Coriocarcinoma gástrico primario: reporte de caso / Primary gastric choriocarcinoma: case report

El coriocarcinoma gástrico primario (CGP) es un tumor extremadamente raro, altamente invasivo y de rápida diseminación hematógena. Presentamos el caso de una paciente de 57 años que inicia con cuadro de hematemesis y, progresivamente, se le suman episodios de melena, baja de peso y epigastralgia. Es derivada al Instituto Nacional de Enfermedades Neoplásicas en donde se le realizan gastroscopía y biopsia. Así, el análisis histológico reportó patrón sugestivo para CGP; el cual se confirmó al realizarle a la paciente los estudios por imágenes necesarios y llevar a cabo el análisis inmunohistoquímico para gonadotrofina coriónica humana y alfa feto proteína. Posteriormente, a la paciente se le realiza una gastrectomía radical D2 con preservación esplénica y de cola de páncreas. Lamentablemente, su evolución no fue favorable y fallece por la progresión de la enfermedad.

Primary gastric choriocarcinoma (PGC) is an extremely rare and highly invasive tumor with rapid hematogenous spread. We present the case of a 57-year-old female patient who started with hematemesis and progressive episodes of melena, weight loss and epigastralgia. It is derived from the National Institute of Neoplastic Diseases where gastroscopy and biopsy are performed. Histological analysis reported pattern suggestive of PGC; that was confirmed by immunohistochemical analysis for human chorionic gonadotrophin and fetal alpha protein. Subsequently, the patient underwent a radical D2 gastrectomy with splenic preservation and tail of the pancreas preservation. Unfortunately, her evolution was not favorable and died due to the progression of the disease.

Caso Clínico: Tumor Neuroendocrino Gástrico / Case Report: Gastric Carcinoid

INTRODUCCIÓN: Los tumores neuroendocrinos gástricos son tumores de muy baja prevalencia, constituyendo el aproximadamente 1.8 % de los tumores gástricos. Suelen ser solitarios, con un tamaño entre 4 y 8 cm, con más frecuencia en el sexo masculino con edad promedio de presentación entre 60 - 70 años. Su diagnóstico es cada vez mayor, gracias al uso generalizado de la endoscopia digestiva alta, siendo ésta la prueba de oro. En cuanto a su tratamiento, la resección quirúrgica de los tumores carcinoides gástricos es de elección cuando no se puede optar por resección endoscópica. CASO CLÍNICO: Paciente de 45 años con cuadro clínico de epigastralgia, náusea y diarrea, de dos meses de evolución. Se realiza endoscopía digestiva alta con reporte de úlcera de antro Forrest III. Biopsia: neruroendocrino grado II. Tomografia abdomen: sin datos de actividad en otro sitio fuera de estómago. EVOLUCIÓN: Se realizó gastrectomía subtotal, con reporte negativo en el estudio transoperatorio de líquido de lavado peritoneal. El reporte de patología confirmó el diagnóstico de tumor neuroendócrino GII 3.5 cm unifocal; en estadio III B según las guías clínicas, con vigilancia por un período de un año sin actividad tumoral. CONCLUSIÓN: Al ser el tumor neuroendocrino gástrico un tipo de cáncer poco frecuente, la endoscopía digestiva alta fue fundamental en el diagnóstico de este caso que le llevó al paciente a buscar evaluación médica. Sin embargo, para disminuir el riesgo de su incidencia se recomienda una alimentación rica en frutas, y verduras frescas acompañado de una actividad física adecuada.

BACKGROUND: Gastric neuroendocrine are very low tumors prevalence, constituting approximately 1.8 % of gastric tumors. They are usually solitary, with a size between 4 and 8 cm, most often in the male with average age of presentation between 60 - 70 years. It is diagnosis is increasing, thanks to the widespread use of upper digestive endoscopy, this being the gold standar. Regarding it is treatment; surgical resection of gastric neruroendocrine tumors is one of the choices when endoscopic resection is not possible. CASE REPORT: 45-year-old patient refers epigastralgia, nauseas and diarrhea, since two months ago. Upper digestive endoscopy is performed with report of Forrest III antrum ulcer. Biopsy: grade II neuroendocrine tumor. Abdominal tomography: no activity data in another place outside the stomach. EVOLUTION: Subtotal gastrectomy was performed, with a negative report in the transoperative study of peritoneal lavage fluid. The pathology report confirmed the diagnosis of unifocal neuroendocrine GII 3.5 cm tumor; in stage III B according to clinical guidelines, with surveillance for a period of one year without tumor activity. CONCLUSION: The gastric neuroendocrine is a rare type of cancer; upper gastrointestinal endoscopy was a fundamental in the diagnosis of this case that led the patient to seek medical evaluation. However, to reduce it is incidence is recommended to eat a diet rich in fruits, and fresh vegetables accompanied by adequate physical activity.

Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres

Transcatheter arterial radioembolization (TARE) with Yttrium-90 (90Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

Effects of D-002 on aspirin-induced ulcers and neutrophil infiltration on the gastric mucosa / Efecto del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica

Introduction: the gastric mucosa is susceptible to the effects of aggressive factors, which are counterbalanced by mucosal defensive factors. Acid peptic diseases result from the imbalance between these aggressive and defensive factors. Aspirin-induced ulcer is a model of NSAIDs-induced damage in which neutrophil infiltration plays a key role. Objective: this paper investigates the protective effect of D-002 against aspirin-induced ulcers and associated neutrophil infiltration in the gastric mucosa. Methods: rats were randomized into six groups of 8 rats each. A negative vehicle control, and five aspirin (300 mg/kg)-treated groups: a positive control, orally treated with the vehicle, three with D-002 (25, 50 and 100 mg/kg, respectively) and other with 10 mg/kg Omeprazole. Five hours after induced damage the rats were sacrificed. The stomachs were removed and opened, and lesions examined macroscopically and microscopically. Ulcer indexes and neutrophil infiltration per ulcer areas were measured. Results: all positive, none negative, controls exhibited aspirin-induced ulcers. Oral treatment with D-002 (25-100 mg/kg) dose-dependently and significantly reduced aspirin-induced gastric lesions (37 to 75 ), the mean number of microscopic ulcers (40 to 72 por ciento) and neutrophil infiltration (41.7 to 83.1 por ciento) in the rat gastric mucosa. Conclusion: Oral treatment with D-002 (25-100 mg/kg) effectively protects against aspirin-induced ulcers and decreases the neutrophil infiltration in the gastric mucosa induced by aspirin ulceration

Introducción: la integridad de la mucosa gástrica depende del balance entre los factores agresivos y defensivos. La úlcera inducida por aspirina es un modelo de daño por antiinflamatorios no esteroidales en el cual el infiltrado de neutrófilos desempeña una función fundamental. Objetivo: evaluar el efecto protector del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica. Métodos: las ratas fueron aleatorizadas en seis grupos de ocho animales cada uno. Un control negativo con vehículo y cinco grupos tratados con aspirina (300 mg/kg): un control positivo, tratado por vía oral con vehículo, tres grupos con D-002 (25, 50 and 100 mg/kg respectivamente) y otro con omeprazol 10 mg/kg. Cinco horas después de inducido el daño las ratas fueron sacrificadas y se extrajeron sus estómagos para su análisis morfológico. Se determinó el índice de úlcera, el número de úlceras microscópicas y el número de neutrófilos por área ulcerada. Resultados: todos los controles positivos y ninguno negativo mostraron lesiones en la mucosa. El tratamiento por vía oral con D-002 (25-100 mg/kg) redujo de modo significativo y dependiente de la dosis el índice de úlceras gástricas (37-75 percent), el promedio de úlceras microscópicas (40- 72 percent) y la infiltración de neutrófilos (41,7-83,1 percent) en la mucosa de las ratas. Conclusiones: el tratamiento por vía oral con D-002 (25-100 mg/kg) protege la mucosa gástrica de las ratas del daño inducido por aspirina, lo que disminuye el índice de úlcera y el infiltrado de neutrófilos

Evaluation of the anti-ulcer activity of NR-ANX-C (a polyherbal formulation) in aspirin & pyloric ligature induced gastric ulcers in albino rats.

