We like aspirin. It’s inexpensive and as effective as any other OTC pain reliever on the market. Millions take it or another NSAID (ibuprofen or naproxen) every day. They swallow such pills to ease joint pain, calm a headache or lessen the discomfort of strains and sprains. Many people have no idea what they are actually swallowing. All they know is a familiar brand name such as Advil, Aleve, Excedrin or Tylenol. Some people recognize that NSAIDs like aspirin, ibuprofen and naproxen can cause heartburn. They may not realize that all NSAIDs are linked to serious GI complications. Aspirin and ulcers are extremely dangerous, as this pharmacist shared.
Excedrin Migraine and Esophagitis:
Q. As a practicing pharmacist, I enjoy reading your column and learning about alternative treatments that you and your readers have found useful. I would like to mention a word of caution about using an NSAID to halt a migraine attack.
My sister used quite a lot of Excedrin Migraine to treat her migraines over the years. Unfortunately, her migraines also caused her to vomit.
She was recently hospitalized for an extremely low hemoglobin count requiring multiple blood transfusions. Upper GI endoscopy revealed a hole in her esophagus.
NSAIDs, aspirin and Excedrin, which contains aspirin, can all lead to ulcers in the stomach or duodenum. These drugs can also erode the esophagus if vomiting is involved.
NSAIDs, Aspirin and Ulcers:
A. Thank you for reminding our readers about the potential hazards of aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs). A recent study pointed out that even low-dose aspirin can lead to dangerous bleeding in older people (New England Journal of Medicine, Oct. 18, 2018).
From our vantage point the risk is relatively low, but because so many individuals take aspirin it can amount to a large number of people. Here is the absolute risk:
In the placebo group, 2.8% of the subjects had a major hemorrhagic event. In the aspirin group it was 3.8%.
The authors describe it this way:
“As in other trials, the incidence of major hemorrhage was higher in the aspirin group than in the placebo group and amounted to an additional 2.4 serious bleeding events per 1000 person-years of exposure.”
It’s not just aspirin. Other NSAIDs like ibuprofen and naproxen can also cause ulcers and hemorrhage.
How Dangerous Are Stomach Ulcers?
Virtually everyone has experienced indigestion or heartburn. A burning pain that hits just below the breast bone and migrates upward is classic for reflux. What many people do not realize is that a stomach ulcer can come on suddenly. It may not always warn you in advance.
A good friend (a pediatrician) was trying to get out of bed to prepare for an important family event. He suddenly experienced severe stomach pain. He had been taking low-dose aspirin for years without any symptoms.
On this day it was a crisis. He looked white as a sheet. He had no energy and could barely drag himself out of bed. His wife recognized it as a medical emergency and got him to the ER immediately. He had a bleeding ulcer.
The pharmacist who wrote to us about her sister noted the need for blood transfusions. Our friend was also experiencing massive bleeding as a result of aspirin and ulcers. He lost a tremendous amount of blood and his blood pressure was in the basement. Blood transfusions saved his life. Even a doctor didn’t realize that low-dose aspirin and ulcers are a thing.
Why Do NSAIDs and Aspirin Cause Ulcers?
Ask any emergency physician about bleeding ulcers and she will likely mention NSAIDs and aspirin. Doctors know that this entire class of pain relievers block the protective chemicals called prostaglandins (PGs).
When the level of PGs drops, the protective mucus layer of the stomach is compromised (Surgical Clinics of North America, Oct. 2011) Doctors know that aspirin and ulcers go together because of this reaction. NSAIDs are just as risky.
Symptoms of a GI Ulcer:
- Burning pain starting under or around the breast bone
- Bloating, belching and/or a feeling of eating too much
- Black tarry stools
- Vomiting what looks like coffee grounds
- Weakness or feelings of faintness
- Nausea and/or vomiting
Anyone taking NSAIDs like ibuprofen, naproxen or aspirin should treat such symptoms as an emergency. Here is Rochelle’s story:
“I’ve been taking NSAIDs for years. Last June I had bleeding ulcers. It was so bad. I was admitted to intensive care for 5 days. I thought I was having a heart attack. I lost sooo much blood and had to have numerous blood transfusions.
“My doctor never informed me of the dangers of NSAIDS. That is no excuse. Now I am very skeptical of taking any drug.”
Learn about other NSAID side effects at this link.
Share your own aspirin or NSAID story below in the comment section.