Why we can't take NSAIDS

Today’s public service announcement.

Most docs tell patients not to take NSAIDS after RNY but they don’t always explain why.

NSAIDS put you at risk for ulcers. They do that to everyone, not just RNY folks.  But ulcers are particularly dangerous to us.  If you get an ulcer in your pouch, even a small one, since your pouch is a lot smaller than a normal stomach, it will cover a much greater percentage of your pouch.  If you get an ulcer in your old stomach, docs can’t even do an endoscopy to see it.  They’d have to do surgery.  Also taking a medication designed to coat the stomach wouldn’t help an ulcer in the old stomach because nothing you take by mouth goes in there.

We really, really don’t want an ulcer.

NSAIDS can cause ulcers because they cause the lining of the stomach (the old stomach and the pouch) to thin out.  This does NOT happen when the medication enters the pouch or touches the pouch.  It happens when the medicine enters your blood stream.  That’s why you can get ulcers in your old stomach.  NSAIDS taken by mouth don’t touch the old stomach but can still cause ulcers there.

Any way you take an NSAID – pill, liquid, shot, IV, patch, gel – it gets into your blood stream.  If it does not get into your blood stream, it will not give you any pain relief or relieve inflammation.  Many docs don’t understand this, though I don’t know why since they have to take pharmacology in medical school. 

Many docs that are not bariatric surgeons also don’t know RNY patients should have not NSAIDS so be very vigilant about what other docs try to give you.  I finally started saying I am allergic to NSAIDS.  They seem to listen to that more.

Some surgeons say it’s OK to take NSAIDS on a very limited basis if you really need them as long as you also take Nexium or something like that to help protect your stomach.  Others say it’s never worth the risk.  A few say it’s OK to take them whenever you want, but I think they are nuts.  But what I really think is that we need to weight the benefits of taking them against the risks.  Is the pain of your bad back or menstrual cramps or whatever worse than the pain of an ulcer would be?  If so, take the NSAID.  But take it with something to protect your tummy.

Now, how likely it is that taking NSAIDS, especially rarely, will cause an ulcer, no one can say.  I know people that took just one dose and got an ulcer.  I know people that took them many times and had no problem.  So it’s just a matter of whether or not you wanna chance it.

Yes, I was so upset when I found out I couldn't take Celebrex. My doctor told me (very seriously) "Well, after a few months you can try taking them for a while. Of course you'll probably get a bleeding ulcer....." LOL. I got the point!

Hi Kelly,
Thank you for posting this. I was never told post-op to avoid NSAIDS, so I continuted to take Ibprofen for my horrible cramps. Luckily after about 4 months of a sore pouch I finally figured out why...I wish I had been told or smart enough to question my pouch pain sooner.

Your doc sure should have told you.  I bet it would have taken me forever to figure out that was causing me pain.  How would you know if no one told you?

Thank you.  We all need reminders like this every so often.

And coffee falls into this category too?  I have friends who have never heard about not being able to have coffee until I told them.  They thought I was crazy.

Not exactly.  Coffee is not an NSAID.  Excessive amounts of caffeine may cause ulcers but not in small amounts, at least not likely. 

So do you think its okay to drink a few cups a week?

I think so.  I can't promise you that you won't get an ulcer from it but I think it very unlikely.  I mostly avoid caffeine at home but if I'm out and about and want an iced tea or something and decaf is not available, I drink regular.

My friend bought these latte protein drinks called Believe from bariatric eating.com and she wanted to split the case with me, but I told her the doctor said caffeine causes ulcers, so she was super surprised and so was I when I found out where she purchased them.