• Korean Journal of Clinical Pharmacy
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• v.24 no.1
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• pp.15-25
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• 2014

Background: Elderly patients with gastrointestinal (GI) and cardiovascular (CV) risk factors may be more easily exposed to NSAID-related side effects (SEs). Based on the ACG guideline of year 2009, the aim of the study is to evaluate proper use of NSAIDs and gastroprotective drugs according to the degree of GI and CV risk strengths in the patients. Methods: Retrospectively surveyed 410 elderly patients with NSAIDs for more than 30 days at a general hospital in Korea. GI risk factor includes age, ulcer history, high-dose NSIADs, concurrent aspirin use, steroids or anticoagulants. CV risk factor includes angina, myocardial infarction, cerebral infarction, atrial fibrillation or coronary intervention requiring low-dose aspirin. These factors were classified as high/low cardiovascular groups and high/moderate/low GI groups. Results: There were 14 patients in high CV risk group and high GI risk group. The group was recommended not to use NSAIDs as it is not adequate. There were 101 patients in high CV risk group and moderate GI risk group. This group was recommended to use naproxen and PPI/misoprostol. But all patients except one were not adequate. There were 9 patients in low CV risk group and high GI risk group. This group was recommended to use selective COX-2 inhibitor and PPI/misoprostol. 5 cases were proper while 4 cases did not. There were 285 patients in low CV risk and moderate GI risk group who were recommended to use non selective NSAIDs and PPI/misoprostol or selective COX-2 inhibitor only. 103 patients were proper while 182 patients not adequate. Overall, the SEs were higher in those cases for inadequate use of drugs comparing to the adequate. CV SEs were statistically significant. However, SEs for each risk groups were different. For the case of low CV risk group and high/moderate GI risk group, the inadequate use of drugs makes the SE high and the other groups are not. Also, it was not statistically significant. Conclusions: In elderly patients, the inappropriate use of NSAIDs can increase the risk of the disease. Therefore, GI and CV risk must be considered simultaneously, and the proper use of NSAIDs and gastroprotective drugs for each risk groups should be reconsidered.

• The Journal of Internal Korean Medicine
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• v.34 no.4
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• pp.412-427
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• 2013

Objectives : This study was carried out to compare the effects of Eejin-tang, Hyangsaeejin-tang and Naeso-san extracts on indomethacin-induced gastric mucosal lesions in mice. Methods : Experimental mice were divided into six groups. The normal group had no gastro-inflammation. In the control group, gastro-inflammation was elicited by indomethacin. Misoprostol, Eejin-tang, Hyangsaeejin-tang and Naeso-san group were those in which misoprostol, Eejin-tang extract, Hyangsaeejin-tang extract and Naeso-san extract were administered after gastro-inflammation is elicited. This study examined the anti-inflammation effects and distribution of mucus secreting cells, zonula occludin-1 (ZO-1), heat shock protein (HSP) 70, periodic acid-schiff reaction stain (PAS), peanut agglutinin (PNA), cyclooxygenase-1 (COX-1), 5-bromo-2'-deoxyuridine (BrdU), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-${\kappa}B$) p65, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Results : 1. The hemorrhagic erosion and damaged mucus secreting cell, the positive reaction HSP70 increased in the control group, but decreased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. 2. The positive reaction of ZO-1, PAS, PNA, COX-1 and BrdU decreased in the control group, but increased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. 3. The positive reaction of NF-${\kappa}B$ p65, iNOS and COX-2 increased in the control group, but decreased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. Conclusions : Among the three extracts, the effects were in the order of Naeso-san, Hyangsaeejin-tang and Eejin-tang group, Naeso-san being the most effective.

