Management Of Peptic Ulcer Research Articles

Evaluation of the Inhibitory Effect of a Medicinal Herb <i>Phyllanthus amarus</i> on the Activity of <i>α</i>-Amylase, Pepsin and Trypsin

The medical herb Phyllanthus amarus play a crucial role in indigenous medicine. Therapeutically, these plants’ extract acts as potential players that inhibits several digestive enzymes that are relevant to the management of Peptic ulcers and Diabetes Mellitus, which occur due to the overproduction of such enzymes. Evaluation of inhibitory effect of this extract was carried out against Pepsin, α-amylase, Trypsin enzymes along with the effect of thermal stability and ammonium sulphate precipitation on these inhibitory assays. P. amarus leave’s extract with different concentration gradients were used in this research analysis. Results obtained along with the literature analysis revealed photochemical compounds such as polyphenols causes inhibitory nature in the extract. Maximal percentage of inhibition of amylase, pepsin and trypsin were found to be 71% (0.32 mg/ml), 85% (0.08 mg/ml) and 87% (1.28 mg/ml) respectively. In thermal stability assay the maximum percentage of inhibition for amylase, pepsin and trypsin was observed at 30% (80°C), 68% (4°C) and 5% (37°C). Enzymes inhibitory assays on ammonium sulphate precipitation elicited maximum percentage of inhibition for amylase, pepsin and trypsin as 42% (at 45% of (NH4)2SO4), 58% (at 15% of (NH4)2SO4) and 40% (at 30% of (NH4)2SO4) respectively. This research concluded that Phyllanthus amarus leave extracts are potential inhibitors of α-amylase, pepsin and trypsin enzymes. Ammonium sulphate precipitation was helpful to purify the polyphenols the active compounds to a good extend. Also, thermal stability was helpful to check the stability of these active photochemical compounds present in the extract. Thus, P. amarus is an effective inhibitor to be used as supplements in the disease management.

Antioxidant and Antiulcerogenic Activity of the Dry Extract of Pods of Libidibia ferrea Mart. ex Tul. (Fabaceae).

Ethnomedicinal studies in the Amazon community and in the Northeast region of Brazil highlight the use of Libidibia ferrea fruits for the treatment of gastric problems. However, there are no data in the literature of this pharmacological activity. Thus, the aim of this paper is to provide a scientific basis for the use of the dry extract of L. ferrea pods (DELfp) for the treatment of peptic ulcers. Phytochemical characterization was performed by HPLC/MS. In vitro antioxidant activity was assessed using DPPH, ABTS, phosphomolybdenum, and superoxide radical scavenging activity. The gastroprotective activity, the ability to stimulate mucus production, the antisecretory activity, and the influence of -SH and NO compounds on the antiulcerogenic activity of DELfp were evaluated. The healing activity was determined by the acetic acid-induced chronic ulcer model. Anti-Helicobacter pylori activity was investigated. HPLC/MS results identified the presence of phenolic compounds, gallic acid and ellagic acid, in DELfp. The extract showed antioxidant activity in vitro. In ulcers induced by absolute ethanol and acidified ethanol, the ED50 values of DELfp were 113 and 185.7 mg/kg, respectively. DELfp (100, 200, and 400 mg/kg) inhibited indomethacin-induced lesions by 66.7, 69.6, and 65.8%, respectively. DELfp (200 mg/kg) reduced gastric secretion and H+ concentration in the gastric contents and showed to be independent of nitric oxide (NO) and dependent on sulfhydryl (-SH) compounds in the protection of the gastric mucosa. In the chronic ulcer model, DELfp reduced the area of the gastric lesion. DELfp also showed anti-H. pylori activity. In conclusion, DELfp showed antioxidant, gastroprotective, healing, and antiulcerogenic activities. The mechanism of these actions seems to be mediated by different pathways and involves the reduction of gastric secretion and H+ concentration, dependence on sulfhydryl compounds, and anti-H. pylori activity. All these actions support the medicinal use of this species in the management of peptic ulcers.

