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Omara AA, Othman HI, Aldamaty MF, Metwally MF. Effect of acidic environment on color and translucency of different indirect restorative materials. BMC Oral Health 2024; 24:472. [PMID: 38641578 PMCID: PMC11027526 DOI: 10.1186/s12903-024-04218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024] Open
Abstract
PURPOSE The aim of the current study was to evaluate the effect of simulated gastric acid on the color and translucency of different indirect restorative materials. MATERIALS AND METHODS A total of 36 disc-shaped samples were cut by using an isomet saw and divided into four equal groups (n = 9) according to the material type: Group Z: translucent zirconia (Ceramill® Zolid ht.+ preshade, Amann Girrbach, Koblach, Austria); Group E: lithium disilicate (IPS e.max CAD, Ivoclar Vivadent AG, Schaan, Liechtenstein); Group C: resin nanoceramic (Cerasmart, GC, Tokyo, Japan); Group P: polyether ether ketone (PEEK) (Bettin Zirconia Dentale Italy) veneered with indirect high impact polymer composite (HIPC) (breCAM HIPC, Bredent GmbH & Co. KG, Germany). The samples were immersed in simulated gastric acid (HCl, pH 1.2) for 96 hours at 37 °C in an incubator. The color change (ΔE00) and translucency (RTP00) were measured every 9.6 hours (one-year clinical simulation) of immersion in simulated gastric acid. RESULTS For color change (∆E00) and translucency (RTP00) among the tested materials, there was a highly statistically significant difference (P < 0.001) after every year of follow-up. The color change in both Z and G groups was the lowest after 1 year of acid immersion, followed by that in group H, and the highest change in color was recorded in group P. CONCLUSION High translucent zirconia is recommended in patients who are concerned about esthetic, especially with acidic oral environment.
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Affiliation(s)
- Abdelaziz A Omara
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, Misr University for Science and Technology, Cairo, Egypt
| | - Hesham I Othman
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, Al-Azhar University, Cairo, 11651, Egypt
| | - Mohamed F Aldamaty
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, Al-Azhar University, Cairo, 11651, Egypt.
| | - Mohamed F Metwally
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, Al-Azhar University, Cairo, 11651, Egypt
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Li S, Dixit Y, Reis MM, Singh H, Ye A. Movements of moisture and acid in gastric milk clots during gastric digestion: Spatiotemporal mapping using hyperspectral imaging. Food Chem 2024; 431:137094. [PMID: 37586231 DOI: 10.1016/j.foodchem.2023.137094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
Ruminant milk is known to coagulate into structured clots during gastric digestion. This study investigated the movements of moisture and acid in skim milk clots formed during dynamic gastric digestion and the effects of milk type (regular or calcium-rich) and the presence/absence of pepsin. We conducted hyperspectral imaging analysis and successfully modelled the moisture contents based on the spectral information using partial least squares regression. We generated prediction maps of the spatiotemporal distribution of moisture within the samples at different stages of gastric digestion. Simultaneously to acid uptake, the moisture in the milk clots tended to decrease over the digestion time; this was significantly promoted by pepsin. Moisture mapping by hyperspectral imaging demonstrated that the high and low moisture zones were centralized within the clot and at the surface respectively. A structural compaction process promoted by pepsinolysis and acidification probably contributed to the water expulsion from the clots during digestion.
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Affiliation(s)
- Siqi Li
- Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand
| | - Yash Dixit
- AgResearch Ltd, Te Ohu Rangahau Kai, Private Bag 11 008, Palmerston North, New Zealand
| | - Marlon M Reis
- AgResearch Ltd, Te Ohu Rangahau Kai, Private Bag 11 008, Palmerston North, New Zealand.
| | - Harjinder Singh
- Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand
| | - Aiqian Ye
- Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand.
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Abaklı İnci M, Özer H, Özaşık HN, Koç M. The effects of gastric acid on pediatric restorative materials: SEM analysis. J Clin Pediatr Dent 2023; 47:145-151. [PMID: 37732448 DOI: 10.22514/jocpd.2023.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/19/2023] [Indexed: 09/22/2023] Open
Abstract
In this study, we aimed to demonstrate changes in the surface roughness and microhardness of three different restorative materials routinely used in pediatric dentistry (composite, compomer and resin-modified glass ionomer cement (RMCIS)) in response to continuous daily exposure to gastric acid. Twelve samples of each of type of restorative material were prepared. Eleven of the specimens were included in the gastric acid cycle. The microhardness and surface roughness of ten samples were measured before and after the cycle. Another sample included in the cycle was compared with the sample not included in the cycle by scanning electron microscopy (SEM). There was a significant difference between the groups in terms of roughness scores following gastric acid cycle (p = 0.039). RMCIS material possessed the highest roughness value. A significant difference was identified in terms of microhardness levels before and after the gastric acid cycle (p = 0.001). The most significant change was observed in the compomer material. SEM analysis, performed after the gastric acid cycle, revealed that most cracks were identified in RMCIS material; this was followed by compomer and composite materials, respectively. Our analysis indicates that the restorative materials used frequently in pediatric dental procedures, show increased surface roughness and reduced microhardness when exposed to gastric acid.
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Affiliation(s)
- Merve Abaklı İnci
- Department of Pediatric Dentistry, Necmettin Erbakan University Faculty of Dentistry, 42090 Konya, Turkey
| | - Hazal Özer
- Department of Pediatric Dentistry, Necmettin Erbakan University Faculty of Dentistry, 42090 Konya, Turkey
| | - Hemra Nur Özaşık
- Department of Pediatric Dentistry, Necmettin Erbakan University Faculty of Dentistry, 42090 Konya, Turkey
| | - Merve Koç
- Department of Pediatric Dentistry, Necmettin Erbakan University Faculty of Dentistry, 42090 Konya, Turkey
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Helle K, Árok AZ, Ollé G, Antal M, Rosztóczy A. Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease. World J Gastroenterol 2023; 29:4774-4782. [PMID: 37664156 PMCID: PMC10473917 DOI: 10.3748/wjg.v29.i31.4774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Heartburn is identically the key symptom of both, gastroesophageal reflux disease (GERD) and functional heartburn (FHB), making the differential diagnosis resource-intensive. Oral manifestations of GERD can be easily examined; therefore, their exploration might be a cheap, widely available, and useful tool in the differentiation of GERD and FHB. AIM To evaluate the prevalence of dental erosions (DE) and periodontal diseases (PD) in patients with heartburn and their association with GERD and FHB. METHODS A total of 116 [M/F: 51/65, mean age: 54 (17-80) years] consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations. RESULTS Dental disorders were detected in 89% (103/116). Patients with PD + DE had significantly more often pathologic reflux (90.0% vs 27.8%; P < 0.05), higher esophagitis scores (1.8 vs 0.9; P < 0.05), and a significantly different mean impedance curve (P = 0.04) than those without any dental diseases. The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD, especially if both were present (28.9% vs 2.0%; P < 0.01), more severe PD (1.5 vs 1.0; P < 0.01), and longer history of heartburn (15 years vs 9 years; P < 0.01) than those with FHB. CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB. Among the studied parameters, the co-appearance of DE and PD seems to be the best predictor of GERD, whereas the absence of dental disorders was mostly observed in FHB.
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Affiliation(s)
- Krisztina Helle
- Department of Internal Medicine, Division of Gastroenterology, University of Szeged, Szeged 6725, Hungary
| | - Anna Zsófia Árok
- Department of Operative and Esthetic Dentistry, University of Szeged, Szeged 6725, Hungary
| | - Georgina Ollé
- Department of Internal Medicine, Division of Gastroenterology, University of Szeged, Szeged 6725, Hungary
| | - Márk Antal
- Department of Operative and Esthetic Dentistry, University of Szeged, Szeged 6725, Hungary
| | - András Rosztóczy
- Department of Internal Medicine, Division of Gastroenterology, University of Szeged, Szeged 6725, Hungary
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Sekizuka H, Miyake H. Relationship between nonrestorative sleep and heartburn among a Japanese occupational population. Indian J Gastroenterol 2023; 42:542-548. [PMID: 37355485 DOI: 10.1007/s12664-023-01366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Nonrestorative sleep (NRS) is a symptom of insomnia and is clearly more associated with objective indices than other insomnia symptoms. Gastroesophageal reflux disease (GERD) and insomnia are known to be strongly related. However, the link between NRS and heartburn, a main symptom of GERD, is poorly understood. Therefore, the relationships between them were investigated in addition to sleep duration. METHODS The results of a single year's medical examinations were investigated for 29,475 Japanese active office workers who were 20 to 59 years old. NRS and heartburn were investigated in a medical interview using a personal computer. The relationships between NRS and heartburn in addition to sleep duration were also analyzed. RESULTS The subjects were 46.6 ± 8.7 years old (mean ± SD) and 27% and 13% of them had NRS and heartburn, respectively. The presence of NRS together with a sleep duration of ≤ 5, 6, 7 or ≥ 8 hours was an independent comorbid factor for heartburn compared with the absence of NRS together with a sleep duration of seven hours (reference; odds ratio [OR], 2.38; 95% confidence interval [CI], 2.11-2.69, OR, 2.44; 95% CI, 2.16-2.76, OR, 2.33; 95% CI, 1.94-2.79; and OR, 1.72; 95% CI, 1.14-2.52). The absence of NRS together with a sleep duration of ≤ 5 hours was also an independent comorbid factor for heartburn compared with the reference (OR, 1.20; 95% CI, 1.05-1.37). CONCLUSIONS NRS in active workers may contribute to heartburn comorbidity despite the sleep duration as in other workers without NRS.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, Fujitsu Clinic, Kawasaki City, 4-1-1 Kamikodanaka, Nakahara-Ku, Kanagawa Prefecture, 211-8588, Japan.
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan.
| | - Hitoshi Miyake
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan
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Liang M, Hu Q, Yi S, Chi Y, Xiao Y. Development of an Au nanoclusters based activatable nanoprobe for NIR-II fluorescence imaging of gastric acid. Biosens Bioelectron 2023; 224:115062. [PMID: 36646014 DOI: 10.1016/j.bios.2023.115062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/08/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Gastric acid is an important functional substance secreted by the stomach of the living organisms, reflecting the gastric physiological condition. The sensing of gastric acid in vivo is of great significance for evaluation of gastric function, diagnosis and treatment of gastric diseases and maintenance of organism health but remains challenging due to the harsh acid and digestive environment of stomach. This study developed an activatable nanoprobe based on Au nanoclusters (Au NCs) for sensitive and real-time noninvasive near-infrared II (NIR-II) fluorescence imaging detection of gastric acid in vivo for the first time. The Au NCs were encapsulated by polydopamine to have enhanced NIR-II luminescence and high stability and combined with methylene blue to possess the pH responsiveness for gastric acid imaging. The developed nanoprobe could not only monitor gastric acid secretion in vivo but also imaging the changes of gastric acid caused by feeding, acid-inhibition drugs and gastric ulcer disease. This study provides a promising avenue for the improvement of the application performance of Au NCs and imaging analysis of gastric acid and related gastric diseases.
