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Lancet (London, England) Jun 2024
Topics: Helicobacter pylori; Humans; Helicobacter Infections; History, 20th Century; Peptic Ulcer; Stress, Psychological
PubMed: 38880103
DOI: 10.1016/S0140-6736(24)01206-6 -
European Journal of Trauma and... Jun 2024The study aimed to evaluate safety of omitting the intraabdominal drains after perforated peptic ulcer repairs.
PURPOSE
The study aimed to evaluate safety of omitting the intraabdominal drains after perforated peptic ulcer repairs.
MATERIALS AND METHODS
We conducted a prospective, randomized, controlled trial from January 2022 to January 2024 at the Emergency surgery department. Patients with perforated peptic ulcers were evaluated for eligibility. They were randomly assigned into two groups. In group A: two intraabdominal drains (pelvic and hepatorenal). in group B: no intraabdominal drains. The primary outcome was hospital length of stay (LOS), and the secondary outcomes included parameters of recovery and 30-day morbidities. The data were analyzed using SPSS 16 ®.
RESULTS
Thirty five patients were in the no drain group, while 36 patients were in the drain group. Patients in the no drains group had significantly earlier bowel motion (21.6 vs 28.69 hours; p = 0.004), fluid diet (73.54 vs 86.78 hours; p 0.001), and solid intake (84.4 vs. 98 hours; p 0.001), less pain severity (p = 0.0001) and shorter hospital stay (4.74 vs 5.75 days; p 0.001). A significant less morbidity, including surgical site infection (p = 0.01), and respiratory complications (p 0.0001), were in the no drain group. There was no difference of fever duration nor wound dehiscence.
CONCLUSIONS
Omitting the intraabdominal drains is safe after peptic ulcer perforation repair. It can improve outcomes. The study was registered at ClinicalTrials.gov Identifier: NCT06084741.
PubMed: 38878063
DOI: 10.1007/s00068-024-02551-6 -
Molecular Biology Reports Jun 2024Vanillic acid (VA; 4-hydroxy-3-methoxybenzoic acid) is a flavouring agent found in various natural sources such as olives, fruits, and green tea. While VA exhibits...
BACKGROUND
Vanillic acid (VA; 4-hydroxy-3-methoxybenzoic acid) is a flavouring agent found in various natural sources such as olives, fruits, and green tea. While VA exhibits numerous pharmacological effects, its potential protective effects against gastric injury warrants further investigation. Therefore, the primary objective of this study is to elucidate investigate the gastroprotective properties of VA against ethanol-induced gastric injury.
METHODS AND RESULTS
Rats were orally administered either saline or VA at different doses (50, 100, and 200 mg/kg/day), with omeprazole (20 mg/kg) serving as a positive control, for fourteen consecutive days before ethanol administration. Blood and gastric tissue samples were collected one hour after ethanol administration for biochemical, molecular, and histological analyses. Pre-treatment with VA before ulcer induction alleviated both macroscopic and microscopic damage. It also increased antioxidant glutathione levels and decreased malondialdehyde and myeloperoxidase activity, along with reducing inflammatory markers such as tumour necrosis factor (TNF)-α, interleukin (IL)-6, and nuclear factor kappa B (NF-κB). Additionally, VA pre-treatment reversed the elevation of Bax mRNA expression and gastric caspase-3 levels induced by gastric damage. It also mitigated the reduction in Bcl-2 mRNA expression.
CONCLUSION
These findings suggest that VA exerts protective effects against ethanol-induced gastric injury in rats. It achieves this by augmenting gastric antioxidant capacity and mitigating oxidative, inflammatory, and apoptotic damage.
Topics: Animals; NF-kappa B; Ethanol; Rats; Apoptosis; Vanillic Acid; Signal Transduction; Male; Stomach Ulcer; Gastric Mucosa; Oxidative Stress; Antioxidants; Protective Agents; Rats, Wistar; Tumor Necrosis Factor-alpha; Glutathione
PubMed: 38874632
DOI: 10.1007/s11033-024-09672-6 -
Helicobacter 2024The overall benefits of the newly introduced family-based Helicobacter pylori (H. pylori) infection control and management (FBCM) and screen-and-treat strategies in...
Family-based Helicobacter pylori infection control and management strategy and screen-and-treat strategy are highly cost-effective in preventing multiple upper gastrointestinal diseases in Chinese population at national level.
