Monteverdia ilicifolia: um protetor gástrico / Monteverdia ilicifolia: a gastric protector / Monteverdia ilicifolia: protector gástrico

Monteverdia ilicifolia, conhecida popularmente como espinheira-santa, é uma planta da família Celastraceae de relevante ação terapêutica devido às suas propriedades medicinais, principalmente a sua atividade gastroprotetora, possuindo efeitos comprovados sobre acidez e úlceras estomacais. Desta forma o objetivo deste trabalho foi encontrar na literatura evidências para o uso terapêutico da M. ilicifolia, como uma alternativa frente aos fármacos sintéticos disponíveis na indústria farmacêutica voltados para o tratamento de problemas estomacais. Foi utilizado no presente trabalho a base de dados Google acadêmico. Os distúrbios estomacais afetam milhares de pessoas, influenciando de forma negativa na qualidade de vida da população e gerando prejuízos ao sistema de saúde. Os fármacos com atividade sobre a secreção da acidez gástrica são as medicações mais prescritas para essas enfermidades, destacando-se os antagonistas do receptor H2 de histamina e os inibidores da bomba de prótons, amplamente utilizados para o tratamento de úlceras e gastrite. Com o tempo, esses medicamentos passaram a ser indiscriminadamente utilizados, prática que põem em risco a saúde íntegra dos pacientes, mediante aos diversos efeitos adversos que esses medicamentos podem causar. As plantas medicinais têm sido aplicadas na terapia de diversas doenças em toda a história da humanidade. Nesse contexto, a espinheira-santa surge como uma alternativa segura e eficaz para a prevenção e tratamento dessas patologias. Dentre os compostos bioativos que podem desempenhar a atividade gastroprotetora, destacam-se os taninos, triterpenos e flavonóides. Os estudos analisados demonstram que a M. ilicifolia possui relevante ação terapêutica, com potencial para substituir os fármacos usualmente empregados no tratamento de úlceras e gastrite.

The Monteverdia ilicifolia, popularly known as espinheira-santa, is a plant of the Celastraceae's family with relevant therapeutic action due to its medicinal properties, mainly its gastroprotective activity, and possesses proven effects on acidity and stomach ulcers. The aim of this work was to find in the literature evidence for the therapeutic use of M. ilicifolia, as an alternative to the synthetic drugs available in the pharmaceutical industry for the treatment of stomach problems. The academic Google database was used in this work. Stomach disorders affect thousands of people, negatively influencing the population's quality of life and causing damage to the health system. The drugs with activity on gastric acid secretion are the most prescribed medications for these diseases, especially histamine H2 receptor antagonists and proton pump inhibitors, widely used for the treatment of ulcers and gastritis. Over time, these drugs began to be used indiscriminately, a practice that jeopardizes the health of patients, due to the various adverse effects that these drugs can cause. Medicinal plants have been applied in the therapy of various diseases throughout human history. In this context, the espinheira-santa emerges as a safe and effective alternative for the prevention and treatment of these pathologies. Among the bioactive compounds that can perform a gastroprotective activity, tannins, triterpenes, and flavonoids stand out. The analyzed studies demonstrate that M. ilicifolia has relevant therapeutic action, with the potential to replace the drugs usually used in the treatment of ulcers and gastritis.

