Anti-gastric Ulcer Research Articles

S3449 OVESCO Clip Can Save Lives - A Success Story of Non-Variceal Upper GI Bleed From a Large Vessel

INTRODUCTION: The most common causes of upper GI bleed are non-variceal. Despite major advances in medical and endoscopic therapies, mortality rate and cost of hospitalization from upper GI bleed are still significant. We report successful use of Over-the-scope clip (OVESCO) in an elderly patient with cardiovascular and other comorbidities presenting with hemodynamically significant upper GI bleed. CASE DESCRIPTION/METHODS: A 79-year-old man with past medical history of CAD s/p CABG, AFib on eliquis, HTN, DM type 2 and CKD stage 3, presented to the ER with black tarry stool for one day and dizziness for one week. Vitals on admission were significant for BP 50/30mmHg and HR 110/min. Abdominal exam was negative for tenderness or stigmata of chronic liver disease. Rectal exam showed black stool. Laboratory findings were significant for Hct 26.2%, Hb 7.4g/dL (baseline ∼ 10), BUN 83mg/dL (baseline ∼ 17), Cr 1.3mg/dL (baseline ∼0.5), platelets 183K and INR 2.5. Elevated INR was attributed to eliquis. Patient was admitted to ICU. Resuscitation was initiated with IV fluids and PRBC transfusions to maintain SBP > 100 and Hb > 8 respectively. Prothrombin complex concentrate was given to normalize INR. Urgent upper endoscopy was done after resuscitation within 24 hours. This showed 5-6mm gastric antral ulcer with a large non-bleeding vessel about 3mm and blood. It was controlled by epinephrine injection around the vessel and OVESCO clip application to completely occlude the vessel and ulcer. Repeat upper endoscopy within 72 hours revealed atrophy of the vessel and absence of rebleed. Patient was restarted on anticoagulant after 72 hours and was discharged home. DISCUSSION: Peptic ulcer disease is the most common cause of NVUGIB. The timing of endoscopy is guided by overall clinical status and type of intervention depends on endoscopic findings. Our patient had high Glasgow Blatchford Score which placed him at high risk for mortality. Urgent upper endoscopy showed a large vessel within an antral ulcer, most likely a branch of the left gastric artery. We thought conventional endoscopic therapy like thermal or standard clips would be insufficient to achieve complete hemostasis and would carry risk of rebleed. Patient was high risk for surgery, therefore epinephrine injection followed by OVESCO clip was chosen to control the bleeding and was successful. To conclude, OVESCO clip should be a part of GI bleed kits in every endoscopy unit. It can be life-saving and spare repeat interventions such as IR therapy or surgery.Figure 1.: Upper endoscopy within 24 hours showing gastric antral ulcer 5–6mm with a large non-bleeding vessel about 3mm and blood.Figure 2.: Upper endoscopy within 24 hours showing OVESCO clip application.Figure 3.: Repeat upper endoscopy within 72 hours showing atrophy of the vessel and absence of rebleed.

Research progress on chemical compositions of Coptidis Rhizoma and pharmacological effects of berberine

Coptidis Rhizoma was a commonly used antipyretic and dampening drug in clinic, which was first recorded in the Shennong's Herbal Classic of Materia Medica and which was listed as one of the highest grade herb in traditional Chinese medicine. Traditionally, Coptidis Rhizoma was used to treat dampness with distention and fullness, vomiting with acid regurgitation, acne, heartbum, etc. At present, a total of 133 chemical components have been isolated and identified from Coptidis Rhizoma, which can be divided into alkaloids(44 species), lignans(32 species), flavonoids(9 species), phenylpropionic acid and its derivatives(26 species) and other compounds(22 species) according to the differences in structure types. Modern studies have shown that berberine is one of the most important active composition of Coptidis Rhizoma, which not only has an effect on the antibacterial, antiviral and anti-gastric ulcer, but also plays a vital role in reducing blood sugar, lowering blood fat, anti-tumor and treating cardiovascular and cerebrovascular diseases. The chemical constituents of Coptidis Rhizoma and pharmacological effects of berberine were reviewed in this study, which was expected to provide references for the further research, development of and clinical application of Coptidis Rhizoma and berberine.

