Esophageal Burns Research Articles

Halofuginone improves caustic-induced oxidative injury of esophagus in rats.

The aim of this study is to evaluate the anti-inflammatory and anti-fibrotic effects of halofuginone in caustic esophageal burn injury in rats. Corrosive esophageal injury (CEI) was produced in male Wistar albino rats by instilling NaOH solution (1ml, 37.5%) into the distal esophagus. Rats were decapitated on the 3rd day (early group) or 28th day (late group), and treated daily with either saline or halofuginone (100µg/kg/day; i.p.), continued on alternate days after the third day. Histopathological evaluation and measurement of nitric oxide (NO), peroxynitrite (ONOO-) and oxygen-derived radicals by chemiluminescence (CL) were made in the distal 2cm of the esophagus. Non-irrigated proximal esophageal samples were assessed for the levels of nuclear factor (NF)-κB, caspase-3, glutathione (GSH), malondialdehyde (MDA) and myeloperoxidase (MPO) activity. GSH, MDA, NF-κB and caspase-3 levels, and MPO activity in the proximal esophagus were not different among groups. Increased number of TUNEL (+) cells in the irrigated esophagus of the early and late caustic injury groups was reduced by halofuginone treatment. High microscopic damage scores in both early and late CEI groups were decreased with halofuginone treatment. NO, ONOO- and CL levels, which were elevated in the saline-treated early CEI group, were reduced by halofuginone treatment, but reduced NO and ONOO- levels in the late period of saline-treated group were increased by halofuginone. In addition to its anti-fibrotic effects, current findings demonstrate that halofuginone exerts antioxidant and anti-apoptotic actions and supports therapeutic potential for halofuginone in CEI-induced oxidative stress.

Лечение химических ожогов пищевода у детей

Objective . To study the treatment efficacy of chemical burns of the esophagus in children with different grades of lesion. Material and methods . For the last seven years in Dnipropetrovsk Regional Children’s Clinical Hospital there were 192 children on treatment with a diagnosis of chemical burn of the esophagus, out of them 108 (56.25%) boys and 84 (43.75%) girls, and prevailed children aged 1-3 years who made up 102 (53.1%). Among damaging agents caused esophageal burns were more often caustic ones 95 (49.47%). In most cases, there was grade II of lesion of esophageal burns in 71 (36.98%) children. Treatment of post-burn esophagitis includes detoxification, stomach lavage, pain management, antibiotic therapy, short course of corticosteroids. Estimation of the patient’s status provided during the first twenty-four hours. Further the restoration of esophageal patency was conducted with the use of instrumental methods of treatment. The main method of corrosive strictures of esophagus was gullet bougienage and dilation. Results . The patients of the study group were treated using bougie over guidewire dilators. Application of this methodology in treatment of patients with the esophageal burns allowed considerably reduce the amount of cicatrical esophageal stenosis, as well as such complications as perforations and mediastinitis. Conclusion . Proper provision of primary care and the selection of correct diagnostic and treatment tactics of patients with chemical burns of the esophagus helps to reduce complications and disability in children with this pathology.

Cytokine profile indicators in rat blood serum in a model of esophagus burn induced by antioxidant chemical preparation

Background: According to modern concepts of burn disease development, one of the main burn complications is inflammation occurrence. Despite the large number of drugs used to treat the effects of chemical burns of the esophagus, we find conflicting information in the literature about their effectiveness. Moreover the problem of burn wound healing process quickening, as well as the prevention measures against possible post burn complications are really relevant if we aim to subjective portability of rehabilitation period facilitation.
 Methods: Study the immune system cytokine levels in immature rat blood serum under the simulation of 1 and 2 degree esophageal chemical burns in case of melanin administration as a drug. Was estimated ELISA using sets of reagents and instructions from Biotrack ELISA System company «Healthcare».
 Results: The significant increase of pro-inflammatory cytokines (PC) was shown mostly on day 7 of the experiment, which reflects the activity and severity of the disease process. In terms of further research the level of pro-inflammatory PC can be multidirectional. The significant decrease of anti-inflammatory cytokines amount was found under conditions of AEB at 15th and 21st days. At 1st and 2nd degree ABE the observed changes were multidirectional. Melanin administration resulted in the fast decrease of blood levels of all cytokines in our experiment to the values close to normal in conditions of esophagus chemical burn progress.
 Conclusion: Therefore, it was shown that some factors have the ability of changing the levels of pro inflammatory and anti-inflammatory cytokines in the models 1st and 2nd degree ABE and AEB in immature rats. The obtained data showed, that 1st degree ABE progressed without septic complications. In the models of 2nd degree ABE and AEB, the risk of poly organic failure remains. Melanin administration resulted in the fast decrease of blood levels of all cytokines in our experiment to the values close to normal in conditions of esophagus chemical burn progress.
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 Peer review method: Single-Blind (Peer-reviewers: 02) Peer-review policy 
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 Date of Original Submission: 13 July 2017
 Date accepted: 05 Sept 2017
 Peer reviewers approved by: Dr. Lili Hami 
 Editor who approved publication: Dr. Phuc Van Pham
 
