I learned too late about Advil

I used to take Advil (ibuprofen) for aches and pains—always on golf days. After about ten years of this (I’m guessing) I started getting acid reflux and heartburn—a condition in which stomach acid flows back into your esophagus (the tube that connects your mouth to your stomach). Normally, when you swallow, a band of muscle (a sphincter) around the bottom of your esophagus relaxes to allow food to flow into your stomach, after which the muscle tightens again. If that sphincter isn’t working as it should, stomach acid can flow back up into the esophagus. It’s usually worse if you’re lying down.

I’d had no idea that Advil and other anti-inflammatory drugs could cause acid reflux and heartburn. It can also increase the risk of stomach ulcers. That’s because it increases acid production in the stomach, inhibits the production of mucus that lines and protects the stomach lining, and irritates the esophagus. I quit taking Advil and the acid reflux stopped, although I still get heartburn occasionally. I wish I’d known.

Advil is in a class of drugs called non-steroidal anti-inflammatories (NSAIDs), which also include aspirin, Motrin, Naproxen, Aleve, and others. To get a tad technical, the fundamental mechanism of NSAIDs is to inhibit the COX enzyme. The problem is that the enzyme comes in two forms: COX-1 and COX-2. COX-1 protects the stomach and gastrointestinal tract (good). COX-2 induces inflammation (pain). Unfortunately, with NSAIDs you can’t reduce inflammation caused by COX-2 without also reducing the protective effects of COX-1.

Pharmaceutical companies have been trying to develop pain-relieving drugs that target just COX-2. No luck so far. Maybe that’s the way Mother Nature wants it.

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