Kimmey, director of gastrointestinal endoscopy, professor of medicine, and assistant chief for clinical affairs at the University of Washington Medical Center, in Seattle, estimates that 50 to 80 percent of the people hospitalized for GI bleeding take pain-relieving drugs. "It's a public health problem," he says.
The pain medications most commonly at fault are the non-steroidal anti-inflammatory drugs or NSAIDs, which include: aspirin, ibuprofen (as found in Advil), naproxen (Aleve), and ketoprofen (Orudis). All NSAIDs provide pain relief and alleviate fevers, although at varying degrees of effectiveness.
According to Kimmey, people who take NSAIDs for prolonged periods of time can develop several GI side effects, such as stomach aches, indigestion, or even ulcers. Ulcers can eventually lead to GI bleeding or may even perforate, spilling the contents of the stomach or small intestine into the sterile abdominal cavity. "Every time they come in with bleeding, they have a 10% chance of dying. I don't think people realize that until it may be too late," warns Kimmey.
Ulcers are found in about 15% of the people who use NSAIDs for at least 3 months. Yet, a majority of the individuals with ulcers do not even know they have them because they do not experience any pain. "It's the painless ulcer. That's really part of the problem because those people don't know they have the ulcer until it actually bleeds or perforates," he explains.
The Arthritis, Rheumatism, and Aging Medical Information System reports that approximately 76,000 people are hospitalized each year for GI complications caused by chronic NSAID use. The estimated annual cost for treating these patients is approximately $760 million dollars.
Kimmey believes that pharmaceutical companies and the federal government are not taking adequate measures to warn consumers about the dangers of NSAID use. "There are so many products that contain (NSAIDs) that are available over-the-counter. Unless we teach the public to read the label for what's in there, they will not realize they're taking (NSAIDs)."
Part of the problem lies in the perception of over-the-counter pain medications. People do not realize that over-the-counter NSAIDs are drugs with potential toxic effects. In fact, Kimmey referred to a study done at the University of Alabama which determined that 25% of the people taking NSAIDs did not even know why they were taking them.
"Most of these drugs are not taken because doctors advise people to take them... People see advertisements and they go and get them without talking to a doctor," said Kimmey, "placing themselves at risk for a catastrophic problem."
To cut down on the risk for developing GI problems due to NSAID use, Kimmey suggests the following:
-- try a weaker NSAID which also may be less toxic.
-- use a lower dose of the current NSAID.
-- use alternative medications which are not toxic to the GI, such as acetaminophen (Tylenol).
But chronic use of NSAIDs should not be substituted with chronic use of acetaminophen, warns Kimmey. Large doses of either drug can damage the liver, especially in alcoholics. Furthermore, certain medications prescribed by a doctor may interact with acetaminophen or NSAIDs, lowering the dose required for toxic effects to develop. "What it comes down to is rational use of the medication.," advises Kimmey.
Most NSAIDs are believed to work by inhibiting cyclooxygenase (COX), an enzyme involved in prostaglandin synthesis. Prostaglandins are molecules which mediate a variety of functions in the body, including inflammation and pain. There are two forms of cyclooxygenase in the body -- one is present in most cells (COX-1), while the other is produced during inflammation or injury (COX-2). NSAIDs inhibit both enzymes, thereby acting as an anti-inflammatory and pain-relieving agent, as well as producing certain side effects.
Thursday July 17, 98
Source: American Medical Association