Monteverdia ilicifolia, conocida popularmente como espinheira-santa, es una planta de la familia Celastraceae de relevante acción terapéutica por sus propiedades medicinales, principalmente su actividad gastroprotectora, con efectos probados sobre la acidez y las úlceras estomacales. Así, el objetivo de este trabajo fue encontrar evidencia en la literatura para el uso terapéutico de M. ilicifolia, como alternativa a las drogas sintéticas disponibles en la industria farmacéutica destinadas al tratamiento de problemas estomacales. En este trabajo se utilizó la base de datos académica de Google. Los trastornos estomacales afectan a miles de personas, influyendo negativamente en la calidad de vida de la población y provocando daños en el sistema de salud. Los fármacos con actividad sobre la secreción ácida gástrica son los más prescritos para estas enfermedades, especialmente los antagonistas de los receptores H2 de histamina y los inhibidores de la bomba de protones, muy utilizados para el tratamiento de úlceras y gastritis. Con el tiempo, estos medicamentos comenzaron a utilizarse de forma indiscriminada, práctica que pone en riesgo la salud de los pacientes, debido a los diversos efectos adversos que estos fármacos pueden ocasionar. Las plantas medicinales se han aplicado en la terapia de diversas enfermedades a lo largo de la historia humana. En este contexto, la espinheira-santa surge como una alternativa segura y eficaz para la prevención y el tratamiento de estas patologías. Entre los compuestos bioactivos que pueden realizar actividad gastroprotectora destacan los taninos, los triterpenos y los flavonoides. Los estudios analizados demuestran que M. ilicifolia tiene una acción terapéutica relevante, con potencial para reemplazar los fármacos habitualmente utilizados en el tratamiento de úlceras y gastritis.

Evolución del tratamiento de la Úlcera péptica duodenal / Evolution of duodenal peptic ulcer treatment

Introducción: Como consecuencia del desarrollo del tratamiento médico de la úlcera péptica duodenal, el tratamiento quirúrgico ha disminuido notablemente. Objetivo: El objetivo del estudio es describir la progresión del tratamiento de la úlcera péptica duodenal. Material y Métodos: Estudio descriptivo, de corte, desde finales del siglo XIX hasta la actualidad. Se utilizó el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: A pesar de ser la úlcera una entidad clínica reconocida desde la antigüedad, los cirujanos la consideraron causada por el ácido, y todos los esfuerzos fueron concentrados en eliminar el ácido por medio de una operación. A partir de 1881, se comenzaron a conocer las complicaciones. En la década de los años 30 del pasado siglo, se tratan las complicaciones y también la enfermedad. Desde 1940, además, se conserva el funcionamiento digestivo y aparecen las tres formas básicas de vagotomía. En la década de 1970, se desarrollaron novedosas técnicas quirúrgicas, la endoscopía, la radiología intervencionista y la cirugía mínimamente invasiva. Sin embargo, el tratamiento médico llegó con los poderosos supresores del ácido y el descubrimiento del Helicobacter pylori. Nuevamente la cirugía ha quedado relegada a tratar las úlceras refractarias y las complicadas. Conclusiones: El tratamiento médico, por medio de la terapia anti-Helicobacter asociada a potentes inhibidores de la secreción gástrica ha conseguido su curación; sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera refractaria o complicada(AU)

Introduction: Surgical treatment of duodenal peptic ulcer has notably decreased as a consequence of the development of medical treatment. Objective: The objective of this study is to describe the advances in the treatment of duodenal peptic ulcer. Material and Methods: A descriptive study was conducted from the end of the 19th century to the present. The historical-logical method and a deductive-inductive analysis of multiple bibliographic sources were used. Development: Despite ulcer has been recognized as a clinical entity since ancient times, surgeons considered that it is caused by acid; therefore, all efforts were concentrated on removing the acid through an operation. From 1881 on, complications began to be treated. In the decade of the 30s of the last century, complications and the disease were treated. Since 1940, the digestive function has also been preserved and the three basic forms of vagotomy appeared. In the 1970s, novel surgical techniques such as endoscopy, interventional radiology, and minimally invasive surgery were developed. However, powerful acid suppressants as well as the discovery of Helicobacter pylori were taken into consideration for medical treatment. Once again, surgery was relegated to the treatment of refractory ulcers and complicated ulcers. Conclusions: Medical treatment with anti-Helicobacter therapy associated with potent inhibitors of gastric acid secretion has managed its healing; however, surgery still plays an important role in the treatment of refractory or complicated ulcer(AU)

Can surface protection prevent damage in margins of composite resin restorations after simulated endogenous erosion?

