Anti-ulcerogenic activity of aqueous extract of Carica papaya seed on indomethacin-induced peptic ulcer in male albino rats / 中西医结合学报

<p><b>OBJECTIVE</b>Carica papaya is an important fruit with its seeds used in the treatment of ulcer in Nigeria. This study investigated the anti-ulcerogenic and antioxidant activities of aqueous extract of Carica papaya seed against indomethacin-induced peptic ulcer in male rats.</p><p><b>METHODS</b>Thirty male rats were separated into 6 groups (A-F) of five rats each. For 14 d before ulcer induction with indomethacin, groups received once daily oral doses of vehicle (distilled water), cimetidine 200 mg/kg body weight (BW), or aqueous extract of C. papaya seed at doses of 100, 150 or 200 mg/kg BW (groups A, B, C, D, E and F, respectively). Twenty-four hours after the last treatment, groups B, C, D, E and F were treated with 100 mg/kg BW of indomethacin to induce ulcer formation.</p><p><b>RESULTS</b>Carica papaya seed extract significantly (P< 0.05) increased gastric pH and percentage of ulcer inhibition relative to indomethacin-induced ulcer rats. The extract significantly (P< 0.05) decreased gastric acidity, gastric acid output, gastric pepsin secretion, ulcer index and gastric secretion volume relative to group B. These results were similar to that achieved by pretreatment with cimetidine. Specific activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glucose-6-phosphate dehydrogenase in the extract-treated groups (D, E and F) were increased significantly over the group B (P< 0.05). Pretreatment with the seed extract protected rats from the indomethacin-mediated decrease in enzyme function experienced by the group B. Similarly, indomethacin-mediated decrease in reduced glutathione level and indomethacin-mediated increase in malondialdehyde were reversed by Carica papaya extract.</p><p><b>CONCLUSION</b>In this study, pretreatment with aqueous extract of Carica papaya seed exhibited anti-ulcerogenic and antioxidant effects, which may be due to the enhanced antioxidant enzymes.</p>

Role of the twenty-four-hour esophageal multichannel intraluminal impedance-pH monitoring in preterm infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical application of 24-hour esophageal multichannel intraluminal impedance-pH monitoring technique in preterm infants.</p><p><b>METHOD</b>This study enrolled 28 preterm (male 20, female 8) infants with symptoms suggestive of gastroesophageal reflux (GER) (frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased). They had postmenstrual age from 26 to 32 weeks, median (28.9 ± 1.9)weeks, had birth weight from 850 to 1 700 g, median (1 250.4 ± 272.8)g, range 850-1700 g, and were studied at corrected gestational age from 28 to 40 weeks, median (34.5 ± 2.3)weeks. Combined measurement of esophageal pH and impedance was performed. The 24-hour pH-impedance recording was uploaded onto a portable storage card and for computer-assisted manual analysis, using a specialized software program. When values were distributed normally, they were presented as mean and standard deviation, compared using t test. When values were not distributed normally, they were presented as median, minimum and maximum. Median values were compared using the Mann-Whitney U non-parametric test. SPSS 17.0 software was used.</p><p><b>RESULT</b>In 28 preterm infants, 71.4% (20/28) had pathological acid refluxes with pH monitor, while 100% with combined measurement of esophageal pH and impedance. Gestational age, birth weight, corrected gestational age had no association with acid GER. Frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased but there was no statistically significant difference between acid GER group and non-acid GER group. Eight cases had no pathological acid refluxes, but showed an increase of weakly acid refluxes than pathological acid refluxes group (P < 0.01) . The median number of reflux events in 24 hours for 28 cases was 64.5 (0-377) , 23.4% were acidic, while 76.4% were weakly acidic; 59.1% were liquid bolus refluxes, while 40.9% were mixed bolus refluxes. The positive ratio of symptoms related index and symptoms association probability were significantly increased combined measurement of esophageal pH and impedance versus pH monitor were used.</p><p><b>CONCLUSION</b>The 24-hour esophageal impedance-pH monitoring technique was safe and had good tolerance. We confirmed that it detected more weakly acidic refluxes, liquid bolus refluxes, and mixed bolus refluxes. And it provided more evidence for explaining the relationship between GER and clinical manifestation.</p>

Esophageal manometry findings and degree of acid exposure in short and long Barrett's esophagus / Alterações manométricas e intensidade do refluxo no esôfago de Barrett curto e longo

