After analyzing 18 years of data from 76,814 women enrolled in the Nurses’ Health Study (NHS), researchers from Massachusetts General Hospital believe they’ve found a link between frequent, high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) and an increased risk for Crohn's disease and ulcerative colitis. This is more bad news for a class of over-the-counter and prescription drugs that have already been associated with an increased risk of heart attacks and strokes.
These medicines are often used to relieve pain and reduce fever and inflammation. Over-the-counter NSAIDs include: aspirin, ibuprofen, and naproxen. Prescription NSAIDs include: celecoxib (Celebrex), ketoprofen, piroxicam (Feldene) and sulindac (Clinoril).
It is important to note that both aspirin and NSAIDs are associated with ulcerations in the gastrointestinal tract, but aspirin use was not associated with an increased risk of Crohn's disease or ulcerative colitis. This suggests that there may be pathways uniquely affected by NSAIDs and not by aspirin. Such pathways could potentially be important in explaining why some people get Crohn's and ulcerative colitis.
Compared with nonusers, women who used NSAIDs for more than 15 days a month faced a greater risk for Crohn's disease and ulcerative colitis. Women who used more than 5 tablets of NSAIDs per week also saw an elevated risk for Crohn's disease compared with women with more than 6 years of NSAID use.
Currently we are aware of up to 99 genetic variations associated with Crohn's disease and ulcerative colitis. But genetic changes explain only about one third of the risk for the diseases, which may mean that the environment has a big influence on why someone gets these diseases.
The study data included 123 confirmed cases of Crohn's disease and 117 cases of ulcerative colitis. In all, 44% of women reported regular use of aspirin and 37% said they regularly used NSAIDs at baseline.
The researchers cautioned against overreacting to their findings. They stressed the importance of weighing the risks and benefits of NSAID use. Approximately 15 in 100,000 people risk getting the conditions.
More studies are needed to compare the safety of NSAIDs and aspirin say study authors noting that people are more likely to take high-dose NSAIDs and take NSAIDs more frequently for pain relief. Those who take aspirin for cardiac protection tend to take low doses. We don't know if taking the same dose of NSAIDs or aspirin are equally safe or equally dangerous, they said.