Investigating Helicobacter pylori-related pyloric hypomotility: functional, histological, and molecular alterations

Multiple theories have been proposed describing the pathogenic mechanisms of Helicobacter pylori (H. pylori)-associated gastric motility disorders. We assessed ex vivo pyloric activity in H. pylori-infected rats, and tried to explore the associated ghrelin hormone alteration and pyloric fibrogenesis. In addition, miR-1 was assessed in pyloric tissue samples, being recently accused of having a role in smooth muscle dysfunction. Ninety adult male Wistar albino rats were assigned into nine groups: 1) control group, 2) sterile broth (vehicle group), 3) amoxicillin control, 4) omeperazole control, 5) clarithromycin control, 6) triple therapy control, 7) H. pylori- group, 8) H. pylori-clarithromycin group, and 9) H. pylori-triple therapy group. Urease enzyme activity was applied as an indicator of H. pylori infection. Ex vivo pyloric contractility was evaluated. Serum ghrelin was assessed, and histological tissue evaluation was performed. Besides, pyloric muscle miR-1 expression was measured. The immunological epithelial to mesenchymal transition (EMT) markers; transforming growth factor β (TGFβ), α-smooth muscle actin (α-SMA), and E-cadherin-3 were also evaluated. By H. pylori infection, a significant (P < 0.001) reduced pyloric contractility index was recorded. The miR-1 expression was decreased (P < 0.001) in the H. pylori-infected group, associated with reduced serum ghrelin, elevated TGFβ, and α-SMA levels and reduced E-cadherin levels. Decreased miR-1 and disturbed molecular pattern were improved by treatment. In conclusion, H. pylori infection was associated with reduced miR-1, epithelial to mesenchymal transition, and pyloric hypomotility. The miR-1 may be a target for further studies to assess its possible involvement in H. pylori-associated pyloric dysfunction, which might help in the management of human H. pylori manifestations and complications.NEW & NOTEWORTHY This work is investigating functional, histopathological, and molecular changes underlying Helicobacter pylori hypomotility and is correlating these with miR-1, whose disturbance is supposed to be involved in smooth muscle dysfunction and cell proliferation according to literature. Epithelial to mesenchymal transition and reduced ghrelin hormone may contribute to H. pylori infection-associated hypomotility. H. pylori infection was associated with reduced pyloric miR-1 expression. Targeting miR-1 could be valuable in the clinical management of pyloric hypofunction.

Gastric Helicobacter suis Infection Partially Protects against Neurotoxicity in A 6-OHDA Parkinson's Disease Mouse Model

The exact etiology of Parkinson’s disease (PD) remains largely unknown, but more and more research suggests the involvement of the gut microbiota. Interestingly, idiopathic PD patients were shown to have at least a 10 times higher prevalence of Helicobacter suis (H. suis) DNA in gastric biopsies compared to control patients. H. suis is a zoonotic Helicobacter species that naturally colonizes the stomach of pigs and non-human primates but can be transmitted to humans. Here, we investigated the influence of a gastric H. suis infection on PD disease progression through a 6-hydroxydopamine (6-OHDA) mouse model. Therefore, mice with either a short- or long-term H. suis infection were stereotactically injected with 6-OHDA in the left striatum and sampled one week later. Remarkably, a reduced loss of dopaminergic neurons was seen in the H. suis/6-OHDA groups compared to the control/6-OHDA groups. Correspondingly, motor function of the H. suis-infected 6-OHDA mice was superior to that in the non-infected 6-OHDA mice. Interestingly, we also observed higher expression levels of antioxidant genes in brain tissue from H. suis-infected 6-OHDA mice, as a potential explanation for the reduced 6-OHDA-induced cell loss. Our data support an unexpected neuroprotective effect of gastric H. suis on PD pathology, mediated through changes in oxidative stress.

Effect of electroacupuncture at different acupoints in treating rapid gastric emptying: Zusanli (ST36) plus Zhongwan (CV12) versus Zhongwan (CV12) alone

OBJECTIVE

To evaluate the effect of electroacupuncture on rapid gastric emptying by comparing the effectiveness of electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) (He-Mu acupoints) versus electroacupuncture at Zhongwan (CV12) alone.

METHODS

Sixty-five patients were randomly divided into two groups; 33 patients in the He-Mu acupoints group received electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12), while 32 patients in the single acupoint group received electroacupuncture only at Zhongwan (CV12). Both groups were treated once daily for 30 min, five times per week for 3 weeks. Before and after the 3-week treatment course, patients underwent gastric emptying scintigraphy and were assessed using the Traditional Chinese Medicine (TCM) symptom scale of gastrointestinal diseases. The two groups were compared regarding the percentages of gastric retention at 30 and 60 min and the TCM symptom scores.

RESULTS

After the treatment course, the percentages of gastric retention at 30 and 60 min were significantly improved in both groups compared with the pre-treatment values (P < 0.01). The improvement in the gastric retention was significantly better in the He-Mu acupoints group than the single acupoint group at 30 min (P <0.01) and 60 min (P < 0.05). The TCM symptom score was significantly decreased after the treatment course in both groups (P < 0.01). The improvement in the TCM symptom score was significantly better in the He-Mu acupoints group than the single acupoint group (P < 0.01). The total effective rate was 93.55% (29/31) in the He-Mu acupoints group and 77.42% (24/31) in the single acupoint group. The treatment effect was better in the He-Mu acupoints group than the single acupoint group (P < 0.05).

CONCLUSIONS

Electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) or at Zhongwan (CV12) alone is effective in treating rapid gastric emptying. Furthermore, electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) is more effective than electroacupuncture at Zhongwan (CV12) alone.

Study on intelligent syndrome differentiation neural network model of stomachache in traditional Chinese medicine based on the real world

Stomachache is not only disease name of Traditional Chinese medicine (TCM) but also the clinical symptom. It is a common and multiple diseases. TCM has its particular advantage in clinical treatment of stomachache. Syndrome differentiation is an important concept in TCM practice. The therapeutic process is virtually a nonlinear mapping process from clinical symptom to syndrome diagnosis with processing and seeking rules from mass data. Artificial neutral network has strong learning ability for nonlinear relationship. Artificial neutral network has been widely used to TCM area where the multiple factors, multilevel, nonlinear problem accompanied by a large number of optimization exist.We present an original experimental method to apply the improved third-order convergence LM algorithm to intelligent syndrome differentiation for the first time, and compare the predicted ability of Levenberg-Marquardt (LM) algorithm and the improved third-order convergence LM algorithm in syndrome differentiation.In this study, 2436 cases of stomachache electronic medical data from hospital information system, and then the real world data were normalized and standardized. Afterwards, LM algorithm and the improved third-order convergence LM algorithm were used to build the Back Propagation (BP) neural network model for intelligent syndrome differentiation of stomachache on Matlab, respectively. Finally, the differentiation performance of the 2 models was tested and analyzed.The testing results showed that the improved third-order convergence LM algorithm model has better average prediction and diagnosis accuracy, especially in predicting "liver-stomach disharmony" and "stomach yang deficiency", is above 95%.By effectively using the self-learning and auto-update ability of the BP neural network, the intelligent syndrome differentiation model of TCM can fully approach the real side of syndrome differentiation, and shows excellent predicted ability of syndrome differentiation.

