Given the heterogeneity seen across the studies, the authors conducted an analysis limited to studies that scored seven or above on the Newcastle-Ottowa Scale for assessing the quality of nonrandomized studies. In this analysis, the risk of Crohn’s disease exacerbations increased significantly with NSAID use (RR = 1.53; 95% confidence interval, 1.08-2.16) but they did not see an association between NSAID use and the risk of ulcerative colitis or other IBD exacerbations.
Similarly, when they restricted their analysis to studies with a low risk of bias, the researchers found there was an increased risk of Crohn’s disease exacerbations, but not ulcerative colitis, with NSAID use.
“American College of Gastroenterology guidelines for management of IBD recognise NSAIDs as potential triggers for disease exacerbation, highlighting the ongoing concern regarding the use of these medications in patients with established disease,” wrote Dr. Oluwatoba Moninuola of Harvard University T.H. Chan School of Public Health, and coauthors.
“Although, it’s well established that NSAIDs may cause de novo damage throughout the gastrointestinal tract, the precise mechanism through which NSAIDs promote IBD exacerbation remains largely unknown.”