CONTEXT: Barrett's esophagus (BE) is characterized by intestinal metaplasia in the distal esophagus and is classified as short-segment (<3 cm - SSBE) or long-segment (>3 cm - LSSBE). It is suggested that LSSBE is associated with more severe esophageal motor abnormalities and increased acid exposure time than SSBE. OBJECTIVE: To evaluate the prevalence of esophageal manometriy abnormalities and acid exposure times in patients with SSBE and LSSBE. METHODS: Barrett's esophagus patients identified by upper endoscopy and confirmed by histopathology were, retrospectively, reviewed and divided into two groups: SSBE and LSBE. Demographic data, symptom duration, prevalence of hiatal hernia, lower esophagus sphincter basal pressure, prevalence of esophageal body abnormalities and acid exposure times were evaluated. RESULTS: Forty-six patients with SSBE (24 males - 52.2%, mean age of 55.2 years) and 28 patients with LSBE (18 males - 64.3%, mean age of 50.5 years). Mean symptom duration was 9.9 years for SSBE and 12.9 years for LSSBE. Hiatal hernia was present in 84.2% of SSBE, 96.3% of LSBE; average lower esophagus sphincter pressure in SSBE 9.15 mm Hg, in LSBE 6.99 mm Hg; lower esophagus sphincter hypotension in SSBE was 65.9%, in LSSBE 82.1%; aperistalsis in SSBE 6.5%, LSSBE 3.6%; mild/moderate ineffective esophageal motility in SSBE 34.8%, LSBE 46.4%; severe moderate ineffective esophageal motility in SSBE 10.9%, LSBE 7,1%; nutcracker esophagus/segmental nutcracker esophagus in SSBE 8.6%, LSBE 0%; normal body in SSBE 39.1%, in LSBE 42.9%, no statistical difference for any of these values (P<0.05). Average % total time pH<4 in SSBE 9.12, LSBE 17.27 (P<0.000); % time pH<4 upright in SSBE 11.91; LSBE 24.29 (P=0.003); % time pH<4 supine in SSBE 10.86, LSBE 33.26 (P = 0.000). CONCLUSION: There was no difference between the prevalence of motor disorders in patients with SSBE and LSSBE. Acid reflux in upright and supine positions was more intense in LSBE.

CONTEXTO: O esôfago de Barrett (EB) se caracteriza pela presença de metaplasia intestinal no esôfago distal, quando menor que 3 cm é chamado Barrett curto (EBC) e com 3 cm ou mais Barrett longo (EBL). Sugere-se que o EBL cursa com mais alterações motoras esofagianas e com refluxo mais intenso que o EBC. OBJETIVO: Avaliar a prevalência de alterações manométricas e a intensidade do refluxo gastroesofágico à pHmetria em pacientes com EBC e EBL. MÉTODOS: Estudo retrospectivo de pacientes com endoscopia digestiva alta e comprovação histopatológica de EB, divididos em dois grupos: EBC e EBL. Foram avaliados os dados demográficos, o tempo de doença, prevalência de hérnia hiatal, dados obtidos à esofagomanometria e pHmetria. RESULTADOS: EBC 46 pacientes (24 masculino 52,2% e média de idade de 55,22 anos), EBL 28 pacientes (18 masculino 64,3% e média de idade 50,5 anos); tempo de sintomas: EBC 9,88 anos e EBL 12,94 anos; hérnia de hiato: EBC 84,2%, EBL 96,3%; pressão média do esfíncter inferior do esôfago: EBC 9,15 mm Hg, EBL 6,99 mm Hg; hipotensão do esfíncter inferior do esôfago: EBC 65,9%, EBL 82,1%; motilidade esofagiana ineficaz (MEI) leve/moderado: EBC 34,8%, EBL 46,4%; MEI acentuado: EBC 5 10,9%, EBL 7,1%; aperistalse: 6,5%, EBL 3,6%; esôfago em quebra-nozes: EBC 8,6%, EBL 0%; corpo normal: EBC 39,1%, EBL 42,9%, sem diferença estatística para qualquer desses valores (P<0,05). Médias de pHmetria: % de tempo total com pH <4: EBC (29/46) 9,12% EBL (15/28) 27,27% P<0,000; % de tempo ereto com pH<4: EBC 11,91%, EBL 24,29% P = 0,003; % de tempo supino com pH <4: EBC 10,86% EBL 33,26% P = 0,000. CONCLUSÕES: Não houve diferença entre a prevalência das alterações motoras em pacientes com EBC e EBL. O refluxo ácido, tanto em posição ereta como em posição supina, foi mais intenso no EBL.