Rapid gastric emptying in diabetes mellitus: Pathophysiology and clinical importance

Although slow gastric emptying (gastroparesis) is a well-known complication of chronic hyperglycemia in diabetes mellitus (DM), it recently has become clear that rapid gastric emptying also is a frequent and important diabetic complication. In contrast, acute hyperglycemia causes slow gastric emptying, and acute hypoglycemia causes rapid gastric emptying. Rapid gastric emptying is frequent in T2DM; however, it may also occur in T1DM, particularly in the early stages of the disease, but may persist even into late stages. Recent studies suggest that usually, the stomach restricts the emptying of nutrients to 1-4 kcals/min. This restriction is due to the action of the gastric 'braking' hormones such as GLP-1, leptin, and amylin acting via the gastric inhibitory vagal motor circuit (GIVMC). Disruption of this braking system leads to rapid gastric emptying. Acute hyperglycemia also slows gastric emptying by stimulating the GIVMC, while acute hypoglycemia causes rapid gastric emptying by stimulating the gastric excitatory vagal motor circuit (GEVMC). In contrast, chronic hyperglycemia causes rapid gastric emptying by inducing oxidative stress in the stomach wall that disrupts inhibitory neuromuscular transmission and increases the contractility of the smooth muscle, while chronic hyperglycemia may also cause slow gastric emptying via severe inflammatory stress caused by proinflammatory macrophages and reduce contractility of the smooth muscle. There is a bidirectional relationship between blood glucose and gastric emptying. Thus, rapid gastric emptying may lead to a sizeable postprandial spike, and slow gastric emptying may blunt it. Postprandial hyperglycemia is involved in the development, progression, and complications of DM. Correction of fast gastric emptying involves agents that activate GIVMC and the use of gastric 'braking' hormones or their analogs. Recognition and treatment of rapid gastric emptying may contribute to better management of postprandial hyperglycemia and prevention of some diabetic complications.

Bayesian inverse methods for spatiotemporal characterization of gastric electrical activity from cutaneous multi-electrode recordings

Gastrointestinal (GI) problems give rise to 10 percent of initial patient visits to their physician. Although blockages and infections are easy to diagnose, more than half of GI disorders involve abnormal functioning of the GI tract, where diagnosis entails subjective symptom-based questionnaires or objective but invasive, intermittent procedures in specialized centers. Although common procedures capture motor aspects of gastric function, which do not correlate with symptoms or treatment response, recent findings with invasive electrical recordings show that spatiotemporal patterns of the gastric slow wave are associated with diagnosis, symptoms, and treatment response. We here consider developing non-invasive approaches to extract this information. Using CT scans from human subjects, we simulate normative and disordered gastric surface electrical activity along with associated abdominal activity. We employ Bayesian inference to solve the ill-posed inverse problem of estimating gastric surface activity from cutaneous recordings. We utilize a prior distribution on the spatiotemporal activity pertaining to sparsity in the number of wavefronts on the stomach surface, and smooth evolution of these wavefronts across time. We implement an efficient procedure to construct the Bayes optimal estimate and demonstrate its superiority compared to other commonly used inverse methods, for both normal and disordered gastric activity. Region-specific wave direction information is calculated and consistent with the simulated normative and disordered cases. We apply these methods to cutaneous multi-electrode recordings of two human subjects with the same clinical description of motor function, but different diagnosis of underlying cause. Our method finds statistically significant wave propagation in all stomach regions for both subjects, anterograde activity throughout for the subject with diabetic gastroparesis, and retrograde activity in some regions for the subject with idiopathic gastroparesis. These findings provide a further step towards towards non-invasive phenotyping of gastric function and indicate the long-term potential for enabling population health opportunities with objective GI assessment.

Subjective Hunger, Gastric Upset, and Sleepiness in Response to Altered Meal Timing during Simulated Shiftwork

Shiftworkers report eating during the night when the body is primed to sleep. This study investigated the impact of altering food timing on subjective responses. Healthy participants (n = 44, 26 male, age Mean ± SD = 25.0 ± 2.9 years, BMI = 23.82 ± 2.59kg/m²) participated in a 7-day simulated shiftwork protocol. Participants were randomly allocated to one of three eating conditions. At 00:30, participants consumed a meal comprising 30% of 24 h energy intake (Meal condition; n = 14, 8 males), a snack comprising 10% of 24 h energy intake (Snack condition; n = 14; 8 males) or did not eat during the night (No Eating condition; n = 16, 10 males). Total 24 h individual energy intake and macronutrient content was constant across conditions. During the night, participants reported hunger, gut reaction, and sleepiness levels at 21:00, 23:30, 2:30, and 5:00. Mixed model analyses revealed that the snack condition reported significantly more hunger than the meal group (p < 0.001) with the no eating at night group reporting the greatest hunger (p < 0.001). There was no difference in desire to eat between meal and snack groups. Participants reported less sleepiness after the snack compared to after the meal (p < 0.001) or when not eating during the night (p< 0.001). Gastric upset did not differ between conditions. A snack during the nightshift could alleviate hunger during the nightshift without causing fullness or increased sleepiness.

Association of oral Helicobacter pylori with gastric complications

AIM

This study was aimed to identify the presence of Helicobacter pylori (H. pylori) genes in oral mucosa and find out their relationship between oral H. pylori infection and gastric complications.

METHODS

This study is a case control study consists of 567 subjects with periodontal infection (278 gastric complication cases and 289 controls normal gastric intestinal mucosa) with age range of 20-80 years. Oral health status was recorded by calculating oral hygiene index (OHI), probing depths (PD) and clinical attachment loss (CAL). Each participant provided gastric biopsy and plaque samples which were subjected to H. pylori detection. Polymerase chain reaction (PCR) with different primers specifically β globulin, 16SrRNA, babA, cagA, ureA, ureC and vacA gene was performed which were then analyzed using gel electrophoresis.

RESULTS

No significant differences (χ² = 11.873, p value > 0.05) were observed between oral H. pylori and gastric infections/complications. However, H. pylori increase the risk of developing gastro-esophageal reflux grade II (OR = 1.458, 95%CI = 0.659-3.226), normal upper GIT mucosa with lax esophageal sphincters (OR = 1.215, 95%CI = 0.285-5.181) and duodenal ulcer/duodenitis (OR = 2.187, 95%CI = 0.225-21.278). This study also showed a significant increased risk of gastritis with babA gene.

CONCLUSION

Oral pathogenic H. pylori genes may enhance the severity of the gastric infection.

Mild diabetes: long-term effects on gastric motility evaluated in rats

Moderate hyperglycaemic levels seem to be related to abnormal gastric motility in diabetes mellitus. However, experimental models designed to evaluate the relationship between motility and diabetes over time are not yet well established. Our objective was to investigate the long-term effects of mild diabetes on gastric motility in rats. Newborn male rats received streptozotocin (mild diabetes groups - MD) or vehicle (control groups - C), and both groups were evaluated after 3 (C3 and MD3) and 6 months (C6 and MD6) postinduction. Mild diabetic animals (MD3 and MD6) showed moderately elevated blood glucose and decreased insulin levels compared with control (C3 and C6). Insulin secretion was enhanced in MD6 compared with MD3, most likely due to partial β-cell regeneration indicated by HOMA-β. In HOMA-IR, it was noticed that MD6 animals had impaired insulin response compared with MD3. Gastric emptying was faster, amplitude of contraction was stronger in MD6 compared with MD3, and in both groups, the differences were significant when compared with control animals. A significant abnormal rhythmic index was calculated for the mild diabetic groups, despite unchanged mean frequency of contraction. In conclusion, despite increased insulin levels over time, constant levels of moderate hyperglycaemia are also related to abnormal gastric motility and impairment of gastric function.

