pH Of Gastric Contents Research Articles

Anti H. pylori, anti-secretory and gastroprotective effects of Thymus vulgaris on ethanol-induced gastric ulcer in Sprague Dawley rats.

The objectives of the present study were to evaluate the acute toxicity, gastroprotective, therapeutic, anti-inflammatory and anti H. pylori activities of T. vulgaris total plant extract against ethanol-induced gastric ulcers in Sprague Dawley rats. Animals were divided into five groups i.e G-1 (Normal Control), Group 2 (ulcer control) were administered orally with 0.5% Carboxymethylcellulose (CMC), Group 3 (omeprazole treated) was administered orally with 20 mg/kg of omeprazole and Groups 4 and 5 (Low dose and High dose of the extract) were administered orally with 250, and 500 mg/ kg of Thymus vulgaris extract, respectively. After 1 hour, the normal group was orally administered with 0.5% CMC (5 ml/kg), whereas absolute alcohol (5ml/ kg) was orally administered to the ulcer control group, omeprazole group, and experimental groups. Stomachs were examined macroscopically and microscopically. Grossly, rats pre-treated with T. vulgaris demonstrated significantly decreased ulcer area and an increase in mucus secretion and pH of gastric content compared with the ulcer control group. Microscopy of gastric mucosa in the ulcer control group showed severe damage to gastric mucosa with edema and leukocytes infiltration of the submucosal layer. However, rats pretreated with omeprazole or Thyme vulgaris exhibited a mild to moderate disruption of the surface epithelium and lower level of edema and leukocyte infiltration of the submucosal layer. The T. vulgaris extract caused up-regulation of Hsp70 protein, down-regulation of Bax protein, and intense periodic acid Schiff uptake of the glandular portion of the stomach. Gastric mucosal homogenate of rats pre-treated with T. vulgaris exhibited significantly increased superoxide dismutase (SOD) and catalase (CAT) activities while malondialdehyde (MDA) level was significantly decreased. Based on the results showed in this study, Thymus vulgaris extract can be proposed as the safe medicinal plants for use and it has considerable gastroprotective potential via stomach epithelium protection against gastric ulcers and stomach lesions.

The Myth Of Superfluous Pre-Operative NPO After Midnight.

Madam, Pre-operative nil per or nothing by mouth from midnight practice has been in work since 1960s.1 Its indiscriminate use is believed to prevent perioperative aspiration causing pneumonia 2, respiratory failure, morbidity and mortality. In almost every hospital in Pakistan and globally, the fasting orders from midnight are excessively used in case of morning elective surgical and medical procedures using general or regional anaesthesia.3 These not take into account the duration and type of surgery, type of sedation, choice of airway, risk stratification for increased chances of aspiration such as obesity, age, esophageal disorders. 4 However, the revolutionised current guidelines for pre-operative fasting by ASA 5-6 suggest the much shorter “2-4-6” hour rule, with NPO for two hours for clear liquids, four hours for breast milk and six hours for solids. Hence, the awareness about this myth needs to change in Pakistani healthcare centres. Recent studies have led to a more sophisticated understanding of gastric emptying and pH of gastric contents. For instance, a cochrane review showed no statistical difference in gastric volumes or stomach pH in patients on a prolonged standard fast vs shortened (<180 minute) liquid fast.7 Furthermore, the 2-4-6 rule minimises the risk of dehydration, electrolyte imbalance, patient discomfort (thirst, hunger, nausea, vomiting, anxiety) 8, hypoglycemia, intraoperative haemodynamic instability, post- operative dehyhydration and extended hospital stay. In this way patient cooperation and satisfaction can be increased. Therefore, it is high time to change the highly controversial NPO policy to reach the international healthcare standard.

The Potential Gastro-Protective Effect of Qaysum (Achillea fragrantissima) Against Ethanol-Induced Gastric Ulcer in Wistar Albino Rats.

