Peptic Ulcer Healing Research Articles

Review article: potassium-competitive acid blockers for the treatment of acid-related disorders.

Potassium-competitive acid blockers (P-CABs) are a novel group of acid-suppressing medicines for the management of acid-related disorders. To review published clinical pharmacology studies and clinical trials of P-CABs. We conducted a comprehensive literature search including Medline (PubMed), EMBASE, Web of Science and the Cochrane Library from inception until November 2020, for studies of the clinical pharmacology of P-CABs and relevant clinical trials of those that are currently licensed or in development. Most publications concerned vonoprazan, which forms the bulk of this review. It is currently licensed in some Asian and South American countries and is being developed for North America. In clinically relevant doses, P-CABs have produced more rapid and profound suppression of intragastric acidity than proton pump inhibitors (PPIs). Vonoprazan was non-inferior to lansoprazole in healing erosive oesophagitis (2 randomised controlled trials [RCTs] in 1137 subjects) and superior in maintaining remission (1 RCT; 607 subjects). In 2 RCTs (1120 total subjects), both vonoprazan and tegoprazan were non-inferior to lansoprazole for healing peptic ulcers. Three RCTs and numerous non-randomised studies have compared vonoprazan-based and PPI-based regimens for Helicobacter pylori infection; vonoprazan-based triple or dual regimens have been highly effective. P-CABs have some potential advantages over PPIs. To date, most research has been conducted in Asia; results of clinical trials that are underway in the United States and Europe are anticipated in 2021.

Triple Drug Therapy with Proton Pump Inhibitor a Better Option for Helicobacter Pylori Eradication

H.Pylori is a gram-negative micro organism residing in the stomach of human. It is a important cause of acidpeptic disorders. Bismuth based triple therapy,triple therapy regimens (Tripple PPI) and Quadruple therapyare the available treatment options to eradicate H. pylori. Controversy still presents regarding the superiorityof treatment modality and results of available studies are variable. Hence this study was undertaken toevaluate and compare the efficacy of triple PPI, Quadruple therapy, and bismuth-based triple therapy intreating acid peptic disorders and Helicobacter pylori eradication. Method: This study was a prospectiveinterventional. After the establishment of a clinical diagnosis of the acid peptic disorder, the patient wasposted for endoscopy. H. pylori status was determined by the rapid urease test and culture examination.All patients divided into three groups and offered three different medical treatments the first group receivedbismuth bases triple therapy, the second group got Tripple PPI therapy and the third one received quadrupletherapy. efficacy and comparison of all these treatment modalities were evaluated and assessed by symptoms,endoscopic findings, and results of the rapid urease test after 6 weeks. Results: In the present study, 150patients with upper gastrointestinal symptoms were studied It was found that the maximum number ofsubjects belonged to the age group 31-40 yrs. Male outnumbers than females. Maximum patients had pain inepigastric region and were having gastritis as a commonest diagnosis., Symptomatic relief by Triple therapywith PPI was maximum than other therapies. Rapid urease test (RUT) was also suggest that treatment with itgives superior eradication rates. Discussion: In our study, we have found that the treatment regime with PPITriple therapy has given maximum symptomatic relief, there is an association of H. Pylori infection in anacid peptic disorder like duodenal ulcer (86.66%), gastric ulcer (75%), and gastritis (82.85%). the efficacyof the Rapid urease test is 66% and that of culture is 38.66% in the diagnosis of H. pylori infection in acidpeptic disorder. Conclusion: PPI Triple therapy is most effective in symptomatic relief and healing of theduodenal and peptic ulcer.