Aim: The study investigated the effect of using surface protection agents in the adaptation of external and internal margins of restorations subjected to simulated erosion. Methods: Cavities with margins in dentin were prepared in bovine incisors (n=120). Adhesive restorations were placed using a three-step etch&rinse adhesive system and nanofilled composite resin. The specimens were divided into four groups, according to the surface protection: negative control, topical application of fluoride (TAF), resin sealant and resin-modified glass ionomer varnish (RMGI varnish). Afterwards, they were divided into three sub-groups, according to the exposure to a simulated solution of gastric acid (DES) (5% HCl, pH=2,2) and subsequent remineralization (RE): negative control, 9 and 18 cycles of DES-RE. The evaluation of the tooth-restoration interface was performed on the internal and frontal images with the aid of a stereoscopic microscope (15x), and the percentage of continuous margins without adhesive failures was quantified. Results: In the external margins, only those groups with surface protection using sealants (resin and glass-ionomer) did not exhibit a significant decrease in the percentage of continuous margins after the erosive challenges. After 18 cycles of DES-RE, the use of resin-modified glass ionomer varnish resulted in the highest percentage of continuous margins. Conclusion: It was concluded that physically covering the surfaces with a sealing agent preserved the marginal adaptation of composite resin restorations exposed to endogenous erosive challenges

Recurrent Clostridium difficile Infection: Risk Factors, Treatment, and Prevention

The most common cause of antibiotic-associated diarrhea is Clostridium difficile infection (CDI). Recurrent C. difficile infection (rCDI) often occurs after successful treatment of CDI. Due to the increased incidence and the difficulty in treating rCDI, it is becoming an important clinical issue. Identifying risk factors is helpful for early detection, treatment, and prevention of rCDI. Advanced age, use of antibiotics, gastric acid suppression, and infection with a hypervirulent strain are currently regarded as the major risk factors for rCDI. Several treatment modalities, including vancomycin, fidaxomicin, and fecal microbiota transplant (FMT), are suggested for rCDI treatment. However, there is currently no definitive treatment method with sufficient evidence for rCDI. Recent studies have focused on FMT and have shown positive results for rCDI. Prevention of rCDI by measures such as hand washing and isolation of patients is very important. However, these preventive measures are often overlooked in clinical practice. Here, we review the risk factors, treatment, and prevention of rCDI.

Decreased mRNA Expression of Cystathionine Gamma lyase and H2S Concentration in Gastric Mucosal Tissue in Diabetic Rats

ABSTRACT Background and aim: It is well established that the rate of gastric lesions increases in diabetic rats. Recently, the protective effect of hydrogen sulfide (H2S) in gastric mucosa has been proven. This study aimed to determine the release of H2S and mRNA expression of cystathionine gamma lyase (CSE) in gastric mucosa in alloxan-diabetic rats in response to distention-induced gastric acid secretion. Twenty-four rats were randomly assigned to 4 groups (6 in each). They were the normal-control, distention-control, diabetic-control, and distention-diabetic groups. Under anesthesia, animals underwent a tracheotomy and midline laparotomy. To washout the gastric contents, a catheter was inserted in the stomach through the duodenum. To determine the effect of distention-induced gastric acid secretion on H2S release and mRNA expression of CSE, the stomachs were distended by normal saline. At the end of experiments, animals were sacrificed and the gastric mucosa was collected to determine H2S concentration and to quantify mRNA expression of CSE by quantitative real-time PCR. Mucosal release of H2S and mRNA expression of CSE significantly increased in response to stimulated gastric acid secretion in normal rats (P<0.01), while the increases in diabetic rats were not significant. Basal release of H2S and mRNA expression of CSE in gastric mucosa were significantly in diabetic rats lower than normal rats. On the basis of the results, we conclude that the decreased release of H2S in response to basal and stimulated gastric acid output in alloxan-diabetic rats compared to normal rats is largely due to downregulation of mRNA expression of CSE.