Gastroprotective effect of Acacia nilotica young seedless pod extract: role of polyphenolic constituents

OBJECTIVE@#To systematically evaluate antiulcer potential of Acacia nilotica in different ulcer models in rats.@*METHODS@#Different extracts [ethanolic, 50% hydroethanolic (50:50), 70% hydroethanolic (70:30) and aqueous] of young seedless pods were examined in pylorus ligation induced gastric ulcers in rats. Various parameters like, volume of gastric acid secretion, pH, free acidity, total acidity, ulcer index, mucin content and antioxidant studies were determined and were compared between extract treated, standard and vehicle control following ulcer induction. The most active extract was also evaluated in swimming stress induced and NSAID induced gastric ulceration.@*RESULTS@#Among different extracts of young seedless pods only hydroethanolic extracts showed significant antiulcer activity in pyloric ligation induced ulceration. Even more the 70% hydroethanolic extract showed better protection as compared to 50% hydroethanolic extract. Further 70 % hydroethanolic extract also showed significant mucoprotection in swimming stress induced and nonsteroidal antiinflammatory drugs induced gastric ulceration.@*CONCLUSION@#The results of present study concluded that the hydroethanolic extract of young seedless pods of Acacia nilotica has antiulcer activity in pylorus ligation, swimming stress and NSAID induced rat ulcer models. The extract containing more amount of phenolic components show high antiulcer activity, indicating the phenolic component of the extract to be responsible for the activity of the extracts.

Duodenitis por strongyloides stercoralis simulando lesion polipoide de duodeno / Strongyloides stercoralis Duodenitis by simulating polypoid lesion of duodenum

La Strongyloidiasis es una parasitosis intestinal producida por un nematodo de distribución mundial, es endémica en zonas tropicales, el parasito penetra a través de los pies en forma de larva filariforme presente en suelos infectados. Puede presentar manifestaciones Dermatológicas, Respiratorias y Gastrointestinales, siendo estas ultimas de variado espectro, que van desde síntomas vagos e inespecíficos hasta Enteritis Invasiva. Los métodos convencionales de examen de heces seriados o radiología no son lo suficientemente sensibles ni específicos. La endoscopia ha aumentado la posibilidad de hacer mejores diagnósticos, así como la biopsia gástrica y duodenal; de hecho se considera a los hallazgos endoscópicos como marcadores de severidad de la infección. Presentamos el caso de un paciente con síntomas dispépticos y hallazgos endoscópicos e histológicos de Duodenitis por Strongyloides Stercoralis. El paciente recibió tratamiento con Ivermectina.

The intestinal strongyloidiasis is a parasitic disease caused by a global distribution nematode endemic in tropical areas, penetrates through the feet in the form of larvae present in infested soil filariform. May present with dermatological, respiratory and gastrointestinal tracts, the latter being varied spectrum of symptoms ranging from vague to invasive enteritis. Conventional methods of serial stool examination, radiology are not sensitive enough nor specific. Endoscopy has increased the possibility of better diagnosis, as well as gastric and duodenal biopsy, in fact considered the endoscopic findings as markers of severity of infection. We report the case of a patient with dyspeptic symptoms with endoscopic and histological findings of Duodenitis for Strongyloides Stercoralis. He was treated with Ivermectin.

Pharmacological effects of aqueous-ethanolic extract of Hibiscus rosasinensis on volume and acidity of stimulated gastric secretion

OBJECTIVE@#To explore the effects of extract of Hibiscus rosasinensis (H. rosasinensis) on the volume, free and total acidity of gastric secretion induced by carbachol.@*METHODS@#Animals were kept on fasting for 48 h, then the pylorus of each animal was ligated. They were randomly divided into 5 groups and treated by carbachol at 600 μg/kg. Then animals in group II - V were treated by H. rosasinensis extract at 250 and 500 mg/kg body weight, cimetidine at 2.5 mg/kg and verapamil at 10 mg/kg body weight intraperitoneally, respectively. The volume, free and total acidity of gastric secretion were observed and compared.@*RESULTS@#It was found that the extract significantly reduced the volume, free and total acidity of gastric secretion (P<0.01). These reductions were comparable to cimetidine and verapamil. And the reduction in the volume and free acidity were more significant in cimetidine and verapamil treated group indicating that cimetidine and verapamil were more effective.@*CONCLUSIONS@#The extract of H. rosasinensis can reduced the volume, free and total acidity of gastric secretion, and can be used effectively in the treatment of peptic ulcer.

