Unhealed Group Research Articles

Esomeprazole-induced healing of gastroesophageal reflux disease is unrelated to the genotype of CYP2C19: Evidence from clinical and pharmacokinetic data

The clinical outcome of acid-related disorders treated by proton pump inhibitors (PPIs) might be dependent on the polymorphically expressed cytochrome P450 (CYP) 2C19, which is involved in PPI metabolism. We tested whether esomeprazole-induced healing of gastroesophageal reflux disease (GERD) is related to CYP2C19 genotype. Two hundred five patients with GERD (Los Angeles classification grade A or B) were included in a case-control study according to endoscopic outcome (healed versus unhealed group, matched for confounders) after treatment with 40 mg esomeprazole daily for 4 weeks. The frequency of CYP2C19 genotypes was determined as the primary outcome measure for both groups. In a second trial plasma levels of esomeprazole and corresponding CYP2C19 and CYP3A4 metabolites (5-hydroxyomeprazole and omeprazole sulfone) were monitored in 10 CYP2C19 wild-type patients with GERD after the first and last doses (day 7) of 40 mg esomeprazole daily to calculate metabolic ratios. CYP2C19 wild-type (n = 148) and heterozygous (n = 51) or homozygous variant (n = 6) patients did not differ with respect to baseline characteristics. The frequency distribution of CYP2C19 genotypes was not different between patients with complete (75/100) and incomplete (73/105) healing (P = .65). When a single esomeprazole dose and multiple dosing were compared, the low contribution of CYP2C19 to the elimination of esomeprazole decreased further by 50%. In contrast, the CYP3A4-dependent formation of omeprazole sulfone increased by 40%, and consequently, the metabolic ratio of omeprazole sulfone to 5-hydroxyomeprazole was elevated from 7.9 to 19.3 (P = .0004). In contrast to other PPIs, esomeprazole-induced healing of GERD is unrelated to the CYP2C19 genotype, which can be explained by the metabolic shift toward the CYP3A4-mediated pathway.

Factors that Influence Healing in Chronic Venous Ulcers Treated with Cryopreserved Human Epidermal Cultures

BACKGROUND Cryopreserved epidermal cultures (CEC) offer an “off the shelf” treatment for chronic wounds. These cultures are derived from neonatal foreskin and grow rapidly in vitro to form epidermal sheets. They do not require a biopsy from the patient, an advantage compared to autografts. They seem to act as a biological dressing, stimulating epithelialization from the wound edges and adnexae, probably through growth factor release. OBJECTIVE To summarize our recent experience with the use of CEC in chronic venous leg ulcers and to determine the factors that influence healing in chronic venous ulcers treated with CEC. PATIENTS AND METHODS A single arm, open label study including a total of 11 patients with documented venous ulcers was performed. The study involved the application of cryopreserved epidermal cultures every other week to nonhealing leg ulcers for a total of 12 weeks or until complete healing of the ulcer. RESULTS A total of 11 patients with one or more leg ulcers were treated. The average age was similar in healed and unhealed groups. Seven patients completely healed after an average of 4.14 CEC applications. Four patients did not heal after a total of 12 CEC applications. CONCLUSION Predictors for failure to heal after CEC application in our patients were long wound duration, wound size, presence of lipodermatosclerosis, and history of failed prior split-thickness skin grafts.

PEPTIC ULCER: PATHOGENESIS, HEALING AND ANTI‐ULCER DRUGS

To investigate pathophysiological diversities in the repairing process of gastric ulcer, distribution density of basic fibroblast growth factor (bFGF)-positive fibroblasts and myofibroblasts and vascular endothelial cells, mucosal haemoglobin content, PAS-positive mucus amount and glandular index were compared in the peripheral region of an open ulcer (the unhealed group; n = 17), the central region of a red scar (the red scar group; n = 32) and the central region of the white scar (white scar group; n = 32). Density of bFGF-positive fibroblasts and myofibroblasts and vascular endothelial cells was highest in the unhealed group, followed by the red scar group, while the white scar group showed a low value close to control. Mucosal haemoglobin content was high in the red scar and unhealed groups. PAS-positive mucus amount in the unhealed and red scar groups showed lower values compared with that in the white scar group. Glandular index in the unhealed group was the lowest, followed by the red scar group, while the white scar group neared control values. Statistically significant correlations were observed between the density of bFGF-positive "fibroblasts and myofibroblasts' and density of bFGF-positive vascular endothelial cells, between the density of bFGF-positive vascular endothelial cells and mucosal haemoglobin content and between the PAS-positive mucus amount and glandular index. Discriminant analysis demonstrated that the unhealed group could be distinguished from the red and white scar groups, based on glandular index, density of bFGF-positive "fibroblasts and myofibroblasts', mucosal haemoglobin content and PAS-positive mucus amount, while the red scar group could be discriminated from the white scar group based on the density of bFGF-positive "fibroblasts and myofibroblasts', density of bFGF-positive vascular endothelial cells, glandular index, haemoglobin content and PAS-positive mucus amount. The white scar group was difficult to discriminate from control. Our present results show that the recovery of glandular formation and mucus production continues throughout the repairing process, whereas the acceleration of angiogenesis and granulation formation is observed only in unhealed ulcers and at the red scar stage.

Clinical parameters and transcutaneous oxygen measurements for the prognosis of venous ulcers

Few data exist on the prognosis of venous ulcers. We therefore prospectively studied 14 patients with severe venous ulcers for up to 18 months and examined various possible prognostic factors, including transcutaneous oxygen tension (TcPO 2) measurements of skin next to the ulcers. The ulcers had been present for a mean duration of 15.6 months before referral to our clinic. During the study only four patients (29%) had ulcers that were healed with conservative management consisting of topical and systemic antibiotics and conventional and occlusive dressings. We observed that the number of ulcers, their duration before admission to the study, and the extent of lipodermatosclerosis were more pronounced in the unhealed group. For all patients the mean ulcer TcPO 2 level (5.6±1.5 mm Hg, mean ± standard error) was significantly reduced when compared with the control chest site (62.4±2.1 mm Hg) ( p<0.001; paired t test). The mean ulcer TcP0 2 was not significantly different between the healed (4.5±2.0 mm Hg) and unhealed groups (6.1±2.0 mm Hg). We conclude that TcPO 2 levels may not be predictive of the response to therapy in venous ulcers. TcP0 2 levels may be markedly reduced, but even extremely low levels are not incompatible with healing.