Background & objectives: The aetiology of gastric ulcers is not completely understood and continuous use of anti-ulcer agents leads to many side effects. In this study we evaluated the anti-ulcer efficacy of a polyherbal formulation with potent antioxidant activity in aspirin and pyloric ligature induced gastric ulcers in rats. Methods: The efficacy of the polyherbal formulation NR-ANX-C (composed of the extracts from Withania somnifera, Camellia sinensis, Ocimum sanctum, shilajith and triphala) was evaluated in terms of antioxidant potential as assessed in terms of protection from lipid peroxidation and the antiulcer activity as seen by the area of gastric lesions, gastric juice volume, gastric pH, total acidity and total adherent gastric mucus content. Results: In our study, NR-ANX-C (25 and 50 mg/kg) was more efficacious than ranitidine in reducing ulcer index in both the models. At the highest dose tested (50 mg/kg), NR-ANX-C was comparable to omeprazole in preventing ulcer formation in the pyloric ligature model. NR-ANX-C showed a dose- dependent decrease in gastric juice volume and total acidity in both the models. A dose-dependent increase in gastric pH and total adherent gastric mucus was also seen in NR-ANX-C treated groups. The extent of lipid peroxidation was also reduced in the test drug treated groups. Interpretation & conclusion: Based on our findings, we presume that the cytoprotective, anti-secretary and antioxidant properties of NR-ANX-C were responsible for its anti-ulcer activity. These findings suggest the potential for use of NR-ANX-C as an adjuvant in the treatment of gastric ulcer.

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study / Úlcera perianastomótica após derivação gástrica em Y-de-Roux mesmo em uso de inibidor de bomba de prótons: estudo prospectivo multicêntrico

CONTEXT: Causal factors of gastrojejunal ulcers after Roux-en-Y gastric bypass include peptic acid secretion from the gastric pouch. Esomeprazole is a potent inhibitor of acid secretion. OBJECTIVE: To assess the occurrence of dyspepsia and gastrojejunal ulcers within the first 2 months after Roux-en-Y gastric bypass during the use of esomeprazole. METHODS: One hundred eighteen morbid obese subjects were submitted to Roux-en-Y gastric bypass. Preoperative upper gastrointestinal tract endoscopy was negative for H. pylori. All subjects received esomeprazole for 60 days after surgery. RESULTS: Two weeks after surgery only 13 mild symptoms were reported. After 2 months, 17 also moderate complaints were registered. Endoscopy around the 60th day showed esophagitis in 10 (8.5 percent), hiatal hernia in 2 (1.7 percent), foreign body in the anastomotic line in 12 (10.2 percent) and gastrojejunal ulcers was observed in 9 (7.6 percent) subjects, 2 of which had a suture material or metallic staple granuloma in the gastrojejunostomy. Ten subjects took nonsteroidal anti-inflammatory drugs at least once during study, but none of them developed ulcer. None of the subjects with ulcer had dyspeptic symptoms. CONCLUSION: The incidence of ulcer in the gastrojejunal anastomosis within the first 2 months following Rouxen-Y gastric bypass under proton pump inhibitors is considerable. It was not related to the use of non-steroidal anti-inflammatory drugs, highlighting the possibility of ischemia and foreign body as causal factors. The ulcers were asymptomatic, and all post-surgical dyspeptic symptoms were moderate in severity.

CONTEXTO: Sintomas dispépticos são comuns após derivação gástrica em Y-de-Roux. Podem decorrer de úlceras de boca anastomótica, cujos possíveis fatores causais incluem a secreção cloridropéptica da bolsa gástrica, isquemia, efeito de corpo estranho dos materiais de sutura e uso de antiinflamatórios não-esteróides. O esomeprazol é um redutor potente da secreção ácida, capaz de diminuir sintomas pépticos e evitar lesões mucosas, mesmo em pacientes usuários de antiinflamatórios não-esteróides. OBJETIVOS: Estudo prospectivo não-randomizado procura avaliar a ocorrência de dispepsia e úlceras perianastomóticas nos 2 primeiros meses após derivação gástrica em Y-de-Roux. MÉTODOS: Cento e dezoito obesos mórbidos foram operados em quatro centros de cirurgia bariátrica pela técnica de derivação gástrica em Y-de-Roux por laparotomia ou laparoscopia. À endoscopia digestiva alta, H. pylori estava ausente. Todos os operados tomaram 20 mg de esomeprazol por dia do 3º ao 60º pós-operatório. RESULTADOS: Entre o 10º e o 15º dia, nenhum paciente referiu epigastralgia ou pirose, um referiu vômitos moderados, quatro dor abdominal e oito náuseas. Entre o 55º e o 65º dia, três referiram epigastralgia leve, seis vômitos, um dor abdominal, dois náuseas e seis pirose. O exame endoscópico neste período revelou esofagite em 10 pacientes (8,5 por cento), hérnia hiatal em 2 (1,7 por cento) e corpo estranho nas linhas de sutura em 12 (10,2 por cento). Em nove pacientes (7,6 por cento) encontrou-se úlcera de boca anastomótica ou adjacente a ela, em dois incluindo granuloma de fio de sutura ou de grampo metálico. Dez pacientes utilizaram alguma vez antiinflamatórios não-esteróides nos 2 meses de estudo, nenhum deles apresentando úlcera. CONCLUSÕES: A ocorrência de úlcera de boca anastomótica 2 meses após derivação gástrica em Y-de-Roux, é considerável, mesmo em uso de esomeprazol. Não houve relação com ingestão de antiinflamatórios não-esteróides, o que realça as possibilidades...