Surgical outcome of management of perforated peptic ulcer: retrospective analysis of 148 cases

Background: Perforated peptic ulcer (PPU) is a common life threatening surgical emergency. Discovery of H. pylori (1985) changed the concept of the management of peptic ulcer. Now-a-days reduction in gastric acid production with proton pump inhibitors along with eradication of H. pylori is recommended.Methods: Clinically suspected cases of PPU were confirmed by radiological and laboratory investigation. These patients were subjected to exploratory laparotomy with Graham’s omental patch repair after adequate fluid resuscitation with optimal hemodynamic status with or without peritoneal drainage, except in too sick patients. Postoperatively; these patients kept in SICU and closely monitored. Data were collected, tabulated and analyzed.Results: Out 150 cases enrolled, 2 cases died before exploratory laparotomy and closure of operation. So only 148 took part in the study. Male patients were predominant than female in a ratio of 148:2. Age ranges from 20 to >60 years. Majority of the patients belongs to the age group 30-40 years of age. The morbidity and mortality rates were 20% and 2.7% respectively.Conclusions: Adequate fluid resuscitation with optimal hemodynamic status and optimal kidney function is the key to decrease morbidity and mortality rates. Simple closure with omental patch followed by H. pylori eradication is effective with excellent outcome in most of survivor despite of late presentation. Old concept of prophylactic peritoneal drainage and “no sunset no sun rise” concept of operation should be discouraged as it is not beneficial. Definitive surgery for ulcer recurrence is no more done except in special situation.

Endoscopic Management of Peptic Ulcer Bleeding: Recent Advances.

Bleeding peptic ulcers remained as one of the commonest causes of hospitalization worldwide. While endoscopic hemostasis serves as primary treatment for bleeding ulcers, rebleeding after endoscopic hemostasis becomes more and more difficult to manage as patients are usually poor surgical candidates with multiple comorbidities. Recent advances in management of bleeding peptic ulcers aimed to further reduce the rate of rebleeding through—(1) identification of high risk patients for rebleeding and mortality; (2) improvement in primary endoscopic hemostasis and; (3) prophylactic angiographic embolization of major arteries. The technique and clinical evidences for these approaches will be reviewed in the current article.

An analytical study of acute abdomen in established cases of pneumoperitoneum

Background: Pneumoperitoneum refers to the presence of air within the peritoneal cavity. The most common cause is a perforation of the abdominal viscous, a perforated ulcer, although a pneumoperitoneum may occur as a result of perforation of any part of the bowel. The exception is a perforated appendix, which seldom causes a pneumoperitoneum. The aim of present investigation was to know the various clinical features of acute abdomen in established cases of pneumoperitoneum and to study the various surgical techniques used in the management.Methods: This study is an analytical study of 103 patients admitted in emergency surgical wards. The relevant history, clinical examination, relevant investigations, and treatment were obtained by pretested proforma.Results: The symptoms such as abdominal pain, abdominal distension, fever, and vomiting were present in our study. The most common symptom was an abdominal pain in almost all cases the overall mortality in our study was 6.79% most of them is due to colonic and duodenal perforations. In most of the cases, the cause of death was diagnosed as septicemia.Conclusions: The incidence of GI Perforations can be reduced by educating the patients with appropriate medical management of peptic ulcer, tuberculosis, typhoid fever and also avoiding factors such as smoking and Alcohol.

