Protect your stomach when taking pain medicines and medicines that prevent blood clotting

Problems caused by excessive secretion of gastric acid are very common. They affect about 30% of people. (1) The most typical symptoms include heartburn, burping, and backflow of gastric acid into the esophagus. (2) All these symptoms have one thing in common: they affect the quality of life. (3)

Excessive secretion of gastric acid may also cause stomach or duodenal ulcers. (4) These ulcers are often the result of concomitant Helicobacter pylori infection or taking non-steroidal anti-inflammatory drugs (NSAIDs), which are indispensable in the treatment of various diseases. (4)

NSAIDs are a diverse group of active substances used to treat pain, fever, and other inflammatory processes.Most people receive NSAID treatment for a short duration. However, some patients need to take these medicines every day. (5)

The main types of NSAIDs include: acetylsalicylic acid, ketoprofen, ibuprofen, diclofenac, naproxen, meloxicam, celecoxib, and etoricoxib.

Patients with chronic pain and inflammatory diseases are familiar with the effects of long-term pain treatment, i.e. reduced pain and inflammation, which contribute to an improved quality of life. (5)

Acetylsalicylic acid can be used to reduce pain and fever. It also prevents the formation of blood clots in blood vessels. This is why many people (mainly patients with cardio-vascular diseases) take low-dose acetylsalicylic acid every day to reduce the risk of cardiovascular complications, including myocardial infarction and stroke. (5)

Despite their many positive effects, NSAIDs reduce the amount of protective mucus in the stomach, exposing its lining to stomach acid. (4) Dyspepsia, stomach pain and heartburn occur in about 40%, while stomach ulcers develop in 10-30% of patients on long-term NSAID therapy. In rare cases, long-term NSAID therapy has been associated with serious complications, such as intestinal bleeding. Such complications require patient hospitalisation and may even result in death. (5)

This is why it is so important to take preventive action and protect your stomach lining. If taken at the same time as NSAIDs, proton pump inhibitors (PPIs) have been proven to be highly effective in preventing conditions related to increased stomach acid secretion. The positive effects of NSAIDs can thus be utilised and injuries to stomach and duodenum prevented. This type of treatment is not only effective, but also safe. (4,5)

Patients with high indication for PPI protection: (5-7)

Those on NSAID therapy with increased risk of injuries to stomach and duodenum:

• Aged > 65 years,
• History of ulcers,
• Concomitant therapy involving high dosage or combination of different NSAIDs,
• Therapy with medicines that prevent blood clotting,
• Corticosteroid therapy,
• Helicobacter pylori infection,
• Excessive alcohol use,
• Smokers.

What you can do yourself

Before you start taking a NSAID or acetylsalicylic acid, think about your risk for digestive system complications. Consult with your doctor if you think you are at risk or are not sure. (5)

When self-medicating, take into account the following: if you are currently taking NSAIDs or acetylsalicylic acid, talk to your pharmacist about the optimal protection for your stomach. (5)

References

1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63:871-880.
2. Hunt R, Armstrong D, Katelaris P et al. GERD Global Perspective on Gastroesophageal Reflux Disease. World Gastroenterology Organisation Global Guidelines. 2015.
3. Liker H. et al. J. Am. Board. Fam. Pract. 2005; 18(5): 393-400.
4. Koželj M. Varnejša uporaba nesteroidnih protivnetnih in antiagregacijskih zdravil. 2008.
5. Koželj M. Varno in učinkovito lajšanje bolečine. V skrbi za vaše zdravje. 2008.
6. Gwee KA, Goh V, Lima G et al. Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs:risk versus benefits. Journal of Pain Research. 2018: 11: 361-374.
7. Lanza FL, Chan FKL, Quigley EMM and the Practice Parameters Committee of the American College of Gastroenterology. Guidelines for Prevention of NSAID-Related Ulcer Complications. Am J Gastroenterol 2009; 104:728 – 738