The Efficacy of Berberine-Containing Quadruple Therapy on Helicobacter Pylori Eradication in China: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

BackgroundBerberine-containing quadruple therapy (adding berberine to the standard triple therapy) is being used to treat Helicobacter pylori infection, but the effects in randomized controlled trials (RCTs) are still controversial. Therefore, a meta-analysis is needed to estimate the efficacy and safety of berberine-containing quadruple therapy on Helicobacter pylori eradication.MethodsTen databases were searched to find the available literature. RCTs about the efficacy and safety of berberine-containing quadruple therapy on Helicobacter pylori eradication were included. The data of Helicobacter pylori eradication rate, peptic ulcer healing rate, relieving rate of clinical symptoms and adverse events were extracted to appraise the net change with a fixed or randomized effect model.ResultsA total of 13 articles were included in the analysis. Pooled results showed that the addition of berberine in standard triple therapy significantly improved Helicobacter pylori eradication rate (RR 1.22; 95% CI 1.16 to 1.27; I2 = 12%), increased the peptic ulcer healing rate (RR 1.15; 95% CI 1.10 to 1.19; I2 = 44%), relieved the clinical symptoms (RR 1.11; 95% CI 1.06 to 1.17; I2 = 44%) and reduced the incidence of side events (RR 0.65; 95% CI 0.53 to 0.80; I2 = 58%) comparing to the standard triple therapy.ConclusionsThe analysis showed that the addition of berberine in standard triple therapy could improve Helicobacter pylori eradication rate and clinical symptom remission rate, accelerate ulcer healing, and reduce adverse events, which is very beneficial to clinical work in China.

Tratamiento inicial y del fracaso en la erradicación de la infección por Helicobacter pylori

Helicobacter pylori is, probably, the most common bacterial infection in the world with a worldwide prevalence rate of 40-50%. In most cases is asymptomatic, but in some cases is associated with peptic ulcer, gastric adenocarcinoma, gastric MALT lymphoma, or dyspepsia. Effective H. pylori eradication therapy allows the complete healing of peptic ulcer, and the elimination of a key cofactor in the appearance of gastric adenocarcinoma and lymphoma. The following protocol includes currently accepted diagnosis methodology, treatment indications and the appropriate therapeutic regimens for the eradication of bacteria as related as acknowledged in recent guidelines

Mesenchymal stem cells promote healing of nonsteroidal anti-inflammatory drug-related peptic ulcer through paracrine actions in pigs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most important causes of peptic ulcer disease in high-income countries. Proton pump inhibitors are the current standard treatment; however, safety and long-term adverse effects of using these drugs are attracting more and more concerns in recent years. Using a porcine model of NSAID-related gastric ulcer, we herein show that adipose-derived mesenchymal stem cells (ADMSCs) delivered by endoscopic submucosal injection promoted ulcer healing with less inflammatory infiltration and enhanced reepithelization and neovascularization at day 7 and day 21 when compared with the controls (saline injection). However, only few engrafted ADMSCs showed myofibroblast and epithelial cell phenotype in vivo, suggesting the ulcer healing process might be much less dependent on the stem cell transdifferentiation. Further experiment with submucosal injection of MSC-derived secretome revealed a therapeutic efficacy comparable to that of stem cell transplantation. Profiling analysis showed up-regulation of genes associated with inflammation, granulation formation, and extracellular matrix remodeling at day 7 after injection of MSC-derived secretome. In addition, the extracellular signal-regulated kinase/mitogen-activated protein kinase and the phosphoinositide-3-kinase/protein kinase B pathways were activated after injection of ADMSCs or MSC-derived secretome. Both signaling pathways were involved in mediating the major events critical to gastric ulcer healing, including cell survival, migration, and angiogenesis. Our data suggest that endoscopic submucosal injection of ADMSCs serves as a promising approach to promote healing of NSAID-related peptic ulcer, and the paracrine effectors released from stem cells play a crucial role in this process.

Peptic Ulcer Healing Activity of Fruit Pulp Extract and Seed Oil of Adansonia digitata Linn