Characterization of Specific IgA Response to Antigenic Determinants of Helicobacter pylori Urease Encoded by ureA and ureB in Children

Helicobacter pylori (H. pylori), a causative agent of chronic gastritis and gastric cancer, has several virulent factors for own survival and progression toward gastric diseases in human stomach. Of those, H. pylori produces mainly urease (10~15% total protein weight) that neutralize the gastric acid for survival. Here, we identified the antigenic epitope of urease and then developed an ELISA using the antigen including the epitope of urease. We identified the antigenic epitope of urease that induces IgA antibodies in human using truncated mutants. Eight kinds of serially-truncated mutant of UreA and UreB were prepared and subjected to immunoblot using pooled sera of patients with gastric disorders. UreBEnd protein containing UreB epitope was produced and investigated its diagnostic value via ELISA in children. As a result, mutants having last 24 amino acid residues of UreB carboxyl terminus deleted did not show IgA-reactive band. The clones that contained the downstream of 448(th) amino acid in UreB showed IgA-reactive band. The serodiagnostic value of the UreBEnd recombinant protein including identified epitope was confirmed via IgA ELISA and shown to have 97% sensitivity and 100% specificity. These results demonstrated that carboxyl terminal region of UreB carries an antigenic epitope for IgA response in human. It may be useful for detecting H. pylori infection with improved test accuracy and minimum use of endoscopy.

Pharmacological Treatment for Peptic Ulcer Bleeding

Peptic ulcer bleeding (PUB) is the most common cause of non-variceal upper gastrointestinal bleeding, and its frequency has been declining over the past decades. However, mortality from PUB persists, and it is still a serious challenge in clinical practice. Although endoscopic intervention is the basic treatment modality for PUB, pharmacological therapy is an important adjunct. The emergence of proton pump inhibitors (PPIs) enables maintenance of intragastric pH >6, which greatly helps in the treatment of PUB. Continuous intravenous infusion of high-dose PPI reduces the re-bleeding rate, thereby helping avoid additional surgery in patients with high-risk stigmata. Moreover, administration of PPIs prior to endoscopy may reduce the need for additional endoscopic intervention. Recently introduced gastric acid suppressants, such as potassium-competitive acid blockers, have shown promising results in further treatment of PUB.

Cirugía de supresión ácida y derivación duodenal laparoscópica vs abierta en esófago de Barrett extenso: resultados y complicaciones a corto y largo plazo / Laparoscopic versus open fundoplication with acid suppression/duodenal diversion technique for long segment Barrettís esophagus

Resumen Introducción: En pacientes con esófago de Barrett largo hemos sugerido efectuar fundoplicatura con antrectomía, vagotomía y derivación duodenal en Y de Roux que podría asociarse con complicaciones y efectos colaterales. Objetivo: El objetivo de este estudio es comparar la cirugía por vía abierta vs laparoscópica en cuanto a complicaciones postoperatorias precoces y alejadas, mortalidad y resultados alejados. Material y método: Se comparan 2 cohortes de pacientes, 73 pacientes con cirugía abierta y 53 pacientes operados con la misma técnica por vía laparoscópica por el mismo equipo. Solo se incluyeron los pacientes con Barret largo. Se controlan clínicamente en el postoperatorio inmediato y alejado, con endoscopia e histología anual, y se evalúan los resultados en cuanto a complicaciones precoces, alejadas y se analiza la calidad de vida y la satisfacción del paciente. Para el análisis se utilizó «t¼ de Student considerando un valor de p < 0,05 como significativo. Resultados: En cuanto a complicaciones precoces en ambos grupos no hubo diferencias significativas. No hubo mortalidad postoperatoria. En las complicaciones tardías las complicaciones totales no son significativamente diferentes entre ambos grupos (solo cambian sus causas y características) ni en cuanto a la clasificación de Visick y el puntaje de calidad de vida. Conclusión: La fundoplicatura con procedimiento de supresión ácida y derivación biliar por vía laparoscópica presenta similares resultados a corto y largo plazo que la cirugía abierta, pero con los beneficios de una cirugía mínimamente invasiva.

