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Peptic ulcer disease is a major cause of morbidity and mortality in the US with more than six million diagnoses annually. Ulcers are reported as the most common cause of hospitalization for upper gastrointestinal (GI) bleeding and are often a clinical concern due to the widespread use of aspirin and nonsteroidal anti-inflammatory drugs, both of whi...
Similar publications
Endoscopic hemostasis is the first-line treatment for upper gastrointestinal bleeding (UGIB). Although several factors are known to be risk factors for rebleeding, little is known about the use of antithrombotics. We tried to verify whether the use of antithrombotics affects rebleeding rate after a successful endoscopic hemostasis for peptic ulcer...
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Background: Current knowledge about clinical and genetic risk factors for aspirin-induced gastric mucosal injury is not sufficient to prevent these gastric mucosal lesions.
Methods: We recruited aspirin takers as the exposed group and healthy volunteers as the control group. The exposed group was categorized into two subgroups such as subgroup A as...
Background & Aims
The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors might therefore be involved in the pathogenesis of GIB. Pa...
AIM
To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients.
METHODS
We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid cond...
Non-steroidal anti-inflammatory drug (NSAID) use increases the risk of gastrointestinal complications such as ulcers or bleeding. The presence of factors like advanced age, history of peptic ulcer, Helicobacter pylori infection and the use of anticoagulants or antiplatelet agents increase this risk further. COX-2 inhibitors and antisecretory drugs,...
Citations
... The inhibition of gastric acid secretion is an effective strategy in patients with GERD, peptic ulcers, and low-dose aspirin (LDA) or non-steroidal anti-inflammatory drug (NSAID)induced peptic ulcers [7,8]. Proton pump inhibitors (PPIs) first appeared in the late 1980s. ...
... Patients with a past history of taking gastric acid suppression therapy and/or gastroesophageal surgery, such as gastrectomy or gastric mucosal resection, other than appendectomy, cholecystectomy or endoscopic-assisted resection of the benign tumor (4) Patients with signs and symptoms such as odynophagia, severe dysphagia, bleeding, weight loss, anemia or hematochezia, which are suggestive of gastrointestinal malignancies (5) Patients with Zollinger-Ellison syndrome (6) Patients with eosinophilic esophagitis (7) Patients with clinically notable abnormalities in the liver, kidney, neurologic system, respiratory system, endocrine system, hemato-oncologic system, cardiovascular system and urologic system (8) Patients with a past history of malignancies within the past five years (9) Patients with psychiatric disorder (10) Patients with a past history of drug or alcohol abuse (11) Patients with AIDS, HBs antigen-positive or HCV antibody-positive hepatitis or those with viral carriers (12) Patients with hypersensitivity reactions or a past history of clinically notable hypersensitivity to drugs containing active constituents of esomeprazole or other similar drugs (e.g., benzimidazoles and antibiotics) (13) Patients who were given any drugs that may affect the results of the current study; these include NSAIDs, acetaminophen, anti-gastric secretion drugs (e.g., PPIs, acid pump antagonists, H 2 receptor antagonists and anti-gastrin agents), cholinergic or anti-cholinergic drugs, sedatives, anti-psychiatric drugs (e.g., anti-psychotic drugs, anti-depressants, anti-manic drugs, anxiolytics and hallucinogens), corticosteroids for systemic use, anti-thrombotic agents (e.g., anti-platelet agents and anti-coagulants), prokinetics, mucosa-protective agents and antacids (e.g., aluminium hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate) (14) Patients who were in need of any treatments using prohibited concomitant medications during the conduct of the current study (15) Patients with a past history of taking treatments for other trials within four weeks prior to study treatments (16) Patients whose serum levels of ALT, AST, ALP, γ-GT, total bilirubin, creatinine and BUN were elevated by >2 × ULN (17) Women who are pregnant or breastfeeding (18) Patients, or their partners, who did not consent to the use of appropriate contraceptive methods during the conduct of the current study (19) Patients who are contraindicated in EGD (20) Patients who are deemed ineligible for study participation according to our judgment. ...
