Peptic ulcer frqquency differences related to h. pylori or aines / Diferentes frequências da úlcera péptica relacionadas com H. pylori ou AINES

Background Peptic ulcer etiology has been changing because of H. pylori decline. Objectives To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. Results Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. Conclusions After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer. .

Contexto A etiologia da úcera péptica vem apresentando mudanças devido à redução da infecção pelo H. pylori. Objetivos Estimar a prevalência da úlcera péptica em dois períodos com intervalo de 10 anos e comparar a associação com a infecção pelo H. pylori com o uso de anti-inflamatórios não esteroides. Métodos Revisão de prontuários em dois períodos: A (1997-2000) e B (2007-2010), com busca por úlcera péptica, H. pylori e uso de anti-inflamatórios não esteroides (AINE). Resultados Úcera péptica apresentou frequência de 30,35% em A e 20,19% em B. Infecção por H. pylori ocorreu em 73,3% em A e em 46,4% em B. Uso de anti-inflamatórios não esteroides ocorreu em 3,5% em A e em 13,3% em B. Nenhuma dessas condições esteve associada em 10,4% e 20,5% das úlceras em A e B, respectivamente. Comparando os dois períodos, houve redução da úlcera péptica associada à H. pylori (P=0,000), aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides (P=0,000) e aumento de úlceras idiopáticas (P=0,002). A associação concomitante de H. pylori e anti-inflamatórios não esteroides foi também mais alta em B (P=0,002). Úlceras gástricas aumentaram e úlceras duodenais diminuíram em B. Conclusões No intervalo de 10 anos, a prevalência de úlcera péptica diminuiu assim como as úlceras relacionadas com H. pylori e houve um aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides. Houve inversão na frequência das lesões gástricas e duodenais e aumento da prevalência da úlcera idiopática. .

gastro-protective effect of antioxidants in ethanol induced gastric ulcer

Peptic ulcer is a state that result from imbalance between the corrosive effect of acid and pepsin and mucosal defense mechanism in the stomach and may be correlated with antioxidant agents. Forty two healthy albino male rats weighing [180-200] gram were used in this study. The animals were allocated to six groups. Each group was given one of the following drugs: Lansoprazole, Zinc sulfate, chromium, Beta-carotene and distilled water as control. After 5 days of treatment with these agents, ethanol 95% was administered orally after one hour of the last dose of these agents. Animals were sacrificed after one hour later .The main parameters used in this study were ulcer preventive index, free radicals, changing of serum electrolytes. Ethanol in high concentrations was found to be highly ulcerogenic agent with ratio of 100% when administered orally in rat .The preventive index of these drugs equal 97.35, 59.99 and 87.78 for Zinc sulfate, chromium and Beta-carotene respectively in comparing with lansoprazole 99.09. All the tested agents produced highly significant changes in free radicals of the gastric tissue decreasing MDA levels and increasing GSH levels and many of serum electrolytes were significantly changed by the tested drugs. Zinc sulfate, chromium and Beta-carotene proved to have gastroprotective activity against ethanol induced gastric ulcer and the possibility to be used for patients with peptic ulcer

Effect of Zinc Salts on Acid Secretion and Peptic Ulceration in Albino Rats.

The present study was carried out to see the effect of two zinc salts i.e zinc sulphate and zinc chloride on gastric ulcers induced by stress, pylorus ligation and aspirin in albino rats. The rats were divided into two main groups (zinc sulphate 30, 60, 90 mg/kg i.p and zinc chloride 10 and 20mg/kg i.p). They were further sub-divided into three sub-groups dependant on ulcer model i.e stress, pylorus ligation and aspirin induced ulcers. It was found that zinc sulphate and zinc chloride had a dose dependant reduction in ulcer index in all three models of gastric ulceration. Also, both the salts had anti acid secretory effect, raised pH of gastric secretion and reduced total acidity significantly. Thus zinc salts prevent gastric ulceration. Probably this effect is mediated by anti acid secretory action.

Effect of aqueous extract of neem (Azadirachta indica) leaves on offensive and diffensive gastric mucosal factors in rats.