[Disorder of Gastric Myoelectric Activity in Patients with Cerebral Infarction:Electrogastrographic Assessment]

In this study, gastric myoelectric activity in patients with acute cerebral infarction was investigated using electrogastrography. The patients were divided into four groups; those with mild brainstem infarction(group A, n=13, men:8, women:5, 75±2 years old), severe brainstem infarction(group B, n=6, men:4, women:2, 79±4 years old), mild non-brainstem infarction(group C, n=14, men:7, women:7, 76±3 years old), and severe non-brainstem infarction(group D, n=9, men:3, women:6, 87±2 years old). In group B, the% ratio of normogastria(2.4-3.6 cycles per minute)was significantly lower in the fasting period. The dominant power(DP)significantly increased after the meal in group C, but did not in group A, compared to before the meal. The DP increased in all patients in group C after the meal, whereas it increased in only five of ten patients in group A. The possibility of gastric dysfunction should be considered in patients with brainstem infarction.

Effects and mechanisms of auricular electroacupuncture on gastric hypersensitivity in a rodent model of functional dyspepsia

Background

Functional dyspepsia (FD) is a common functional gastrointestinal disease, and abdominal pain is one of the main symptoms. The aim of this study was to explore the effects and mechanisms of auricular electro-acupuncture (AEA) on gastric hypersensitivity in a rodent model of FD.

Methods

Ten-day-old pups were gavaged with 0.2 ml of 0.1% iodoacetamide daily for 6 days. AEA at the “stomach” point with different parameters or sham-EA was performed on 8-week-old animals. Gastric sensitivity to gastric distention was measured under different conditions. Autonomic functions were assessed from the spectral analysis of heart rate variability (HRV) derived from the electrocardiogram. Naloxone was injected intraperitoneally before AEA to explore the opioid mechanism. Gastric emptying was measured at the end of the study.

Results

1) Gastric sensitivity to gastric distention was higher in the FD rats. AEA with parameters of 0.1s on, 0.4s off, 100Hz, 0.3ms and 0.4–0.5mA, but not other parameters or sham-EA, decreased gastric hypersensitivity in the FD rats. Naloxone did not block the effect of AEA. 2) Lower vagal activity and higher sympathovagal ratio were noted in the FD rats, compared with the controls. AEA increased vagal activity and improved sympathovagal imbalance.

Conclusions

AEA ameliorates gastric hypersensitivity in FD rats and this effect may be attributed to the improvement of sympathovagal balance.

Hedgehog signaling in the stomach

The Hedgehog (Hh) signaling pathway not only plays a key part in controlling embryonic development, but in the adult stomach governs important cellular events such as epithelial cell differentiation, proliferation, gastric disease, and regeneration. In particular, Sonic Hedgehog (Shh) signaling has been well studied for its role in gastric physiology and pathophysiology. Shh is secreted from the gastric parietal cells and contributes to the regeneration of the epithelium in response to injury, or the development of gastritis during Helicobacter pylori infection. Dysregulation of the Shh signaling pathway leads to the disruption of gastric differentiation, loss of gastric acid secretion and the development of cancer. In this chapter, we will review the most recent findings that reveal the role of Shh as a regulator of gastric physiology, regeneration, and disease.

Association of Endoscopic Esophageal Variceal Ligation with Duodenal Ulcer

OBJECTIVE

To determine the frequency of duodenal ulcer (DU), as well as other clinical characteristics occurring after endoscopic variceal ligation (EVL) of the esophagus.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

The First Affiliated Hospital of Fujian Medical University, Fuzhou, China, from April 2012 to April 2013.

METHODOLOGY

A total of 47 patients with esophageal varices (EVr) who had also undergone EVL and gastroscopic follow-up within 3 months of the procedure was retrospectively analyzed. The status of Helicobacter pylori(Hp) infection, Child-Pugh classification, and the grades of portal hypertensive gastropathy (PHG) were collected. Sixty EVr patients without EVL treatment, but with clinical data available, served as the control group.

RESULTS

The frequency of DU in the EVL group (29.8%, 14/47) was higher than the control group (6.7%, 4/60) (p=0.02). Hp infection rate in EVLgroup was 19.15% (9/47), while in control group was 21.67% (13/60) (p=0.813). Hp positive rate (12.5%, 1/8) in patients exhibited new DUs after EVL was comparable to the patients without DU in the EVL group (12.1%, 4/33) (p=1.00). Patients with DU after EVL received 18.79 &amp;plusmn;8.48 of ligating bands, while in those who did not exhibit DUs received 13.85 &amp;plusmn;6.47 (z = -2.042, p = 0.041). Logistic regression analysis showed that the occurrence of DU was not associated with age, gender, Child-Pugh classification, or the grade of PHG (p &amp;gt; 0.05).

CONCLUSION

Esophageal EVL is associated with a higher frequency of developing DU, which is related to a larger number of applied bands but is not correlated with Hp infection status or other variables.

[INVOLVEMENT OF THE GASTROINTESTINAL TRACT IN RHEUMATIC DISEASES]

AIM

The aim of the present study was to show different aspects of the interrelation between pathology of the gastrointestinal tract and rheumatic diseases based on literature rewiev, single-centers data and case reports.

MATERIALS AND METHODS

First literature review was performed (databases PubMed, Medline). Then was analyzed information according presence of gastrointestinal disease in 126 patients with axial spondyloarthritis (SpA) and collected case reports as illustration the problem.

RESULTS

Involvement of the gastrointestinal tract in rheumatic diseases in general is characterized by clinical, etiologycal and pathogenetic heterogeneity. It was found a few typical combinations: the defeat of the digestive tract as one of the clinical manifestations of rheumatic disease (hemorrhagic vasculitis, etc.); the defeat of the digestive tract and rheumatic disease as equal related conditions (Crohn’s disease and ankylosing spondylitis); the defeat of the digestive tract as a consequence of long-existing inflammation (amyloidosis, esophagus Barrett); gastrointestinal tract involvement as complication of treatment of the rheumatic disease (bleeding when using nonsteroidal anti-inflammatory drugs); rheumatic disease as a manifestation of paraneoplastic syndrome of the digestive tract. The presence of diseases of the gastrointestinal tract is established in more than half (58%) patients with axial SpA. In the group of patients considered the most frequently met gastritis (15%), chronic pancreatitis (15.9%) and chronic cholecystitis (19%).

CONCLUSIONS

Gastrointestinal tract occurs no less than half of the patients with rheumatic diseases and may be either primary or secondary to systemic disease. The possibility of coexistence of diseases of the gastrointestinal tract and rheumatic disease must be taken into account in the course of patient care. In some cases, treatment should be carried out together - a gastroenterologist and a rheumatologist.

