Digestive Health Inflammatory Bowel Disease Treatment Are NSAIDs Safe for People With IBD? Check with a gastroenterologist before taking a painkiller Print By Amber J. Tresca | Medically reviewed by a board-certified physician Updated January 03, 2019 Tharakorn Arunothai / EyeEm/Getty Images More in Inflammatory Bowel Disease Treatment Diagnosis Living With Support & Coping Crohn's Disease Ulcerative Colitis Related Conditions Surgery Nutrition View All Look in almost any medicine cabinet and you are likely to find an NSAID (non-steroidal anti-inflammatory drug). NSAIDs, which are used to treat pain and inflammation, are so common that they often have their own aisle in drugstores. In fact, care needs to be taken to ensure that people do not accidentally take too many NSAIDS, especially because it can be easy to use more than one of these over-the-counter drugs to treat pain and fever from the flu or other common illnesses. Other uses of NSAIDs include treating headaches, muscle pain, menstrual cramps, and relieving everyday aches and pains. People with inflammatory bowel disease (IBD) experience aches and pains just like anyone else. Many also experience pain on a daily basis due to extra-intestinal conditions such as arthritis or from drug side effects such as headaches. However, some gastroenterologists recommend that their IBD patients stay away from NSAIDs. The reason: NSAIDs may have an adverse effect on Crohn's disease and ulcerative colitis. How NSAIDs Work NSAIDs work by blocking two particular enzymes in the body: cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 plays a role in the digestive system and COX-2 plays a role in the inflammatory process. The function of COX-1 is to regulate substances called prostaglandins that protect the lining of the stomach from the acids that help digest food. The prostaglandins synthesized by COX-2 mediate the inflammatory process and the pain response. What this means is that while NSAIDs dampen the cycle of inflammation and pain, they also cause the digestive system to lose some of its normal protective substances. This could create problems for people who already have inflammation, or the potential for inflammation, in their digestive tract. NSAIDs and Ulcers Even in people without IBD, NSAIDs can contribute to ulcers in both the stomach and the first part of the small intestine (called the duodenum). NSAIDs can cause inflammation and worsen bleeding in the small intestine. Some digestive specialists are concerned that NSAIDs could cause IBD to come out of remission. NSAIDs and IBD Research on whether NSAIDs contribute to IBD symptoms is conflicting, creating a controversy on their use among gastroenterologists. For the class of drugs called COX-2 inhibitors, there is currently not a lot of evidence about their effects on people with IBD. Some research shows that NSAIDs may affect only a certain percentage of people with IBD, but it's impossible to know who is going to be affected and who is not. It has been speculated that using a COX-2 inhibitor, rather than a drug that is both a COX-1 and a COX-2 inhibitor, might be used with caution in those whose IBD is in remission. People with IBD should consult with their gastroenterologist before taking NSAIDs, even those available over the counter. It is also extremely important to make all members of a patient's healthcare team aware of the effect NSAIDs may have on their IBD. What Those Who Live With IBD Can Do People who have IBD who are looking for over-the-counter pain relief may wish to consider acetaminophen. Acetaminophen, sold under many brand names, including Tylenol, is not an NSAID and may be a better choice for people with IBD who need a pain reliever. How acetaminophen works to block pain isn't completely understood, but it is thought to involve stopping the creation of prostaglandins. People with IBD should always question the addition of a new drug prescription, especially those that are used to manage pain. Not every healthcare professional is aware of the possible connection between painkillers and IBD. When people with IBD are going to undergo surgery or procedures not related to the digestive tract, it's important to loop a gastroenterologist in for a discussion about pain relief to make sure the latest information about NSAIDs and how they apply to IBD is being taken into account. Below is a table of NSAIDs available by prescription or over-the-counter. This is by no means an exhaustive list, so please consult a pharmacist or doctor for concerns about specific drugs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Brand Name Generic Name Advil, Excedrin IB, Genpril, Haltran, Ibuprin, Ibuprohm, Ibu-Tab, Midrin 200, Medipren, Midol IB, Motrin, Nuprin, Pamprin-IB, Rufen, Trendar Ibuprofen Aleve, Anaprox, Naprosyn Naproxen Sodium Amigesic, Anaflex 750, Marthritic, Mono-Gesic, Salflex, Salsitab, Disalcid Salsalate Anacin, Bayer, Bufferin, Ecotrin Choline salicylate Ansaid, Froben Flurbiprofen Oral Apo-Keto, Orudis, Oruvail, Rhodis Ketoprofen Apo-Sulin, Clinoril, Novo-Sundac Sulindac Aspergum, Genuine Bayer, Bayer Childrens, Bufferin, Easprin, Ecotrin, Empirin, Genprin, Halfprin, Magnaprin, ZORprin Aspirin Butazolidin Phenylbutazone Cataflam, Voltaren Diclofenac Systemic DayPro Oxaprozin Dolobid Diflunisal Feldene, Novo-Pirocam, Nu-Pirox Piroxicam Indocin SR, Indocid, Novo-Methacin Indomethacin Lodine Etodolac Meclomen Meclofenamate Sodium Mobic Meloxicam Nalfon Fenoprofen Calcium Ponstan, Ponstel Meclofenamic acid Relafen Nabumetone Tolectin Tolmetin Sodium Was this page helpful? Thanks for your feedback! We're providing tips on how to take better care of your gut. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Kefalakes H, Stylianides TJ, Amanakis G, Kolios G. "Exacerbation of inflammatory bowel diseases associated with the use of nonsteroidal anti-inflammatory drugs: myth or reality?" Eur J Clin Pharmacol. 2009 Oct;65:963-970. Long MD, Kappelman MD, Martin CF, et al. "Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease." J Clin Gastroenterol. 2016 Feb;50:152-156. Mahadevan U, Loftus EV Jr, Tremaine WJ, Sandborn WJ. "Safety of Selective Cyclooxygenase-2 Inhibitors in Inflammatory Bowel Disease.." Am J Gastroenterol 2002 Apr;97: 910-914. Matuk R, Crawford J, Abreu MT, et al. "The spectrum of gastrointestinal toxicity and effect on disease activity of selective cyclooxygenase-2 inhibitors in patients with inflammatory bowel disease." Inflam Bowel Dis 2004 Jul;10: 352-356. Ribaldone DG, Fagoonee S, Astegiano M, et al. "Coxib's Safety in Patients with Inflammatory Bowel Diseases: A Meta-analysis." Pain Physician. 2015 Nov;18:599-607. Sandborn WJ, Stenson WF, Brynskov J, et al. "Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study." Clin Gastroenterol Hepatol 2006 Feb;4: 203-2011. Singh S, Graff LA, Bernstein CN. "Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?" Am J Gastroenterol 2009; 104:1298–1313; published online 31 March 2009. Takeuchi K, Smale S, Premchand P, et al. "Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease." Clin Gastroenterol Hepatol. 2006 Feb;4:196-202. 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