The Impacts of Peptic Ulcer on Stroke Recurrence

Peptic ulcer has been associated with an increased risk of stroke. This study aimed to evaluate the impacts of peptic ulcer on stroke recurrence and mortality. Patients with first-ever ischemic stroke were retrospectively confirmed with or without a history of peptic ulcer. The primary end point was defined as fatal and nonfatal stroke recurrence. Risks of 1-year fatal and nonfatal stroke recurrence were analyzed with the Kaplan-Meier method. Predictors of fatal and nonfatal stroke recurrence were evaluated with the Cox proportional hazards model. Among the 2577 enrolled patients with ischemic stroke, 129 (5.0%) had a history of peptic ulcer. The fatal and nonfatal stroke recurrence within 1 year of the index stroke was higher in patients with peptic ulcer than in patients without peptic ulcer (12.4% versus 7.2%, P = .030). Cox proportional hazards model detected that age (hazard ratio [HR] = 1.018, 95% confidence interval [CI] 1.005-1.031, P = .008), hypertension (HR = 1.397, 95% CI 1.017-1.918, P = .039), and history of peptic ulcer (HR = 1.853, 95% CI 1.111-3.091, P = .018) were associated with stroke recurrence. Ischemic stroke patients with peptic ulcer may have an increased risk of stroke recurrence. The results emphasize the importance of appropriate prevention and management of peptic ulcer for secondary stroke prevention.

GC-MS Analysis and Gastroprotective Evaluations of Crude Extracts, Isolated Saponins, and Essential Oil from Polygonum hydropiper L.

Peptic ulceration is among the most prevalent gastrointestinal disorders characterized by pepsin and gastric acid mediated mucosal damage, as result of imbalance between defensive and offensive processes. The main objective of the current study was to investigate the antiulcer potentials of Polygonum hydropiper crude methanolic ectract (Ph.Cr) in aspirin induced ulcerogenesis using pylorus ligated rat model. In-vitro urease and Proteus mirabilis inhibitory potentials were evaluated using standard protocols. All fractions were analyzed using GC-MS to identify major components. The aspirin induced ulcerogenesis in pylorus ligated rat model was associated with significant changes in the mean ulcer score [F(5, 30) = 7.141, P = 0.0002], gastric juice volume [F(5, 30) = 8.245, P < 0.0001], gastric juice pH [F(5, 30) = 5.715, P = 0.0008], free acidity [F(5, 30) = 4.544, P = 0.0033], total acidity [F(5, 30) = 2.740, P = 0.0373], and pepsin concentration [F(5, 30) = 2.335, P = 0.0664]. Pre-treatment with Ph.Cr at 100, 200, and 400 mg/kg dose exhibited marked gastroprotective and anti-ulcerogenic effect in the aspirin induced pyloric ligation ulcerogenesis model at 100, 200, and 400 mg/kg as indicated by ulcerative biochemical parameters. In urease inhibition assay, leaves essential oil (Ph.Lo), saponins (Ph.Sp), and chloroform extract (Ph.Chf) exhibited highest activities with IC50 of 90, 98, and 520 μg/ml, respectively. Ph.Sp, Ph.Chf, ethyl acetate (Ph.EtAc), and Ph.Cr showed MICs of 25, 30, 32.25, and 40.50 μg/ml, respectively against P. mirabilis. Several compounds were identified in GC-MS analysis of samples. Significant in-vivo antiulcer, urease inhibitory as well as anti-proteus potentials of P. hydropiper solvent extracts, signify its potential use for the management of peptic ulcers and may provide scientific bases for the traditional uses of the plant.

Association of Vagotomy and Decreased Risk of Subsequent Ischemic Stroke in Complicated Peptic Ulcer Patients: an Asian Population Study.

