NSAID damage

Crohn's Disease Forum

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We are having big debate here about use of Advil. I'm now curious. Can anyone give me a primer before I call GI? I know that NSAID can cause some harm that mimics Crohn's. Are there certain parts of the tract more likely to be impacted? Does damage show up on scope or biopsy or both? How does pathologist determine what it is? How is it treated? Etc?
 
If you have Crohns nsaid are out
Not sure why you would take them
They can cause bleeding
Ulcers
And inflammation anywhere in the GI tract

That said if a child has arthritis and mild Crohns
They have been known to trial cox-2 type nsaids
But not plain Jane Advil
Even mobic is easier on the gut

Most GI will not scope until your off nsaid for a set period of time if there is question
 
So generally, kids with Crohn's are not supposed to take NSAIDs.

But in special cases, your GI may allow them.

My daughter has severe juvenile Ankylosing Spondylitis. She needs an NSAID. We have tried to stop it many times, but it ends with excruciating pain and increasing stiffness and very swollen joints.

Her GI and rheumatologist spoke when she was diagnosed with Crohn's, and decided that since her AS is so much worse and her Crohn's is relatively mild (scopes show ulcers but no strictures/fistulae/abscesses etc), that she can continue her NSAID.

It took a LOT of trial and error to find one that worked for her and did not bother her stomach. Initially when she was diagnosed with arthritis (way before we had even seen a GI), she tried many NSAIDs and they all upset her stomach. Caused stomach pain, nausea and because it hurt to eat, she lost 10 lbs or more in a couple months.

Then finally we were referred to a GI and she was given a PPI to protect her stomach. That helped a LOT. And we used Carafate to heal her stomach (we actually still use it).

Generally, Advil is tough on the stomach. A rheumatologist would usually prescribe Celebrex since it's easiest on the gut. Mobic is also often used. Relafen is another one that is easy on the stomach.

Aleve and Advil were disastrous for my girl.

Both my daughters need a PPI as long as they are NSAIDs.

In my younger daughter's case, NSAIDs do NOT raise her FC. She has had controlled Crohn's while on NSAIDs - with a very low FC (20s, 30s - definitely less than 50). However, when her Crohn's flares, it goes back up to 200-500ish.

It is generally stated here as a "rule" that NSAIDs are out if you have Crohn's. While that is true - they certainly shouldn't be used liberally unless absolutely necessary - but it's the sort of thing you need to ask your doc about.

There are always exceptions to the rule, like my daughter. NSAIDs are a good option for her and so far, her Crohn's has not been too bad.
 
I've heard the same, no NSAIDs for IBD

They are a gastric irritant, generally.

My son used to take a lot of motrin before dx, he was always sick or in pain, which probably didn't help his IBD development any...

My (nonIBD) husband was in the hospital just a couple months ago with a few bleeding stomach ulcers after too much excedrin (and probably age/cumulative effect) but that was new. Now we all limit them, though I cannot survive without Advil for premenopause periods right now, ugh! ;)
 
My son had a sore back for a few months prior to being diagnosed. At the time, he played hockey and would sometimes get injured and had also had a big growth spurt so, after running tests, his ped couldn't say for certain if the pain was being caused by hockey/injuries or because he'd grown so much, so quickly that it was muscles/ligaments/bones trying to catch up with one another (plus the slouching that came from hunching over the computer when playing games for hours! :facepalm:). Regardless of the cause, her suggestion was that he take advil prior to (and, after, if needed) games/practices to minimize inflammation. At the time, he was taking up to 3-8 advils some weeks (depending on schedule and/or pain). In hindsight, I don't know why I didn't think taking so many advils would cause some sort of harm. :( I suppose I thought it was 'temporary' and would end when the injury healed.

About 2 months after starting this, he complained of having some diarrhea in December. But, it went away after a few days. By February, still continuing with the advils, he was losing weight, looking pale and soon began to have stomach flu symptoms. Eventually diagnosed with crohns.

At dx, GI couldn't say whether the back pain was caused by related intestinal inflammation (in which case, the crohns started 'before' the back pain) or if the use of the advils for injury related back pain triggered (not 'caused') the crohns.

But, if possible, I would avoid any nsaids (ibuprofen, advils, etc.)
 


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