Background: Fexuprazan (Fexuclue®; Daewoong Pharmaceutical Co., Ltd., Seoul, Korea) is a novel potassium-competitive acid blocker (P-CAB). This multi-center, randomized, double-blind, active-controlled, parallel-group, therapeutic confirmatory, phase III study was conducted to assess its efficacy and safety compared with esomeprazole (Nexium®; AstraZeneca, Gothenburg, Mölndal, Sweden) in Korean patients with erosive esophagitis (EE). Methods: This study evaluated patients diagnosed with EE at a total of 25 institutions in Korea between 13 December 2018 and 7 August 2019. After voluntarily submitting a written informed consent form, the patients were evaluated using a screening test and then randomized to either of the two treatment arms. The proportion of the patients who achieved the complete recovery of mucosal breaks at 4 and 8 weeks, the proportion of those who achieved the complete recovery of heartburn at 3 and 7 days and 8 weeks, and changes in the GERD–Health-Related Quality of Life Questionnaire (GERD-HRQL) scores at 4 and 8 weeks from baseline served as efficacy outcome measures. The incidence of treatment-emergent adverse events (TEAEs) and adverse drug reactions (ADRs) and the serum gastrin levels served as safety outcome measures. Results: The study population comprised a total of 231 patients (n = 231) with EE, including 152 men (65.80%) and 79 women (34.20%); their mean age was 54.37 ± 12.66 years old. There were no significant differences in the efficacy and safety outcome measures between the two treatment arms (p > 0.05). Conclusions: It can be concluded that the efficacy and safety of Fexuclue® are not inferior to those of esomeprazole in Korean patients with EE.
... Changes in microcirculation and endothelial dysfunction, triggered by ulcer-related complications or inflammatory responses, might impact RBC integrity or exacerbate conditions predisposing individuals to hemolysis. [23] Understanding these potential pathophysiological links between peptic ulcers and hemolysis provides a conceptual framework for exploring shared mechanisms and systemic effects. While current evidence is preliminary, further research is warranted to elucidate the precise connections and clinical implications, potentially offering new insights into the management and holistic approach to these seemingly distinct medical conditions. ...
This paper investigates the intriguing relationship between peptic ulcers and hemolysis, 2 seemingly distinct medical conditions, aiming to unravel their potential interconnections and clinical implications. While traditionally studied in isolation, recent evidence has surfaced suggesting possible links and shared mechanisms between these conditions. This paper explores the underlying pathophysiological associations, shared risk factors, diagnostic challenges, management strategies, and implications for clinical practice and health policy. The interplay between peptic ulcers and hemolysis stems from shared inflammatory pathways, notably attributed to Helicobacter pylori infection in peptic ulcers, which might trigger systemic inflammatory responses contributing to hemolysis. Common risk factors including genetic predispositions, autoimmune disorders, and medication use (such as nonsteroidal anti-inflammatory drugs) are implicated in the development of both peptic ulcers and hemolytic conditions, suggesting a potential convergence of these disorders in affected individuals. Diagnostic considerations pose challenges, as overlapping symptoms and laboratory findings may complicate accurate differentiation between peptic ulcers and hemolysis. Recognizing the potential interplay between peptic ulcers and hemolysis holds significant implications for clinical practice and health policy. Streamlining diagnostic algorithms, fostering interdisciplinary collaborations, and developing tailored guidelines are pivotal in optimizing patient care. Continued research efforts, collaborative clinical approaches, and informed health policies are essential in advancing our understanding and enhancing patient care for individuals navigating the intersection of peptic ulcers and hemolysis. Abbreviations: CBC = complete blood count, H pylori = Helicobacter pylori, NSAIDs = nonsteroidal anti-inflammatory drugs, RBCs = red blood cells.
... Another important aspect of the combined zinc-aspirin treatment is the anti-ulcerogenic activity of zinc (26), which could be beneficial in the prevention of the ulcer-causing side effect of aspirin in case of long-term treatment (27). The continuation of aspirin prior to CABG is still debated due to the increased bleeding risk, however, data suggest its beneficial effects on postoperative outcomes without increasing the rate of surgical re-exploration due to bleeding and the need for red blood cell transfusion when low doses are applied (28). ...
