Evaluation Of Gastric Antisecretory Antiulcer Activity Of Jambira (citrus Limon Linn.): An Experimental Study

Acid peptic disorders, especially hyperacidity is not uncommon in the current era because of altered life style of human being. In India prevalence of H. Pyloric infection in young age is 83.8%. Peptic ulcer occurs at young age with highest incidence between 20-40 years, men are affected more than women. If these Acid peptic disorders are not treated in time, it may lead to peptic ulcer, haematemasis, malena and perforation of duodenal ulcer which are common now a day with 50% mortality. Generally it is accepted that gastric ulcers result from an imbalance between aggressive factors and the maintenance of the mucosal integrity through endogenous defense mechanisms. Use of synthetic antiulcer drugs may damage to the cell membrane of mucosal, parietal and endothelial cells. To avoid such hazards, it is essential to find out some antiulcer agents from Ayurvedic treasure of therapeutics. Ancient sages have explained many herbal preparations which are beneficial in pain in abdomen (Shoola) and/or hyperacidity (Amlapitta) etc. Jambira (Citrus limon Linn.), mentioned as Shoola-hara (pain relieving) drug in Ayurvedic classics, is abundantly available and cost effective drug and may satisfy the need of present day situation by acting as potent herbal antacid drug. With this perspective, the study was taken for the critical assessment of gastric anti-secretory and anti-ulcer activity of Jambira (Citrus limon Linn.) as an experimental study but the results of experimental study did not support that Jambira (Citrus limon Linn.) fruit juice is a potent antisecretory and antiulcer natural source compared to control in pylorus ligation rat model.

Utilización de probióticos, antisecretores y zinc en la gastroenteritis aguda en pediatría en Uruguay / Use of probiotic, antisecretory drugs and zinc for acute gastroenteritis in Uruguayan pediatric patients / Uso de probióticos, drogas anti-secretoras e zinco em gastroenterite aguda em pediatria no Uruguai

Resumen: Introducción: luego de la difusión de las sales de rehidratación oral, que resultó en una radical disminución en la morbimortalidad por gastroenteritis aguda (GEA), existe interés creciente en tratamientos destinados a reducir su duración. Objetivo: conocer la utilización de los tratamientos para disminuir la duración de la GEA (probióticos, antisecretores, zinc) por los pediatras uruguayos. Método: encuesta online difundida a través de la Sociedad Uruguaya de Pediatría. Resultados: n=245 encuestas de pediatras procedentes de 17/19 departamentos del país (59% Montevideo). El 39,4% no indica probióticos en tratamiento de GEA; 5,8% lo indica siempre, y 49% en algunas situaciones (15,2% ingreso hospitalario; 21,2% inmunodeprimidos). La elección se basa en 13% en evidencia científica y 47,9% por disponibilidad en el lugar de cobertura. El 32,2% conoce adecuadamente el impacto en la duración de la diarrea. El 61,4% nunca utiliza antisecretores y 24,9% lo utiliza (96,6% racecadotrilo; 3,4% loperamida) en algunas situaciones (56,7% <5 años; 41,6% >5 años; 21,6% en pacientes que requieren internación). El 22% conoce adecuadamente el impacto de su utilización en la duración de la diarrea. En relación con el uso de zinc, 76,3% lo utiliza en algunas situaciones (64% pacientes desnutridos; 46% pacientes internados; 31% >6 meses y 26% <6 meses), y 6,9% lo utiliza siempre). Conclusiones: existe una amplia utilización de probióticos y zinc y un escaso uso de antisecretores en nuestro medio. Los pediatras uruguayos reconocen el posible rol de estos fármacos en la GEA. Un alto porcentaje de los pediatras no conoce la evidencia que fundamenta su uso. Es necesaria la implementación de programas de educación médica continua para guiar su uso.