Current status of peptic ulcer disease in Port Harcourt metropolis, Nigeria.

Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in hospital admissions in Western countries. This paper aimed to study the current status and risk factors of PUD in a Nigerian metropolis. A cross-sectional study of symptomatic patients at upper gastrointestinal (GI) endoscopy diagnosed with PUD from February 2014 to September 2019 at a referral endoscopy facility in Port Harcourt, Niger delta region of Nigeria. The variables studied included demographics, symptoms and duration, blood group, chronic non-steroidal anti-inflammatory (NSAID) use, smoking, endoscopic and histology findings. Statistical analysis was performed using SPSS version 20. A total of 434 upper GI endoscopies were performed during the study period with thirty-one diagnosis of PUD made. The mean age of gastric ulcer (GU) and duodenal ulcer (DU) cases were 54.4 ± 20.2yrs and 48.1 ± 14.5yrs respectively (p = 0.367). GU to DU ratio was 1.4:1. H. pylori infection, chronic NSAID use and blood group O were seen in 7(22.5%), 8(25.8%) and 18(72.0%) respectively. Major indication in 21(67.7%) cases was gastrointestinal bleeding. There is a low diagnostic rate of PUD (6.7%) with pre-pyloric antral gastric ulcers as most common type and multifactorial aetiology.

Evaluation of Gastroprotective Activity of Cemot Leaves (Passiflora foetida L.) Extracted by Ultrasonic Assisted Extraction (UAE) Against Ethanol-Induced Gastric Lesions in Rats

Peptic ulcers are one of the global health problems in the world. However, most of these drugs have unwanted side effects and drug interactions that this research focuses on the use of plant products as an anti gastric ulcer. The phytochemical of Passiflora foetida L. leaves or better known by the name of the Central Borneo with 'Cemot' such as flavonoids, alkaloids, and tannin has potential as a gastroprotective. This study used the method of extraction of non-conventional, namely the UAE, because it has advantages compared with other conventional methods. This study aims to investigate the gastroprotective activities of ethanol extract of Passiflora foetida leaves-UAE. Cemot extract was obtained by UAE method using a concentration of ethanol (70%), the ratio of sample/liquid (10g/mL) for 3 minutes. Three groups of rats treated with a respective dose of the extract (50, 100 and 200 mg/kg BW), one group of rats treated with omeprazole 36 mg/kg BW for seven days before peptic ulcer induction using ethanol. The activity gastroprotective with measurement of lesion of gastric ulcer index and the percentage of inhibition ulcer. Group of rats treated with 200 mg/kg BW extract showed a decreased the ulcer index and ulcer inhibition than the other extract dosage groups, respectively 2.83 and 35.34%. Conclusion: Based on the results of this study concluded that the cemot extract has potential as a gastroprotective.

Evaluation of the Gastric Antiulcer Efficacy of Helianthus annuus L, Leaves Extract and Fractions

Peptic ulcer disease is one of the most common gastrointestinal diseases worldwide. Its treatment is becoming increasingly difficult due to the implication of Helicobacter pylori and its increasing resistance to antimicrobial agents leading to a cyclical course of exacerbation and remission. This study evaluated the antiulcer effects of methanol leaf extract and fractions of Helianthus annuus. The crude extract was prepared by cold maceration with methanol. A portion of the extract (300 g) was partitioned with n-hexane, ethyl acetate and methanol to yield n-hexane (HF), ethyl acetate (EF) and methanol (MF) fractions respectively. The extract was subjected to oral acute toxicity (LD50) and phytochemical studies. The antiulcer activity of the extract and fractions was evaluated in rat experimental ulcer models induced with aspirin, ethanol and histamine. Omeprazole and Tween 80 served as the standard drug and negative control respectively. Activities related to antiulcer properties such as effect on gastrointestinal transit and antimicrobial activities were investigated. Outcome measures were ulcer index, percentage ulcer protection, percentage gastrointestinal inhibition and antimicrobial potency. Ulcers induced by the three ulcerogens were significantly (p < 0.05) ameliorated by the extract and the fractions. The extract and fractions significantly (p < 0.05) inhibited gastrointestinal motility in mice. They exhibited potent antibacterial activity but were devoid of anti-fungicidal property. At a dose of 5000 mg/kg (p.o), the extract caused no obvious signs of toxicity or death in mice. Phytochemical analysis revealed the presence of saponins, tannins, flavonoids, steroids, glycosides, terpenoids, as well as reducing sugars. The results show that the leaves of Helianthus annuus possess antiulcer properties with n-hexane fraction offering best ulcer protection. Cytoprotection, antispasmodic, as well as antibacterial actions may account for the mechanisms of the antiulcer effects.

