Gastrointestinal Ulcers Research Articles

Different protective capability of chlorogenic acid and quercetin against indomethacin-induced gastrointestinal ulceration.

The study compared the protective effects against indomethacin-induced GI ulceration of chlorogenic acid with quercetin in rats. Rats were orally given chlorogenic acid or quercetin (100 mg/kg; 5 days), followed by indomethacin (40 mg/kg; single dose). After 24 h, GI tissues were assessed for histopathological damages, then analysed by ELISA and western blot methods. Cell viability was measured in vitro by MTT assay. Unlike quercetin, chlorogenic acid could not prevent gastric ulcers in indomethacin-treated rats. The levels of gastric prostaglandin E2 (PGE2) and Bax/Bcl-2 ratio in the chlorogenic acid-treated group were not different from those receiving indomethacin alone. Nevertheless, both compounds alleviated jejunum ulcers through suppression of PERK/eIF-2/ATF-4/CHOP-related endoplasmic reticulum (ER) stress and decrease Bax/Bcl-2 ratio. Moreover, at 100 µM, they abolished the cytotoxicity of tunicamycin (an ER stress inducer) in gastric (AGS) and intestinal (Caco-2) cells. In silico docking studies suggested that both compounds could interact with key amino acid residues in the -catalytic domain of PERK. Chlorogenic acid and quercetin exerted comparable protective effects against indomethacin-induced intestinal ulcer through suppression of ER stress-mediated apoptosis but, unlike quercetin, chlorogenic acid offered no protection against gastric ulceration due to its -inability to increase PGE2 production.

Development of acute peptic ulcers complicated by gastrointestinal bleeding in patients with novel coronavirus infection

The study enrolled patients with acute gastrointestinal ulcers and gastrointestinal bleeding, EGD confirmed, against the background of the novel coronavirus infection (61 patients). There were 39 men (63.9 %), women — 22 (36.1 %), the mean age of the patients was 57 years. It was found that preventive schemes of acid blockers administration have not been sufficiently effective and is unsafe for the patients with COVID-19. Based on this, as a prevention of the acute gastrointestinal ulcers in patients with the novel coronavirus infection without GI bleeding, we recommend the administration of the H2 receptor antagonists. The risk of gastrointestinal bleeding increases in patients with COVID-19, so there is a need for further investigation of the efficacy and safety of the preventive therapy in this category of patients.

Garcinia gummi-gutta: Phytochemicals and pharmacological applications.

Garcinia gummi-gutta, also known as Garcinia cambogia, is a member of the Guttiferae family. Garcinia is a polygamous genus consisting 200 species of trees and shrubs. It is found in different zones of the planet including Asia's tropical regions. In India alone, around 30 species have been discovered. They are widely used as a flavoring agent to garnish fish curry in southern India, particularly in Kerala and Karnataka. The fruit rind of G. gummi-gutta has traditionally been used to treat gastrointestinal problems, diarrhea, and ulcers. South Indian people have been utilizing it traditionally as evidenced by its ethnobotanical properties. In vivo and in vitro effects of the crude fruit extract showed anti-inflammatory, anti-cancer, anthelmintic, anti-microbial, and antioxidant activities. G. gummi-gutta fruit rind is medicinally significant and is frequently used in ayurvedic and traditional medicine for many diseases. Various secondary metabolites such as organic acids-hydroxycitric acid (HCA), flavonoids, terpenes, polysaccharides and polyisoprenylated benzophenones-garcinol, xanthochymol, guttiferone, benzophenone, xanthone, biflavonoids, alkaloids, tannins, phenols, and saponins isolated from the G. gummi-gutta have diverse pharmacological activities. This review provides a summary of G. gummi-gutta, including itsbiological activities, phytochemistry, and ethnobotanical applications.