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Affiliation(s)
- Miao Liang
- Hubei Collaborative Innovation Center for Advanced Organic Chemical Materials, Ministry-of-Education Key Laboratory for the Synthesis and Application of Organic Functional Molecules & College of Chemistry and Chemical Engineering, Hubei University, Wuhan, Hubei, 430062, PR China
| | - Qing Hu
- Hubei Collaborative Innovation Center for Advanced Organic Chemical Materials, Ministry-of-Education Key Laboratory for the Synthesis and Application of Organic Functional Molecules & College of Chemistry and Chemical Engineering, Hubei University, Wuhan, Hubei, 430062, PR China
| | - Shuxiao Yi
- Hubei Collaborative Innovation Center for Advanced Organic Chemical Materials, Ministry-of-Education Key Laboratory for the Synthesis and Application of Organic Functional Molecules & College of Chemistry and Chemical Engineering, Hubei University, Wuhan, Hubei, 430062, PR China
| | - Yajie Chi
- Hubei Collaborative Innovation Center for Advanced Organic Chemical Materials, Ministry-of-Education Key Laboratory for the Synthesis and Application of Organic Functional Molecules & College of Chemistry and Chemical Engineering, Hubei University, Wuhan, Hubei, 430062, PR China
| | - Yan Xiao
- Hubei Collaborative Innovation Center for Advanced Organic Chemical Materials, Ministry-of-Education Key Laboratory for the Synthesis and Application of Organic Functional Molecules & College of Chemistry and Chemical Engineering, Hubei University, Wuhan, Hubei, 430062, PR China.
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Choi YJ. [Treatment of Acid-related Diseases Using Potassium-competitive Acid Blockers]. Korean J Gastroenterol 2022; 80:247-253. [PMID: 36567437 DOI: 10.4166/kjg.2022.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
Proton pump inhibitors (PPIs) have several limitations to their efficacy including insufficient acid suppression, slow onset of action, and variable efficacy among patients due to CYP2C19 metabolism. Potassium-competitive acid blockers inhibit H+-K+-ATPase in a reversible and K+-competitive manner, are novel acid suppressive drugs with rapid onset of action, meal independence, and prolonged control of intragastric acidity compared to PPIs. Potassium-competitive acid blockers exhibited non-inferior therapeutic efficacies on reflux esophagitis, gastric ulcers, and Helicobacter pylori eradication. The review is focused on the unmet needs across the acid-related diseases and recent updates on clinical studies using vonoprazan and tegoprazan.
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Affiliation(s)
- Yoon Jin Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Brusselaers N, Pereira M, Alm J, Engstrand L, Engstrand Lilja H. Effect of proton pump inhibitors in infants with esophageal atresia on the gut microbiome: a pilot cohort. Gut Pathog 2022; 14:47. [PMID: 36527125 PMCID: PMC9758939 DOI: 10.1186/s13099-022-00518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The effects of proton-pump inhibitors (PPIs) on the infant microbiome remain unclear. Swedish pilot cohort study to assess the longitudinal effect of long-term PPI on the infant gut microbiome, including ten newborn infants operated for esophageal atresia exposed to PPIs (mean 57 weeks), compared to healthy one-year-old controls. All children were born vaginally and were otherwise healthy. Within- and between sample diversity of the fecal microbiome was assessed using untargeted whole genome Shotgun metagenomics which sequences all the DNA in the sample and can capture genes rather than a taxonomic fingerprint. RESULTS A longer duration of PPI-use was associated with considerable changes in evenness and high variation on diversity within samples compared to a shorter duration of use. The limited difference between baseline samples and controls suggests that this shift was most likely due to the drug exposure and not the underlying alterations on the microbiome. We found no associations with the number of antibiotic treatment episodes among the PPI-users. CONCLUSION Prolonged PPI-use may alter the early infant gut microbiome composition, especially those with the most prolonged duration of use.
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Affiliation(s)
- Nele Brusselaers
- grid.4714.60000 0004 1937 0626Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, 17165 Stockholm, Sweden ,grid.5284.b0000 0001 0790 3681Global Health Institute, University of Antwerp, B-2610 Antwerp, Belgium ,grid.5342.00000 0001 2069 7798Department of Head and Skin, Ghent University, B-9000 Ghent, Belgium
| | - Marcela Pereira
- grid.4714.60000 0004 1937 0626Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, 17165 Stockholm, Sweden
| | - Johan Alm
- grid.4714.60000 0004 1937 0626Department of Clinical Science, Karolinska Institutet, 17165 Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Lars Engstrand
- grid.4714.60000 0004 1937 0626Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, 17165 Stockholm, Sweden
| | - Helene Engstrand Lilja
- grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, 17165 Stockholm, Sweden
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Ghoshal UC, Blaachandran A, Rai S, Misra A. Nocturnal acid breakthrough and esophageal acidification during treatment with dexlansoprazole as compared to omeprazole in patients with gastroesophageal reflux disease. Indian J Gastroenterol 2022; 41:405-414. [PMID: 35771390 DOI: 10.1007/s12664-022-01270-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nocturnal acid breakthrough (NAB) may differ based on duration of proton pump inhibitor (PPI) action and Helicobacter pylori (H. pylori) infection; NAB may influence esophageal acidification (EA) and mucosal damage. Dexlansoprazole, a long-acting PPI, was not compared with omeprazole for NAB, gastric acid suppression, and EA in relation to H. pylori infection. METHODS In this prospective open-label comparative observational study, gastroesophageal reflux disease (GERD) patients were evaluated using 24-h dual-channel pH-impedance monitoring while on dexlansoprazole (60 mg, n = 39) and omeprazole (20 mg, n = 41) to study the degree of gastric acid suppression, esophageal acid exposure, and NAB (primary outcome measures). H. pylori was detected by rapid urease test and histology. RESULTS NAB tended to be frequent with omeprazole than dexlansoprazole (33/41 [80.5%] vs. 23/39 [59%]; p = 0.06). Though nocturnal mean esophageal pH was comparable between the dexlansoprazole and omeprazole groups, its duration was less with the former (181.5 [15.2-334.2] vs. 283 [158-366] min, p = 0.03). NAB was as frequent in the H. pylori-infected than the non-infected group (11/19 [57.9%] vs. 45/61 [73.8%]; p = 0.1). The nocturnal gastric and esophageal pH in the H. pylori-infected group was higher than in the non-infected group (4.6 ± 1.7 vs. 4 ± 1.6, p = 0.157; 6.1 ± 0.6 vs. 5.8 ± 0.6, p = 0.128). Dexlansoprazole tended to increase 24-h and nocturnal mean gastric pH among H. pylori-infected more than omeprazole (5.9 ± 1.1 vs. 4.2 ± 1.7, p = 0.023; 5.7 ± 1.2 vs. 3.8 ± 1.5, p = 0.006). CONCLUSION Dexlansoprazole is more effective than omeprazole in suppressing gastric acid secretion, resulting in lesser EA and NAB, particularly in the presence of H. pylori.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Arjun Blaachandran
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sushmita Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
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Willers AE, Branco TB, Sahadi BO, Faraoni JJ, Dibb RGP, Giannini M. Effect of erosive challenge with HCl on restorative materials. Clin Oral Investig 2022; 26:5189-5203. [PMID: 35441897 DOI: 10.1007/s00784-022-04487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Investigate the effect of erosive challenge with hydrochloric acid (HCl) on the surface of five different restorative materials. MATERIAL AND METHODS Ten plates of five restorative materials (Admira Fusion, Activa BioActive-Restorative, Charisma, Equia Forte HT Fil/EF, Filtek Universal Restorative/FU) were obtained. Half of the plate surfaces was covered with an adhesive tape, creating a control area, and the other side was submitted to the HCl (0.06 M HCl; pH 1.2; at 37 °C; for 30 h). Plates with control and HCl-treated areas were analyzed regarding the surface roughness (Sa), roughness profile (Rv), surface loss (SL), microhardness (MI), and gloss (GL) (n = 10). Surface morphology was analyzed by SEM and chemical elements were identified by EDX (n = 5). Data were evaluated by ANOVA and Tukey's test (α = 0.05). RESULTS Most materials were not affected by HCl. FU showed the lowest Sa and Rv, and the highest GL after HCl. On the other hand, EF presented the highest Sa, Rv, and SL, and the lowest GL. The MI of materials was not changed after HCl. Topographical and chemical alterations were observed after HCl only for EF. CONCLUSIONS The composites showed minor surface changes after HCl, which was not observed for the glass ionomer cement (EF). FU presented the best performance regarding the parameters evaluated. CLINICAL RELEVANCE The effects of erosive challenge with HCl on composites were minimal, while the glass ionomer cements might not be indicated as restorative material for patients with gastroesophageal reflux disease.
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Affiliation(s)
- Amanda Endres Willers
- Operative Dentistry Division, Department of Restorative Dentistry, State University of Campinas, Piracicaba Dental School, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil.
| | - Thaís Bulzoni Branco
- Operative Dentistry Division, Department of Restorative Dentistry, State University of Campinas, Piracicaba Dental School, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
| | - Beatriz Ometto Sahadi
- Operative Dentistry Division, Department of Restorative Dentistry, State University of Campinas, Piracicaba Dental School, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
| | | | | | - Marcelo Giannini
- Operative Dentistry Division, Department of Restorative Dentistry, State University of Campinas, Piracicaba Dental School, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
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Kermanshah H, Ahmadi E, Rafeie N, Rafizadeh S, Ranjbar Omrani L. Vickers micro-hardness study of the effect of fluoride mouthwash on two types of CAD/CAM ceramic materials erosion. BMC Oral Health 2022; 22:101. [PMID: 35354455 PMCID: PMC8969233 DOI: 10.1186/s12903-022-02135-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the protective effects of fluoride mouthwash on the surface micro-hardness of two types of CAD/CAM ceramics after exposure to acidic solutions. Methods 40 samples (5 × 5 × 3 mm3) were prepared from two different ceramics: Vitabloc Mark II CAD, and IPS e.max CAD. The samples were randomly divided into 5 groups in each ceramic (n = 8) immersed in different solutions: Gs: saliva: GGA: gastric acid, GAA: acetic acid, GFGA: sodium fluoride + gastric acid, GFAA: sodium fluoride + acetic acid. The microhardness of samples was measured before and after immersion in different solutions by Vickers microhardness tester. By subtracting the microhardness values after and before immersion, the microhardness changes of the samples were obtained. Data were analyzed by Two-way analysis of variance, one-way analysis of variance, and Tukey test (α = 0.05). Results Immersion in different solutions reduced the microhardness. Microhardness loss was significantly affected in G FAA and G FGA groups in both types of ceramics (P < 0.05). For Vitabloc Mark II groups, the microhardness loss was significantly higher in GFAA and GFGA compared to IPS e.max CAD P < 0.001). Conclusion Fluoride mouthwash in conjunction with acidic solutions may adversely affect microhardness of Vitabloc Mark II CAD, and IPS e.max CAD that may consequently compromise the clinical service. Vitabloc Mark II CAD was significantly more affected than IPS e.max CAD. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02135-z.
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Affiliation(s)
- Hamid Kermanshah
- Restorative Dentistry Department, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ahmadi
- Restorative Dentistry Department, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Niyousha Rafeie
- Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Rafizadeh
- School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ladan Ranjbar Omrani
- Restorative Dentistry Department, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. .,Restorative Dentistry Department, School of Dentistry, Tehran University of Medical Sciences, North Kargar, Tehran, 14174, Iran.