Influencia da ranitidina e pantoprazol no pH gastrico em pacientes septicos / Ranitidine is unable to maintain gastric pH level above 4 in septic patients

Objetivo: Avaliar a capacidade da ranitidina e do pantoprazol em elevar e manter o pH gástrico = 4 em pacientes sépticos. Material e métodos: Foram estudados 20 pacientes internados na UTI, com diagnóstico de sepse/choque séptico, em ventilação mecânica. Dez receberam ranitidina (50 mg em bolo 8/8 horas) e outros 10 pacientes receberam pantoprazol 40 mg, em bolo de 12/12 horas. O pH gástrico foi medido de forma contínua por 48 horas. Foi realizada endoscopia digestiva alta antes e após o estudo e encaminhado para análise um fragmento obtido por biópsia e pesquisa de Helicobacter pylori. Resultados: O grupo ranitidina permaneceu por 46,27 ± 38,21 % e o grupo do pantoprazol 81,57 ± 19,65% do tempo estudado com pH gástrico = 4 (p=0,04). No subgrupo de ranitidina sem atrofia gástrica o pH esteve = 4 em 15,97 % e em cinco casos com atrofia em 79,44% do tempo estudado. No subgrupo do pantoprazol que realizou biópsia, quatro pacientes não apresentavam atrofia gástrica e o tempo de pH =4 foi de 81,17%. Em um paciente com atrofia da mucosa gástrica, o pH gástrico se manteve =4 durante todo o período do estudo. Conclusões: A ranitidina intravenosa, usada para profilaxia de úlcera de estresse, não foi capaz de manter o pH gástrico acima de quatro em pacientes sépticos. Todos os casos do grupo ranitidina, onde o pH foi mantido acima de quatro, apresentavam hipotrofia ou atrofia gástrica. O pantoprazol manteve o pH acima que quatro por período maior de tempo durante o estudo.

Purpose: To evaluate whether ranitidine and pantoprazole are able to maintain gastric pH = 4 in septic patients. Material and methods: Twenty intensive care unit (ICU) patients from a University teaching hospital, with sepsis. Ten patients received ranitidine (50 mg as an intermittent bolus t.i.d.) and ten received pantoprazole (40 mg as an intermittent bolus b.i.d.). Gastric pH was measured continuously for 48 hours. Endoscopy of the upper digestive tract, gastric biopsy and investigation for Helicobacter pylori were carried out prior to and at the end of the study. Results: pH values = 4 were maintained for 46.27 ± 38.21 % and 81.57 ± 19.65% of observation time in the ranitidine and pantoprazole groups, respectively (p=0.04). In the subgroup of ranitidine without atrophy gastric pH was = 4 at 15.97% and in five cases with atrophy in 79.44% of the time studied observation time. In the subgroup of pantoprazole who underwent biopsy, four patients did not have mucosal atrophy and gastric pH was = 4 for 81.17% of the time. In one patient with mucosal atrophy, gastric pH remained = 4 for the entire study period. Conclusions: Intravenous ranitidine was unable to maintain gastric pH above 4 in septic patients. All cases in the ranitidine group in whom pH remained above 4 were found to have mucosal gastric hypotrophy or atrophy. Pantoprazole successfully maintained pH above 4.

