Gastric Ulcer Research Articles

Luteolin ameliorates Indomethacin-Induced Gastric Ulcer in Rats via Activation of Nrf2/HO-1 Pathway

Luteolin ameliorates Indomethacin-Induced Gastric Ulcer in Rats via Activation of Nrf2/HO-1 Pathway

An ESIPT-active orange-emissive 2-(2'-hydroxyphenyl)imidazo[1,2-a]pyridine-derived chemodosimeter for turn-on detection of fluoride ions via desilylation.

Fluoride is an essential element for oral health with an optimum concentration of 0.7-1.2 ppm in drinking water, but it is detrimental at higher concentrations, causing fluorosis, acute gastric ulcer, urolithiasis, and kidney infection, which adds immense significance to its detection in water sources. In the current study, a new chemodosimeter (HIPS-Br) is designed by protecting a 2-(2'-hydroxyphenyl)imidazo[1,2-a]pyridine derivative (HIP-Br) with a fluoride recognizable tert-butyldiphenylsilane moiety and utilized for the selective detection of F- ions by an excited-state intramolecular proton transfer (ESIPT)-based fluorimetric response. The probe HIPS-Br exhibits blue fluorescence in solution, and upon the incremental addition of F- ions, it exhibits a turn-on response, exhibiting a strong orange emission at 598 nm by spontaneous cleavage of the tert-butyldiphenylsilane group to release fluorescent HIP-Br in the working solution. HIPS-Br displayed no or insignificant response towards numerous common anions, cations and small molecules, affirming its selectivity to F- ions and offered a low limit of detection (LOD) of 1.2 ppb (6.6 × 10-8 M). The real sample analysis by spiking fluorides in water and toothpaste samples showed excellent percent recoveries. The chemodosimeter was successfully utilized in the solid-phase detection of F- ions on silica-coated TLC plates and analyzed by ImageJ analysis, marking its utility in on-site quantitation purposes.

National trends in hospitalizations for gastrointestinal bleeding in Japan.

Gastrointestinal bleeding (GIB) is a significant public health concern, predominantly associated with high morbidity. However, there have been no reports investigating the trends of GIB in Japan using nationwide data. This study aims to identify current trends and issues in the management of GIB by assessing Japan's national data. We analyzed National Database sampling data from 2012 to 2019, evaluating annual hospitalization rates for major six types of GIB including hemorrhagic gastric ulcers, duodenal ulcers, esophageal variceal bleeding, colonic diverticular bleeding, ischemic colitis, and rectal ulcers. In this study, hospitalization rates per 100,000 indicated a marked decline in hemorrhagic gastric ulcers, approximately two-thirds from 41.5 to 27.9, whereas rates for colonic diverticular bleeding more than doubled, escalating from 15.1 to 34.0. Ischemic colitis rates increased 1.6 times, from 20.8 to 34.9. In 2017, the hospitalization rate per 100,000 for colonic diverticular bleeding and ischemic colitis surpassed those for hemorrhagic gastric ulcers (31.1, 31.3, and 31.0, respectively). No significant changes were observed for duodenal ulcers, esophageal variceal bleeding, or rectal ulcers. The findings of this study underscore a pivotal shift in hospitalization frequencies from upper GIB to lower GIB in 2017, indicating a potential shift in clinical focus and resource allocation.

The protective effects of betanin against experimental gastric ulcer by reduction of ROS and suppression of inflammatory genes via NF-κB, iNOS, COX-2 and TNF-α pathways