Abortitristoside A and desrhamnosylverbanscoside: the potential COX-2 inhibitor from the leaves of Nyctanthes arbor-tristis as anti-inflammatory agents based on the in vitro assay, molecular docking and ADMET prediction

The plant Nyctanthes arbor-tristis belongs to the genus Nyctanthes (Oleaceae family) which is used in the treatment of many diseases like diabetes, cancer, inflammation, intestinal problem and tuberculosis in many countries of Asia. In this analysis, we have investigated the anti-inflammatory activity of various extracts of leaves of Nyctanthes arbor-tristis by the in vitro method as the cyclooxygenase inhibitory potential. The reported phytochemical constituent of the plant was in silico screened to find the cyclooxygenase inhibitory potential by molecular docking method. The molecular docking study of pre-isolated phytochemicals from the leaves of plants shows that compounds possess a great inhibition potential against COX-1 and COX-2 therefore, an in vitro comparative study is required to conclude the selective and potential COX-2 inhibitor for the development of new anti-inflammatory drug without causing any gastrointestinal ulcer. Here, we deliver a new strategy to design a selective COX-2 inhibitor from the plant origin natural compound by using molecular docking technique and in vitro screening of plant extract. In the other part of the paper, abortitristoside A (1) and abortitristoside B (2) were isolated from the leaves part of the plant. The isolated compound possesses good activity against COX-2 and COX-1 (IC50 value 7.91–8.00 μM against COX-2) which is also established by structure–activity relationship analysis.

Aetiology and Pattern of Presentation of Upper Gastrointestinal Tract Ulcers among Patients Attending the Gastroenterology Department of BSMMU-A Tertiary Level Hospital

Background: Upper gastrointestinal endoscopy is the most common procedure performed in Gastroenterology department for numerous indications and ulceration of the upper GI tract is one of the major pathological findings during endoscopy. Early diagnosis of upper GI ulcers with definite cause is the mainstay of therapy for patient’s cure and prevention of complications. Different clinical features are observed in different types of ulcer. Objective: The objective of this study is to find out the causes of different types of ulceration in the upper gastrointestinal tract along with their clinical presentation. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, BSMMU, Dhaka, Bangladesh during the period of July 2016 to April 2017. Patients referred for upper GI endoscopy for different indications were primarily selected. Consecutive 220 patients having ulcers anywhere in the upper GIT were finally included in the study. Ulcer diseases were diagnosed through analysis of morphology of the ulcers, histopathology of biopsy materials, relevant clinical history and further investigations if required. All the findings were documented in predesigned data collection sheet. Any association between various types of ulcers with age, gender, BMI, lifestyle, location of ulcer, different signs and symptoms was assessed. Results: Out of 220 patients duodenal ulcer was found in 45.9%, gastric ulcer in 30.0%, oesophageal ulcer in 7.7%, ulceration at multiple sites in 13.6%, and stomal ulcer in 2.7% cases. Among the aetiologies H. pylori infection (62.8%), NSAIDs (14.6%) and malignant ulcers (9.1%) were found in majority of cases. Less common causes were tubercular ulcer, lymphoma, GIST, Crohn’s disease and caustic injury. Aetiology could not be identified in 6.8% cases. Among various presenting complaints epigastric pain, early satiety, anorexia, vomiting and GI bleeding were the symptoms that differ significantly in patients with ulcers ...........

Acute and subacute oral toxicity assessment of Gancao Xiexin decoction in Sprague-Dawley rats.

Gancao Xiexin decoction (GCXXD), a well-known classic traditional Chinese medicine prescription, is used to treat various oral ulcers, Behcet disease, gastrointestinal ulcers, etc. However, there is very little information on its safety. This study aimed to investigate the acute and subacute oral toxicity of GCXXD in Sprague-Dawley rats. In the acute toxicity study, rats were orally administered 10g/kg GCXXD three times a day. Clinical signs of abnormality and mortality were observed daily for 14days. In the subacute toxicity study, rats were orally administered 0, 1.47, 3.83, or 10g/kg GCXXD for 28days. The rats' clinical signs, body weight, food consumption, hematological and biochemical parameters, bone marrow smear, organ index, and pathological morphology were analyzed. The acute toxicity study showed that GCXXD is safe in rats without any obvious toxicity via an oral dose of 30g/kg/day (3 × 10g/kg). After 28days of administration, slightly decreased RBC, HGB, and HCT were observed in female rats at 10g/kg, suggesting that repeated doses of high-dose GCXXD may cause mild anemia in female rats. The no-observed-adverse-effect level (NOAEL) and lowest-observed-adverse-effect level (LOAEL) of oral administration of GCXXD for 28days in rats are considered to be 3.83g/kg and 10g/kg, respectively. Long-term toxicity studies are recommended to strengthen the findings.