Introduction
Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure. The prognosis of revascularization via CABG is determined by the patency of the used grafts, for which an intact endothelium is essential. The degree of ischemia-reperfusion injury (IRI), which occurs during the harvest and implantation of the grafts, is an important determinant of graft patency. Preconditioning with aspirin, a nonsteroidal anti-inflammatory drug has been shown to reduce the functional and molecular damage of arterial grafts in a rodent model. Studies have found that the zinc-aspirin complex may be able to exert an even better protective effect in pathological cardiovascular conditions. Thus, our aim was to characterize the protective effect of zinc-aspirin complex on free arterial grafts in a rodent model of revascularization.
Methods
Donor Lewis rats were treated with either zinc-aspirin, aspirin, or placebo (n = 8) for 5 days, then the aortic arches were harvested and stored in cold preservation solution and implanted heterotopically in the abdominal cavity of the recipient rats, followed by 2 h of reperfusion. There was also a non-ischemia-reperfusion control group (n = 8). Functional measurements using organ bath and histomorphological changes using immunohistochemistry were analyzed.
Results
The endothelium dependent maximal vasorelaxation was improved (non-transplanted control group: 82% ± 3%, transplanted control group: 14% ± 2%, aspirin group: 31% ± 4%, zinc-aspirin group: 52% ± 4%), the nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the groups preconditioned with aspirin or zinc-aspirin. However, zinc-aspirin proved to be more effective in the reduction of IRI, than aspirin alone.
Discussion
Preconditioning with zinc-aspirin could be a promising way to protect the function and structural integrity of free arterial grafts, thus improving the outcomes of CABG.
... Therefore, it may be challenging to balance the dose and toxicity in each patient. High doses of these drugs can cause gastrointestinal irritation, gastrointestinal ulcerations, hemorrhagic events, and nephrotoxicity induced by nonsteroidal anti-inflammatory drugs (NSAIDs) [9][10][11]. Nevertheless, the role of present-day therapists is to relieve pain and not disease remission or a state of low disease activity. ...
Background
The biological function of Acanthopanax sessiliflorus Harm (ASH) has been investigated on various diseases; however, the effects of ASH on arthritis have not been investigated so far. This study investigates the effects of ASH on rheumatoid arthritis (RA).
Methods
Supercritical carbon dioxide (CO2) was used for ASH extract preparation, and its primary components, pimaric and kaurenoic acids, were identified using gas chromatography-mass spectrometer (GC–MS). Collagenase-induced arthritis (CIA) was used as the RA model, and primary cultures of articular chondrocytes were used to examine the inhibitory effects of ASH extract on arthritis in three synovial joints: ankle, sole, and knee.
Results
Pimaric and kaurenoic acids attenuated pro-inflammatory cytokine-mediated increase in the catabolic factors and retrieved pro-inflammatory cytokine-mediated decrease in related anabolic factors in vitro; however, they did not affect pro-inflammatory cytokine (IL-1β, TNF-α, and IL-6)-mediated cytotoxicity. ASH effectively inhibited cartilage degradation in the knee, ankle, and toe in the CIA model and decreased pannus development in the knee. Immunohistochemistry demonstrated that ASH mostly inhibited the IL-6-mediated matrix metalloproteinase. Gene Ontology and pathway studies bridge major gaps in the literature and provide insights into the pathophysiology and in-depth mechanisms of RA-like joint degeneration.
Conclusions
To the best of our knowledge, this is the first study to conduct extensive research on the efficacy of ASH extract in inhibiting the pathogenesis of RA. However, additional animal models and clinical studies are required to validate this hypothesis.
... These processes result in diminished cytoprotective mucus synthesis and, as a result, stomach ulcers. In this regard, it has been reported that indomethacin administration could lead to accumulation of lipid peroxidation in the gastric tissue, and hence could cause peptic-ulcer (Bialonska, et al., 2009) Pomegranate ellagitannins release ellagic acid in the stomach, which is weakly absorbed in the small intestine; nevertheless, ellagic acid is substantially converted into urolithins by human gut microbiota in the intestinal lumen (Cryer, and Mahaffe, 2014). ...