Antiulcer activity of methanolic extract and fractions of Picralima nitida seeds(Apocynacaea) in rats

OBJECTIVE@#To investigated the antisecrectory activities of the methanol extract, chloroform fraction and methanol fraction of Picralima nitida seeds.@*METHODS@#The methanol extract of Picralima nitida seeds was fractionated into chloroform fraction and methanol fraction. They were evaluated for antiulcer activity and gastric emptying time in rats using aspirin-pylorus-ligation model.@*RESULTS@#Oral administration of the methanol extract, chloroform fraction and methanol fraction at 1 000 mg/kg reduced gastric ulcer by 56.4%, 40.0% and 56.3%, respectively; and the fractions of the extract significantly (P<0.05) reduced gastric emptying time when compared to the control. Gastric acidity was significantly decreased when compared with saline group, 40.25 mEq/L in methanol extract, 50.0 mEq/L in chloroform fraction 51.25 mEq/L in methanol fraction but had no significant effect on the gastric secretion volume.@*CONCLUSIONS@#These findings showed that methanol extract, chloroform fraction and methanol fraction of the seeds of Picralima possessed potent antiulcer properties and some antisecretory properties.

Effects of bifidobacteria on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of bifidobacterium on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation.</p><p><b>METHODS</b>The eligible neonates were randomly assigned into two groups: observed (n=38) and control (n=43). The observed group was given bifidobacteria daily (one capsule per time, for 7 days) by nasal feeding from the next day after mechanical ventilation. Gastric pH, gastric bacteria colonization, feeding intolerance, weight gain, the incidence of ventilator-associated pneumonia (VAP), and the homology between the bacteria isolated from intra-gastric colonization with those causing VAP were observed.</p><p><b>RESULTS</b>The incidence of gastric pH≤3 in the observed group was significantly higher than that in the control group 3, 5 and 7 days after mechanical ventilation (P<0.01). The rate of gastric bacteria colonization in the observed group was significantly lower than that in the control group 5 and 7 days after mechanical ventilation (P<0.01). The incidences of feeding intolerance and VAP in the observed group were significantly lower than those in the control group (P<0.05, P<0.01, respectively). The rate of homology of the bacteria isolated from intra-gastric colonization with those causing VAP in the observed group was significantly lower than that in the control group (P<0.01). There were no significant differences in the weight gain between the two groups.</p><p><b>CONCLUSIONS</b>Bifidobacterium can decrease gastric pH, gastric bacteria colonization and feeding intolerance, thus blocks the infection route "stomach-oropharynx-respiratory tract" indirectly and decreases the incidence of endogenous VAP in neonates receiving mechanical ventilation.</p>

Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery

Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for preemptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidlne versus pantoprazole given in regulating gastric pH in elective surgery. This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A [n = 40] participants received placebo tablet, in group B [n = 40] participants received ranitidine tablet while in group C [n = 40], participants received pantoprazole tablet and their gastric pH estimated serially. The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A [Friedman test; P>0.05] and group C participants. [P>0.05]. However, the mean preoperative gastric pH values [7.140 +/- .7652] were significantly lower than mean pH values [7.253 +/- .7514] after 2 h postoperatively in group B participants [P<0.05]. From the observations and analyses of the present study, it can be inferred that ranitidine is more effective than pantoprazole to raise the gastric pH for prevention of aspiration pneumonitis

Clinical features and prevalence of gastroesophageal reflux disease in infants attending a pediatric gastroenterology reference service / Doença do refluxo gastroesofágico associada ao refluxo ácido em lactentes atendidos em um serviço de referência de gastroenterologia pediátrica