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Kim HJ, Kim N, Park JH, Choi S, Shin CM, Lee OJ. Helicobacter pylori Eradication Induced Constant Decrease in Interleukin- 1B Expression over More Than 5 Years in Patients with Gastric Cancer and Dysplasia. Gut Liver 2021; 14:735-745. [PMID: 32703913 PMCID: PMC7667922 DOI: 10.5009/gnl19312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Helicobacter pylori (Hp) suppresses gastric acid secretion by repressing the expression of the H+, K+-adenosine triphosphatase (H+, K+-ATPase) and stimulating interleukin-1 (IL-1β; encoded by IL-1B). This study was aimed at evaluating the expression of the H+, K+-ATPase and IL-1β after Hp eradication. Methods Two hundred twenty-one subjects were categorized as Hp-negative (n=84) or Hp-positive (n=137) according to the results of Hp tests (histology, CLO test, culturing, and serology). The mRNA expression levels of IL-1B and ATP4A (the gene encoding the α-subunit of H+, K+-ATPase) were measured in biopsy specimens from the gastric corpus using real-time polymerase chain reaction. Results The Hp-positive group had significantly higher IL-1B mRNA levels than the whole Hp-negative group and the intestinal metaplasia (IM)-negative subgroup. After Hp eradication, the difference between the Hp-negative and Hp-eradicated groups disappeared, including in the IM-negative subgroup. The IL-1B mRNA level did not significantly change from the baseline level. Within the gastric cancer (GC)/dysplasia subgroup, the IL-1B mRNA levels at 1, 2, 3–4, and ≥5 years after Hp eradication were significantly lower than the baseline level. The difference in ATP4A mRNA levels between the Hp-negative and Hp-positive groups was not significant at baseline, and the changes in the ATP4A mRNA levels after Hp eradication compared to the baseline levels in the whole group and subgroups stratified by the presence of IM and GC/dysplasia were not significant. Conclusions Infection with Hp has an effect on the level of IL-1B mRNA in IM-negative subjects. The continuous reduction in the IL-1B mRNA level in patients with GC/dysplasia after Hp eradication contributes to the prevention of metachronous GC after Hp eradication.
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Affiliation(s)
- Hee Jin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Korea
| | - Ji Hyun Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Korea
| | - Sunkyu Choi
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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13
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Sumi S, Ishimura N, Mikami H, Okimoto E, Tamagawa Y, Mishiro T, Kinoshita Y, Ishihara S. Evaluations of Gastric Acid Pocket Using Novel Vertical 8-Channel pH Monitoring System and Effects of Acid Secretion Inhibitors. J Neurogastroenterol Motil 2021; 27:370-376. [PMID: 34210902 PMCID: PMC8266495 DOI: 10.5056/jnm20115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The gastric acid pocket has an important role in gastroesophageal reflux disease development. In this study, we utilized a novel 8-channel pH monitoring system with sensor intervals of 1 cm on the vertical axis for evaluation of postprandial gastric acid pocket in healthy Japanese adults, as well as the effects of vonoprazan and rabeprazole. Methods Twelve healthy volunteers without Helicobacter pylori infection were enrolled. A catheter was inserted transnasally and positioned under X-ray guidance, then postprandial acid pocket formation was monitored over time in a sitting position. Thereafter, acid pocket changes were assessed following administration of vonoprazan (20 mg) or rabeprazole (20 mg). Results The gastric acid pocket was successfully measured by use of the present system in 10 cases, while failure occurred in 2 because of inappropriate catheter positioning. Observed acid pockets were visualized with a mean length of 2.2 ± 0.4 channels on the top layer of food contents approximately 20 minutes after finishing a meal. There were some variations for lasting time of the acid pocket. Complete elimination within 3 hours after administration of vonoprazan was noted in all cases. Likewise, following administration of rabeprazole, the acid pocket was eliminated in 7 cases, while acidity was reduced though the pocket remained observable in 3. Conclusions Gastric acid pocket observations were possible using our novel vertical 8-channel sensor catheter. The present findings showed that vonoprazan strongly suppressed acid secretion within a short period, suggesting its effectiveness for gastroesophageal reflux disease treatment.
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Affiliation(s)
- Shohei Sumi
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hironobu Mikami
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yuji Tamagawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan.,Department of Medicine, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
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14
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Kuzumoto T, Tanaka F, Sawada A, Nadatani Y, Otani K, Hosomi S, Kamata N, Taira K, Nagami Y, Tanigawa T, Watanabe T, Fujiwara Y. Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histological responses in patients with eosinophilic esophagitis. Esophagus 2021; 18:372-379. [PMID: 32960382 DOI: 10.1007/s10388-020-00783-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic allergic disease with esophageal symptoms and intraepithelial eosinophil infiltration. Effects of potassium-competitive acid blockers (P-CABs) on EoE have not been elucidated. We aimed to examine and compare the effects of P-CABs and PPIs on symptomatic, endoscopic, and histological responses of patients with EoE. METHODS We analyzed 118 EoE patients who received PPI or P-CAB therapy with rabeprazole 10 mg (RPZ10, N = 22), rabeprazole 20 mg (RPZ20, N = 34), esomeprazole 20 mg (EPZ20, N = 25), or vonoprazan 20 mg (VPZ20, N = 33). We evaluated symptomatic responses by classifying the patients into three groups: complete relief, partial relief, and no change. Endoscopic responses were evaluated using the endoscopic reference score (EREFS) following PPI or P-CAB therapy. Histological responses were evaluated by determining eosinophil counts in esophageal biopsy samples and classifying the patients into two groups: complete remission [0/1 eosinophil/high-power field (eos/HPF)] and remission (< 15 eos/HPF). RESULTS There were no differences among the therapy groups in terms of clinical characteristics, endoscopic findings, and histological findings of the patients before treatment. The rate of complete relief in clinical symptoms was 54.5% in the RPZ10 group, 64.7% in the RPZ20 group, 72.0% in the EPZ20 group, and 75.7% in the VPZ20 group. There were no significant differences in the therapeutic effect among the therapy groups. Similarly, endoscopic and histological complete remission rates were not significantly different among the therapy groups. CONCLUSIONS Vonoprazan showed similar efficacy to PPIs in EoE.
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Affiliation(s)
- Takuya Kuzumoto
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Akinari Sawada
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koji Otani
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koichi Taira
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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15
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Nabeta H, Shinozaki S, Abe Y, Koyanagi R, Nakamichi T, Kobayashi Y, Lefor AK, Hirashima H. A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication. Digestion 2021; 101:332-338. [PMID: 30991394 DOI: 10.1159/000499857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/25/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Although a potassium-competitive acid blocker (PCAB)-based regimen improves the rate of successful Helicobacter pylori first-line eradication, the efficacy of a PCAB-based regimen as second-line therapy is unclear. The aim of this study is to compare the success of second-line eradication of H. pylori using PCAB and proton pump inhibitor (PPI)-based regimens. METHODS From 2014 to 2017, 624 patients who underwent second-line H. pylori eradication were enrolled. A standard triple regimen for second-line H. pylori eradication includes metronidazole 250 mg, amoxicillin 750 mg, and PPI or PCAB twice daily for 7 days. The success of eradication was compared using intention-to-treat, per-protocol, and propensity-score matching analysis. RESULTS All patients completed the 7-day course of therapy. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen in both intention-to-treat (90% [298/330] vs. 85% [250/294], p = 0.045) and per-protocol analyses (96% [298/309] vs. 91% [250/274], p = 0.008). Adverse events occurred in 4 patients. Propensity score matching analysis acquired 274 matched pairs. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen (96% [264/274] vs. 91% [250/274], p = 0.013). CONCLUSIONS PCAB-based second-line H. pylori eradication is significantly better than PPI-based therapy.
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Affiliation(s)
- Haruaki Nabeta
- Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
| | - Satoshi Shinozaki
- Shinozaki Medical Clinic, Utsunomiya, Japan, .,Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan,
| | - Yasuhiro Abe
- Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
| | - Ryota Koyanagi
- Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
| | - Taro Nakamichi
- Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
| | - Yasutoshi Kobayashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Hayato Hirashima
- Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
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16
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Cui Y, Cui Y. [Intraoperative Aspiration]. Zhongguo Fei Ai Za Zhi 2021; 23:393-401. [PMID: 32429641 PMCID: PMC7260386 DOI: 10.3779/j.issn.1009-3419.2020.101.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
术中误吸是外科手术中常见的肺部并发症,麻醉和体位是导致术中误吸的主要因素。近年来,围手术期肺保护已受到外科和麻醉医师的广泛关注,如何加速术后康复进程,减少相关并发症发生,显著改善患者预后已成为当前外科治疗的主要目标。本文将以术中误吸为重点,从解剖、病理生理、表现、诊断、处理和预防等方面展开综述。
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Affiliation(s)
- Yiyao Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
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17
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Kim BC, Song MA, Kwon SH. Endoscopic Characteristics of Rugal Hyperplasia and Related Acid Condition in Helicobacter pylori-Infected Stomach. Clin Endosc 2020; 54:73-84. [PMID: 33317224 PMCID: PMC7939774 DOI: 10.5946/ce.2020.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Rugal hyperplastic gastritis (RHG) is associated with Lauren’s diffuse-type gastric cancer (GC) and the accompanying active inflammation is linked to gastric hypoacidity. We tried to establish the steps for identifying high-risk GC patients.
Methods We included 196 patients with confirmed Helicobacter pylori infection by rapid urease test during screening endoscopy for health check-up from January 2016 to September 2016; all patients underwent blood tests for pepsinogen I and II and fasting serum gastrin. We compared RHG findings with various other endoscopic mucosal images. We also evaluated the relationships between RHG and other mucosal aspects for a given acid status based on serological markers.
Results Hypoacid and ultra-low-acid (67%) statuses were dominant, with only 18% hyperacid patients. RHG with high acid was related to a less atrophic body type (p=0.001), and RHG with ultra-low acid was associated with body xanthoma (p=0.029) and increased serum gastrin level (p=0.038). However, RHG’s influence on gastric acidity was only seen in closed-type endoscopic atrophic border (EAB), not in open type (p=0.001).
Conclusions The majority of RHG patients had hypoacid status. RHG frequency showed no difference between closed and opentype EAB, but gastric acidity was influenced by RHG only in closed-type EAB.
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Affiliation(s)
- Byung Chul Kim
- Department of Internal Medicine, Hangsarang Hospital, Ulsan, Korea
| | - Mi Ae Song
- Department of Internal Medicine, Hangsarang Hospital, Ulsan, Korea
| | - Sung Ho Kwon
- Department of Internal Medicine, Kangnam Medical Clinic, Ulsan, Korea
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18
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Abstract
Proton pump inhibitors strongly inhibit gastric acid production, but digestion problems do not generally arise. We can intake almost ordinary food even after total gastrectomy. Small intestine itself can digest and absorb food using various digestive enzymes without digestion in the stomach. The pH level of gastric acid in humans is much lower than that of most animals, and very close to that of carrion-eating animals called scavengers. It is assumed that ancient humans became bipedal approximately 4 million years ago. It was difficult for humans, who just started unstable bipedal locomotion, to catch quadrupedal-walking animals that can move faster, without special hunting tools. They may have eaten remaining carcasses, which is mainly the leftovers of carnivora species, as animal-derived food. The benefit to produce a volume of gastric acid for humans is carrion eating, in which disinfection by gastric acid is important. Humans produce a high concentration of gastric acid to enable consumption of a diet containing some bacteria and support this lifestyle by consuming significant energy to protect themselves from gastric acid. Now, the opportunity for strong deleterious bacteria to enter the gastrointestinal tract has decreased because of the organized clean environment. If this hygienic environment is maintained for a long time, our gastric acid level must be decreased gradually.