Garlic (Allium sativum) as an antidote or a protective agent against natural or chemical toxicities: A comprehensive update review.

Garlic (Allium sativum, Liliaceae) is used widely as a spice and medicinal herb not only in its native region (Central Asia and northeastern Iran) but also all around the world. Garlic has abundance chemical compounds such as allicin, alliin, S-allyl cysteines, thiacremonone, diallyl-disulfide, diallylsulfide, and others. This medicinal plant and its constituents offer a lot of benefits including free-radical scavenging, anti-inflammatory, anticholesterolemic, anti-gastric ulcer, antimicrobial, anticancer, and antioxidant properties. Garlic also modulates the activity of several metabolizing enzymes. This review summarizes various in vitro and animal studies on the protective effects of garlic against natural and chemical toxicities. It has been shown that garlic and its major components can ameliorate the toxicity of different agents in brain, kidney, blood, liver, embryo, spleen, pancreas, heart, reproductive system in part through radical scavenging, antioxidant effect, reducing lipid peroxidation, anti-inflammatory, chelating agent, cytoprotective activities, increase protein synthesis in damaged tissues, suppressing apoptosis, modulation of p53, phosphoinositide 3-kinase, Akt, nuclear factor (erythroid-derived 2)-like 2, antioxidant responsive element, p38 MAPK, inducible nitric oxide synthase, cyclooxygenase-2, cytosolic phospholipases A2, cleaved-caspase-9, cleaved-caspase-3 Bcl-2, Bcl-2-associated X, peroxisome proliferator-activated receptor gamma, NF-jB, nuclear factor-kappaB signaling pathways and cytochrome P450 enzymes. With controlled clinical trials, garlic may be introduced as a universal antidote or protective plant against many toxic agents.

Preventive effects of Rhizoma Coptidis and Atractylodes on mice with gastric-ulcer.

To detemine preventive effects of compound formula Rhizoma Coptidis and Atractylodes on mice with gastric-ulcer. The mice were randomly divided into a normal group, a gastric ulcer group, a ranitidine positive drug group, a Rhizoma Coptidis group, an Atractylodes group, and a Rhizoma Coptidis plus Atractylodes group (the ratios of Coptidis to Atractylodes were 9꞉1, 8꞉2, 7꞉3, 6꞉4, 5꞉5, or 4꞉6, respectively). Gastric ulcer models were established by intragastric administration of anhydrous ethanol after 6 days of preventive infusion. The mice were killed 6 days after the treatments. The whole stomach was opened to observe gross morphology of gastric mucosa. The pathological changes of gastric tissue were observed under microscope, and serum samples were collected to detect the contents of superoxide dimutase (SOD), malondialdehyde (MDA), NO, and endothelin-1 (ET-1). The Rhizoma Coptidis and Atractylodes decoction significantly decreased ulcer area (P<0.001), and the effects of compound formula are better than those of Coptidis and Atractylodes alone (P<0.05, P<0.01, or P<0.001). The anti-ulcer effect of compound formula (Coptidis꞉Atractylodes=6꞉4) was the best one, and the anti-gastric ulcer effect of the high-dose group was significantly better than that of the ranitidine-positive group (P<0.001). The ranitidine positive drug group, the high-dose group of Rhizoma Coptidis, the high-dose group of Atractylodes, and the high-dose group of Rhizoma Coptidis-Atractylodes (6꞉4) significantly reduced MDA, ET-1 (P<0.01 or P<0.001), and significantly increased SOD, NO in serum (P<0.01 or P<0.001). Rhizoma Coptidis and Atractylodes decoction exerts the effect on preventing ethanol-induced gastric ulcer in mice in a ratio-dependent and dose-dependent manner. The mechanism might be related to anti-oxidation and relaxion of blood vessels. The combination of the two drugs shows a synergistic effect.

