More than 70 percent of patients
who took painkillers such as ibuprofen for more than three
months suffered damage to their small intestines, U.S. researchers
The study is yet another blow
to patients trying to find ways to treat arthritis pain, after
reports that the most advanced drugs, called COX-2 inhibitors,
can raise the risk of heart death.
Dr. David Y. Graham of the
Baylor College of Medicine in Houston and colleagues studied
21 patients taking a range of drugs called non-steroidal anti-inflammatory
drugs, or NSAIDS. They compared them to 20 patients taking
either acetaminophen, an unrelated painkiller, or nothing.
"Small-bowel injury was seen
in 71 percent of NSAID users compared with 10 percent of controls,"
they wrote in Monday's issue of the journal Clinical Gastroenterology
"We have always known that
NSAIDs can cause potentially deadly stomach complications,
but the extent of the impact on the small intestine was largely
unknown until now," Graham added.
Arthritis pain is incurable
but can be treated with a range of drugs, including NSAIDS
such as aspirin, ibuprofen or naproxen; acetaminophen; or
the newer drugs called COX-2 inhibitors.
NSAIDS work very well but damage
the stomach and intestine. They are blamed for 16,500 deaths
a year in the United States alone, Graham said.
BENEFIT VS. RISK
"Anybody who takes aspirin
or (other) NSAIDS for a year has a 1 to 4 percent risk of
serious gastrointestinal complications," Graham said in a
"If the drugs didn't have such
benefits, we'd have taken them off the market some time ago."
Acetaminophen, sold generically
and also under the brand name Tylenol, does not work for many
patients, Graham said.
The COX-2s were designed specifically
to overcome the deadly side-effects of NSAIDS. But a series
of studies has linked them to heart disease and one, Merck
and Co. Inc.'s Vioxx, was pulled from the market in September.
In December the U.S. Food and
Drug Administration issued an advisory telling doctors to
limit their prescribing of other COX-2s, including Pfizer's
Celebrex and Bextra.
And a study published in December
indicated that an over-the-counter NSAID called naproxen might
also raise the risk of heart attack and stroke.
Graham's team used an endoscope
in the form of a swallowed camera in a capsule to examine
the intestines of their volunteers. Although people taking
NSAIDs frequently suffer stomach pain or anemia, none of the
volunteers in this study had any symptoms.
"We saw some ulcers and we
saw lots of erosions," Graham said.
Some experts have recommended
using antacid drugs called proton pump inhibitors (PPI) to
reduce the damaging effects of stomach acid in NSAID patients.
But PPIs do not affect the small intestine, Graham said.
Instead, he said, an older
drug called misoprostol can help protect the stomach lining.
"It is the only drug approved
to reduce the rate of bleeding," Graham said.
A U.S. government study published
last month found that acupuncture can help to further relieve
arthritis pain in the knee in patients getting more standard
The American Gastroenterological
Association estimates that more than 30 million Americans
take over-the-counter or prescription drugs for headaches