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Affiliation(s)
- Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Inzai 270-1694, Chiba, Japan
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19
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Elsaka S, Hassan A, Elnaghy A. Effect of gastric acids on surface topography and bending properties of esthetic coated nickel-titanium orthodontic archwires. Clin Oral Investig 2020; 25:1319-1326. [PMID: 32617780 DOI: 10.1007/s00784-020-03438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of simulated gastric acid solution on surface topography and bending properties of esthetic coated nickel-titanium (NiTi) archwires. MATERIALS AND METHODS Three brands of as-received white-coated superelastic NiTi upper archwires were used in this study: Dany, Perfect, and Nitanium. Uncoated metallic areas for each white-coated NiTi archwire were used for comparison with the coated areas. The specimens for each archwire were divided into two groups according to coating as follows: Group A, uncoated, and group B, coated. Then, each group was further subdivided into two subgroups according to the immersion medium as follows: Subgroup 1, immersed in artificial saliva, and subgroup 2, immersed in simulated gastric acid. Surface roughness, surface morphology, and three-point bending test were performed. The data were analyzed statistically using ANOVA and Tukey test. RESULTS The archwires immersed in simulated gastric acid solution showed significantly higher surface roughness and lower forces on loading and unloading than the archwires immersed in artificial saliva (P < 0.001). Perfect archwire showed significantly the highest surface roughness compared with Dany and Nitanium archwires (P < 0.001). The uncoated archwires showed higher loading and unloading forces compared with coated archwires for all groups (P < 0.001). Nitanium archwire showed the lowest loading and unloading forces at different deflections (P < 0.001). CONCLUSIONS The simulated gastric acid solution decreased considerably the amount of force applied at a given deflection. The loading-deflection and surface roughness properties of coated archwires were affected by the type of coating material. CLINICAL RELEVANCE The impact of gastric acids on surface and mechanical properties of orthodontic archwires depend on type of coating materials.
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Affiliation(s)
- Shaymaa Elsaka
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt. .,Department of Restorative Science, Alfarabi Private College of Dentistry and Nursing, Jeddah, Saudi Arabia.
| | - Ali Hassan
- Department of Restorative Science, Alfarabi Private College of Dentistry and Nursing, Jeddah, Saudi Arabia.,Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr Elnaghy
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Abstract
Several risk factors have a significant impact on the development of nonventilator health care-associated pneumonia (NV-HAP). This section discusses both the modifiable and nonmodifiable risk factors contributing to the incidence of NV-HAP. Lack of mobility, malnutrition, high blood glucose, inhibition of gastric acid and central nervous system depressants underscored in this section. Efforts to treat, modify, or alter these risk factors as opportunities to decrease the incidence of NV-HAP. In addition, we to address and assess nonmodifiable risk factors.
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21
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Shioi I, Yokoyama N, Hirai M, Komatsu M, Kubota A, Aoki M, Sato D, Otani T. Perforation of anastomotic peptic ulcer following pancreaticoduodenectomy: a report of three cases. BMC Surg 2020; 20:79. [PMID: 32306934 PMCID: PMC7168954 DOI: 10.1186/s12893-020-00743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In this article, we present three cases of marginal peptic ulcer perforation after PD that we experienced in our institute and attempt to clarify its appropriate treatment and prevention. CASE PRESENTATION Marginal ulcer perforation confirmed with computed tomography and/or surgical exploration occurred in 3 (1.8%) of 163 consecutive patients who underwent PD (including 160 patients who underwent a total or subtotal stomach-preserving procedure) at our institution. The three patients (one man and two women) had a median age of 77 (65-79) years. Two of these patients had a medical history of duodenal peptic ulcer. All three patients had biliary neoplasms. Two of the patients underwent subtotal stomach-preserving PD with antro-jejunal anastomosis, and the other patient underwent pylorus-preserving PD with duodenal jejunostomy. The perforation occurred with a sudden and severe onset of abdominal pain 34, 94, and 1204 days, respectively, after the PDs. At the time of the perforation, all of the patients had been withdrawn from postoperative prophylactic antipeptic ulcer agents, with the cessation periods ranging from 12 to 1008 days. In addition, all the patients were in fasting conditions for 1 to 13 days just before the perforation. Surgical treatment with direct suturing of the perforated ulcer was performed for two patients, while conservative therapy was performed for one patient. Their primary treatment courses were satisfactory. Chronic antisecretory agent therapy was prescribed for 562, 271, and 2370 days, respectively, from marginal ulcer perforation, and no ulcer recurrence was noted in any of the patients. CONCLUSIONS Lack of antisecretory therapy and fasting were considered an essential cause of marginal peptic ulcer perforation after PD. In addition, unlike the native duodenum, the jejunal limb used for reconstruction to a preserved stomach may be at increased risk of ulceration. Chronic permanent administration of antisecretory agents and fasting avoidance are desirable for patients who have undergone stomach-preserving PD to prevent marginal ulcer perforation.
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Affiliation(s)
- Ikuma Shioi
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan.
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Motoharu Hirai
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Masaru Komatsu
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Akira Kubota
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Makoto Aoki
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
| | - Tetsuya Otani
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan
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22
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Abstract
BACKGROUND The long-term safety of proton pump inhibitors (PPIs) is increasingly questioned. The aim of our study was to assess the risk of pancreatic cancer among long-term PPI users in Sweden. METHODS This population-based nationwide Swedish cohort study including 796,492 adult long-term PPI users has been used to calculate the standardized incidence rate ratios (SIRs) and 95% confidence intervals (CI) for pancreatic cancer, stratifying by indications of use, age, sex, and duration of use. The risk among all 20,210 long-term H2-receptor antagonist users was assessed as comparison. RESULTS Pancreatic cancer was found in 1733 long-term PPI users, and 25 H2-receptor antagonist users. For PPI users, the risk of pancreatic cancer was increased overall (SIRs = 2.22; 95% CI 2.12-2.32) and in all subgroup analyses, with the highest risk among PPI-users younger than 40 years (SIR = 8.90, 95% CI 4.26-16.37), and among individuals with a history of Helicobacter pylori (SIR = 2.99, 95% CI 2.54-3.49). After the first year after enrolment (during which PPI use may be because of early symptoms of pancreatic cancer), the risk remained increased over time, with SIR = 1.57 (95% CI 1.38-1.76) after 5 years. No associations were found for H2-receptor antagonists (SIR = 1.02, 95% CI 0.66-1.51). CONCLUSIONS This large study showed an increased risk of pancreatic cancer in long-term users of PPIs in Sweden, in particular among the youngest users.
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Affiliation(s)
- Nele Brusselaers
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Visionsgatan 4, 171 64, Stockholm, Sweden.
- Science for Life Laboratory (SciLifeLab), Stockholm, Sweden.
- Department of Head and Skin, Faculty of Medicine, Ghent University, Ghent, Belgium.
| | - Omid Sadr-Azodi
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, St Göran Hospital, Stockholm, Sweden
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Visionsgatan 4, 171 64, Stockholm, Sweden
- Science for Life Laboratory (SciLifeLab), Stockholm, Sweden
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23
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Pagan JD, Petroski-Rose L, Mann A, Hauss A. Omeprazole Reduces Calcium Digestibility in Thoroughbred Horses. J Equine Vet Sci 2019; 86:102851. [PMID: 32067660 DOI: 10.1016/j.jevs.2019.102851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/18/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Proton pump inhibitors such as omeprazole reduce nutrient digestibility in humans. This study determined the effect of omeprazole on the digestibility of diets containing limestone or marine-derived calcium (BMC) and to assess changes in blood parameters associated with gastric acid production and calcium status in horses. Thoroughbreds were used to evaluate the digestibility of diets containing different calcium sources with or without omeprazole over four 21-day periods. Each 21-day period had a 15-day diet adaptation phase followed by a 6-day collection phase, consisting of a 5-day total fecal collection period and a final day for gastroscopy and blood sampling. Horses were fed the same diet with either 60 g/d BMC or 50 g/d limestone, so the total diet provided ∼45 g calcium. Horses on omeprazole were given GastroGard once daily for the final 14 day of each 21-day period, which supplied 3.91 ± 0.17 mg/kg BW/d of omeprazole. On day 21, blood samples were taken and gastric fluid pH was measured 8 hour after omeprazole administration. Omeprazole had a profound effect on gastric fluid pH in omeprazole-treated horses compared with nontreated horses. Serum gastrin doubled in omeprazole-treated horses compared with nontreated horses. Omeprazole and calcium source did not affect digestibility of phosphorus, magnesium, potassium, sodium, iron, copper, zinc, or manganese but did affect calcium digestibility. Omeprazole reduced apparent calcium digestibility from 52.0% to 41.4% in limestone and from 55.1% to 46.5% in BMC, equalling a 20.3% and 15.6% decrease in calcium digestibility in the limestone and BMC, respectively. Mineral source had a significant effect on calcium digestibility with BMC at 50.8% and limestone at 46.7%.
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Affiliation(s)
| | | | - Alana Mann
- Kentucky Equine Research, Versailles, KY
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Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases - Pathogenesis, diagnosis, and treatment. Allergol Int 2019; 68:420-429. [PMID: 31000445 DOI: 10.1016/j.alit.2019.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are divided into eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), depending on the involved gastrointestinal tract, though both are considered to be chronic Th2-type allergic diseases caused by food or environmental allergens. In development of EoE, refluxed gastric acid may also have an important role. For diagnosis of EGIDs, the presence of symptoms possibly originating from the involved gastrointestinal tract and dense eosinophil infiltration are important factors. Imaging studies, including endoscopy and computed tomography, along with histopathological examinations of biopsy specimens are useful for diagnosis, whereas laboratory testing of blood, urine, and stool samples has limited value. Three useful options for treating EoE patients are acid inhibitors, swallowed topical corticosteroids, and an elimination diet, while systemic administration of glucocorticoids is the standard treatment of EGE, though information is limited. Since the prevalence of EGIDs is increasing in Western countries as well as Japan, development of effective treatments based on sufficient evidence is becoming an urgent need.
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Remes-Troche JM, García García FD, Rojas-Loureiro G, Rivera-Gutiérrez X, Reyes-Huerta J, Amieva-Balmori M. Intragastric pH effect of 20mg of levo-pantoprazole versus 40mg of racemic pantoprazole the first seven days of treatment in patients with gastroesophageal reflux disease. Rev Gastroenterol Mex (Engl Ed) 2019; 85:48-55. [PMID: 31104856 DOI: 10.1016/j.rgmx.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/AIM Levo-pantoprazole, the S-enantiomer of pantoprazole, is a proton pump inhibitor that has been shown in animal studies to be faster and stronger than its racemic formulation. There are no studies on humans and therefore our aim was to evaluate the effects of levo-pantoprazole versus racemic pantoprazole on intragastric pH. MATERIALS AND METHODS A randomized controlled study was conducted on patients with erosive gastroesophageal reflux disease that were given 20mg of levo-pantoprazole (n = 15) versus 40mg of racemic pantoprazole (n = 15) for 7 days. Baseline and end-of-treatment symptom evaluation and intragastric pH measurement were carried out. RESULTS There were no differences between the groups in the baseline evaluations. From 40 to 115min after the first dose of levo-pantoprazole, the mean intragastric pH was higher, compared with that of racemic pantoprazole (p < 0.05). After one week, levo-pantoprazole and racemic pantoprazole significantly reduced intragastric acid production and its esophageal exposure (p < 0.05). Even though there was no statistically significant difference, a larger number of patients that received levo-pantoprazole stated that their heartburn improved within the first 3 days. CONCLUSIONS The S-enantiomer of pantoprazole (levo-pantoprazole) had a faster and stronger effect with respect to acid suppression, compared with its racemic formulation. Although the effect on symptoms was faster with levo-pantoprazole, occurring within the first days of treatment, it was equivalent to that of the racemate at one week of treatment.