 
 
 
 

Effect of polaprezinc on experimental corrosive esophageal burns in rats.

Unconsciously caustic ingestion is one of the most common causes of serious esophageal strictures in children. The aim of this study is to determine the efficiency of polaprezinc in preventing stricture formation after corrosive esophageal burns (CEB); this was the first time it has been used to treat experimental CEB in rats. Twenty-four rats were divided into four groups, three of which received CEB by the instillation of 1 mL of 10% NaOH solution into their isolated esophageal segments for three minutes. Group C (control) was uninjured and untreated. Group B (esophageal burn) received CEB but were left untreated. Groups PT1 and PT2 had CEB and received 100 mg/kg/day and 200 mg/kg/day, respectively, of intraperitoneal polaprezinc treatment (PT) for the first two weeks, then oral PT for another two weeks. We assessed the treatment's efficiency of the treatment after the fourth week by evaluating the stenosis index (SI) and the histopathological damage score, determining tissue hydroxyproline content (HP), and measuring the weight of the rats before and after the experiment. Mean SI was statistically lower in the groups PT1 and PT2 when compared with Group B (p =0.006, 0.004, respectively). HP levels were highest in Group B, but it was insignificant (P>0.05). In terms of histopathological damage score, treatment groups demonstrated less collagen deposition, mucosal, and submucosal damage than both Group B (p =0.01) and Group C (p =0.02). Group PT1 and Group PT2 (P>0.05) showed similar results, indicating the treatment's effectiveness was independent of dosage. Outside of Group C, weight gain was detected only in Group PT2, though it was statistically insignificant. In Group PT1, weight loss was lower than in Group B. Polaprezinc, with its antifibrotic, antioxidant, anti-inflammatory, wound-healing and antiapoptotic effects, was efficient in reducing stricture formation by decreasing HP levels and histopathologic damage, preventing stenosis, and weight gain in higher dosages in the treatment group.

Clinical and endoscopic findings of children hospitalized in Qa'em Hospital of Mashhad due to caustic ingestion (2011-2013).

IntroductionOne of the leading causes of damage to the gastrointestinal tract in children is caustic ingestion which is sometimes life-threatening. The most reliable way to study the severity and extent of damage is endoscopy, which can be harmless in terms of time and technique. The aim of this study was to investigate, evaluate and compare clinical findings and endoscopic results of caustic ingestion.MethodsThis retrospective cross-sectional study was conducted on the records of children diagnosed with caustic ingestion, and hospitalized in Qa’em Hospital of Mashhad from March 2011 to December 2013. Intended data were extracted from patients’ records and in case of any ambiguity, it was removed by phone call. Obtained data were analyzed using SPSS 11.5 and chi-square test.ResultsOf 54 patients, there were 36 cases of burn with acidic substance and 16 cases of burn with alkaline. The highest value was related to caustics related to acid batteries (31.5%) and in 77.5% of cases the container of caustic agent was not standard. In endoscopic results, 50 patients out of 54, had esophagus burn such that in 6 cases it was grade I burn, in 15 cases grade IIa, 27 cases with grade IIb and 2 cases with Grade IIIa burn. In addition, mild erythema of stomach in 6 cases, average erythema in 5 cases, mild ulcer in 15 cases, average ulcer in 5 cases and 3 cases with severe ulcer were reported. There was no significant relation between clinical findings and endoscopic results (p=0.68).ConclusionSince caustic ingestion can be regarded as a life-threatening factor for children, the importance of observing precautions in the storage of caustics and the role of training and adequate attention of parents to this issue to prevent such accidents is clear.

