I have a duodenal ulcer. Can taking Advil for pain affect my ulcer? I have a lower back problem and the only thing that relieves the pain is Advil.

Okie

Ulcers occur in the stomach and upper small intestine (duodenum) as a result of an imbalance between the harmful and protective forces acting on the lining of these organs. The harmful forces are stomach acid and digestive enzymes. The protective forces include mucus (produced by the stomach) and bicarbonate (a buffer produced by the duodenum and stomach).

The two main things that can upset this balance are a bacterium called Helicobacter pylori (H. pylori) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include ibuprofen (Advil, Motrin), aspirin and naproxen (Aleve), just to name a few.

Obviously, not all people who take NSAIDs develop ulcers, since these drugs are used by millions of people daily for such problems as arthritis and pain. It is not clear why some people's digestive tracts are very sensitive to the effects of these drugs and why others can tolerate them without any problems. We do know that certain groups of people are more likely to develop ulcers and complications (bleeding, perforation, obstruction) as a result of NSAIDs. These include older patients (over 60), those with other chronic medical problems (heart disease, kidney disease), patients who have had ulcers before, patients who take more than one type of NSAID, and patients who also take steroid medications and/or anti-clotting medications (anticoagulants). Obviously, it's important for these people to avoid NSAIDs, and taking the smallest dose possible is a prudent recommendation for anyone taking NSAIDs.

That said, some patients -- such as those with severe arthritis or inflammation -- still need to take NSAIDs regardless of the ulcer risks. In such cases, doctors usually recommend the patient also take an acid-suppressing medication such as omeprazole (Prilosec) or lansoprazole (Prevacid). These drugs have been proven to reduce NSAID-induced ulcers in persons who need to take these drugs.

Remember, it is always better to stop the NSAID if at all possible, rather than take the medication along with an acid-suppressing drug. Another new option now is using a class of NSAID that does not appear to cause injury to the stomach and duodenum. These drugs, called COX-2 inhibitors, act at sites of inflammation without causing ulcers. You should discuss these options with your physician and gastroenterologist.