Treatment Of Duodenal Ulcer Research Articles

Chemical Composition, Antioxidant and Antimicrobial Activities of Sanguisorba officinalis L. Extracts.

Sanquisorba officinalis has been used internally for the treatment of intestinal infections and duodenal ulcers, as well as hemorrhoids, phlebitis and varicose veins and female disorders, and topically to heal wounds, burns, and ulcers. In our study, the antioxidant and antimicrobial activities, as well as quantitative analysis of polyphenols (phenolic acids, flavonoids and total polyphenols) in methanol and aqueous extracts from S. officinalis herbs are presented. A correlation between the antioxidant activity and composition of tested extracts indicates that flavonoids are the major compounds causing scavenging of free radicals. Higher content of flavonoids was found in the methanol extract, while the content of total phenolics was higher in the aqueous extract. Both extracts from S. officinalis herbs showed antioxidant activity and high antimicrobial activity in a wide spectrum of test strains.

Combination of endoscopic methods in diagnostics and surgical treatment of perforative duodenal ulcer

To present the results of perforative duodenal ulcer surgical management using combination of endoscopic methods. The study included 279 patients with perforative duodenal ulcer who were operated for the period from 1996 to 2012. Diagnostics and medical tactics were based on developed in our clinic algorithm that includes use of both esophagogastroduodenoscopy and laparoscopy. Presented technique confirmed correct diagnosis, defined medical tactics and choice of surgery in 100% of cases. 67 patients had contraindications for laparoscopic suturing and underwent conventional operations. Herewith postoperative complications and death were observed in 25 (37.3%) and 9 (13.4%) patients respectively. Laparoscopic suturing was performed in 212 patients. Complications were diagnosed in 19 (8.9%) cases including 8 (3.7%) intraoperative and 11 (5.2%) postoperative. Deaths were absent.

Changing patterns in the surgical treatment of perforated duodenal ulcer - single centre experience.

IntroductionAlthough the surgical treatment of patients with perforated duodenal ulcer is the method of choice, the introduction of effective pharmacotherapy has changed the surgical strategy. Nowadays less extensive procedures are chosen more frequently. The introduction of laparoscopic procedures had a significant impact on treatment results.AimTo present our experience in the treatment of perforated duodenal ulcer in two periods, by comparing open radical anti-ulcer procedures with laparoscopic ulcer repair.Material and methodsThe analysis covered patients operated on for perforated duodenal ulcer. Two groups of patients were compared. Group 1 included 245 patients operated on in the period 1980–1994 with a traditional method (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). Group 2 included 106 patients treated in the period 2000–2014 with the laparoscopic technique supplemented with PPI therapy. Groups were compared in terms of patients’ demographic structure, operative time, complication rate and mortality.ResultsThe mean operative time in group 1 was shorter than in group 2 (p < 0.0001). Complications were noted in 57 (23.3%) patients in group 1 and 14 (13.5%) patients in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In group 1, median length of hospital stay was 9 days and differed significantly from group 2 (6 days, p < 0.0001).ConclusionsWithin the last 30 years, significant changes in treatment of perforated peptic ulcer (PPU) have occurred, mainly related to abandoning routine radical anti-ulcer procedures and replacing the open technique with minimally invasive surgery. Thus it was possible to improve treatment results by reducing complication and mortality rates, and shortening the length of hospital stay. Although the laparoscopic operation is longer, it improves outcomes. In the authors’ opinion, in each patient with suspected peptic ulcer perforation, laparoscopy should be the method of choice.

Comparação do teor de taninos entre duas espécies de espinheira-santa (Maytenus aquifolium Mart.e Maytenus ilicifolia Mart. ex Reissek)cultivadas no Horto Medicinal do Refúgio Biológico Bela Vista - RBBV da Itaipu Binacional - Foz do Iguaçu, PR - Brasil.