Diyaliz Hastalarnda Üst Gastrointestinal Sistem Hastalıkları

The prevalence of co-morbid gastrointestinal symptoms is high in dialysis patients, and dyspeptic symptoms, such as nausea, vomiting, and epigastric burning are the most common symptoms. Upper gastrointestinal disorders e.g., peptic ulcer disease and gastroparesis underlie most of these symptoms, while less common but severe complications are also likely that include gastrointestinal bleeding from gastric antral vascular ectasia, erosions or ulcers. Incidence of gastrointestinal disorders is considered to increase with the duration of renal failure, independent of dialysis modality. While uremia and dialysis have been linked to an increased risk of gastrointestinal tract lesions, pathogenesis of gastrointestinal dysfunction in end-stage renal disease is considered to be multifactorial and has not yet been clarified. In addition, conflicting data exist on the association of renal dysfunction with gastrointestinal disorders, and there are no explicit guidelines for the management of co-morbid gastrointestinal problems in patients with concomitant renal failure. Herein, we review the common upper gastrointestinal disorders that occur among dialysis patients, with an emphasis on prevalence, pathogenesis and diagnostic strategies

Gastric Adenocarcinoma in a Young Nigerian – A Case Report

Abstract Gastric adenocarcinoma is uncommon among young Nigerians. We present Mrs O.V. a 41year old Nigerian who presented with one year history of recurrent epigastric pain that was peppery/burning in nature, non-radiating, aggravated by eating and temporarily relieved with the use of antacids. There is associated progressive weight loss and secondary amenorrhea since the onset of her illness. She started vomiting two weeks prior to presentation which was non-projectile, containing both recently ingested meals and partially digested stale food substances, vomitus was non-bilous. Episodes of vomiting is usually preceded by abdominal bloating or feeling of indigestion. Clinical examination revealed a chronically ill-looking young woman with a positive succussion splash on abdominal examination. Examination of the other systems was normal. Provisional diagnosis was suspected Chronic Gastric Antral Ulcer complicated by Gastric Outlet Obstruction to rule out Gastric Antral Adenocarcinoma. Abdominal ultrasound and CT scans showed features consistent with Gastric Outlet Obstruction. Upper GI Endoscopy revealed Gastric Antral Adenocarcinoma with Duodenal extension and Chronic Duodenal Ulcer complicated by Gastric Outlet Obstruction. Histology showed well differentiated Gastric Antral Adenocarcinoma. She had a Bilroth II procedure(Partial Gastrectomy and Gastro-Jejunostomy)and was commenced on adjunct chemotherapy: FAM regimen(5-Fluorouracil, Adriamycin and Mitomycin). She was also placed on long term proton pump inhibitor therapy. She has sustained remarkable clinical improvement with resolution of all her initial symptoms and she is currently on regular clinic follow-up. More cases of Gastric Adenocarcinoma among young Nigerians are being reported. There is a need for more extensive studies on this and possibly an indication for commencing endoscopy screening at an earlier age among individuals presenting with recent onset dyspepsia. Key words: Gastric, Adenocarcinoma, Young, Nigerians.

Optimization of phenolic compounds extraction from Campomanesia lineatifolia leaves

Abstract Campomanesia lineatifolia (gabiroba) is a native edible species found in the Amazon Rainforest. Previous studies have demonstrated the flavonoid nature of ethanolic extract from the C. lineatifolia leaves, in addition to gastroprotective activity and TNF inhibition. However, the extraction process used was long and consumed a large amount of solvent. Therefore, the objective of this study was to obtain a bioactive extract rich in phenolics, in an extractive method of simpler, faster, and lower-cost execution. The C. lineatifolia leaves were dried and crushed, and the extractions were carried out in different solvents/mixtures (ethanol, methanol, ethyl acetate, and water) under ultrasonic bath (UB), electromagnetic stirring, and continuous reflux extraction (R). The extraction efficiency was evaluated by the flavonoid major compound concentration in the extracts, in a method developed by ultra-high performance liquid chromatography (UHPLC). Injection and pattern matching tests, and UHPLC analyses coupled to ultraviolet spectrometry were conducted to identify catechin and quercitrin. It has been demonstrated that the ethanolic extraction by R and the mixture of ethanol: water (8:2) by UB represented optimized methods in obtaining the flavonoid compounds identified. Thus, the results may contribute to chemical-biological extract standardization for gastric antiulcer activity evaluation.