Betanin, a prominent compound found in beetroot, however, the potential protective effects of this compound against gastric damage and ulceration have yet to be explored. This study aims to investigate the impact of purified beetroot betanin (Bet) on the activities of inflammatory enzymes and gene expressions associated with inflammation in gastric tissues. Gastric ulcer rats were induced by ethanol at dose 5ml/kg body weight. Ulcerated rats were treated by purified betanin or omeprazole; from which some inflammation-related genes and gastric-inflammation enzymes were investigated using RT-PCR and biochemical analysis, respectively. Bet effectively suppressed the activities of key enzymes involved in gastric mucosal inflammation, including 5-Lipoxygenase (5-LO), Hyaluronidase (HAase), and myeloperoxidase (MPO), by 58%, 50%, and 45%, respectively. Docking studies showed Bet binding to catalytic sites or key regions for enzymes’ activities, thus explaining the inhibitory capacity. Bet ingestion decreased the expression levels of inflammation-related genes, factor-kappa B (NF-ϰB) by 57%. This down-regulation subsequently led to a reduction in the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and tumour necrosis factor-α (TNF-α). Bet ingestion supressed thiobarbituric acid reactive substance (TBARS) rates by 59%, augmented nitric oxide (NO) level by 107% and protected gastric tissues from damage and ulceration. Bet revealed gastro-protective effects as confirmed by a reduction in the ulceration surface area and the acidity by 75.9% and 40%, respectively, and a significant increase in the weight of mucus and the curative index by 117% and 74.5%, respectively. In conclusion, these outcomes of physiological and molecular-based investigations are indicative of potential use of Bet as a functional food additive for the prevention of gastric ulcer.

Low-dose Potassium bromate enhances ischemia-reperfusion-induced gastric ulcer healing in Thyroidectomised Rats.

Gastric ulcer healing is impaired in both hypothyroid and hyperthyroid conditions. Thyroid hormones regulate growth, energy metabolism and mitochondrial oxidative metabolism. Xenobiotics have been documented to negatively impact the thyroid gland at high doses but the redox and cellular interactions at low doses during wound healing process remains unclear. Potassium bromate has been documented to be toxic at high doses but there is dearth of information on its activities at a low dose in varied thyroid states which was evaluated in this study. 60 male Wistar rats (g, n=10) were randomised into 2 conditions: Normal, ulcerated untreated, ulcerated treated with 12.5mg/kg p.o KBrO3 and thyroidectomised groups: thyroidectomised ulcerated, thyroidectomised ulcer treated with KBrO3 and thyroidectomised treated with thyroxine (100µg/kg) Total thyroidectomy was used to model hypothyroidism, and ischaemia-reperfusion-induced gastric ulcers were monitored for healing. Daily body weights, Levels of thyroxine, Gastric mucin content, redox and sodium pump activity were examined alongside other markers of hepatic and haematological toxicity by days 3 and 7 post ulceration. Data were analysed using descriptive statistics and ANOVA α 0.05. The bromate-exposed hypothyroid rats showed increased gastric ulcer healing potential with reduced gastric epithelial oedema and inflammation; hepatic steatosis, and periportal inflammation. Haematological variables and markers of hepatic functions were normal. There were reduced levels of gastric and hepatic malondialdehyde levels. Thyroxine and potassium bromate treatment resolved the redox and cellular toxicity possibly via increasing catalase and sulfhydryl levels and increased Na+ K+ pump activity. We conclude that potassium bromate enhanced gastric ulcer healing in hypothyroid state, similar to thyroxine treatment.

A Study on the Correlation between SLC25A26 Polymorphism and Gastritis and Gastric Ulcers in Koreans

A Study on the Correlation between <i>SLC25A26</i> Polymorphism and Gastritis and Gastric Ulcers in Koreans

The Effect of Washing After Protein Blocking on Immunohistochemical Staining Applied to Paraffin Sections

Aim: Immunohistochemistry is still frequently preferred in both diagnostic and experimental studies&#x0D; because it can show proteins where they are in the tissue. One of the main problems in immunohistochemistry&#x0D; is the background staining, which can be prevented by protein blocking and which occurs as&#x0D; a result of binding of primary antibodies to tissue proteins and Fc receptors in the tissue due to antigenic&#x0D; similarity. There is no consensus on whether to wash after protein blocking in current publications and&#x0D; immunohistochemistry manuals published by manufacturers.&#x0D; Material and Methods: In our study, routine immunohistochemistry procedure was applied to determine&#x0D; the expression of TNF-α on 5 μm thick sections obtained from rat gastric tissue samples in which an&#x0D; experimental gastric ulcer model was created with ethanol, and two groups were formed, with and without&#x0D; washing after protein blocking, with 10 sections in each group. For semi-quantitative evaluation, the&#x0D; histological score (h-score) was calculated from the images obtained from the immunohistochemically&#x0D; stained preparations of both groups and the obtained data were statistically compared.&#x0D; Results: As a result of our study, no statistically significant difference was found between the h-score&#x0D; values of the groups that were washed after protein blocking in immunohistochemical staining and&#x0D; the groups that did not wash (p=0.971). The median (min-max) values of the groups with and without&#x0D; washing are 211 (179-244) and 215 (171-251), respectively.&#x0D; Conclusion: In the immunohistochemical staining procedure, washing after protein blocking does not&#x0D; change the staining intensity, does not create background staining, and does not affect the result of&#x0D; the h-score for semiquantitative evaluation. Similar studies are recommended for other species, tissue&#x0D; types and antigens.

