New Analysis Challenges Common Belief that Links NSAID Use to IBD Exacerbation

New Analysis Challenges Common Belief that Links NSAID Use to IBD Exacerbation
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NSAID use

A recent analysis found no consistent association between the use of nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen and exacerbation of inflammatory bowel disease (IBD), challenging a long-held belief about the effects of these pain medications on the disease.

The analysis was published in the journal Alimentary Pharmacology and Therapeutics in a study titled, “Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn’s disease and ulcerative colitis exacerbation.

“We were surprised to see that there is little data in the literature to support our common recommendation to patients with inflammatory bowel disease to avoid all NSAIDs,” Hamed Khalili, MD, senior author of the work, from the Massachusetts General Hospital in Boston, said in a press release.

Consumption of NSAIDs, such as aspirin, Celebrex (celecoxib), or ibuprofen, has been linked to an increased risk of IBD exacerbation. In fact, NSAIDs are usually associated with the development of ulcers in the gastrointestinal tract, especially in the stomach and intestine. Prolonged use of NSAIDs has also been linked to the development of Crohn’s disease and ulcerative colitis.

As a result, NSAID use for IBD patients is discouraged in clinical practice because of these potential effects on disease activity. Instead, physicians recommend the use of paracetamol, also known as acetaminophen, for pain management.

In this retrospective analysis, researchers analyzed previous studies to investigate the association between NSAID use or paracetamol consumption and the risk of ulcerative colitis and Crohn’s disease exacerbation.

Researchers included 18 studies published between 1983 and 2016 for a total of 6,276 participants across the studies pooled for the analysis.

Contrary to the generally accepted belief, analysis of these studies found no consistent association between paracetamol or NSAID use and the risk of ulcerative colitis and Crohn’s disease exacerbation.

However, when only studies with low risk of bias were taken into account, researchers did find a positive association between NSAID use and exacerbation of Crohn’s disease but not ulcerative colitis.

Larger, well-designed studies are necessary to study the relationship between NSAID or paracetamol use and disease activity in IBD patients, the researchers concluded.

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