Rare localization of avascular necrosis during treatment of COVID-19 with glucocorticosteroids

The development of bony avascular necrosis induced by glucocorticoid treatment of COVID-19 is a common adverse effect, with femoral head being the most commonly affected. Timely detection of avascular necrosis is important in the prevention of osteoarthrosis and other complications.
 We present a clinical case of a 54-year-old patient hospitalized for novel coronavirus infection with complaints of severe pain in both knees 2 weeks after the disease onset. Magnetic resonance imaging revealed pronounced changes in both knees, corresponding to avascular necrosis. The results of conservative therapy, including non-steroidal anti-inflammatory drugs and bisphosphonate bone resorption inhibitors, produced a pronounced positive result. At follow-up examination 3 months later, there was no pain, but the knee joints still had slight restrictions of movement. Magnetic resonance imaging showed a significant decrease in the previously detected changes.
 The side effects of glucocorticoids (impaired glucose tolerance, increased blood pressure, tachycardia, gastrointestinal erosive ulcers, sleep disorders, etc.) are widely known, but knee osteonecrosis caused by steroid intake rarely comes to the attention of clinicians. This clinical case emphasizes the complex nature of osteonecrosis pathogenesis and demonstrates a wide range of complications in corticosteroid therapy.

Gastrointestinal ulceration in dogs with portosystemic shunt

Portosystemic shunt (PSS) in dogs is a common abnormality in which blood from the intestines bypasses the liver flowing directly to the systemic circulation through an aberrant vessel. The lack of hepatic detoxication can lead to a fatal outcome. Treatment of choice is a surgical occlusion of the shunt. Gastrointestinal ulceration/ erosion (GUE) has been described as one of the numerous clinical consequences of PSS, As these lesions are a severe complication, and seem to be underestimated, this review presents the current knowledge about GUE in dogs with PSS. Although the pathogenesis of these lesions is not clear and experimental data are scarce, we conclude that proton pump inhibitors should be administered pre- and postoperatively to dogs with PSS to reduce the incidence of GUE and thus increase the recovery rate.

A Comprehensive Review on Ulcer and Their Treatment.

A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a significant source of worldwide morbidity and mortality. The Gastrointestinal ulcers and duodenal ulcers are considered the two most extreme types of peptic ulcers. Peptic ulcers are found to be caused by an excess of violent factors including Hydrochloric acid (HCL) pepsin, refluxed bile leukotrienes (LT), reactive oxygen species (ROS) and protective factors, these include mucus-bicarbonate barrier functions, prostaglandins (PGs), mucosal blood flow, cell regeneration and migration, non-enzymatic and enzymatic and certain growth factors. The primary cause of peptic ulcer disease is pylori infection and the use of NSAIDs. This review article underscores the importance of a multidisciplinary approach in the management of ulcers to improve patient outcomes and quality of life.

Histomorphological evaluation of the combined therapeutic potential of Carica papaya and Musa paradisiaca on indomethacin induced gastric injury