Gastroprotective effect of Vien Khoi Tim capsules on indomethacin-induced gastric ulcers in rats

Available anti-ulcer drugs unveil partial effectiveness and numerous adverse reactions. Plants offer an alternative strategy in the search for new drugs in the therapy and prevention of peptic ulceration. The present study investigated the possible protective effect of the herbal formulation Vien Khoi Tim (VKT) on indomethacin-induced gastric mucosal damage in rats. VKT was tested at two doses (1.44 &amp; 0.48 capsules/kg/d po) ten days before the indomethacin single-dose challenge (40 mg/kg po). Animals were sacrificed six hours after indomethacin administration, and gastric tissues were collected for gross observation and histopathological analyses. The results revealed that the administration of indomethacin caused evident gastric mucosal damage with morphological and histological manifestations. VKT pretreatment tended to avert the rise in lesion numbers, reduce the ulcer index, and improve the severity of bleeding streaks and epithelial sloughing in gastric mucosa on the macroscopic examination compared to the model group. It is worth noting that no ulcerative lesions were observed in the gastric tissues of rats receiving VKT upon microscopic examination. Our results indicated that Vien Khoi Tim capsules might possess a protective role against indomethacin-induced gastric ulcers. Additional research is needed to better understand the mechanism by which Vien Khoi Tim capsules exert their gastroprotective effect.

Antiulcer activity of the stem bark aqueous extract of Croton oligandrum (Euphorbiaceae) against Ethanol/HCl-induced gastric mucosal injury in rats

Gastric ulcer is an alteration of the lining of the stomach with destruction of mucus-producing cells. Many factors are contributing to the development of peptic ulcer such as phygiological stress, high production of acid, non-steroidal anti-inflammatory drugs (NSAIDs) and alcohol consumption. Croton oligandrum is traditionally used to treat many diseases including gastric ulcers. This study aims to investigate the cytoprotective activity of Croton oligandrum. To assess the gastroprotective potential of Croton oligandrum ulcer models were established using ethanol and indomethacin. Sucralfate was used as reference anti-ulcer drugs. Rats were treated with Croton oligandrum before induction of gastric ulceration by ethanol/HCl or HCl-ethanol-Indomethacin. The area and ulcer index appearance of ulcers were quantified, and mucus was measured. Pretreatment with Croton oligandrum showed a remarkable decrease in ulcer area when compared with control groups. Croton oligandrum (50, 100 mg/kg and 200 mg/kg of body weight) exhibited gastroprotective activity and prevented both gastric lesions induced in rats.

Research on medicinal uses and chemical composition of Chenopodium botrys

Medicinal plants have been used by humans for many years in the prevention and treatment of diseases. Chenopodium botrys species has been used as a medicinal plant since the past in human history. The genus Chenopodium, which belongs to the Chenopodiaceae family, is widely grown in Western Asia, Europe and North America. It is used medically in the treatment of inflammatory disorders, diabetes, gastric and parasitic ulcers, bacterial, fungal and viral diseases. Traditionally, it is also used in the treatment of various conditions such as cough, abdominal pain and congestion among the people. In addition, according to studies conducted in recent years, it has been determined that essential oil has healing properties for wounds.

