Digestive Health Archives

Pain Medications and Gastrointestinal Injury

Every day we are bombarded with ads for medications to ease the pain of arthritis. The majority of these ads are for a common class of drugs called nonsteroidal anti-inflammatory drugs or NSAIDs. These are very commonly used drugs – more than 30 million Americans take these medications on a daily basis.

NSAIDs include aspirin, over the counter medications like Advil, Motrin, Aleve, Nuprin and the generic version, ibuprofen. A few of the well-known brand name prescription medications within this same class include Naprosyn, Mobic, Indocin, Relafen and Clinoril.

These drugs are also combined with antihistamines and marketed as a sleep aid such as Advil PM. Additionally, NSAIDs are combined with a decongestant and marketed as Motrin Cold and Sinus.

While NSAIDs are very effective medications for lessening inflammation and fever and easing the pain of arthritis, they can also cause serious side effects, mainly in the gastrointestinal (GI) tract.

Both limited and chronic use of NSAIDs can lead to stomach ulcers and may also cause damage to the lining of the small intestines and colon. These injuries are referred to as NSAID-induced gastropathy, enteropathy and colopathy.

The general public is aware of the risk of stomach ulcers, but lesser known is the risk of NSAID-induced intestinal ulcers, strictures, perforation and colitis. Studies in humans taking chronic NSAIDs have shown 50-70% of the individuals have evidence of damage to the small intestines^(1,2).

Decreased Intestinal Inflammation: Yet Another Benefit of Probiotics

NSAIDs prevent the production of a protective mucus barrier in the small intestines. Without this protective barrier, bile acids, enzymes and harmful intestinal bacteria are able to damage the intestinal lining cells. However, experimental studies in mice have shown that the NSAIDs cannot cause this injury to the small intestines if the intestinal tract is sterile⁽⁴⁾.

Since our intestines and GI tracts are not sterile, a study was undertaken to determine if probiotic bacteria given to individuals taking NSAIDs could protect against small intestinal damage⁽³⁾. They studied 20 healthy volunteers who took either a placebo or a probiotic. All volunteers received indomethacin, and their stools were collected to measure for a protein called calprotectin. This protein is increased in stools if there is damage to the intestines⁽⁴⁾.

The study found that the volunteers receiving the placebo had a statistically significant increase in calprotectin concentration in their stools beginning on the second day of taking indomethacin compared to the group that received the probiotic. The authors concluded that the results of this study suggest that a probiotic given before and during indomethacin therapy could be useful in decreasing intestinal inflammation. They recommended that further studies be performed to confirm their results.

Take Home Message

Each year scientific studies are discovering new health benefits of probiotics. Based on the current study, I would suggest if individuals need to be on NSAID drugs, they should consider taking a probiotic with a mixture of bacteria in a dose of greater than 10 billon per serving – like EndoMune Advanced.

Finally, I think it is important for the general population to understand that taking NSAIDs in any form has potential adverse effects and the risks versus benefits should be considered.

Thank you for your interest in EndoMune.

Eat healthy, exercise and live well!

Dr. Lawrence Hoberman

(1) Is non-steroidal anti-inflammatory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Adebayo D, Bjarnason I.Postgrad Med J. 2006 Mar;82(965):186-91

(2) Present status and strategy of NSAIDs-induced small bowel injury. Higuchi K, Umegaki E, Watanabe T, Yoda Y, Morita E, Murano M, Tokioka S, Arakawa T.J Gastroenterol. 2009;44(9):879-88. Epub 2009 Jul 1

(3) The effects of a probiotic mixture on NSAID enteropathy: a randomized, double-blind, cross-over, placebo-controlled study.Montalto M, Gallo A, Curigliano V, D’Onofrio F, Santoro L, Covino M, Dalvai S, Gasbarrini A, Gasbarrini G.Aliment Pharmacol Ther. 2010 Apr 7

(4) Fecal calprotectin as a promising marker of inflammatory diseases. Paduchova Z, Durackova Z.Bratisl Lek Listy. 2009;110(10):598-602.

To Go or Not To Go… that is the problem

Digestive Health, Disease, Women’s Health / By @drHoberman

Dear EndoMune subscribers,

Now that we are enjoying the beauty of the spring days, we really don’t want to be slowed down by any GI issues. The following real case report describes how EndoMune can make a positive difference in your health this season:

Case Study: Constrained By Constipation

Karen, a 34-year old corporate executive, saw her primary care physician due to a problem of constipation. Karen had a longstanding history of difficulty with normal stool habits. She had tried a variety of diets and laxatives with no real improvement.