Background: Medicinal plants are often used for the preparation of remedies for the treatment of several ailments especially in rural areas. Objective: The study investigated the combined effect of Carica papaya (pawpaw) and Musa paradisiaca (plantain) leaves extract on the stomach walls of albino rats against indomethacin induced gastric ulceration. Materials and Methods: Twenty-five (n-25) albino rats were weighed and divided randomly into five groups. Each group consisted of five (n-5) rats. Group A served as negative control and received rat feeds and water ad libitum. Group B received feeds and a single dose of indomethacin (25 mg/kg body weight) via orogastric administration and organs were harvested 4 hours after administration. Group C rats were administered with Carica papaya leaf extract (250 mg/kg body weight) daily for 14 days. Group D was administered with Musa paradisiaca leaf extract (250 mg/kg body weight) for 14 days. Group E received combined extract of Carica papaya (250 mg/kg body weight) and Musa paradisiaca (250 mg/kg body weight) daily for 14 days. All the animals were allowed access to feed and water. The animals in groups C-E fasted for 24 hours and were administered with a single dose of indomethacin (25 mg/kg body weight). Four hours later, the animals were sacrificed under chloroform inhalation, organs harvested, processed and stained with haematoxylin and eosin for histomorphological evaluation. Result: The result of the study shows that the single dose of indomethacin caused gastric ulceration within 4 hours. Musa paradisiaca leaf extract ameliorated the effect of indomethacin on the stomach. Combination of Carica papaya and Musa paradisiaca leaves extract exacerbated the effect of indomethacin on gastrointestinal tract ulcers. Conclusion: The practice of using combined extract of Carica papaya and Musa paradisiaca should be avoided in ulcer patients or individuals on indomethacin therapy

Prognostic value of free air under diaphragm on chest radiographs in correlation with peritoneal soiling intraoperatively

Gastrointestinal perforation is a significant injury that originates mainly from gastrointestinal ulcers. It is associated with a high rate of morbidity and mortality. The height of the column of the air under the diaphragm can be used to estimate the amount of peritoneal soiling due to viscus perforation. This study aimed to determine the correlation between this estimate and the incidence of morbidity and mortality. To achieve this aim, a prospective cohort study was conducted on 83 patients at Kasr al ainy hospital who, between March 2021 and March 2022, presented to the emergency department with free air under the diaphragm at chest X-ray and required surgical intervention for a perforated viscus. For each case, the amount of peritoneal soiling and the amount of air under the diaphragm as determined by a chest X-ray were recorded. The mean air under the diaphragm in a plain erect chest X-ray was 1.78 ± 1.92cm, and the mean amount of peritoneal soiling was 1201.83 ± 948.99 CC. There are positive correlations between the amount of air under the diaphragm as shown on an X-ray and the size of the perforation (p = 0.034), the amount of peritoneal soiling (p = 0.003), and the mortality (p = 0.013). There was a statistically significant correlation between air under the diaphragm according to X-ray and the amount of peritoneal soiling in patients with a perforated viscus. This measure can be used as a sensitive tool to predict morbidity and mortality as more free air in the chest X-ray is associated with significant mortality. These results may enhance the decision making using sensitive and available tool of diagnosis.

Temporary Reversal of Hepatoenteric Collaterals during 90Y Radioembolization Planning and Administration

This paper aims to evaluate the safety and efficacy of the temporary redirection of blood flow of hepatoenteric collaterals using a balloon catheter in the common hepatic artery (CHA) to prevent the nontarget deposition of 90Y microspheres. In this retrospective single-center study of patients who received 90Y radioembolization (RE) from September 2010 to September 2015, diagnostic (67 patients) or treatment (72 patients) angiograms with the attempted use of a balloon catheter in the CHA to temporarily direct blood flow away from the hepatoenteric arteries were analyzed. SPECT/CT nuclear scintigraphy was performed after both diagnosis and treatment. Overall, only 12 hepatoenteric arteries in 11 patients required embolization due to persistent hepatoenteric flow despite the use of the balloon occlusion technique in a total of 86 patients. Physicians performed the 90Y RE using balloon occlusion with glass (n = 22) or resin (n = 50) microspheres. Over 80% administration of the prescribed 90Y dose was accomplished in 34 (67%) resin and 20 (95%) glass microsphere patients. Post-treatment 90Y RE scintigraphy confirmed the absence of extrahepatic activity in all patients. One grade 2 gastrointestinal ulcer was present after 90 days of follow-up. Temporary CHA occlusion with a balloon catheter is a reliable and reproducible alternative to the conventional coil embolization of hepatoenteric arteries during diagnostic Tc-99m macroaggregated albumin and therapeutic 90Y RE delivery.

Contribution to the Study of The Antipyretic Effects of Aqueous Extracts of Two Plants « Urtica dioica and Nerium oleander ».