Treatment tactics for gastric erosive-ulcerative bleeding on the background of liver cirrhosis

Analysing the polymorphism of etiological factors that contribute to the development of erosive‑ulcerative gastric lesions in patients with liver cirrhosis (acid‑peptic factors, transformation of venous blood flow, immune complexes, etc.), it should be noted that portal hypertension is the most important cause of these lesions. Bleeding from erosive‑ulcerative gastric lesions is a direct cause of death, occupying the first place in the structure of mortality and far exceeding ulcer perforations in this regard. Mortality in the first massive acute gastric bleeding reaches 50%, after the second — 70%, in hepatic coma — 80% or more. Objective — to improve the treatment outcomes for patients with erosive and ulcerative bleeding in the stomach due to liver cirrhosis. Materials and methods. The treatment outcomes of 192 patients with the hepatic form of portal hypertension (liver cirrhosis) who were hospitalised in the therapeutic and surgical departments, which are the clinical bases of the Department of Surgery No. 2 at Bogomolets National Medical University, were studied for the period from 2005 to 2023. During upper endoscopy, degenerative changes in the gastric mucosa were detected in 94 (48.9%) patients. Specifically, gastric erosions were observed in 31 (33.0%) patients, gastric ulcers in 34 (36.2%), and portal gastropathy in 29 (30.8%) patients. A total of 88 (46.6%) patients with liver cirrhosis and acute gastric bleeding were admitted to the surgical department as an emergency. According to the Child‑Pugh scale, the vast majority of patients were at the stage of sub‑ and decompensation (71 patients, or 89.1%). In 41 (45.2%) patients, gastric cancer was attributed to gastric erosive and ulcerative lesions: erosive gastritis — in 20 (48.8%) patients and gastric ulcer — in 21 (51.2%) patients. Results. Enhancing the protective properties of the mucous‑bicarbonate barrier of the gastric mucosa as part of pathogenetic conservative treatment schemes can reduce the influence of this mechanism on the development of hemorrhagic complications in 89.4% of patients. The risk of bleeding in this group of patients with liver cirrhosis is 15.1%, which requires the search for new methods of conservative treatment. In 79.6% of cases, primary endoscopic hemostasis of bleeding erosive‑ulcerative gastric lesions was effective when combined with drug therapy. For 53.1% of patients, it proved to be the final treatment. This enabled a reduction in overall mortality to 22.4% from 50% (p &lt;0.05) and, if necessary, a delay in surgical intervention. Out of the total number of patients, 19 (38.8%) patients required surgical intervention, with 73.7% of them undergoing urgent surgery and 26.3% undergoing delayed surgery. When considering operative methods for peptic ulcers complicated by hemorrhage, preference should be given to organ‑ and function‑preserving interventions. They yield more favourable immediate outcomes for this extremely challenging group of patients (postoperative mortality was reduced to 26.3% vs. 50.0% (p &lt;0.05). Conclusions. Acute gastric bleeding resulting from erosive‑ulcerative gastric lesions, which are complications of liver cirrhosis, can significantly impair the health of patients. However, by implementing modern treatment technologies, such as surgical procedures, it is feasible to achieve a 50% reduction in both overall and postoperative mortality.

Measured levels of positive transglutaminase 2 antibodies are not associated with presentation or incidental endoscopic findings at celiac disease diagnosis

Objectives It has been suggested that celiac disease could be diagnosed non-invasively in adults with transglutaminase antibody (TGA) levels >10x upper limit of normal (ULN). It is, however, unclear if high values signify more advanced disease and higher risk of co-morbidities. We investigated the association between the TGA levels, clinical characteristics and non-celiac endoscopic findings. Methods Medical data on 450 celiac disease patients at diagnosis were collected. They were further divided into those with high positive (>10x ULN, n = 164), moderately positive (1–10x ULN, n = 219), and negative (n = 67) TGA. Results Median age of patients was 50 years and 60% were women. Patients with negative TGA were older (median age 58 vs. 51 vs. 46 years respectively, p = 0.002) and had more often weight loss (27% vs. 10% vs. 9%, p < 0.001) and abdominal pain or dyspepsia (40% vs 27% vs. 22%, p = 0.017) than did those with moderately positive/high TGA. The groups did not differ in sex, BMI, or other symptoms. Major endoscopic findings included one esophageal adenocarcinoma presenting with dysphagia, six esophagitis, three gastric ulcers, and 39 H. Pylori or other active gastritis. High, moderately positive or negative TGA levels were not associated with these findings in crude or age-adjusted analyses. Conclusions Presentation was similar in patients with moderate or high levels of TGA, whereas patients with negative TGA were different. The level of TGA was not associated with incidental endoscopic findings and the only malignancy presented with an alarm symptom atypical to celiac disease.