[Establishment of animal model with gastric cold syndrome]

This study is to establish the gastric cold model of rats. After gastric feeding with cold water for 5 weeks and extra iced water bath in the last 2 weeks, model group show distinct physical sign of gastric cold syndrome. The pathology of gastrics reveals gastricism of model group, while treatment group(treated with Fanzuojin Wan) show mild lesion. Elisa detection of model group show that the solution of interleukin-2 (IL-2) is higher than blank group. The difference with significance among model group, treatment group and blank group reveals the success of the establishment of gastric cold syndrome.

[Establishment of animal model with gastric hot syndrome]

This study is to establish the gastric hot model of rats. After gastric feeding with ethanol solution for 3 weeks and feeding with extra capsaicin and ethanol solution for another 2 weeks, model group show distinct physical sign of gastric hot syndrome. The pathology of gastrics reveals gastricism of model group, while treatment group (treat with Zuojin Wan) shows mild lesion. Elisa detection of model group show that the solution of interleukin-2 (IL-2) is higher than the blank group. The obvious difference among model group, treatment group and blank group reveals the success of the establishment of gastric hot model.

[Effects of acupuncture stimulation of different acupoint groups on sleeping latency, serum and hippocampal TNF-α and IL-25 contents in rats with gastric mucosal injury]

OBJECTIVE

To observe the effect of acupuncture intervention on gastric ulcer (GU) and sleeping quality from the viewpoint of brain-gut axis which plays an important role in the regulation of many vital functions in the body.

METHODS

Forty male Wistar rats were randomized into normal control, GU model, acupuncture of "Zhongwan"(CV 12)-"Zusanli"(ST 36, gastric function regulating acupoints), acupuncture of "Shenmai" (BL 62)-"Zhaohai" (KI 6, sleep-promotion acupoints), and acupuncture of CV 12-ST 36+ BL 62-KI 6 (combined treatment) groups, with 8 rats in each group. GU model was established by intragastric perfusion of dehydrated alcohol (1 mL/rat), and sleep model established by intraperitoneal injection of pentobarbital sodium (40 mg/kg) after the last treatment. The abovementioned acupoints were punctured with filiform needles and stimulated by manipulating the needle for about 30 s, once every 5 min during 20 min of needle retention. The treatment was conducted once daily for five days. The contents of tumor necrosis factor-alpha (TNF-α) and interleukin-25(IL-25) in the serum and hippocampal tissues were detected by ELISA.

RESULTS

Compared with the normal control group, the gastric ulcer index score, barbiturate-induced sleeping time, and TNF-α and IL-25 contents in both serum and hippocampus were significantly increased in the model group (P < 0.01). Following acupuncture treatment, in comparison with the model group, the gastric ulcer index score, barbiturate-induced sleeping time, and TNF-α and IL-25 contents in both serum and hippocampus were significantly down-regulated in the CV 12-ST 36, BL 62-KI 6 and combined treatment groups (P < 0.01, P < 0.05). The effects of the CV 12-ST 36 and combined treatment groups were remarkably superior to those of the BL 62-KI 6 group in down-regulating ulcer index score, serum IL-25, and hippocampal TNF-α and IL-25 contents (P < 0.01, P < 0.05). In addition, the effects of the BL 62-KI 6 and combined treatment groups was considerably better than that of the CV 12-ST 36 group in shortening barbiturate-induced sleeping time (P < 0.01, P < 0.05). The effect of the combined treatment group was markedly better than that of the CV 12-ST 36 and BL 62-KI 6 groups in lowering serum TNF-α content (P < 0.05).

CONCLUSION

Acupuncture stimulation of CV 12, ST 36, KI 6 and BL 62 can relieve the gastric mucosal lesion, and shorten barbiturate-induced sleeping time in gastric ulcer rats, which may be related to its effects in reducing TNF-α and IL-25 contents in the serum and hippocampus tissues, suggesting a correlation between the gastrointestinal disorder and sleeping.

[ABOUT CO-OCCURRENCE OF CRHONIC PANCREATITIS WITH GASTRODUODENAL DISEASES]

The article summarizes clinical features of the course when chronic pancreatitis goes in combination with diseases of gastroduodenal and hepatobiliary systems and features of functional and morphological changes. The article also represents justification of need to include the combined medicine Doktovit (combination of Dexpanthenol and S-methylmethionine) into complex treatment of the pathology, describes mechanism of its gastro protective and reparative action.

[FEATURES OF FUNCTIONAL DISORDERS GASTRODUODENOBILIARY SYSTEM IN PATIENTS WITH CELIAC DISEASE]

The disturbances in synchronous functioning of gastroduodenal and biliary system and in their consequent interaction underlies functional disorders of the digestive tract. Motor and evacuation functioning of the gastrointestinal tract depends on the bile flow to the duodenum, which influences on digestive processes. Functional disorders of the biliary tract, contributing disturbances of the gastrointestinal motor activity, cause gastrointestinal symptoms. The cause of biliary dysfunctions often are gallbladder anomalies, which are accompanied by disturbances in drainage system of bile flow, development of the pathological refluxes, inflammation and formation of the biliary sludge. The progression of the biliary system deflux dysfunction leads to motor and evacuation dysfunction of the gut. According to the numerous data, gall bladder anomalies, which underlies functional disorders in bile deflux, are common in patients with coeliac disease. The results, obtained in the conducted research, revealed hypertonic hyperkinetic motor disorders of the upper part of the gastrointestinal tract and inflammation changes of the gastroduodenal zone in patients with coeliac disease with fixed bend in the gallbladder neck, necking and different deformation of the gallbladder, which are the visceral signs of undifferentiated connective tissue dysplasia. Disorders in every component of the digestive tract upper part motor activity lead to the corresponding clinical manifestations.

Does Braun enteroenterostomy reduce delayed gastric emptying after pancreaticoduodenectomy?

Whether an additional Braun enteroenterostomy is necessary in reducing delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) has not yet been well investigated. Herein, in this retrospective study, 395 consecutive cases of patients undergoing classic PD from 2009 to 2013 were reviewed. Patients with and without Braun enteroenterostomy were compared in preoperative baseline characteristics, surgical procedure, postoperative diagnosis, and morbidity including DGE. The DGE was defined and classified by the International Study Group of Pancreatic Surgery recommendation. The incidence of DGE was similar in patients with or without Braun enteroenterostomy following PD (37/347, 10.7% vs 8/48, 16.7%, P = 0.220). The patients in the 2 groups were not different in patient characteristics, lesions, surgical procedure, or postoperative complications, although patients without Braun enteroenterostomy more frequently presented postoperative vomiting than those with Braun enteroenterostomy (33.3% vs 15.3%, P = 0.002). Bile leakage, pancreatic fistula, and intraperitoneal abscess were risk factors for postoperative DGE (all P < 0.05). Prokinetic agents and acupuncture were effective in symptom relief of DGE in 24 out of 45 patients and 12 out of 14 patients, respectively.The additional Braun enteroenterostomy following classic PD was not associated with a decreased rate of DGE. Postoperative abdominal complications were strongly correlated with the onset of DGE. Prokinetic agents and acupuncture could be utilized in some patients with DGE.