The primary management of peptic ulcers is medical treatment. Persistent exacerbation of a peptic ulcer may lead to complications (perforation and/or bleeding). There has been a trend toward the use of a less invasive surgical simple suture, simple local suture or non-operative (endoscopic/angiography) hemostasis rather than acid-reducing vagotomy (i.e., vagus nerve severance) for treating complicated peptic ulcers. Other studies have shown the relationship between high vagus nerve activity and survival in cancer patients via reduced levels of inflammation, indicating the essential role of the vagus nerve. We were interested in the role of the vagus nerve and attempted to assess the long-term systemic effects after vagus nerve severance. Complicated peptic ulcer patients who underwent truncal vagotomy may represent an appropriate study population for investigating the association between vagus nerve severance and long-term effects. Therefore, we assessed the risks of subsequent ischemic stroke using different treatment methods in complicated peptic ulcer patients who underwent simple suture/hemostasis or truncal vagotomy/pyloroplasty. We selected 299,742 peptic ulcer patients without a history of stroke and Helicobacter pylori infection and an additional 299,742 matched controls without ulcer, stroke, and Helicobacter pylori infection from the National Health Insurance database. The controls were frequency matched for age, gender, Charlson comorbidity index (CCI) score, hypertension, hyperlipidemia history, and index year. Then, we measured the incidence of overall ischemic stroke in the two cohorts. The hazard ratio (HR) and the 95% confidence intervals (CIs) were estimated by Cox proportional hazard regression. Compared to the controls, peptic ulcer patients had a 1.86-fold higher risk of ischemic stroke. There were similar results in gender, age, CCI, hypertension, and hyperlipidemia stratified analyses. In complicated peptic ulcer patients, those who received truncal vagotomy and pyloroplasty had a lower risk of ischemic stroke than patients who received simple suture/hemostasis (HR=0.70, 95% CI=0.60-0.81). Our findings suggest that patients with peptic ulcers have an elevated risk of subsequent ischemic stroke. Moreover, there were associations between vagotomy and a decreased risk of subsequent ischemic stroke in complicated peptic ulcer patients.

Role of Vegetables (Shaka Dravyas) in Prevention and Management of Gastro - Intestinal Tract Diseases: A Critical Review

Background: Ayurveda describes diet as the best preventive medicine and mentioned its role for the prevention and management of many diseases. Classical texts of Ayurveda delineated different vegetables under “Shakavarga”, with their properties and indications in different disease conditions. These vegetables are advocated as Pathya Ahara (wholesome diet) in clinical practice for treating different lifestyle diseases due to faulty food habits. Aims: To critically evaluate the role of vegetables indicated as Pathya for gastrointestinal tract diseases. Material and methods: Four Samhita and eleven different Nighantu were reviewed. The obtained data have been analyzed and being presented in a precise manner with regards to their various reported activity on gastrointestinal diseases. Results: Analysis of the compiled data reveals that out of 324 plants, described under Shakavarga, 58 vegetables are indicated in the diseases related to gastrointestinal tract like Ajirna (Dyspepsia), Arshas (Hemorrhoids), Grahani (Malabsorption syndrome) etc. Among them, botanical identity of 57 classical plants has been established and maximum number of vegetables belongs to the family Cucurbitaceae & Solanaceae. Different parts of the plants like leaves, fruits, rhizome/tuber, stem, owers are recommended as vegetables in gastrointestinal diseases. Some of these vegetables are also reported for their effect in the management of peptic ulcer, chronic inammatory bowel disease etc. Conclusion: The observed results may be helpful in planning further scientic studies about the efcacy of these plants on prevention as well as management of gastrointestinal diseases.

Gastroprotective potential of hydro-alcoholic extract of Pattanga (Caesalpinia sappan Linn.)

Ethno-pharmacological relevancePattanga is botanically equated as Caesalpinia sappan Linn. (Family: Caesalpiniaceae) and is used in Ayurveda system of medicine since ages. According to Ayurveda, useful part is Heartwood, which is bitter, astringent and acrid and is useful in vitiated conditions of vata and pitta, burning sensation, wounds, ulcers, leprosy, skin diseases, menorrhagia, leucorrhea, and diabetes. It is used as a major ingredient in Ayurvedic formulations and preparations like Patrangasava, Chandanadya Thalia, and Karpuradyarka. Aim of the studyThe present study is planned to evaluate the gastroprotective activity of the selected Ayurvedic drug using three different in vivo gastric ulcer models, so as to provide scientific evidence for the Ayurvedic claims. Materials and methodsFor this study, Wistar albino rats fasted overnight were selected. The hydroalcoholic extract of Caesalpinia sappan heartwood at the dose level 250 and 500mg/kg body weight was selected and administered orally before necrotizing agents. Antioxidant and antiulcer parameters were evaluated and the stomach samples were subjected for histopathological studies. In addition, PGE2 estimation and protein expressions of COX-1, COX-2 and iNOS were analyzed by Western blot. The plant extract was subjected to LCMS/MS analysis. In addition, Cytoprotective effect in isolated gastric mucosal cells, TUNEL Assay, Acid neutralizing capacity assay, H+/K+ ATPase inhibitory assay were performed. ResultsThe ulcer protection was found to be 92%, 86% and 64% against ethanol, NSAID and pylorus ligation induced ulcer respectively. The hydro-alcoholic extract of C. sappan heartwood exhibited cytoprotective effect with 76.82% reduction against indomethacin-induced cytotoxicity at the concentration of 25µg/ml. C. sappan showed 63.91% inhibition in H+/K+ ATPase inhibitory assay at the concentration 500µg/ml. ConclusionsOur results depict that Caesalpinia sappan heartwood possesses gastroprotective activity, possibly mediated through cytoprotection and antioxidant mechanisms. The data obtained in the present study provides scientific support for the traditional use of Caesalpinia sappan in the management of peptic ulcer.

