The frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a class of pain relievers, is second only to infection by the bacterium Helicobacter pylori (H. pylori) as a cause of peptic ulcers. Further, complications are more common with NSAID-induced peptic ulcers than those that result from other causes. The U.S. Food and Drug Administration (FDA) requires that the labels and package inserts of both prescription and over-the-counter NSAIDs contain warnings about these and other gastrointestinal (GI) risks.

NSAIDs are used to treat pain and inflammation in the body. They work by suppressing enzymes that produce prostaglandins, chemicals produced in response to pain that also protect the stomach lining. NSAIDs therefore have the combined effect of reducing pain while making the stomach lining more susceptible to damage. People who take NSAIDs regularly to alleviate chronic pain are more likely to develop problems such as peptic ulcers as the medication harms the stomach lining. However, damage may also occur in patients who only take NSAIDs occasionally or only take small doses.

Newer NSAIDs called COX-2 inhibitors affect only the inflammation-producing prostaglandins and are less damaging to the stomach lining. However, COX-2 inhibitors have been linked to an increased risk of serious cardiovascular problems (e.g., heart attack, stroke) and severe skin reactions. Because of this, several COX-2 inhibitors have been withdrawn from the U.S. market.

Not everyone has the same risk of GI side effects with NSAIDs. Most patients can take occasional NSAIDs without increasing their risk of peptic ulcers.

Patients who take prescription or over-the-counter NSAIDs should talk with a physician about the risk of ulcers and other GI side effects. Reduced dosages and alternative or additional medications may lessen these risks. The benefits of these medications must be weighed against their risks.

When ulcers occur, it is generally recommended that patients stop using any NSAIDs. Various other pain relievers (e.g., acetaminophen) may be used as alternatives to NSAIDs. However, it is not always possible to stop taking NSAIDs. These medications can be an important part of therapy for many inflammatory pain conditions (e.g., arthritis).

When the risk of adverse effects is high and NSAIDs are still required, reducing the dosage or changing or adding medications may help prevent peptic ulcers. Not all NSAIDs have the same degree of GI risk. In certain high-risk cases, medications frequently used to treat ulcers (e.g., proton pump inhibitors, H2 blockers) may be prescribed with NSAIDs to reduce the chance of developing the ulcers. The medication misoprostol (a synthetic version of a substance in the body that protects the stomach lining), has also been used successfully to prevent peptic ulcers in patients taking NSAIDs.

Because of the side effects caused by NSAIDs and their many interactions with other drugs and substances, patients are encouraged to consult their physician before using these drugs. Patients who take NSAIDS and experience the symptoms of a peptic ulcer should seek medical attention.