Introduction: Pomegranate (Punica granatum L.) is a well-known fruit that grows in tropical and subtropical areas of the world. In this study, we wanted to find out how pomegranate juice (POMJ) affected rats with gastric ulcers caused by standard drugs. Indomethacin is the most common drug causes gastric ulcer also, most of the NSAID drugs have harmful side effects, so studies have focused on finding an alternative natural solution. Methods: In this study, 25 male albino rats were used and were split into four groups of five rats each. These groups were called control, pomegranate, indomethacin, and standard. The examination took one week to complete. Indomethacin saline suspension (100 mg/kg rat weight) caused gastric ulcers. Pomegranate peel juice (5-10%) reduced stomach ulcer area and ulcer index, gastric juice volume, and acidity. Pomegranate juice restores stomach mucus content and tissue at the histological level. Results: Rats that were given indomethacin and then given pomegranate juice were significantly less likely to get a gastric ulcer. It also lowered the ulcer index to 0.7093±0.36 showing that 52.25 % prevention. Conclusion: The study's macroscopical and microscopical results showed that pomegranate juice might be able to reduce the ulceration caused by indomethacin in a rat model. Pomegranate as a protective food supplement against gastric ulcers.
... Among these complications, upper gastrointestinal bleeding (UGIB) has emerged Healthcare 2023, 11, 2853 2 of 11 as a salient issue because of its substantial morbidity and mortality [3,7,8]. This complication has a broad range of incidence rates, from 2.5% to 11%, and its mortality can reach 50% [9][10][11][12][13][14]. Although UGIB represents a significant concern, the existing body of literature has inadequately investigated its incidence and the associated risk factors in older adults undergoing surgery for limb fractures [15,16]. ...
(1) Background: Upper gastrointestinal bleeding (UGIB), a major postoperative complication after surgical fixation of major limb fractures, can be fatal but is often neglected. This study determined the incidence rates of and related risk factors for perioperative UGIB among older patients with major upper limb fractures but without a history of peptic ulcer disease (PUD). (2) Methods: We collected the data of patients aged more than 65 years who underwent surgery for major limb fracture between 1 January 2001 and 31 December 2017, from Taiwan’s National Health Insurance Research Database and excluded those with a history of UGIB and PUD before the date of surgery. The primary outcome was the incidence of UGIB requiring panendoscopy during hospitalization. A multiple logistic regression model was used to identify the independent predictors of UGIB, with adjustment for confounding factors. The final model included variables that were either statistically significant in univariate analyses or deemed clinically important. (3) Results: The incidence of UGIB was 2.8% among patients with major limb fractures. Male sex, older age, major lower limb fracture, and a history of chronic renal disease were significant risk factors for the increased incidence of perioperative UGIB. (4) Conclusions: Patients with major limb fractures who underwent surgery exhibited a higher rate of stress ulceration with UGIB, even when they had no history of PUD. Perioperative preventive protocols (e.g., protocols for the administration of proton-pump inhibitors) may be necessary for patients with these major risk factors.
... Interestingly, Shimamura et al. [159] studied the protective effects of hesperidin-rich extract obtained from C. unshiu (Chenpi) peel and commercially supplied hesperidin on aspirin-induced oxidative damage in rats. One of the major possible side effects of aspirin prescription and consumption is the possibility of peptic ulcer formation, which represents a serious gastrointestinal disease [160]. The citrus extract was obtained by reflux extraction, and a HPLC analysis confirmed the abundant presence of hesperidin in the extract sample. ...