Standardization of Hibiscus rosa-sinensis Flower by HPTLC, HPLC and AAS

Hibiscus rosa-sinesis, a well-known flowering plant in India, is used to worship Lord Ganesha. It is a member of the Malvaceae family. It is used in traditional medicine in many tropical countries to treat wounds, inflammation, fever, diabetes, infections, hair loss, and gastric ulcers. Therapeutic benefits of Hibiscus rosa-sinesis are attributed to flavonoids, tannins, terpenoids, saponins, and alkaloids. Hibiscus rosa-sinesis flowers are a good source of flavonoids, which are important components of herbal and Ayurvedic preparations. The goal of this study was to standardize the flower extract through qualitative phytochemical screening and quantitative HPTLC analysis of quercetin, an active biomarker. The result of the HPTLC analysis was compared to those obtained using HPLC. HPTLC found that the extract contained 0.33% quercetin, while HPLC found that it contained 0.37% quercetin. Further, heavy metals and trace elements were measured using atomic absorption spectroscopy (AAS). Results showed that cadmium, lead, arsenic, copper, chromium, and mercury levels (in ppm±SEM) were within acceptable limits: cadmium (0.018±0.050), lead (0.630±0.025), arsenic (0.041±0.014), copper (2.605±0.045), chromium (0.450±0.025), and mercury (0.023±0.006). This method allows standardization of plant material for raw material and finished product testing, ensuring better efficacy and safety.

Seasonal and Geographic Variation in Peptic Ulcer Disease and Associated Complications in the United States of America.

Hospitalization for peptic ulcer disease (PUD) has been described outside of North America as peaking in the fall and winter. However, no recent literature has so far investigated the seasonal fluctuations and complications of PUD in the USA. Study Design: Cross-sectional population database review. Patients with a diagnosis of either acute gastric or acute duodenal ulcers from January 1, 2015, through December 31, 2017, were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample. The proportion of admissions with either hemorrhage or perforation was determined for each season and further subdivided into geographic regions. Of 18829 hospitalizations for PUD, admissions were the highest in the fall (25.9%) while being the lowest in the summer (23.9%). Complications, hemorrhage or perforation, were the highest and the lowest in the fall and spring, respectively (75.7% vs. 73.6%; P=0.060 for comparing all 4 seasons). Geographically, the West had the highest rate of peptic ulcer hemorrhage (64.5%, P=0.004), while the northeast had the highest rate of perforation (14.3%, P=0.003). Hemorrhage was more common in males, those who used aspirin, nonsteroidal anti-inflammatory drugs, or anticoagulants, and diabetics (P<0.05). Perforation was less common in males, those with diabetes, obesity, or hypertension (HTN), or those using aspirin or anticoagulants (P<0.05). Helicobacter pylori infection was more associated with perforation in the fall and winter months. Seasonal and regional trends in hospitalizations due to PUD may help identify modifiable risk factors, which can improve diagnostic and treatment outcomes for patients by allowing for more targeted identification of vulnerable populations.

Chemical Characterization and Pharmacological Evaluation of Phytophenols-Etodolac Mutual Prodrugs

Etodolac is choice of drug for pain and inflammation but has major side effects of gastric ulcers that are due to free carboxylic group. Etodolac belongs to the chemical class of non-selective COX-inhibitor but preferentially COX-2 inhibitor. Here the ester linked mutual prodrugs of etodolac with phytophenols like vanillin, carvacrol, umbelliferone, guaiacol, sesamol and syringaldehyde were synthesized. All the prodrugs were characterized by IR-spectroscopy, 1H-NMR, 13C-NMR and mass spectrometry. Among the synthesized prodrugs, the Eto-van, Eto-umbe, Eto-sesa and Eto-syr showed improved analgesic and anti-inflammatory activity compared to etodolac. All the synthesized prodrugs showed less ulcerogenic side effects compared to etodolac.