Risk Factors for Development and Recurrence of Peptic Ulcer Disease / 대한소화기학회지

BACKGROUND/AIMS: Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. METHODS: From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. RESULTS: Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD. CONCLUSIONS: For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.

Hallazgos endoscópicos en pacientes ambulatorios referidos a endoscopia por síntomas digestivos altos / Endoscopic findings in ambulatory patients referred to endoscopy for upper digestive symptoms

Antecedentes: La realización de endoscopia como primer estudio de un paciente con dispepsia es muy controvertida. Objetivos: Conocer la frecuencia de patología orgánica en pacientes con dispepsia a quienes se les solicita endoscopia digestiva alta, tanto desde la atención primaria como desde los consultorios de especialidades. Métodos: Se analizó la base de datos de endoscopias de nuestro centro en el período 1999-2002. Los diagnósticos de cáncer se confirmaron histológicamente. Resultados: En 10.275 endoscopias practicadas en ese período, 1.488 fueron por dispepsia, 2.536 por síndrome ulceroso y 1.055 por reflujo gastroesofágico. En el grupo con dispepsia se encontró patología orgánica en un 33 por ciento, predominando la gastritis significativa y la esofagitis erosiva. La frecuencia de cáncer gástrico fue baja (0,1 por ciento) y sólo apareció en pacientes sobre 40 años y especialmente en mayores de 60. Lo mismo ocurrió en pacientes referidos por síndrome ulceroso y por reflujo gastroesofágico. Conclusiones: Solicitar endoscopia a pacientes con dispepsia está justificado porque un tercio de ellos tienen patologías de fácil y efectivo tratamiento. El acceso irrestricto a la endoscopia como screening de cáncer gástrico no parece en cambio ser útil en pacientes de menores de 60 años.

Background: The performance of upper digestive endoscopy as a first line study in patients with dyspepsia is highly controversial. Objectives: To investigate the frequency of organic diseases in dyspeptic patients referred from Primary Care centers or from Gastroenterology clinics for upper digestive endoscopy. Methods: The Endoscopy database of our unit was reviewed for the period 1999-2002. The endoscopic diagnosis of gastric cancer was confirmed by positive biopsies. Results: Out of 10.275 endoscopies performed in the study period, the reference diagnosis was: dyspepsia 1.488; ulcer syndrome 2.536 and gastroesophageal reflux 1.055. In the dyspepsia group, 33 percent of cases had some organic pathology, mainly gastritis and erosive esophagitis. The frequency of gastric cancer was low (0.1 percent) and it was found only in patients older than 40 years and specially older than 60 years. Similar results were found in patients referred for ulcer syndrome or gastroesophageal reflux. Conclusions: An upper digestive endoscopy in the initial work up of patients with dyspepsia seems to be acceptable one third of them present organic diseases with easy and effective therapies. On the other hand the irrestrictive acces to endoscopy as screening of gastric cancer does not seem to be useful in patients under 60 years.

Atividades antiúlcera e antioxidante de Syzygium jambos(L. ) Alston / Antiulcer and antioxidant activities of Syzygium jambos(L. ) Alston

O jambeiro (Syzygium jambos (L.) Alston) constitui uma das diversas espécies frutíferas e medicinais pertencentes à família Myrtaceae. O extrato hidroetanólico a 70 ´POR CENTO´ liofilizado de folhas de S. jambos apresentou atividade dose-dependente em modelo de úlcera gástrica induzida por etanol acidificado, sendo que a dose de 400 mg/kg reduziu significativamente a Área Total de Lesão (81,64%) e a Área Relativa de Lesão (65,11%), em comparação ao grupo controle. Nesta dose, o extrato apresentou-se mais eficaz que o fármaco empregado como referência (Iansoprazol 30 mg/kg). No modelo de indução de úlcera gástrica por ácido acético, o extrato (400 mg/kg) não apresentou resultados significativos na cura das lesões. A atividade antioxidante do mesmo extrato e de quatro frações foi avaliada através da medida da capacidade seqüestrante de radicais 1, 1-difenil-2-picrilidrazila. O extrato hidroetanólico a 70% liofilizado apresentou CE `IND.50´ de 5,36 ± 0,06 µg/mL, valor comparável ao do Trolox (CE `IND.50´ = 4,98 ± 0,04 µg/mL), substância antioxidante de referência...

