Giant Gastric Ulcers: An Unusual Culprit

Perforated giant peptic ulcer of the stomach in a female patient with multiple sclerosis

Giant peptic ulcer of the stomach is defined with a diameter of more than 3 cm. About 2/3 of them are benign peptic ulcers and perforate in 1%-2% of all peptic ulcer stomach perforations. High rates of postoperative morbidity and mortality are reported. The treatment options include omental patch repair, jejunal serosal patch repair, duodenal exclusion, and gastric resection. Postoperative omental patch repair failure is reported and is strongly associated with the ulcer diameter. This case reports a giant peptic stomach ulcer perforation in a female patient treated successfully with omental patch repair, according to Cellan-Jones.

Gastroprotective effect of eupatilin, a polymethoxyflavone from Artemisia argyi H.Lév. & Vaniot, in ethanol-induced gastric mucosal injury via NF-κB signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Artemisia argyi H.Lév. & Vaniot (AA) has been extensively utilized as an important medicine and food homology in China, Japan, Korea, and eastern parts of Russia, owing to its pharmacological effects, which include anti-inflammatory, antibacterial, antitussive, and antiallergic properties. Despite the extract of AA can significantly alleviate gastric mucosal injury, its precise material basis for effectiveness is not yet clear. As one of the polymethoxy flavonoids with high content in AA, the gastroprotective activity and molecular mechanism of eupatilin (EUP) require further investigation.

AIM OF THE STUDY

This study aims to investigate the gastroprotective effects and possible mechanisms of EUP by using an ethanol-induced gastric mucosal injury model in rats.

MATERIALS AND METHODS

EUP was isolated from 95% ethanol extract of AA using a systematic phytochemical method. The gastroprotective activity of EUP was evaluated using a male SD rat model with ethanol-induced gastric mucosa injury. Histopathology evaluation of gastric tissues was performed using hematoxylin and eosin (H&E) staining. The levels of cytokines in the plasma and tissues were tested using the ELISA kits, while western blot analysis was employed to assess the expressions of COX-2, iNOS, and NF-κB pathway proteins.

RESULTS

A sufficient amount of EUP was obtained from AA through chromatographic methods and identified by NMR experiment. In vivo, experimental results proved that EUP could significantly alleviate pathological features, increased SOD, GSH, and IL-10 levels, and decreased the contents of MDA, TNF-α, IL-1β, and IL-6. Further in vitro and in vivo Western blot experimental results showed that EUP significantly down-regulates the expressions of the NF-κB signal pathway to relieve inflammatory responses.

CONCLUSION

This study demonstrated that EUP could exert gastroprotective effects by inhibiting inflammation, enhancing gastric mucosal defense, and ameliorating oxidative stress, which is beneficial for providing scientific data for the development of gastric protection.

Drug-Associated Gastropathy: Diagnostic Criteria

Drugs are widely used to treat different diseases in modern medicine, but they are often associated with adverse events. Those located in the gastrointestinal tract are common and often mild, but they can be serious or life-threatening and determine the continuation of treatment. The stomach is often affected not only by drugs taken orally but also by those administered parenterally. Here, we review the mechanisms of damage, risk factors and specific endoscopic, histopathological and clinical features of those drugs more often involved in gastric damage, namely NSAIDs, aspirin, anticoagulants, glucocorticosteroids, anticancer drugs, oral iron preparations and proton pump inhibitors. NSAID- and aspirin-associated forms of gastric damage are widely studied and have specific features, although they are often hidden by the coexistence of Helicobacter pylori infection. However, the damaging effect of anticoagulants and corticosteroids or oral iron therapy on the gastric mucosa is controversial. At the same time, the increased use of new antineoplastic drugs, such as checkpoint inhibitors, has opened up a new area of gastrointestinal damage that will be seen more frequently in the near future. We conclude that there is a need to expand and understand drug-induced gastrointestinal damage to prevent and recognize drug-associated gastropathy in a timely manner.