In vivo acute toxicity and anti-gastric evaluation of a novel dichloro Schiff base: Bax and HSP70 alteration.

Chlorine is shown to possess anti-gastric ulcer activity, since it can inactivate Helicobacter pylori, which is regarded as one of the most common risk factors for causing gastric problems. In the current study, the gastroprotective property of a novel dichloro-substituted Schiff base complex, 2, 2′- [−1, 2-cyclohexanediylbis(nitriloethylidyne)] bis(4-chlorophenol) (CNCP), against alcohol-induced gastric lesion in SD rats was assessed. SD rats were divided into four groups, i.e. normal, ulcer control, testing, and reference groups. Ulcer area, gastric wall mucus, and also gastric acidity of the animal stomachs were measured. In addition, antioxidant activity of CNCP was evaluated and its safe dose was identified. Immunohistochemistry staining was also carried to evaluate two important proteins, i.e. Bcl2-associated X protein (Bax) and heat shock protein 70 (HSP70). Moreover, the activities of super oxide dismutase and catalase, as well as the levels of prostaglandin E2 (PGE2) and malondialdehyde (MDA) were also measured. Antioxidant activity of CNCP was approved via the aforementioned experiments. Histological evaluations showed that the compound possesses stomach epithelial defense activity. Additionally, periodic acid-Schiff staining exhibited over-expression of HSP70 and down-expression of Bax protein in the CNCP-treated rats. Moreover, CNCP caused deceased MDA level and elevated PGE2 level, and at the same time increased the activities of the two enzymes.

Spirogyra neglecta Aqueous Extract Attenuates LPS-Induced Renal Inflammation.

Spirogyra neglecta (SN), commonly named "Tao" in Thai, is a genus of filamentous green macroalgae. SN contains polyphenols such as isoquercetin, catechin, hydroquinone and kaempferol. These constituents exhibit beneficial effects including anti-oxidant, anti-gastric ulcer, anti-hyperglycaemia and anti-hyperlipidaemia in both in vitro and in vivo models. Whether SN extract (SNE) has an anti-inflammatory effect in vivo remains unclear. This study examined the effect of SNE on renal function and renal organic transport in lipopolysaccharide (LPS)-induced renal inflammation in rats. Rats were randomised and divided into normal saline (NS), NS supplemented with 1000 mg/kg body weight (BW) of SNE (NS + SNE), intraperitoneally injected with 12 mg/kg BW of LPS and LPS treated with 1000 mg/kg BW of SNE (LPS + SNE). Biochemical parameters in serum and urine, lipid peroxidation concentration, kidney function and renal organic anion and cation transports were determined. LPS-injected rats developed renal injury and inflammation by increasing urine microalbumin, total malondialdehyde (MDA) and inflammatory cytokines, tumor necrosis factor (TNF)-α and interleukin (IL)-1β protein expression, respectively. In addition, uptake of renal organic anion, [3H]-oestrone sulphate (ES), was reduced in LPS-injected rats together with increased expression of organic anion transporter 3 (Oat3). However, the renal injury and inflammation, as well as impaired Oat3 function and protein expression, were restored in LPS + SNE rats. Accordingly, SNE could be developed as nutraceutical product to prevent inflammation-induced nephrotoxicity.