Effectiveness of endoscopic balloon dilatation in grade 2a and 2b esophageal burns in children

Purpose: To evaluate the predictability of the initial endoscopic evaluation of the effectiveness of endoscopic balloon dilatation (EBD) in childhood esophageal strictures caused by corrosive ingestion.Material and methods: Medical records of 635 endoscopies caused by corrosive ingestion between January 2000 and December 2015 in children between the ages of 0 and 18 years were retrospectively analyzed. Among them, five children with grade 2a and 15 with grade 2 b who developed esophageal strictures were evaluated for the effectiveness of endoscopic balloon dilatation.Results: The stricture rate was 5/136 (3.6%) in grade 2a and 17/25 (68%) in grade 2 b esophageal burns. Strictures with grade 2a burn had seven (1–10) EBD sessions, and grade 2 b had 8.8 (1–30) EBD sessions. For grade 2a burns, the treatment period was 15 months and 18.8 months for grade 2 b burns. Three patients with grade 2 b and two patients with grade 2a are still on the EBD program.Conclusion: Initial endoscopy for caustic ingestion and esophageal injury grading may help to provide healthcare givers with information about future stricture formation and management.

ЗМІНИ БІЛКОВОГО СКЛАДУ СИРОВАТКИ КРОВІ ТА ГОМОГЕНАТУ СТРАВОХОДУ ПРИ РОЗВИТКУ КИСЛОТНОГО ОПІКУ СТРАВОХОДУ СТАТЕВОНЕЗРІЛИХ ЩУРІВ

The steady increase of the number of chemical esophagus burns is noted over the past tenth anniversary. The esophageal acid burns are seen frequently in children ages 1 to 8 years. The chemical injuries sights are characterized by increase synthesis and degradation of proteins and scar formation. The cicatricial changes of the esophagus, developing as a result of burns, remain one of the most difficult problems of physiological functions maintaining. Despite of numerous studies, there are many insufficiently studied issues of esophagus burn healing and scarring process at the cellular and molecular level. Further study of the esophageal burns healing process would be useful to create effective approaches to prevention of scarring formation in esophagus.

БІОХІМІЧНІ ПОКАЗНИКИ СИРОВАТКИ КРОВІ ЩУРІВ ПРИ ЛУЖНОМУ ОПІКУ СТРАВОХОДУ ІІ СТУПЕНЯ ЗА УМОВ УВЕДЕННЯ ВОДНОГО РОЗЧИНУ СУХОГО ЕКСТРАКТУ ЛУШПИННЯ P. VULGARIS

During modeling of esophageal alkali burns II degree in immature rats were observed violations of various metabolic systems. It was shown that under the esophageal burns there occurred violations of protein (total protein, albumin), nitrogen metabolism (creatinine, urea), changed the activity of enzymes (GOT, GPT), violated fluid and electrolyte balance (Na+, К+, Cl-, Ca2+, Mg2+). In the groups of animals with the alkaline burn of the esophagus, that were injected aqueous extract of pod of bean (Phaseolus vulgaris) there can be traced a change of the indicators in the direction of normalization, indicating about the obvious therapeutic effect of aqueous extract of pod of bean (Phaseolus vulgaris).

Correction of melanin proteolytic activity upon modeling of alkali burns of the esophagus

During the esophageal burns first and second degree, were observed the increase of total proteolytic activity and of the main proteinase (metalloproteinases and serine). Experimental melanin correction at a dose of 0.1 mg / kg contributed to the normalization of the pathological increase of total proteolytic activity and the activity of the main proteinase (metalloproteinases and serine), which indicates the normalization of the proteolysis system.

Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats.