RESUMO As duas espécies de espinheira-santa Maytenus aquifolium Mart. e Maytenus ilicifolia Mart. ex Reissek pertencentes à família Celastraceae e têm sido intensamente exploradas nas populações nativas devido seu alto valor medicinal. O grande interesse pela espinheira-santa é para o tratamento de gastrites, úlceras gástricas e duodenais. O efeito antiulcerogênico está relacionado com a presença de polifenóis totais, mais especificamente com os taninos. Este trabalho teve como objetivo comparar o teor de taninos entre essas duas espécies cultivadas no Horto Medicinal do Refúgio Biológico Bela Vista - RBBV da Itaipu Binacional no município de Foz do Iguaçu, PR - Brasil. Foram realizadas duas coletas com intervalo de um mês para cada espécie e para a quantificação foi realizada a análise por espectrofotometria segundo a Farmacopeia Brasileira V. Os resultados foram analisados através do teste de variância (ANOVA) e a diferença no teor de taninos foi evidenciada pelo teste Tukey, a 5% de nível de significância empregando-se o software SISVAR. Foram obtidos em média 0,61% para o lote 1 e 2 de Maytenus aquifolium e (3,90%) para Maytenus ilicifolia, resultando em uma média de 84,35% de taninos a mais para Maytenus ilicifolia em comparação com Maytenus aquifolium concluindo assim que as espécies não devem ser intercambiáveis.

X-ray fluorescence determination of bismuth in the drugs De-Nol and Vikalin

The possibility of effective use of X-ray fluorescence analysis of bismuth contents in the antibacterial drugs De-Nol and Vikalin is described. These drugs are used for treatment of gastritis, gastric ulcer, and duodenal ulcer. An algorithm for calculation of the theoretical calibration function for X-ray bismuth determination in drugs is presented. An alternative method is given that allows provision of a high accuracy of analysis results without the use of standards. The effectiveness of the developed approaches is confirmed using the titrimetric method of analysis.

Formulasi Mikrokapsul Ranitidin HCl Menggunakan Rancangan Faktorial dengan Penyalut Etil Selulosa

Ranitidin HCl adalah H2-antagonis histamin yang digunakan dalam pengobatan ulkus lambung dan duodenum. Formulasi mikrokapsul ranitiditin HCl ditujukan untuk memperpanjang regimen dosis untuk meningkatkan bioavailabilitas dan waktu paruh. Tujuan dari penelitian untuk merumuskan dan mengoptimalkan mikrokapsul ranitidin HCl untuk menyiapkan sistem pelepasan yang sesuai dengan desain faktorial. Mikrokapsul disusun menggunakan etilselulosa dengan teknik penguapan pelarut. Variasi konsentrasi penstabil Span 80 (1-2%) dan rasio obat/polimer (2: 2-1: 2) dilakukan untuk mengamati efek efisiensi penjerapan. Analisis data menunjukkan bahwa mikrokapsul dengan efisiensi penjerapan optimal didapatkan pada formula yang mengandung 2% span 80, dan 1:2 rasio obat/polimer. Hasil penelitian menunjukkan mikrokapsul berbentuk sferis, dan berpori, dengan waktu pelepasan hingga 10,55 jam.

Role of dietary phospholipids and phytosterols in protection against peptic ulceration as shown by experiments on rats.

Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher in regions where the diet is based on milled rice, refined wheat or maize, yams, cassava, sweet potato, or green bananas, and is lower in regions where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs). It also promoted ulcer healing. The lipid from the pulse, Dolichos biflorus, horse gram which was highly protective was used to identify the fractions with protective activity in the lipid. The protective activity lay in the phospholipid, sterol and sterol ester fractions. In the phospholipid fraction phosphatidyl choline (lethicin) and phosphatidyl ethanolamine (cephalin) were predominant. In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol, stigmasterol, and an unidentified isomer of β-sitosterol. The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration, both singly and in combination. This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers. A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.

Peptic Perforation of the 4th Duodenal Segment. Case Report

Introduction: Even if the prevalence of peptic ulcer disease has decreased in the last years, duodenal perforation remains a life threatening complication. The duodenum is the second most common site of gastrointestinal perforations after the colon and perforation of the 4th portion is very rare. Case Presentation: A 67-yers-old man was admitted to the emergency department of the Annecy Hospital with intense abdominal pain, vomiting and no transit for the last 24 hours. The laboratory count showed an inflammatory syndrome. A CT scan revealed free air and fluid near the Treitz’s angle. An exploratory laparotomy was performed that revealed a perforation of the forth portion of the duodenum. A duodenal resection with duodeno-jejunal anastomosis was performed. Discussions: Peptic ulcer disease is a common disease and the perforation is one of its most life threatening complications. The localization of the DP on the forth segment of the duodenum is very unusual. The most frequent localization of DP is the first duodenal segment. Abdominal CT scan is the most sensitive radiological exam if there is suspicion of a DP. A Zollinger-Ellison syndrome must be taken into count. Peritonitis is an indication for immediate laparoscopy or laparotomy, taking into account the patient’s condition. Despite the successful medication therapy and the progress in treatment of duodenal ulcer, perforation remains a serious complication, requiring an emergency surgical treatment. Conclusion: Duodenal perforation of the fourth portion is an extremely rare complication of the peptic ulcer disease and the surgery is the primary modality of treatment.