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Affiliation(s)
- J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México.
| | - F D García García
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - G Rojas-Loureiro
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - X Rivera-Gutiérrez
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - J Reyes-Huerta
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, México
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Kinoshita Y, Ishimura N, Ishihara S. Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use. J Neurogastroenterol Motil 2018; 24:182-196. [PMID: 29605975 PMCID: PMC5885718 DOI: 10.5056/jnm18001] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/28/2018] [Accepted: 02/09/2018] [Indexed: 12/13/2022] Open
Abstract
Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies.
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Affiliation(s)
- Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Shimane,
Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Shimane,
Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Shimane,
Japan
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Abstract
The first histamine H2 receptor antagonists (H2RAs) were developed in the early 1970s. They played a dominant role in treating peptic ulcer disease and gastroesophageal reflux disease (GERD). H2RAs block the production of acid by H+, K+-ATPase at the parietal cells and produce gastric luminal anacidity for varying periods. H2RAs are highly selective, and they do not affect H1 receptors. Moreover, they are not anticholinergic agents. Sequential development of H2RAs, proton pump inhibitors (PPIs), and discovery of Helicobacter pylori infection changed the paradigm of peptic ulcer disease with marked decrease of morbidity and mortality. PPIs are known to be the most effective drugs that are currently available for suppressing gastric acid secretion. Many studies have shown its superiority over H2RAs as a treatment for acid-related disorders, such as peptic ulcer disease, GERD, and Zollinger-Ellison syndrome. However, other studies have reported that PPIs may not be able to render stomach achlorhydric and have identified a phenomenon of increasing gastric acidity at night in individuals receiving a PPI twice daily. These nocturnal acid breakthrough episodes can be eliminated with an addition of H2RAs at night. The effectiveness of nighttime dose of H2RA suggests a major role of histamine in nocturnal acid secretion. H2RAs reduce secretion of gastric acid, and each H2RA also has specific effects. For instance, nizitidine alleviates not only symptoms of GERD, but also provokes gastric emptying, resulting in clinical symptom improvement of functional dyspepsia. The aim of this paper was to review the characteristics and role of H2RAs and assess the future strategy and treatment of upper gastrointestinal disease, including acid related disorders.
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Affiliation(s)
- Young Kwang Shim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Borbély Y, Kröll D, Nett PC, Moreno P, Tutuian R, Lenglinger J. Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2018; 14:764-768. [PMID: 29631982 DOI: 10.1016/j.soard.2018.02.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 01/20/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%. OBJECTIVE To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors. SETTING University hospital, cross-sectional study. METHODS Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow. RESULTS Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8-12.6); median patient age was 36.5 years (19.1-67.2). Median body mass index was 30.3 kg/m2 (20.3-47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off-proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH<4) was found in 27 (61.4%), an increased number of reflux episodes (>53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%). CONCLUSION The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment.
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Affiliation(s)
- Yves Borbély
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
| | - Dino Kröll
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Philipp C Nett
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Peter Moreno
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Radu Tutuian
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Lenglinger
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Wombwell E, Chittum ME, Leeser KR. Inpatient Proton Pump Inhibitor Administration and Hospital-Acquired Clostridium difficile Infection: Evidence and Possible Mechanism. Am J Med 2018; 131:244-249. [PMID: 29122635 DOI: 10.1016/j.amjmed.2017.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/02/2017] [Accepted: 10/19/2017] [Indexed: 12/26/2022]
Abstract
The incidence of Clostridium difficile infection continues to increase globally. Particularly concerning are hospital-acquired cases that attribute significant morbidity, mortality, and expenditures to the health care system. Proton pump inhibitors, which are widely prescribed and generally considered to have minimal adverse effects, have recently come under scrutiny for positive associations with C. difficile infection development. This article will specifically review the current state of evidence demonstrating a positive association between nosocomial proton pump inhibitor administration and the incidence of hospital-acquired C. difficile infection. In addition, the article delivers state-of-the-art knowledge relative to mechanisms by which proton pump inhibitor exposure may propagate the manifestation of C. difficile infection.
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Affiliation(s)
- Eric Wombwell
- Department of Pharmacy, Centerpoint Medical Center, Independence, Mo; Division of Pharmacy Practice and Administration, University of Missouri - Kansas City School of Pharmacy, Kansas City.
| | - Megan E Chittum
- Department of Pharmacy Services, Saint Louis University Hospital, St. Louis, Mo
| | - Kayla R Leeser
- UMKC School of Pharmacy Drug Information Center, Kansas City, Mo
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Brusselaers N, Engstrand L, Lagergren J. Maintenance proton pump inhibition therapy and risk of oesophageal cancer. Cancer Epidemiol. 2018;53:172-177. [PMID: 29477057 DOI: 10.1016/j.canep.2018.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association of long-term use of proton pump inhibitors (PPIs) with oesophageal adenocarcinoma has been poorly defined. Our aim was to assess the risk of oesophageal cancer assessing confounding by indication. METHODS This population-based cohort study included all 796,492 adults exposed to maintenance therapy with PPIs in Sweden in 2005-2012. Standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated to assess the risk of oesophageal adenocarcinoma (and squamous cell carcinoma as a comparison) among long-term PPI users relative to the corresponding background population. The different indications for maintenance PPI therapy were analysed separately. RESULTS Among all individuals using maintenance PPI therapy, the overall SIR of oesophageal adenocarcinoma was 3.93 (95% CI 3.63-4.24). The SIRs of adenocarcinoma were increased also among individuals without gastro-oesophageal reflux disease who used PPIs for indications not associated with any increased risk of oesophageal adenocarcinoma. For example, the SIRs among participants using maintenance PPI therapy because of maintenance treatment with non-steroidal anti-inflammatory drugs and aspirin were 2.74 (95% CI 1.96-3.71) and 2.06 (95% CI 1.60-2.60), respectively. The SIRs of oesophageal squamous cell carcinoma were increased for most investigated indications, but to a lesser degree than for oesophageal adenocarcinoma. CONCLUSION In conclusion, the long term use of PPIs is associated with increased risk of oesophageal adenocarcinoma in the absence of other risk factors. Long term use of PPIs should be addressed with caution.
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Minaiyan M, Sajjadi SE, Amini K. Antiulcer effects of Zataria multiflora Boiss. on indomethacin-induced gastric ulcer in rats. Avicenna J Phytomed 2018; 8:408-415. [PMID: 30345228 PMCID: PMC6190242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Zataria multiflora has been reported to have several medicinal properties including antioxidant, antibacterial, antispasmodic, and expectorant activities. This study aimed to investigate the effect of Z. multiflora hydro-alcoholic extract (ZMHE) on peptic ulcer caused by indomethacin in rats. MATERIALS AND METHODS ZMHE was prepared by maceration, condensed by rotary evaporator and dried by a freeze-drier. In this study, 72 male Wistar rats were randomly divided into 12 groups, six in each including: normal rats, control rats, ranitidine-treated, and animals that were treated with ZMHE (100, 200, 400 mg/kg). Parenteral and oral treatments were done 1 and 2 hours, respectively before gastric ulcer induction by indomethacin (25 mg/kg, i.p.). After 6 hours, animals were sacrificed, two sides of the stomach were ligated and gastric contents and tissues were investigated in terms of pH and biochemical and histologic parameters, respectively. RESULTS ZMHE (at all doses) considerably decreased the ulcer area and ulcer severity in comparison to control group after oral and parenteral administration. Oral administration of this extract increased the pH of stomach contents while diminished pepsin activity in a dose-dependent manner. Following parenteral treatment, a significant difference in pH of stomach content was observed only by ZMHE 400mg/kg in comparison to control group. The myeloperoxidase (MPO) enzyme activity decreased in groups that received the extract via both oral and parenteral routes. CONCLUSION It might be concluded that ZMHE could protect against experimental gastric ulcer induced by indomethacin and this action is probably mediated via reducing acid secretion and pepsin activity besides enhancing tissue antioxidant capacity.
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Affiliation(s)
- Mohsen Minaiyan
- Department of Pharmacology and Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding Author:Tel: +983137927088, Fax: +983136680011,
| | - Sayed-Ebrahim Sajjadi
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Amini
- Schools of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Choi YJ, Kim N, Lee JY, Nam RH, Suh JH, Lee SM, Ham MH, Jo HJ, Shim YK, Park YH, Lee JC, Choi YJ, Lee HS, Lee DH. PMK-S005 Alleviates Age-Related Gastric Acid Secretion, Inflammation, and Oxidative Status in the Rat Stomach. Gut Liver 2017; 10:749-56. [PMID: 27172930 PMCID: PMC5003198 DOI: 10.5009/gnl15584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/05/2015] [Indexed: 12/12/2022] Open
Abstract
Background/Aims The aim of this study was to evaluate the effect of the synthetic S-allyl-l-cysteine (SAC) PMK-S005 on gastric acid secretion, inflammation, and antioxidant enzymes in aging rats. Methods The rats were divided into four groups at 31 weeks of age and were continuously fed a diet containing a vehicle control, PMK-S005 (5 or 10 mg/kg), or lansoprazole (5 mg/kg). Gastric acid secretion and connective tissue thickness of the lamina propria were evaluated at 74 weeks and 2 years of age. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and COX-2 levels were measured by using enzyme-linked immunosorbent assays (ELISAs) or Western blot assays. Levels of antioxidant enzymes, including heme oxyganase 1 (HO-1) and NAD(P)H:quinone oxidoreductase 1 (NQO-1), were also measured. Results As the rats aged, gastric acid secretion significantly decreased, and the connective tissue of the lamina propria increased. However, 74-week-old rats in the PMK-S005 group exhibited greater levels of gastric acid secretion than those of the control and lansoprazole groups. The increase of TNF-α, IL-1β, and COX-2 expression in 74-week and 2-year-old control rats were inhibited by PMK-S005. In addition, the decrease in HO-1 and NQO-1 protein expression that occurred with aging was inhibited by PMK-S005 in the 74-week-old rats. Conclusions These results suggest that PMK-S005 has therapeutic potential as an antiaging agent to ameliorate age-related gastric acid secretion, inflammation, and oxidative stress in the stomach.
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Affiliation(s)
- Yoon Jeong Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Yup Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ryoung Hee Nam
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyung Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Min Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Hee Ham
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jin Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Kwang Shim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yo Han Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Park HJ, Park SH, Shim KN, Kim YS, Kim HJ, Han JP, Kim YS, Bang BW, Kim GH, Baik GH, Kim HH, Park SY, Kim SS. The Prevalence and Clinical Features of Non-responsive Gastroesophageal Reflux Disease to Practical Proton Pump Inhibitor Dose in Korea: A Multicenter Study. Korean J Gastroenterol 2017; 68:16-22. [PMID: 27443619 DOI: 10.4166/kjg.2016.68.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS In Korea, there are no available multicenter data concerning the prevalence of or diagnostic approaches for non-responsive gastroesophageal reflux disease (GERD) which does not respond to practical dose of proton pump inhibitor (PPI) in Korea. The purpose of this study is to evaluate the prevalence and the symptom pattern of non-responsive GERD. METHODS A total of 12 hospitals who were members of a Korean GERD research group joined this study. We used the composite score (CS) as a reflux symptom scale which is a standardized questionnaire based on the frequency and severity of typical symptoms of GERD. We defined "non-responsive GERD" as follows: a subject with the erosive reflux disease (ERD) whose CS was not decreased by at least 50% after standard-dose PPIs for 8 weeks or a subject with non-erosive reflux disease (NERD) whose CS was not decreased by at least 50% after half-dose PPIs for 4 weeks. RESULTS A total of 234 subjects were analyzed. Among them, 87 and 147 were confirmed to have ERD and NERD, respectively. The prevalence of non-responsive GERD was 26.9% (63/234). The rates of non-responsive GERD were not different between the ERD and NERD groups (25.3% vs. 27.9%, respectively, p=0.664). There were no differences between the non-responsive GERD and responsive GERD groups for sex (p=0.659), age (p=0.134), or BMI (p=0.209). However, the initial CS for epigastric pain and fullness were higher in the non-responsive GERD group (p=0.044, p=0.014, respectively). CONCLUSIONS In conclusion, this multicenter Korean study showed that the rate of non-responsive GERD was substantially high up to 26%. In addition, the patients with the non-responsive GERD frequently showed dyspeptic symptoms such as epigastric pain and fullness.