Abstract Introduction: In patients with long Barrett esophagus we have suggested to perform fundoplication with antrectomy, vagotomy and Roux-en-Y duodenal diversion however it could be associated with complications and side effects. Objective: The objective of this study is to compare open versus laparoscopic surgery for early and early postoperative complications, mortality and distant outcomes. Material and method: We compare 2 cohorts of patients, 73 patients with open surgery and 53 patients, who underwent laparoscopic surgery using the same technique. Only patients with Long Barrett were included. They are clinically monitored in the early and late postoperative period, with endoscopy and histology at long term follow-up (3-5 years). The results were evaluated in terms of early and late complications, the quality of life and patient satisfaction were analyzed. For the analysis we used t-student considering a P < .05 as significant. Results: As for early complications, there were no significant differences in both groups. There was no postoperative mortality. In the late complications, the total complications are not significantly different between the two groups (only their causes and characteristics changed) neither in terms of Visick's classification and the quality of life score Conclusion: The fundoplication, with laparoscopic acid suppression and duodenal diversion, presents similar short-term and long-term results than open surgery, with the benefits of a mini-invasive procedure.

Role of Potassium-Competitive Acid Blockers in Helicobacter pylori Eradication

The first-line therapy for Helicobacter pylori infection comprises triple therapy with the combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. However, the H. pylori eradication rate after PPI-based triple therapy has fallen below 80% in many countries, and even reached 70% in recent Korean studies. The main cause of eradication failure has been attributed to the increased antibiotic resistance of H. pylori. To overcome the limitations of the current eradication therapy, the maintenance of a high gastric pH, which increases the function of the antibiotics, may be a successful strategy. Potassium-competitive acid blockers (PCABs) inhibit H⁺, K⁺-ATPase in a reversible and K⁺-competitive manner and result in an almost complete inhibition of gastric acid secretion. However, the clinical development of most PCABs has been discontinued owing to their hepatic toxicity or similar efficacy to PPIs. Vonoprazan has a completely different chemical structure and higher pKa value compared with those of other PCABs and produces more potent and sustained acid inhibition. A recent phase III randomized study reported that vonoprazan was highly effective as a component of first-line or second-line triple therapy. In this study, we reviewed the literature regarding the role of PCAB in the eradication of H. pylori.

Not All Children with Cystic Fibrosis Have Abnormal Esophageal Neutralization during Chemical Clearance of Acid Reflux / 대한소아소화기영양학회지

PURPOSE: Acid neutralization during chemical clearance is significantly prolonged in children with cystic fibrosis, compared to symptomatic children without cystic fibrosis. The absence of available reference values impeded identification of abnormal findings within individual patients with and without cystic fibrosis. The present study aimed to test the hypothesis that significantly more children with cystic fibrosis have acid neutralization durations during chemical clearance that fall outside the physiological range. METHODS: Published reference value for acid neutralization duration during chemical clearance (determined using combined impedance/pH monitoring) was used to assess esophageal acid neutralization efficiency during chemical clearance in 16 children with cystic fibrosis (3 to <18 years) and 16 age-matched children without cystic fibrosis. RESULTS: Duration of acid neutralization during chemical clearance exceeded the upper end of the physiological range in 9 of 16 (56.3%) children with and in 3 of 16 (18.8%) children without cystic fibrosis (p=0.0412). The likelihood ratio for duration indicated that children with cystic fibrosis are 2.1-times more likely to have abnormal acid neutralization during chemical clearance, and children with abnormal acid neutralization during chemical clearance are 1.5-times more likely to have cystic fibrosis. CONCLUSION: Significantly more (but not all) children with cystic fibrosis have abnormally prolonged esophageal clearance of acid. Children with cystic fibrosis are more likely to have abnormal acid neutralization during chemical clearance. Additional studies involving larger sample sizes are needed to address the importance of genotype, esophageal motility, composition and volume of saliva, and gastric acidity on acid neutralization efficiency in cystic fibrosis children.

