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- Bovine colostrum for NSAIDs

NSAIDs are commonly prescribed medicine that often cause adverse effects in the gastrointestinal tract, such as both gastric and intestinal tissue damages. Bovine colostrum contains large amounts of growth factors and have proven highly beneficial against the adverse effects from NSAIDs when co-administrated.

NSAID

Non Steroidal Anti-Inflammatory Drugs (NSAID) are widely and commonly used prescribed medicine. They are used as analgesic, antipyretic and anti-inflammatory agents, against musculoskeletal diseases and as pain treatment when paracetamol is insufficient (Playford et al., 2001). In Denmark, commonly types of NSAID includes Ibuprofen and Diclofenac, and more than 50% of the adult population redeemed at least one prescription of an NSAID during 1997-2005. During this time period, Ibuprofen was the most commonly prescribed NSAID comprising 51 % of the total NSAIDs, followed by Diclofenac which comprised 22% of the total NSAIDs (Sondergaard et al., 2017).

Adverse side effects

Chronic use is reported to result in gastric and intestinal tissue damages in both the small and large intestine, causing increased permeability leading to blood and protein loss and a narrowing of the gut (stricture formation), the latter being a distinctive feature of Crohn’s disease (Bjarnason et al., 1987; Allison et al., 1992). These injuries are caused by several mechanisms, including reduction of prostaglandin levels and blood flow in the gut mucosa, and may stimulate cell damage and even death through apoptosis (Levi & Shaw-Smith, 1994). Short-term treatment with NSAIDs increase intestinal permeability, and thus intestinal permeability is used to assess the degree of small intestinal damage in patients caused by NSAIDs, with Crohn’s disease, or coeliac disease (Bjarnason et al., 1988).

Studies report that 10-30% of patients taking NSAIDs have gastric tissue injuries (McCarthy, 1989), 20-40% have intestinal lesions, while up to 70% show intestinal diseases associated with high gut permeability and thus protein loss (Bjarnason et al., 1993).

Current treatment

Today, the side effects of NSAIDs are treated with co-administration of acid supplements or prostaglandin analogues, which are efficient in reducing gastric tissue injuries and thus in the protection of the stomach, but show only very little protective effect in the small intestine (Bjarnason et al., 1988). Prostaglandin analogues also cause diarrhea, a very troublesome side effect (Playford et al., 2001).


Bovine colostrum as effective therapy when co-administrated

Bovine colostrum has been reported to reduce gut permeability in both patients taking short-term and long-term NSAID treatment when co-administrated, but not for patient chronically taking NSAIDs while being free of adverse effects in the gastrointestinal tract. The difference in efficiency is likely due to short-term doses of NSAIDs appearing to consistently increase intestinal permeability while long-term in some patients may result in an adaptation by the small intestine, at least in certain individuals (Playford et al., 2000; Kelly, 2003).


Effect from bovine colostrum relates to growth factors

The positive effects of colostrum is likely influenced by the presence of numerous growth factors, such as the insulin-like growth factors (IGF-I and IGF-II), epidermal growth factors (EGF’s) and tissue growth factors (TGF-α and TGF-β) that are capable of stimulating growth and repair processes in the gastrointestinal tract by contributing to the maintenance of equilibrium mucosal mass and integrity in the gastrointestinal tract (Playford et al., 2000; Kelly, 2003).


References

Allison, M. C., Howartson, A. G., Torrance, C. J., Lee, F. D. & Russell, R. I.(1992) Gastrointestinal damage associated with the use of non-steroidal anti-inflammatory drugs. The New England Journal of Medicine, 327, 749–754.

Bjarnason, I., Zanelli, G., Smith, T., Prouse, P., Williams, P., Smethurst, P., Delacey, G., Gumpel, M. J. & Levi, J. A. (1987) Nonsteroidal anti-inflammatory drug induced intestinal inflammation in humans. Gastroenterology 93(3), 480–489.

Bjarnason, I. (1988) Non-steroidal anti-inflammatory drug induced small intestinal inflammation in man. In Recent Advances in Gastroenterology (Pounder, R., ed.), pp. 23–46, Churchill Livingstone Press, London

Bjarnason, I., Hayllar, J., Macpherson, A. J. and Russell, A. S. (1993) Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology 104(6), 1832–1847.

Kelly, G. S. (2003) Bovine colostrums: a review of clinical uses. Alternative Medicine Review, 8(4), 378-394.

Levi, S. and Shaw-Smith, C. (1994) Non-steroidal anti-inflammatory drugs; how do they damage the gut? Rheumatology, 33(7), 605–612.

McCarthy, D. (1989) Non-steroidal anti-inflammatory drug induced ulcers: Management by traditional therapies. Gastroenterology 96(2,2), 662–674.

Playford, R. J., Macdonald, C. E. & Johnson, W. S. (2000) Colostrum and milk-derived peptide growth factors for the treatment of gastrointestinal disorders. The American Journal of Clinical Nutrition, 72(1), 5-14.

Playford, R. J., Macdonald, C. E., Calnan, D. P., Floyd, D. N., Podas, T., Johnson, W. S., Wicks, A. C., Bashir, O. & Marchbank, T. (2001) Co-administration of the health food supplement, bovine colostrum, reduces the acute non-steroidal anti-inflammatory drug-induced increase in intestinal permeability. Clinical Science, 100, 627-633.

Sondergaard, K. B., Weeke, P., Wissenberg, M., Olsen, A.-M. S., Fosbol, E. L., Lippert, F. K., Torp-Pedersen, C., Gislason, G. H. & Folke, F. (2017) Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case-time-control study. European Heart Journal – Cardiovascular Pharmacotherapy, 3, 100-107.
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