CONTEXT: In infants, it is not always easy to distinguish between pathological and physiological gastroesophageal reflux based only on clinical criteria. In Brazil, studies about gastroesophageal reflux disease in infants are few and are even rare those that used prolonged esophageal pH monitoring for its evaluation. OBJECTIVE: To describe the clinical features of gastroesophageal reflux disease and to determine its prevalence in infants with gastroesophageal reflux attending a tertiary Pediatric Gastroenterology Service and submitted to esophageal pH monitoring for investigation. METHODS: Descriptive study in 307 infants in whom esophageal pH monitoring (Mark III Digitrapper, Synectics Medical AB, Sweden) was performed during the period December, 1998-December, 2008. The clinical features studied were age group (1-12 months and 13-24 months), and clinical manifestations that motivated the indication of pH monitoring. RESULTS: One hundred twenty-four (40.4 percent) were female and 183 (59.6 percent) male with mean age 12.2 ± 6.2 months (1-23 months). The prevalence of gastroesophageal reflux disease was 18.2 percent (56/307). One hundred forty-eight (48.2 percent) were 1-12 months old and 159 (51.8 percent), 13-24 months. No significant difference was found between the prevalence of these two age groups (P = 0.3006). Gastroesophageal reflux disease was more frequent in those with digestive manifestations (24.2 percent), crisis of cyanosis/apnea (23.8 percent) and mixed manifestations (21.5 percent). Respiratory manifestations were the most frequent indication (39.1 percent) of pH monitoring. However, the prevalence of gastroesophageal reflux disease was lower (12.5 percent) in this group compared with in those with digestive manifestations (P = 0.0574), crisis of cyanosis/apnea (P = 0.0882) and mixed manifestations (P = 0.1377). All infants that presented clinical manifestations as crisis of cyanosis/apnea and abnormal pH-metry were < ...

CONTEXTO: Em lactentes, nem sempre é fácil diferenciar o refluxo gastroesofágico fisiológico do patológico baseado somente em dados clínicos. No nosso meio, são escassos os estudos sobre doença do refluxo gastroesofágico em lactentes, sendo ainda mais raros os que tenham utilizado a pHmetria esofágica prolongada para a sua avaliação. OBJETIVO: Descrever os aspectos clínicos da doença do refluxo gastroesofágico e determinar a sua prevalência em uma população de lactentes com refluxo gastroesofágico atendida e submetida a pHmetria esofágica num serviço terciário de gastroenterologia pediátrica. Métodos - Estudo descritivo em 307 lactentes submetidos a pHmetria esofágica (Digitrapper MKIII, Synectics Medical AB, Sweden) no período de dezembro de 1998 a dezembro de 2008. Os aspectos clínicos analisados foram: faixa etária (1-12 m e 13-24 m) e manifestações clínicas que motivaram a indicação de pHmetria. RESULTADOS: Cento e vinte e quatro (40,4 por cento) eram meninas e 183 (59,6 por cento) meninos, com idade média de 12,2 ± 6,2 m (1-23 m). A prevalência de doença do refluxo gastroesofágico foi de 18,2 por cento (56/307). Cento e quarenta e oito (48,2 por cento) tinham idades entre 1-12 m e 159 (51,8 por cento), 13-24 m. Não houve diferença significativa entre as prevalências observadas nessas duas faixas etárias (P = 0,3006). Doença do refluxo gastroesofágico foi mais frequentemente detectada nos lactentes com manifestações digestivas (24,2 por cento), crises de cianose/apneia (23,8 por cento) e manifestações mistas (21,5 por cento). Manifestações respiratórias motivaram maior percentagem (39,1 por cento) de indicação de pHmetria. Entretanto, a prevalência de doença do refluxo gastroesofágico nesse grupo (12,5 por cento) resultou menor quando comparada com a de manifestações digestivas (P = 0,0574), crises de cianose/apneia (P = 0,0882) e mistas (P = 0,1377). Todos lactentes que apresentaram manifestações clínicas sob forma de crises de cianose/apneia ...

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.

Suppressive effect of pomegranate on gastric ulcer in the experimental rats

This research aimed to evaluate the some chemical composition, screen of phytochemical substances in pomegranate rind and juice and also to study the suppressive effect of pomegranate rind either extract or powder and juice on aspirin induced gastric mucosal ulcer in rats. Forty-two adult male albino rats Sprague-Dawley strain were classified into control negative [-ve] group and five ulcer rat groups which were control positive [+ve], drug, rind extract, rind powder and juice groups. The rind of pomegranate contains the higher value of ash, protein, fat and carbohydrate than juice of pomegranate. Tannins, terpenes, alkaloids, saponins, flavonoids, cardenolides and resins were found in juice but tannins, alkaloids, flavonoids and cardenolides only were found in 70% methanolic rind extract of pomegranate fruit. The control [+ve] group showed a significant decrease in final weight, weight gain percentage, feed efficiency ratio and gastric catalase, superoxide dismutase [SOD] and glutathione [GSH] but a significant increase in nitric oxide [NO] and malondialdehyde [MDA] compared with control [-ve] group. The drug, rind extract, rind powder and juice groups showed a significant increase in feed efficiency ratio in compared with control [-ve] group. The drug group showed a significant increase in feed efficiency ratio, [NO] and [MDA] while the rind extract group showed a significant increase in feed efficiency ratio, volume of gastric juice and gastric [NO] but a significant decrease in glutathione compared with control [-ve] group. The rind powder group showed a significant increase in feed efficiency ratio, volume of gastric juice, total acidity and gastric [NO] and [MDA] and a significant decrease in glutathione while the juice group showed a significant increase in feed efficiency ratio, volume of gastric juice, total acidity and gastric [NO] and [MDA] but a significant decrease in glutathione compared with control [-ve] group. The highest decrease values of gastric juice percent and total acidity percent, was in drug, rind extract, juice then rind powder groups. The highest value of ulcer index appeared in descending manner in control [+ve], rind powder, rind extract, juice, and drug groups but curative ratio percent were drug, juice, rind extract and rind powder groups