Gastric ulcer (GU) is among the peak prevalent syndromes. This study investigates the defensive properties of Achillea fragrantissima (Forssk.) Sch.Bip. extract (AFE) against ethanol-induced stomach lesions. Twenty-eight rats were allocated into negative control, positive control, AFE + ethanol, and omeprazole ethanol. In serum and gastric homogenates, oxidative stress displays (e.g., malondialdehyde (MDA), decreased glutathione (GSH), superoxide dismutase enzyme (SOD), and catalase enzyme (CAT)) and inflammatory parameters (e.g., tumor necrosis factor-alpha (TNF-α)) were estimated. GU markers (gastric lesions, ulcer index (UI), pH) were evaluated, and gastric histopathological examinations were performed. The positive control cluster exhibited severe gastric mucosal injuries, reduced stomach mucus secretion, and pH of gastric content. Furthermore, AFE-pretreated rats displayed meaningfully increased periodic acid-Schiff (PAS) countenance in their stomach epithelial layers. Pretreatment with AFE reduced stomach lesions, UI, MDA, and TNF-α levels, while mucus, pH, CAT, GSH, and SOD levels increased. Stomach examination showed significant improvement in gastric mucosa reduced edema and leukocyte infiltration of the submucosal level in pretreatment with the AFE and omeprazole groups versus the ethanol group. Additionally, AFE extracts increase the intensity of the stomach epithelium's PAS. The acute toxicity experiment with an advanced dosage of 5 g/kg AFE did not exhibit any signs of toxicity in the rats. In conclusion, the AFE reduced the effect of ethanol on the gastric mucosa, which may be due to its antioxidants and anti-inflammatory properties.

Effects of Vitamin B on experimentally induced gastric ulcers in rodents

Background: Peptic ulcer disease (PUD) is associated with water soluble vitamin deficiencies. B group vitamins play vital roles in maintenance of essential body functions. PU patients are found to present with Vitamin B deficiency and high rates of Helicobacter pyloric infection. This study aims to investigate the effect of vitamin B (VB) on experimentally induced gastric ulcers in mice Method: Gastric ulcers were induced in adult Swiss albino mice using absolute ethanol, a nonsteroidal anti-inflammatory agent, diclofenac and acetic acid. Animal were treated for 7 days with vitamin B at 12.5, 25 and 50 mg/kg before ulcer induction with ethanol and diclofenac, while in the acetic acid induced ulcers, treatment (VB 50 mg/kg) was administered for 14 and 28 days post ulcer induction. The degree of gastric ulceration was scored after which tissues subjected to histological analysis Results: The results showed that vitamin B ameliorated ulceration caused by absolute ethanol, diclofenac and acetic acid. In the ethanol induce ulcer, pretreatment with VB produced dosedependent reduction in severity of ulcer when compared to control group. Ulceration of gastric mucosa was inhibited by 3.57%, 23.86% and 55.71% at 12.5, 25 and 50 mg/kg of VB respectively. Omeprazole produced an inhibition of 69.71% at 20mg/kg. VB similarly inhibited diclofenac induced ulceration by 54.31%, 69.05% and 78.94% respectively at tested doses, while omeprazole had 87.79%. For the acetic acid-induced ulcer animals, treatment significantly increased pH of gastric contents when compared with control. Histological analysis revealed dose-dependent (ethanol and diclofenac) and time - dependent (Acetic acid) decrease in severity of damage caused by the ulcerogens on treatment with VB Conclusion: These findings suggest that vitamin B possesses potential gastro-protective effects.

Prevention of Psychological Stress Induced-Ulcer in rats Treated with Fruit Extract of Gymnospora montana

Gymnosporia montana (Roth) Bemth. is a traditional herbaceous plant of Celastraceous family found in different regions of India. We have earlier reported its antiulcer activity in aspirin-induced, pylorus-ligation induced, and cysteamine-induced ulcer models. As stress-induced ulcer amount to a majority of clinically evident ulcers, it was thought worthy to investigate the effects of the ethanolic extract of Gymnosporia montana in stress-induced ulcer paradigm. Psychological stress was produced by intra-species emotional communication in a jumping box. Rats were randomly divided into two groups; one was used as the ‘sender’ group that received electrical foot shocks of 10 s duration with 50 s intervallic current for the shock was increased stepwise from 10mA to 25mA. The animals showed emotional responses such as abnormal squealing and jumping. The other group called the ‘responder’ group were able to observe the ‘sender’ group mice but were not subjected to the shocks. A separate group of sender rats was used on each day. The receiver group was exposed to sender group for three consecutive days at the end of which, they were sacrificied and were observed for the presence of gastric lesions. Separate groups of rats were treated half an hour before with Ethanolic extract (500mg/kg, p.o.) and diazepam (5mg/kg, p.o.) and the protocol was repeated. At the end the ulcer index, pH of gastric contents and gastric volume was determined. Further, hisotopathology was also performed. Results revealed a good anti-ulcer activity which was comparable to that of diazepam. In conclusion, the present study affords a significant contribution in confirmation of the forklore effects of a traditional remedy.