Adansonia digitata (AD) Linn has been used to cure PU in Ayurveda but its efficacy has not been validated. The current study was so carried out to evaluate the antiulcer activity of ethanolic extract of Adansonia digitata fruit pulp (ADFP), n hexane extract of Adansonia digitata seed oil (ADSO) and their combination (ADFP+ADSO) in rats. The effect of AD on gastric ulcer in pylorus ligation induced and ethanol induced models was studied using doses [ADFO (500 mg/kg), ADSO (300 mg/kg) and combination of ADFP and ADSO] for 10 days. Omeprazole (10 mg/kg) were used as the standard drug. Depending on the model, outcomes measures were gastric volume, pH, free acidity, total acidity, ulcer index, percentage inhibition of ulcer index, protein, pepsin, mucus, antioxidant marker enzyme level (Superoxide dismutase, Catalase, Lipid peroxidation), morphological and Histopathological study. The result obtained with combination was set up near to the standard drug and consequence showed that the combination of ADFP and ADSO was found to be more effective than the individual extract of AD. The outcomes were statistically evaluated with the one-way ANOVA followed by the test of Dennett’s‘t’. The secondary-metabolites such as flavonoids, proteins, saponins, tannins, phenols, terpenoids, alkaloids and Fatty acids (palmitic acid, oleic acid, linoleic acid) are potent as antioxidant, antiulcer and anti-inflammatory. The finding of this reading confirmed that AD has antiulcer activity due to 1 or more of the secondary-metabolites present in it. Therefore, this study validates its antiulcer use in Ayurveda. Future investigation on separation of specific phytochemicals and elucidate MOA are needed.

Can Helicobacter pylori Infection Accelerate the Healing of Nonsteroidal Anti-inflammatory Drugs-induced Peptic Ulcer and Bleeding?

Can Helicobacter pylori Infection Accelerate the Healing of Nonsteroidal Anti-inflammatory Drugs-induced Peptic Ulcer and Bleeding?

Continuation of low-dose aspirin combined with rabeprazole on healing of peptic ulcer bleeding

Objective To investigate the effect of low-dose aspirin combined with rabeprazole on the healing of peptic ulcer after hemostasis with aspirin-related peptic ulcer bleeding, and to explore the independent factors associated with ulcer healing failure. Methods A total of 138 patients with acute upper gastrointestinal hemorrhage in the Department of Gastroenterology of the Second Affiliated Hospital of Fujian Medical University from June 2016 to June 2018 were enrolled.The clinical data of 138 patients with upper gastrointestinal ulcer bleeding caused by aspirin were analyzed.The patients were randomly divided into two groups.Aspirin group (n=68) received aspirin 100 mg/d plus rabeprazole 80 mg/d, while the placebo group (n=70) received rabeprazole 80 mg/d plus placebo.The patients were treated for 8 weeks.Subjects with H. pylori infection were treated with standard quadruple therapy.Follow-up endoscopy was performed at the end of 8 weeks.The primary endpoint was the healing of peptic ulcers. Results The ulcer healing rate was 79.4%(54/68) in the aspirin group and 84.3%(59/70) in the placebo group.There was no statistically significant difference between the two groups(χ2=0.552, P>0.05). There were 5 cases of ulcer bleeding in aspirin group and placebo group.The rehaemorrhage rate was 7.4%(5/68) and 7.1%(5/70), respectively.There was no statistically significant difference between the two groups(χ2=0.002, P>0.05). Among the factors affecting the healing of aspirin-associated peptic ulcer, the healing rate was significantly associated with steroid use during treatment (χ2=6.135, P=0.041) and smoking status(χ2=5.616, P=0.018). Other factors, including age, hypertension, diabetes, alcohol history, history of previous ulcer bleeding, initial Helicobacter pylori status, and ulcer location did not affect ulcer healing. Conclusion After aspirin-associated peptic ulcer bleeding, continued low-dose aspirin plus rabeprazole did not affect the healing of peptic ulcers, and the use of steroids and smoking status are independent risk factors for ulcer healing. Key words: Dose-response relationship, drug; Aspirin; Nonsteroidal antiinflammatory drugs; Rabeprazole; Drug therapy, combination; Peptic ulcer hemorrhage; Peptic ulcer; Risk factors

EXPRESSIONS OF BASIC FIBROBLAST GROWTH FACTOR IN THE PEPTIC ULCER HEALING DUE THE NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