Citrus fruits processing results in the generation of huge amounts of citrus by-products, mainly peels, pulp, membranes, and seeds. Although they represent a major concern from both economical and environmental aspects, it is very important to emphasize that these by-products contain a rich source of value-added bioactive compounds with a wide spectrum of applications in the food, cosmetic, and pharmaceutical industries. The primary aim of this review is to highlight the great potential of isolated phytochemicals and extracts of individual citrus by-products with bioactive properties (e.g., antitumor, antimicrobial, antiviral, antidiabetic, antioxidant, and other beneficial activities with health-promoting abilities) and their potential in pharmaceutical, biomedical, and biological applications. This review on citrus by-products contains the following parts: structural and chemical characteristics; the utilization of citrus by-products; bioactivities of the present waxes and carotenoids, essential oils, pectins, and phenolic compounds; and citrus by-product formulations with enhanced bioactivities. A summary of the recent developments in applying citrus by-products for the treatment of different diseases and the protection of human health is also provided, emphasizing innovative methods for bioaccessibility enhancements (e.g., extract/component encapsulation, synthesis of biomass-derived nanoparticles, nanocarriers, or biofilm preparation). Based on the representative phytochemical groups, an evaluation of the recent studies of the past six years (from 2018 to 2023) reporting specific biological and health-promoting activities of citrus-based by-products is also provided. Finally, this review discusses advanced and modern approaches in pharmaceutical/biological formulations and drug delivery (e.g., carbon precursors for the preparation of nanoparticles with promising antimicrobial activity, the production of fluorescent nanoparticles with potential application as antitumor agents, and in cellular imaging). The recent studies implementing nanotechnology in food science and biotechnology could bring about new insights into providing innovative solutions for new pharmaceutical and medical discoveries.
... Leukocyte adhesion has been demonstrated to impair microcirculation, causing ischemia and mucosal injury that form ulcers (Eamlamnam et al. 2006). Due to the acidic environment, a small dose of Aspirin® causes GI mucosal and systemic effects via inhibiting COX-1; In the absence of natural prostaglandins that encourage the creation of bicarbonate and mucus, Aspi-rin® remains nonionised, causing it to accumulate in stomach mucosal cells, changing their permeability, and leading to ulceration within minutes of administration (Cryer and Mahaffey 2014). Aloe vera reduces inflammation by acting as a bradykininase inhibitor and enhancing vascular permeability in the stomach's microscopy in the Aloe vera group. ...
Background
Many drugs have been restricted in the treatment of gastric ulcers (GU). So, herbal medicines are now in great demand for their better cultural acceptability, compatibility, and minimal side effects. Therefore, our study aimed to assess the protective efficacy of Aloe vera gel and Geranium robertianum extracts against Aspirin®-induced GU in Wistar rats.
Methods
Antioxidant activity and chemical composition of both herbs were analysed. Then, we divided forty female Wistar rats into five groups: a negative control group, a positive control group of Aspirin®-induced GU, and pretreated groups with Aloe Vera, geranium, and Famotidine (reference drug). The locomotor disability, anxiety-like behaviour, and ultrasonography were assessed. Ultimately, scarification of animals to determine gastric juice pH and ulcer index. Then the collection of stomach and liver for histopathological and immunohistochemical examinations, besides tracing the oxidative stress biomarkers and related genes.
Results
High content of polyphenols was revealed in both extracts. The pretreatment with Aloe vera gel and geranium showed significant antioxidant activities with free radical scavenging and ferric-reducing power (FRAP). Moreover, they improved the stomach architecture and alleviated anxiety-like behaviour and motor deficits. They significantly reduced the expression of proinflammatory cytokine (TNF-α), inflammatory, and oxidative stress genes (NF-KB, HO-1, Nrf-2) while increasing the Keap-1 in gastric mucosa.
Conclusion
Data presented a significant protective effect of Aloe vera gel and geranium against Aspirin®-induced GU; they reduced gastric mucosal injury with potential anxiolytic effects through their anti-inflammatory and antioxidant properties. Therefore, they may be considered promising agents for preventing or treating gastric ulceration.
... Ulcers have been identified as one of the leading cause of death in the United States. Due to the increased use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin (which are known to cause ulcers), gastrointestinal (GI) bleeding is still a significant clinical concern [5]. Stomach ulcers affect 5-10% of the world's population, according to estimates, a gastric or duodenal epithelial rupture that extends beyond the muscularis mucosa layer, an imbalance between mucosal protective factors (such as mucous production, bicarbonate secretion, and blood flow) and mucosal aggressive factors (such as acid and pepsin) causes this [6]. ...