BACKGROUND
The overall benefits of the newly introduced family-based Helicobacter pylori (H. pylori) infection control and management (FBCM) and screen-and-treat strategies in preventing multiple upper gastrointestinal diseases at national level in China have not been explored. We investigate the cost-effectiveness of these strategies in the whole Chinese population.
MATERIALS AND METHODS
Decision trees and Markov models of H. pylori infection-related non-ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC) were developed to simulate the cost-effectiveness of these strategies in the whole 494 million households in China. The main outcomes include cost-effectiveness, life years (LY), quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER).
RESULTS
When compared with no-screen strategy, both FBCM and screen-and-treat strategies reduced the number of new cases of NUD, PUD, PUD-related deaths, and the prevalence of GC, and cancer-related deaths. The costs saved by these two strategies were $1467 million and $879 million, quality-adjusted life years gained were 227 million and 267 million, and life years gained were 59 million and 69 million, respectively. Cost-effectiveness analysis showed that FBCM strategy costs -$6.46/QALY and -$24.75/LY, and screen-and-treat strategy costs -$3.3/QALY and -$12.71/LY when compared with no-screen strategy. Compared to the FBCM strategy, the screen-and-treat strategy reduced the incidence of H. pylori-related diseases, added 40 million QALYs, and saved 10 million LYs, but at the increased cost of $588 million. Cost-effectiveness analysis showed that screen-and-treat strategy costs $14.88/QALY and $59.5/LY when compared with FBCM strategy. The robustness of the results was also verified.
CONCLUSIONS
Both FBCM and screen-and-treat strategies are highly cost-effective in preventing NUD, PUD, and GC than the no-screen strategy in Chinese families at national level. As FBCM strategy is more practical and efficient, it is expected to play a more important role in preventing familial H. pylori infection and also serves as an excellent reference for other highly infected societies.
Topics: Humans; Helicobacter Infections; Cost-Benefit Analysis; China; Helicobacter pylori; Quality-Adjusted Life Years; Male; Middle Aged; Stomach Neoplasms; Female; Mass Screening; Adult; Gastrointestinal Diseases; Aged; Infection Control; Peptic Ulcer; East Asian People
PubMed: 38874128
DOI: 10.1111/hel.13063 -
Journal of Agricultural and Food... Jun 2024Koidz, a traditional Chinese medicine, contains atractylenolide I (ATR-I), which has potential anticancer, anti-inflammatory, and immune-modulating properties. This...
Koidz, a traditional Chinese medicine, contains atractylenolide I (ATR-I), which has potential anticancer, anti-inflammatory, and immune-modulating properties. This study evaluated the therapeutic potential of ATR-I for indomethacin (IND)-induced gastric mucosal lesions and its underlying mechanisms. Noticeable improvements were observed in the histological morphology and ultrastructures of the rat gastric mucosa after ATR-I treatment. There was improved blood flow, a significant decrease in the expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-1β, and IL-18, and a marked increase in prostaglandin E (PGE) expression in ATR-I-treated rats. Furthermore, there was a significant decrease in the mRNA and protein expression levels of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), cysteinyl aspartate specific proteinase-1 (caspase-1), and nuclear factor-κB (NF-κB) in rats treated with ATR-I. The results show that ATR-I inhibits the NLRP3 inflammasome signaling pathway and effectively alleviates local inflammation, thereby improving the therapeutic outcomes against IND-induced gastric ulcers in rats.
Topics: Animals; NLR Family, Pyrin Domain-Containing 3 Protein; Indomethacin; Stomach Ulcer; Rats; Sesquiterpenes; Lactones; Inflammasomes; Male; Rats, Sprague-Dawley; Atractylodes; Gastric Mucosa; Humans; NF-kappa B; Tumor Necrosis Factor-alpha; Interleukin-1beta; Caspase 1; Interleukin-6; Interleukin-18
PubMed: 38872428
DOI: 10.1021/acs.jafc.3c08188 -
International Immunopharmacology Jun 2024Yucca filamentosa (YF) is widely used in folk medicine for its anti-inflammatory effects. Our study aimed to evaluate the chemical profile of YF extracts. Additionally,...