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Affiliation(s)
- Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soo Heon Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong Sung Kim
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Pil Han
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yong Sik Kim
- Department of Internal Medicine, Eulji University, Seoul, Korea
| | - Byoung Wook Bang
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyung Hun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Seon Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
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Boyce M, van den Berg F, Mitchell T, Darwin K, Warrington S. Randomised trial of the effect of a gastrin/CCK 2 receptor antagonist on esomeprazole-induced hypergastrinaemia: evidence against rebound hyperacidity. Eur J Clin Pharmacol 2017; 73:129-39. [PMID: 27796466 DOI: 10.1007/s00228-016-2150-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/18/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Hypergastrinaemia induced by proton pump inhibitor (PPI) therapy may cause ECL-cell and parietal-cell hyperplasia and rebound hyperacidity and dyspepsia after PPI withdrawal. The aim of the study was to assess the effect of different dosage-regimens of netazepide, a gastrin/CCK2 receptor antagonist, on PPI-induced hypergastrinaemia and elevated chromogranin A (CgA). METHODS Six groups of eight healthy subjects participated in a randomised, double-blind study of esomeprazole 40 mg daily for 28 days, in combination with netazepide 1, 5 or 25 mg or placebo, daily, during the last 14 days of esomeprazole or during 14 days after treatment withdrawal. Fasting serum gastrin and plasma CgA were measured during treatment and after withdrawal, as biomarkers of acid suppression and ECL-cell activity, respectively. Dyspepsia was monitored throughout the study. RESULTS Esomeprazole increased gastrin and CgA. Netazepide increased gastrin, but not CgA, and inhibited dose dependently the CgA response to esomeprazole. Gastrin and CgA returned to baseline within 2-3 days of esomeprazole withdrawal; netazepide did not shorten that time. There was no rebound dyspepsia after esomeprazole withdrawal. CONCLUSIONS Esomeprazole and netazepide each increase gastrin, consistent with a secondary effect of gastric acid suppression, but by different mechanisms. Esomeprazole-induced hypergastrinaemia stimulates ECL cells and thereby increases CgA. Netazepide-induced hypergastrinaemia does not increase CgA, because netazepide blocks gastrin/CCK2 receptors on ECL cells. Co-administration of netazepide 5 mg abolishes the effect of esomeprazole-induced hypergastrinaemia on ECL cells. The quick return to baseline of gastrin and CgA and absence of dyspepsia after esomeprazole withdrawal do not support the concept of rebound hyperacidity.
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Uberti F, Bardelli C, Morsanuto V, Ghirlanda S, Molinari C. Role of vitamin D 3 combined to alginates in preventing acid and oxidative injury in cultured gastric epithelial cells. BMC Gastroenterol 2016; 16:127. [PMID: 27717330 PMCID: PMC5054561 DOI: 10.1186/s12876-016-0543-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/30/2016] [Indexed: 12/14/2022] Open
Abstract
Background Gastric diseases are a worldwide problem in modern society, as reported in the USA, in the range of 0.5–2 episodes/year/person and an incidence of 5–100 episodes/1000/week according to seasons and age. There is convincing evidence that oxidative stress is involved in the pathogenesis of acute gastric injury. Acid secreted from gastric parietal cells determines mucosal injuries which in turn cause inflammation and oxidative stress. Consequent inflammation produces free radicals by mitochondria thus causing lipid peroxidation, oxidative and acidic stress, which can lead to cell apoptosis. Vitamin D3, the active form of vitamin D, may counteract intracellular cell death and improve epithelial regeneration. Methods This study was planned to assess whether vitamin D3 is a protective factor against acid injury and oxidative stress in gastric epithelial cells. Primary epithelial cells and GTL-16 cells have been used to test the effects of Grisù® alone or in combination with vitamin D3 during oxidative stress or high acid exposition measuring cell viability, ROS production, cellular adhesion time along with apoptotic, autophagic and survival pathways. The combined effect of Grisù® and vitamin D3 was found more effective in counteracting the negative consequences of oxidative stress and acidity conditions than some other gastroprotective agents, such as Maalox® or Gaviscon®. Results In case of oxidative stress or acidity condition the stimulation with Grisù® alone caused an improvement of cell viability and a reduction of ROS production on epithelial gastric cells. In addition, the adhesion time of the cells was improved. All these effects were increased by the presence of vitamin D3. Similar data were also observed in primary gastric epithelial cells confirming the results obtained in GTL-16 cells. Conclusions These results suggest that Grisù® in combination with vitamin D3 may exert a gastroprotective effect to maintain or restore the integrity of gastric epithelium through an antioxidant pathway, inhibiting apoptosis and activating survival kinases. Moreover, the combination of Grisù® and vitamin D3 improves cell viability and decreases ROS production compared to other gastroprotective agents combined with vitamin D3. All these data were validated using primary cells isolated from gastric tissue. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0543-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Uberti
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, Novara, 28100, Italy.
| | - Claudio Bardelli
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, Novara, 28100, Italy
| | - Vera Morsanuto
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, Novara, 28100, Italy
| | - Sabrina Ghirlanda
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, Novara, 28100, Italy
| | - Claudio Molinari
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, Novara, 28100, Italy
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Abstract
Helicobacter pylori infects about 50 % of the world's population, causing at a minimum chronic gastritis. A subset of infected patients will ultimately develop gastric or duodenal ulcer disease, gastric adenocarcinoma, or MALT (mucosa-associated lymphoid tissue) lymphoma. Eradication of H. pylori requires complex regimens that include acid suppression and multiple antibiotics. The efficacy of treatment using what were once considered standard regimens have declined in recent years, mainly due to widespread development of antibiotic resistance. Addition of bismuth to standard triple therapy regimens, use of alternate antibiotics, or development of alternative regimens using known therapies in novel combinations have improved treatment efficacy in specific populations, but overall success of eradication remains less than ideal. Novel regimens under investigation either in vivo or in vitro, involving increased acid suppression ideally with fewer antibiotics or development of non-antibiotic treatment targets, show promise for future therapy.
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Affiliation(s)
- Elizabeth A Marcus
- Department of Pediatrics, DGSOM at UCLA, Los Angeles, CA, USA.
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA.
| | - George Sachs
- Department of Physiology, DGSOM at UCLA, Los Angeles, CA, USA
- Department of Medicine, DGSOM at UCLA, Los Angeles, CA, USA
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA
| | - David R Scott
- Department of Physiology, DGSOM at UCLA, Los Angeles, CA, USA
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA
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Shinozaki S, Nomoto H, Kondo Y, Sakamoto H, Hayashi Y, Yamamoto H, Lefor AK, Osawa H. Comparison of vonoprazan and proton pump inhibitors for eradication of Helicobacter pylori. Kaohsiung J Med Sci. 2016;32:255-260. [PMID: 27316584 DOI: 10.1016/j.kjms.2016.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
Alternative eradication therapies for Helicobacter pylori infection are needed because of an increasing failure rate over the past decade. The aim of this study was to determine if vonoprazan, a new potassium-competitive acid blocker, showed superiority to existing proton pump inhibitors for primary eradication of H. pylori in routine clinical practice. Data for 573 patients who underwent primary H. pylori eradication therapy were retrospectively reviewed. Regimens included clarithromycin 200 mg, amoxicillin 750 mg, and an acid-suppressing drug [lansoprazole 30 mg (LAC), rabeprazole 10 mg (RAC), esomeprazole 20 mg (EAC), or vonoprazan 20 mg (VAC)] twice daily for 1 week. Eradication was successful in 73% (419/573) of patients using intention-to-treat (ITT) analysis and 76% (419/549) of patients in per-protocol (PP) analysis. The VAC group had a significantly superior eradication rate compared with the LAC and RAC groups in ITT (VAC 83%, LAC 66% and RAC 67%, p < 0.01) and PP analysis (VAC 85%, LAC 69% and RAC 70%, p < 0.01), and had a similarly high eradication rate to the EAC group (83% in ITT and 87% in PP). Although the eradication rate in the VAC and EAC groups was not significantly higher than in the LAC and RAC groups in patients with mild gastric atrophy with both ITT and PP analyses, it was significantly higher in patients with severe gastric atrophy (p < 0.01). The VAC group had a significantly higher H. pylori eradication rate than the LAC and RAC groups, and a > 80% eradication rate regardless of the degree of atrophy.
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Abdel-Salam O. Gastric acid inhibitory and gastric protective effects of Cannabis and cannabinoids. ASIAN PAC J TROP MED 2016; 9:413-9. [PMID: 27261847 DOI: 10.1016/j.apjtm.2016.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 11/26/2022] Open
Abstract
Cannabis sativa has long been known for its psychotropic effect. Only recently with the discovery of the cannabinoid receptors, their endogenous legends and the enzymes responsible for their synthesis and degradation, the role of this 'endocannabinoid system' in different pathophysiologic processes is beginning to be delineated. There is evidence that CB1 receptor stimulation with synthetic cannabinoids or Cannabis sativa extracts rich in Δ(9)-tetrahydrocannabinol inhibit gastric acid secretion in humans and experimental animals. This is specially seen when gastric acid secretion is stimulated by pentagastrin, carbachol or 2-deoxy-d-glucose. Cannabis and/or cannabinoids protect the gastric mucosa against noxious challenge with non-steroidal anti-inflammatory drugs, ethanol as well as against stress-induced mucosal damage. Cannabis/cannabinoids might protect the gastric mucosa by virtue of its antisecretory, antioxidant, anti-inflammatory, and vasodilator properties.
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Affiliation(s)
- Omar Abdel-Salam
- Department of Toxicology and Narcotics, Medical Division, National Research Centre, Tahrir Street, Dokki, Cairo, Egypt.
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Goswami C, Tanaka T, Jogahara T, Sakai T, Sakata I. Motilin stimulates pepsinogen secretion in Suncus murinus. Biochem Biophys Res Commun 2015; 462:263-8. [PMID: 25957475 DOI: 10.1016/j.bbrc.2015.04.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/26/2015] [Indexed: 12/13/2022]
Abstract
Motilin and ghrelin are gastrointestinal hormones that stimulate the migrating motor complex (MMC) of gastrointestinal motility during the fasting state. In this study, we examined the effect of motilin and ghrelin on pepsinogen secretion in anesthetized suncus (house musk shrew, Suncus murinus), a ghrelin- and motilin-producing mammal. By using a gastric lumen-perfusion system, we found that the intravenous administration of carbachol and motilin stimulated pepsinogen secretion, the latter in a dose-dependent manner, whereas ghrelin had no effect. We then investigated the pathways of motilin-induced pepsinogen secretion using acetylcholine receptor antagonists. Treatment with atropine, a muscarinic acetylcholine receptor antagonist, completely inhibited both carbachol and motilin-induced pepsinogen secretion. Motilin-induced pepsinogen secretion was observed in the vagotomized suncus. This is the first report demonstrating that motilin stimulates pepsinogen secretion, and suggest that this effect occurs through a cholinergic pathway in suncus.