1938 A Case of Diffuse Antral and Pyloric Ulcers

INTRODUCTION: Antral gastric ulcers are typically managed through endoscopic therapy, proton-pump inhibitors, and treating any underlying cause such as Helicobacter pylori. However, in the presence of multiple, deep, continuously bleeding ulcers, partial gastrectomy is a mainstay of treatment. We present a case of a patient who was found to have diffuse, deep antral and pyloric ulcers and was managed through solely interventional radiology embolization. CASE DESCRIPTION/METHODS: A 59 year old male patient with multiple bouts of alcoholic pancreatitis, hypertension, and chronic obstructive pulmonary disease who presented with anemia but no signs of overt GI bleeding. Patient's risk factors included NSAID use. However, CT A/P showed active bleeding with extravasation into the stomach with subsequent respiratory failure led to intubation and ICU admission. EGD showing diffuse, partially obstructing, deep antral and pyloric ulcers covering the entire antrum and pylorus not amenable to endoscopic intervention with recommendation to possibly pursue surgical intervention. Arteriograms of the celiac trunk, SMA, left gastric artery, splenic artery, common hepatic artery, and gastroduodenal artery demonstrated no active bleeding. Surgery was consulted and recommended no immediate surgical intervention, opting for interventional radiology to preform embolization if patient continues to bleed. As the patient continued to bleed, the decision was made to embolize the gastroduodenal artery. The patient did well post-procedure with stable hemoglobin with plans to follow up outpatient to determine the cause of the diffuse ulcerations. DISCUSSION: Diffuse, bleeding antral gastric ulcers are a consideration for antrectomy or partial gastrectomy if the lesions are not amenable to endoscopic intervention. However, in the case of our patient, interventional radiology embolized the gastroduodenal arterial, despite no active bleeding on CT angiography. The empiric embolization successfully treated the source of bleeding without need for surgical intervention. Our case helps emphasize that Interventional Radiology embolization of the gastroduodenal artery may be considered in patients with multiple actively bleeding, antral gastric ulcers who are not surgical candidates despite the lack of bleeding on CT angiography.

2788 Double Pylorus in a Patient With Alcoholic Cirrhosis and Intractable Vomiting

INTRODUCTION: Gastroduodenal fistula (GDF) or double pylorus is a rare, often asymptomatic, condition with a prevalence of approximately 0.02-0.08%. The majority of previously reported cases have been in Asian countries and it has been found to be more prevalent in males than females. Although Helicobacter pylori and NSAID use has been associated with the formation of gastroduodenal fistulae, the actual mechanism of the condition is unknown. CASE DESCRIPTION/METHODS: We present the case of a 65-year old female with alcoholic cirrhosis and a long history of intractable vomiting due to unknown etiology. She was found to have a pre-pyloric gastric antral ulcer during an emergent endoscopy for an episode of hematemesis seven years ago. Follow up endoscopies over a course of three years found the antral ulcer to be healing. Seven years from the discovery of the initial lesion, a gastroduodenal fistula was found. The pre-pyloric antral ulcer in the process of healing fistulized into the duodenal bulb creating the appearance of a double pylorus. DISCUSSION: Gastroduodenal fistula or double pylorus can be acquired or congenital. Acquired GDF is a very rare complication of peptic ulcer disease. They can be a result of healing due to bridging fibrosis within the pylorus or, as in this case, fistulization from the gastric antral ulcer. Most GDF are found incidentally during endoscopy that was done for another reason. This case report follows the serial endoscopic examination of a cirrhotic patient with a pre-pyloric antral ulcer that developed into GDF. We propose that the GDF was caused by fistulization of a pre-pyloric antral ulcer with no other predisposing factors and gastrointestinal fistulization processes.