Background: Basic Fibroblast Growth Factor (bFGF) or FGF2 is the most active angiogenic peptide and plays important role in the pathogenesis of ulcers healing. High levels of bFGF have been describe in healing ulcer in gastrointestinal (GI) or systemic disease. However, its role in phase of peptic ulcer especially at NSAIDs user remains limited data in human. This study was to know the expressions of bFGF in the process of NSAID-induced peptic ulcer healing. Method: Peptic ulcer biopsies were processed for immunohistochemical staining characterization from 46 patients with a history of NSAIDs consumption and upper GI bleeding. Expression of bFGF was quantified as semiquantitative scoring of positive stain as a whole (from 0-+3). Phase evaluation of healing peptic ulcer (Active=A), Healing=H, Cicatrix=C) by Sakita and Fukotomi endoscopy classification. Results: Twenty-seven (58,7%) subject were male patient, mean age 61 ± 8 years and most frequently consumed NSAIDs are meloxicam (12/26,1%). Majority of the subject was in active (A) phase of peptic ulcer healing (27/58,7%). Expression of bFGF was significantly higher in patients with A phase (2.4±0,5) compared with H and C Phase (1.2±0.4; 0.4±0.5 respectively; p

Polymorphisms in the host CYP2C19 gene and antibiotic-resistance attributes ofHelicobacter pyloriisolates influence the outcome of triple therapy

Eradication of Helicobacter pylori is influenced by susceptibility to antimicrobial agents, elevated bacterial load and degree of acid inhibition, which can be affected by genotypes of drug-metabolizing enzymes [cytochrome P450 (CYP) 2C19 polymorphism]. Theoretically, the choice and dose of proton pump inhibitor may also influence the suppression of H. pylori infection. The CYP2C19 genotype has recently been found to have an impact on peptic ulcer healing, H. pylori eradication and therapeutic efficacy of proton pump inhibitors. Here, we investigated the impact of the CYP2C19 genotype polymorphism and the success of triple therapy (fluoroquinolones/metronidazole/clarithromycin) on antibiotic-resistant strains in eradicating H. pylori in human subjects with non-ulcer dyspepsia (NUD), in human subjects with peptic ulcer disease (PUD) and in asymptomatic human subjects (positive and negative for H. pylori infection). Based on the CYP2C19 genotypes, determined by Droplet Digital PCR (ddPCR) analysis, we found 11.2%, 62.5% and 26.3% corresponding to rapid metabolizers, intermediate metabolizers and poor metabolizers, respectively. However, we did not find any significant effect for homozygous ABCB1 or CYP2C19*2 and CYP2C19*3 alleles. We detected several participants heterozygous for both ABCB1 and CYP2C19*2, CYP2C19*3 and CYP2C19*17 loci. The participants heterozygous for both ABCB1 and CYP2C19*2 and *3 loci should be defined as intermediate and poor metabolizers according to the haplotype analysis in the NUD, PUD and asymptomatic subjects. Consequently, fluoroquinolones/metronidazole/clarithromycin-based triple therapies can be used to eradicate H. pylori infection, if one does not know the CYP2C19 genotype of the patient.

Magic Bullet! Rebamipide, a Superior Anti-ulcer and Ophthalmic Drug and Its Large-Scale Synthesis in a Single Organic Solvent via Process Intensification Using Krapcho Decarboxylation

Rebamipide (1) is a superior drug compared to existing drugs for use in healing of peptic ulcers, gastrointestinal bleeding, and dyspepsia. It is also useful as an ophthalmic drug for the treatment of dry eye syndrome. Process intensification for its synthesis was achieved by (i) averting uncontrollable frothing using Krapcho decarboxylation instead of conventional acid hydrolysis, where uncontrollable frothing became chaotic, (ii) minimizing organic waste generation by using a single organic solvent, and (iii) avoiding anti-foaming agents (n-octanol, acetophenone) and acetic acid. With these trifling modifications, the overall yield of active pharmaceutical ingredient (API) was ≥83% with excellent purity (≥99.89%), and the process meets the metrics of “green” chemistry with an E-factor = 11.5. The developed hassle-free commercial process is viable for multi-kilogram synthesis of Rebamipide (1) as the key step, Krapcho decarboxylation is safe to run at 130–140 °C in DMSO, and it was proved to be effective...