Characteristics of fluid composition of left displaced abomasum in beef cattle fed high-starch diets

To clarify the pathophysiology of left displaced abomasum (LDA), beef cattle fed high-starch diets were examined. The abomasal pH in beef cattle with LDA was lower than that in non-LDA reference animals (data from beef cattle at an abattoir), suggesting that it facilitated acidity. Bacteriological examinations of the abomasal fluid in cattle with LDA revealed the presence of Pseudomonas spp., Clostridium spp. and Candida spp., presumably reflecting the accelerated influx of ruminal fluid into the abomasum. Biochemical analyses of serum revealed that LDA cattle had higher lactic acid and lower vitamin A and E levels than non-LDA reference animals. These results indicate that beef cattle with LDA may suffer from vitamin A and E deficiencies due to maldigestion of starch and the high acidity of abomasal fluid.

[Differential diagnosis of motor-evacuatory function disorders of the stomach and intestines in patients in early postoperative period]

Incorrect estimation of disorders of intestinal motility can lead to worsening of treatment results and development postoperative complications. The analysis of computeric peripheral electrogastroenterography date is presented, that to permit allow maximally objectify and accelerate receiving information about intestinal function in pre- and postoperative period.

The protective effect of apelin against water-immersion and restraint stress-induced gastric damage

The aim of the present study was to investigate the gastroprotective effect of apelin on water-immersion and restraint stress (WIRS)-induced gastric lesions. Male Wistar rats were divided into four groups: control, WIRS, F13A + WIRS and F13A. APJ receptor antagonist F13A was administered to rats to determine the influence of apelin on stress-induced gastric injury. WIRS administered for 6 h resulted in the development of gastric mucosal lesions accompanied by a significant increase in plasma corticosterone. WIRS increased the concentration of 4-hydroxynonenol (4-HNE) + malondialdehyde (MDA) and the expression of apelin and hypoxia inducible factor-1α (HIF-1α) in gastric mucosa. In addition, WIRS reduced the mucosal blood flow and gastric prostaglandin E(2) (PGE(2)) concentration. Plasma corticosterone, which was increased due to stress, was significantly decreased in the F13A + WIRS group. Gastric lesions and the 4-HNE + MDA concentration were also higher in the F13A + WIRS compared to the WIRS group. We conclude that apelin has a gastroprotective effect against stress-induced lesions possibly by reducing lipid peroxidation in gastric mucosa.

[Gastric sarcoidosis]

Sarcoidosis is a multisystemic disease of unknown etiology characterized by formation of non-caseificating epithelioid cell granulomas in affected organs. The clinically manifest involvement of the gastrointestinal tract (GIT) in the pathological process is documented in less than 1% of the patients, with stomach being involved in 10% ofthe cases. Pancreatic sarcoidosis is a very rare occurrence. Gastric sarcoidosis (GS) is usually an isolated disease but may be just as well a component of a generalized process. Isolated GS is as a rule a latent condition, its clinical symptoms (epigastric pain, nausea, vomiting) develop in association with erosion and ulceration of gastric mucosa. An endoscopic study of upper GIT may reveal narrowing of the distal half of the stomach with pre-pyloric ulcers or erosion and atrophy; thickened gastric folds may show up diffuse manifestations in the form of a "cobblestone pavement". The leading role in GS diagnostics is played by a histological study of gastric biopsies demonstrating classical sarcoid non-caseificating epithelioid cell granulomas. Treatment of GS must include intake of glucocorticoids and proton pump inhibitors.

Effects of ghrelin on gastric distention sensitive neurons in the arcuate nucleus of hypothalamus and gastric motility in diabetic rats

This study was performed to observe the effects of ghrelin on the activity of gastric distention (GD) sensitive neurons in the arcuate nucleus of hypothalamus (Arc) and on gastric motility in vivo in streptozocin (STZ) induced diabetes mellitus (DM) rats. Electrophysiological results showed that ghrelin could excite GD-excitatory (GD-E) neurons and inhibit GD-inhibitory (GD-I) neurons in the Arc. However, fewer GD-E neurons were excited by ghrelin and the excitatory effect of ghrelin on GD-E neurons was much weaker in DM rats. Gastric motility research in vivo showed that microinjection of ghrelin into the Arc could significantly promote gastric motility and it showed a dose-dependent manner. The effect of ghrelin promoting gastric motility in DM rats was weaker than that in normal rats. The effects induced by ghrelin could be blocked by growth hormone secretagogue receptor (GHSR) antagonist [d-Lys-3]-GHRP-6 or BIM28163. RIA and real-time PCR data showed that the levels of ghrelin in the plasma, stomach and ghrelin mRNA in the Arc increased at first but decreased later and the expression of GHSR-1a mRNA in the Arc maintained a low level in DM rats. The present findings indicate that ghrelin could regulate the activity of GD sensitive neurons and gastric motility via ghrelin receptors in the Arc. The reduced effects of promoting gastric motility induced by ghrelin could be connected with the decreased expression of ghrelin receptors in the Arc in diabetes. Our data provide new experimental evidence for the role of ghrelin in gastric motility disorder in diabetes.

[On the mechanism of action of cryomassage of the abdominal wall in the patients presenting with gastroduodenal pathology]

The mechanism of action of cryomassage of the abdominal wall in the patients presenting with gastroduodenal pathology is considered. The authors suppose that the positive effect of cryotherapy is underlain by normalization of microcirculation in the digestive organs and the resulting improvement of energy and plastic support of intracellular processes, e.g. phosphorylation.

Influence of percutaneous local therapy for hepatocellular carcinoma on gastric function

AIM: To investigate the influence of percutaneous local therapy on gastric myoelectrical activity in patients with hepatocellular carcinomas.

METHODS: Forty-four patients with hepatocellular carcinoma (HCC) [27 males and 17 females, ranging in age from 49 to 81 years old (69.7 ± 8.01 years)] who were admitted for percutaneous local therapy were enrolled in this study. We examined clinical abdominal symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) before and 3 d after percutaneous local therapy. We also measured cutaneous fasting and postprandial electrogastrography (EGG) recordings before and 3 d after percutaneous local therapy.

RESULTS: We found that the percentage of normogastria in the fasting period was lower in the Child B group than in the Child A group (66.8% ± 8.6% vs 84.0% ± 3.8%). After percutaneous local therapy for HCC, the percentages of normogastria in the fasting period were significantly decreased (81.6% ± 3.5% vs 75.2% ± 4.5%). None of the postprandial EGG parameters changed significantly after percutaneous local therapy for HCC. Percutaneous local therapy for HCC reduced the power ratio (PR). In particular, the PR of tachygastria was significantly decreased after therapy (P < 0.01). However, no significant differences were found in the postprandial EGG parameters. Likewise, no significant differences were found in the calculated GSRS scores obtained from the questionnaire before and after therapy.

CONCLUSION: Gastric slow-wave dysrhythmias were induced by percutaneous local therapy in HCC patients, even though the GSRS scores obtained from the questionnaire did not change significantly.