Summary: Introduction: there is an increasing interest regarding treatments that shorten the duration of acute gastroenteritis (AG) in children, although little is known about it in Uruguay. Aim: that Uruguayan pediatricians get acquainted with probiotics, antisecretory drugs and zinc treatments. Methods: online survey sent to pediatricians members of the Uruguayan Pediatrics Association. Results: n=245 surveys carried out by pediatricians at 17/19 departments in Uruguay (59% from Montevideo). 39.4% stated they had not used probiotics to treat AG, 5.8% had always used it and 49% used it depending on the situation (15.2% used it with inpatients and 21.2% with immune depressed children). The choice of probiotics was based: 13% on scientific evidence and 47.9% on availability. 32.2% of pediatricians knew the real impact of probiotics on the duration of AG. 61.4% did not use antisecretory drugs and 24.9% used them depending on the situation (56.7% <5 years old, 41.6% >5 years, 21.6% inpatients). 96.6% of them chose Racecadotril and 3.4% Loperamide. 22% were aware of the real impact of the duration of AG. 76.3% of pediatricians used zinc to treat GEA in some situations (64% malnourished children, 46% inpatients, 31% >6 months, 26% <6 months) and 6.9% always used it. Conclusion: while probiotics and zinc are widely used, antisecretory drugs are slightly used as AG treatments in Uruguay. Uruguayan pediatricians identify the potential useful role of these treatments for AG, although many of them are not aware of its real use, so it is necessary to offer permanent medical training programs in this respect.

Resumo: Introdução: há um interesse crescente em tratamentos para reduzir a duração da gastroenterite aguda (GA) em pediatria, embora ainda há pouco conhecimento do tratamento no Uruguai. Objetivo: que os pediatras uruguaios se familiarizem com os tratamentos com probióticos, medicamentos anti-secretores e zinco. Métodos: pesquisa online enviada aos pediatras da Sociedade Uruguaia de Pediatria. Resultados: n = 245 pesquisas realizadas por pediatras em 17/19 departamentos do Uruguai (59% de Montevidéu). 39,4% afirmaram não ter usado probióticos para tratar a GEA, 5,8% sempre usaram e 49% usaram dependendo da situação (15,2% usaram com pacientes internados e 21,2% com imunossuprimidos). A escolha dos probióticos foi baseada: 13% na evidência científica e 47,9% na disponibilidade. 32,2% dos pediatras conheciam o real impacto dos probióticos na duração da GA. 61,4% não faziam uso de drogas antisecretoras e 24,9% usaram dependendo da situação (56,7% <5 anos, 41,6% ± 5 anos, 21,6% internados). 96,6% deles escolheram Racecadotril e 3,4% Loperamida. 2% conheciam o impacto real na duração da GA. 76,3% dos pediatras usaram zinco para tratar a GA em algumas situações (64% das crianças desnutridas, 46% dos pacientes internados, 31% >6 meses, 26% <6 meses) e 6,9% sempre usaram. Conclusão: os probióticos e o zinco são amplamente utilizados, enquanto os antisecretores são pouco usados no Uruguai. Pediatras uruguaios tem identificado o potencial papel útil desses tratamentos para a GA, embora muitos deles ainda não conheçam seu uso real, por isso é necessário oferecer programas permanentes de capacitação médica nesse assunto.

Racecadotril in the Management of Rotavirus and Non-rotavirus Diarrhea in Under-five Children: Two Randomized, Double-blind, Placebo-controlled Trials.

Objective: To study the effect of racecadotril on reduction in the duration of acute rotavirus and non-rotavirus diarrhea. Design: Two randomized double-blind placebo-controlled trials Setting: Community-based trial in an urban area in Vellore, hospital-based trial at a secondary hospital in Vellore Participants: 199 and 130 3-59 month old children in the community- and hospital-based trials, respectively. Methods: Racecadotril (1.5 mg/kg/dose, thrice a day for three days) or placebo were given to manage acute diarrhea in both trials. Main outcome measure: Median duration of diarrhea. Results: Among 124 children completing the hospital trial, the median duration of diarrhea was 25 h in both arms (P=0.5); median total stool weight was 74 g/kg and 53.5 g/kg in racecadotril group and placebo group, respectively (P=0.4); and average fluid intake per day was 3.6 mL/kg/h and 3mL/kg/h in racecadotril and placebo arms, respectively (P=0.3). Among rotavirus-positive children, median duration of diarrhea was 26.9 h and 30.2 h in racecadotril and placebo arms, respectively (P=0.7). In the community, 196 completed the trial, the median duration of diarrhea was 2 days for both arms (P=0.8) and rotavirus positive children had similar outcomes with median diarrheal duration of 3 d in both arms (P=0.4). Conclusion: Treatment with racecadotril did not reduce diarrheal duration, stool volume or the requirement for fluid replacement in children with acute gastroenteritis, both with and without rotavirus infection.