ANTI-ULCER ACTIVITY OF AFRICAN LEAVES (VERNONIA AMYGDALINA DEL.) ETHANOL EXTRACT ON MALE RAT

Objectives: This study aims to evaluate the anti-ulcer activity of African leaves (Vernonia amygdalina Del.) ethanol extract on male rat.Methods: African leaf powder was extracted used ethanol 96% by percolation, then made into a suspension preparation used 0.5% Na-CMC with 3 dose variations (100, 200 and 400 mg/kg). Further tested its effectiveness in healing peptic ulcer in gastric-induced rats using acetosal dose 800 mg/kg with oral administration every day until surgery at 3, 8, and 14. Observations include macroscopic (number and index of ulcer) and microscopic (histopathological test).Results: A significant healing of ulcer was observed. The extract 100, 200, and 400 mg/kg group showed significant (p<0.05) reduction in number and index of ulcer as compared to the negative control. The most effective dose is 200 mg/kg because it has the greatest ability to reduce the number and index of ulcers and has the fastest recovery day.Conclusion: Results of this study indicated that African leaves (V. amygdalina Del.) ethanol extract has potential anti-ulcer activity.

Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials

SummaryBackgroundGastroprotectant drugs are used for the prevention and treatment of peptic ulcer disease and might reduce its associated complications, but reliable estimates of the effects of gastroprotectants in different clinical settings are scarce. We aimed to examine the effects of proton-pump inhibitors (PPIs), prostaglandin analogues, and histamine-2 receptor antagonists (H2RAs) in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs.MethodsWe searched MEDLINE and Embase from Jan 1, 1950, to Dec 31, 2015, to identify unconfounded, randomised trials of a gastroprotectant drug (defined as a PPI, prostaglandin analogue, or H2RA) versus control, or versus another gastroprotectant. Two independent researchers reviewed the search results and extracted the prespecified outcomes and key characteristics for each trial. We did meta-analyses of the effects of gastroprotectant drugs on ulcer development, bleeding, and mortality overall, according to the class of gastroprotectant, and according to the individual drug within a gastroprotectant class.FindingsWe identified comparisons of gastroprotectant versus control in 849 trials (142 485 participants): 580 prevention trials (110 626 participants), 233 healing trials (24 033 participants), and 36 trials for the treatment of acute upper gastrointestinal bleeding (7826 participants). Comparisons of one gastroprotectant drug versus another were available in 345 trials (64 905 participants), comprising 160 prevention trials (32 959 participants), 167 healing trials (28 306 participants), and 18 trials for treatment of acute upper gastrointestinal bleeding (3640 participants). The median number of patients in each trial was 78 (IQR 44·0–210·5) and the median duration was 1·4 months (0·9–2·8). In prevention trials, gastroprotectant drugs reduced development of endoscopic ulcers (odds ratio [OR] 0·27, 95% CI 0·25–0·29; p<0·0001), symptomatic ulcers (0·25, 0·22–0·29; p<0·0001), and upper gastrointestinal bleeding (0·40, 0·32–0·50; p<0·0001), but did not significantly reduce mortality (0·85, 0·69–1·04; p=0·11). Larger proportional reductions in upper gastrointestinal bleeding were observed for PPIs than for other gastroprotectant drugs (PPIs 0·21, 99% CI 0·12–0·36; prostaglandin analogues 0·63, 0·35–1·12; H2RAs 0·49, 0·30–0·80; phet=0·0005). Gastroprotectant drugs were effective in preventing bleeding irrespective of the use of non-steroidal anti-inflammatory drugs (phet=0·56). In healing trials, gastroprotectants increased endoscopic ulcer healing (3·49, 95% CI 3·28–3·72; p<0·0001), with PPIs more effective (5·22, 99% CI 4·00–6·80) than prostaglandin analogues (2·27, 1·91–2·70) and H2RAs (3·80, 3·44–4·20; phet<0·0001). In trials among patients with acute bleeding, gastroprotectants reduced further bleeding (OR 0·68, 95% CI 0·60–0·78; p<0·0001), blood transfusion (0·75, 0·65–0·88; p=0·0003), further endoscopic intervention (0·56, 0·45–0·70; p<0·0001), and surgery (0·72, 0·61–0·84; p<0·0001), but did not significantly reduce mortality (OR 0·90, 0·72–1·11; p=0·31). PPIs had larger protective effects than did H2RAs for further bleeding (phet=0·0107) and blood transfusion (phet=0·0130).InterpretationGastroprotectants, in particular PPIs, reduce the risk of peptic ulcer disease and its complications and promote healing of peptic ulcers in a wide range of clinical circumstances. However, this meta-analysis might have overestimated the benefits owing to small study bias.FundingUK Medical Research Council and the British Heart Foundation.

