Tosin took ibuprofen three times on an empty stomach for period pain. By the next morning, her stomach was burning. Mascot Healthcare diagnosed NSAID-induced gastritis and treated it with a PPI — and taught her the two rules for safe painkiller use.
Graphic designer, Yaba. Presented with 5-day history of epigastric burning, nausea, and reduced appetite — beginning the morning after taking three doses of ibuprofen 400 mg on an empty stomach for menstrual pain. No GERD history. H. pylori stool antigen negative.
Acute Drug-Induced Gastritis (NSAID-associated)Tosin had severe menstrual cramps on a Sunday — the kind that had made her stay in bed before. She took one ibuprofen 400 mg at 9 am with a cup of tea. The pain returned at 1 pm; she took another with only water. At 6 pm the cramps were back; she took a third, again without food.
By Monday morning, her stomach was burning. She assumed it would pass. By Wednesday, she had barely eaten for 2 days and the burning was constant. She came to Mascot Healthcare.
The doctor asked about NSAID use. The three ibuprofen doses on near-empty stomach told the story. "Ibuprofen strips away the protective layer of your stomach wall," the doctor explained. "On an empty stomach, the acid has nothing to attack except the gastric lining itself."
NSAIDs (ibuprofen, diclofenac, aspirin) inhibit prostaglandins that protect the gastric mucosa. Taking them on an empty stomach — especially repeatedly — can cause acute gastritis or ulceration within hours.
Burning pain in the upper-middle abdomen — present on waking and worsening before meals.
Persistent nausea throughout the day — worse when she thought about food.
Lost interest in eating because food seemed to trigger the burning.
Characteristically worse when the stomach was empty; improved briefly after eating.
Clear temporal relationship: symptoms started 6 hours after the third dose of ibuprofen taken without food.
Gelusil antacid — some temporary relief; insufficient for established gastritis.
Eating less (to avoid triggering the pain) — counterproductive; food buffers acid and reduces gastric burning.
Omeprazole bought from pharmacy (1 day) — appropriate; insufficient duration.
H. pylori stool antigen test: negative. The ibuprofen was discontinued, and a stomach-protecting medication was prescribed for several weeks to allow the gastric mucosa to heal.
Food advice: eat small, regular meals; avoid coffee, alcohol, and citrus while healing. The two rules for safe NSAID use were explained: (1) always take with or after food; (2) use the minimum effective dose for the shortest time. If NSAIDs are needed regularly, the doctor can add a stomach-protecting medication alongside them.
For future period pain, the doctor discussed gentler alternatives to ibuprofen, taken after food.
Acute Drug-Induced Gastritis (NSAID-associated — ibuprofen × 3 on empty stomach; H. pylori negative)
Stop ibuprofen; a stomach-protecting medication course; food-with-NSAID rule education; a gentler alternative painkiller for period pain (with food)
At 1 week: burning 70% improved; appetite returned. At 4 weeks: fully resolved. Repeat treatment course not needed.
Full resolution within 4 weeks of treatment. Tosin now takes any NSAID only with food. She has not had a recurrence of gastritis.
Ibuprofen and all NSAIDs must be taken with food to protect the stomach lining. The gastric mucosa can be damaged within hours of NSAID use on an empty stomach.
Anyone needing regular NSAIDs for chronic pain conditions should have a PPI co-prescribed. This is routine in good prescribing practice — but patients taking OTC NSAIDs often don't know this.
Always take ibuprofen with food. On an empty stomach, it burns your stomach lining — not just your pain.
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