Comparative study of oral erythromycin-ranitidine combination and metoclopramide-ranitidine combination in reducing residual gastric fluid volume and acidity in elective surgery

Prokinetic agents and H-2 receptor antagonists are commonly used to decrease the volume and increase the pH of the gastric fluid. This study was conducted to compare the effect of oral erythromycin-ranitidine combination and metoclopramide-ranitidine combination in reducing gastric fluid volume and acidity in patients undergoing elective surgery. 80 patients were divided into two groups by convenient sampling technique after meeting inclusion criteria; Group A was given oral erythromycin 250 mg-ranitidine 150 mg while group B was given oral metoclopramide 10 mg-ranitidine 150 mg two hours before surgery. Gastric fluid was aspirated with orogastric tube after induction. Volume and pH of the gastric fluid were determined. Data analysis of our study showed statistically significant reduction in mean gastric fluid aspirate volume in group A [3.4ml+2.3 vs. 7.2m1+3.1]. [P-value = 0.001 and T-value = 6.24]. There was no statistically significant difference between the two groups as far as increase in gastric pH was concerned [6.5+1.6 vs. 6.2+1.3]. [T-value = 0.925 / Two tailed P-value = 0.36]. In both the groups' gastric pH was increased from the average normal value [0.3-2.9]. Combination of erythromycin-ranitidine is more effective than metoclopramide-ranitidine in reducing the gastric aspirate fluid volume and thus in prevention of acid aspiration syndrome

Acid-base disarrangement and gastric intramucosal acidosis predict outcome from major trauma / Desarranjo ácido-base e acidose gástrica intramucosal predizem desfecho de trauma grave

INTRODUCTION: This prospective non-interventional study intended to assess the prognostic value of gastric intramucosal acidosis in patients with severe trauma admitted to a medical/surgical ICU. METHODS: Gastric tonometer catheters were introduced to measure air PCO2 level (Tonocap device) in forty consecutive critically ill trauma patients. Gastric intramucosal pH, air PCO2 gradient, lactate and acid-base parameters were measured at admission and at 6, 12 and 24 h thereafter. RESULTS: The median age, mean APACHE II and SOFA scores were higher in nonsurvivors than in survivors (p<0.05). There were significant differences in the PCO2 gradient between survivors and nonsurvivors at 12 and 24 hours (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; p<0.05). Gastric intramucosal pH values were lower in nonsurvivors than in survivors, on admission and after 12 or 24 hours (p<0.05). Arterial pH and bicarbonate were lower, lactate concentration higher, and base excess more negative in nonsurvivors. Prediction of outcome (mortality and MODS) at 24 hours of ICU assessed by their ROC curves was similar (p=NS). At 24 hours, air PCO2 gradient > 18 mmHg carried a relative risk of 4.6 for death, slightly higher than a HCO3 <20 mEq/L (RR=4.29) or base excess of <-2 mmol/L (RR=3.65). CONCLUSION: Bicarbonate, base deficit, lactate, gastric intramucosal pH and PCO2 gradient discriminate survivors from nonsurvivors of major trauma. A critical air PCO2 gradient carried the greatest relative risk for death at 24 hours of ICU. Inadequate regional blood flow as detected by a critical PCO2 gradient seems to contribute to morbidity and mortality of severe trauma patients.