... The causes and pathogenesis of ulcers have improved since the discovery of H. pylori, and treatment protocols have evolved. The assumption that ulcers are caused by an acid-driven mechanism has been replaced by the belief that ulcers are caused by a combination of factors such as H. pylori infection and use of NSAIDs, such as aspirin [5]. ...
... Aspirin was originally developed to relieve pain and inflammation, but its antiplatelet qualities have made it a popular treatment for preventing cardiovascular disease. Standard aspirin doses of 500 to 1,000 mg per day are typically prescribed for inflammatory disorders and pain relief, whereas antiplatelet doses of 75 to 325 mg per day are commonly prescribed for primary and secondary prevention of cardiovascular and cerebrovascular events [5]. ...
Aim: This study examined the histological effect of ethanolic extracts of fruits of Acacia nilotica and flowers of Calotropis procera on aspirin-induced stomach ulcer in male albino rats. Acacia nilotica fruits and Calotropis procera flowers are among the plant parts which are used in the treatment of ulcers by local folks in Wukari, Nigeria. Study Design: Seventy healthy male albino rats were used in this study; they were randomly distributed into 7 groups of 10 animals each. The test animals were induced with ulcer using 500 mg/kg body weight of aspirin and then treated with Acacia nilotica fruits and Calotropis procera flowers for 5 and 14 days respectively. Results: Photomicrograph of the gastric tissue of normal rats showed normal epithelial lining with mucosa and submucosa appearing unremarkable. Photomicrograph section of gastric tissue of rat administered aspirin only showed moderate ulceration of the epithelial lining. Photomicrograph of gastric tissues of rats administered both plant extracts showed moderate to severe ulcerations of the epithelial lining with unremarkable mucosa and submucosa. Conclusion: The results of this study showed that treatment of stomach ulcer in albino rats caused by administration of excess dose of aspirin with ethanolic extracts of fruits of Acacia nilotica and flowers of Calotropis procera did not heal the stomach ulcer in the albino rats after 5 days and 14 days treatment.
... The predisposing factors included Helicobacter Pylori infection (H. Pylori), [1] and many medications like low-dose aspirin, [2] non-steroidal anti-inflammatory drugs (NSAIDs), [3,4] and glucocorticoids. [5] Syria is a developed country where death registration is inadequate and insufficient. ...
Peptic ulcer bleeding is associated with significant morbidity and mortality, while monitoring mortality is extremely beneficial to public health, and the latest estimates date back to 2010 for the Syrian population. This study aims to estimate the in-hospital mortality rate and risk factors associated with peptic ulcer bleeding among adult inpatients at Damascus Hospital, Syria. A cross-sectional study with systematic random sampling. Sample size (n) was calculated using the proportional equation: [n = Z2P (1 - P)/d2], with the following hypothesis: Z = 1.96 for the 95% confidence level, P = .253 for mortality in patients hospitalized with complicated peptic ulcers, a margin of error (d) = 0.05, 290 charts were reviewed, and the Chi-square test (χ2 test) was used for categorical variables, and the t test for continuous data. We reported the odds ratio in addition to mean and standard deviation with a 95% confidence. A P value less than .05 was considered statistically significant. Data were analyzed using a statistical package for the social sciences (SPSS). The mortality rate was 3.4%, and the mean age was 61.76 ± 16.02 years. The most frequent comorbidities were hypertension, diabetes mellitus, and ischemic heart disease. The most commonly used medications were NSAIDs, aspirin, and clopidogrel. 74 patients (25.52%) were using aspirin with no documented indication P < .01, odds ratio = 6.541, 95% CI [2.612-11.844]. There were 162 (56%) Smokers. Six patients (2.1%) suffered from recurrent bleeding, and 13 (4.5%) needed surgery. Raising awareness about the risks of using non-steroidal anti-inflammatory drugs may reduce the occurrence of peptic ulcers and, as a result, peptic ulcer complications. Larger, nationwide studies are needed to estimate the real mortality rate in complicated peptic ulcer patients in Syria. There is a lack of some critical data in the patients' charts, which necessitates action to correct.