Non-healing gastric ulcer associated with Candida infection.

Candida bezoars of the stomach usually occur after gastric surgery. We report a small Candida mass occurring on a non-healing gastric ulcer in a 40-year-old male non-smoker. The ulcer healed with fluconazole and withdrawal of the proton pump inhibitor.

Is the presence or absence of Helicobacter pylori in gastric mucosa a greater risk?

Helicobacter pylori is a unique organism which is pathogenic for stomach-duodenum (chronic gastritis, duodenal ulcer, gastric ulcer, gastric malignancy, mucosa-associated lymphoid tissue (MALT) lymphoma) and protective for oesophagus (Barrett's oesophagus, oesophageal adenocarcinoma) at the same time in an individual. For prevention of diseases, the necessity of presence of some bacteria throughout the gastrointestinal lumen needs to be emphasized. The concept--only good Helicobacter pylori is a dead Helicobacter pylori, is dangerous and humans should learn to live in harmony with a few bacteria throughout the gastrointestinal tract.

Protective effect of quercetin [QRT], a bioflavonoid on stress-induced gastric ulcers in rats

Peptic ulcer is one of the most common diseases which represent a serious medical problem due to its frequency, high economic cost and frequent adverse reactions associated with drugs used in its management. In this work, an attempt was undertaken to investigate the protective effect of quercetin [QRT], the most abundant natural bioflavonoid which is widely distributed in edible plants and has a powerful antioxidant effect on stress-induced gastric ulcers in rats. In this experimental model the pathogenesis of the lesions has been related to the production of reactive oxygen species. The rats were randomly classified into 4 equal groups, [10 animals each] as follows: [1] Control group, [2] Pylorically ligated group in which animals were subjected to pyloric ligation only, [3] Cold restraint stress [CRS] group in which rats were subjected to pyloric ligation, allowed to recover, and then restrained by immobilizaiton and placed in a refrigerator at 4°C for 3 hours, and [4] Quercetin [QRT] treated group that received 50 mg/kg QRT intraperitonealy 1 hour before pyloric ligation and induction of gastric mucosal ulceration by cold restraint stress. Three hours later, all rats were decapitated, their stomachs were removed and the gastric content of groups 2, 3 and 4 were collected. Then, gastric juice parameters [volume, total acidity, total acid output, total pepsin concentration as well as glycoprotein contents] were studied. Also, the effect of QRT on stress induced gastric ulcer parameters [ulcer incidence; ulcer score; ulcer index and preventive index] were investigated in groups 1, 3 and 4. On the other hand, prior to decapitation, blood samples were collected from all animals for measurement of superoxide dismutase [SOD] activity in red blood cell [RBC] lysates as an index of the antioxidant state. The results obtained in the present study clearly demonstrate that intraperitioneal administration of QRT led to a markedly significant reduction in the occurrence of gastric ulceration in all treated rats as evidenced by the reduction of the mean ulcer score and ulcer index with a preventive index of 73.5%. Pretreatment with QRT was also associated with a significant decrease in the total acid and pepsin concentrations as well as a highly significant increase of glycoprotein contents compared with cold restraint group. Furthermore, the administration of QRT significantly increased SOD level as compared to cold restraint group. It is concluded that QRT has a protective effective role against stress-induced gastric ulcer in rats and the relevance of these results was discussed

Gastric zygomycosis--an unusual cause of massive upper gastrointestinal bleed.

We report a 62-year-old man with cardiac failure and acute renal failure, who had massive hematemesis. Upper GI endoscopy showed a large gastric lesser curvature ulcer. Billroth II gastrectomy specimen showed fungal invasion. He received amphotericin B postoperatively, and recovered uneventfully.