The current treatment of febrile conditions involves non-steroidal anti-inflammatory drugs (NSAIDs), which are widely prescribed because of their efficacy in the management of pain, fever, and inflammation. However, their long-term therapeutic use is often associated with adverse effects such as gastrointestinal ulcers. Therefore, current research is based on the substitution of chemical treatments with natural treatments that are equally effective but have fewer side effects. One of the most widespread remedies is the use of substances of plant origin. Urtica dioica and Nerium oleander are two medicinal plants widely used for the treatment of various diseases in traditional medicine. The aim of this study was to evaluate the antipyretic effect of the aqueous extract of these plants in vivo. The administration of these extracts significantly reduced brewer's yeast-induced hyperthermia. The results of this study contribute to validating the medicinal virtues of these plants, especially in the treatment of febrile states. The phytochemical constituents are probably responsible for their pharmacological properties and could replace some drugs as they cause undesirable side effects.

Retrospective Clinical Outcomes of Proton Beam Therapy for Unresectable Locally Advanced Pancreatic Cancer

<h3>Purpose/Objective(s)</h3> We retrospectively researched on the treatment outcomes and assessed the efficacy of proton beam therapy (PBT) for unresectable locally advanced pancreatic cancer (LAPC). <h3>Materials/Methods</h3> Fifty-four patients who were diagnosed unresectable LAPC and administered PBT between April 2009 to March 2020 at our institution. Patients who could not completed PBT, had new distant metastases during treatment, and did not have enough follow-up time were excluded in this study. Statistical analyses were performed by calculating overall survival rate (OS) and local control rate (LC). Median survival time (MST) was analyzed by several following factors; maximum standardized uptake values (SUV_max) of FDG-PET evaluation, performance status (PS), tumor site, total irradiation dose, and combination use of chemotherapy. Treatment toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE ver.5.0). OS, MST, and LC were analyzed using the Kaplan-Meier method and log-rank test. The cut-off values for SUV_max and tumor diameter were estimated using the receiver operating characteristic (ROC) curve and area under the curve (AUC) based on MST. <h3>Results</h3> This study included 28 men and 26 women whose median age was 67.5 years (range, 40 to 88 years). All patients were clinical stage III LAPC according to the Union for International Cancer Control (UICC) TNM staging system (8th edition). Median follow-up time was 17.4 months (range, 4.0 to 89.7 months). The median total dose was 67.5GyE (range, 50-77 GyE/25-35 fractions). The median tumor diameter was 36.5mm (range, 15 to 90 mm). The median SUV_max was 5.85 (range, 2.1 to 27.6). Chemotherapy regimens during PBT were following; 24 patients were gemcitabine alone, 5 were tegafur-gimeracil-oteracil (TS-1) alone, 17 were paclitaxel and TS-1. Eight patients did not receive chemotherapy because of their poor general condition. The One-year, 2-year, 3-year OS were 74.1%, 33.3%, 10.8%, respectively. The One-year, 2-year, 3-year LC were 89.0%, 84.6%, 84.6%, respectively. The MST was 17.1 months. Only one patient survived longer than 5 years. The cut-off values were estimated for SUV_max: 4.8 and tumor diameter: 37mm. Two-year OS based on PS-score group were following; PS 0/1/2: 26.1/ 13.4/8.0 months, respectively with significant differences (each group P<0.01). Treatment related acute toxicities were neutropenia (Grade1/2/3: 2/6/17 patients), leukopenia (Grade1/2/3: 1/4/11 patients), thrombocytopenia (Grade1/2: 1/4 patients), respectively. Late toxicity was gastrointestinal ulcer (Grade1/2: 2/2 patients). No Grade 3 or higher late adverse events were observed. <h3>Conclusion</h3> PBT combined standard chemotherapy achieved excellent local control. However, it did not control systematic tumor progression. PS score at first visit could be important prognostic factor.