The Effect of H₂ Receptor Antagonist in Acid Inhibition and Its Clinical Efficacy / 대한소화기학회지

The first histamine H₂ receptor antagonists (H₂RAs) were developed in the early 1970s. They played a dominant role in treating peptic ulcer disease and gastroesophageal reflux disease (GERD). H₂RAs block the production of acid by H⁺, K⁺-ATPase at the parietal cells and produce gastric luminal anacidity for varying periods. H₂RAs are highly selective, and they do not affect H₁ receptors. Moreover, they are not anticholinergic agents. Sequential development of H₂RAs, proton pump inhibitors (PPIs), and discovery of Helicobacter pylori infection changed the paradigm of peptic ulcer disease with marked decrease of morbidity and mortality. PPIs are known to be the most effective drugs that are currently available for suppressing gastric acid secretion. Many studies have shown its superiority over H₂RAs as a treatment for acid-related disorders, such as peptic ulcer disease, GERD, and Zollinger-Ellison syndrome. However, other studies have reported that PPIs may not be able to render stomach achlorhydric and have identified a phenomenon of increasing gastric acidity at night in individuals receiving a PPI twice daily. These nocturnal acid breakthrough episodes can be eliminated with an addition of H₂RAs at night. The effectiveness of nighttime dose of H₂RA suggests a major role of histamine in nocturnal acid secretion. H₂RAs reduce secretion of gastric acid, and each H₂RA also has specific effects. For instance, nizitidine alleviates not only symptoms of GERD, but also provokes gastric emptying, resulting in clinical symptom improvement of functional dyspepsia. The aim of this paper was to review the characteristics and role of H₂RAs and assess the future strategy and treatment of upper gastrointestinal disease, including acid related disorders.

Risk of Bacterial Infection from Proton Pump Inhibitor Use

Currently, proton pump inhibitors are used in a wide range of patients with gastroesophageal reflux disease, peptic ulcer, and upper gastrointestinal symptoms such as dyspepsia. In addition, the application of proton pump inhibitors for prevention of gastrointestinal complications induced by non-steroidal anti-inflammatory drugs is expected to increase their use in the future. The use of proton pump inhibitors promotes bacterial growth by reducing gastric acid concentration. If the acidity (pH) of the stomach fluid is lower than 4, most pathogens can be sterilized. However, patients who need to use a proton pump inhibitor should maintain a gastric acidity of at least 5 or 6, and can be at risk of infections such as pneumonia and Clostridium difficile infection. Several infectious diseases associated with the use of proton pump inhibitors were reviewed.

Treatment of dental erosion caused by intrinsic and extrinsic etiology: a case report

Dental erosion is defined as tooth structure loss by acidic chemical substance. It is caused by extrinsic factors such as acidic foods, drugs, and working environments, and also intrinsic factors such as gastric acid regurgitation in gastro-esophageal disorder or intensive vomiting in bulimia nervosa. These lesions can be treated with direct resin filling, laminate or full contour crown depending on the intensity of clinical problem. This is a case report about treatment of rare clinical case: labial erosion of anterior tooth caused by frequent intake of acidic fruit and palatal erosion of anterior tooth caused by intensive vomiting in bulimia nervosa.

Protective Effects of Cinnamic Acid Derivatives on Gastric Lesion

P-methoxycinnamic acid and 3,4,5-trimethoxycinnamic acid are the compounds found in Polygalae Radix, the root of Polygala tenuifolia Willdenow, and have been reported to have hepatoprotective and anti-neurodegenerative effects. On the other hand, there are no reports of their effects on gastric lesions. This study examined the inhibitory effects of cinnamic acids, including p-methoxycinnamic acid, 3,4,5-trimethoxycinnamic acid, and 8 compounds (cinnamic acid, 2-(trifluoromethyl) cinnamic acid, 3-(trifluoromethyl) cinnamic acid, trans-4-(trifluoromethyl) cinnamic acid, 4-(dimethylamino) cinnamic acid, 3,4-(methylenedioxy) cinnamic acid and 3,4-dihydroxycinnamic acid), which were selected based on their presence in medicinal herbs and molecular weight, against gastric lesions. Animal models were used to confirm the protective effects on acute gastritis caused by the administration of HCl/EtOH. Gastric acid inhibition was examined by an acid-neutralizing test and the proton pump (H⁺/K⁺-ATPase) inhibiting activity. In addition, antioxidant tests were performed and the gastric emptying rate was determined. The results showed that cinnamic acid, p-methoxycinnamic acid, and 3,4,5-trimethoxycinnamic acid had an inhibitory effect on gastric lesions.