Successful open abdomen treatment for multiple ischemic duodenal perforated ulcers in dermatomyositis.

IntroductionDermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition.MethodsA 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented.ResultsOur first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months.ConclusionsIn patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery.

Curative effect analysis on Helicobacter pylori positive duodenal ulcer by quadruple therapy

Objective To study the quadruple therapy for Helicobacter pylori positive duodenal ulcer treatment,the therapeutic effects were analyzed.Methods In our hospital from 2010 January to 2011 January 60 cases were treated for Helicobacter pylori positive duodenal ulcer,they were randomly divided into two groups,30 cases in each group,the treatment group was treated with oral ray Bella of 10 mg,timeranitidine bismuth citrate 350 mg 1 time 1000 mg1 times,amoxicillin,furazolidone 100 mg 1 time,taking 4 days.The control group was treated by omeprazole 20 mg1,1000 mg1 500 mg1 amoxicillin,clarithromycin,medication time 1 day 2 times,a total of medication for 7 days.After treatment,patients of two groups also needed to take the ray Bella of 10mg 1 time,1 time 1 day,a total of 2 weeks after taking.After treatment the curative effect was observed after 5 weeks,and after 1 year of follow-up.Results The rate of ulcer healing in the treatment group and the control group were 96.67％ and 76.67％ respectively,the Hp removing rate was 96.67％ comparing with 86.67％ of the control group.In the treatment group,the ulcer healing rate and the eradication rate of Hp were higher than those of control group.The treatment group was found to ulcer recurrence rate and Hp reinfection rate were lower than those of control group.There were both significant differences between the treatment group and control group (P ＜ 0.05).Conclusion The quadruple therapy plus Reba La for Helicobacter pylori positive duodenal ulcer treatment,has remarkable treatment effect,worthy of clinical application. Key words: Helicobacter pylori positive; Duodenal ulcer; Quadruple therapy

Re: Gonenc M, Dural AC, Celik F, et al: Enhanced postoperative recovery pathways in emergency surgery: a randomized controlled clinical trial

First suggested for patients with perforated gastric ulcers in 1894, 1 Bennet W.H. A case of ruptured gastric ulcer successfully treated by immediate suture. Lancet. 1894; 2: 21-22 Abstract Scopus (4) Google Scholar omental patch closure of a perforated duodenal ulcer was popularized by Graham in 1937 2 Graham R.R. The treatment of perforated duodenal ulcers. Surg Gynecol Obstet. 1937; 64: 235-238 Google Scholar and has remained a surgical mainstay. Over time and before the descriptions of Helicobacter pylori, H2-receptor antagonists, and proton-pump inhibitors, omental patch closure was one of the 4 operations used to treat perforated gastroduodenal ulcers. These included gastrectomy for perforated gastric ulcers and truncal vagotomy and pyloroplasty, truncal vagotomy and resection, and proximal gastric vagotomy with omental patch closure for perforated duodenal ulcers. 3 Feliciano D.V. Surgical options and results of treatment of perforated ulcers. Problems Gen Surg. 1987; 4: 301-307 Google Scholar , 4 Feliciano D.V. Do perforated duodenal ulcers need an acid-decreasing surgical procedure now that omeprazole is available?. Surg Clin N Am. 1992; 72: 369-380 PubMed Google Scholar , 5 Jordan Jr., G.L. DeBakey M.E. Duncan Jr., J.M. Surgical management of perforated peptic ulcers. Ann Surg. 1974; 179: 628-633 Crossref PubMed Scopus (49) Google Scholar These “definitive” operations were used from the 1940s to the 1990s because of the following problems or limitations of omental patch closure as follows: (1) technical difficulties in patching gastric or large duodenal perforations; (2) early reperforation or bleeding; (3) recurrent symptoms (73% of patients) postoperatively 5 Jordan Jr., G.L. DeBakey M.E. Duncan Jr., J.M. Surgical management of perforated peptic ulcers. Ann Surg. 1974; 179: 628-633 Crossref PubMed Scopus (49) Google Scholar ; (4) late reperforation (9% of patients) 6 Griffin G.E. Organ Jr., C.H. The natural history of the perforated duodenal ulcer treated by suture plication. Ann Surg. 1976; 183: 382-385 Crossref PubMed Scopus (46) Google Scholar ; and (5) a large number of reoperations (48% of patients). 7 Skovgaard S. Late results of perforated duodenal ulcer treated by simple suture. World J Surg. 1977; 1: 521-526 Crossref PubMed Scopus (12) Google Scholar Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trialThe American Journal of SurgeryVol. 207Issue 6PreviewEnhanced recovery pathways are now widely used in elective surgical procedures. The feasibility of enhanced postoperative recovery pathways in emergency surgery for perforated peptic ulcer disease was investigated in this randomized controlled clinical trial. Full-Text PDF