Protocatechuic acid, the main effective monomer in Wuqi Powder, can inhibit gastric ulcers induced by acetic acid and Helicobacter pylori

OBJECTIVE

To explore the effective ingredients of Wuqi Powder and their mechanism of action, so as to provide a theoretical basis for clinical application.

METHODS

Enzyme-linked immunosorbent assay was used to determine interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels. Rapid urease test and Giemsa staining were conducted to detect Helicobacter pylori (H. pylori) in gastric tissue. CCK-8, EdU and wound healing assay were used to measure the proliferation and migration of GES-1 cells. The number of intracellular and extracellular bacteria of GES-1 cells was counted to evaluate infection and adhesion of H. pylori. RT-qPCR was conducted to evaluate the level of alpA, alpB and cagA genes of H. pylori. Bioinformatics methods were used to predict the potential targets and signaling pathways of protocatechuic acid (PCA) in GES-1 cells. Then, RT-qPCR was used to detect the expression of target genes, and Western blot was conducted to detect the interaction of the target pathways.

RESULTS

PCA is the effective ingredient in Wuqi Powder, which alleviated the symptoms of gastric ulcers, reduced H. pylori in gastric tissue and IL-6, TNF-α in rat serum. In addition, PCA accelerated the proliferation and migration of GES-1 cells and inhibited the infection and adhesion of H. pylori to GES-1 cells. Furthermore, PCA inhibited the TNF and Smad pathways and activated the vascular endothelial growth factor A (VEGFA) pathway of GES-1 cells.

CONCLUSION

PCA is the key component in treating gastric ulcers induced by acetic acid and H. pylori. It promotes gastric ulcer repair by inhibiting the Smad pathway, TNF pathway and activating the VEGFA pathway.

Unusual Complicated Gastric Ulcers

We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with haemorrhage- or perforation-induced complications. This category of ulcers, i.e., giant (over 2–3 cm) and multiple ulcers, is rarely encountered. We discuss the circumstances determining the occurrence of such lesions, their diverse aetiology and pathogenesis, their common manifestations, and the severity of their evolution. Some of the lesions are benign (chronic or acute ulcers), whereas others are neoplastic: carcinoma, stromal tumours, and lymphomas. In gastric ulcers, the characteristics of this particular and rare category of lesions strictly places them in the surgical field, requiring primary surgical intention. Conservative treatments are not effective in such cases, and preoperative biopsies are not appropriate for emergency interventions. Whether these unusual ulcers are benign or malign, they need to be surgically removed.

Rabeprazole inhibits inflammatory reaction by inhibition of cell pyroptosis in gastric epithelial cells

Background

Helicobacter pylori (H. pylori) is a common pathogen in development of peptic ulcers with pyroptosis. Rabeprazole, a critical component of standard triple therapy, has been widely used as the first-line regimen for H. pylori infectious treatment. The aim of this study to explore the function of Rabeprazole on cell pyroptosis in vitro.

Methods

The clinical sample from patients diagnosed with or without H. pylori-infection were collected to analyze by Immunohistochemistry (IHC). Real-time quantitative PCR (qPCR), western blot (WB) and enzyme linked immunosorbent assay (Elisa) were performed to analyze the effect of Rabeprazole on cell pyroptosis, including LDH, IL-1β and IL-18.

Results

In this study, we showed that Rabeprazole regulated a phenomenon of cell pyroptosis as confirmed by lactate dehydrogenase (LDH) assay. Further results showed that Rabeprazole inhibited cell pyroptosis in gastric epithelial cells by alleviating GSDMD-executed pyroptosis, leading to decrease IL-1β and IL-18 mature and secretion, which is attributed to NLRP3 inflammasome activation inhibition. Further analysis showed that ASC, NLRP3 and Caspase-1, was significantly repressed in response to Rabeprazole stimulation, resulting in decreasing cleaved-caspase-1 expression. Most important, NLRP3 and GSDMD is significantly increased in gastric tissue of patients with H. pylori infection.

Conclusion

These findings revealed a critical role of Rabeprazole in cell pyroptosis in patients with H. pylori infection, suggesting that targeting cell pyroptosis is an alternative strategy in improving H. pylori treatment.