The clinical and endoscopic aspects of peptic ulcers secondary to the use of nonsteroidal anti-inflammatory drugs of various origins

Trends in upper gastrointestinal bleeding management

Upper gastrointestinal bleeding (UGIB) can be attributed to either non-variceal or variceal causes. The latter is more aggressive with hemodynamic instability secondary to decompensated cirrhosis and portal hypertension. Non-variceal UGIB (NVUGIB) occurs due to impaired gastroprotective mechanisms attributed to several drugs such as anticoagulants and nonsteroidal anti-inflammatory drugs. Helicobacter pylori infection contributes to the development of peptic ulcer bleeding as well. NVUGIB presentation can be either hemodynamically stable or unstable. During the initial assessment a scoring system including patient-related factors (current cardiac, renal, and liver diseases and hemodynamic and laboratory parameters) is used to determine the patient's prognosis. The Glasgow Blatchford score has been shown to be the most useful and precise. Those with high-risk NVUGIB require urgent assessment and upper endoscopy to achieve better short-term and long-term outcomes such as less hospitalization, blood transfusion, and surgery.

Change in Prevalence and Pattern of Peptic Ulcer Disease in the Northern Savannah of Nigeria: An Endoscopic Study

Background

Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria.

Aim

This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world.

Methods

Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North-West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed.

Results

Over a 9-year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 14-85), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged <40 years were significantly more likely to be diagnosed with DU than GU (54.7% vs. 33.9%, P = 0.016) while those >40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU.

Conclusion

The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed - patients were predominantly male and older, and GU predominated.

Laser therapy versus pulsed electromagnetic field therapy as treatment modalities for early knee osteoarthritis: a randomized controlled trial

BACKGROUND

This randomized controlled trial aimed to compare the effects of pulsed electromagnetic field therapy (PEMFT) and low-level laser therapy (LLLT) on pain and physical function of participants with knee osteoarthritis (KOA).

METHODS

According to the Kellgren-Lawrence classification, participants with grade 2-3 KOA were randomized to receive PEMFT or LLLT for six sessions lasting 15 min/session over a 3-week period. Pain at rest and when walking, standing from a sitting position, and climbing the stairs was assessed using the visual analog scale. Functional level was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up-and-go test (TUG), and 10-m walk (10 MW) test. Measurements were obtained before and after the interventions. Significance was determined at p ≤ 0.05.

RESULTS

Forty participants were included in the study. Pain and physical function improved significantly (p < 0.0001) in both groups. PEMFT was significantly more effective in reducing pain at rest, when standing from a sitting position, and when climbing the stairs, and in improving both WOMAC scores and TUG results (p ≤ 0.0003). The improvements in pain during the activities and the WOMAC scores reached the minimal clinically important difference. No adverse events occurred.

CONCLUSION

Six sessions of PEMFT and LLLT had immediate positive effects on pain and physical function in individuals with low-grade KOA, with PEMFT resulting in significantly better results.

TRIAL REGISTRATION

ISRCTN registry trial ID: ISRCTN17001174.

Analagesic and Anti-Inflammatory Potentials of a Less Ulcerogenic Thiadiazinethione Derivative in Animal Models: Biochemical and Histochemical Correlates

Purpose

Gastric ulcer induced by NSAIDs is the major medical concern and researchers are utilizing several approaches to combat this medical issue. In the current study, we investigated the efficacy of thiadiazinethione derivative (2,2’(2-thioxo-1,3,5-thiadiazinane-3,5-diyl) diacetic acid, as new less ulcerogenic compound.

Methods

2,2’(2-thioxo-1,3,5-thiadiazinane-3,5-diyl) diacetic acid was evaluated using standard animal models including hot plate, writhing test and formalin induced nociceptive models. Anti-inflammatory activity was assessed via carrageenan-induced paw oedema model. Involvement of opioidergic nociceptive mechanism was confirmed via naloxone administration in hot plat assay. The gastro-ulcerogenic potential of test and standard compounds were evaluated via NSAID-induced pyloric ligation model followed by standard histopathological and biochemical analysis.

Results

In acetic acid-induced writhing test, our compound significantly reduced abdominal constrictions at the tested doses of 15 (p < 0.05), 30 (p < 0.01) and 45 mg kg⁻¹ (p < 0.001) as compared to control (p < 0.001). In hot plate test, after 30 min of administration, our test compound showed significant anti-nociceptive potential (p < 0.05 at 15 and 30 mg kg⁻¹ and p < 0.01 at 45 mg kg⁻¹) and tramadol (p ˂ 0.001) at 30 mg kg⁻¹ dose. After 60 min tramadol (30 kg⁻¹) and test sample (30, 45 mg kg⁻¹) exhibited significant anti-nociceptive activity p < 0.001. In Formalin-induced nociceptive response, a significant decline (p ˂ 0.001) was observed for aspirin and test compound during acute and chronic phases. Decline in the anti-nociceptive potential of tramadol and test sample via administration of naloxone indicate the involvement of opioidergic mechanism. Our compound exhibited significant anti-inflammatory activity in second phase of carrageenan induced paw oedema model. Histological and biochemical parameters exhibited less ulcerogenic potential as compared to aspirin.

Conclusion

Our findings suggests that our test compound has desirable anti-nociceptive and anti-inflammatory potentials with less propensity to cause gastric ulcer.