Health Consequences of Overexposure to Disinfectants and Self-Medication against SARS-CoV-2: A Cautionary Tale Review

To control and prevent the spread of the infectious agents in the environment and body, various measures have been taken, including the use of disinfectants for hands and surfaces, use of detergents, self-medication by herbal concoctions, and dietary supplements. Although these actions may have a therapeutic effect or reduce the viral load, incorrect use (abuse or overuse) could have negative health repercussions. Therefore, public awareness in this context is essential. The purpose of this narrative review was to evaluate the health consequences of overexposure to disinfectants and self-medication against infectious agents, specially SARS-CoV-2. The literature search for this review was conducted using related keywords in PubMed, Web of Science (WOS), and Scopus databases. This review found a significant number of reported poisoning cases during the pandemic as a result of the overuse of alcoholic hand sanitizers, household bleach products, and detergents. This paper also provides an integrated systemic overview of the possible toxic effects of self-medication, alcohol consumption, and self-administration of dietary supplements and herbs during the COVID-19 pandemic. The present review indicated that the main adverse effects associated with the overuse of popular preventative actions against contagious respiratory illnesses specially COVID-19 and Influenza (flu) were methanol intoxication, skin damage, respiratory problems, gastrointestinal ulcers, nausea, vomiting, epigastric pain, and liver injury. Due to the significant increase in the use of these preventative measures, it is essential to raise public awareness of the side effects of their excessive and unnecessary use.

S2567 Vaping-Induced Duodenal Ulcer

Introduction: Vaping, or electronic cigarette use has tremendously increased. It is estimated a population of five million is involved in vaping each year. While lung injury associated with vaping has gained national attention, the systemic burden of vaping has not been established. To date, there is no current report on the prevalence of gastrointestinal symptoms alone in association with vaping, yet it has been reported that 90% of patients who present with lung injury also have gastrointestinal symptoms. This raises the concern that vaping may also result in gastrointestinal injury such as seen with tobacco smoking and use of nicotine products. To our knowledge, vaping has not been shown to be associated with gastrointestinal ulcers or peptic ulcer disease. Case Description/Methods: We report a case of a 19-year-old male who was admitted to the intensive care unit for concern of hemorrhagic shock after presenting with hematemesis from a duodenal ulcer. The patient had no other medical history or known risk factors for peptic ulcer disease. However, he did report a seven-month history of vaping marijuana and THC products through a vaping pen for several hours per day prior to his onset of gastrointestinal symptoms and eventual hematemesis. Patient gastrin levels were normal. Gastric biopsies were negative for H Pylori. He denied using NSAIDS, including BC powders and goody powders. Discussion: This case emphasizes the need for clinicians to obtain a medical history of vaping when assessing patients with gastrointestinal symptoms. Future research in vaping should evaluate if the various compounds in vaping products or if the different methods of vaping can cause adverse gastrointestinal side effects such as ulcers.

S582 Gastroparesis Is Associated With More Concurrent Gastrointestinal Symptoms and Motility Disorders Than Functional Dyspepsia

