Gastric ulcer

Formononetin inhibits inflammation and promotes gastric mucosal angiogenesis in gastric ulcer rats through regulating NF-κB signaling pathway

To investigate the effects of formononetin on rats with gastric ulcer and further to explore its possible mechanism. Rats were randomly divided into sham operation group (Sham), model group (Model), omeprazole control group (Omeprazole) and formononetin in different dose groups (FOR-L, FOR-M, FOR-H). Rats model with gastric ulcer were established by 100% glacial acetic acid. Hematoxylin-eosin (H&E) staining was used to observe the pathological morphology of gastric mucosa. Immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were used to detect the level of inflammatory and angiogenesis related factors. The expressions of nuclear factor kappa-B (NF-κB) signaling pathway-related proteins were detected by western blot. Formononetin and omeprazole could ameliorate the pathological morphology of gastric mucosa in gastric ulcer rats. Compared with Model group, the levels of tumor necrosis factor (TNF)-α, Interleukin (IL)-1β, IL-6, myeloperoxidase (MPO), human endothelin (ET)-1 and p-P65 protein in formononetin treatment and omeprazole groups were significantly decreased (p < 0.05). Moreover, formononetin could increase the content of vascular endothelial growth factor (VEGF), nitric oxide (NO) and the levels of CD34, tight junction proteins (ZO-1 and occludin) and p-IκBα in a dose-dependent manner. Formononetin can ameliorate gastric ulcer in rats by inhibiting inflammation and promoting gastric mucosal angiogenesis, and its mechanism maybe related to NF-κB signaling pathway.

Bleeding giant gastric ulcer

BACKGROUND

A consecutive series of 269 cases of bleeding gastric ulcer were studied prospectively from 1979 to 1993 inclusive.

METHOD

Fifty-five (21%) had a giant gastric ulcer with a diameter of 3 cm or more. These cases were compared with those with ulcers less than 3 cm in diameter in terms of clinical details, prognostic factors, urgent operation and outcome.

RESULTS

Death occurred in 13 cases (5%), urgent surgery was performed in 75 cases (29%) and there were 11 postoperative deaths (15%) within a month of surgery. The patient details in the two groups matched in terms of age, sex distribution, ulcer history, previous complication and recent ingestion of analgesics. Clinical comparison showed that giant ulcer had a poorer prognosis with a higher mortality (10 vs 3%, P < 0.01), urgent surgery rate (65 vs 12%, P < 0.01) and operative mortality (23 vs 11%, difference not significant). Study of risk factors in patients with giant ulcer revealed significantly more with concurrent illness, shock, anaemia and endoscopic stigmata of recent haemorrhage.

CONCLUSION

More severe bleeding and poorer general condition in the giant ulcer group stresses the importance of early diagnosis and accurate resuscitation in these patients. Survival depends on optimal condition and prompt and timely surgery.

Relative risks of complications in giant and nongiant gastric ulcers

There are two divergent views regarding giant gastric ulcers. Traditionally, they have been regarded as a virulent disease prone to massive hemorrhage, intractability, and perforation. Recently, an entirely opposing viewpoint has developed that considers them no different from ordinary gastric ulcers. In this study between 1984 and 1989, 62 patients with giant ulcers (greater than or equal to 3 cm) were compared with 476 benign gastric ulcer patients to evaluate their relative risks of ulcer complications. The results showed that giant ulcers are more prone to severe hemorrhage (44% versus 27%; chi 2 test: p less than 0.009) but not more prone to free perforation. Penetration into contiguous organs occurred more frequently with giant gastric ulcers (45% versus 10%; chi 2 test: p less than 0.0001). The risk of the presence of microscopic malignancy in the macroscopically benign-looking giant ulcer is significantly greater than in the nongiant type (13% versus 3%; Fisher's exact test: p = 0.0013). The data showed that patients with giant gastric ulcers are more at risk for the development of life-threatening complications and, hence, more likely to require surgery.

A controlled study of human resting gastric mucosal blood flow by endoscopic laser-Doppler flowmetry

We investigated regional variation in resting focal gastric mucosal blood flow obtained by endoscopic laser-Doppler flowmetry in patients with symptoms of dyspepsia or peptic ulcer (N = 12) and asymptomatic healthy volunteers (N = 6). Mucosal blood flow was measured for 1 min at the duodenum (first part), prepylorus, antrum and body (anterior and posterior walls), angularis, mid-greater curvature, fundus, and distal esophagus. At all sites, mean +/- SE blood flow in patients was 71.88% of the corresponding value in volunteers (1.15 +/- 0.10 and 1.60 +/- 0.13 volts, p less than 0.02, t test). In both groups, blood flow was highest in the fundus, followed by the body and lowest in the antrum; the angularis had a high blood flow, second only to the fundus. There was no correlation between age and blood flow. We conclude that regional variation in resting gastric mucosal blood flow exists in health and disease.