NSAID-Induced Gastric Ulcer

NSAID-Induced Gastric Ulcer Information

NSAID-Induced Gastric Ulcers are ulcers caused by the nonsteroidal anti-inflammatory drugs. The nonsteroidal anti inflammatory drugs are a common prescribed medication in the inflammations of arthritis or other body tissues, such as tendonitis or bursitis. Drugs that are in the group of the NSAIDs are:

The most common side effects of the NSAIDs are related to the effect they have on the stomach and bowels –gastrointestinal system-. Most of the patients cannot tolerate the NSAID treatments because of their side-effects, which include:

• Upset stomach
• Diarrhea
• Abdominal pain

Usually patients who take long-term treatment with NSAIDs develop NSAID-Induced Gastric Ulcers (ulcerations of the duodenum and stomach); even though they may be asymptomatic the risk of developing serious ulcer complications like bleeding or perforation of the stomach is very high. The risk of developing complications is higher in the elderly patients, patients who are taking blood thinning treatment and those with rheumatoid arthritis, also patients that take cortisone based treatments and those with heart diseases. Prostaglandins are natural chemicals that are a kind of messengers that promote inflammations. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammations. However, certain prostaglandins are also important in protecting the stomach lining from the effects of the stomach acid as well as playing an important role in maintaining the healthy conditions of the stomach lining.

NSAID-Induced Gastric Ulcer – Symptoms

The major symptom of a NSAID-Induced Gastric Ulcer is a burning feeling in the stomach area that can last between 30 minutes and 3 hours. This pain is often interpreted as heartburn, indigestion or hunger. The pain is usually located in the upper abdomen, but sometimes it may occur below the breastbone. In some patients the pain occurs immediately after eating. In other individuals, the pain may not occur until hours after eating. The pain may wake up the patients in the middle of the night. Weeks of pain may be followed by weeks of not having pain. Pain triggered by NSAID-Induced Gastric Ulcers can be relieved by drinking milk, eating, resting and also by taking antacids.
Appetite and weight loss are other symptoms. Patients that have NSAID-Induced Gastric Ulcer (especially duodenal ulcers) can experience weight gain because the patients eat more to ease discomfort. Other symptoms include:

• Vomiting
• Blood in the stool
• Aemia
• Chest pain
• Unexplained weight loss
• Nausea
• Vomiting of blood
• Feel worse when the stomach is empty
• Be felt anywhere from your navel to your breastbone
• Difficulty swallowing
• Black or tar-like stool
• Severe pain in the abdominal area
• pain that radiates in the back
• pain that does not disappear even if you take certain medication
• Unusual weakness
• Belching
• General discomfort of the stomach
• Loss of appetite and is some cases even increased appetite
• Tiredness which is caused by a bleeding ulcer
• Dizziness
• Fatigue
• Fainting
• Excessive sweating
• Confusion
• Indigestion

NSAID-Induced Gastric Ulcer – Treatment

Treatment of NSAID-Induced Gastric Ulcers involves discontinuing the NSAID, reducing the stomach’s acidity with H2-blockers, or more effectively, with proton pump inhibitors (such as Prilosec) or synthetic prostaglandins (such as Cytotec). As H. pylori bacteria is a common cause of ulcers, eradication of the bacteria with a combination of antibiotics can also promote the ulcer’s healing. In the case that you have the symptoms listed above you should consult a doctor. Treatment for NSAID-Induced Gastric Ulcers usually involves a combination of medications in order to kill the Helicobacter pylori bacteria, reduce acid levels and protect the gastro-intestinal tract. This combination of the medications usually helps the ulcer to heal and to reduce the chances of the coming back. The medication that is usually prescribed may include one or more of the following:

• Antibiotics to kill Helicobacter pylori bacteria such as amoxicillin , clarithromycin and Metronidazole (such as Flagyl).
• Acid blockers
• Proton pump inhibitors
• Medications that protect the tissue lining
• Bismuth (may help protect the lining and kill the bacteria)

If a patient has a bleeding ulcer (NSAID-Induced Gastric Ulcer), than an EGD (which is an esophagogastroduodenoscopy) is required in order to stop the bleeding, but if the bleeding cannot be stopped with the EGD or if the ulcer caused a perforation of the stomach then surgery may be needed. An EGD is an examination of the esophagus, stomach and upper duodenum with a small camera, names flexible endoscope, which is inserted down the throat. Possible combinations could be:

• Omeprazole + amoxicillin + clarithromycin.
• Omeprazole + Metronidazole + clarithromycin (if penicillin allergic).
• HeliClear  – is a one-pack treatment available on prescription that contains all the necessary treatments in a one-week course.

A less common treatment for NSAID-Induced Gastric Ulcers is from three to four different types of medicine four times daily for a total of 2 weeks (proton pump inhibitor + bismuth subcitrate + amoxicillin + Metronidazole). This treatment form is only used under special circumstances and carefully supervised by the doctors. The treatment for bleeding NSAID-Induced Gastric Ulcers depends on the quantity and severity of the blood loss. Here are some types of treatment for this type of ulcer:

It is very important to remember that these treatments for NSAID-Induced Gastric Ulcers no matter if they are for a bleeding ulcer or for a normal ulcer do not work properly if the diagnosis is incorrect and that if you are diagnosed by you doctor with ulcer you should take some test in order to find out if the ulcer you have is caused by the H. bacteria.