PurposeThe effectiveness of platelet-rich plasma (PRP), thymoquinone, and zeolite in corrosive esophageal burns was investigated in a rat model.MethodsFour groups were comprised as containing 10 rats in each group. For group I, oesophagitis was induced and no other procedure was performed (control group). For group II, oesophagitis was induced and thymoquinone was administered for 1 week via oral gavage once a day (thymoquinone group). For group III, oesophagitis was induced for 1 week via oral gavage once a day (PRP group). For group IV, oesophagitis was induced and zeolite was administered for 1 week via oral gavage once a day (zeolite group). On the 10th day, the rats were sacrificed under anaesthesia and venous blood sampling was performed from the vena portae. The oesophaguses were totally excised. Biochemically, interleukin (IL)-1B, IL-6, TNF-α, and MCP-1 were examined from venous blood. Inflammation score was evaluated histopathologically in oesophageal tissue that was collected.ResultsThere was a statistically significant difference among groups in terms of IL-1, IL-6, MCP levels, compared to the control group; median IL-1, IL-6, MCP levels of thymoquinone, PRP, and zeolite groups were statistically significantly lower. There was a statistically significant difference among groups in terms of inflammation scores, compared to group I; median inflammation scores of groups II, III and IV were statistically significantly lower thymoquinone.ConclusionPRP, and zeolite exhibited positive effect on recovery in oesophagitis by reducing inflammation in the involved segment.

Перспективы использования фитопрепарата на основе календулы лекарственной в комплексном лечении химического ожога пищевода

Currently worldwide chemical burns of the esophagus rank first among all diseases of the esophagus in children and second in adults. Because of commonly accepted algorithms of rendering of medical aid in case of chemical burns of the esophagus in the prehospital and hospital stages (washing of the esophagus and the stomach, adequate anesthesia, corticosteroid, antibiotic therapy, the group of antacids and symptomatic treatment), the choice of drug and method of local impact on the surface of chemical burn of the esophagus remain an urgent problem. The lack of standardized approach in treatment of local changes in chemical burns of the esophagus, severe and unsatisfactory results of using medication algorithms inspire a search for alternative methods of treatment and drug development. Herbal remedies are comparable in effectiveness, but also have the combined multivalent effect on the entire body, causing minimum of side effects. Basing on the literature review, we have come to a conclusion that the most balanced composition of biologically active substances and a positive influence on the basic pathogenesis of esophageal chemical burns has Calendula officinalis. Features and scope of Calendula officinalis are not fully understood. The creation of a multidrug for the local treatment chemical burns of the esophagus based on this herb proves to be very promising.

Tentativa de suícidio por ingestão de soda cáustica. Aspectos psicológicos e sociais. Relato de caso grave

A ingestão de soda caustica (SC) e substâncias corrosivas, como tentativa de suicídio no adulto, tem sido uma ocorrência freqüente, causando graves queimaduras no esôfago e sofrimento. O sucesso do tratamento de paciente com um episódio depressivo depende essencialmente da qualidade da relação médico-paciente. A Psicóloga e a Assistente Social possuem um papel fundamental, resgatando vínculos familiares e provendo assim a sua reinserção como portador de direitos e resgate de sua autoestima que foram perdidos ao longo do tempo, inserindo a família no processo doença-saúde e recuperação. O estudo contou com aplicação de questionários específicos pela Psicóloga seguidos de atendimentos e entrevista pela Assistente Social. Foi realizado durante a internação em um período de 14 meses. A paciente foi operada para reconstrução do trânsito alimentar. Na evolução apresentou pneumonias graves de repetição, teve a traqueostomia definitiva, passando a ingerir alimentos líquidos e pastosos via oral com facilidade. Apresentava quadro depressivo grave, moderada ansiedade e com idéias suicidas. A Psicologia e a Assistente Social estiveram ligadas a esses cuidados, encaminhando o caso para o Centro de Atendimento Psicossocial (CAPS) onde está sendo conduzido com atividades diárias, além do suporte territorial do Centro de Referencia de Assistência Social (CRAS). Apesar de tratar-se de doença adquirida benigna, as complicações existentes podem limitar ou impedir a vida normal e a qualidade de vida dos doentes. É importante e fundamental que os pacientes com essas complicações tenham apoio multidisciplinar da equipe que o assiste, principalmente do ponto de vista psicológico, social e humano.

