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Researchers tackle arthritis sufferers' dilemma


Pain-relievers can cause ulcers

April 4, 1997
Web posted at: 11:15 p.m. EST (0415 GMT)

From Correspondent Andrew Holtz

PALO ALTO, California (CNN) -- Pain is a constant companion for millions of people with arthritis, and relief comes with a price.

Pain-relievers such as ibuprofen, naprosyn and others can have serious and even life-threatening side-effects such as ulcers and gastrointestinal bleeding.

One option is anti-ulcer medication.

"We have found a very well-tolerated drug that has been shown to be effective against ulcers produced by painkillers," says Dr. Ali Taha of Eastbourne General Hospital in Eastbourne, England.


That drug is famotidine, known by the brand name Pepcid. It received considerable attention in an article in the prestigious New England Journal of Medicine last year.

But it was followed by an article in the Archives of Internal Medicine warning that the tactic might backfire. Researchers said suppressing stomach problems with acid blockers like Pepcid, which are also known as H2 antagonists, might raise the risk of potentially dangerous bleeding ulcers.

Acid blockers double the risk of ulcers


"You're given a false sense of security," says Dr. Gurkirpal Singh of Stanford University. "It turns out in our study that 1,400 people who were taking H2 antagonists and antacids on a prophylactic basis, actually have more than twice as high a risk of getting a serious (gastrointestinal) complication."

The apparently contradictory nature of the research leaves doctors and patients in the middle.

"From a clinician's point of view, sometimes we get answers to questions that are not always entirely clear," says Dr. Ronald van Vollenhoven of Stanford. "So then we have to really start thinking about the individual patient."

And sometimes doctors are out of the loop altogether.

Several anti-inflammatory pain relievers are available over the counter. And some acid blockers can be purchased without a prescription, which means patients could be combining them without their doctors knowing it.

Promising drug still being researched

Everyone agrees it is best to reduce the number of drugs taken whenever possible, and finding the right kind of drugs to fight arthritis may also help reduce the need for anti-inflammatory pain-relievers.

One such drug, called a Cox-2 inhibitor, shows promise of delivering the pain-relief demanded of anti-inflammatory drugs without triggering ulcers.

Until such drugs appear on pharmacy shelves, however, rheumatoid arthritis patients and their doctors will have to keep performing a balancing act between controlling pain and risking ulcers.


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