Controversias en el manejo de la enfermedad por reflujo gastroesofágico, un análisis crítico / Controversies in the management of gastroesophageal reflux disease, a critical analysis

Introducción: La enfermedad por reflujo gastroesofágico está presente cuando el reflujo del contenido gástrico provoca síntomas y/o complicaciones. Se presenta con frecuencia suficiente como para superar la capacidad defensiva de la mucosa esofágica y provocar un cuadro con sintomatología variable, típica o atípica, con repercusiones clínicas, provocando ocasionalmente esofagitis (0,5%) y/o estenosis esofágicas (0,1%). Objetivo: Identificar la existencia de controversias en el abordaje en los pacientes que se sospecha o están diagnosticados con esta enfermedad. Material y Métodos: Se diseñó una encuesta de opinión tipo cuestionario, anónima y de participación voluntaria. Se realizaron 105 encuestas a pediatras de atención hospitalaria, policlínica / centro de salud, subespecialista y residentes de pediatría de instituciones públicas del país. Resultados: El 88% de los encuestados utilizaría algún examen de gabinete para confirmar el diagnóstico inicial de ERGE. La primera línea de manejo del ERGE son los cambios en el estilo de vida y seguimiento, esta fue señalada como la correcta en un 31% de los encuestados. El 49% utilizaría los inhibidores de bomba de protones para el manejo de la esofagitis lo que si respalda el manejo actual recomendado por la NASPGHAN. Conclusiones: Los resultados muestran una variabilidad en las conductas diagnósticas y terapéuticas que adoptan los médicos en el abordaje clínico. Es importante proponer un manejo estandarizado de la enfermedad por reflujo gastroesofágico con el fin de aunar criterios y llegar al diagnóstico sin el progreso a las complicaciones de esta enfermedad.

Introduction: The gastroesophageal reflux disease is present when the reflux of stomach contents causes symptoms and / or complications. It occurs frequently enough to overcome the defensive capacity of the esophageal mucosa and cause a variable, typical or atypical symptoms, with clinical implications, occasionally causing esophagitis (0.5%) and / or esophageal stenosis (0.1%). Objective: To identify the existence in the approach to patients suspected or are diagnosed with this disease. Material and Methods: An opinion poll questionnaire, anonymous and voluntary participation type was designed. We did 105 surveys including hospital care pediatricians, Polyclinic / health center, subspecialist pediatric, residents in all public medical institutions. Results: 88% would use a test or exam to confirm the initial diagnosis of GERD. The first line of management of GERD are changes in lifestyle, this was designated as correct by 31% of respondents. 49% would use proton pump inhibitors for the management of esophagitis which supports the current management recommended by the NASPGHAN. Conclusions: The results show inconsistency in the diagnostic and treatment practices adopted by physicians in the clinical approach. It is important to propose a standardized management of gastroesophageal reflux disease in order to build consensus and reach a diagnosis without progress to complications of this disease.

Bioprospecting of Medicinal Plant Couroupita Guianensis for its Potential Anti -Ulcer Activity.

In the present investigation anti ulcer activity of methanol extract (flower) of the medicinal plant Couroupita guianensis was evaluated in Wistar rats .The experimental rats were divided into four groups (n= 6). The rats were administered with distilled water (Control), Omeprazole (10 mg/kg) (Positive control), MECG (200mg/kg b.w) MECG (400mg/kg b.w) and was followed by the ligation of pylorus region of the stomach for ulcer induction. The stomach of the sacrificed rats were microscopically analysed ,gastric juice parameters such as gastric juice volume, pH, free acidity and total acidity and the biochemical parameters such as carbohydrate ,protein and pepsin level were quantified. The results of the present investigation revealed that the ulcer protection was 86.82% in rats treated with MECG 400 mg/ml and the ulcer score level was found 4.93±0.22 %. .The MECG reduced gastric juice, free acidity, total acidity and PH in the experimental Wistar rats. The total acidity range and free acidity level was recorded 88.50± 5.09 and 61.83±4.71 respectively at the concentration of 400 mg / ml.The biochemical marker enzyme pepsin level was reduced to 15.36 μg/ml when compared with the ulcer induced control group (24.62 μg/ml).