Dietary Wheat Bran Lowers Colonic pH in Rats

The effect of chronic dietary wheat bran supplementation on the pH of gastrointestinal contents was examined in thirty-one Sprague-Dawley rats. Ten control rats received a fiber-free diet while twenty-one rats were fed the same diet plus a 20% wheat bran supplement. The fiber-fed rats developed a greater acidity of intestinal contents: cecal pH was 6.30 ± 0.07 (SEM) as compared to 6.76 ± 0.06 in the control group (P < 0.001). The effect on pH of gastric contents was the opposite, 3.90 ± 0.15 in the fiber-fed rats compared to 2.74 ± 0.33 in the controls (P < 0.01). These changes in gastrointestinal pH may be of relevance to the nutrient modulation of gastric and colonic tumor development.Wheat bran dietary fiber colonic pH gastric pH colonic cancer

Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial.

This study aimed to determine the effect of hard candies on gastric content volume and pH in patients undergoing elective esophagogastroduodenoscopy and colonoscopy. Additionally, the study evaluated the difficulty of the procedure, complications, and satisfaction levels of the endoscopist and patient. A randomized controlled study equally recruited 108 outpatients to candy and control groups. The patients in the candy group could consume sugar-free candies within 2 hours before anesthesia, while the controls remained fasted. The endoscopic procedure began under topical pharyngeal anesthesia and intravenous sedation. A blinded endoscopist suctioned the gastric volume through an endoscope. A blinded anesthesia provider tested the gastric pH with a pH meter. The primary outcome variables were gastric volume and pH. The secondary outcome variables were complications, the difficulty of the procedure, and endoscopist and patient satisfaction. The characteristics of both patient groups were comparable. The mean gastric volume of the candy group (0.43 [0.27-0.67] mL/kg) was not significantly different from that of the control group (0.32 [0.19-0.55] mL/kg). The gastric pH of both groups was similar: 1.40 (1.10-1.70) for the candy group and 1.40 (1.20-1.90) for the control group. The procedure-difficulty score of the candy group was higher than that of the control group. The satisfaction scores rated by the endoscopist and the patients in both groups were comparable. In addition, most endoscopists and patients in the candy and control groups reported being "very satisfied". No complications were observed in either group. Hard candies did not affect gastric volume or pH. Elective gastrointestinal endoscopic procedures in adult patients who preoperatively consume candies could proceed to prevent delays and disruption of workflows.

Evaluation of mechanism(s) of action underlying the antioxidant and antiulcer activity of Sesamum indicum leaves extract in experimental rats.

The current study aimed to estimate phytochemical screening, in vitro antioxidant activity, and gastroprotective activity of Sesamum indicum Linn ethanolic extract. The current study was held out by ulceration induced by pylorus ligation and indomethacin-induced ulcer screening models in Wister albino rats. The screening of antiulcer activity of ethanolic extract of S. indicum leaves (EESIL) at the different amounts (100, 200, and 400 mg/kg; per orally for 7 days) was compared with omeprazole as a usual antiulcer drug. Additional parameters such as gastric content, pH, total acidity, pepsin activity ulcer score, free acidity, ulcer index (UI), % inhibition of ulcers, mean mucin, pepsin content, and total protein content were observed. In the pylorus ligation model, the pepsin activity free acidity, pepsin content, UI, total acidity, ulcer score, total protein content, and percentage ulcer inhibition were considerably decreased (P < 0.05 and P < 0.01), and mean mucin and gastric content pH extensively elevated (P < 0.05 and P < 0.01) in EESIL tested groups in the comparison of the control group. Doses (100, 200, and 400 mg/kg p.o.) of EESIL showed dose-reliant gastro protective outcomes, a considerable (P < 0.05 and P < 0.01) decrease in gastric parameters as UI and ulcer score and induction in gastric pH and percentage inhibition of ulcer compared with the control group. Antioxidant, anti-Ulcer, EESIL, and EESIL show antioxidant activity at different concentration. The fallout of the study indicated that the EESIL had improved antiulcer potential due to the decrease in offensive factors and increase in defensive factors.

