach lining slowly gets exposed to highly corrosive acid, a stage is set for the development of peptic ulcers.
What Are Peptic Ulcers?
A sore in the lining of the digestive route—the food pipe (oesophagus), stomach and small intestine—is called a peptic ulcer. Ones in the stomach are called gastric ulcers, while those at the junction of the stomach and the small intestine—duodenum—are called duodenal ulcers.
NSAIDs and Gastric Ulcers
Prolonged use of NSAIDs can cause stomach ulcers by increasing exposure of stomach cells to an acidic environment.
NSAIDs and Duodenal Ulcers
As the food moves further into the intestines, the bicarbonate ions produced by the duodenum neutralise the acid mixed with the food. This is beneficial because the mucus lining the small intestine is thin and offers poor protection against the acid.
As NSAIDs reduce prostaglandins, more stomach acid is produced, overwhelming the bicarbonate production in the duodenum and leading to duodenal ulcers.
NSAIDs and Oesophageal Ulcers
While NSAIDs don’t directly lead to oesophageal ulcers, excess stomach acid production may be causing them, as reported in medical literature.
Caution
- If you are at risk for heart disease, high blood pressure, kidney problems or digestive system ulcers, be very careful about using NSAIDs on your own.
- Discuss alternatives with your doctor if you need to take them for a long duration.
- Do not overlook non-medicinal ways of bringing out inflammation, such as ice, rest and anti-inflammatory foods.
- Supplements of anti-inflammatory nutrients in fish oil (EPA and DHA), garlic (allicin), ginger (gingerols), cinnamon (cinnamaldehyde and eugenol), turmeric (curcumin), green tea (catechins), grapes (resveratrol), pineapple (bromelain) and vitamins A, C and vitamin D may also be considered. However, keep in mind that these act over the long term and are not substitutes for immediate medicinal relief.
To Read More
- VeryWellHealth: NSAIDs and Peptic Ulcer Risk
- Scientific American: Why don’t our digestive acids corrode our stomach linings?
- Dept of Health, Victoria, Australia: Medications – non-steroidal anti-inflammatory drugs
- Penn Medicine: Peptic Ulcer Disease
- MedlinePlus: Peptic Ulcer
- National Library of Medicine: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- NHS.UK: NSAIDs
- On this Website: Acidity (Heartburn): Do’s and Don’ts
First Published on: 26th February 2024
Image Credit: ArtPhoto_studio on Freepik
Last Updated on: 28th February 2024