Introduction: Gastroparesis (GP) and functional dyspepsia (FD) present with overlapping upper gastrointestinal (GI) symptoms, such as: nausea, vomiting, early satiety, postprandial fullness, epigastric pain, and bloating. Other gastrointestinal motility disorders may be concurrent in patients with GP. The goal of study was to compare the presence of GI symptoms and other motility disorders in patients with GP and FD. Methods: A retrospective cohort study was performed on IBM Explorys (1999-2022), which contains de-identified healthcare information from more than 64 million patients across the United States. Adult patients who have completed gastric emptying study were selected, and subsequently divided into GP and FD cohorts. GP cohort consists of patients with a diagnosis of gastroparesis, with exclusion criteria: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. FD cohort was similarly constructed with additional exclusion criteria: gastroparesis, gastrointestinal ulcer, brain neoplasm and pancreatitis. The presence of GERD, IBS, GI symptoms and common GI medications were collected. Odds ratios (ORs) with 95% confidence interval were used to compare the cohorts. Results: GP and FD cohort consisted of 17,570 and 60,230 patients respectively (Table). There was a higher prevalence of concurrent motility disorders in patients with GP than FD, including GERD and IBS (65.1 vs 50.9%, 18.6 vs 13.3%). Patients with GP tend to present with more upper and lower GI symptoms than FD, including nausea (65.1 vs 46.3%), vomiting (53.0 vs 33.3%), epigastric pain (36.9 vs 27.2%), heartburn (8.6 vs 7.5%), diarrhea (34.6 vs 23.3%) and constipation (37.2 vs 21.8%) (P< 0.0001) (Figure). However, there was no difference in terms of early satiety and bloating when comparing the two groups. Acid reducing medications, anti-nausea medications and prokinetic agents were more commonly prescribed for patients with GP than FD, including proton pump inhibitors (PPIs), H2 receptor antagonists (H2RA), Metoclopramides and Ondansetron (p< 0.0001). Conclusion: GP is associated with more concurrent GI symptoms and motility disorders compared with FD. Acid reducing medications, anti-nausea and prokinetic medications are more commonly prescribed for patients with GP.Figure 1.: Comparison of GI symptoms between gastroparesis and functional dyspepsia Table 1. - Comparison of GI motility disorders, symptoms and medications between gastroparesis and functional dyspepsia GP (N=17570) % FD (N=60230) % OR P GI diseases GERD 11430 65.1% 30650 50.9% 1.74-1.86 < 0.0001 IBS 3260 18.6% 8030 13.3% 1.42-1.55 < 0.0001 Symptoms Upper GI symptoms Nausea 11430 65.1% 27910 46.3% 2.08-2.23 < 0.0001 Vomiting 9310 53.0% 20060 33.3% 2.18-2.34 < 0.0001 Early satiety 1660 9.5% 5780 9.6% 0.93-1.04 0.5556 Epigastric pain 6490 36.9% 16380 27.2% 1.51-1.62 < 0.0001 Heartburn 1510 8.6% 4500 7.5% 1.10-1.24 < 0.0001 Lower GI symptoms Diarrhea 6070 34.6% 14050 23.3% 1.67-1.80 < 0.0001 Constipation 6540 37.2% 13110 21.8% 2.06-2.21 < 0.0001 Bloating 60 0.3% 170 0.3% 0.90-1.63 0.2039 Medications PPI 13680 77.9% 35430 58.8% 2.37-2.56 < 0.0001 H2RA 7710 43.9% 18310 30.4% 1.73-1.85 < 0.0001 Metoclopramide 8630 49.1% 12490 20.7% 3.56-3.82 < 0.0001 Ondansetron 12570 71.5% 31330 52.0% 2.24-2.41 < 0.0001

S2138 TACE-Induced Ischemic Colitis

Introduction: Transarterial chemoembolization (TACE) is a locoregional treatment used in patients with hepatocellular carcinoma (HCC). This therapy entails injecting a chemotherapeutic agent into a branch of the hepatic artery supplying blood to the tumor while cutting off blood supply through particle embolization. This procedure may be utilized in a patient who is not a candidate for surgical resection or as a bridge to liver transplantation. Here we present a case of a ischemic colitis in the setting of a recent TACE. Case Description/Methods: A 65-year-old female with history of HCC underwent an outpatient TACE procedure for a 3.6 cm liver lesion. Soon after the procedure the patient complained of severe abdominal pain and was admitted. On day 2 of hospitalization, she developed significant bright red blood per rectum. Computed tomography (CT) demonstrated mild wall thickening and pericolonic fat stranding in the ascending colon concerning for acute colitis. Lactic acid was elevated at 5.8 mmol/L (normal < 2). Colonoscopy demonstrated multiple ulcers and erythema stretching from the cecum to descending colon suggestive of ischemic colitis. Biopsies demonstrated superficial mucosal erosion and necrosis, crypt atrophy, and lamina propria hemorrhage with hyalinization, consistent with acute ischemic colitis. CT angiography demonstrated a patent abdominal aorta and all major branches. The patient was treated conservatively without further episodes of hematochezia and was discharged home (Figure). Discussion: Postembolization syndrome is the most common adverse effect of TACE, which occurs in 60 to 80 percent of patients. This has been reported to be related to either tumor necrosis or due to ischemic damage to normal liver parenchyma. One case of gastrointestinal ulceration has been reported after TACE. To date, there has been no reported case of ischemic colitis after TACE. This presentation of ischemic colitis in our patient may be due to regurgitation of embolized particles into superior mesenteric arterial circulation leading to hypoperfusion of the colon, resulting in ischemic colitis. One should consider this presentation on the differential diagnosis in a patient with hematochezia after TACE.Figure 1.: Ascending and transverse colon demonstrating multiple ulcers and erythema suggestive of ischemic colitis on colonoscopy.