Gastroprophylactic Effects of p-Cymene in Ethanol-Induced Gastric Ulcer in Rats

The prevalence of gastric ulcers has increased in recent years, mainly because of non-steroidal anti-inflammatory drug utilization. Therefore, the current study investigates the gastroprotective effect of p-Cymene on absolute ethanol-induced acute gastric mucosal hemorrhagic lesions in rats. Thirty Sprague Dawley rats were randomly separated into five groups: normal control, ulcer control, reference, and two experimental groups. The normal and ulcer control groups were orally fed with 0.5% carboxymethylcellulose (CMC). The reference group was fed orally with 20 mg/kg omeprazole. The experimental groups were fed with 30 mg/kg and 60 mg/kg p-Cymene, respectively. After one hour, the normal group was fed with 0.5% CMC, and groups 2–5 were given absolute alcohol. After another hour all rats were sacrificed. The ulcer control group showed severe superficial hemorrhagic gastric mucosal lesions with decreased gastric mucus secretion and pH of gastric content. p-Cymene significantly reduced ethanol-induced gastric lesions, as evidenced by increased mucus and pH of gastric content, decreased ulcer area, reduced or absence of edema, and leucocyte infiltration of the subcutaneous layer. In gastric mucosal homogenate, p-Cymene displayed a significant increase in superoxide dismutase (SOD), catalase (CAT) activities, prostaglandin E2 (PGE2), and significantly reduced the malondialdehyde (MDA) level. In addition, p-Cymene increased the intensity of periodic acid–Schiff (PAS) stain of the gastric epithelium, and produced up-regulation of the HSP 70 protein and down-regulation of the Bax protein of the stomach epithelium, as well as a reduction in the levels of tumor necrotic factor-alpha and interleukin-6, while the level of interleukin-10 was increased. p-Cymene decreased the level of TNF-a and IL-6, and increased the level of IL-10. Acute toxicity with a higher dose of 500 mg/kg p-Cymene did not manifest any toxicological signs in rats and could enhance defensive mechanisms against gastric mucosal lesions. p-Cymene showed gastroprotective effects that could be attributed to its antioxidant nature, or its ability to increase mucus secretion, increase endogenous enzymes (SOD, CAT, PGE2), reduce MDA level, up-regulate HSP 70 protein, down-regulate Bax protein, and modulate inflammatory cytokines.

Comparison of Preoperative Assessment of Gastric Volume and pH in Patients Undergoing Elective Surgery with Prior Two Hour Fasting versus Overnight FastingA Randomised Clinical Trial

Introduction: Aspiration of gastric content is a known lifethreatening, yet preventable complication of anaesthesia. While mostly all elective procedures do follow the preoperative fasting protocols as recommended by American Society of Anaesthesia (ASA), there are many situations where the fasting guideline cannot be followed considering the emergency. In such cases, bedside ultrasound assessment of gastric volume can become an important tool to stratify aspiration related risk. Aim: To find out the actual trends of gastric volume and pH in patients with two hour fasting with a prokinetic drug versus overnight fasting who are undergoing elective procedures. Materials and Methods: This single centre, randomised clinical trial was conducted in the Department of Anaesthesia at Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India, between December 2020 and July 2021, among 50 patients of ASA grade I undergoing elective procedures under general anaesthesia. Participants were divided into two groups. Group A patients were advised overnight fasting while group B participants were advised two hour fasting for clear liquids followed by intravenous (i.v.) metoclopramide injection. Assessment of gastric volume and other gastric parameters were done using a portable ultrasound machine. The pH of gastric content was measured using pH strips. Gastric content was obtained using Ryle’s Tube placed in the patient, postinduction of anaesthesia. Collected data was statistically analysed using Unpaired t-test for all qualitative data. Results: Significant difference in the anteroposterior diameter (3.46±0.34 in group A versus 2.24±0.30 in group B), cranio-caudal diameter (4.77±0.51 in group A versus 3.71±0.36 in group B), antral curved surface area (9.90±0.77 in group A versus7.77±1.04 in group B) and gastric volume (127.48±13.09 in group A versus 104.65±15.43 in group B) and pH (2.08±0.28 in group A versus 2.80±0.41 in group B) was observed (p-value=0.0001). However, no significant difference in any gastric parameter, mentioned above, was noted before and after injecting intravenous metoclopramide. Conclusion: Bedside ultrasound assessment of gastric volume is an important toolfor aspiration risk stratification especially in emergency, non-fasting patients.

