Common pain relievers can cause ulcers

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Millions of Americans casually take aspirin, ibuprofen, and related drugs to relieve common ills like arthritis, cramps, or headache. But these same medications can cause bleeding ulcers if taken too frequently, according to the American Gastroenterological Association, which is helping to launch a campaign to make people aware of the danger. Falling under the heading of non-steroidal anti-inflammatory drugs, or NSAIDs, the potentially offending pain relievers also include naproxen and a number of prescription drugs such as diclofenac (Voltaren) or piroxicam (Feldene). Combined, NSAIDs send about 76,000 people to the hospital each year for ulcer complications ranging from pain to internal bleeding to perforation of the stomach or intestinal lining.

Indeed, NSAIDs are the second most common cause of ulcers in this country, after the bacterium H. pylori. It's estimated that about 25 percent of regular NSAID users, many of whom are over 60, will develop ulcers as a side effect of using the drugs.

NSAIDs produce ulcers by breaking down the protective mucus barrier in the stomach or intestinal lining, allowing acid to make its way into the stomach or intestinal wall itself. Since NSAID-induced ulcers often develop painlessly, it's easy to think that the drugs aren't causing harm when, in fact, an ulcer may already have developed and started to bleed. Consider that in one study of people who were hospitalized for particularly severe NSAID-induced ulcers, only one in five had ever noticed any early warning signs pointing to stomach trouble.

Since pain is an unreliable first signal that an NSAID-induced ulcer may be brewing, be on the lookout instead for very dark stools or unusual feelings of weakness or fatigue, both of which could be red flags for internal bleeding. NSAID ulcers tend to occur most frequently in older people, in long-term NSAID users, and in those who have a history of peptic ulcer disease or difficulty tolerating aspirin.

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