Algorithm for surgical treatment of gastroduodenal ulcer with multiple combined complications

Surgical management of gastroduodenal ulcers (GDU) and multiple combined complications (MCC) remains a relevant, complex and unresolved issue. There are currently no well‑defined algorithms, strategies, or surgical procedures for the treatment of gastroduodenal ulcers accompanied by a variety of complications. Objective — to improve the results of surgical treatment and reduce the mortality of patients with GDU and MCC by implementing a surgical treatment algorithm. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period 2000—2022 are presented. A total of 395 (100.0%) patients with GDU accompanied by MCC (a combination of two or more complications) were operated on. There were 52 (13.16%) patients with gastric ulcer perforation and 301 (76.2%) patients with duodenal perforation. A combination of two complications was noted in 299 (75.69%) patients, three — in 88 (22.28%) patients, and four — in 8 (2.03%) patients. Results. A total of 352 (89.11%) operative interventions were performed in an emergency, 43 (10.88%) were performed in the early delayed period (EDP). The implementation of a new algorithm of surgical treatment in the main group and the use of modern measures of endoscopic hemostasis made it possible to increase the rate of operated patients in EDP by 2.6 times, and reduce the mortality rate from 10.14% to 6.45%. The highest rate of mortality is associated with gastric resection in patients with GDU and MCC — 3 (42.87%) out of 7 patients. The lowest mortality rate was among patients who underwent one of the types of organ‑saving surgery — 7 (2.86%) patients out of 245 operated on in this group. Conclusions. The implementation of the algorithm for providing surgical care to patients with GDU accompanied by MCC made it possible to reduce intraoperative mortality from 10.14% to 6.45%. The use of modern means of endoscopic hemostasis made it possible to stabilise, adequately prepare, and operate patients in EDP, which is confirmed by the increase of this indicator in the main group by 2.6 times. The highest mortality rate was in patients who underwent gastric resection and was 42.87%.

Gastro-BaseNet: A Specialized Pre-Trained Model for Enhanced Gastroscopic Data Classification and Diagnosis of Gastric Cancer and Ulcer.

Most of the development of gastric disease prediction models has utilized pre-trained models from natural data, such as ImageNet, which lack knowledge of medical domains. This study proposes Gastro-BaseNet, a classification model trained using gastroscopic image data for abnormal gastric lesions. To prove performance, we compared transfer-learning based on two pre-trained models (Gastro-BaseNet and ImageNet) and two training methods (freeze and fine-tune modes). The effectiveness was verified in terms of classification at the image-level and patient-level, as well as the localization performance of lesions. The development of Gastro-BaseNet had demonstrated superior transfer learning performance compared to random weight settings in ImageNet. When developing a model for predicting the diagnosis of gastric cancer and gastric ulcers, the transfer-learned model based on Gastro-BaseNet outperformed that based on ImageNet. Furthermore, the model's performance was highest when fine-tuning the entire layer in the fine-tune mode. Additionally, the trained model was based on Gastro-BaseNet, which showed higher localization performance, which confirmed its accurate detection and classification of lesions in specific locations. This study represents a notable advancement in the development of image analysis models within the medical field, resulting in improved diagnostic predictive accuracy and aiding in making more informed clinical decisions in gastrointestinal endoscopy.