[Theoretical and clinical application of insomnia caused by "stomach disorder could lead to excess of yang-qiao meridian"]

To explore the mechanism of insomnia caused by "stomach disorder could lead to excess of yang-qiao meridian" and clinical application of treating insomnia with acupoints in qiao meridian as the main points. From meridian theory, intersection between stomach meridian of Foot-Yangming and yang-qiao meridian is through Chengqi (ST 1). Qiao meridian for sleep is mainly because it is connected with eyes through the Bladder Meridian of Foot-Taiyang. For Stomach Meridian of Foot-Yangming is intersected with the Bladder Meridian of Foot-Taiyang in Jingming (BL 1), and intersected with yin and yang qiao meridian beside the mouth and under the eye, once functional disorder of the stomach, it can affect qi movements of the whole body and give rise to various pathological changes that cause insomnia. Meanwhile examples are given to explain the clinical application of treating subborn insomnia with corresponding acupoint of stomach and yang-qiao meridian.

Physiology of the ageing gut

PURPOSE OF REVIEW

This article will review the recent publications (over the last 1-2 years) concerning the effects of ageing on gastrointestinal function, with an emphasis on the motor and sensory function of the gut.

RECENT FINDINGS

Recent publications support earlier observations of an age-related selective decline in the number of cholinergic neurons in the enteric nervous system, but also reveal a progressive loss of interstitial cells of Cajal in the stomach and colon throughout adult life. These changes appear to have surprisingly little effect on gastrointestinal motor function in healthy ageing, although gut sensation is impaired and older individuals have an increased susceptibility to gastrointestinal complications of comorbid illnesses.

SUMMARY

Alterations in gut function with ageing have particular implications in the oesophagus, colon, and anorectum. Dysphagia, gastro-oesophageal reflux disease, constipation, and faecal incontinence are the most prevalent clinical manifestations. Older individuals are also susceptible to postprandial hypotension, in which altered cardiovascular responses to intestinal nutrient exposure are pivotal. Dysphagia, delayed gastric emptying, and constipation are increasingly being recognized as early features of Parkinson's disease, and frequently precede the neurological manifestations.

Gastric electrical stimulation decreases gastric distension-induced central nociception response through direct action on primary afferents

Background & Aims

Gastric electrical stimulation (GES) is an effective therapy to treat patients with chronic dyspepsia refractory to medical management. However, its mechanisms of action remain poorly understood.

Methods

Gastric pain was induced by performing gastric distension (GD) in anesthetized rats. Pain response was monitored by measuring the pseudo-affective reflex (e.g., blood pressure variation), while neuronal activation was determined using c-fos immunochemistry in the central nervous system. Involvement of primary afferents was assessed by measuring phosphorylation of ERK1/2 in dorsal root ganglia.

Results

GES decreased blood pressure variation induced by GD, and prevented GD-induced neuronal activation in the dorsal horn of the spinal cord (T9–T10), the nucleus of the solitary tract and in CRF neurons of the hypothalamic paraventricular nucleus. This effect remained unaltered within the spinal cord when sectioning the medulla at the T5 level. Furthermore, GES prevented GD-induced phosphorylation of ERK1/2 in dorsal root ganglia.

Conclusions

GES decreases GD-induced pain and/or discomfort likely through a direct modulation of gastric spinal afferents reducing central processing of visceral nociception.

Gastrointestinal involvement in spinal cord injury: a clinical perspective

Bowel problems occur in 27% to 62% of patients with spinal cord injuries (SCI), most commonly constipation, distention, abdominal pain, rectal bleeding, hemorrhoids, bowel accidents, and autonomic hyperreflexia. The acute abdomen, with a mortality of 9.5%, does not present with rigidity or absent bowel sounds but rather with dull/poorly-localized pain, vomiting, or restlessness, with tenderness, fever, and leukocytosis in up to 50% of patients. Fecal impaction may present with anorexia and nausea. Methods used for bowel care include laxatives, anal massage, manual evacuation, and enemas. Randomized, double-blind studies demonstrated the effectiveness of neostigmine, which increases cholinergic tone, combined with glycopyrrolate, an anticholinergic agent with minimal activity in the colon that reduces extracolonic side-effects. Improved bowel function occurs with anterior sacral root stimulators which may be combined with an S2 to S4 posterior sacral rhizotomy which interrupts the reflex arc by cutting the posterior roots carrying the spasticity-causing sensory nerves. For severe constipation, a colostomy reduces time for bowel care, providing a clean environment so decubitus ulcers may heal. Gallstones occur in 17% to 31% of patients, and acalculous cholecystitis in 3.7% of patients with acute SCI. A high index of suspicion is needed to properly diagnose bowel problems in SCI.

Experimental soybean meal intoxication in cattle

BACKGROUND

Cattle are commonly fed soybean meal (SBM) and accidental intoxication sometimes occurs.

OBJECTIVES

To describe the biologic and clinical features of SBM intoxication.

ANIMALS

Four steers with ruminal cannula.

METHODS

Controlled experimental trial. SBM was administered once at 1 and 2% of body weight (BW) via cannula at 2-month intervals.

RESULTS

This study showed a 2-phase pathogenic course for 2% BW SBM intoxication. The 1st phase (until 10 hours post-administration) is restricted to ruminal modification with volatile fatty acid overproduction and moderate ruminal ammonia concentration. In the 2nd phase (12-22 hours post-administration), ruminal pH returned to initial values and marked ammonia accumulation occurred in blood, inducing severe metabolic alkalosis with hyperglycemia, hyperinsulinemia, and delayed aciduria (30-40 hours post-administration). Among the clinical signs, nervous signs were only observed during the period with increased plasma ammonia concentration. At 1% BW, ruminal and blood modifications were less pronounced than at 2% BW, and clinical signs were not observed.

CONCLUSIONS AND CLINICAL RELEVANCE

Ammonia accumulation in blood during the second phase is the consequence of continued ammonia production, decreased carbohydrate fermentation, and overwhelming of hepatic detoxifying capacity. Because ammonia accumulation is associated with the clinical signs, treatment of SBM intoxication could be similar to treatment of urea intoxication, including rumenotomy, oral administration of cold water and vinegar, and measurement of ruminal pH.

The mechanisms of gastric mucosal injury: focus on microvascular endothelium as a key target

This paper reviews and updates current views on gastric mucosal injury with a focus on the microvascular endothelium as the key target and the role of the anti-apoptosis protein survivin. Under normal conditions, mucosal integrity is maintained by well structured and mutually amplifying defense mechanisms, which include pre-epithelial "barrier"--the first line of defense; and, an epithelial "barrier". Other important defense mechanisms of gastric mucosa include: continuous epithelial cell renewal, blood flow through mucosal microvessels (providing oxygen and nutrients), an endothelial microvascular "barrier," sensory innervation, and generation of PGs, nitric oxide and hydrogen sulfide. The microvascular endothelium lining gastric mucosal blood microvessels severs not only as a barrier but is a biologically active tissue involved in many synthetic and metabolic functions. It allows transport of oxygen and nutrients, and produces prostaglandins and leukotriens, procoagulant factors, nitric oxide, endothelin, ghrelin, HSP, growth factors such VEGF, bFGF, angiopoietin 2 and others, specific types of collagen, plasminogen activator, and can also actively contract. Accumulating evidence indicates that the gastric microvascular endothelium is a critical target for injury by ethanol, NSAIDs, free radicals, ischemia-reperfusion and other damaging factors. The injury--microvessel rupture, plasma and erythrocyte extravasation, platelet aggregation and fibrin deposition caused by these damaging factors--occurs early (1-5 min), precedes glandular epithelial cell injury and results in cessation of blood flow, ischemia, hypoxia and impaired oxygen and nutrient transport. As a consequence, mucosal necrosis develops. One of the main reasons for the increased susceptibility of gastric microvascular endothelial (vs. epithelial) cells to injury is reduced expression levels of survivin, an anti-apoptosis protein, which is a regulator of both proliferation and cell survival.