A comprehensive gastroenterological evaluation did not reveal any abnormality. She was told that her problem was due to “irritable bowel syndrome.”

The physician recommended a high fiber diet, stool softeners and exercise.

Karen continued to have problems with bloating, distention and constipation. Her GI issues made it hard for her to function at work. Enjoying outdoor activities like hiking and biking with her family were difficult.

Karen read about probiotics and decided to try EndoMune.

After one week of therapy, Karen’s constipation markedly improved. She was so delighted with the results that she emailed to let me know how EndoMune had made such a difference in her life.

The Discomfort of Constipation

After reading the case report, it is apparent that this month’s newsletter is about how probiotics can ease the problem of constipation.

Constipation is a common condition affecting children and adults. In the vast majority of cases, no underlying natural cause is found and functional constipation or “irritable bowel syndrome” is diagnosed.

Did you know that:

Constipation is medically defined as less than 3 stools per week and associated with straining1

Constipation is one of the most common GI disorders in clinical practice

Approximately 20% of the general population suffers from chronic constipation during their lifetime

Childhood constipation accounts for 3-5% of all visits to pediatricians2

Approximately 70-80% of nursing home residents have constipation3

Finding Relief

In the last 5-6 years, there have been a number of medical studies evaluating whether probiotics can improve constipation and associated symptoms. Not all of them have shown benefit.

I have listed the results of some of the most well done studies:

In 2011, Guerra et al4 reported the results of a study involving 59 children suffering with constipation. Over a 10-week period, the group receiving probiotics had significant improvement in stool frequency, consistency and less abdominal pain.

In 2011, Waller et al5 published a study done on 100 adults with chronic constipation. The group receiving probiotics for 14 days had significantly improved stool frequency and decreased abdominal symptoms compared to the control group.

In 2010, Hyang et al6 reported the results of a clinical study using probiotics in a group of nursing home patients. After 2 weeks of therapy, there was a significant improvement in frequency and consistency of the stools.

In addition to improving GI function, there were no adverse side effects associated with the use of probiotics in these medical studies. This is a very important and unique benefit of probiotic use when compared to other constipation therapies.

How probiotics improve intestinal function is being actively researched by medical experts. Studies7 have found that the bacterial flora in constipated individuals is different than in individuals with regular bowel movements in that they lack the ability to produce beneficial fermented products that enhance intestinal function. Adding probiotics reestablishes a healthy intestinal flora resulting in improved intestinal activity.

Take Home Message

If you struggle with GI issues, consider adding EndoMune to your daily regimen and enjoy these beautiful spring days comfortably!

Eat healthy, exercise and take EndoMune!

Best Wishes,

Lawrence Hoberman MD

1) Epidemiology of constipation in North America: a systematic review.Higgins PD, Johanson JF.Am J Gastroenterol. 2004 Apr;99(4):750-9. Review

2) Epidemiology of childhood constipation: a systematic review.van den Berg MM, Benninga MA, Di Lorenzo C.Am J Gastroenterol. 2006 Oct;101(10):2401-9. Review.

3) Chronic Constipation in the Elderly free Juan F Gallegos-Orozco, Amy E Foxx-Orenstein, Susan M Sterler & Jean M StoaThe American Journal of Gastroenterology 107, 18-25
doi:10.1038/ajg.2011.349

4) Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind,controlled trial.Guerra PV, Lima LN, Souza TC, Mazochi V, Penna FJ, Silva AM, Nicoli JR, Guimarães EV.World J Gastroenterol. 2011 Sep 14;17(34):3916-21.

5) Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults.Waller PA, Gopal PK, Leyer GJ, Ouwehand AC, Reifer C, Stewart ME, Miller LE.Scand J Gastroenterol. 2011 Sep;46(9):1057-64. Epub 2011 Jun 13.

6) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents.An HM, Baek EH, Jang S, Lee do K, Kim MJ, Kim JR, Lee KO, Park JG, Ha NJ.Nutr J. 2010 Feb 5;9:5.

7) Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome (pages 828–838) C. Chassard, M. Dapoigny, K. P. Scott, L. Crouzet, C. Del’homme, P. Marquet, J. C. Martin, G. Pickering, D. Ardid, A. Eschalier, C. Dubray, H. J. Flint and A. Bernalier-DonadilleAlimentary Pharmacology and Therapeutics, 03/19/2012

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