Hrev_master Healthcare in Low-resource Settings 2023; volume 11:11729 Efficacy of turmeric (Curcuma longa Linn) decoction to reduce pain in patients with gastritis Ismansyah Ismansyah,1 Frana Andrianur,1 Rini Ernawati2 1Health Polytechnic, Ministry of Health, East Kalimantan, Samarinda; 2Faculty of Nursing, Muhammadiyah University of East Kalimantan, Samarinda, Indonesia Abstract Turmeric (Curcuma longa Linn) has been used by Indonesian people for a long time to treat pain in digestive disorders. The pur- pose of this study was to determine the efficacy of turmeric decoc- tion on pain in gastritis patients. This study employed a quasi- experimental design with a one-group pre- and post test approach. The consecutive sampling method was employed to recruit 100 participants in Samarinda, Indonesia. After assessing baseline pain levels (Pretest), participants were administered the intervention, which involved the consumption of turmeric decoction for 14 con- secutive days, with a regimen of 2×150 mL daily, specifically 15 minutes before breakfast and dinner. Post-test measurements were recorded on days 5, 10, and 14. Pain scores were evaluated using the Numeric Rating Scale, Data analysis utilized the paired T-test to determine differences in mean gastritis pain levels before and after the intervention. The findings revealed a significant reduc- tion in gastritis pain scores between the Pretest measurements is 3.8 and the post-test on day 5 (1.34), day 10 (0.62), and day 14 (0.31). The statistical analysis yielded a p-value of 0.000. The study demonstrated the efficacy of turmeric decoction in alleviat- ing pain among gastritis patients, with notable improvements observed as early as day 5 of the treatment regimen. Consequently, we recommend the incorporation of turmeric decoction as a com- plementary and non-pharmacological therapeutic approach for the effective management of gastritis symptoms. Introduction Gastritis is a digestive tract disorder with the most frequent causes are the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), corticosteroids, lifestyles with high levels of stress,1,2 helicobacter,3,4 consumption of alcohol, coffee, and smoking and the attitude of gastritis sufferers who pay less attention to the food consumed every day.3,5–7 The complication of this disease is gas- tric bleeding which causes the patient to die.3 Gastritis in Indonesia amounted to 40.8% in 2018 with almost the same variation in every region in Indonesia.8,9 Data from the Samarinda City Health Office, gastritis is included in the top 10 visits at the Public Health Center in 2022 10. Acute gastritis has symptoms of nausea and pain such as burning or discomfort in the epigastrium.11,12Among the non-pharmacological measures that can overcome pain is to use herbal medicine or traditional medicine, namely turmeric.11,13 The curcuminoid content in turmeric functions as an herbal medicine to relieve pain in the injured gastric mucosa and can reduce stomach acid levels.11,14 Turmeric is an herbal therapy that has long been known to the Indonesian people as a health drink and is used to treat gastritis pain complaints as a complementary approach or non-pharmaco- logical therapy.15 Turmeric (Curcuma longa Linn) is a safe and non-toxic ingredient that is safe for consumption.16,17 Turmeric is an herbal therapy ingredient and is used as traditional medicine.18 Turmeric (C. longa L.) is a type of tropical plant from the Zingiberaceae family.19 The content of turmeric rhizome, especial- ly curcumin, is known to have many pharmacological effects and Correspondence: Ismansyah Ismansyah, Politeknik Kesehatan Kemenkes Kalimantan Timur, Samarinda, Indonesia. E-mail: ismanamin18@gmail.com Key words: turmeric decoction; gastritis; pain reduction. Contributions: ISM, Conceptualization, Data Curation, Formal Analysis, Methodology, Validation, Visualization, Writing - Initial Draft, Review & Editing; FA, Conceptualization, Investigation, Methodology, Validation, and Writing - Initial Draft, Review & Editing; RE, Resources, Investigation, supervision and Writing - Review & Editing. Conflict of interest: the authors declare no conflict of interest. Ethics approval and consent to participate: this research has received ethical approval from the Health Research Ethics Commission of the Health Polytechnic of the East Kalimantan Ministry of Health based on ethical certificate No. DP.04.03/7.1/07746/2023. During the research, researchers paid attention to the ethical principles of infor- mation to consent, respect for human rights, beneficence, and non- maleficence. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Funding: this research received no external funding. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received: 9 September 2023. Accepted: 9 October 2023. Early access: 16 October 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11:11729 doi:10.4081/hls.2023.11729 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affili- ated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2023; 11:11729] [page 31] Non -co mmerc ial us e o nly has been shown to exhibit high antibacterial,20 anticarcinogenic, anti-inflammatory,21,22 and antioxidant properties and has immuno- suppressive activity.23,24 The anti-inflammatory mechanism of cur- cumin is by inhibiting prostaglandins and proinflammatory cytokines, COX-2, iNOS, NF-kB, AP-1 and also MMP.25 Empirically, the researcher’s experience while working in the community, found that for generations, people have used turmeric decoction to treat various complaints they experience, including complaints of indigestion. People consume turmeric to reduce pain, but research on the benefits of turmeric, especially to reduce gastritis pain, is still lacking. This study aims to determine the effectiveness of turmeric decoction to treat pain in gastritis patients in Samarinda, Indonesia. Materials and Methods Research design This type of research is a pseudo-experiment, to determine the efficacy of turmeric decoction on gastritis patient pain with a one group pre and post test design approach. The study was conducted for 2 months from April 01 to May 30, 2023, at the Community Health Center in Samarinda, Indonesia. Researchers met partici- pants at the Community Health Center and then continued with home visits. Participants were given a turmeric decoction which was consumed for 14 days without a break. The rules for consum- ing 2×150 mL are 15 minutes before breakfast and dinner. The first day a pre-test was conducted, then turmeric decoction was given, day 5 post test I, day 10 post test II and day 14 post test III. Post test measurements were taken 3 times to determine differences in the effect of Curcuma longa Linn decoction on pain. The schedule for consuming turmeric decoction was controlled through text messages to participants to ensure the intervention was carried out according to schedule. Research participants The participants of this study were gastritis patients, totaling 100 participants, obtained by consecutive sampling method. Participants who met the criteria and were willing to participate were sampled, conducted a pre-test and continued to provide inter- ventions with home visits. Participants were aged between 17 years and 45 years, diagnosed with gastritis, experiencing mild pain and not taking analgesic drugs. Variables, instruments and data collection The dependent variable measured was gastritis pain, measured pretest and 3 times post test measurements, namely on day 5, day 10 and day 14. The instrument used was the Numeric Rating Scale (score 0-10).1 Data analysis The data analysis used is the dependent t test through data pro- cessing software. The pre-test measurement results were compared with Post test 1 (Day 5), post test 2 (Day 10) and post test 3 (Day 14). The degree of confidence was set at 95% (α=0.05). Ethical clearance This study has received a certificate of ethical clearance from the Ethical Review Commission of the East Kalimantan Health Polytechnic, according to the ethical review certificate No. DP.04.03/7.1/07746/2023. During the research, the researchers paid full attention to the fulfillment of ethical principles, imple- menting informed consent, respect for human rights, confidential- ity, beneficience and non-maleficience. Results Based on Table 1, it was found that the characteristics of par- ticipants based on gender were 89 participants (89%) female and the remaining 11 participants (11%) were male, the age of partici- pants 51 (51%) participants were between 17-25 years old, 27 (27%) were 36-45 years old and 22 (22%) were between 26-35 years old. While the participants’ education level, 64 (64%) high school, 19 (19%) junior high school, 14 (14%) higher education and the remaining 3 (3%) elementary school. 