Drug-Induced Gastritis

How medicines damage the stomach

The stomach lining protects itself with mucus, bicarbonate and good blood flow, maintained partly by prostaglandins. NSAIDs and aspirin block the COX enzymes that make prostaglandins, weakening these defenses throughout the gut. They also irritate the lining directly. Acid then damages the unprotected surface, causing inflammation (gastritis), small erosions and, over time, peptic ulcers.

Because the main effect is body-wide, enteric-coated tablets, suppositories and injections of NSAIDs still carry risk.

Doctors sometimes call NSAID damage NSAID gastropathy, since biopsies often show little inflammation despite erosions. See NSAID gastropathy.

Medicines that can cause gastritis

Symptoms

• burning or gnawing pain in the upper abdomen
• nausea and sometimes vomiting
• bloating or early fullness
• loss of appetite
• indigestion and belching

Many people, especially older adults, have no symptoms until a complication occurs. Signs of gastrointestinal bleeding are vomiting blood, coffee-ground vomit, black tarry stools (melena), or unexplained tiredness and breathlessness from anemia.

Risk factors for complications

• age over 65
• previous peptic ulcer or bleeding
• high-dose or multiple NSAIDs, including aspirin with another NSAID
• use of anticoagulants, antiplatelets, corticosteroids or SSRIs
• Helicobacter pylori infection
• serious heart, kidney or liver disease
• heavy alcohol use

Diagnosis

A doctor will ask about all medicines, including over-the-counter pain relievers and supplements, and examine you. Tests may include:

• blood count for anemia
• H. pylori testing (breath, stool or biopsy)
• upper endoscopy to see erosions or ulcers and take biopsies, especially with bleeding, anemia, weight loss, difficulty swallowing, persistent vomiting or age over 60 with new symptoms

Treatment

• Stop or reduce the offending medicine if possible. Do not stop low-dose aspirin or blood thinners prescribed for heart or stroke prevention without talking to your doctor.
• Proton pump inhibitors (PPIs) such as omeprazole heal erosions and ulcers, usually over 4 to 8 weeks.
• H2 blockers are an alternative for mild cases.
• Treat H. pylori if present.
• Switch pain relief: acetaminophen (paracetamol) is gentler on the stomach. Topical NSAID gels have much less effect on the stomach.
• Hospital care for bleeding: endoscopic treatment, IV PPIs and sometimes transfusion.

Prevention

If you need regular NSAIDs:

• use the lowest effective dose for the shortest time
• take them with food
• avoid combining two NSAIDs, or an NSAID with aspirin, unless prescribed
• limit alcohol
• ask about a PPI if you are at higher risk, or a COX-2 selective NSAID (such as celecoxib) plus a PPI for the highest-risk patients
• get tested and treated for H. pylori before starting long-term NSAIDs if you have had ulcers

Frequently asked questions

Can ibuprofen cause gastritis?

Yes. Ibuprofen and other NSAIDs reduce the stomach's protective prostaglandins, which can lead to inflammation, erosions and ulcers. The risk increases with higher doses, longer use, older age and taking it with aspirin, steroids or blood thinners.

How long does drug-induced gastritis take to heal?

Once the medicine is stopped and a proton pump inhibitor is started, symptoms often improve within days, and erosions usually heal within 4 to 8 weeks. Ulcers may take longer. Your doctor may recommend follow-up if bleeding occurred.

What pain reliever is safest for the stomach?

Acetaminophen (paracetamol) does not damage the stomach lining at recommended doses, though it must be kept within the label limit to protect the liver. Topical NSAID gels for joint pain also cause far fewer stomach problems than tablets.

Can low-dose aspirin cause stomach bleeding?

Yes. Even 81 mg daily aspirin increases the risk of stomach erosions and bleeding, especially in older adults and with blood thinners. If you take aspirin for heart protection, do not stop without advice; your doctor may add a stomach-protecting medicine.