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“НАШЕ ЖИТТЯ”, СІЧЕНЬ 2015 WWW.UNWLA.ORG 33 ARE YOU AT RISK FOR AN ULCER? by Ihor Magun, MD, FACP One of the most commonly prescribed and non-prescribed classes of medications world- wide are medications which fall into the category of NSAIDs—nonsteroidal anti-inflammatory drugs. These medications, which I am certain eve- ryone has taken, provide anti-inflammatory, an- algesic, and fever-reducing effects. Ibuprofen and naproxen are the most common NSAIDs found in the nonprescription dose, and many additional NSAID medications are available with a prescrip- tion. About twenty-five percent—a relatively large number—of individuals who chronically ingest these medications are likely to develop an ulcer. NSAIDs’ mechanism of action inhibits COX. Cyclooxyenase (COX) is an enzyme that is responsible for formation of prostaglandins which provide protection to the lining of the stomach and intestine. Without the mucosal protective prostaglandins, NSAIDs can lead to direct dam- age to the walls of the stomach and intestine— producing irritation or ulcer formation. Inhibition of COX-1 is most likely the rea- son for NSAID related intestinal ulcers and bleed- ing. New, selective COX-2 only products, like Celebrex, are much less toxic to the gastrointesti- nal tract and may be a better choice in a select group of patients. Who are at risk for development of these ulcers? People with the greatest vulnerability to NSAID-induced ulcers are the elderly, individuals with a previous history of an ulcer, chronic users of steroids or anticoagulants, and persons who may harbor an intestinal infection with the bacte- ria Helicobacter pylori . Tests for this infection can be done easily in the office or as an outpa- tient. It may be prudent for patients who are on long-term NSAIDs, or who will initiate treatment, to be evaluated for this infection. By eradicating this infection, the possibility of ulcer formation is dramatically reduced. Currently, there are three classes of medi- cations that are helpful in preventing ulcers. These medications are taken concomitantly with the NSAID agent. The two most common nonpre- scription medications classes (one other is strictly prescription) are: 1. H2RA anti-histamine like Pepcid, Tagamet, and Zantac; and 2. PPI proton pump inhibitors like Prevacid, Prilosec, and Nexium. Of the classes listed, the PPIs are more effective in preventing ulcer formation from NSAID use. H2RA are helpful but not as effective in clinical studies. Should everyone ingesting NSAIDs be taking these ulcer preventing medications and, thus, increase their pill burden? Individuals who are at risk for ulcerations and take NSAIDs on a regular basis would benefit from an added protection. Some individuals who are candidates for COX-2 agents like Celebrex can try this preventive medicine as an option and may or may not need to take any additional protective agents. This determination varies per individual. As with any medication, one should al- ways consider potential risks and weigh those against the desired level of relief and the neces- sary duration of treatment. Short courses of treatment with NSAIDS do not necessarily trans- late into no risks. Many cases of bleeding and ul- cer formation have been documented even with short duration of treatment. One must always remember that any medication is not to be taken without good reason and medical need. I sincerely hope that you al- ways heed this advice. До редакції журналу «Наше Життя» У листопадовому (2014 р.) числі журналу «Наше Життя»в рубриці «Ділимося вістками і думками...» на ст. 3 було подано певну неточність. Як відомо, пам’ятник Лесі Українці в Культурному городі м. Клівленда було встановле- но у 1961 році. У серпні 2011 року було відзначено його 50-ліття існування, на якому голова СУА Маріянна Заяць у своїй промові подала правильну і чітку історію побудови цього пам’ятника. 8-ий Відділ СУА був заснований у 1985 році, який у 2011 році відреставрував цей пам’ятник і продовжує інтенсивно доглядати його, за що їм належиться велика подяка і признання. Ольга Дем’янчук, пресова секретарка 12-го Відділу СУА, Огайо.
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