Enfoque del paciente con dispepsia y dispepsia funcional: actualización / Update on Approaches to Patients with Dyspepsia and Functional Dyspepsia

La dispepsia (DP) describe el dolor o malestar en el abdomen superior. Puede ser dispepsia no investigada o dispepsia funcional (DF), cuando después de realizar pruebas diagnósticas, como la endoscopia digestiva alta (EDA) y ocasionalmente ecografía abdominal superior, no se encuentran alteraciones orgánicas que la expliquen. No obstante, hallazgos recientes controvierten la clasificación de la DF en DP tipo dolor y DP posprandial, pese a su amplia difusión. Se discute el enfoque del paciente con DP y la fisiopatología y el tratamiento farmacológico de la DF.

Dyspepsia (DP) is pain or discomfort in the upper abdomen. It may be uninvestigated dyspepsia or functional dyspepsia (FD) which is diagnosed after diagnostic tests such as upper endoscopy and occasionally upper abdominal ultrasound find no organic changes that explain the condition. Despite the wide dissemination of the classifications of dyspepsia, functional dyspepsia and postprandial dyspepsia, recent findings controvert these classifications. This article discusses the approach to patients with dyspepsia and the pathophysiology and drug treatment of functional dyspepsia.

Anti-ulcerogenic and antisecretory effects of Celtis iguanaea (Jacq. ) Sargent hexane leaf extract / Efeito anti-ulcerogênico e antisecretório do extrato hexânico das folhas de Celtis iguanaea (Jacq. ) Sargent

The Celtis iguanaea (Jacq.) Sargent (Cannabaceae) is one of the native species of the Cerrado region of Brazil widely used in folk medicine to treat dyspepsia. The objective of the present study was to evaluate the gastroprotective effect of the Celtis iguanaea (Jacq.) Sargent (HE) hexane leaf extract in the lesion and gastric secretion models.Antiulcerogenic activity of the Celtis iguanaea (HE) hexane leaf extract was observed with the experimental models, such as indomethacin and pyloric ligation-induced gastric ulcers. In order to evaluate the antisecretory activity of this extract, isolated Rana catesbeiana mucosa and pyloric ligation in mice were used. The HE treatment reduced the lesion index of indomethacin and pyloric ligation-induced ulcer. This extract also reduced the gastric acid secretion and total acidity (increasing the gastric pH) in mice. The secretion of H+ was reduced in the basal values (15.58 ± 1.99 µEq H+/g/15 min) when isolated Rana catesbeiana mucosa was incubated with HE. Intraduodenal administration of HE reduced the gastric secretion produced by bethanecol or histamine. The antiulcerogenic and antisecretory efficacy of HE in this study suggest anticholinergic and antihistaminergic mechanism or interruption of intracellular events that are linked to acid secretion.

Celtis iguanaea (Jacq.) Sargent (Cannabaceae) é uma das espécies nativas do cerrado brasileiro, sendo amplamente utilizada na medicina popular para o tratamento de dispepsia. O objetivo do presente trabalho foi avaliar o efeito gastroprotetor do extrato hexânico das folhas de Celtis iguanaea (Jacq.) Sargent (EH) em modelos de secreção e de lesões gástricas. A atividade antisecretória do extrato hexânico das folhas de Celtis iguanaea (EH) foi avaliada no modelo de mucosa isolada de Rana catesbeiana e pelo modelo de ligadura pilórica em camundongos. A avaliação da atividade anti-ulcerogênica do EH foi determinada no modelo de úlceras gástricas induzidas por indometacina e ligadura pilórica. Quando a mucosa de Rana catesbeiana isolada foi incubada com o EH, a secreção de H+ foi reduzida em comparação com o valor basal (15,58 ± 1,99 µEq H+/g/15 min). O tratamento com o EH reduziu o índice de lesões na úlcera induzida por indometacina e ligadura pilórica. O EH também reduziu o volume de secreção, a acidez total, e aumentou o pH gástrico. A administração intraduodenal reduziu a secreção gástrica produzida por betanecol ou histamina. A eficácia anti-ulcerogênica e antisecretória do EH neste estudo, sugere um mecanismo anticolinérgico e antihistaminérgico ou interrupção de eventos intracelulares que estão ligados à secreção ácida.