Gastric dysfunction in dialysed patients with chronic renal failure

BACKGROUND

Gastric motor functions are disturbed in patients with chronic renal failure (CRF). The aim of this study was to find the relationship between GI symptoms, gastric myoelectrical activity and regulatory peptides (gastrin, motilin, VIP, CCK) in patients with CRF treated with hemodialyses (HD) and peritoneal dialyses (CAPD).

METHODS

Gastric myoelectric activity was evaluated with cutaneously recorded electrogastrographs (EGGs) measurement in: group A: 23 pts with CRF treated with CAPD, group B: 21 pts treated with HD and group C: 48 matched healthy controls. GI symptoms severity was quantified with specially designed questionnaire. The laboratory evaluation of plasma parameters, such as: gastrin, motilin, VIP and CCK was performed.

RESULTS

The patients with CRF treated with CAPD and HD showed a significantly lower percentage of normal 2-4 cpm wave's rhythm in both fasting (65.3 +/- 29.3% vs 43.5 +/- 35.9% vs 86.4 +/- 10.2%) and fed conditions (72.7 +/- 34.2% vs 69.5 +/- 22.1% vs 89.3 +/- 9.5%) in comparison to controls. In the fasting state, none of the healthy controls had an abnormal EGG, whereas the 27 patients with CRF (61.3%) had an abnormal EGG. In the fed state the 18 patients with CRF (40.9%). No significant increase of the dominant power (PDP) after meal in CRF patients was observed. The plasma concentrations of gastrin, CCK were increased in fasted and fed CRF patients, whereas VIP and motilin only in fed state.

CONCLUSIONS

The patients with CRF showed impaired gastric myoelectrical activity in response to food and high levels of GI hormones. Gastric dysmotility and high peptides appears to be partially responsible for GI symptoms.

Obstructive and inflammatory gastric heterotopic pancreatic tissue

Heterotopic pancreas is defined as pancreatic tissue arising ectopically with no vascular or anatomic contiguity with the pancreas proper and is believed to arise embryologically during rotation of the foregut and fusion of the dorsal and ventral pancreatic buds. We report a case of gastric heterotopic pancreas presenting as an obstructive inflammatory mass with the clinical differential diagnosis of gastric carcinoma. A 54 year-old woman presented with a history of four days of severe, acute-onset abdominal pain. Abdominal ultrasound showed a gastric antral mass. This was confirmed on computerized tomography, which revealed a hypo-dense mass with heterogeneous enhancement in the gastric antrum and multiple ill-defined hypo-dense areas in the liver suspicious for metastases. A preoperative diagnosis of malignant neoplasm was strongly favored, and a subtotal gastrectomy was performed. Microscopic examination of the specimen revealed submucosal and deeply seated intra-muscular and mural heterotopic pancreatic tissue, comprised of both ductal and acinar structures, surrounded by exuberant acute and chronic inflammation. The ducts were inflamed and showed marked cytologic atypia, favored to be of reactive nature. There was overlying mucosal ulceration with marked acute and chronic full-thickness gastric mural inflammatory response with abscess formation. This is the second reported case of obstructive gastric heterotopic pancreas, presenting as an inflammatory mural gastric mass.

The management of portal hypertensive gastropathy and gastric antral vascular ectasia

Portal hypertensive gastropathy and gastric antral vascular ectasia are gastric mucosal lesions that can cause chronic gastrointestinal haemorrhage and, consequently, chronic anaemia, in patients with cirrhosis. Although chronic anaemia is the most common clinical manifestation, these entities may also lead to acute gastrointestinal bleeding. Despite similar clinical manifestations, their pathophysiology and management are entirely different. Their diagnosis is endoscopic and although generally each of them has a characteristic endoscopic appearance and distribution, there are cases in which the differential is difficult and must rely on histology. This review focuses on the management of both entities. The mainstay of management of portal hypertensive gastropathy is based on portal-hypotensive pharmacological treatment whilst gastric antral vascular ectasia benefits from endoscopic therapy. More invasive options should be reserved for refractory cases.

[Specific formation of esophageal autotransplant in the compromized and resected stomach]

An experience with 60 operated patients allows introduction of accuracy in the idea of possibility to use the compromised with different diseases and surgical procedures stomach in plasty of the esophagus. Technical specific features of forming the transplant are developed. Practicability of esophageal plasty with the small bowel using the loop of the bowel involved in digestive anastomoses is shown. In nonstandard situations the success of surgery is determined by an individual choice of plastic material, using reconstructive vascular surgery and rational method of placing the transplant.

The clue of Interstitial Cell of Cajalopathy (ICCpathy) in human diabetic gastropathy: the ultrastructural and electrical clues of ICCpathy in human diabetic gastropathy

Recent studies of diabetic animal models suggest an important role of ICC in the pathogenesis of gastropathy. The aim of this study was to characterize the ultrastructural features of ICC and record the electrical properties in the stomach of patients with type 2 DM. Gastric specimens were obtained from 13 diabetic patients and 6 control subjects with gastric cancer that underwent gastrectomy. All specimens were taken from disease-free areas. The samples were processed for both electron microscopic and electrophysiologic examination. The characteristic ultrastructural changes of the ICC were observed in both the nucleus and cytoplasm in patients with type 2 DM. Wrinkling of the nuclear envelope and changes in the cytoplasm such as dilatation of the endoplasmic reticulum, an increase of autophagic vacuoles, were more frequently observed in the diabetic patients. Apoptosis characterized by nuclear karyorrhexis or pyknosis was observed only in the diabetic patients. Slow waves were recorded in the circular muscle of stomach. In diabetic patients, the mean resting membrane potential was higher and amplitude was lower than controls. These changes of electrical activities of slow waves were accompanied with ultrastructural changes of ICC, particularly the characteristic nuclear changes. In human diabetic patients, the characteristic ultrastructural changes of ICC such as preapoptosis, accompanied with electrical dysrhythmia of slow waves, were observed. These results show several evidence converging to support that degeneration of the ICC may be associated with the pathogenesis of diabetic gastropathy.