70 (70%) did not have a job, 27 (27%) worked in the private / self-employed sector and 3 (3%) as Civil Servants, based on the length of time suffering from gastritis were participants who suffered from gastritis for 1 month as many as 35 participants (35%), for 2 months as many as 40 participants (40%), and for 3 months as many as 25 participants (25%). Based on Table 2, it is known that the pain score experienced by participants (gastritis patients), the highest in the pre-test was 6.00, the lowest pain score was 3.00, mean 3.83, median 4.00, mode 4.00, and standard deviation value 0.68. The highest pain score in Post test 1 (Day 5) was 3.00 and the lowest pain score was 1.00, mean 1.34, median 1.00, mode 1.00 and standard deviation Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 1. Characteristics of participants by gender, age, education, occupation. In Samarinda, Indonesia (N=100). Indicator n % Gender Female 89 89 Male 11 11 Age 17-25 51 51 26-35 22 22 36-45 27 27 Education Elementary school 3 3 Junior high school 19 19 High school 64 64 Higher education 14 14 Job Not working 70 70 Civil servant 3 3 Private/self-employed 27 27 Duration of gastritis 1 month 35 35 2 months 40 40 ≥ 3 months 25 25 Table 2. Results of pre and post test pain score measurements. Pain Pre Post Test 1 Post Test 2 Post Test 3 test (Day 5) (Day 10) (Day 14) Mean 3.83 1.34 0.62 0.31 Median 4.00 1.00 1.00 0.00 Mode 4 1 1 0 Standard deviation 0.68 0.536 0.546 0.465 Min-Max 3-6 1-3 0-2 0-1 [page 32] [Healthcare in Low-resource Settings 2023; 11:11729] Non -co mmerc ial us e o nly value 0.536, Post test 2 (Day 10) the highest pain score was 2.00 and the lowest pain score was 0.00, mean 0.546, median 1.00, mode 1.00 and standard deviation value 0.546, and Post test 3 (Day 14) the highest pain score was 1.00 and the lowest pain score was 0.00, mean 0.31, median 0.00, mode 0.00 and standard deviation value 0.465. Based on Table 3, the results of the paired t test of pain scores between Pretest, Post test 1 (Day 5), post test 2 (Day 10) and post test 3 (Day 14), obtained p=0.000<α=0.05. The difference in pain scores between pretest and post test 1=2.49 pain scale scores. The difference in pain scores between Post test 1 (Day 5) and post test 2 (Day 10) was 0.72 and the difference in pain scores between post test 2 (Day 10) and post test 3 (Day 14) was 0.31. Discussion The results of this study prove the efficacy of turmeric decoc- tion against gastritis pain which is characterized by a decrease in pain scores after being given turmeric decoction. After 5 days of consuming turmeric decoction, there was a significant decrease, from an average pain of 3.86 down to 1.34 (a difference of 2.49), on day 10 the pain decreased from 1.34 to 0.62 (a decrease of 0.72), on day 14 there was a decrease in pain score to 0.31 (a decrease of 0.31). Statistically there is still a decrease in the pain scale in the 2nd and 3rd measurements, but clinically there is no significant difference because it is in the mild category of pain. Curcumin found in turmeric is a potential agent for controlling pain due to irritation of the gastric mucosal epithelium due to inflammation in gastritis, including gastritis caused by Helicobacter pylori.26,27 A common result of inflammation is pain.11,27 If allowed to continue, it can cause progressive damage to tissues and organs, especially the gastric mucosal epithelium. Traditional communities in Indonesia have been using non-phar- macological approaches, namely turmeric as a natural remedy to treat epigastric pain and other digestive disorders.28 Turmeric, is a plant that is often used as a traditional medicine that can empirical- ly reduce pain due to inflammation in the body. One of the active substances of Curcuma longa Linn is curcumin.18,23,27 A number of studies have reported that curcumin has various biological activi- ties including antimicrobial, anti-oxidant, anti-tumor and anti- inflammatory effects.18,29 In addition, curcumin has some immuno- suppressive activity, increasing the phagocytic activity of macrophages, including the expression of cytokines such as IL-1 and TNF-α.28,30 Curcuminoids are components that give yellow color which are antioxidants and have properties such as hypocholesteromic, cholagogue, choleretic, bacteriostatic, spasmolytic, antihepatotox- ic, and