Salovum Egg Yolk Containing Antisecretory Factor As an Adjunct Therapy in Severe Cholera in Adult Males: A Pilot Study.

Cholera involves stimulation of intestinal secretory process in response to cholera toxin leading to profuse watery diarrhoea that might cause death due to dehydration unless timely rehydration therapy is initiated. Efforts to identify and test potential antisecretory agents are ongoing. Antisecretory factor (AF) is a naturally-occurring protein produced in the human secretory organs, including the intestine, with antisectory properties demonstrated in animal and human models of secretory diarrhoea. Salovum egg yolk powder contains proteins with antisecretory properties in a much higher (500 times) concentration than that of normal hen eggs. This is achieved by feeding hens with specially-processed cereals, capable of inducing proteins with antisecretory properties in the yolk. The aim of the study was to examine the effect of Salovum egg yolk powder containing AF in the treatment of adult cholera patients. In an open, randomized controlled trial (pilot study), 40 adult male patients with severe cholera were studied: 20 received standard treatment (oral rehydration solution, antibiotic, and usual hospital diet) plus Salovum egg yolk powder (study group) and 20 received standard treatment alone (control group). All the patients received tablet doxycycline (300 mg) once immediately after randomization. Written informed consent was obtained from each subject before enrollment. The main outcome measures were stool weight and duration of diarrhoea. The demographic and baseline clinical characteristics of the study patients were comparable between the groups. No significant differences were found in the mean stool weight, g/kg of body-weight during the first 24 hours [study vs control group, mean±standard deviation (SD), 218±119 vs 195±136], second 24 hours (mean±SD, 23±39 vs 22±34), and cumulative up to 72 hours (mean±SD, 245±152 vs 218±169). The duration (hours) of diarrhoea after admission in the hospital was also similar in both the groups (mean±SD, 33±14 vs 32±10). No adverse effect was observed. Salovum egg powder containing AF as an adjunct therapy in the treatment of severe cholera could not demonstrate any beneficial effect. Further studies with higher doses of Salovum egg yolk powder might be considered in future to establish its antisecretory effect.

Anti-ulcerogenic and proton pump (H+, K+ ATPase) inhibitory activity of Kolaviron from Garcinia kola Heckel in rodents.

Anti-ulcer potential and proton pump inhibitory activity of kolaviron (KV) isolated from Garcinia kola Heckel has been evaluated using different ulcer models. Cold-restraint (CRU), aspirin (ASP), alcohol (AL), pyloric ligation (PL) induced gastric ulcer models were used to assess  anti-ulcerogenic activity of KV in rats. Effects of KV on gastric juice for free and total acidity, peptic activity and mucin secretion were also evaluated. The H+, K+-ATPase activity was assayed in gastric microsomes, spectrophotometrically. Results of this study showed that KV (200 mg/kg) reduced the incidence of ulcers in CRU (69.0%), PL (67.6%), ASP (68.6%) and AL (51.5%). Reductions were also observed in free acidity (32.6%), total acidity (56.2%) and peptic activity (35.4%) with increase in mucin secretion by 40.1%. KV inhibited the H+,K+-ATPase activity with IC50 of 43.8 g/ml compared with omeprazole with IC50 of 32.3 g/ml. KV showed both cyto-protective and anti-secretory potentials against peptic ulcer models, and a proton pump inhibitory activity. KV may emerge as a potent anti-ulcer compound.