Poppers Not Only Make You High: A Rare Case of Amyl Nitrate-Induced Hypoxia

SESSION TITLE: Fellow Case Report Poster - Pulmonary Physiology SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: “Poppers” are inorganic nitrites that have become an increasingly popular recreational inhalant. They cause vasodilation, smooth muscle relaxation, and aphrodesia. Amyl nitrites act as oxidizing agents which can cause methemoglobinemia. As a result, tissue hypoxia occurs from decreased oxygen binding capacity of methemoglobin. CASE PRESENTATION: A 55 year old male with occasional cocaine use and no significant medical history presented with slurred speech for one day. Initial vital signs showed BP 122/73, HR 64, RR 18, Tm 97.2, SaO2 84% on room air. Physical examination was notable for lethargy and slurred speech. There was no facial asymmetry or focal deficits noted. Blood work was remarkable for Na 147 and Hgb 11. Urinalysis was positive for cocaine. CT head and brain MRI were negative. Patient was given IVF with resolution of symptoms. He was noted to be persistently hypoxic without symptomatology. CT angiogram of the chest was negative for pulmonary embolism. ABG showed pO2 142 and O2 sat of 92% on 2L NC, and co-oximetry disclosed a methemoglobin level of 0.5%. Transthoracic echocardiogram with bubble study ruled out an intra-atrial shunt, and no other etiology for persistent hypoxia could be determined. On directed questioning, the patient admitted to using a combination of cocaine, tylenol PM and “poppers” the night before onset of symptoms. Patient was educated about complications from drug use. His oxygen saturation normalized spontaneously and patient was discharged with pulmonary follow up. DISCUSSION: A low oxygen saturation by pulse oximetry measured in patients with normal arterial blood gases can be an indication of methemoglobinemia. Intravenous (IV) methylene blue is the first-line antidotal agent. Additional adverse effects from poppers include retinal toxicity, esophageal burns, memory impairment, neuropathy, and coma. CONCLUSIONS: This case serves to demonstrate how methemoglobinemia may not always be detected on routine co-oximetry. A fixed abnormal pulse oximetry without an alternate etiology for hypoxia in the setting of methemoglobinemia should prompt a more thorough history. Polysubstance abuse in which cocaine and amyl nitrite is combined may predispose individuals to develop methemoglobinemia with greater severity. In the absence of measured methemoglobinemia, clinicians managing patients with unexplained cyanosis or hypoxia must consider the possibility of acute nitrite toxicity, particularly in patients with a recent or remote history of substance abuse. Reference #1: Edwards R.J., Usma, J. et al. Extreme methaemoglobinaemia secondary to recreational use of amyl nitrite. J of Accident and Emerg Med 1995 12,138-142 Reference #2: Faley B, Chase H. A Case of Severe Amyl Nitrite Induced Methemoglobinemia Managed with Methylene Blue. J Clin Toxicology 2012, 2:4 Reference #3: Hunter L, Gordge L, et al. Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review. Br J Clin Pharmacol 2011 72: 18-26 DISCLOSURE: The following authors have nothing to disclose: Coral Olazagasti, Janvi Paralkar, Michael Vishnevetsky, Aloke Chakravarti, Roxana Sulica, Kristine Favila No Product/Research Disclosure Information

Clinical features and treatment of corrosive esophagitis

Purpose: The esophageal burns caused by corrosive substances are of great importance since they progress along with serious complications. Here, we have aimed to evaluate our 39 cases we followed up and treated in our clinic due to taking in corrosive substances according to their clinical characteristics and our treatment approaches. Materials and Methods: Thirty nine patients whose file records could be obtained and who were treated for corrosive esophagitis between January 2000 and December 2007 were included in our study. Clinical features and treatment of those cases were recorded and evaluated. Results: The intake rate of corrosive substances was higher in women. The amount of corrosive substance taken in was prominently higher in those having it for suicidal purposes compared to those having it by accident. According to their endoscopic features, 82.1% of the cases were found to have had endoscopic findings referred to as normal or grade 1. While ulcer grade 2-3 comprised 10.3% of all the cases, grade 4 comprised 7.7% of all the cases with severe burns. Conclusion: To stop the oral intake, performing an endoscopic evaluation and making a treatment plan in accordance with the endoscopy results for the patients applying the clinic in the early stage due to the intake of corrosive substances are of great importance in terms of preventing the complications likely to occur.