2656 A Rare Case of Gastrointestinal and Hepatic Extra-Pulmonary Involvement of Sarcoidosis Mimicking Crohn’s Disease

INTRODUCTION: Sarcoidosis is a systemic disease characterized by noncaseating granulomas. While pulmonary and lymphatic involvement is common, gastrointestinal involvement is rare. We report a case of diffuse gastrointestinal and hepatic involvement of sarcoidosis initially mimicking Crohn’s disease. CASE DESCRIPTION/METHODS: A 62 year-old man with history of chronic thrombocytopenia and sarcoidosis, presented for further evaluation of suspected Crohn’s disease after undergoing high-risk surveillance colonoscopy. The colonoscopy was significant for congested mucosa in the terminal ileum and colon as well as multiple colonic erosions (Figure 1). Pathology showed chronic active colitis with crypt abscesses in the left colon and poorly formed granulomas without dysplasia in the right colon suggestive of Crohn’s disease. The patient reported no gastrointestinal or systemic complaints and stated good control of his underlying sarcoidosis. An esophagogastroduodenoscopy (EGD) was then completed and showed moderately-congested mucosa with many non-bleeding gastric body, antral and superficial duodenal ulcers positive for Helicobacter pylori. Despite normal liver chemistries, given the presence of indirect signs of portal hypertension (splenomegaly, thrombocytopenia), a transjugular liver biopsy was pursued which was significant for portal hypertension as well as moderate chronic portal hepatitis with cirrhosis, non-necrotizing granulomas consistent with sarcoid involvement, and no histologic features of PBC (Figure 2). Labs, including hepatitis B and C serologies, ANA, and anti-mitochondrial antibody, were grossly unremarkable. After establishing an elevated portal pressure gradient, a repeat EGD was done approximately six-months later which was significant for grade I esophageal varices, erythematous and nodular mucosa in the gastric antrum and erythematous duodenopathy; biopsies were negative for H. Pylori. The patient was then referred back to pulmonology for further assessment of his pulmonary disease prior to consideration of treatments for his progressed liver disease. DISCUSSION: Typically presenting with pulmonary involvement, gastrointestinal involvement of sarcoidosis, particularly of the small bowel, is a very rare extra-pulmonary manifestation of sarcoidosis. Hepatic involvement with progression to cirrhosis is uncommon. Above, we present a very interesting case with both diffuse gastrointestinal and hepatic sarcoidosis subsequently noted to have progressive liver disease with portal hypertension.

Biochemical, Anti-Diarrhoeal and Anti-Gastric Ulcer Activities of Commiphora myrrha

Mohammad Kamil* and TM Abdalla Author Affiliations Department of Health, Division of Healthcare Licensing & Medical Education, Abu Dhabi, UAE Received: July 03, 2019 | Published: July 09, 2019 Corresponding author: Mohammad Kamil, Zayed Complex-for Herbal Research & Traditional Medicine, Division of Healthcare Licensing & Medical Education, Department of Health, Abu Dhabi, UAE DOI: 10.26717/BJSTR.2019.19.003306 Also View In:

Prodigiosins from a marine sponge-associated actinomycete attenuate HCl/ethanol-induced gastric lesion via antioxidant and anti-inflammatory mechanisms.

Gastric ulcer is sores that form in the stomach mucosal layer because of erosion caused by high acid secretion and excessive use of non-steroidal anti-inflammatory drugs. Prodigiosins (PdGs) are red-pigmented secondary metabolites produced by bacteria, including actinomycetes. Butylcycloheptylprodigiosin (1) and undecylprodigiosin (2) were identified and isolated from a crude extract of the actinomycete RA2 isolated from the Red Sea Sponge Spheciospongia mastoidea. Chemical structure of 1 and 2 was determined by NMR and mass spectroscopy. Although their antioxidant and anti-inflammatory properties are known, their effect on gastric lesion is unknown. Therefore, this study aimed to investigate gastroprotective effects of PdGs against HCl/ethanol-induced gastric lesion in rats. Oral pretreatment with PdGs (100, 200, and 300 mg/kg) attenuated severity of HCl/ethanol-induced gastric mucosal injury, as evidenced by decreases in gastric lesion index scores, ulceration area, histopathologic abnormality, and neutrophil infiltration. These effects were comparable to those of omeprazole, a standard anti-gastric ulcer agent. HCl/ethanol-induced gastric erosions was associated with tremendous increases in lipid peroxidation, nitric oxide, and pro-inflammatory cytokines and mediators (myeloperoxidase, interleukin-1β, tumor necrosis factor-α, and cyclooxygenase-2), and with significant decreases in enzymatic and non-enzymatic antioxidant activities. However, PdGs ameliorated gastric inflammation and oxidative stress by downregulating nuclear factor kappa B and inducible nitric oxide synthase expression and upregulating heme oxygenase-1 expression. PdGs prevented gastric mucosal apoptosis by downregulating Bax and caspase-3 expression and upregulating Bcl-2 expression, thereby increasing prostaglandin E2 production. Our results suggested that PdGs exerted gastroprotective effects by decreasing the levels of inflammatory mediators, apoptotic markers, and antioxidants.

Trachyspermum ammi (L.) Sprague, superb essential oil and its major components on peptic ulcers: in vivo combined in silico studies.