Updates in Drug Development Strategies against Peptic ulcer

Traditional use of antacids and use of histamine inhibitors have become ineffective in the management of peptic ulcer. Irreversible inhibition of proton pump although reduces ulceration, in the long run leads to adverse issues. It has not been possible to develop an ideal proton pump inhibitor. In this scenario, search for alternatives by capitalizing on the multifactorial etiology of ulceration holds promise.

Circadian time structure of circulating plasma lipid peroxides, antioxidant enzymes and other small molecules in peptic ulcers

BackgroundThe circadian rhythm, as part of a broad time structure (chronome) of lipid peroxides and antioxidant defense mechanisms may relate to prevention, efficacy and management of preventive and curative chronotherapy. MethodsFifty newly diagnosed patients with peptic ulcers, 30–45years of age, and 60 age-matched clinically healthy volunteers were synchronized for one week with diurnal activity from about 06:00 to about 22:00 and nocturnal rest. Breakfast was served around 08:30, lunch around 13:30 and dinner around 20:30. Drugs known to affect the free-radical systems were not taken. Blood samples were collected at 6-hour intervals for 24h under standardized, presumably 24-hour synchronized conditions. Plasma lipid peroxides, in the form of malondialdehyde (MDA), blood superoxide dismutase (SOD), glutathione peroxide (GPx), glutathione reductase (GR), catalase (CAT) activities, and serum total protein, albumin, ascorbic acid, total serum cholesterol, and HDL-cholesterol concentrations were determined. ResultsBy population-mean cosinor analysis, a marked circadian variation was demonstrated for all variables in healthy subjects and in ulcer patients (p<0.001). As compared to controls, patients had a lower MESOR of MDA, SOD, GPx, GR, ascorbic acid, and HDL-C. They also had smaller circadian amplitude of SOD, CAT, GPx, GR, ascorbic acid, T-C, and HDL-C, but larger circadian amplitude of MDA and albumin. As compared to healthy subjects, the circadian acrophase of ulcer patients occurred later for MDA and GR and earlier for GPx. ConclusionMapping circadian rhythms, important chronome components that include trends with age and extra-circadian components characterizing antioxidants and pro-oxidants, is needed for exploring their putative role as markers in the treatment and management of peptic ulcers.

Vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų diagnostika ir gydymas

ObjectivesPerforated peptic ulcer (PPU) is a rare but life-threatening surgical emergency in childhood. The aim of our study was to analyse the clinical features, diagnosis and management of PPU in children.MethodsThe data of children diagnosed with gastroduodenal PPU at Children’s Surgery Department, Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos from 1994 to 2012 were reviewed. The patients’ age, sex, anamnesis, clinical features, examination results, operative findings and methods, medication therapy and outcomes were assessed. Statistical analysis was performed using MS Excel.ResultsThere were 14 (93.3%) males and one female aged 14 to 18 years (16.3 ± 1.3) included in the study. Twelve patients (80%) were diagnosed with gastric and 3 (20%) with duodenal PPU. Eleven patients (73.3%) had dyspepsia before PPU, of them 4 had a history of peptic ulcer disease. Most patients (46.6%) arrived to the hospital within 6 hours of symptom onset. All presented with severe epigastric pain, 8 (53.3%) with nausea and vomiting. Only one patient (6.6%) complained of melena. One (6.6%) suffered from epigastric pain radiating to the left shoulder. Physical examination revealed positive peritoneal signs in 13 patients (86.6%). Subdiaphragmatic free air was detected in 12 patients (80%). The mean duration of perforation was 34.47 ± 57.41 hours (2–178). Thirteen patients (86.6%) underwent laparotomy, 2 laparoscopic repair. The anterior wall of the prepyloric gastric region was the commonest perforation site (80%). Eight patients (53.4%) had a course of H. pylori eradication therapy. The average hospital stay was 10.6 ± 6.3 days (4–32). Fourteen patients (93.3%) had an uneventful postoperative period, one developed nephrotic range proteinuria. All recovered fully.ConclusionsGastroduodenal PPU should be suspected in adolescent boys with a sudden onset of severe abdominal pain, positive peritoneal signs, and confirmed by pneumoperitoneum in the plain X-ray. Simple closure and eradication of H. pylori (when infection confirmed) are mandatory for a complete recovery.

Role of dietary polyphenols in the management of peptic ulcer.

Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.

An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults

Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer.

Gastroretentive drug delivery systems for therapeutic management of peptic ulcer.

A peptic ulcer, stomach ulcer, or gastric ulcer, also known as peptic ulcer disease (PUD), is a very common chronic disorder of the stomach which is mainly caused by damage or impairment of the stomach lining. Various factors such as pepsin, gastric acid, H. pylori, NSAIDs, prostaglandins, mucus, bicarbonate, and blood flow to mucosa play an important role in causing peptic ulcers. In this review article, our main focus is on some important gastroretentive drug delivery systems (GRDDS) (floating, bioadhesive, high density, swellable, raft forming, superporous hydrogel, and magnetic systems) which will be helpful in gastroretention of different dosage forms for treatment of peptic ulcer. GRDDS provides a mean for controlled release of compounds that are absorbed by active transport in the upper intestine. It also enables controlled delivery for paracellularly absorbed drugs without a decrease in bioavailability. The above approaches are specific for targeting and leading to a marked improvement in the quality of life for a large number of patients. In the future, it is expected that they will become of growing significance, finally leading to improved efficiencies of various types of pharmacotherapies.

Scientific evaluation of edible fruits and spices used for the treatment of peptic ulcer in traditional Iranian medicine.

In traditional Iranian medicine (TIM), several edible fruits and spices are thought to have protective and healing effects on peptic ulcer (PU). The present study was conducted to verify anti-PU activity of these remedies. For this purpose, edible fruits and spices proposed for the management of PU in TIM were collected from TIM sources, and they were searched in modern medical databases to find studies that confirmed their efficacy. Findings from modern investigations support the claims of TIM about the efficacy of many fruits and spices in PU. The fruit of Phyllanthus emblica as a beneficial remedy for PU in TIM has been demonstrated to have antioxidant, wound healing, angiogenic, anti-H. pylori, cytoprotective, antisecretory, and anti-inflammatory properties. The fruit of Vitis vinifera has been found to be anti-H. pylori, anti-inflammatory, wound healing, angiogenic, cytoprotective, and antioxidant. The fruit and aril of seed from Myristica fragrans exert their beneficial effects in PU by increasing prostaglandin, modulation of nitric oxide and inflammatory mediators, wound healing, antisecretory, antacid, antioxidant, and anti-H. pylori activities, and improving angiogenesis. Pharmacological and clinical studies for evaluation of efficacy of all TIM fruits and spices in PU and their possible mechanisms of action are recommended.