Not Available

Introduction: Caustic ingestion (CI) in children and adolescents may lead to esophageal burns, esophageal stenosis and secondary dysphagia. These complications may limit the normal feeding process leading to malnutrition and growth impairment. Aims: Our aim was to evaluate the nutritional status and its association with dysphagia and esophageal stenosis in children with CI. Methods: Sixty-two patients with caustic ingestion treated at a pediatric referral hospital were included in this cross-sectional study. Independent variables were dysphagia/normal swallowing and esophageal stenosis/normal barium-swallow. The dependent variables were growth and nutritional status evaluated by anthropometry. Analysis: c2 test, OR, 95% CI, kappa test and Student’s t-test. Results: The average age at the time of CI was 39.7 months; 38.7% of the patients were girls. Endoscopy performed upon admission revealed erosive esophagitis (II-b, III-a, and III-b) in 46 (77.8%) of the patients, dysphagia in twenty-four (38.7%) and esophageal stenosis in forty (64.5%). Both complications occurred simultaneously in 20 children (32.3%, kappa = 0.3, p = 0.014).The z-score of height-for-age was below -2 SD in five children (8.1%). The z score of body mass index (BMI) was < -2 SD in three children (4.8%) and it was above +1 SD in 24.2%. The z-score means of the arm anthropometric indicators of fat stores and muscle mass in both the dysphagia and esophageal stenosis groups were located in the negative area of the z-score curve and their values differed significantly from the z-scores of the non-dysphagia and non-stenosis groups. Conclusions: The proportion of erosive esophagitis, esophageal stenosis and dysphagia was high. Children with dysphagia and/or esophageal stenosis associated with CI had lower fat stores and muscle mass than the cases without esophageal complications.

БІОХІМІЧНІ ЗМІНИ В СИРОВАТЦІ КРОВІ ЩУРІВ ЗА УМОВ ЕКСПЕРИМЕНТАЛЬНОЇ ОПІКОВОЇ ХВОРОБИ ТА ЇХ КОРЕКЦІЯ МЕЛАНІНОМ

During modeling of esophageal alkali burns 1 and 2 degrees in immature rats were observed violations of various metabolic systems, melanin administration helped to normalize the biochemical parameters. It was shown that under the esophageal burns there occurred violations of protein (total protein, albumin), nitrogen metabolism (creatinine, urea) metabolism of carbohydrate (glucose) and lipids (cholesterol), changed the activity of enzymes (GOT, GPT, CC), violated fluid and electrolyte balance (K +, Na +, Cl-, Ca2 +, Mg2 +, phosphates), while the introduction of melanin contributed to the normalization of these indicators. The most effective dose were of 0.5 mg/ kg and 1 mg/kg. There were found anti-toxic properties of melanin, which may be a promising drug for the normalization of metabolism in patients with burns of esophagus and prevent its complications.

Endoscopic therapy of oesophageal strictures in children - a multicentre study.

IntroductionOesophageal strictures are rare in children but may require endoscopic dilation.AimTo gather information on centres performing endoscopic oesophageal dilation in Poland.Material and methodsThe data were obtained from questionnaires concerning the relevant data mailed to 22 paediatric endoscopy centres. Completed questionnaires were received from 11 centres.ResultsIn 2010 the 11 Polish paediatric endoscopy centres performed a total of 10,650 endoscopic procedures. This included 347 oesophageal dilations in 106 paediatric patients aged from 1 month to 18 years. The numbers of patients treated at individual centres ranged from 2 to 40. The indications for oesophageal dilation were as follows: postoperative strictures in 68 children, oesophageal burns in 17 children, postinflammatory strictures in 14 children, achalasia in 4 children, and strictures caused by a foreign body in 3 children. Rigid guidewire dilators were used in the majority of procedures (271), rigid dilators without a guidewire in 32 procedures, and balloon dilators in 45 procedures. A total of 203 procedures were conducted under fluoroscopic guidance, and 144 without the use of fluoroscopy. The number of dilating sessions performed in individual children varied from 1 to 6 and more.ConclusionsOesophageal dilation constituted a minor proportion of all paediatric endoscopic procedures. The majority of children requiring dilation were patients up to 3 years of age with postoperative oesophageal strictures. In the majority of the centres rigid guidewire dilators were used, and in one third of the procedures these dilators were introduced without fluoroscopic guidance.