Standardized aqueous extract of Neem (Azadirachta indica) leaves (AIE) has been reported to show both ulcer protective and ulcer healing effects in normal as well as in diabetic rats. To study the mechanism of its ulcer protective/healing actions, effects of AIE (500 mg/ kg) was studied on various parameters of offensive acid-pepsin secretion in 4 hr pylorus ligation, pentagastrin (PENTA, 5 microg/kg/hr)-stimulated acid secretion and gastric mucosal proton pump activity and defensive mucin secretion including life span of gastric mucosal cells in rats. AIE was found to inhibit acid-pepsin secretion in 4 hr pylorus ligated rats. Continuous infusion of PENTA significantly increased the acid secretion after 30 to 180 min or in the total 3 hr acid secretion in rat stomach perfusate while, AIE pretreatment significantly decreased them. AIE inhibited the rat gastric mucosal proton pump activity and the effect was comparable with that of omeprazole (OMZ). Further, AIE did not show any effect on mucin secretion though it enhanced life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus, our present data suggest that the ulcer protective activity of AIE may be due to its anti-secretary and proton pump inhibitory activity rather than on defensive mucin secretion. Further, acute as well as sub acute toxicity studies have indicated no mortality with 2.5 g/kg dose of AIE in mice and no significant alterations in body or tissues weight, food and water intake, haematological profile and various liver and kidney function tests in rats when treated for 28 days with 1 g/kg dose of AIE.

Antioxidant and antiulcer activity of aqueous extract of a polyherbal formulation.

The aqueous extract of Hingwashtak churna was evaluated for gastroprotection in rats using the ibuprofen and ethanol induced ulcer models. Efficacy was assessed by determination of mean ulcer size, ulcer number and ulcer index. Oral administration of the aqueous extract (750 mg/kg) significantly protected against gastric lesions by 84.96% and 91.12% as compared to ranititidine (95.54 and 95.2%) in the ibuprofen and alcohol induced ulcer models respectively. The findings suggest that the significant gastroprotective activity could be mediated by its antioxidant activity which was evaluated by using different antioxidant models of screening.

Doxycycline-induced esophagitis

Esophageal ulceration occasionally occurs in patients taking doxycycline capsules or tablets. We report two patients who develop acute esophageal ulceration after ingestion of doxycycline capsules for Acne vulgaris. Despite extensive investigation, no evidence of other causes was found. The ulcers are postulated to result from close contact between the capsules and the esophageal mucosa. We show the endoscopic image of the lesion, symptomatology, diagnosis, treatment, and prevention of doxycycline-induced esophageal lesions

Effect of ethanol extract of Piper betle Linn leaf on healing of NSAID-induced experimental ulcer--a novel role of free radical scavenging action.

Treatment with ethanol extract of leaf of P. betle at a dose of 150 mg/kg body weight daily for 10 days, after induction of peptic ulcer by NSAID in albino rats, produced significant healing effect. During healing process, on treatment with the extractive, antioxidative factor, e.g. superoxide dismutase and catalase activity, mucus and total gastric tissue sulfhydryl group were increased. In contrast, oxidised lipid and oxidatively modified proteins were reduced to near normalcy, within 7 to 10 days, however, change in the untreated group was not significant. The extract also showed significant in vitro free radical scavenging action. The results suggest that the antioxidant or free radical scavenging activity of the plant extract, may be responsible for its healing action.

Effect of melatonin and beta-carotene on indomethacin induced gastric mucosal injury.

The study was conducted to examine the role of free radicals in Indomethacin induced gastric mucosal injury and to evaluate the gastroprotective effects of melatonin and beta-carotene. Gastric mucosal injury was produced in rats by administering indomethacin 30 mg/kg subcutaneously. Melatonin was administered in three different doses of 5, 10 and 20 mg/kg, 30 minutes prior to the administration of indomethacin. Beta-carotene was administered as a single dose of 100 mg/kg. Following parameters were calculated: ulcer index, lipid peroxidation and antioxidant defense enzymes i.e. superoxide dismutase, glutathione peroxidase and catalase. Indomethacin caused gastric mucosal injury in the form of haemorrhages, increased the lipid peroxidation and decreased the levels of the antioxidant defense enzymes. Melatonin (20 mg/kg) and beta-carotene decreased the ulcer index and lipid peroxidation, and reduced the decrease in antioxidant enzyme levels. These findings suggest the melatonin and beta-carotene show protective effect against indomethacin induced gastric injury and this effect is mediated by scavenging of oxygen derived free radicals.

Effect of SR 58611A, a beta-3 receptor agonist, against experimental gastro-duodenal ulcers.

The present study was designed to study the effect of SR 58611A, a selective beta 3-adrenoceptor agonist against gastric ulcers: pylorus ligation, water immersion plus restraint stress (WIRS), ethanol, aspirin-induced and on cysteamine-induced duodenal ulcers, in rats. SR 58611A (10 mg/kg, p.o.) was found to be effective in attenuating gastric ulceration and the results were comparable with those from standard cimetidine-treated group. Apart from reducing ulcer index, SR 58611A significantly decreased total acidity and thereby exhibited antisecretory activity in pylorus ligation model. SR 58611A showed significant reduction in ulcer index alongwith significant rise in the gastric wall mucus content in WIRS model. Further it showed significant cytoprotective activity against ethanol insult, that was evident from significant reduction in ulcer index. It showed significant reduction in gastric ulceration in aspirin-treated rats. The drug was found to be ineffective in inhibiting the cysteamine-induced duodenal ulcers as evident from the ulcer index and total lesion area parameters. It is concluded that SR 586111A possesses significant gastroprotective activity. This activity could be attributed to the inhibition of gastric acidity, increase in gastric wall mucus content and the reversal of gastric microvascular injury resulting into protection of the vascular integrity.

