Camera Pill Reveals Damage From Anti-inflammatory Drugs

Baylor College Of Medicine ^ | May 20, 2003 | Dr. David Graham

[forsnax5]

HOUSTON (May 20, 2003)-- Non-steroidal anti-inflammatory drugs (NSAIDs) may damage more of the intestine than previously thought, according to images taken by a swallowable, capsule-size camera pill used in a Baylor College of Medicine study. According to the study, announced today at the Digestive Disease Week 2003 conference in Orlando, capsule endoscopy detected NSAIDs-related injury in the small bowel, an area of the gastrointestinal tract unreachable by other diagnostic tools such as endoscopes. The tool detected small bowel erosions in 62 percent of NSAID users compared to 5 percent of non-NSAID users.

"More than 100 million prescriptions for NSAIDS are written annually in the United States," said Dr. David Graham, lead author of the study and a professor of medicine and molecular virology at Baylor in Houston and chief of the gastroenterology section of Houston VA Medical Center. "The study shows that the patients who take NSAIDs regularly have an increased risk of small intestinal mucosal ulceration and bleeding."

NSAIDs are medications which reduce pain and inflammation over time. The drugs work by affecting chemicals in the body which cause inflammation, the prostaglandins. The same group of chemicals are also in the stomach, leading NSAIDs to cause indigestion, and possibly duodenal or stomach ulceration.

The capsule endoscope, developed by Given Imaging, allows medical professionals to view the entire small intestine. The system uses a disposable miniature video camera contained in a capsule, which the patient swallows. The capsule passes through the digestive tract, transmitting color images, without interfering with the patient's normal activities. Capsule endoscopy diagnoses a range of diseases of the small intestine including Crohn's Disease, Celiac disease, benign and malignant tumors of the small intestine, vascular disorders, medication related small bowel injury and pediatric small bowel disorders.

The study enrolled 40 patients, with a mean age of 49.5, who had arthritis including osteoarthritis, rheumatoid arthritis and gout. Twenty patients took NSAIDS daily for three months. Twenty patients took acetaminophen alone or nothing at all. All patients fasted overnight and underwent capsule endoscopy. The pylorus, the sphincter muscle that controls the lower opening of the stomach where it empties into the upper part of the small intestine, was marked on each video. Two investigators who were not told which therapy the participants received, reviewed each video beginning after the pylorus, where the small intestine starts.

Severe injury to the small bowel was seen in 23 percent of NSAID users compared to no severe injury in the controls. Severe damage was associated with high doses of indomethacin, naproxen, oxyprozocin and ibuprofen.

"This is a significant finding and suggests the need for periodic diagnostic monitoring with capsule endoscopy of patients who take NSAIDs regularly," Graham said.

[forsnax5]

Another bit of science fiction hits the mainstream and provides a warning about casual use of NSAIDs.

[tang-soo]

I sometimes take Indomethacin for gout. I think this may fall in this catagory. Anyone know for sure? One of its' side effects is stomach irratation.

Thanks in advance - Barry

[from occupied ga]

. I think this may fall in this catagory

Yes it does

[ChadsDad]

I eat naproxen-sodium (generic Aleve) like candy 4 to six a day for disc problems in my neck and lower back. If you take it with food, it does not cause any noticable stomach irritation. I have worried about long term effects. But it's better than getting hooked on persc. pain killers! Isn't it?

[from occupied ga]

Look at www.nsaid.net

[from occupied ga]

I have worried about long term effects. But it's better than getting hooked on persc. pain killers! Isn't it?

I dunno. My kid is the one that knows this sort of thing, but yeah it's probably better. I was told that different individuals have different responses to NSAIDS and that if you need to take them you should try different ones until you could find one that you tolerate. There are probably at least 20 of them if you count the prescription ones.

[bourbon]

The over-the-counter NSAID (Aleve) almost gave me an ulcer after I took it for just one week. For certain people, these drugs are worse than rot-gut whiskey. Admittedly, it's a damn shame I can't take these drugs b/c they are incredibly effective at relieving muscle pain.

[Born Conservative]

I eat naproxen-sodium (generic Aleve) like candy 4 to six a day for disc problems in my neck and lower back. If you take it with food, it does not cause any noticable stomach irritation. I have worried about long term effects. But it's better than getting hooked on persc. pain killers! Isn't it?

Chronically overdosing on NSAIDS (Aleve, Aspirin, Ibuprofen,etc.) can cause kidney damage and possibly kidney failure, especially if you have an undiagnosed kidney disease. While it's ideally best to limit narcotics, you are at high risk for kidney damage. Do yourself a favor, and tell your doctor; he/she may want to check some blood work to make sure your creatinine (kidney function) is within normal limits. Kidney failure=dialysis and possibly kidney transplant. Also, you are correct that it can also cause damage to the stomach.

[AppyPappy]

I only take the Crocus pills, not the anti-inflammatory.

[bigfootbob]

Depends. I have DJD and osteoarthritis. Naproxen-sodium is a liver killer eventually. I've tried NSAIDS and the Cox-II inhibitors without success. Most upset my stomach.

I now use Ultram, (Tramadol HCL 50mg) 4-6 times daily along with Marinol 10 ml. and varorized medical pot. I also have hepatitis C with grade 3/4 cirrosis and fatty liver disease. I have to be extremely cautious about what goes into my system because everything goes through the liver.

Since I started taking the combination of drugs mentioned 6 months ago, I'm beginning to build my stamina and control pain enough so I'll be returning to work as soon as I'm finished with the peglyated interferon injections I'm currently taking for the heptatitis C infection.

Becareful with the naproxen, it's hard on the body.

[texasbluebell]

Having used an nsaid for about 8 months, with only a moderate amount of relief for my neck which was nearly immobilized and causing awful pain for the past year, I was fortunately steered to this topical gel, which within 3 weeks had loosened my neck and stopped the pain.

I'm very happy not to be using anything at this time. And consider this stuff to be miraculous. I couldn't stand the thought of living the rest of my life with the kind of pain I was in.

arniflora

[Paradox]

The over-the-counter NSAID (Aleve) almost gave me an ulcer after I took it for just one week. For certain people, these drugs are worse than rot-gut whiskey. Admittedly, it's a damn shame I can't take these drugs b/c they are incredibly effective at relieving muscle pain.

Screwed me up to. I was taking some rather high dosages (aleve and advil) for some bad tooth pain. After a week, my stomach was screwed up. Even after I got off the damn things (and had a root canal), I had terrible hearburn. Luckily, my doctor had me tested for H. Pylori, and I was found to be positive, so I got "the treatment" for it and it all but eliminated my problems.

[S.O.S121.500]

bookBUMP

[lorrainer]

Common OTC names include:
ibuprofen (Advil®)
naproxen (Aleve® or Naprosyn®)
aspirin (Bayer®)
acetaminophen (Tylenol®) a non-opiod analgesic {not technically an NSAID}


Rx (prescription) names include:
celecoxib --Celebrex®
diclofenac -- Voltaren®
etodolac --Lodine®
fenoprofen -- Nalfon®
indomethacin -- Indocin®
ketoprofen - Orudis®, Oruvail®
ketoralac --Toradol®
oxaprozin -- Daypro®
nabumetone -- Relafen®
sulindac -- Clinoril®
tolmetin -- Tolectin®
rofecoxib -- Vioxx®
__________________________________________

Uh-oh
I always knew something was hinky with Diclofenac...

[BlueMango]

I've heard that inflammation can be controlled on some level by the food that we eat. I found this list of anti-inflammatory foods and wondered what people think about the idea?

Can you really control inflammation and pain with food?

I remain skeptical.