How taking painkillers can destroy your stomach lining in days
By Abigail Butcher
Created 8:29 PM on 26th September 2011
'Every day is an uphill battle,' said Claire Calder after a taking non-steroidal anti-inflammatory drug
When Claire Calder was prescribed painkillers for a common foot condition, she didn’t think twice about taking them.
Claire suffers from Morton’s Neuroma, an extremely painful complaint caused when a small growth forms on a nerve in the foot. To relieve the pain, her GP prescribed a non-steroidal anti-inflammatory drug.
But within six days of taking the pills, Claire’s stomach lining was so damaged that seven months later she is still suffering from searing stomach pain.
‘Every day is an uphill battle,’ says the former sales rep from Oxfordshire.
Non-steroidal anti-inflammatories (NSAIDs), which include aspirin and ibuprofen, are painkilling drugs taken by countless Britons every day.
Last year, there were nearly 17 million prescriptions for NSAIDs, with many more being sold over the counter.
But evidence is emerging to show these medications can cause significant side-effects. And what worries experts is that this problem may be much greater than previously thought.
A Canadian study published last month showed that drugs such as ibuprofen more than doubled the risk of miscarriage among pregnant women. The women studied had been given at least one prescription for NSAIDs from the start of their pregnancy.
Meanwhile, a recent U.S. study found an increase in the risk of renal cell cancer among those taking the painkillers regularly for four to ten years.
NSAIDs have been linked to a 22 per cent increased risk of erectile dysfunction if taken three times a day for more than three months.
Worryingly, the side-effects can be almost immediate, as Claire, 40, discovered earlier this year.
Just two days after she started taking the drug diclofenac (a 75mg tablet morning and night) she woke up early, with a burning sensation in her stomach.
‘I thought I was hungry, so I had a glass of milk and a biscuit,’ she says — but that didn’t help.
Claire went back to her GP, who gave her a drug to help protect the stomach lining, called omeprazole.
But the feeling didn’t go away, and after six days Claire stopped taking all the pills. A few days later, she was doubled over with burning pain in her stomach.
Her GP referred her to a gastro-enterologist, who diagnosed non-ulcer dyspepsia — a condition that causes chronic stomach pain. And the cause? Her painkillers.
Claire says she was not warned of any potential dangers.
‘I wish someone had mentioned the risks to my stomach lining,’ she says.
Graeme Williams was also unaware of the risks when he started taking over-the-counter ibuprofen for a migraine.
‘My doctor told me to take ibuprofen and codeine until it went,’ he says.
Just seven days later, the 66-year-old property consultant from Kingston, Surrey, developed acid reflux, where stomach acid splashes back up his oesophagus, or gullet.
Three weeks later, suffering severe discomfort when swallowing, he underwent tests that showed his oesophagus had become ulcerated. As with Claire, the specialist confirmed that the painkillers were to blame.
Last year, there were nearly 17 million prescriptions for NSAIDs
Non-steroidal anti-inflammatories work by interfering with specific enzymes in the body, the cyclo-oxygenase or cox enzymes. Cox enzymes trigger inflammation — NSAIDs prevent this happening.
For this reason, they are used to treat pain, particularly when it’s accompanied by inflammation and fever. They are commonly prescribed for arthritis, as well as back and neck pain.
However, the drugs have another, unwanted effect, reducing blood flow to the stomach and duodenal lining. This impairs healing and reduces the mucus layer that forms a protective barrier in the gut.
Without this layer, stomach acid can damage the gut lining.
‘Everyone who takes NSAIDs will get small erosions of the stomach (antral erosions), which can happen after a single dose,’ says Dr Ray Shidrawi, a consultant gastroenterologist at Homerton University Hospital in London.
Indeed, it is well documented that NSAIDs can cause stomach problems, particularly when prescribed over a period of months.
However, Dr Shidrawi believes the risks are underestimated. He blames not just ignorance about the dangers, but the widespread use of the drugs and their effectiveness — this lulls people into a sense of security.
COULD YOU BE AT RISK?
Confused about whether the painkillers you’re taking are NSAIDs?
Here, we list some of the most common forms.
Over-the-counter:
- Aspirin (also sold as Disprin and Aspro)
- Ibuprofen (trade names include Nurofen and Cuprofen)
- Diclofenac (trade names include Voltarol)
Prescription:
- Ibuprofen and diclofenac are also available on prescription from your doctor
- Naproxen
- Celecoxib
- Mefenamic acid
- Indomethacin
‘NSAIDs have become so commonplace in our medicine cabinets at home and people take them like Smarties,’ he says.
‘As a result patients think, “It’s not going to happen to me” when it comes to side-effects.’
In fact, many of the 6,000 cases admitted to hospital every year with gastrointestinal bleeding are caused ‘directly’ by painkillers.
This bleeding can be life-threatening. If it is significant, there is a 5 to 10 per cent risk of the patient dying, which rises to 20 per cent if you’re over 60 or suffer from a serious illness such as liver, kidney or heart problems, or cancer.
In the U.S., a study in 1998 found the death rate for gastric bleeding linked to NSAIDs was higher than for cervical cancer, asthma or malignant melanoma (skin cancer).
Doctors have yet to establish why some people react so badly and others don’t. Or why they can sometimes occur after a few days.
There is no doubt NSAIDs are life-transforming for many people and all painkillers have risks.
For many who would otherwise be incapacitated by pain, the benefits of a daily small dose of aspirin or ibuprofen outweigh the risks.
‘People should not stop taking NSAIDs, but if they have concerns they should speak to their doctor,’ says a spokesman for the UK Medicines and Healthcare products Regulatory Agency.
However, what should be happening is that patients taking the painkillers are also given a proton pump inhibitor. This was the drug Claire Calder was prescribed when she started experiencing stomach pain.
These drugs work by cutting stomach acid production and so help protect the stomach lining.
Dr Shidrawi says a proton pump inhibitor should be automatically prescribed to anyone taking NSAIDs for a long-term condition, such as arthritis, when the drugs may be taken for months.
‘If you get even mild abdominal pain while taking a NSAID for any length of time, see a doctor,’ he says. ‘If you vomit or cough blood or notice blood in your stools, go straight to hospital.
‘If you need a painkiller, always start with paracetamol because side effects are rare. Avoid NSAIDs unless the pain is severe, and don’t take them for a long time unless on medical advice.’
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