Prevention of HCl-ethanol induced gastric mucosal injury in rats by Garcinia cambogia extract and its possible mechanism of action.

Oral pretreatment of rats with G. cambogia fruit extract (1 g/kg body weight/day at interval of 7 and 15 days) protected gastric mucosa against HCl-ethanol induced damage by decreasing the volume and acidity of gastric juice. Increased lipid peroxidation, decreased activity of antioxidant enzymes, altered levels of protein and glycoproteins in the ulcerated mucosa, and gastric juice were maintained at near normal levels in G. cambogia pretreated rats. The results suggest the anti-ulcer activity of G. cambogia by virtue of its ability to decrease acidity and increase mucosal defense.

Selectividad "in vivo" de daines cox-1 - cox-2 y ulceras gastrointestinales, en ratas / In vivo selectivity of nonsteroidal anti-inflammatory drugs on COX-1 - COX-2 and gastrointestinal ulcers, in rats

En ratas Wistar "in vivo", se evaluó la selectividad COX-2 - COX-1 de 16 DAINEs, dados en dois ulcerógenas, en dos modelos experimentales: A) Ayuno 36 horas, comida sólida 1 hora y AINE sc, donde indometacina (inhibidor selectivo COX-1) produce úlceras en antro gástrico y erosines en intestino delgado y B) Ayuno 36 horas y DAINEs dados por vía oral. Se estudiaron: indometacina, aceclofenac, ácido mefenámico, aspirina, diclofenac, etodolac, ibuprofeno, ketoprofeno, ketorolac, meloxicam, nabumetona, naproxeno, nimesulida, paracetamol, piroxicam y tenoxicam. Se concluyó que los AINEs con menor daño gastrointestinal y prevalentes inhibidores COX-2 fueron: aceclofenac, meloxicam, nabumetona, nimesulida y paracetamol.

Manifestaciones ácido-pépticas en pacientes con enfermedades reumáticas bajo tratamiento con AINE y medicamantos que modifican el curso y progreción (MMPC) de la enfermedad; su asociación con Helicobacter pylori / Relation of rheumatic diseases with peptic manifestation and H. pylori infection

La enfermedad ácido péptica se asocia al uso de AINE y está estrechamente relacionada con Helicobacter pylori. Frecuentmente se requiere de AINE y MMCP en las enfermedades reumáticas. Por lo anterior, decidimos realizar un estudio prospectivo observacional en pacientes con lupus eritematoso generalizado bajo tratamiento con AINE y con artritis reumatoide que recibían ambos tipos de tratamiento. A estos grupos de pacientes se les realizó endoscopia gastrointestinal alta y toma de biopsia para la búsqueda del H. pylori y así conocer los potenciales asociaciones entre manifestaciones de la enfermedad ácido-péptica, la modalidad terapéutica y la presencia de este microorganismo. Se utilizó el método de Fisher para análisis estadístico. La mayoría de los pacientes con osteoartrosis presentaron síntomas (14 de 17), alteraciones endoscópicas y 13 de los 14 con síntomas tuvieron H. pylori. Sólo 3 de los 7 con lupus tuvieron manifestaciones clínicas y alteraciones mínimas en el estudio endoscópico; 3 de 4 que recibían MMCP tuvieron H. pylori y sólo uno lo tuvo sin este tratamiento. De aquellos con artritis reumatoide, 18 tuvieron H. pylori, 9 de los cuales refirieron síntomas y de éstos, 8 tenían alteraciones

Effect of certain pharmacological agents on some neuropepyides and adrenal hormones in stressed rats. an evidence for a specific role in stress ulcerogenesis

This work aimed to study the effect of certain pharmacological agents [6-hydroxydopamine [6HD], metyrapone and naloxone]] on plasma adrenal hormones [corticosterone, epinephrine, norepinephrine and dopamine], brain and mucosal somatostatin and prostaglandin E2 [PGE2] as well as mucosal beta-endorphin in rats exposed to restraint stress. The specific actions of the different drugs used in this study helped to delineate the relative contribution of the different components in the pathogenesis of stress ulceration. The sympatho-adrenal medullary activity appears to be protective and neutralize the ulcerogenic effects involving the vagal activation and opioid mechanisms. Meanwhile, the adreno-cortical activity through the glucocorticoids appear to offer a permissive role in ulcer development