Evaluation of Nitric Oxide Activity of Torilis Leptophyllain Indomethacin Induced Gastric Ulcer in Mice

Objective: To evaluate the Nitric Oxide activity of Torilis leptophylla in Indomethacin-induced gastric ulcers in mice. Study Design: Laboratory-based experimental study Place and Duration of Study: Pharmacology Department, University of Health Sciences, Lahore Pakistan, from Jan to Dec2016. Methodology: Thirty-six adult healthy male BALB/C mice with a weight range of 25-35 g were equally divided into six groups and designated as Group-I (Control), Group-II (Positive Control), Groups III to V (Torilis leptophylla extract trial Groups) and Group-VI (Omeprazole). Gastric ulceration was induced by a single dose of Indomethacin (20mg/kg) in Groups II–VI. The plant extract was administered in Groups III-V (100, 200, 300 mg/kg) whereas Omeprazole (3mg/kg) in Group-VI by gavage daily for three days as treatment of gastric ulceration. Nitric Oxide content was measured in gastric juice and serum of all groups by Nitric Oxide assay kit. Results: The positive Control-Group showed little Nitric Oxide in gastric juice and serum. Torilis leptophylla treated Groups (100 mg/kg, 200mg/kg and 300 mg/kg) showed significantly raised Nitric Oxide content in both gastric juice and serum than the Control Group (p&lt;0.001). Conclusion: The study has determined that Torilis leptophylla possesses antiulcer and mucosal protective effects owing to the antioxidant activity of nitric oxide. This supports the use of the plant for the treatment of gastric ulcers.

Rescue Therapy in Gastric Mucosal Bleed using Haemospray™

Abstract Hemostatic agents are used extensively in endoscopic management of gastrointestinal (GI) bleed. Conventional endoscopic techniques such as thermal, mechanical (clipping), and injection treatment fail in up to 5%–10%. These agents are used particularly in anatomically challenging areas, lesions with poor visibility, diffuse bleeding, and friable tissues. We present an endoscopic management of gastric bleed in a 17-year-old male with leukemia (early T-cell precursor acute lymphoblastic leukemia), who underwent haplotransplant. Posttransplant patient developed pneumonia with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support with multiorgan dysfunction syndrome, graft versus host disease. During his hospital stay, he developed persistent GI bleed from multiple large excavating gastric ulcers. Multiple sessions of conventional hemostatic endoscopic procedures such as hemoclips, glue injection, and sclerosants failed to achieve hemostasis. Mucosal surface bleeds are difficult to manage hence we used Hemospray for achieving good hemostasis.

Хірургічні аспекти лікування перфоративних гастродуоденальних виразок із поєднаними ускладненнями пенетрацією, стенозом та гострою кровотечею

The problem of surgical treatment of perforation of gastroduodenal ulcers (GDU) remains relevant and difficult, despite the introduction of new schemes of anti-ulcer and eradication therapy. Algorithms of surgical approaches and tactics of surgical treatment of patients with perforated GDU in combination with other complications in various combinations have not been developed. Purpose - to improve the results of surgical treatment of GDU with associated complications. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period from 2000 to 2022 are presented. In total, 353 (100%) patients with perforated GDU in combination with other complications (a combination of two or more complications) were operated on. There were 52 (14.7%) patients with gastric ulcer perforation, and 301 (85.3%) patients with duodenal perforation. There were 267 (75.6%) patients with a combination of two complications; with a combination of three complications in 78 (22.1%) patients; four - 8 (2.3%) patients. The combination of perforation with gastrointestinal bleeding was observed in 138 (39.1%) patients. Results. The vast majority of patients (267 (75.6%)) had a combination of two complications. The number of patients with a combination of three complications was 78 (22.1%). The number of patients with a combination of all complications was insignificant - 8 (2.3%) people. The implementation of the developed algorithm made it possible to reduce the number of postoperative complications and mortality from 12% to 6.5%. The highest rate of complications and mortality was observed among patients with a combination of multiple (three and four) complications who underwent gastric resection - 3 (33.3%) patients, and the lowest mortality rate was observed among patients who underwent organ-preserving operations - 6 (2.8%) patients. Conclusions. In patients with perforated GDU in combination with bleeding, the use of endoscopic hemostasis made it possible to stabilize the patient and better prepare him for surgical intervention, and reduce the number of postoperative complications and mortality rates by almost 2 times. The use of resection techniques was extremely limited and had the highest rate of complications and mortality. Implementation of the developed algorithm made it possible to optimize surgical tactics when combining perforation with other complications of GDU. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.