• The Journal of Korean Medicine
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• v.28 no.2 s.70
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• pp.166-184
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• 2007

Objectives : This study was conducted to investigate the effects of Daegeum-eumja, Igwi-tang, and Sihosogan-san on gastric mucosal lesions induced by alcohol, indomethacin, and burn-stress in mice. Methods : Experimental mice were divided into six groups. The normal group (NOR) did not receive any treatment to elicit gastropathy. In the control group (GE), gastropathy was elicited by alcohol, indomethacin, and stress. In the misoprostol group (MS), misoprostol was administered after gastropathy was elicited by alcohol, indomethacin, and stress. In the Daegeum-eumja group (DG), Daegeum-eumja was administered after gastropathy was elicited by alcohol, indomethacin, and stress. In the Igwi-tang group (IW), Igwi-tang was administered after gastropathy was elicited by alcohol, indomethacin, and stress. In the Sihosogan-san group (SH), Sihosogan-san was administered after gastropathy waselicited by alcohol, indomethacin, and stress. The effects on gastric mucosal lesions were evaluated by the morphological change of gastric mucosa, the anti-oxidant effect, HSP 70, $NF-{\kappa}B$ p65, $I{\kappa}B$, COX-1, PNA, BrdU, and iNOS. Results : Hemorrhage erosion, HSP70, and $NF-{\kappa}B$ in the DG, IW and SH groups decreased more than that of the control. The $I{\kappa}B$, COX-1, PNA, BrdU, and iNOS in the DG, IW, and SH groups increased more than that of the control. DG showed the most effect against gastric mucosal lesions induced by alcohol; IW against gastric mucosal lesions induced by indomethacin; and SH against gastric mucosal lesions induced by burn-stress. Conclusions: Daegeum-eumja, Igwi-tang, and Sihosogan-san extracts have excellent effects on gastric mucosal lesions induced by alcohol, indomethacin, and burn-stress, respectively.

• Journal of Veterinary Clinics
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• v.31 no.3
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• pp.220-222
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• 2014

A 14 year-old Shih-tzu was referred to the Veterinary Medical Teaching Hospital of Chungnam National University with a history of foreign body ingestion and vomiting. The vomitus contained ketoprofen plaster, which is used for orthopedic analgesia in humans. Supportive care and gastrointestinal (GI) protective agents were administered, including famotidine, misoprostol, sucralfate, omeprazole, and fluid therapy. However, the clinical signs worsened, and anemia, melena, leukocytosis, and azotemia developed. The patient was diagnosed with GI hemorrhage and underwent a whole blood transfusion followed by barium sulfate administration. After administering barium sulfate as a GI protectant, the clinical signs improved, and the patient was discharged.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.4
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• pp.79-92
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• 2020

Purpose : The purpose of this study was to evaluate the prescription pattern of NSAIDs and GPAs in the arthritis patients over 65 years old to prevent the GI adverse events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used agents to treat arthritis, can cause gastrointestinal (GI) adverse effects. Recent guidelines recommend that moderate risk patients who have one or two risk factors, should be prescribed either combination of non-selective NSAID (nsNSAIDs) and gastroprotective agent (GPAs) or selective NSAID alone. Methods : Study population was National Patient Sample of 2011. Number of drugs used were 138 for NSAIDs and 21 for GPAs. Chi-square test was used to compare prescribing patterns. Results : The appropriate prescription rate follows the guideline was 11.2%: co-prescription with nsNSAID and proton pump inhibitor (PPI) or misoprostol was 1.6% and selective NSAID alone was 9.6%. Inappropriate prescription rates were as follows: co-prescription with nsNSAID and Histamine-2 receptor antagonist (H2RA) or antiacid was 53.8% and nsNSAID alone was 35.0%. The appropriate prescription rate among the types of medical institute was 54.4% in tertiary hospital, 31.2% in secondary hospital, and 6.0% in primary hospital. The appropriate prescription rate among the regions was 19.4%, highest in Seoul and 4.2%, lowest in Jeju. The appropriate prescription rate among the medical departments was as follow: 12.2% in orthopaedic surgery, 11.0% in internal medicine, and 7.7% in other departments. Conclusion : This finding suggests the needs to revise the national medical insurance imbursement policy, provide continuing medical education about the guideline of medical doctors.