INTRODUÇÃO: O objetivo deste estudo prospectivo, não-intervencionista, foi avaliar o valor prognóstico da acidose gástrica intramucosal em pacientes com trauma grave admitidos numa UTI. MÉTODOS: Cateteres tonométricos gástricos foram introduzidos para medir o nível de PCO2 aéreo em 40 pacientes traumatizados. O pH gástrico intramucosal, o gradiente de PCO2 aéreo, o lactato e os parâmetros ácido-base foram medidos na admissão e 6, 12 e 24 h após a admissão. RESULTADOS: A idade mediana, o APACHE II e os escores SOFA médios foram maiores nos não-sobreviventes que nos sobreviventes (p<0.05). Não houve diferenças significativas para o gradiente de PCO2 entre sobreviventes e não-sobreviventes após 12 e 24 horas (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; P<0.05). Os valores de pH gástrico intramucosal foram menores nos não-sobreviventes que nos sobreviventes na admissão e após 12 ou 24 horas (P<0.05). O pH arterial e o bicarbonato foram menores, a concentração de lactato maior, o excesso de base mais negativo nos não-sobreviventes. Predição do desfecho (mortalidade e FMOS) nas 24 horas de UTI acessada pelas curvas ROC foi similar (p=NS). Nas 24 horas, um gradiente de PCO2 aéreo >18 mmHg acarretou um risco relativo de 4.6 para óbito, um pouco maior que um HCO3 <20 mEq/L (RR=4.29) ou um excesso de base <-2 mmol/L (RR=3.65). CONCLUSÃO: Bicarbonato, déficit de base, lactato, pH gástrico intramucosal e o gradiente de PCO2 discriminaram os sobreviventes dos não-sobreviventes de trauma. Um gradiente crítico de PCO2 aéreo acarretou o maior risco relativo para óbito após 24 horas de UTI. Fluxo sangüíneo regional inadequado detectado por um gradiente crítico de PCO2 parece contribuir para a morbidade e mortalidade de pacientes traumatizados graves.

Efficacy and safety of famotidine for the treatment of stress ulcers in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of famotidine treatment for stress ulcers in neonates.</p><p><b>METHODS</b>Fifty-four neonates with stress ulcers from 2001 to 2006 were enrolled. Seven cases were confirmed with stress ulcers by gastroscopy. Famotidine was administered intravenously at a dosage of 0.5 mg/kg every other 12 hrs. After cessation of hematemesis and vomiting, famotidine was administered once a day for two days. Primary diseases and complications were concurrently treated. Clinical symptoms and gastric pH were assessed before and after famotidine treatment. Possible adverse effects of famotidine treatmentdouble ended arrowrelated were observed.</p><p><b>RESULTS</b>After 24 hrs of famotidine treatment, hematemesis and vomiting ceased in 52 patients (96.3%). Clinical symptoms disappeared in all of the 54 patients 48 hrs after famotidine treatment. Gastric pH value increased 6, 12, 24, 36 and 48 hrs after famotidine treatment from 2.07+/-0.22 (before treatment) to 5.01-5.15 (P<0.01). All of the 54 patients were successfully treated. Famotidine treatment did not lead to abnormal respiration, heart rate and blood pressure. Loss of appetite, nausea, vomiting, diarrhea, constipation and rashes were not seen after famotidine treatment. There were significant differences in white cell count, platelet count and hepatic enzyme levels before and after famotidine treatment. An augmented side effect of the other drugs concurrently used due to famotidine treatment was not noted.</p><p><b>CONCLUSIONS</b>Famotidide is effective and safe for the treatment of stress ulcers in neonates.</p>

