Why does aspirin cause bleeding and stomach problems?

A Answers (1)

  • AMichael Roizen, MD, Internal Medicine, answered

    Aspirin is clearly a wonder drug, but even a wonder drug can have a downside. As well as reducing pain, aspirin (and all of the non-steroidal anti-inflammatory drugs (NSAIDs) can also eat away at the stomach lining (causing bleeding and ulcers), inhibit clotting, and in rare cases damage the kidneys.

    The problem with aspirin and its cousins, such as ibuprofen, is that they aren't "specific." That is, their effects aren't targeted -- limited to just one thing -- and so they have many effects, some desirable and some perhaps undesirable. Their beneficial effects come from their ability to block cyclooxygenase-2 (COX-2), an enzyme that promotes inflammation, pain, and fever. Unfortunately, the drugs are even more effective at inhibiting COX-1, a related enzyme essential for the health of the stomach lining and kidneys. It might be very beneficial to create compounds that selectively inhibit only (target) COX-2 but don't have any effect on COX-1. At least three drugs do exactly that, including celecoxib (Celebrex).

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