Management of acute upper gastrointestinal bleeding

The medical management of patients with acute upper gastrointestinal bleeding includes both diagnostic and therapeutic procedures. Emergency or early endoscopy has greatly improved the diagnosis, but it has not yet changed the therapeutic approach very much. The main emphasis is still on close observation of the patients in order to give blood transfusions when necessary and to identify those who need urgent operation. Most patients stop bleeding spontaneously, but the frequency of rebleeding is high. Patients with continuous bleeding or rebleeding are candidates for emergency operation. Much effort has been made to prevent rebleeding because, if the patients can be operated on electively, the frequency of complications is lower and vagotomy may be preferable to resection. Several medical treatments including antacids, H2-receptor antagonists, pepsin inhibitors and specific antifibrinolytic agents have been tried, but their value is still sub judice. Curiously, methods of treatment that are clearly effective in healing peptic ulcers seem less effective in preventing rebleeding from eroded vessels within such ulcerations.

Exendin-4, a glucagon-like peptide-1 analogue accelerates healing of chronic gastric ulcer in diabetic rats

BackgroundDiabetes mellitus is an independent risk factor for impaired healing of peptic ulcers, and there are currently no supplementary therapeutics other than the standard antipeptic medicine to improve the ulcer healing in diabetes. This study examined the potential pleiotropic effect of a glucagon-like peptide (Glp)-1 analogue exendin (Ex)-4 on the regeneration of gastric ulcer in streptozotocin-induced diabetic rats.Methods and resultsChronic ulcer was created in rat stomach by submucosal injection of acetic acid and peri-ulcer tissues were analyzed 7 days after operation. Ulcer wound healing was impaired in diabetic rats with suppressed tissue expression of eNOS and enhanced levels of pro-inflammatory reactions. Treatment with intraperitoneal injection of Ex4 (0.5 μg/kg/d) significantly reduced the area of gastric ulcer without changing blood glucose level. Ex-4 restored the expression of pro-angiogenic factors, and attenuated the generation of regional inflammation and superoxide anions. The improvement of ulcer healing was associated with increased expression of MMP-2 and formation of granulation tissue in the peri-ulcer area.ConclusionAdministration of Ex4 may induce pro-angiogenic, anti-inflammatory and anti-oxidative reactions in the peri-ulcer tissue of diabetic rats that eventually enhances tissue granulation and closure of ulcerative wounds. Our results support the potential clinical application of Glp-1 analogues as supplementary hypoglycemic agents in the antipeptic ulcer medication in diabetes.

Effect of add-on proton pump inhibitors on parameters of glycemic control in type-2 diabetic patients

Proton pump inhibitors (PPIs) block the parietal cell H+/K+ ATPase, are superior at suppressing acid secretion &amp; promoting peptic ulcer healing, wildly used clinically for the therapy of gastro-esophageal reflex disease, gastritis due to excess stomach acid, and gastric ulcers. After blocking the production of gastric acid, the proton-pump inhibitors indirectly elevate serum gastrin levels via a negative feedback effect. Evidences are reported that gastrin promotes β cell neogenesis in pancreatic ductal complex, modest pancreatic β cell replication and improvement of glucose tolerance in animal models. Some recent clinical studies have shown improved glucose tolerance in type-2 diabetes mellitus (T2DM). Although PPIs may be possible candidates for a new approach in the therapy of diabetes, a prospective, long-term, randomized, double-blind, placebo-controlled study is needed to establish the effect of PPIs on glycemic control in a large number of patients with T2DM.

Chemopreventive effect and angiogenic activity of punicalagin isolated from leaves of Lafoensia pacari A. St.-Hil.

