From the Guidelines
NSAIDs should be avoided in patients with gastroparesis due to the potential to worsen symptoms and cause complications. The use of NSAIDs in patients with gastroparesis can irritate the stomach lining and delay gastric emptying, which is already impaired in gastroparesis 1. This can increase the risk of developing gastric ulcers, bleeding, and perforation in these patients. For pain management in gastroparesis patients, acetaminophen (Tylenol) is typically a safer alternative. If pain control is inadequate, consultation with a healthcare provider is recommended to discuss other options such as topical analgesics, certain antidepressants for pain modulation, or carefully monitored low-dose or enteric-coated NSAIDs if absolutely necessary. The concern with NSAIDs stems from their mechanism of action - they inhibit prostaglandin synthesis, which normally helps protect the gastric mucosa and promotes normal gastric motility. In gastroparesis, where stomach emptying is already compromised, this additional burden on gastric function can exacerbate symptoms like nausea, vomiting, early satiety, and abdominal pain. Some key points to consider when managing gastroparesis include:
- Avoiding medications that can worsen gastrointestinal motility, such as opioids, anticholinergics, and tricyclic antidepressants 1
- Using prokinetic agents, such as metoclopramide, with caution and only for severe cases that are unresponsive to other therapies 1
- Considering alternative therapies, such as gastric electrical stimulation, for patients with severe symptoms that are refractory to other treatments 1
From the Research
NSAIDs and Gastropardesis
- There are no direct studies that mention the contraindication of NSAIDs with gastroparesis 2, 3, 4, 5, 6.
- However, it is known that NSAIDs can cause gastrointestinal toxicity, including gastrointestinal damage and peptic ulceration 2, 4, 5, 6.
- Patients with gastrointestinal risk factors, such as previous bleeding ulcers, should receive preventive therapies, such as cotherapy with a proton pump inhibitor (PPI) or misoprostol, or a coxib alone 2, 3, 5.
- The use of COX-2 selective inhibitors, such as celecoxib, may be safer for the gastrointestinal tract than traditional NSAIDs, but their use should be prescribed with caution in patients with increased cardiovascular risk 2, 3, 6.
- The risk of gastrointestinal toxicity with combined therapy of aspirin and coxib may be lower than that with traditional NSAIDs plus aspirin, but all these patients may benefit from PPI cotherapy 2.
Gastrointestinal Safety of NSAIDs
- The gastrointestinal safety of NSAIDs has been assessed in several studies, which show that the risk of gastrointestinal toxicity is associated with the type of NSAID, dose, and duration of use 3, 4, 5, 6.
- The use of proton pump inhibitors has been shown to be effective in preventing NSAID-induced upper gastrointestinal injury 5.
- The risk of bleeding is increased with advancing age, presence of Helicobacter pyli, previous history of bleeding, anticoagulant use, etc. 6.
Prevention of Gastrointestinal Adverse Effects
- Several strategies have been adopted to limit the gastrointestinal side effects of NSAIDs, including the use of COX-2 specific drugs, comedication of acid suppressants like proton pump inhibitors and prostaglandin analogs 2, 3, 4, 5.
- The use of misoprostol, a prostaglandin analogue, has been shown to be effective in reducing NSAID-related peptic ulcers and their complications 3, 5.