Dr Forrest and colleagues from Cheshire in England undertook a systematic review of the published evidence on the association between paracetamol or non-steroidal anti-inflammatory drugs and relapse in inflammatory bowel disease.
The researchers performed Medline searches until June 2004 and Embase until April 2003.
In addition, the investigators hand-searched abstracts published in Gut and Gastroenterology from 1999 to 2004.
The researchers identified a total of 29 relevant abstracts and papers.
The investigators found that 22 patients with relapse of inflammatory bowel disease following exposure to non-steroidal anti-inflammatory drugs had been described in case-reports.
4 patients were re-exposed to non-steroidal anti-inflammatory drugs and relapsed again.
2 had relapsed after taking a cyclo-oxygenase 2 inhibitor.
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1 study that the researchers reviewed described increased inflammatory activity and clinical relapse in some patients after challenge with naproxen or nabumetone.
The research group also identified 15 epidemiological studies which had small sample sizes and many had methodological problems.
Out of these, the research identified 6 studies that found evidence for an association between non-steroidal anti-inflammatory drug use and relapse of inflammatory bowel disease, but the association was significant in only two.
3 studies suggested a relationship between paracetamol use and exacerbations of inflammatory bowel disease.
Non-steroidal anti-inflammatory drugs may precipitate a relapse in some patients with inflammatory bowel disease. This may be an idiosyncratic reaction.
Dr Forrest concluded, "The published evidence does not support the view that non-steroidal anti-inflammatory drugs are important in inducing relapse of inflammatory bowel disease."
"There is weak evidence that paracetamol may be more important."