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A Warning about NSAIDs

By Oliver C. Whipple, MD FACS


Non-steroidal anti-inflammatory drugs (NSAIDs) are aspirin-like products that are used to treat common body aches and pains. NSAIDs are the main ingredient in most over the counter pain medications (Advil®, Ibuprofen, Aleve®, Naproxen, etc.) and some prescription pain medications. NSAIDs inhibit an enzyme called cyclooxygenase. This helps our bodies reduce inflammation and pain. However, it also prevents the stomach’s goblet cells from producing mucous. We need mucous to protect our stomach’s lining from its own acid. When NSAIDs are taken it causes increased exposure of the stomach lining to acid. This can result in pain, ulcers, bleeding, and perforation. Gastric bypass patients are much more susceptible to this than people who have not had this type of bariatric surgery. Sleeve gastrectomy patients can tolerate NSAIDs much easier than patients who have had gastric bypass. Adjustable gastric band patients can also experience discomfort or ulcer formation with NSAID use.


The use of either NSAIDs or steroid medications inhibits the stomach’s natural defenses against acid. This in combination with a gastric bypass puts patients at very high risk of ulcer formation. Ulcer formation after gastric bypass surgery affects about 5% of patients. The ulcer can be in the gastric pouch itself, but more commonly the ulcer occurs on the small intestine side of the anastomosis. Ulcers can form immediately after surgery, or this problem may develop months or years after the surgery.


Tylenol® or acetaminophen is the only over the counter pain medicine you should take after gastric bypass surgery. Acetaminophen does not increase the risk of stomach ulcers. If you have any questions about whether or not a new medication is an NSAID ask your pharmacist or doctor.