Non-Steroidal Anti Inflammatory Drugs: NSAIDs are a class of medicines commonly used as painkillers and are available 'over the counter' or by prescription. Typical examples are Aspirin, Ibuprofen, Diclofenac, and Naproxen.

These drugs should not be taken by a person with Inflammatory Bowel Dissease (IBD) unless on the advice of a Gastroenterologist, or colorectal surgeon, as NSAIDs can irritate the gut. There is also a link between [wiki]Crohn's Disease[wiki] and Ulcerative Colitis with NSAID use, especially if used often, at higher dosage and long duration. [1] The literature regarding Aspirin and its effect on Crohn's Disease or Ulcerative Colitis risk is mixed. [1] This also applies to topical preparations like gels or creams. See also NSAID Induced Colitis.

You may have heard of "COX2 inhibitors" such as such as Celebrex (Celecoxib) or Etoricoxib, which have proven themselves to have less GI problems with non-IBD patients however they still cause bowel irritation and therefore use must really be approved by your GI consultant.


Mechanism of Action of NSAIDs relating to the gut

Traditional NSAIDs, like Aspirin and Ibuprofen, inhibit your body's production of a family of enzymes called Cyclooxygenase (COX), which in turn is used to produce signal chemicals called Prostaglandins. These keep the lining of the gut, the mucosa, healthy. Take away the Prostaglandins and you leave the gut open to attack, by residual stomach acids, bacteria, and foods. Irritation occurs, bleeding may start, and ulceration.

Cyclooxygenase-2 (COX2) Selective Inhibitors

COX2 inhibitors target very particular forms of the Cyclooxygenase enzyme, and so allow the production of at least some of the beneficial Prostaglandins. Their success varies with the individual drugs, but none are so successful that they are safe for people who's gut mucosa is already under attack.

Topical Application or Intravenous Delivery of NSAIDs

The way an NSAID is delivered has no part to play in the mechanism the various enzymes work around the body. Whether it is swallowed, injected into a vein, or absorbed through the skin, it still gets into the blood where it can either work for you, or in our case against!

It is important when you go for surgery, related to IBD or not, that the anesthetist or similar person who looks after your pain relief before, during and after your operation, is aware you should not be given any form of NSAID even intravenously. It is common practice in some hospitals to give patients IV Diclofenac post-operatively in preference to 'old fashioned' opiates. Don't let them do that.

Alternative Pain Relief

For general, occasional, pain relief, paracetamol (acetominophen), with or without codeine phosphate, can be used.


[pos]1a[/pos][1]. Ananthakrishnan AN, Higuchi LM, Huang ES, Khalili H, Richter JM, Fuchs CS, Chan AT. Aspirin, Nonsteroidal Anti-inflammatory Drug Use, and Risk for Crohn Disease Ulcerative Colitis: A Cohort Study. Ann Intern Med. 2012; 156(5): 350-359. http://europepmc.org/articles/PMC336...ihms378283.pdf

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