In VivoModels Used for Evaluation of Potential Antigastroduodenal Ulcer Agents

Peptic ulcer is among the most serious gastrointestinal diseases in the world. Several orthodox drugs are employed for the treatment of the disease. Although these drugs are effective, they produce many adverse effects thus limiting their use. In recent years, there has been a growing interest in alternative therapies, especially those from plants due to their perceived relative lower side effects, ease of accessibility, and affordability. Plant medicines with ethnomedicinal use in peptic ulcer management need to be screened for their effectiveness and possible isolation of lead compounds. This requires use of appropriate animal models of various ulcers. The limited number of antiulcer models for drug development against gastric and duodenal ulcer studies has hindered the progress of targeted therapy in this field. It is, therefore, necessary to review the literature on experimental models used to screen agents with potential antigastroduodenal ulcer activity and explain their biochemical basis in order to facilitate their use in the development of new preventive and curative antiulcer drugs. Clinical trials can then be carried out on agents/drugs that show promise. In this paper, currentin vivoanimal models of ulcers and the pathophysiological mechanisms underlying their induction, their limitations, as well as the challenges associated with their use have been discussed.

An Evidence-based Review on Medicinal Plants used for the Treatment of Peptic Ulcer in Traditional Iranian Medicine

Many medicinal plants have been identified in Traditional Iranian Medicine (TIM) for the treatment of Peptic Ulcer (PU) but they are still unknown to scientific community. In the present study anti PU activity of these remedies were systematically reviewed and identified. For this purpose, medicinal plants proposed for the management of PU in TIM were collected from TIM sources and they were searched in modern medical databases like PubMed, Scirus, Sciencedirect and Google Scholar to find studies confirmed their efficacy. Findings from modern investigations support the claims of TIM about the efficacy of many of these plants in PU. For example, the oleogum resin o£Boswellia carterii and B. serrata as a beneficial remedy for PU in TIM were demonstrated to have wound healing, cytoprotective, antisecretory, antacid, prostaglandin production and inflammatory modulating properties. Fruit and leaves oiMyrtus communis was found to be antioxidant, anti H. pylori wound healing, antisecretory, antacid and cytoprotective. The aerial part from Melissa officinalis exerts its beneficial effects in PU by antioxidant, anti H. pylori, prostaglandin elevating, cytoprotective, antisecretory, antacid and leukotriene reducing properties. Furthermore, Polygonum species demonstrated its function on PU with prostaglandin enhancement, inflammatory modulation, wound healing, cytoprotection, antacid, antioxidant and anti-H. pylori activity. In contrast, for some of herbal remedies used in TIM such as Dolichos lablab flower, Symphytum species, Zizyphus spina-christi fruit, Alisma plantago-aquatica, Cupressus sempervirens fruit, Acacia Arabica gum, Cyperus species root, Althaea officinalis flower and Nymphaea alba flower there is no enough evidence in modern medicine to prove their effectiveness in the management of PU. Pharmacological and clinical studies for evaluation of efficacy of these herbs in PU and their possible mechanisms of action are recommended. © 2013 Asian Network for Scientific Information.

Role of antisecretory agents for gastric endoscopic submucosal dissection

Gastric endoscopic submucosal dissection (ESD) causes artificial gastric ulcers and there is no consensus regarding the optimal perioperative management in terms of prevention of intra- or postoperative bleeding and promotion of healing. Traditionally, 8-week administration of proton pump inhibitors (PPI) and mucosal protective agents were used in the same way as for peptic ulcer management. However, recent studies have revealed that prior use of PPI might reduce intraoperative bleeding or early-phase postoperative bleeding, and combination of histamine-2 receptor antagonist (H2RA), and second-look endoscopy might have a similar effect on postoperative bleeding to PPI. Additionally, the advantage of PPI over H2RA is not proven and the optimal duration of PPI may be shortened until 2 weeks when the deteriorating factors for ESD ulcer are excluded. Furthermore, mucosal protective agents may facilitate ulcer healing. Further studies are needed to determine the optimal treatment protocol before and after ESD for both prevention of bleeding complication and promotion of ulcer healing, by using available antisecretory agents and mucosal protective agents.