Efficacy of ilaprazole in the treatment of duodenal ulcers: a meta-analysis.

To compare the efficacy and tolerance of ilaprazole compared with other proton pump inhibitors (PPIs) in the treatment of duodenal ulcer. An electronic database search of Medline, Embase, the Cochrane controlled trials register, Web of Science, PubMed, and the Chinese Biomedical Literature Database (updated to July 2013), and manual searches were conducted. A meta-analysis of randomized controlled trials comparing the efficacy and tolerance of ilaprazole and other PPIs in the treatment of duodenal ulcers was performed. Five articles involving 1481 patients were included. The meta-analysis showed no difference in the 4-wk healing rate between ilaprazole and other PPIs [89.7% vs 87.0%; relative risk (RR) = 1.02; 95%CI: 0.98-1.06; Z = 1.00; P = 0.32]. The results did not change in the sensitivity analyses. The meta-analysis indicated that the adverse effect rate in the ilaprazole group was lower than that in the control group, but the difference was not significant (9.7% vs 13.0%; RR = 0.81; 95%CI: 0.60-1.07; Z = 1.47; P = 0.14). Ilaprazole is a highly effective and safe PPI in the treatment of duodenal ulcers. Ilaprazole can be recommended as a therapy for acid-related disorders, especially in Asian populations.

Laparoscopic Repair of Duodenal UlcerPerforation: A Randomized Controlled Clinical Trial

Background: Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated duodenal ulcer in many institutions. The literature established that laparoscopic repair of perforation when compared to open repair, is associated to lower wound dehiscence, less analgesic use, less pain and hospital stays. The drawbacks are length of operative time and the laparoscopic surgeon's experience in intra corporeal suturing and knotting. Methods: Over a one year period 83 patients presenting with perforated duodenal ulcer were randomly assigned to undergo either an open or a laparoscopic omental patch repair. They were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Those with clinically sealedoff perforations without signs of peritonitis or sepsis were treated without surgery. The endpoint was operative time, postoperative pain score, post-operative analgesic requirement, and length of postoperative hospital stay, morbidity, mortality and the date of return to normal daily activities. Results: Out of a total of 95 cases with diagnosis of duodenal perforations, 12 were excluded and 83 patients were analyzed. Both the groups were comparable in terms of age, gender, duration of symptoms, history of acid peptic disease, NSAIDs use, presence of comorbid conditions and size of perforation. Most of them presented after 24 hrs of onset of pain with the mean duration of 54.58 ± 32.4 hrs. There was one conversion in laparoscopic group due to intolerance to pneumoperitoneum. The duration of surgery was not significantly different but was high in the first five laparoscopic repairs (mean 91 mins as compared with 65 mins for the last 5 laparoscopic repairs). Those in laparoscopic group had significantly (p<0.001) less postoperative pain, analgesic requirement, time to return to normal diet, full ambulation and hospital stay. Morbidity was significantly high in open group (36.29 % vs 13.88 % in laparoscopic group; p 0.01). Open group had significantly high surgical site infection (19.14 vs 0%; p 0.005) and chest infection (29.78 vs 11.11%; p 0.04). One case in each group had mortality. Conclusion: Laparoscopic repair is safe and is a reliable procedure even in delayed presentation. It has significantly less postoperative pain, less need for analgesics, shorter hospital stay, early return to normal diet and work, and less complications without any difference in mortality.