S2247 Gastric Irritation Noted in Patients Using New Tablet-Based Colonoscopy Preparation

Introduction: In November 2020, the FDA approved a novel colonoscopy preparation, a tablet-based bowel prep containing poorly absorbed sulfate salts. This case series includes 3 patients undergoing upper and lower endoscopy who were found to have gastric irritation thought to be caused by this bowel preparation. Case Description/Methods: A 35-year-old male with gastroesophageal reflux presented with 5-day history of hematochezia and abdominal pain. He underwent colonoscopy which showed internal hemorrhoids and esophogastroduodenoscopy (EGD) showed ulceration of the stomach body (Figure, top left). Biopsies showed focal active gastritis and superficial erosion without H. pylori organisms. The patient started daily PPI and 3 months later repeat EGD showed normal mucosa both visually and pathologically. A 59-year-old female endorsed abdominal bloating and heartburn after completing treatment for H. pylori 1-month prior. She underwent EGD with colonoscopy (for screening). EGD showed multiple diminutive round erythematous spots in the stomach antrum with pinpoint foci of dark heme suggestive of hemorrhagic gastritis (Figure, top right). Biopsies showed moderate inactive chronic inflammation without H. pylori organisms. A 70-year-old female requested endoscopy as she had a personal history of remote H. pylori infection and her father had gastric cancer. On EGD, there were superficial erosions in the lesser curve of the stomach (Figure, bottom 3). Biopsies were obtained and showed gastric mucosa with reactive epithelial changes without evidence of H. pylori infection. Discussion: The preparation consists of 24 tablets total, each taken with 16 ounces of water. The ingredients include magnesium sulfate, potassium chloride, and sodium sulfate. The sulfate salts are responsible for the osmotic and therefore laxative effects of the medication. Potassium chloride is included to avoid diarrhea induced hypokalemia. Potassium chloride is a mucosal irritant that has been reported to cause upper gastrointestinal ulcers and erosions. In each case, gastric irritation was an unexpected finding in a patient without significant risk factors for developing gastric ulcers. The common factor among them all is the same tablet-based preparation used for colonoscopy. Noted was a similar pattern of ulceration in the gastric antrum and body noted in these patients, which was in a pattern of the tablets resting on the greater curve of the stomach. While gastric ulceration may be asymptomatic, it may lead to diagnostic confusion and further unnecessary workup.Figure 1.: Colonoscopy images.

Prophylactic acid suppressants in patients with primary neurologic injury: A systematic review and meta-analysis of randomized controlled trials.

Neurocritical care patients are at risk of stress-induced gastrointestinal ulceration. We performed a systematic review and meta-analysis of stress ulcer prophylaxis (SUP) in critically ill adults admitted with a primary neurologic injury. We included randomized controlled trials (RCTs) comparing SUP with histamine-2-receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) to placebo/no prophylaxis, as well as to each other. The primary outcome was in-ICU gastrointestinal bleeding (GIB). Predefined secondary outcomes were all-cause 30-day mortality, ICU length of stay (LOS), nosocomial pneumonia, and other complications. We identified 14 relevant trials enrolling 1036 neurocritical care patients; 11 trials enrolling 930 patients were included in the meta-analysis. H2RAs resulted in a lower incidence of GIB as compared to placebo or no prophylaxis (Risk ratio [RR] 0.42, 95% CI 0.30-0.58; p < 0.001); PPIs with a lower risk of GIB compared to placebo/no prophylaxis (RR 0.37, 95% CI 0.23-0.59; p < 0.001). No significant difference was observed in GIB comparing PPIs with H2RAs (RR 0.53, 95% CI 0.26-1.06; p = 0.07; I2 = 0%). In neurocritical care patients, the overall high or unclear risk of bias of individual trials, the low event rates, and modest sample sizes preclude strong clinical inferences about the utility of SUP.