Anti-Inflammatories and Your Stomach: What You Need to Know
In clinic, anti-inflammatory medications such as ibuprofen, naproxen, or diclofenac are something we discuss regularly. They can be very effective in helping settle pain and inflammation, but they are not without risk, particularly when it comes to the stomach.
As an osteopath, I do not prescribe medication or advise on specific drugs. That sits with your GP or pharmacist. However, when patients tell me they are taking NSAIDs, whether prescribed or over the counter, I often explain how to use them safely and why that guidance matters.
It is also important to recognise that NSAIDs are not suitable for everyone. Certain medical conditions, allergies, or other prescribed medications, particularly those related to heart health, may mean they are not appropriate or need to be used with caution. This is why individual medical advice is essential.
Over the years, I have seen many patients who are no longer able to tolerate NSAIDs due to previous irritation or damage to the stomach lining. This is often linked to taking them incorrectly, for example on an empty stomach or over longer periods without guidance. It can then become a challenge when trying to manage future inflammatory flare-ups, where these medications might otherwise have been useful.
For those who are able to take them, one of the most important pieces of advice is to take them with food. This is not just a precaution. There is a clear physiological reason behind it, and understanding this often makes it much easier to follow.
A simple look at the stomach
Your stomach is a highly specialised organ designed to handle an extremely acidic environment. It produces hydrochloric acid, which helps break down food and supports digestion. This acid is strong enough to damage tissue, so the body has built-in protective systems to prevent the stomach from effectively digesting itself.
The inner surface of the stomach is lined with a layer called the mucosa. This lining produces a thick, gel-like mucus which acts as a protective barrier between the stomach wall and the acid within it. Alongside this, bicarbonate is secreted to help neutralise acid at the surface of the lining.
There is also a rich blood supply to the stomach wall. This helps deliver oxygen and nutrients, supports ongoing repair, and removes waste products. Together, these systems maintain a careful balance between acid and protection.
When this balance is maintained, the stomach functions as it should without irritation.
How NSAIDs affect this balance
NSAIDs work by blocking enzymes called cyclooxygenase, or COX enzymes. These enzymes are responsible for producing prostaglandins.
In the context of pain and injury, prostaglandins contribute to inflammation and sensitivity, which is why reducing them can be helpful. However, prostaglandins also play a crucial protective role in the stomach.
They help stimulate the production of the mucus barrier, maintain healthy blood flow to the stomach lining, and support the regulation of acid levels.
When NSAIDs reduce prostaglandin production, these protective mechanisms are also reduced.
This means the mucus layer can become thinner and less effective. Blood flow to the stomach lining may decrease, reducing its ability to repair itself. At the same time, stomach acid continues to be produced as normal.
The result is a stomach lining that is more exposed and more vulnerable.
Why this can lead to irritation or ulcers
When the protective barrier is weakened, stomach acid can begin to irritate the lining. Initially, this may present as discomfort, indigestion, or a burning sensation.
If this continues, it can lead to inflammation of the stomach lining, known as gastritis. In more severe cases, the acid can erode deeper into the tissue, leading to the formation of an ulcer.
This process does not usually happen instantly. It tends to develop over time, particularly with repeated use, higher doses, or taking medication on an empty stomach.
Why taking NSAIDs with food helps
Taking NSAIDs with food helps reduce this risk in several ways.
Food acts as a buffer within the stomach, helping to dilute the acid and reduce its direct contact with the stomach lining. It also reduces the immediate contact between the medication and the stomach wall, making it less irritating.
In addition, digestion slows the absorption slightly, which can reduce the intensity of the impact on the stomach lining.
While this does not completely remove the risk, it provides an important layer of protection.
The clinical message
This is something I regularly explain in clinic, because when patients understand why the advice matters, they are far more likely to follow it.
NSAIDs can be very helpful when used appropriately, but they are not something to take casually or on an empty stomach. Being mindful of how you take them is a simple step that can prevent longer-term problems.
If you are needing to take anti-inflammatory medication regularly, or are unsure what is appropriate for you, it is always worth discussing this with your GP or pharmacist. Often additional medications to help protect your stomach can be prescribed with stronger anti-inflammatories due to the risks involved.