Trachyspermum ammi (L.) Sprague is used for treating gastrointestinal disorders. Several studies indicated gastric antiulcer activity of T. ammi extract, yet the effect of its essential oil has not been studied on. The present study evaluates chemical composition of T. ammi essential oil and anti-peptic ulcer effect of the essential oil as well as its three major components in ethanol induced-gastric ulcers in rats. Primarily chemical composition of the essential oil was analyzed by gas chromatography-mass spectrometry (GC/MS). Rats received the essential oil (500, 250, 125, 62.5, 31.25mg/kg), thymol (30, 100mg/kg), para-cymene (100, 150mg/kg) and gamma-terpinene (100, 150mg/kg) using gavage tube along with ethanol 80%. Finally, dissected stomachs were assessed both macroscopically and microscopically to evaluate anti-ulcerative effect of the essential oil and the pure compounds. Moreover, molecular docking was utilized to explore the interactive behavior of the main components with active site residues of H+/K+ ATPase. Analysis of the essential oil indicated that para-cymene (37.18%), gamma-terpinene (35.36%) and thymol (20.51%) are the main components. Administration of different doses of the essential oil noticeably diminished the number of peptic ulcers in a dose-dependent manner. Among the main components, thymol was more potent than para-cymene and gamma-terpinene. Administration of the essential oil (500mg/kg) and thymol (100mg/kg) observed maximum inhibition percentage (98.58% and 79.37%, respectively). Molecular docking study provides the evidence of thymol ability to inhibit H+/K+ ATPase. The findings revealed that T. ammi essential oil can be applied to treat gastric ulcer as a natural agent. Graphical abstract.

PREPARATION OF MUCOADHESIVE GASTRORETENTIVE DRUG DELIVERY SYSTEM OF ALGINATE BEADS CONTAINING TURMERIC EXTRACT AND ANTI-GASTRIC ULCER ACTIVITY

Objectives: The objectives of this study were to prepare the mucoadhesive mucoadhesive gastroretentive drug delivery system of alginate beads containing turmeric extract and to evaluate its anti-gastric effect.Methods: Turmeric extract was made by macerating turmeric powder in ethanol 96% and evaporated using rotary evaporator at 50°C to obtained concentrated extract. Then, it was prepared alginate beads containing 5% turmeric extract by gelation method. The mucoadhesive properties of alginate beads containing turmeric extract were tested in vitro in male rats and the anti-gastric ulcer effect was tested on HCl-induced gastric ulcer in rats.Results: The mean diameter of alginate beads obtained was 1.13±0.19 mm. Bioadhesion test showed that alginate beads containing turmeric extract could be attached on gastric rats mucosa. Anti-gastric ulcer test showed that the healing of gastric lesions in rats was faster using alginate beads containing turmeric extract compared to untreated ones.Conclusions: The results of this study suggest that mucoadhesive drug delivery systems of alginate beads containing turmeric extract are potentially developed as an anti-gastric ulcer.

PREPARATION OF MUCOADHESIVE GASTRORETENTIVE DRUG DELIVERY SYSTEM OF ALGINATE BEADS CONTAINING TURMERIC EXTRACT AND ANTI-GASTRIC ULCER ACTIVITY

Objectives: The objectives of this study were to prepare the mucoadhesive mucoadhesive gastroretentive drug delivery system of alginate beads containing turmeric extract and to evaluate its anti-gastric effect.Methods: Turmeric extract was made by macerating turmeric powder in ethanol 96% and evaporated using rotary evaporator at 50°C to obtained concentrated extract. Then, it was prepared alginate beads containing 5% turmeric extract by gelation method. The mucoadhesive properties of alginate beads containing turmeric extract were tested in vitro in male rats and the anti-gastric ulcer effect was tested on HCl-induced gastric ulcer in rats.Results: The mean diameter of alginate beads obtained was 1.13±0.19 mm. Bioadhesion test showed that alginate beads containing turmeric extract could be attached on gastric rats mucosa. Anti-gastric ulcer test showed that the healing of gastric lesions in rats was faster using alginate beads containing turmeric extract compared to untreated ones.Conclusions: The results of this study suggest that mucoadhesive drug delivery systems of alginate beads containing turmeric extract are potentially developed as an anti-gastric ulcer.