anti-inflammatory.4,13,30 Curcuminoids are components that give yellow color which are antioxidants and have properties such as hypocholesteromic, cholagogue, choleretic, bacteriostatic, spas- molytic, antihepatotoxic, and anti-inflammatory.18,29 Curcumin is reported to have multicellular activity because it can ward off and reduce the risk of various diseases including antiproliferation and antioxidant by inhibiting 97.3% of cellular lipid peroxidation activity, binding to various types of cell proteins and inhibiting enzyme kinase activity, regulating cellular transcription factor activity, expression of inflammatory enzymes, cytokines, molecu- lar adhesion, decreasing cyclin D1, cyclin E and increasing gene expression mechanism of p21, p27 and p53 in the process of car- cinogenesis.23,27 The physical properties of curcumin which is a flavonoid compound insoluble in water but soluble in ethanol, dimethylsulfoxid, and acetone. Curcumin has a boiling point of 183°C.30 Efficacy of turmeric decoction (Curcuma longa Linn) against gastritis pain A total of 100 gastritis participants experienced an average pre- test pain score of 3.83, gradually decreasing to 1.34 on day 5, and 0.62 on day 10, on day 14 down to 0.31. A significant decrease in pain scores occurred in Post test 1 (Day 5). The difference in pain scores between pre test and Post test 1 (Day 5) was 2.49. The results showed that the administration of turmeric decoction was effective in reducing pain scores because turmeric decoction is an herbal plant containing curcumin which can reduce stomach acid levels and prevent gastric infections that cause pain in the stomach. Curcumin compounds contained in the rhizome of C. longa L. have anti-inflammatory effects on gastritis.4,14,16 In addition to working as an analgesic, the anti-inflammatory effect of Curcumin Longa Linn helps reduce pain and accelerate the healing process in gastritis patients. Curcumin contained in turmeric can inhibit the occurrence of cyclooxygenase (COX) reactions so that it can inhibit and reduce inflammation and inhibit and reduce pain and have an effect as an analgesic.31-33 The efficacy of curcumin to reduce pain is also shown in cases of osteomyelitis.17 Turmeric decoction is proven to reduce pain in gastritis suffer- ers and long-term use can cure gastritis.22,27 The content of turmeric (curcumin) can accelerate reepithelialization, cell proliferation and act as an antioxidant.22,24 Turmeric can inhibit histamine H2 (RH2) receptors directly and inhibit gastrin receptors so that gastric acid secretion decreases.21 Through this mechanism, gastritis pain can decrease because gastric mucosal epithelial irritation is prevented or inhibited.21,26 Another benefit of turmeric is that it can protect the gastric mucosa by increasing mucus secretion and has a vasodilator effect so it is very useful for increasing the resistance of the gastric mucosa and coating the epithelial surface of the gas- tric mucosa from ulcers.24,25 Studies show that turmeric and its major curcumin compounds are effective as gastroprotective agents.13,16 In various models of gastric ulceration such as in pyloric ligation, indomethacin, reserpine, and hypothermic restraint stress. In vitro studies have shown that curcumin is effec- tive on Helicobacter pylori bacterial infection.11 Conclusions The efficacy of turmeric decoction in reducing pain was observed in gastritis patients, with significant improvements noted to occur from day 5 of treatment. Based on these results, the researchers recommend the use of turmeric decoction as a comple- mentary and non-pharmacological therapeutic approach in the effective management of gastritis symptoms. Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 3. Test of differences in mean pain scores between pretest, post test 1, post test 2 and post test 3. Test Average pain score SD n p Pre 3,83 0,68 100 0,000 Post test 1 (Day 5) 1,34 0,536 100 0,000 Post test 2 (Day 10) 0,62 0,546 100 0,000 Post test 3 (Day 14) 0,31 0,465 100 0,000 [Healthcare in Low-resource Settings 2023; 11:11729] [page 33] Non -co mmerc ial us e o nly References 1. 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[page 34] [Healthcare in Low-resource Settings 2023; 11:11729] Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Non -co mmerc ial us e o nly