Tack for getting my yak sack back

May 21, 2009 10:12 PM

What is the characteristic regeneration time for the stomach lining, after daily NSAIDs or alcohol?

I know two facts: 1) NSAIDs erode the stomach lining, leading to the possibility of ulcers, and 2) the stomach lining constantly regenerates, even in the absence of this corrosion.

If I were to stop taking NSAIDs (or, stop drinking alcohol), how long would it take before my stomach lining was back to 100%? Never? A month? A year if I was just on the verge of an ulcer?

What is the characteristic time for regeneration of the stomach lining, in terms of resistance to ulcers?

[Bonus only: is the "average load" on the lining the only important issue here, or does the simultaneous occupation of my stomach by NSAID and alcohol cause disproportionately bad things to happen?]

posted by gensubuser to health & fitness (6 comments total)

Just a correction to your first (presumed) fact: NSAIDs do not directly erode the stomach lining. Rather they inhibit the formation of prostaglandins. Prostaglandins are important for protection of the gastric because they mediate the production and proliferation of the gastric mucosal barrier (see this abstract from >25 years ago). When you take an NSAID, you inhibit primarily COX-1, which then results in decrease formation of prostaglandins and decreased maintenance of the protective barrier. Thus the lining of the stomach and duodenum become more susceptible to the low pH environment of the stomach.

Ethanol, on the other hand, is a direct gastric irritant. The two together - not such a good combination.

As for proliferation of the mucosal epithelium (lining) of the stomach and the rest of the alimentary tract -- it's pretty fast. Probably from 3-10 days for the entire epithelia layer to turn over.

Healing of ulcers is a different story -- some ulcerations can actually go well through the mucosa, through the submucosa and into the muscularis where there are small veins (venules) and arteries (arterioles) that can lead to bleeding (see this diagram of the layers of the stomach for reference). Healing of this deep of a lesion can take significantly longer (weeks), and for ulcers that go through the serosa and perforate, one may require surgical intervention to fix the lesion.

You can/should do a PubMed search for "alcohol AND NSAIDs AND stomach" and look at the review papers to get a flavor of why combining the two isn't such a good idea.
posted by scblackman at 5:50 AM on May 22 [3 favorites]

[Bonus only: is the "average load" on the lining the only important issue here, or does the simultaneous occupation of my stomach by NSAID and alcohol cause disproportionately bad things to happen?]

Might want to get yourself checked for H. pylori as well.
posted by arachnid at 6:30 AM on May 22

Different types of cells in the stomach have different turnover times; more than you probably want to know can be found here. The bottom line is that some cells turn over in 3 days, others take up to 194 days. So healing in theory will be well on its way in 3 days but can take up to 3 months or so to be complete. In practice there will be some cells still remaining in an area of injury, so those are the maximum times for healing and in practice it will be a good bit less.
posted by TedW at 6:40 AM on May 22

There are medications that can help thicken the gastric lining. I damaged my esophagus with a pill that didn't get to my stomach (lesson: take pills with LOTS of water) and the medication helped a lot.
posted by theora55 at 9:53 AM on May 22

Are you taking NSAIDs so frequently that you are worried about this? If so, I would recommend talking to a doctor. There may be better medications for whatever your problem is or hey, they might even be able to figure out a way to cure you and thus palliative medicine is no longer necessary.

Or, if NSAIDs really are the best option, being under the care of a physician is worthwhile. They can coprescribe drugs to protect your stomach lining from being eroded so easily. One such option is misoprostol.
posted by sickinthehead at 10:21 AM on May 22

My doctor has prescribed meloxicam, a COX-2 inhibitor iirc. I used to "binge" about once a month, which in reality was never, ever a concern. I now abstain completely; when I asked my doctor, who should be very knowledgeable about NSAIDs and impeccably qualified, he said that if I took the pill in the morning and had a drink at night that was fine, but that I shouldn't "wash it down with alcohol." Since I don't yet envision ever functioning without the pills, I figured it was a small (yet significant) thing to sacrifice. Alcohol is important in student life, but I've found some other outlets.

In particular, I wondered if I could justify drinking moderately every day of spring break if I stopped taking the pill for a week before, during, and after. The answer seems definitely no. I had asked about a prevacid like co-treatment, and he didn't think it was necessary.

Thanks for correcting my question, and the PubMed prompting. I found earlier a paper by Mae F. Go, focusing on NSAIDs alone. It seems a single number won't be enough. Old people are more "at risk" and if you've had an ulcer, you remain at elevated risk for on the order of 5 years, for example.

If there are any more pointers to specific papers that try to boil down a timescale, even behind paywall, lmk.
posted by gensubuser at 2:38 PM on May 22