Protective effect of nitric oxide against gastric ulcer in rats

Recent research has indicated that nitric oxide [NO] has gastric mucosal protective effects similar to those of prostaglandins [PGs], and that NO and PGs may act synergistically to maintain gastric mucosal integrity. Therefore, the present study aimed at evaluating the anti-ulcer activity of NO and its possible mechanism[s] of action. This was established by investigating the effects of orally administered single and repeated doses of the NO donor sodium nitroprusside [SNP, 3 mg / Kg] or the NO precursor L-arginine [200 mg / Kg] on cold restraint stress-induced and aspirin-induced gastric ulcer in rats, as well as on total gastric acidity in pyloric-ligated rats subjected to stress ulcer. The effects of the H2-receptor antagonist ranitidine also were investigated for comparison. Single and repeated doses of SNP caused a significant decrease in the number [56% and 64%, respectively] and length [51% and 48%, respectively] of gastric lesions in stress-induced ulcer. The protective effect of SNP against ulcer formation was even more marked on aspirin-induced ulcer, causing 71% and 92% decrease in the number, and 62% and 82% decrease in the length of gastric lesions, respectively. Single and repeated doses of L-arginine also were effective in reducing the number and length of gastric lesions in both ulcer models, but to a lesser extent than with SNP. In pyloric-ligated rats, single and repeated doses of SNP or L-arginine caused only moderate reductions in total gastric acidity [27% and 31% for SNP; 20% and 25% for L-arginine, respectively]. Single and repeated doses of ranitidine also produced a significant decrease in the number and length of gastric lesions in both ulcer models, and in total gastric acidity in pyloric-ligated rats. The order of anti-ulcer activity of the three drugs was as follows: Stress-induced ulcer: ranitidine > SNP > L-arginine. Aspirin-induced ulcer: SNP > L-arginine > ranitidine. These results show that NO exerts a significant protective effect against both stress-induced and aspirin-induced ulcer. Inhibition of gastric acid secretion may contribute but is not the only mechanism of the anti-ulcer activity of NO. The results also suggest that concurrent administration of NO donors or L-arginine may be beneficial in prophylaxis against non-steroidal anti-inflammatory drugs [NSAIDs]- induced gastric ulcer

Effects of alpha-lipoic acid on induced gastric ulcer in albino rats

This work was designed to study the protective effect of Alpha lipoic acid [ALA] on stress-induced gastric ulcers and to evaluate its effect on gastric secretions in rats exposed to cold restraint stress [CRS], The rats were divided into 2 main groups; [A] and [B] to study the effect of CRS on gastric secretion and ulceration, respectively, and their modulation by Alpha lipoic acid. Group [A] was subdivided into [4] subgroups each consisted of [10] Rats and received ALA in a dose of [50 and 100 mg/kg/day, respectively] for [14 days]. Group [B] was subdivided into [3] subgroups each consisted of [10] Rats and received ALA in a dose of [50 and 100 mg/kg/day, respectively] for [14 days]. The present study showed that, orally administered A LA, in a dose of [50 and 100 mg/kg/day] produced statistically significant reduction of the mean acid concentration and the mean acid output. The mean pepsin concentration was also significantly increased with [P<0.05]: ALA also, produced statistically insignificant reduction of the volume of gastric contents in comparison to the CRS group. ALA [50 mg/kg/day] also, reduced the incidence of ulceration, where the mean ulcer severity score and the ulcer index were significantly reduced with [P<0.05]. The preventive index was [48.8 4%] while ALA in dose [100 mg/kg/day] reduced the incidence of ulceration. The mean ulcer severity score and the ulcer index were insignificantly reduced with [P> 0.05]. With preventive index [28%]. These significant protective effects of ALA may be due to one or more of the following mechanisms; stimulation of PGs synthesis [one of the main inhibitors of gastric acid secretion], increase of the volume of gastric juice probably by an increase in gastric mucus and water secretion and as an antioxidant [ALA is considered as one of the most potent antioxidant, acts intra-and extra-cellular, recycling other antioxidants and possesses metal chelating activity]. It was concluded that; ALA used in the study showed statistically significant effect on all parameters of gastric secretion in comparison to the control group. They also significantly reduced the incidence of ulceration, the mean ulcer severity score and the ulcer index with a good preventive index. This protective anti-ulcer effect may be mediated through PGs whose synthesis is regulated by ALA

Extraesophageal Manifestations of Gastroesophageal Reflux Disease / 대한소화기학회지

Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.

Normal Ambulatory 24-Hour Esophageal pH Values in Koreans: A Multicenter Study

Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to establish normal values for gastroesophageal acid exposure in healthy Koreans. Fifty healthy volunteers (24 males and 26 females; mean age, 45 yr) without reflux symptoms and without reflux esophagitis or hiatal hernia on upper endoscopy underwent ambulatory 24-hr esophageal pH monitoring after esophageal manometry. The 95th percentiles for the reflux parameters were: the percent total time pH 5 min, 1.5; the duration of the longest episode, 12.5 min; and the composite score, 14.2. Age and gender were not associated with any of the pH parameters. In conclusion, physiological gastroesophageal reflux occurs in healthy Koreans. These normal esophageal pH values will provide reference data for clinical and research studies in Korea.

Usefulness of Multichannel Intraluminal Impedance-pH Metry in Children with Suspected Gastroesophageal Reflux Disease / 대한소화기학회지

BACKGROUND/AIMS: pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events. METHOS: Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring. RESULTS: While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p<0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003). CONCLUSIONS: This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children.