Gallic acid prevents nonsteroidal anti-inflammatory drug-induced gastropathy in rat by blocking oxidative stress and apoptosis

Nonsteroidal anti-inflammatory drug (NSAID)-induced oxidative stress plays a critical role in gastric mucosal cell apoptosis and gastropathy. NSAIDs induce the generation of hydroxyl radical ((*)OH) through the release of free iron, which plays an important role in developing gastropathy. Thus, molecules having both iron-chelating and antiapoptotic properties will be beneficial in preventing NSAID-induced gastropathy. Gallic acid (GA), a polyphenolic natural product, has the capacity to chelate free iron. Here, we report that GA significantly prevents, as well as heals, NSAID-induced gastropathy. In vivo, GA blocks NSAID-mediated mitochondrial oxidative stress by preventing mitochondrial protein carbonyl formation, lipid peroxidation, and thiol depletion. In vitro, GA scavenges free radicals and blocks (*)OH-mediated oxidative damage. GA also attenuates gastric mucosal cell apoptosis in vivo as well as in vitro in cultured gastric mucosal cells as evident from the TUNEL assay. GA prevents NSAID-induced activation of caspase-9, a marker for the mitochondrial pathway of apoptosis, and restores NSAID-mediated collapse of the mitochondrial transmembrane potential and dehydrogenase activity. Thus, the inhibition of mitochondrial oxidative stress by GA is associated with the inhibition of NSAID-induced mitochondrial dysfunction and activation of apoptosis in gastric mucosal cells, which are responsible for gastric injury or gastropathy.

Characterization of gastric electrical activity using magnetic field measurements: a simulation study

Gastric disorders are often associated with abnormal propagation of gastric electrical activity (GEA). The identification of clinically relevant parameters of GEA using noninvasive measures would therefore be highly beneficial for clinical diagnosis. While magnetogastrograms (MGG) are known to provide a noninvasive representation of GEA, standard methods for their analysis are limited. It has previously been shown in simplistic conditions that the surface current density (SCD) calculated from multichannel MGG measurements provides an estimate of the gastric source location and propagation velocity. We examine the accuracy of this technique using more realistic source models and an anatomically realistic volume conductor model. The results showed that the SCD method was able to resolve the GEA parameters more reliably when the dipole source was located within 100 mm of the sensor. Therefore, the theoretical accuracy of SCD method would be relatively diminished for patients with a larger body habitus, and particularly in those patients with significant truncal obesity. However, many patients with gastric motility disorders are relatively thin due to food intolerance, meaning that the majority of the population of gastric motility patients could benefit from the methods developed here. Large errors resulted when the source was located deep within the body due to the distorting effects of the secondary sources on the magnetic fields. Larger errors also resulted when the dipole was oriented normal to the sensor plane. This was believed to be due to the relatively small contribution of the dipole source when compared to the field produced by the volume conductor. The use of three orthogonal magnetic field components rather than just one component to calculate the SCD yielded marginally more accurate results when using a realistic dipole source. However, this slight increase in accuracy may not warrant the use of more complex vector channels in future superconducting quantum interference device designs. When multiple slow waves were present in the stomach, the SCD map contained only one maximum point corresponding to the more dominant source located in the distal stomach. Parameters corresponding to the slow wave in the proximal stomach were obtained once the dominant slow terminated at the antrum. Additional validation studies are warranted to address the utility of the SCD method to resolve parameters related to gastric slow waves in a clinical setting.

Can gastric cancer be prevented?

Gastric adenocarcinoma is the fourth most common malignancy worldwide and is globally the second leading cause of cancer-related deaths each year. Among the risk factors are genetic factors (genetic diffuse gastric cancer - E-cadherin mutation (CDH1), pro- and anti-inflammatory cytokine genes and innate immune response gene polymorphisms), environmental factors (infection with the bacterium Helicobacter pylori (H. pylori), Epstein-Barr virus, nutrition: nitroso compounds, salt and antioxidants intake) and other factors (pernicious anemia, gastric polyps, gastric surgery, reproductive hormones, smoking). The bacterium H. pylori has been found to be the major carcinogen in gastric cancer development. Approximately 65%-80% of non-cardia gastric adenocarcinoma is attributable to H. pylori infection. One percent of patients infected with H. pylori will develop gastric cancer. American and European guidelines on the management of H. pylori infection recommend H. pylori eradication in all patients with atrophy and/or intestinal metaplasia and in all first-degree relatives of gastric cancer patients. In the Asian Pacific Gastric Cancer Consensus, it was suggested for the first time that it is time for population-based screening and treatment of H. pylori infection in regions with gastric cancer incidence above 20/100000 per year. Population screen and treat of H. pylori infection should be recommended in regions with gastric cancer incidence above 20/100000 per year. This can be a good approach in H. pylori infected patients before they develop premalignant gastric lesions. In patients with intestinal metaplasia, atrophy or dysplasia, regular endoscopic and histological surveillance should be done.

Mucosal strengthening activity of central and peripheral melatonin in the mechanism of gastric defense

This review summarizes the involvement of centrally and peripherally applied melatonin, a major hormone of pineal gland, in the mechanism of gastric mucosal integrity, gastroprotection and ulcer healing. Melatonin was originally shown to attenuate gastric mucosal lesions but the controversy exists in the literature as to whether melatonin derived from the pineal gland, considered as the major source of this indole or rather that locally generated from L-tryptophan within gastric mucosa, plays predominant role in the mechanism of gastrointestinal integrity. Both, intragastric (i.g.) and intracerebroventricular (i.c.v.) administration of melatonin and its precursor, L-tryptophan to rats without or with removed pineal gland by pinealectomy attenuates in the dose-dependent manner the formation of on gastric lesions induced by topical irritants and water immersion restraint stress (WRS). Melatonin accelerated the gastric ulcer healing and this was accompanied by the rise in gastric blood flow (GBF), the plasma melatonin and gastrin levels, the mucosal generation of PGE(2) and luminal NO content. Pinealectomy, which suppresses the plasma melatonin levels, markedly aggravated the gastric lesions induced by WRS. Concurrent supplementation of pinealectomized animals with melatonin or L-tryptophan, the melatonin precursor, attenuated the lesions induced by WRS. Treatment with luzindole, an antagonist of Mel(2) receptors, or with L-NNA, the NO-synthase inhibitor, significantly attenuated melatonin- and L-tryptophan-induced protection and the acceleration of ulcer healing and the accompanying increase in the GBF and luminal content of NO. We conclude that 1) exogenous melatonin and that released from the L-tryptophan attenuate lesions induced by topical irritant such as ethanol and WRS via interaction with MT(2) receptors and due to an enhancement of gastric microcirculation, probably mediated by NO and PG derived from cNOS, iNOS and COX-2 overexpression and activity, and 2) the pineal gland plays an important role in the limitation of WRS-induced gastric lesions and acceleration of ulcer healing via releasing melatonin predominately at night time, that exerts gastroprotective and ulcer healing actions.

c-Fos expression in the supraoptic nucleus is the most intense during different durations of restraint water-immersion stress in the rat

Restraint water-immersion stress (RWIS) can induce anxiety, hypothermia, and severe vagally-mediated gastric dysfunction. The present work explored the effects of different durations of RWIS on neuronal activities of the forebrain by c-Fos expression in conscious rats exposed to RWIS for 0, 30, 60, 120, or 180 min. The peak of c-Fos induction was distinct for different forebrain regions. The most intense c-Fos induction was always observed in the supraoptic nucleus (SON), and then in the hypothalamic paraventricular nucleus (PVN), posterior cortical amygdaloid nucleus (PCoA), central amygdaloid nucleus (CeA), and medial prefrontal cortex (mPFC). Moreover, body temperature was reduced to the lowest degree after 60 min of RWIS, and the gastric lesions tended to gradually worsen with the prolonging of RWIS duration. These data strongly suggest that these nuclei participate in the organismal response to RWIS to different degrees, and may be involved in the hypothermia and gastric lesions induced by RWIS.