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patients with high risk group and treatment of mucosal lesion for the group patients must
be consumed the NSAIDs continuously.
The management of Nsaids gastropathy divided for 2 aspects according to
patophysiology:
1. Direct effect of Nsaids to gastric mucosal, this condition strongly related to acid
concentration (pH) in the gastric lumen. PPI will be use for prevention in high risk group
and the treatment for patients with gastric mucosal lesion that Nsaids still consumed
continuously. PPI that control or decrease acid in the stomach are considered a valuable
palliative; if taken regularly while NSAIDs are used, they offer some protection to those
who must take NSAIDs.
All five PPIs appear to have similar efficacy in the treatment of various acid-peptic
disorders. The newer agents, rabeprazole, seem to have fewer drug interactions. This is
a particularly important consideration in older patients who are already taking several
other medications. While the average wholesale prices of all agents in this class are
similar.
Differences in the onset of action and the relative potencies of the various PPIs are
largely due to differences in the acid instability of the parent compounds. A PPI such as
rabeprazole, for example, is more acid unstable (ie, has a higher pKa) than the firstgeneration PPIs -- thus, in the parietal cell canaliculus, it is protonated earlier and at a
higher pH compared with omeprazole or lansoprazole.
Additionally, these investigators determined that rabeprazole achieved 88% of maximal
acid suppression after the first dose, versus 42% with omeprazole.
2. Systemic effect of Nsaids togastric mucosal, this condition strongly related to
defensive factors especially to thickness and quality of mucus. Human gastric mucins
play a major role in gastroprotection against acid and pepsin. Thus, the primary
function of MUC6 could be the protection of epithelial cells from endogenous agents
such as proteases, Mucus as the first mucosal barrier to prevent noxious agent in the
lumen to influence the epithel of gastric mucosa. Cytoprotector drugs will be use for
prevention and aggravation of mucosal lesion, although the patient consumed Nsaids
continuously. Teprenone have systemic effects for cytoprotection, to prevent and
treatment acute gastric mucosal lesion.
The double blind study of teprenone in Gastroenterology Division, Department of
Internal Medicine, co-operation with The Center of Clinical Drugs Study (PUKO),
Department of Pharmacology, Medical Faculty, University of Indonesia, for prevention
and treatment acute gastric mucosal lesions due to NSAIDs, clinical symptoms and
endoscopic appearance for the patients with teprenone consumed, have improved of
clinical symptoms (79.5%) and endoscopic appearance in the first week (p<0.0001)
and the second week (p<0.001). The result of study the teprenone group compared
with placebo group have significantly difference. (p<0.05)
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