Is your medicine cabinet causing stomach problems?
Reaching for an over-the-counter pain reliever may feel harmless, but gastroenterologists say habitual use of common household medications is now the second-leading cause of peptic ulcers.
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, are the biggest culprit. These NSAIDs ease pain by blocking enzymes that create inflammatory chemicals, but those same enzymes also help the stomach produce protective mucus for digestion.
“Taking one dose of medication for a headache is rarely a problem,” reassures Dr. Peter Sargon, a gastroenterologist at Advocate Health Care. “The issue is when you exceed the recommended dose or combine medications that contain the same active ingredient that problems may arise.”
Peptic ulcers sometimes stay silent until they bleed, but most announce themselves with a burning pain between the breastbone and belly button. Pain that wakes you at night, black or tarry stools, sudden nausea or vomiting that looks like coffee grounds are symptoms that signal urgent care is needed.
Several other common medications can amplify the risk of peptic ulcers when combined with NSAIDs or taken alone. These include:
- Selective serotonin reuptake inhibitors (SSRIs): These popular antidepressants reduce a platelet’s ability to form a protective clot, making any small erosion more likely to bleed. Discuss any concerns about taking SSRIs with your health care provider. Never stop SSRIs abruptly.
- Blood thinners: Direct oral anticoagulants and older drugs, such as warfarin, do not cause ulcers outright, but they could turn a shallow sore into a life-threatening hemorrhage. People on these medications should avoid taking over-the-counter NSAIDs. Discuss with your health care provider if you have concerns about taking blood thinners or if you need alternative pain control methods in place of NSAIDs.
- Oral steroids and certain osteoporosis drugs: Both can irritate the stomach wall, especially in older adults already taking NSAIDs.
“There is a common misconception that natural equals safe,” Dr. Sargon adds. “Patients often assume only prescription medications pose risks as opposed to herbal supplements or vitamins. However, certain supplements, such as willow bark or high dose fish oil, can also thin the blood. It is important to share your full list of supplements with your doctor at every visit.”
Dr. Sargon offers these tips to help protect your stomach:
- Limit NSAIDs. Follow the 10-day rule on product labels and use the lowest effective dose. If you are prescribed aspirin, discuss any concerns about side effects with your health care provider.
- Take pills with food and water. A full stomach buffers acid and reduces irritation.
- Ask about alternatives. Pain management options such as acetaminophen, topical gels or physical therapy may control pain without harming the gut.
- Consider a proton pump inhibitor (PPI). If you need daily aspirin or another drug that increases your ulcer risk, a PPI can cut acid and lower your odds of bleeding. If you use an over-the-counter PPI, make sure to tell your health care provider since long-term use requires extra monitoring and review for drug interactions.
- Test for pylori. A simple breath or stool test can reveal the bacteria that cause most ulcers. If positive, antibiotics eradicate it before it teams up with NSAIDs to produce ulcers.
If you have questions about your medications, never hesitate to ask your health care provider or pharmacist.
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