[Study of the CagA gene prevalence in helicobacter pylori strains isolated from patients with upper gastrointestinal disorders in Iran]

Helicobacter pylori commonly is associated with gastritis: but only sometimes it causes clinically significant diseases such as gastric and duodenal ulcer. The development of disease depends on the virulence of the infecting H. pylori strain, the susceptibility of the host, and environment co-factors. The cytotoxin associated protein encoded by cagA gene is an important virulence factor that is produced by some H. pylori strains, and has been used as virulence marker in some populations. The aim of the study was to examine the prevalence of cagA gene in the isolated strains of H. pylori from patients with dyspeptic disease and to investigate the association of cagA gene and the severity of H. pylori related diseases in Iran. In this study, biopsy specimens were obtained from the antrum of 180 patients. After isolation of H. pylori and its DNA by standard methods, polymerase chain reaction [PCR] technique was used for detection of cagA bacterial gene. 92 out of the 180 patients had H. pylori strains. 70% were cagA gene positive. All patients with peptic ulcer [100%] and 44 out of 72 [61%] patients with non-ulcer dyspepsia were cagA positive [p<0.01]. There was significant difference in frequency of cagA gene in peptic ulcer disease and non-ulcer dyspepsia [p<0.01]. It showed that the risk of PUD in patients with cagA+ H. pylori infection may be higher than in those with cagA- H. pylori infection

Antiinflamatorios no esteroideos (AINES) / Non steroiodal antiinflammatory (NSAID)

Non steroidal anti-inflammatory (NSAID) are some of the most frequently used drugs and their side effects are, as high as 20/100, a reason for their discontinuation. Their gastrointestinal adverse events are well known, with a three fold increase compared to non users, and it is even higher with the concomitant use of steroids or age above 70. Helicobacter Pylori infection may increase the risk of complications.When the use of NSAID in patients with peptic ulcer can not be avoided an anticulcerative regime and careful folow up should be indicated.

Patología digestiva alta y SIDA / Upper digestive pathology and AIDS

Para el manejo de la patología digestiva alta es necesario conocer el espectro de causas. Se debe determinar el estado de la infección por VIH para estratificar el riesgo de una infección oportunista. La historia es inmensamente útil para definir la etiología probable. También es importante definir la presencia de odinofagia. Es necesario hacer un diagnóstico diferencial endoscópico, con el objeto de tomar las muestras según corresponda. La toma de muestras y sus procesamiento se debe hacer de acuerdo con este diagnóstico diferencial

Infección por Helicobacter pylori en un grupo de pacientes VIH/SIDA / Helicobacter pylori infection in a group of HIV/AIDS patients

La prevalencia de la infección por Helicobacter pylori (H. pylori) en pacientes con SIDA ha sido objeto de controversias. Se realizó un estudio de tipo descriptivo, prospectivo, controlado, en un grupo de 64 pacientes infectados por el virus de inmunodeficiencia humana (VIH). La detección de la bacteria se realizó mediante estudio endoscópico, durante el cual se tomaron 2 muestras de biopsia de antro y cuerpo gástrico, respectivamente, para estudio histológico y 2 muestras de antro y cuerpo gástrico para prueba de ureasa. Se encontró una prevalencia de infección por H. pylori de 56,3 porciento. El grupo de comparación estuvo constituido por 110 pacientes serológicamente negativos a infección por VIH, con una prevalencia de la infección de 77,2 porciento. En el grupo VIH+/SIDA se encontró una frecuencia de úlcera gástrica en 1,5 porciento y ninguno presentó úlcera duodenal, mientras que el grupo de comparación tuvo una frecuencia de úlcera gástrica de 8,1 porciento y duodenal de 15,5 porciento. Los pacientes VIH+/SIDA de la categoría I tuvieron una prevalencia de infección por H. pylori de 68,7 porciento, los de la II de 39,2 porciento y los de la III 21,0 porciento. Se observó una asociación inversa entre el grado de deterioro inmunológico y la prevalencia de la infección por H. pylori

Alkyl ester prodrugs for improved topical delivery of ibuprofen.

Topical delivery of ibuprofen directly to the site of inflammation can overcome gastrointestinal side effects associated with its long term oral administration. The set of physicochemical properties necessary for optimum topical delivery of ibuprofen can be imparted by formation of its ester prodrugs. Various alkyl ester prodrugs (methyl, ethyl, n-propyl, iso-propyl, n-butyl, iso-butyl, sec-butyl, tert-buty, n-pentyl, hexyl, heptyl, octyl, lauryl, cetyl and octadecyl esters) were synthesised and studied for their physicochemical properties and activity in the carrageenan induced rat paw oedema by topical route. Favourable shift in lipophilicity and self penetration enhancing effect of prodrugs responded in improved topical activity over the parent drug ibuprofen.