Can NSAID reaction look like Crohn's?

September 23, 2007 8:11 AM

Medical/pharm filter: Could use of NSAIDs end up looking like Crohn's or IBD? (Warning: contains potentially gross descriptions of Crohn's.)

I've suffered with GI tract problems since my early teens. I started using Ibuprofen in my late teens or early 20s. I was diagnosed with Crohn's Disease in my early 20s. Tests showed ulceration and I frequently had bleeding. In my mid-20s, I was put on an NSAID (Alleve) to control some migraine problems. That entire year, I was in and out of the ER with bowel problems, especially bleeding and blood in the stool. I ended up with a fistula and an abscess, following by surgery. THings settled down and, aside from bouts of diarrhea (which could be just IBS, I suppose), I was fine. A few years later, I had a baby and was given Voltaren, an NSAID, which is contraindicated for people with Crohn's and IBD. I started having bloody diarrhea right after the birth and then a Crohn's flare up caused ulceration of a perineal tear. My GI explained that I should not have ever been given Voltaren suppository, since it is an NSAID. I don't think I was ever told to avoid NSAIDs before that. My GP, OB and a few other doctors were stunned to hear that Crohn's patients should not have NSAIDs.

Aside from occasional bouts of "normal" diarrhea, my Crohn's has gone into remission. Scopes and tests show that all the ulceration has gone away. Even when I had the flare up after childbirth, all the internal ulceration was gone and the external ulceration was around the tear.

I am expecting another baby. Because of the problems healing, my team of doctors has recommended a C-section. After researching childbirth & Crohn's and going through what I went through before, I absolutely agree with them. (Among other things, I don't want a recto-vaginal fistula, let alone any of the things I experienced last time.)

However, is it at all possible that I don't have Crohn's and that all the problems have been caused by NSAIDs so far? Could it just be a repeated reaction to NSAIDs?

I know you are not my doctor and that you are probably not a doctor. However, I can't get in to see a GI for 2-3 months and I wouldn't mind some info right now. I'm also not sure if I could get referred to a GI just to ask that question.

posted by anonymous to Health & Fitness (6 answers total)

If you have biopsy proven Crohn's (there are certain things you look for on biopsy that are consistent with Crohn's), and colonoscopies showing the classic lesions, AND you've had a fistula and abscess, it sure sounds like you have inflammatory bowel disease. People taking NSAIDs can have GI bleeding from erosion of stomach mucosa, but they don't develop fistulas in general as a result, and don't often present as "bloody diarrhea."
posted by gramcracker at 9:03 AM on September 23, 2007

NSAIDs can cause ulceration that mimics inflammatory bowel disease, but it is probably more likely that the medication is exacerbating your underlying disease (since you mention that you've had GI problems since your early teens). It would depend on how definitive your original diagnosis was, but I think it is highly unlikely that your GI would ever be able to definitively determine that NSAIDs are the sole source of all the problems.

The warning about not taking NSAIDs if you have any sort of IBD is well known among GI doctors, (one of the first things I was told when they suspected I had Crohn's disease), but I often have to remind other doctors that NSAIDs are not recommended for people with IBD. I usually check with the pharmacist as well.

Also, I've read that pregnancy can affect Crohn's in some strange ways (i.e., women in flares before they become pregnant often go into remission, but the reverse can also occur). And sometimes the disease goes into remission all on its own for whatever mysterious reason. Either way, congrats on being disease-free now, and if avoiding NSAIDs keeps you that way - yay!

(IANAD, but I do have Crohn's, and I read lots of medical journal articles about it. If you search scholar.google.com for "nsaids and crohn's or ibd" you can probably read at least the abstracts of some recent research on the topic)
posted by raxast at 10:22 AM on September 23, 2007

The short answer to your question is probably not. Crohn's may have overlap with other inflammatory bowel disease depending on the circumstances, but in general it's unlikely that whatever you have is actually due to NSAIDs, though they certainly may not have helped matters. Granted, I'm speaking in generalities, and I am not your doctor. I do not know how convincing your diagnostic evaluation has previously been for Crohn's and that makes all the difference. So obviously, ask your gastroenterologist.
posted by drpynchon at 11:37 AM on September 23, 2007

IANAD, I do have CD, and I have read the literature related to CD extensively.

While NSAIDs are not causative of Crohn's, they have been implicated as triggers of flare-ups. I don't know how much reading you've done on the topic, but the current consensus is that the disease progresses like this:

1) It starts with irritation, caused by NSAIDs, bacterial overgrowth, or other factors that lead to irritation of the mucosal lining of your GI tract.

2) This leads to inflammation of your GI tract, as your body tries to repair the damage.

3) The microorganisms that live in your gut take advantage of this inflammation and make their way into the outer layer of your gut. Since you have Crohn's, you're not very good at clearing these bacteria out of there. (the technical term is 'defective microbial clearance')

4) Your immune system recognizes the bacteria and launches a massive attack against these invaders. This causes more inflammation. (GOTO step 2). Your body is in something of a vicious cycle now.

So the real problem here isn't the NSAIDs - they were just the trigger. The problem is that your body isn't reacting appropriately to the presence of normal intestinal bacteria, and can't keep them out of the lining of your GI tract.

So the answer to your question is no. It's rather unlikely that all of your symptoms have been caused by NSAIDs. If you've been diagnosed with CD, you should probably stop taking them though, as they exacerbate symptoms in most people.

Lastly, and I can't stress this enough, you need to be having this conversation with your gastroenterologist. He or she can help get you on the right medications to control your disease and get you back into remission.
posted by chrisamiller at 12:00 PM on September 23, 2007

I was diagnosed with collagenous colitis at Mayo Clinic. The specialist told me that it was caused by excessive use of ibuprofen. (I was taking up to six ibuprofen daily for muscle aches.) Since I have stopped the ibuprofen, my colitis has presented no symptoms (which were diarrhea daily, 4-6 times a day, urgent and nocturnal). So, I think it probably does contribute alot to any intestinal disorder.
posted by wafaa at 12:38 PM on September 23, 2007

Here's my advice: Ignore every other answer in this thread, both above and below my post. This question is for your doctor to answer, not anyone else.
posted by ikkyu2 at 2:58 PM on September 23, 2007 [1 favorite]