Recent increase in campylobacteriosis incidence in the Netherlands associated with proton-pump inhibitor use

BackgroundProton pump inhibitors (PPIs) are prescribed to patients requiring prevention or treatment of gastric and duodenal ulcers. PPIs inhibit gastric acid secretion by specific action on proton pumps of parietal cells. The resulting pH increase is favourable for gastrointestinal pathogen survival. Indeed, PPIs are reported repeatedly as potential risk factors for infections, such as Campylobacter and Salmonella infections. The current study examined national trends in PPI use, reported campylobacteriosis cases between 2004 and 2011, and estimated the excess disease burden potentially related to PPI use. MethodsIn a negative-binomial regression model, annual numbers of campylobacteriosis cases were related to PPI use per capita, age (four classes: 0–25, 25–50, 50–70, and >70 years), and chicken meat consumption (an established risk factor). Annual PPI prescription data were obtained from the Foundation for Pharmaceutical Statistics for the two most frequently dispensed PPIs, omeprazole and pantoprazole. The number of reported campylobacteriosis cases was obtained from national surveillance data. Annual chicken meat consumption (fresh and frozen) was based on retail data. Annual population counts per age category were obtained from Statistics Netherlands. A counterfactual approach was used to estimate the total excess incidence due to PPI use between 2004 and 2011. The associated disease burden was quantified using an existing model for estimating the disease burden. FindingsThe trend and yearly fluctuations in campylobacteriosis cases were explained statistically by PPI use (p<0·0001), age (p<0·0001), their interaction (p=0·04), and frozen chicken meat consumption (p=0·003). The estimated total counterfactual attributable proportion for PPI use increased from 8% (2004) to 27% (2011), and was about 40% for the elderly in 2011. This corresponds to a disease burden of 980 disability-adjusted life-years (undiscounted and not age weighted) and a cost-of-illness of €21 million (discounted at 4%). InterpretationThe current study is the first to quantify the adverse effects of PPI use on gastrointestinal disease burden at the population level. Other enteric pathogens might display similar effects. A risk–benefit analysis for PPI use involving disease burden measures for multiple health outcomes is warranted. FundingMinistry of Health, Welfare and Sports, The Hague, Netherlands.

Outcome of laparoscopic repair of perforated duodenal ulcers

Laparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy. This was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score. Of the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort. LSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Changes in gastric pH and in pharmacokinetics of ulipristal acetate – a drug-drug interaction study using the proton pump inhibitor esomeprazole

Ulipristal acetate is a novel selective progesterone receptor modulator for the treatment of benign gynecological conditions such as uterine myoma. As a Biopharmaceutical Classification System (BCS) II compound, it is highly soluble at low pH but has low solubility at neutral conditions. Esomeprazole, a proton pump inhibitor used widely for treatment of gastric and duodenal ulcers, efficiently increases gastric pH. Thus, the aim of this study was to determine the effects of esomeprazole on the pharmacokinetics of ulipristal acetate. This was a nonrandomized, single sequence, 2 period, open, study in 18 healthy female subjects. Subjects received oral ulipristal acetate tablets (10 mg) once on Days 1 and 13 and daily esomeprazole administrations (20 mg) from Days 9 through 14. Co-administration of esomeprazole decreased geometric mean Cmax of ulipristal acetate by 65% (geometric mean ratio point estimate (90% CI): 0.35 (0.28 - 0.42)), and delayed median tmax from 0.75 to 1.00 h (Hodges-Lehmann estimate of difference (90% CI): tmax 0.63 (0.25 - 1.25)) but had minor effects on AUCs of +15% and +11% (geometric mean ratio point estimates (90% CI): AUC0-t 1.15 (1.02 - 1.31) and AUC0-∞ (1.11 (0.98 - 1.27)), respectively. A total of 6 adverse events were reported by 4 subjects, none of them being serious. Concomitant use of ulipristal acetate with esomeprazole at therapeutic concentrations led to a modified absorption rate while exposure in terms of AUC remained close to bioequivalence limits. In the context of chronic administration of ulipristal acetate, no clinically significant effects are expected from co-administration with drugs increasing gastric pH.