Punicalagin is the major ellagitannin constituent from leaves of Lafoensia pacari, a Brazilian medicinal plant widely used for the treatment of peptic ulcer and wound healing. Genotoxic, cytotoxic, antigenotoxic, and anticytotoxic effects of punicalagin were assessed using micronucleus (MN) test and comet assay in mice. Due to the extensive use of L. pacari in the wound healing process, we also assessed the angiogenic activity of punicalagin using the chick chorioallantoic membrane (CAM) angiogenic assay. The highest dose of punicalagin (50mg/kg) showed significant cytotoxic effect by MN test and in the co-treatment with cyclophosphamide (CPA), this cytotoxicity was enhanced. Co-treatment, pre-treatment and post-treatment of punicalagin with CPA led to a significant reduction in the number of DNA breaks and in the frequency of CPA-induced MN, indicating antigenotoxic effect. Using the CAM model, punicalagin exhibited angiogenic activity in all doses mainly at the lowest concentration (12.5μg/μL). Therefore, these findings indicate an effective chemopreventive role of punicalagin and a high capacity to induce DNA repair. Also, the angiogenic activity presented by punicalagin in this study could contribute for the processes of tissue repairing and wound healing.

Mo1266 Submucosal Injection of Adipose Derived Mesenchymal Stem Cells Enhanced Healing of Peptic Ulcer

Mo1266 Submucosal Injection of Adipose Derived Mesenchymal Stem Cells Enhanced Healing of Peptic Ulcer

Protocolo diagnóstico y tratamiento de la infección por Helicobacter pylori

EpidemiologyWith a worldwide prevalence rate of 50%, H. pylori is the most common bacterial infection in the world. Clinical manifestationsAlthough the majority of patients are asymptomatic, different symptoms and relevant pathologies may be caused by it, highlighting dyspepsia, peptic ulcer and gastric cancer. In fact, H. pylori infection is the main cause of peptic ulcer disease and is an important cofactor in the development of gastric lymphoma and adenocarcinoma. Diagnosis and treatmentH. pylori eradication therapy allows the complete healing of peptic ulcer, which has meant a real revolution in the gastroenterology. The proper diagnosis methodology, treatment indications and the most appropriate therapeutic regimens for the eradication of bacteria are related in the present guidelines.

Effect of Sanhuangwuji powder, anti-rheumatic drugs, and ginger-partitioned acupoint stimulation on the treatment of rheumatoid arthritis with peptic ulcer: a randomized controlled study

ObjectiveTo observe the efficacy and safety of oral Sanhuangwuji powder, anti-rheumatic drugs (ARDs), and ginger-partitioned acupoint stimulation at Zusanli (ST 36) on the treatment of rheumatoid arthritis (RA) complicated by peptic ulcer. MethodsThis prospective randomized controlled study included 180 eligible inpatients and outpatients randomly assigned to an ARD treatment (n = 60), ginger-partitioned stimulation (n = 60), or combination treatment (n = 60). Patients assigned to the ARD group were given oral celecoxib, methotrexate, and esomeprazole. Patients assigned to theginger-partitioned stimulation group were given ginger-partitioned acupoint stimulation at Zusanli (ST 36) in addition to the ARDs. Patients in the combination treatment group were given oral Sanhuangwuji powder, ginger-partitioned acupoint stimulation at Zusanli (ST 36), and ARDs. All patients were followed up for 2 months to evaluate clinical effects and safety. The study was registered in the World Health Organization database at the General Hospital of Chengdu Military Area Command PLA (ChiCTR-TCC12002824). ResultsThe combination treatment group had significantly greater improvements in RA symptoms, laboratory outcomes, and gastrointestinal symptom scores, compared with the other groups (P < 0.05). The peptic ulcer healing rate in the combination treatment group was significantly greater than that in the ARD treatment group (χ2 = 16.875, P < 0.05) and the ginger-partitioned stimulation group(χ2 = 6.171, P < 0.05). ConclusionsCombination treatment with ginger-partitioned acupoint stimulation at Zusanli (ST 36), oral Sanhuangwuji powder, and ARDs had a better clinical effect for RA with complicated peptic ulcer, compared with ARD treatmentalone or in combination with ginger-partitioned acupoint stimulation.