Nonsteroidal anti-inflammatory drugs and exacerbations of inflammatory bowel disease

Scand J Gastroenterol. 2015 Mar;50(3):255-63. doi: 10.3109/00365521.2014.966753. Epub 2014 Oct 14.


Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesics for treatment of variety of pain and inflammatory conditions. Their effects on the gastrointestinal tract are well described, but their possible propensity to cause clinical relapse in patients with inflammatory bowel disease (IBD) remains somewhat unclear.

Aim: We reviewed case reports, case-control and cohort studies, as well as clinical trials of NSAIDs in patients with quiescent IBD in order to better assess the magnitude and type of effect.

Results: The published literature on this subject is of mixed quality and many of the studies are open to criticism. The majority of patients with IBD tolerate these medications, while in the sole clinical trial of NSAIDs 20% experienced a clinical and laboratory documented relapse of disease, within 7-10 days of NSAID ingestion. The data on cyclooxygenase (COX)-2-selective anti-inflammatory analgesic are somewhat unclear, but nimesulide, celecoxib and etoricoxib do not appear to be associated with relapse of disease.

Conclusion: Conventional NSAIDs may cause clinical relapse in about 20% of patients with quiescent IBD, which may be due to dual inhibition of the COX enzymes. Certain COX-2-selective NSAIDs appear to be safe.

Keywords: COX-1; COX-2; Crohn’s disease; cyclooxygenase; exacerbations; indeterminate colitis; inflammatory bowel disease; nonsteroidal anti-inflammatory drugs; ulcerative colitis.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Celecoxib
  • Clinical Trials as Topic
  • Cyclooxygenase 2 / metabolism
  • Cyclooxygenase 2 Inhibitors / adverse effects*
  • Etoricoxib
  • Gastrointestinal Tract
  • Humans
  • Inflammatory Bowel Diseases / chemically induced*
  • Observational Studies as Topic
  • Pain / drug therapy
  • Pyrazoles / adverse effects
  • Pyridines / adverse effects
  • Recurrence
  • Sulfonamides / adverse effects
  • Sulfones / adverse effects


  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase 2 Inhibitors
  • Pyrazoles
  • Pyridines
  • Sulfonamides
  • Sulfones
  • Cyclooxygenase 2
  • Celecoxib
  • nimesulide
  • Etoricoxib