GC-MS, FTIR and Antiulcer Screening of Aqueous Seed Extract and Oil of Nigella sativa in Wistar Rats

Peptic ulcer disease (PUD) is a sore in the lining of the stomach or duodenal mucosa. This study was aimed at evaluating the antiulcer activity of the aqueous extract of Nigella sativa (black seed) and its constitutents. The pharmacognostic properties of the dry seeds were determined. The seeds were extracted using two methods digestion and hydro-distillation. The acute toxicity, phytochemical constituents and the antiulcer evaluation were performed on ethanol-induced ulcer in wistar rats using a standard method. FTIR and GC-MS analysis of the aqueous seed extract was also determined using standard methods. Nigella sativa seed shows the presence of starch grains, lignified tissues, tannins, cellulose, protein and oil globules. The aqueous extract has a high safety margin. The phytochemical studies revealed the presence of saponins, flavonoids, alkaloids, tannins, glycosides, fats and oil. The black seed aqueous and oil extract at 500 mg/kg significantly reduced the acidity, total acidity, and ulcer index, and pH of gastric content when compared with the positive control (Famotidine). The FTIR analysis identified the presence of the following functional groups chloro, ether, amine, carboxylic acid, nitriles, methylene, alcohol, while the GC-MS identified five compounds such as glycerin, n-Hexadecanoic acid, 9, 12-octadecadienoic acid-methyl ester, 9, 12-octadecadienoic acid and 9, 12-octadecadienoyl chloride. The pharmacognostic properties can act as a reliable tool for the standardization of the plant part. This study suggests that aqueous and oil extract possess antiulcer properties. Thus the aqueous and oil extract of black seed can be considered as antiulcer medication traditionally.&#x0D; Keywords: Nigella sativa, Black seed, Pharmacognostic, Phytochemical, Acute toxicity (LD50), Antiulcer.

EVALUATION OF GASTROPROTECTIVE EFFECTS OF METHANOL EXTRACT OF TEPHROSIA VILLOSA AGAINST EXPERIMENTALLY INDUCED ULCERS IN WISTAR RATS

Objective: The present research work was designed to investigate the gastroprotective potentials of methanol extract of Tephrosia villosa. Methods: The aerial parts of Tephrosia villosa were dried under shade, powdered and deffated with petroleum ether and then marc leftover was subjected to methanol extraction using soxhlet apparatus using soxh-let apparatus. Antiulcer activity of methanol extract was determined against stress-induced and aspirin-induced ulcers in experimental animal models. The total number of ulcers formed, ulcer index, percentage inhibition, ulcerated area, protected area, pH and Total acidity were parameters in the study. Results: Methanol extract of Tephrosia villosa at medium (200 mg/kg) and high (200 mg/kg) could significantly (P&lt;0.01) reduced the total number of ulcers formed, ulcer index, ulcerated area and total acidity in therapeutic groups compared to vehicle control and thereby significantly (P&lt;0.01) increased percentage inhibition of ulcers and protected area which was evident by the significant rise in pH of gastric content. The effect of extracts was dose-dependent and results were comparable to that of standard drug omeprazole. Conclusion: The results obtained from the present work suggest that the methanol extract of Tephrosia villosa possess significant anti-ulcer potentials against experimentally induced ulcers in albino rats.

