Why NSAIDs Are Bad for Crohn's and Ulcerative Colitis

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.

A woman suffering with IBD
Tharakorn Arunothai / EyeEm/Getty Images 

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.


Research on whether NSAIDs contribute to IBD symptoms is conflicting, creating 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 person'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
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By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.