Boston—Patients with Crohn’s disease and ulcerative colitis often are warned about the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) because of concerns that the painkillers could exacerbate their conditions.

A new review in Alimentary Pharmacology & Therapeutics did not make a clear connection, however.

“Contrary to generally accepted belief, a recent review and analysis of published studies did not reveal a consistent association between the use of or acetaminophen and exacerbation of Crohn’s disease and ulcerative colitis,” write authors led by Massachusetts General Hospital researchers. “Nevertheless, when the analysis was limited to studies with a low risk of bias, there was a link between NSAIDs use and exacerbation of Crohn’s disease but not ulcerative colitis.”

The researchers conducted a systematic review and meta-analysis of previous studies examining the association between acetaminophen and NSAIDs including cyclooxygenase (COX-2) inhibitors use, and risk of Crohn’s disease (CD) and ulcerative colitis (UC) exacerbation.

Published manuscripts and abstracts through March 1, 2017, were collected by systematic search of Medline, Embase, Cochrane, and other trial registries. Quality assessment was done using Newcastle-Ottawa scale, while random?effect meta?analysis using pooled relative risks (RRs) and 95% CIs were calculated.

Overall, 18 publications between years 1983 and 2016 were identified. For the meta-analysis, pooled RRs of disease exacerbation with NSAIDs use were (1.42, 95% CI, 0.65-3.09), I2 = 60.3% for CD, and (1.52, 95% CI, 0.87-2.63), I2 = 56.1% for UC. The corresponding values for acetaminophen use were (1.40, 95% CI, 0.96?2.04), I2 = 45.6% for UC, and (1.56, 95% CI, 1.22-1.99), I2 = 0.0% for IBD. 

Sensitivity analyses limited to studies with low risk of bias showed a significantly increased risk of CD exacerbation (1.53, 95% CI, 1.08-2.16) but not UC (0.94, 95% CI, 0.36-2.42) with NSAID usage. 

“Contrary to generally accepted belief, we did not find a consistent association between NSAIDs use and risk of CD and UC exacerbation,” study authors conclude. “There was also no consistent evidence for association with acetaminophen although further studies are needed.”

“We were surprised to see that there is little data in the literature to support our common recommendation to patients with inflammatory bowel disease to avoid all NSAIDs,” added senior author Hamed Khalili, MD, MPH, of Massachusetts General Hospital. 
 « Click here to return to Weekly News Update.