Морфофункціональна характеристика окремих органів травної системи людини

Today, the growing trend of the prevalence of diseases of the digestive system is a very important issue not only in Ukraine but also around the world. This problem applies not only to practical areas of health care, but also to theoretical medicine. The study of the anatomical structure and functional state of the digestive system is the theoretical basis for the extrapolation of various pathological conditions in laboratory animals. Analysis of scientific sources showed a lack of comprehensive morphological studies of the human digestive system. The purpose of the paper was to study the features of some organs of the human digestive system in the morphological aspect by bibliographic analysis of literature. Materials and methods. This bibliographic analysis is based on published peer-reviewed articles, books, textbooks, monographs, abstracts of dissertations. For the purposes of this systematic review, literature search (concerning the study of the structure of the human digestive system) was carried out on the Internet, domestic literature sources, scientific and electronic libraries of Poltava State Medical University by the following keywords: "digestive system", "morphology", "gastrointestinal tract", "colon", "cаecum", "embryonic development of the digestive system". Results and discussion. Digestive system (Latin «systema digestorium») is a system of organs of various structures and functions formed in phylogeny, the importance of which lies in the perception, mechanical and chemical (enzymatic) processing and absorption of nutrients needed to compensate for energy and material costs in the body. Conclusion. Significant progress has been made in understanding the development of the human digestive system over the past two decades. The human digestive system is formed in phylogeny community of similar in structure and function of organs, the importance of which is the digestion of food, mechanical and enzymatic breakdown, absorption of breakdown products into the internal environment of the body and their transport to the liver. The structure of the gastric mucosa is well thought out for secretion and protection against low pH of gastric contents, which is regulated by hydrochloric acid. The pancreas, like the gland of external secretion, produces many digestive enzymes in an inactive form. Activation usually occurs in the lumen of the small intestine. The liver receives most of the nutrients absorbed through the portal vein and then uses them to synthesize many larger molecules

Phytochemical and Pharmacological Evaluation of Annona reticulate

Annona reticulate (AR) is indigenous to the tropical areas of India and worldwide. The use of plant as remedy for diarrhea and ulcer is well documented in Ayurvedic system of medicine. However, pharmacological evidence does not exist to substantiate its therapeutic efficacy for the same. The aim was to investigate the antiulcer and anti-diarrheal activity of methanolic (ME) and aqueous extracts (AE) of A. reticulate in animal model. The antiulcer activity of extracts was investigated using ethanol and pylorus ligation-induced ulcer. The anti-diarrheal activity of MEAR and AEAR extracts was evaluated by castor oil induced diarrhea and gastro intestinal motility using parameters such as onset of diarrhea, number of wet stools, total number of stool and weight of total number of stools. The antiulcer activity of the extracts was confirmed by a reduction in ulcer index along with the decrease in gastric volume, total acidity, and an increase in pH of gastric content in both the models. A. reticulate extracts were more efficacious in reducing number of total stools in both the models of diarrhea and showed a dose-dependent antidiarrheal effect. The obtained results have established a pharmacological evidence for the folkloric use of the A. reticulate as antiulcer and antidiarrhoeal agent.

Volume and pH of Gastric Contents in Patients Undergoing Gynecologic Laparoscopic Surgery during Emergence from General Anesthesia: A Prospective Observational Study

Objective: To find out the volumes and pH values of the digestive contents during emergence in patients undergoing elective gynecologic laparoscopic surgery under general anesthesia. Materials and Methods: One hundred patients scheduled for surgery under general balanced anesthesia with standard monitoring were allocated in the present study. Gastric volumes greater than 0.4 mL/kg and pH of less than 2.5 were set as cut-off points to establish the risk of aspirated pneumonitis. Prior to insufflation of CO₂ gas into the participants’ abdominal cavity and placing them in lithotomy or Trendelenburg position, anesthetists inserted an orogastric tube to deflate the patients’ stomach. Then gastric volumes and pH values were measured at hourly intervals through the operation. Results: Eighty-nine participants completed the study. The pH and gastric volumes of high-risk and non-high-risk groups showed statistically significant differences (p&lt;0.001), as 1.1±0.4 and 1.1±0.8 mL/kg, and 2.8±2.2 and 0.3±0.4 mL/kg, respectively. Though their ages (p=0.047), body mass index (BMI) (p=0.015), and pre-medication drugs (p&lt;0.001) showed significant differences, they were not apparent in the pre-fluid loading, fasting, and surgical time. Conclusion: During emergence from general anesthesia, 65.2% of the patients undergoing gynecologic laparoscopic surgery were exposed to a high risk of aspirated pneumonitis. The present study showed significant association with age, BMI, and pre-medication drugs. Investigators suggested that patients with a BMI greater than 25 kg/m², administering H₂ receptor antagonist or a proton pump inhibitor as premedication, and having gastric content drainage prior to endotracheal tube extubation should have a low risk of pulmonary aspiration. Keywords: Anesthesia, Gynecology, Gastric content, Laparoscopic surgery