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Affiliation(s)
- Chayon Goswami
- Area of Regulatory Biology, Division of Life Science, Graduate School of Science and Engineering, Saitama University, Saitama, Japan
| | - Toru Tanaka
- Faculty of Pharmaceutical Sciences, Department of Pharmaceutical and Health Sciences, Josai University, Saitama, Japan
| | - Takamichi Jogahara
- Laboratory of Animal Management and Resources, Department of Zoology, Faculty of Science, Okayama University of Science, Okayama, Japan
| | - Takafumi Sakai
- Area of Regulatory Biology, Division of Life Science, Graduate School of Science and Engineering, Saitama University, Saitama, Japan
| | - Ichiro Sakata
- Area of Regulatory Biology, Division of Life Science, Graduate School of Science and Engineering, Saitama University, Saitama, Japan.
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Budzyński J, Kłopocka M. Brain-gut axis in the pathogenesis of Helicobacter pylori infection. World J Gastroenterol 2014; 20:5212-5225. [PMID: 24833851 PMCID: PMC4017036 DOI: 10.3748/wjg.v20.i18.5212] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/11/2014] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is the main pathogenic factor for upper digestive tract organic diseases. In addition to direct cytotoxic and proinflammatory effects, H. pylori infection may also induce abnormalities indirectly by affecting the brain-gut axis, similar to other microorganisms present in the alimentary tract. The brain-gut axis integrates the central, peripheral, enteric and autonomic nervous systems, as well as the endocrine and immunological systems, with gastrointestinal functions and environmental stimuli, including gastric and intestinal microbiota. The bidirectional relationship between H. pylori infection and the brain-gut axis influences both the contagion process and the host’s neuroendocrine-immunological reaction to it, resulting in alterations in cognitive functions, food intake and appetite, immunological response, and modification of symptom sensitivity thresholds. Furthermore, disturbances in the upper and lower digestive tract permeability, motility and secretion can occur, mainly as a form of irritable bowel syndrome. Many of these abnormalities disappear following H. pylori eradication. H. pylori may have direct neurotoxic effects that lead to alteration of the brain-gut axis through the activation of neurogenic inflammatory processes, or by microelement deficiency secondary to functional and morphological changes in the digestive tract. In digestive tissue, H. pylori can alter signaling in the brain-gut axis by mast cells, the main brain-gut axis effector, as H. pylori infection is associated with decreased mast cell infiltration in the digestive tract. Nevertheless, unequivocal data concerning the direct and immediate effect of H. pylori infection on the brain-gut axis are still lacking. Therefore, further studies evaluating the clinical importance of these host-bacteria interactions will improve our understanding of H. pylori infection pathophysiology and suggest new therapeutic approaches.
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Arawwawala LDAM, Arambewela LSR, Ratnasooriya WD. Gastroprotective effect of Piper betle Linn. leaves grown in Sri Lanka. J Ayurveda Integr Med 2014; 5:38-42. [PMID: 24812474 PMCID: PMC4012360 DOI: 10.4103/0975-9476.128855] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/04/2013] [Accepted: 09/22/2013] [Indexed: 01/10/2023] Open
Abstract
Background: Piper betle Linn. (Piperaceae) is used as a remedy for gastric ulcers in traditional medicinal systems in Sri Lanka. However, the gastroprotective activity has never been proven scientifically using betel leaves grown in Sri Lanka. Objective: To evaluate the gastroprotective activity of hot aqueous extract (HAE) and cold ethanolic extract (CEE) of P. betle in rats as the experimental model. Materials and Methods: Three doses (200, 300, and 500 mg/kg/bw) of both extracts were evaluated for the gastroprotective activity against ethanol induced gastric ulcers in rats. The parameters evaluated were (a) effects of HAE on mucus content adhering to the wall of the gastric mucosa, (b) acidity (total and free), (c) volume and (d) pH of the gastric juice. Results: Oral administration of HAE and CEE provided marked dose dependent (HAE: r2 = 0.97; CEE: r2 = 0.96) and significant (P ≤ 0.05) protection against gastric damage caused by absolute ethanol. The gastroprotective effect of CEE was comparable with that of HAE. Further, gastroprotective activity of the highest dose of both extracts were significantly greater (P ≤ 0.05) than that of misoprostol, the reference drug. The HAE significantly (P ≤ 0.05) increased the mucus content adhering to the wall of the gastric mucosa and inhibited the volume of gastric acid. However, acidity (total and free) and pH of the gastric juice remained unaltered. Conclusion: It is concluded that both HAE and CEE of P. betle leaves have a strong gastroprotective activity.
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Affiliation(s)
- L D A M Arawwawala
- Industrial Technology Institute, Herbal Technology Section, Bauddhaloka Mawatha, Colombo 7, Sri Lanka
| | - L S R Arambewela
- Industrial Technology Institute, Herbal Technology Section, Bauddhaloka Mawatha, Colombo 7, Sri Lanka
| | - W D Ratnasooriya
- Department of Zoology, University of Colombo, Colombo 3, Sri Lanka
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Takahashi Y, Fujii T, Fujita K, Shimizu T, Higuchi T, Tabuchi Y, Sakamoto H, Naito I, Manabe K, Uchida S, Sasaki S, Ikari A, Tsukada K, Sakai H. Functional coupling of chloride-proton exchanger ClC-5 to gastric H+,K+-ATPase. Biol Open 2014; 3:12-21. [PMID: 24429108 PMCID: PMC3892156 DOI: 10.1242/bio.20136205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
It has been reported that chloride–proton exchanger ClC-5 and vacuolar-type H+-ATPase are essential for endosomal acidification in the renal proximal cells. Here, we found that ClC-5 is expressed in the gastric parietal cells which secrete actively hydrochloric acid at the luminal region of the gland, and that it is partially localized in the intracellular tubulovesicles in which gastric H+,K+-ATPase is abundantly expressed. ClC-5 was co-immunoprecipitated with H+,K+-ATPase in the lysate of tubulovesicles. The ATP-dependent uptake of 36Cl− into the vesicles was abolished by 2-methyl-8-(phenylmethoxy)imidazo[1,2-a]pyridine-3-acetonitrile (SCH28080), an inhibitor of H+,K+-ATPase, suggesting functional expression of ClC-5. In the tetracycline-regulated expression system of ClC-5 in the HEK293 cells stably expressing gastric H+,K+-ATPase, ClC-5 was co-immunoprecipitated with H+,K+-ATPase, but not with endogenous Na+,K+-ATPase. The SCH28080-sensitive 36Cl− transporting activity was observed in the ClC-5-expressing cells, but not in the ClC-5-non-expressing cells. The mutant (E211A-ClC-5), which has no H+ transport activity, did not show the SCH28080-sensitive 36Cl− transport. On the other hand, both ClC-5 and its mutant (E211A) significantly increased the activity of H+,K+-ATPase. Our results suggest that ClC-5 and H+,K+-ATPase are functionally associated and that they may contribute to gastric acid secretion.
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Affiliation(s)
- Yuji Takahashi
- Department of Pharmaceutical Physiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
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Abstract
Zollinger-Ellison syndrome (ZES) is an endocrinopathy characterized by gastrin-secreting tumors, responsible for causing the formation of multiple, refractory, and recurrent peptic ulcers in the distal duodenum and proximal jejunum. Two main variants have been described, sporadic and those found in association with parathyroid and pituitary tumors, a genetic disorder known as multiple endocrine neoplasia-1 (MEN-1). Biochemical serum evaluation for elevated gastrin, followed by radiological or nuclear localization of the primary lesion, is mandated for establishing diagnosis. The mainstays of treatment include management of hypersecretory state with medical suppression of gastric acid production and surgical resection of primary tumor for the prevention of malignant transformation and metastatic complications. Medical therapy with proton pump inhibitors has virtually eliminated the need for acid-reducing surgical procedures. Surgical approach to sporadic and MEN-1-associated ZES varies based on our understanding of the natural history of the condition and the probability of cure; however, resection to a negative microscopic margin is indicated in both cases. Postoperative surveillance involves measurement of gastrin level, followed by imaging if elevation is detected. Re-excision of recurrent or resection of metastatic disease is a subject of controversy; however, at the present time aggressive cytoreductive approach is favored.
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Affiliation(s)
- Irene Epelboym
- Department of Surgery, Columbia University Medical Center, New York, New York, USA; Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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Jo HJ, Kim N, Nam RH, Chang H, Kim JH, Park JH, Kang JM, Lee DH, Jung HC. The Effect of Cochinchina momordica Seed Extract on Gastric Acid Secretion and Morphologic Change in Aged Rat Stomach. Gut Liver 2013; 7:560-8. [PMID: 24073314 PMCID: PMC3782671 DOI: 10.5009/gnl.2013.7.5.560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/09/2013] [Accepted: 06/18/2013] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Cochinchina momordica seed extract (SK-MS10) has a gastric protective effect. We aimed to assess the effect of SK-MS10 on gastric acid secretion with morphologic changes in the aged rat. Methods Acid secretions were evaluated in the male F344 rats of four different ages (6-, 31-, 74-week, and 2-year). The 31-week-old rats were divided to three groups and continuously administered chow containing vehicle, SK-MS10 and lansoprazole, respectively. At the age of 74 weeks and 2 years, basal and stimulated acid was measured and the expression of mRNA and protein of H+-K+-ATPase were determined. The area of connective tissue of lamina propria was measured. Results Basal and stimulated gastric acid significantly decreased and connective tissue of lamina propria increased with age. The expression of mRNA and protein of H+-K+-ATPase significantly decreased with age. However, 74-week-old rats in the SK-MS10 group had higher stimulated gastric acid secretion than those in the vehicle and lansoprazole groups. In 2-year-old rats of SK-MS10 group, there was no increase of connective tissue. Conclusions As SK-MS10 kept the capacity of acid secretion as well as connective tissue area to comparable to young rats, it might valuable to perform further research regarding mechanism of SK-MS10 as an antiaging agent in the stomach.
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Affiliation(s)
- Hyun Jin Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Gyawali S, Khan GM, Lamichane S, Gautam J, Ghimire S, Adhikari R, Lamsal R. Evaluation of anti-secretory and anti-ulcerogenic activities of avipattikar churna on the peptic ulcers in experimental rats. J Clin Diagn Res 2013; 7:1135-9. [PMID: 23905120 DOI: 10.7860/jcdr/2013/5309.3058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Avipattikar churna, a poly-herbal formulation, is one of the popular ayurvedic formulations which is used for peptic ulcer diseases but the scientific documentation with regards to its effect for the indication is lacking. AIMS This study was carried out to evaluate the anti-secretory and the anti-ulcerogenic activities of the churna and to compare its activity with that of ranitidine in a pyloric ligated model of rats. MATERIAL AND METHODS Four groups of rats with 6 animals in each served as the ulcer controls, churna low dose (500 mg/kg), churna high dose (750mg/kg) and ranitidine (25mg/kg). The control group rats received only vehicle (2% (v/v) gum acacia), while the rats of the other groups received the respective dose of the churna or ranitidine which was suspended in the vehicle. The treatments were given twice a day, orally, for two days. After 1 hour of the last dose, pyloric ligations were performed and the rats were sacrificed for evaluation after four hours of the ligations. The gastric contents were collected and its volume, pH and acidity were measured. The numbers of ulcers and their lengths were measured which were used to calculate the gastric irritancy index and the curative ratio. The histological examinations of the gastric tissues were also performed. RESULTS The churna, in both doses, significantly decreased the volumes of the gastric contents, the ulcer score, the length of the ulcer, the gastric irritancy index and pH increased as compared to those in the control group. The effects of the churna were comparable to that of ranitidine. The histopathological evaluation of the gastric tissue also supported the results. CONCLUSION Avipattikar churna has anti-secretory and anti-ulcerogenic effects which are comparable to those of ranitidine in peptic ulcer diseases.