Yucca filamentosa (YF) is widely used in folk medicine for its anti-inflammatory effects. Our study aimed to evaluate the chemical profile of YF extracts. Additionally, the gastroprotective efficacy of its crude leaf extract and nano-cubosomal formulation was assessed in a rat model of ethanol-induced gastric injury by altering the HMGB-1/RAGE/TLR4/NF-κB pathway. The phytochemical composition of YF was investigated using FTIR spectroscopy and LC-MS/MS techniques. Standardization was further accomplished using HPLC. Rats were treated orally with yucca crude extract or its nano-cubosomal formulation at doses of 25, 50, and 100 mg/kg. Famotidine (50 mg/kg, IP) was used as a reference drug. After 1 h, rats were administered ethanol (1 ml, 95 %, orally). One hour later, the rats were sacrificed, and the serum was separated to determine TNF-α and IL-6 levels. Stomachs were excised for the calculation of the ulcer index and histopathological examinations. Stomach tissue homogenate was used to determine MDA and catalase levels. Additionally, the expression levels of HMGB-1/RAGE/TLR4/NF-κB were assessed. Phytochemical analysis confirmed the predominance of steroidal saponins, sucrose, organic and phenolic acids, and kaempferol. The nano-cubosomal formulation demonstrated enhanced gastroprotective, anti-oxidant, and anti-inflammatory efficacy compared to the crude extract at all tested doses. The most prominent effect was observed in rats pretreated with the YF nano-cubosomal formulation at a dose of 100 mg/kg, which was similar to normal control and famotidine-treated rats. Our results highlighted the enhanced gastroprotective impact of the yucca nano-cubosomal formulation in a dose-dependent manner. This suggests its potential use in preventing peptic ulcer recurrence.
PubMed: 38870882
DOI: 10.1016/j.intimp.2024.112440 -
Obesity Surgery Jun 2024Loop duodenojejunal bypass with sleeve gastrectomy (LDJBSG) is effective for weight loss and resolution of obesity-related associated medical problems. However, a...
PURPOSE
Loop duodenojejunal bypass with sleeve gastrectomy (LDJBSG) is effective for weight loss and resolution of obesity-related associated medical problems. However, a description of the reoperative surgery following LDJBSG is lacking.
MATERIAL AND METHODS
In this retrospective study, we analyzed the surgical complications and reoperation (conversion or revision) following LDJBSG from 2011 to 2019 in a single institution.
RESULTS
A total of 337 patients underwent LDJBSG during this period. Reoperative surgery (RS) was required in 10LDJBSG patients (3%). The mean age and BMI before RS were 47 ± 9 years and 28.9 ± 3.6 kg/m, respectively. The mean interval between primary surgery and RS for early (n = 5) and late (n = 5)complications was 8 ± 11 days and 32 ± 15.8 months, respectively. The conversion procedures were Roux-en-Y gastric bypass(n = 5), followed by Roux-en-Y duodenojejunal bypass (n = 2) and one-anastomosis gastric bypass (n = 1); other revision procedures were seromyotomy (n = 1) and re-laparoscopy (n = 1). Perioperative complications were observed in four patients after conversion surgery such as multiorgan failure (n = 1), re-laparoscopy (n = 1), marginal ulcer (n = 1), GERD (n = 1), and dumping syndrome (n = 1).
CONCLUSION
LDJBSG has low reoperative rates and conversion RYGB could effectively treat the early and late complications of LDJBSG. Because of its technical demands and risk of perioperative complications, conversion surgery should be reserved for a selected group of patients and performed by an experienced metabolic bariatric surgical team.
PubMed: 38869832
DOI: 10.1007/s11695-024-07348-5 -
International Journal of General... 2024infection is a common gastrointestinal infection that affects around 50% of the global population. This infection can lead to various health conditions such as peptic...
INTRODUCTION
infection is a common gastrointestinal infection that affects around 50% of the global population. This infection can lead to various health conditions such as peptic ulcer disease, dyspepsia, gastric carcinoma, and mucosa-associated lymphoid tissue lymphoma. The triple therapy which consists of proton-pump inhibitors, clarithromycin, and amoxicillin or metronidazole for 14 days is considered the first-line treatment for and its eradication, especially in areas where clarithromycin sensitivity is still high. However, recent research shows that the efficacy of this treatment is decreasing due to antibiotic resistance.
METHODS
This was a retrospective study that took place at Al-Hayat Jazan Hospital in Jazan, Saudi Arabia. The study analyzed the medical records of 186 patients with who had undergone the standard triple therapy. The objectives of this study were to determine the eradication rate of H. pylori by using the standard triple therapy, and to highlight the influence of some demographic characteristics such as age, gender, diabetes mellitus, and smoking on the eradication rate, in Jazan region, Saudi Arabia.
