JK was 50 years old and had

JK was 50 years old and had for several years suffered progressively from joint pain, especially in his fingers. This pain was not incapacitating and he still had almost complete manual dexterity, but the pain was, at times, severe. His condition was diagnosed as rheumatoid arthritis and he was prescribed the non-steroidal anti-inflammatory drug ketoprofen, which he had been taking on and off for several years. Recently, he had begun to suffer from epigastric pain, and his general practitioner replaced his ketoprofen capsules with the same medication in suppository form. this proved to be beneficial for several months. More recently, however, JK suffered from a massive haematemesis with concomitant melaena. This necessitated emergency surgery, which resulted in a partial gastrectomy for a gastric ulcer. After his surgery, JK still needed pain relief, but his doctor was concerned about resorting to anti-inflammatories again, so prescribed ibuprofen and misoprostol. this did not cause epigastric pain but resulted in frequent episodes of diarrhea. this was then controlled with an ispaghula preparation and JK is now leading a life relatively free of symptoms of his rheumatoid arthritis or epigastric pain. Questions Why would suppositories be preferred to the capsules for JK? What was the most probable cause of JK’s gastric haemorrhage? Why would the combination of ibuprofen and misoprostol be prescribed? Why would JK gt diarrhoea? Why would ispaghula control diarrhoea? SCIENCE

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