Use of Misoprostol in Pregnancy- A Review Article

Prostaglandins are the pharmacological agents used for induction of labour and augmentation of labour. Prostaglandin E2 gel is used for cervical ripening and induction of labour. These are however, costly and need to be stored in a refrigerator at a temperature of 2 - 8°C, half life 18 months. The Tablet form of prostaglandin E2 is not available in Bangladesh. Misoprostol, a synthetic prostaglandin (PG) E1 analogue is used orally for the treatment of gastric and duodenal ulcer and used as a cytoprotective agent. It was first used for labour induction in 1987. Prostaglandin can be used in several gynaecological and obstetric conditions. It can be given through several routes. This article will elaborately delinate the role of misoprostol, a prostaglandin in obstetrics and gynaecological conditions. Medicine Today 2010 Volume 22 Number 02 Page 94-98 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12443

Exacerbation of Nonsteroidal Anti-Inflammatory Drug-Induced Small Intestinal Lesions by Antisecretory Drugs in Rats: The Role of Intestinal Motility

Antisecretory drugs such as histamine H2-receptor antagonists (H2-RAs) and proton pump inhibitors (PPIs) are commonly used for the treatment of gastric and duodenal ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs). However, the effects of these drugs on NSAID-induced small intestinal ulcers are not fully understood. The effects of H2-RAs and PPIs on NSAID-induced gastrointestinal lesions and small intestinal motility were examined in rats. Male Wistar rats (180-220 g) were used. Indomethacin (10 mg/kg) was administered orally in fasted or fed rats, and gastrointestinal lesions were examined 24 h after indomethacin administration. Intestinal motility was measured by using a balloon method under urethane anesthesia. Indomethacin produced multiple lesions in the gastric corpus in fasted rats and in the small intestine in fed rats: 1) H2-RAs (cimetidine, ranitidine, and famotidine) and PPIs (omeprazole, lansoprazole, and rabeprazole) markedly inhibited the formation of gastric lesions. 2) The drugs, except for lansoprazole, increased intestinal lesions. 3) H2-RAs augmented the increase in intestinal motility caused by indomethacin, and the effects of H2-RAs on motility and intestinal lesions were markedly inhibited by atropine. 4) Lansoprazole inhibited the formation of intestinal lesions, and the effect was prevented by both pharmacological ablation of capsaicin-sensitive sensory neurons and pretreatment with N-nitro-l-arginine methyl ester, a selective inhibitor of nitric-oxide synthesis. The results suggest that: 1) inhibition of acid secretion by antisecretory drugs may exacerbate NSAID-induced intestinal lesions, 2) H2-RAs further aggravate lesions by increasing intestinal motility via the activation of cholinergic pathways, and 3) lansoprazole protects the intestinal mucosa against NSAID-related ulcerative stimuli.

Synthesis and carbonic anhydrase inhibitory properties of novel bromophenols and their derivatives including natural products: Vidalol B

A series of bisphenol, bromophenol, and methoxyphenol derivatives (2–24) including the natural bromophenols vidalol B, 3,4,6-tribromo-5-(2,5-dibromo-3,4-dihydroxybenzyl)benzene-1,2-diol (2) and 5,5′-methylenebis(3,4,6-tribromo-benzene-1,2-diol) (3) were prepared. In the current study, inhibition of four human carbonic anhydrase (hCA, EC 4.2.1.1) isozymes, I, II, IV, and VI, with these compounds 2–24 was investigated. The compounds 2–24 were found to be promising carbonic anhydrase inhibitors, some of which showed interesting inhibitory activities. Some of the compounds investigated here showed effective hCA inhibitory activity, and might be used as leads for generating novel carbonic anhydrase inhibitors which are valuable drug candidates for the treatment of glaucoma, epilepsy, gastric and duodenal ulcers, neurological disorders, and osteoporosis.

The Applicability of Laparoscopic Gastrectomy in the Surgical Treatment of Giant Duodenal Ulcer Perforation

The present study aims to provide an applicability of laparoscopic gastrectomy used in the treatment of giant duodenal ulcer perforation. Between July 2010 and April 2011, laparoscopic distal gastrectomy with ROUX-EN-Y gastrojejunostomy and truncal vagotomy was performed in consecutive 5 patients with giant duodenal ulcer perforation. There was no conversion to open surgery. There was no severe postoperative complication. The days of normalization of leukocytosis were 3, 1, 2, 2, and 5, respectively. The times to first flatus were postoperative days 2, 3, 5, 2, and 3. The days of commencement of a soft diet were postoperative days 5, 5, 6, 5, and 5. They were discharged on postoperative days 9, 11, 20, 10, and 11. We suggest that laparoscopic surgery may be a good surgical method to improve surgical outcomes and is worth a try in experts.