RESULTS
The medical records of 186 patients were included in the study. The overall rate of successful eradication was found to be 77.4%. The results of the study showed that the decline in the eradication rate was significantly associated with the presence of diabetes and smoking status (with p-values of <0.001 and <0.004, respectively).
CONCLUSION
This study finds that the standard triple therapy for eradication is less effective than optimal standards, as per literature and guidelines. Given its declining efficacy globally, alternative first-line treatments may be necessary. Further research is needed to assess its effectiveness in various regional contexts.
PubMed: 38859911
DOI: 10.2147/IJGM.S456865 -
Gastric Cancer : Official Journal of... Jun 2024To compare the risks of gastric cancer and other gastric diseases in patients with type-2 diabetes mellitus (T2DM) exposed to sodium-glucose cotransporter 2 inhibitors...
Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for new-onset gastric cancer and gastric diseases in patients with type 2 diabetes mellitus: a population-based cohort study.
OBJECTIVE
To compare the risks of gastric cancer and other gastric diseases in patients with type-2 diabetes mellitus (T2DM) exposed to sodium-glucose cotransporter 2 inhibitors (SGLT2I), dipeptidyl peptidase-4 inhibitors (DPP4I) or glucagon-like peptide-1 receptor agonists (GLP1a).
DESIGN
This was a population-based cohort study of prospectively collected data on patients with T2DM prescribed SGLT2I, DPP4I or GLP1a between January 1st 2015 and December 31st 2020 from Hong Kong. The outcomes were new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1) using the nearest neighbour search was performed, and multivariable Cox regression was applied. A three-arm comparison between SGLT2I, DPP4I and GLP1a was conducted using propensity scores with inverse probability of treatment weighting.
RESULTS
A total of 62,858 patients (median age: 62.2 years old [SD: 12.8]; 55.93% males; SGLT2I: n = 23,442; DPP4I: n = 39,416) were included. In the matched cohort, the incidence of gastric cancer was lower in SGLT2I (Incidence rate per 1000 person-year, IR: 0.32; 95% confidence interval, CI 0.23-0.43) than in DPP4I (IR per 1000 person-year: 1.22; CI 1.03-1.42) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of gastric cancer (HR 0.30; 95% CI 0.19-0.48), PU, acute gastritis, non-acute gastritis, and GERD (p < 0.05) compared to DPP4I use. In the three-arm analysis, GLP1a use was associated with higher risks of gastric cancer and GERD compared to SGLT2I use.
CONCLUSIONS
The use of SGLT2I was associated with lower risks of new-onset gastric cancer, PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I use. SGLT2I use was associated with lower risks of GERD and gastric cancer compared to GLP1a use.
PubMed: 38856768
DOI: 10.1007/s10120-024-01512-7 -
Journal of the Science of Food and... Jun 2024Stress-related diseases are on the rise and stress is one of the common factors that lead to ulcer. Stress-induced mucosal bleeding is a serious complication observed in...
BACKGROUND
Stress-related diseases are on the rise and stress is one of the common factors that lead to ulcer. Stress-induced mucosal bleeding is a serious complication observed in many critically ill patients. Due to the harmful side effects of proton pump inhibitors, natural and active alternative treatment methods for peptic ulcer treatment that are safe in terms of side effects are an urgent need for human health. We aimed to investigate the dose-dependent protective effects of Lactobacillus rhamnosus GG (LGG) against stress ulcers induced by cold restraint stress in rats. This study was performed in a total of 42 rats, in control group (C), stress group (S), pantoprazol (20 mg kg day) group (P), LGG (3 × 10 cfu mL day) + stress group (M1), LGG (15 × 10 mL day) + stress group (M5) and LGG (30 × 10 mL day) + stress group (M10) (each n = 7). Ulceration areas (mm) were determined quantitatively with ImageJ software. Glucocorticoid, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels were determined by ELISA and malondialdehyde levels were determined by spectrophotometric measurement. Histopathological examinations were performed in gastric tissue.
RESULTS
Therapeutic dose of LGG increased CAT, SOD and GPx levels; prevented excessive activation of the hypothalamic-pituitary-adrenal axis; reduced ulceration and bleeding in the gastric mucosal layer; and provided stabilization of mast cells.
CONCLUSIONS
We can suggest that LGG may be beneficial for reducing the negative effects of stress on the body, for protecting against ulcer disease and for reducing or preventing the risk of stress-induced gastrointestinal bleeding in patients staying in intensive care units. © 2024 The Author(s). Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
PubMed: 38856115
DOI: 10.1002/jsfa.13641