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Affiliation(s)
- Sudesh Gyawali
- Assistant Professor, Department of Pharmacology, Manipal College of Medical Sciences (MCOMS) , Deepheight, Pokhara, Nepal
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Abstract
AIM: To investigate the effect of Nesfatin-1 on gastric acid secretion in rats.
METHODS: Thirty-six male Sprague-Dawley rats were randomly and equally divided into six groups to receive intracerebroventricular injection of 0.05, 0.5 μg of Nesfatin-1 or sterile water and intravenous injection of 10, 50 μg/kg of Nesfatin-1 or sterile water. Gastric secretion was measured using the pylorus-ligation method. Three hours after treatment, rats were killed to remove the stomach and collect the gastric contents. The volume of gastric secretion was measured and the amount of gastric acid was determined by titration with NaOH. H+-K+-ATPase mRNA expression was detected by RT-PCR.
RESULTS: Intracerebroventricular infusion of 0.05 or 0.5 μg of Nesfatin-1 significantly reduced the volume of gastric juice (3.3 mL/3 h ± 0.3 mL/3 h vs 2.4 mL/3 h ± 0.3 mL/3 h; 3.3 mL/3 h ± 0.3 mL/3 h vs 2.5 mL/3 h ± 0.3 mL/3 h, both P < 0.05), inhibited gastric acid output (582.7 μmol/3 h ± 59.3 μmol/3 h vs 373.6 μmol/3 h ± 61.5 μmol/3h, 582.7 μmol/3 h ± 59.3 μmol/3h vs 380.0 μmol/3 h ± 55.8 μmol/3h, both P < 0.05), and decreased gastric H+-K+-ATPase mRNA expression (both P < 0.05). Intravenous injection of 10 or 50 μg/kg of Nesfatin-1 had no significant effect on the volume of gastric juice (3.7 mL/3 h ± 0.7 mL/3 h vs 3.3 mL/3 h ± 0.4 mL/3 h, 3.7 mL/3 h ± 0.7 mL/3 h vs 3.8 mL/3 h ± 0.5 mL/3 h, both P > 0.05), gastric acid output (647.6 μmol/3 h ± 102.8 μmol/3 h vs 573.8 μmol/3 h ± 97.4 μmol/3 h, 647.6 μmol/3 h ± 102.8 μmol/3 h vs 594.4 μmol/3 h ± 121.0 μmol/3 h, both P > 0.05) and gastric H+-K+-ATPase mRNA expression (both P >0.05 ).
CONCLUSION: Nesfatin-1 acts in the central nervous system to inhibit gastric acid secretion in rats.
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Abstract
Proton pump inhibitor (PPI) is a prodrug which is activated by acid. Activated PPI binds covalently to the gastric H+, K+-ATPase via disulfide bond. Cys813 is the primary site responsible for the inhibition of acid pump enzyme, where PPIs bind. Omeprazole was the first PPI introduced in market, followed by pantoprazole, lansoprazole and rabeprazole. Though these PPIs share the core structures benzimidazole and pyridine, their pharmacokinetics and pharmacodynamics are a little different. Several factors must be considered in understanding the pharmacodynamics of PPIs, including: accumulation of PPI in the parietal cell, the proportion of the pump enzyme located at the canaliculus, de novo synthesis of new pump enzyme, metabolism of PPI, amounts of covalent binding of PPI in the parietal cell, and the stability of PPI binding. PPIs have about 1hour of elimination half-life. Area under the plasmic concentration curve and the intragastric pH profile are very good indicators for evaluating PPI efficacy. Though CYP2C19 and CYP3A4 polymorphism are major components of PPI metabolism, the pharmacokinetics and pharmacodynamics of racemic mixture of PPIs depend on the CYP2C19 genotype status. S-omeprazole is relatively insensitive to CYP2C19, so better control of the intragastric pH is achieved. Similarly, R-lansoprazole was developed in order to increase the drug activity. Delayed-release formulation resulted in a longer duration of effective concentration of R-lansoprazole in blood, in addition to metabolic advantage. Thus, dexlansoprazole showed best control of the intragastric pH among the present PPIs. Overall, PPIs made significant progress in the management of acid-related diseases and improved health-related quality of life.
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Li JH, Li XL, Wu J, Jia FY, Lin L. Nesfatin-1 inhibits gastric acid secretion by cultured rat gastric mucosa cells. Shijie Huaren Xiaohua Zazhi 2012; 20:1123-1130. [DOI: 10.11569/wcjd.v20.i13.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify the effect of nesfatin-1 on gastric acid secretion and the expression of the H+/K+-ATPase mRNA and protein in rat gastric mucosa cells in vitro.
METHODS: Gastric mucosa cells were isolated from SD rats by enzymolysis and identified by immunofluorescence staining. Cultured rat gastric mucosa cells were divided into control group and nesfatin-1 group, and the nesfatin-1 group was pretreated with different concentrations (0, 10-4, 10-3, 10-2, 10-1 μmol/L) of nesfatin-1 for different durations (0, 1, 2, 3, 4 h). The effect of nesfatin-1 on gastric acid secretion was investigated by monitoring 14C-aminopyrine (14C-AP) accumulation, and the expression of H+/K+-ATPase α and β subunit mRNA and protein was examined by real-time PCR and Western blot.
RESULTS: Pretreatment with nesfatin-1 at a dose of 10-1 or 10-2 μmol/L for 2 or 3 h inhibited gastric acid secretion, but nesfatin-1 at a dose of 10-3 or 10-4 μmol/L had no such effect. Nesfatin-1 at a dose of 10-1 μmol/L inhibited the expression of H+/K+-ATPase α subunit mRNA after pretreatment for 1, 2, or 3 h and inhibited the expression of H+/K+-ATPase β subunit mRNAs after pretreatment for 1 or 2 h. In the dose range between 10-4 to 10-1 μmol/L, nesfatin-1 dose-dependently inhibited the expression of H+/K+-ATPase α subunit and β subunit mRNA after pretreatment for 2 h. Nesfatin-1 at a dose of 10-1 μmmol/L inhibited H+/K+-ATPase α subunit protein expression after pretreatment for 1, 2 or 3 h and inhibited H+/K+-ATPase β subunit protein expression after pretreatment for 2 or 3 h. In the dose range between 10-3 to 10-1 μmol/L, nesfatin-1 dose-dependently inhibited H+/K+-ATPase α and β subunit protein expression after pretreatment for 2 h.
CONCLUSION: Our data suggest that nesfatin-1 inhibits gastric acid secretion by rat gastric mucosa cells in vitro possibly by down-regulating the expression of H+/K+-ATPase mRNA and protein..
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Sugano K. Should we still subcategorize helicobacter pylori-associated dyspepsia as functional disease? J Neurogastroenterol Motil 2011; 17:366-71. [PMID: 22148105 PMCID: PMC3228976 DOI: 10.5056/jnm.2011.17.4.366] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 12/14/2022] Open
Abstract
Functional dyspepsia is a group of disorders featuring symptoms believed to be derived from the stomach and duodenum such as upper abdominal discomfort, pain, postprandial fullness and early satiety. A key diagnostic requisite is the absence of organic, metabolic, or systemic disorders to explain "dyspeptic symptoms." Therefore, when peptic ulcer diseases (including scars), erosive esophagitis and upper gastrointestinal malignancies are found at endoscopic examinations, the diagnosis of functional dyspepsia is excluded. One notable exception, however, is Helicobacter pylori infection. According to the Rome III definition, H. pylori infection is included in functional dyspepsia. This is an obvious deviation from the diagnostic principle of functional dyspepsia, since H. pylori infection is a definite cause of mucosal inflammation, which affects a number of important gastric physiologies such as acid secretion, gastric endocrine function and motility. The chronic persistent nature of infection also results in more dramatic mucosal changes such as atrophy or intestinal metaplasia, the presence of which in the esophagus (Barrett's esophagus) precludes the diagnosis of functional dyspepsia. Since careful endoscopic examination can diagnose reliably H. pylori infection not only in Japan but also in Western contries, it is now feasible and more logical to exclude patients with chronic gastritis caused by H. pylori infection as having dyspeptic symptoms. It is time to establish the Asian consensus to declare that H. pylori infection should be separated from functional dyspepsia.
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Affiliation(s)
- Kentaro Sugano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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Fohl AL, Regal RE. Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all? World J Gastrointest Pharmacol Ther 2011; 2:17-26. [PMID: 21731913 PMCID: PMC3124633 DOI: 10.4292/wjgpt.v2.i3.17] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 05/25/2011] [Accepted: 06/02/2011] [Indexed: 02/06/2023] Open
Abstract
Over the past two decades, proton pump inhibitors (PPIs) have emerged as highly effective and relatively safe agents for the treatment of a variety of gastrointestinal disorders. Unfortunately, this desirable pharmacological profile has also contributed to superfluous and widespread use in both the inpatient and outpatient settings. While generally well-tolerated, research published over the last decade has associated these agents with increased risks of Clostridium difficile disease, fractures likely due to calcium malabsorption and both community-acquired (CAP) and hospital-acquired pneumonias (HAP). The mechanism behind PPI-associated pneumonia may be multifactorial, but is thought to stem from compromising the stomach’s “acid mantle” against gastric colonization of acid-labile pathogenic bacteria which then may be aspirated. A secondary postulate is that PPIs, through their inhibition of extra-gastric H+/K+-ATPase enzymes, may reduce the acidity of the upper aerodigestive tract, thus resulting in increased bacterial colonization of the larynx, esophagus and lungs. To date, several retrospective case control studies have been published looking at the association between PPI use and CAP. Some studies found a temporal relationship between PPI exposure and the incidence of pneumonia, but only two could define a dose-response relationship. Furthermore, other studies found an inverse correlation between duration of PPI use and risk of CAP. In terms of HAP, we reviewed two retrospective cohort studies and one prospective study. One retrospective study in a medical ICU found no increased association of HAP in PPI-exposed patients compared to no acid-lowering therapy, while the other in cardiothoracic surgery patients showed a markedly increased risk compared to those receiving H2RAs. The one prospective study in ICU patients showed an increased risk of HAP with PPIs, but not with H2RAs. In conclusion, the current literature shows a slight trend toward an association between PPI use and pneumonia and an increased risk with PPIs over H2RAs, but the findings are not consistent across all studies. Larger controlled trials still need to be done to better identify the risk that PPIs impart towards patients contracting CAP or HAP. Until these are completed, we will have to continue to extrapolate across smaller controlled trials to predict the associated risks in our respective patient populations. In the interim, it appears prudent to limit the use of PPIs to situations where they are clinically indicated and, in such cases, use them at the lowest effective dose. In the case of prescribing for stress ulcer prophylaxis in ICU patients, perhaps H2RAs should be used as the preferred agents over PPIs.
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Affiliation(s)
- Alexander L Fohl
- Alexander L Fohl, University of Michigan Hospitals and College of Pharmacy, Ann Arbor, MI 48109-5008,, United States
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