The Prevalence and Clinical Features of Non-responsive Gastroesophageal Reflux Disease to Practical Proton Pump Inhibitor Dose in Korea: A Multicenter Study / 대한소화기학회지

BACKGROUND/AIMS: In Korea, there are no available multicenter data concerning the prevalence of or diagnostic approaches for non-responsive gastroesophageal reflux disease (GERD) which does not respond to practical dose of proton pump inhibitor (PPI) in Korea. The purpose of this study is to evaluate the prevalence and the symptom pattern of non-responsive GERD. METHODS: A total of 12 hospitals who were members of a Korean GERD research group joined this study. We used the composite score (CS) as a reflux symptom scale which is a standardized questionnaire based on the frequency and severity of typical symptoms of GERD. We defined "non-responsive GERD" as follows: a subject with the erosive reflux disease (ERD) whose CS was not decreased by at least 50% after standard-dose PPIs for 8 weeks or a subject with non-erosive reflux disease (NERD) whose CS was not decreased by at least 50% after half-dose PPIs for 4 weeks. RESULTS: A total of 234 subjects were analyzed. Among them, 87 and 147 were confirmed to have ERD and NERD, respectively. The prevalence of non-responsive GERD was 26.9% (63/234). The rates of non-responsive GERD were not different between the ERD and NERD groups (25.3% vs. 27.9%, respectively, p=0.664). There were no differences between the non-responsive GERD and responsive GERD groups for sex (p=0.659), age (p=0.134), or BMI (p=0.209). However, the initial CS for epigastric pain and fullness were higher in the non-responsive GERD group (p=0.044, p=0.014, respectively). CONCLUSIONS: In conclusion, this multicenter Korean study showed that the rate of non-responsive GERD was substantially high up to 26%. In addition, the patients with the non-responsive GERD frequently showed dyspeptic symptoms such as epigastric pain and fullness.

Diagnosis and treatment of functional dyspepsia

Functional dyspepsia is defined as the presence of the symptoms that originate from the gastroduodenal area, without evidence of any organic, systemic, or metabolic disease that could explain these symptoms. The pathophysiology of functional dyspepsia includes chronic duodenal inflammation, Helicobacter pylori, excessive gastric acid secretion, dietary factors, and psychosocial, genetic, and environmental factors. However, gastric dysmotility and visceral hypersensitivity are thought to play a major role in the pathogenesis of functional dyspepsia, and other factors may affect gastric motility and visceral hypersensitivity. In the diagnosis of functional dyspepsia, upper gastrointestinal endoscopy is important to rule out organic diseases; an H. pylori test-and-treat strategy is currently not recommended for the initial diagnostic step in Korea where both H. pylori prevalence and gastric incidence are very high. Anti-secretory drugs (proton pump inhibitors and histamine 2 receptor antagonists) and prokinetics can be used as a first-line treatment depending on the patient's symptoms (postprandial distress syndrome vs. epigastric pain syndrome). If initial treatment is not effective, tricyclic antidepressants and/or anxiolytics (fundic relaxants) could be used in selected patients.