Non-medicine Methods of Treatment of Gastroesophageal Reflux Disease

Few decades away a problem of throwing of acidic gastric content into an esophagus was reduced to the concept of reflux-esophagitis. In-depth study of pathogenesis of a disease resulted in “gastroesophageal reflux disease” (GERD) term which is acknowledged as leading disease of digestive system in terms of frequency and dangerous complications. GERD formation is determined by influence of numerous factors, however, it is generally accepted, that it is mainly related to insufficiency of lower esophageal sphincter (LES). Also, role of vasoactive intestinal peptide (VIP) in regulation of functional state of LES is determined. In spite of success in field of pharmacology, number of GERD patients has no downward trend which mainstreams search for non-medicine treatment methods. Physical factors affecting pathological processes by influencing regulatory processes are among these methods. Goal of this study is elaboration, scientific justification and clinical implementation of natural and preformed physical factors and acupuncture in treatment of patients with gastroesophageal reflux disease. Materials and Investigation methods: Randomized placebo-controlled study included 137 patients with gastroesophageal reflux disease, 63 (46%) men and 74 (54%) women, at the age of 18 to 65. Investigation included patients with no contraindications for physiotherapy. Patients with Barrett’s esophagus, stricture of esophagus, esophagus ulcer have also been excluded from investigation. Patients were divided into 3 groups: Ist group – 40 GERD patients, including high-frequency electromagnetic field effect and general iodine bromine bathes. II nd group - 67 GERD patients passing acupuncture treatment course. Control group was comprised of 30 GERD patients, receiving placebo MEF therapy. Treatment was carried out without medicines. Therapeutic effectiveness of complex influence of microwave electromagnetic field therapy (MEF-therapy) applied to collar area alternated with general iodine-bromine bathes on clinical manifestations of GERD is determined. Treatment course contributed to reliable decrease of increased count of VIP – a neurotransmitter, regulating LES tonus. In term, it contributed to improve of functional state of LES, reliable decrease of reflux index, and, as a result, improvement of clinical and functional indicators. Estimation of clinical manifestations of a disease among patients of 2nd group displayed positive dynamics of clinical and functional indicators. Round-clock pH-monitoring of stomach and esophageal content shows reliable decreaseof transitory relaxations of LES during single acupuncture procedure and increase of pH of gastric content. Acupuncture course also resulted in decrease of elevated VIP numbers.

Randomised clinical trial to compare ultrasonography guided gastric volume in patients after overnight fasting and after ingestion of clear fluids two hours before surgery

Aspiration of the gastric contents in the peri-operative period is a serious complication of surgery and anaesthesia. Pre-operative fasting aims to decrease the volume and increase the pH of gastric contents, hence reducing the risk of aspiration. According to the past literature gastric contents of 25 ml (0.4ml/kg) and with pH &amp;#60;/= 2.5 predisposes the patient to pulmonary aspiration hence pre-operative fasting was recommended. But prolonged fast doesn’t guarantee empty stomach. Use of two-dimensional ultrasonography is an accurate non-invasive tool to determine gastric volume. With an aim to reduce the hours of pre-operative fasting without increasing the risk of aspiration pneumonia we compared the gastric volume using ultrasonography and pHof gastric aspirate by pH strip in patients after overnight fasting and after ingestion of 200 ml clear fluids (water) 2 hours prior to surgery. The study was conducted in 60 ASA I patients undergoing elective surgery after obtaining Institutional ethical committee clearance &amp; written informed consent from all the patients. Thorough pre anaesthetic evaluation was done, investigations were noted. After having achieved the inclusion and exclusion criteria and having obtained informed consent, patients were randomized based on computer generated randomization table into one of the two groups. Group A: Patients with Overnight fastingGroup B: Patients receiving 200 ml of clear fluids (water) 2 hours before surgery.Gastric antral dimensions were noted and gastric volume was calculated.We observed that the age and gender distribution were comparable between the two groups. The mean gastric volume by USG in group A is 29.7±8.0ml and group B is 19.2±4.9 ml. The reduced gastric volume in group B is statistically significant (&amp;#60;0.00001).The mean pH of gastric aspirate in group A is 1.4 and group B is 2.63. The results reveal that group B has a better results in terms of pH of the gastric contents and is statistically significant (p&amp;#60;0.00001).The mean gastric volume in patients who had consumed 200 ml of clear fluid 2 hours prior (group B) was lesser than patients who fasted overnight (group A).The mean pH in patients who had consumed 200 ml of clear fluid 2 hours prior (group B) was higher than patients who fasted overnight (group A).