CHARACTERISTICS OF IMMUNE RESPONSE UNDER EXPERIMENTAL MODELS OF ACID BURNS OF THE ESOPHAGUS

It is well known that the immune system is actively involved in the regeneration and healing process of burn wounds. However, unanswered questions remain about the role of humoral immunity in the mechanisms of healing and complications of burn wounds. We have developed an experimental model of the acid burns of the esophagus (ABE) corresponding esophageal burns in children 1-8 years. We studied the features of humoral immunity in rats with AВE, with the observed reduction of IgG and increase levels of medium and low circulating immune complexes (CIC) on the first day after the burn of the esophagus. On the 21st day after the burn, we observed an increase in the concentration of IgG and a slight accumulation of medium- and low-CIC. Studied indicators can be used for the differentiation of ABE.

Beneficial effects of garlic (Allium sativum) oil in experimental corrosive esophageal burns effects of garlic oil in esophageal burns.

Corrosive esophageal burns, particularly common in developing countries, lead to different problems in different age groups. The ingestion of corrosive substances can cause such problems as stricture of the esophagus, to acute perforation, and even death. Because stricture formation is related to the severity of the initial injury, the prevention of stricture constitutes a main goal of treatment. The aim of this study was to investigate the protective and anti-inflammatory effects of garlic (Allium sativum) oil in corrosive esophageal burn. Twenty-eight rats were randomly divided into 4 equal groups: group 1 (sham), group 2 (control), group 3 (topical treatment), and group 4 (topical and systemic treatment). In groups 2, 3, and 4, corrosive esophageal burns were generated by applying sodium hydroxide to a 1.5-cm segment of the abdominal esophagus. Normal saline was applied to group 2, topical garlic oil to group 3, and topical and systemic garlic oil were used in group 4. The level of hydroxyproline was lower in the topical treatment groups than in the control group (p=0.023). There was difference in tumor necrosis factor alpha level between the systemic treatment groups and the control group (p=0.044). Treatment with garlic oil decreased stenosis index (SI) and histopathological damage score (HDS) in corrosive esophageal burn rats. The SI in the topical treatment group was significantly lower than that of the control group (p=0.016). The HDS was significantly lower in group 4 when compared with the control group (p=0.019). Garlic oil is an effective agent in promoting the regression of esophageal stenosis and tissue damage caused by corrosive burns. While the protective effect of garlic oil on tissue damage is more significant when applied topically, the anti-inflammatory effect is more pronounced when applied systemically. Therefore, we believe that the application of garlic oil in patients with corrosive esophageal burns can reduce complication rates.

FUNCTIONING PROTEASES IN THE ESOPHAGUS MUCOSA AFTER CHEMICAL BURNS

The main result of esophagus burn is the formation of scars, that caused by excessive synthesis of collagen and changes the balance of metalloproteinases and their tissue inhibitors. It was studied the activity of proteolytic enzymes, participation of MMP (metalloproteinase) and their tissue inhibitors (TIMP) in alkali burns of the esophagus 1st and 2nd degrees. We have shown a significant increase of TIMP level in homogenate after alkali burns of the esophagus (an average of 31-56% depend on of burn degree). We observed a reduced activity of serine proteinase after 1st degree burns on 15th, 21st day 35 and 18% respectively, after burns 2nd degree on 15th, 21st day 54 and 50%. The decrease of activity MMP after 1st degree burns on 15th and 21st day 30, 19%, respectively, in conditions of chemical burns 2nd degree on 15th and 21st day 30, 37%. These data may indicate the development of scarring after burn simulation of 2nd degree. Further investigation of the MMP and TIMP in the process of wound healing can be useful in creating effective approaches to prevent formation of post scarring of the esophagus.