Factors Influencing Gastric Microbiota

Researches on microbiota in the stomach have entered a revolutionary period in recent years due to the advanced technology that can detect culture-independent gastric microfloras. In spite of its harsh environment, stomach plays a role as an ecosystem for some microbiota. Their composition and number of colony forming units are influenced by several innate defense mechanisms such as low gastric pH, gastric mucus layer, migrating motor complex and some external factors such as gastric acid lowering medications and diet patterns. Here, we review the literatures concerning factors that influence the gastric microbiota.We believe this will be helpful for understanding the role of microbiota in the stomach.

Gastric Microbiota and Gastric Cancer

The stomach had been recognized as an organ where many bacteria cannot survive due to the presence of gastric acid. However, a number of bacteria have been detected after the discovery of Helicobacter pylori with recent advances in nucleotide sequencing techniques and bioinformatics. These include Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria and Fusobacteria. Several animal studies suggested that the imbalance of gastric microbiotas could be associated with the development of gastric cancer. Changes in the composition of the gastric microbiota may increase the production of N-nitroso compounds, which is known to be a carcinogen. Further studies on the actual function and proteomics of gastric microbiota could be beneficial for prevention, early diagnosis, and new treatment strategies of gastric cancer.

The Management of Systemic Voice Disorders

Variable systemic diseases affect larynx and vocal fold and result in voice change. Asthma and chronic obstructive pulmonary disease make increase of intra-abdomimal pressure followed by reflux of gastric acid, which stimulate vagal-bronchopulomary reflex aggravating cough and respiratory disturbance. Fungal laryngitis in the general population is extremely rare, but can occur in immunocompromised AIDS patients. Although, initially, empirical antifungal therapy for candidiasis is often given without biopsy, diagnostic direct laryngoscopy and biopsy is imperative if a substantial clinical response is not rapidly achieved. In the highly active anti-retroviral therapy era, HIV-positive patients are living longer and are at higher risk for developing non-AIDS-defining malignancies. The incidence of head and neck cancer (HNC) which is related with human papilloma virus infection has increased. The survival is significantly lower among the AIDS-HNC patients with CD4 counts ≤200 cells/µL. Rheumatoid arthritis (RA) cause voice disturbance by developing cricoarytenoid joints fixation or nodule on vocal fold. Post-menopausal voice disorder (PMVD) is caused by decreased secretion of estrogen-progesterone resulting in decrease of fundamental frequency (F0). Hormonal replacement therapy is helpful to reduce F0 decrease. RA and PMVD result in slight voice change, but it could crucial in professional voice user.

PMK-S005 Alleviates Age-Related Gastric Acid Secretion, Inflammation, and Oxidative Status in the Rat Stomach

BACKGROUND/AIMS: The aim of this study was to evaluate the effect of the synthetic S-allyl-l-cysteine (SAC) PMK-S005 on gastric acid secretion, inflammation, and antioxidant enzymes in aging rats. METHODS: The rats were divided into four groups at 31 weeks of age and were continuously fed a diet containing a vehicle control, PMK-S005 (5 or 10 mg/kg), or lansoprazole (5 mg/kg). Gastric acid secretion and connective tissue thickness of the lamina propria were evaluated at 74 weeks and 2 years of age. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and COX-2 levels were measured by using enzyme-linked immunosorbent assays (ELISAs) or Western blot assays. Levels of antioxidant enzymes, including heme oxyganase 1 (HO-1) and NAD(P)H:quinone oxidoreductase 1 (NQO-1), were also measured. RESULTS: As the rats aged, gastric acid secretion significantly decreased, and the connective tissue of the lamina propria increased. However, 74-week-old rats in the PMK-S005 group exhibited greater levels of gastric acid secretion than those of the control and lansoprazole groups. The increase of TNF-α, IL-1β, and COX-2 expression in 74-week and 2-year-old control rats were inhibited by PMK-S005. In addition, the decrease in HO-1 and NQO-1 protein expression that occurred with aging was inhibited by PMK-S005 in the 74-week-old rats. CONCLUSIONS: These results suggest that PMK-S005 has therapeutic potential as an antiaging agent to ameliorate age-related gastric acid secretion, inflammation, and oxidative stress in the stomach.