Assessment of Hepatoprotective and Antiulcer Activity of Launaea aspleniifolia Hook in Laboratory Animals

Background: Launaea aspleniifolia Hook (Family Asteraceae) is used traditionally in medicine in Indian system for the treatment of leucoderma. This study was conducted to evaluate the hepatoprotective and antiulcer effects using the methanolic extract of Launaea aspleniifolia Hook (MELA). Methods: The MELA in the dose of 200 and 400 mg/kg body weight (b.w.) was administered orally, daily for 7 days to prevent the acetaminophen-induced hepatotoxicity and peptic ulcer. In order to determine the antioxidant enzymes activity, various enzymatic parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBL), direct bilirubin (DBL), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), high density lipoproteins (HDL), random glucose test (RBS), serum creatinine levels (SCL) and direct bilirubin (DBL) were determined. Further, the histopathology of tissue and various gastric secretion parameters like free acidity, total acidity ulcer score, % ulcer inhibition, gastric volume, pH, Na+ and K+ and histopathology were determined in PLinduced ulcer model. Results: MELA showed dose-dependent hepatoprotective and ulcer protective effect in acetaminopheninduced hepatotoxicity and antiulcer activity. Furthermore, tissue antioxidant parameter such as reduced Malondialdehyde (MDA), histopathology was also investigated. MELA was more potent in controlling all the serological parameter of liver like ALT, AST, TBL, DBL, ALP, HDL, RBS, SCL, TP and ALB in a dose-dependent manner (P&lt;0.05) induced by Acetaminophen. Apart from this, antiulcer activity MELA was confirmed by the low level of ulcer index along with the reduction of free acidity, total acidity ulcer score, % ulcer inhibition, gastric volume, Na+ and an increase K+, pH of gastric content in a dose-dependent manner (P&lt;0.05) induced PL model. Conclusion: The results indicated a significant dose-dependent effect of MELA from injuries induced in liver and stomach. These protective effects of MELA can be examined in various other toxicities as alone and in combinations.

Ultrasonographic estimation of gastric volume in patients after overnight fasting and after ingestion of clear fluids two hours before surgery

Pre-operative fasting aims to decrease the volume and increase the pH of gastric contents, hence reducing the risk of aspiration. According to the past literature gastric contents of 25 ml (0.4 ml/kg) and with pH ≤ 2.5 predisposes the patient to pulmonary aspiration hence pre-operative fasting was recommended. Use of two-dimensional ultrasonography is an accurate non-invasive tool to determine gastric volume. We compared the gastric volume using ultrasonography and pH of gastric aspirate by pH strip in patients after overnight fasting and after ingestion of 200 ml clear fluids (water) 2 h prior to surgery.

The Role of Hydrogen Sulfide in Chronic Unpredictable Stress-Induced Gastric Lesions.

The aim of this study was to investigate the possible protective role of Hydrogen sulfide on chronic unpredictable stress (CUS) -induced gastric lesions. Materials and methods: 40 rats were divided into 4 groups: control group, stressed rats group, stressed + Aminooxyacetic acid (AOAA) (inhibitor of H2S synthesis; 50mg/kg/48hour; IP), stressed + Sodium hydrosulfide (NaHS) (donor of H2S, 5mg/kg/48hour; IP). In all the groups exposed to CUS, a set of chronic unpredictable stressors was applied for 6 weeks in random order. At the end of experimental protocol blood samples, gastric content and gastric tissues samples were collected. Gastric tissues histopathological changes were evaluated by macroscopic and microscopic examination. Gastric content pH, serum MDA level, whole blood GSH level were estimated. Expression of Caspase-3 (apoptotic marker) and BCL-xl (anti-apoptotic marker) was assessed by immunohistochemistry. Results: In all the groups exposed to CUS, there was a significant reduction in gastric pH value and a range of gastric lesions ranging from superficial to deep ulceration as evident by macroscopic and microscopic examination. Also, there was significant elevation in MDA serum level and significant reduction in anti-oxidant GSH blood level. In all stressed rats, the expression of Caspase-3 was significantly higher whereas a significant decrease in expression of anti-apoptotic protein BCL-xl was observed. These findings were aggravated by AOAA while using NaHS improved them. Conclusion: it seems that increasing bioavailability of H2S could have a protective role against CUS induced gastric lesions. The results suggest that this protection could be through anti-oxidant and anti-apoptotic effects.