A formulation of Glycine max L. and Drakshasava, widely used by traditional healers for the treatment of pepticulcer in rural northern Karnataka in India, appears to be effective, as assessed by patients. The present study was undertaken to evaluate the safety and efficacy of the formulation. The study, approved by IAEC was carried out in male Wistar rats after assessing its toxicity in mice. Three groups of rats (N=6) were treated with aspirin200mg/kg oral. In addition to aspirin control group received 2% gum acacia, standard group received ranitidine 50 mg/kg and third group received test formulation 40mg/kg. All the treatments were administered orally every 24hrs for 7days .After 24 hrs fasting, on eighth day under anesthesia stomach contents were aspirated to estimate free & total acidity. Ulcer scoring in stomachs opened along the greater curvature was done to calculate ulcer index. The results were analyzed by one way ANOVA followed by Dunnets post hoc test. P ≤ 0.05 was considered as significant. The test formulation found to be effective against Aspirin induced ulcers.
Family: Liliaceae, Parts used: Roots and leaves. Chemical constituents: Sitosterol; benzaldehyde, undecanyl cetanoate. quercetin 3 glucoronide, saccharine and mucilage. The root extract shows inhibitory effect on the digestive enzymes, lipase and trypsin and lead to the stoppage in the degradation of food material in the intestinal tract. Medicinal uses: It is used o treat pepticulcer disease. Pharmacological activities: It also acts mucilaginous, diuretic, anti dysenteric, demulcent, antispasmodic and aphrodisiac. Study (1): Bhatnagar et al reported the antiulcer and antioxidant activity of Asparagus racemosus and Withania somnifera in rats. A study was conducted to investigate anti-secretory and anti-ulcer activity of these plants. Ranitidine was used as standard drug. Indomethacin was used to induce ulcer. Study indicated that methanolic extract of Asparagus racemosus and Withania somnifera reduce ulcer. Methanolic extract was given at dose of 100 mg/kg/day. Extract was administered orally. Extracts were given for fifteen days. Efficacy of Asparagus racemosus was more significant in ulcer induced by indomethacin and Withania somnifera was effective in stress-induced gastric ulcer. Results of plants extracts were similar to standard drug ranitidine 44 . Study (2): In another study, Bhatnagar reported
Anti-ulcer drugs mainly focuser on decreasing the acid secretion and/or strengthening the mucosal defence system. The treatment goals for peptic ulcers are to relieve symptoms, promote ulcer healing and prevent ulcer recurrence and complications. There are so many classes of drugs currently used to combat acid-peptic disorders. The current treatment strategies of gastric ulcer include following categories of drugs each of which act through a different mechanism. 1) Acid neutralizing/ inhibitory drugs This category of drugs includes: (a) H 2 receptor antagonists (cimetidine, ranitidine and famotidine) (b) Proton pump inhibitors (omeprazole, lansoprazole and raberoprazole) (c) Antacid 2) Cytoprotective agents (sucralfate) 3) Prostaglandin analog (misoprostol) 4) Miscellaneous drugs (anticholinnergic drugs and rabempimide)
In pylorus ligation induced gastric ulcer Juglans regia.L has shown significant reduction in ulcer index when compared to that of the control. Whereas the decrease in gastric secretion volume & total acidity are not significant. It is also observed that ulcer index is significantly high in aspirin induced & ethanol induced pepticulcer group as compared to the Juglans regia.L extract treated group which shows marked reduction(p<0.01) in gastric lesions. In histopathological examination of stomach specimens of control group from all the models it was seen that there was extensive gastric damage, even involving all the layers of the stomach wall in some regions. The mucosal epithelial cells were completely eroded and there was severe infiltration by inflammatory cells. The submucosal layer was edematous and engorged blood vessels could be seen. The muscular layer was also edematous. However the groups treated with Juglans regia.L extract and ranitidine did not show any such findings of that extensive gastric damage.
receptor antagonist (H2RA) medication used in pepticulcer disease therapy, acute stress ulcers, gastroesophageal reflux and related disorders (indications and dosages are summarized in Tables 1 and 2). This medication is often used intravenously in the operating room and during recovery in surgical departments or intensive care units, and orally in medical departments . Ranitidine has an excellent safety record [2,3] and we found no reports of fatalities related to this drug in the literature, although the incidence of anaphylactic reaction to H2RAs and proton pump inhibitors together has been reported as 0.3% to 0.7% (see ). Several other adverse events are reported in clinical trials or in the routine management of patients
perforated duodenal ulcer or seepage from the gallbladder region passes to the right and then both upwards to reach the right subphrenic space and downwards to the right iliac fossa. Thus, on one hand, there is subphrenic abscess and shoulder tip pain and on the other hand, the occasional diagnostic confusion between appendicitis and either perforated peptic- ulcer or acute biliary tract conditions.
Here the study conclude that the Sangu parpam II shows good anti secretary via anti ulcer action towards cold resistant stress induced model on rats. It reduces the average number of ulcers, both superficial and deep ulcer when compared with standard drug like ranitidine and it may be due to its antioxidant and antisecretory activity on the stomach. Ranitidine and Sangu parpam II significantly decreased the ulcer index. It shows significant anti ulcer activity in dose dependant manner when compare to that of standard drug like ranitidine. Its effect was further confirmed by histological examination showing prevention of mucosal lesions and sub-mucosal edema in stomach 80
experimented in rats at a dose of 2.5 g/kg. It was studied on various parameters of possible mechanism for treating ulcer. The main mechanism is to prevent acid- pepsin secretion. Neem did not show any effect on mucin secretion though it improved life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus the ulcer protective activity is due to its anti-secretory and proton pump inhibitory activity rather than on defensive mucin secretion. Bark extract of Azadirachta indica inhibits H+-K+-ATPase activity in vitro. It stops oxidative damage of the gastric mucosa by blocking lipid peroxidation and by scavenging the endogenous hydroxyl radical (OH), the major causative factor for ulcer 11,12,13 .
The patient suffered from pepticulcer disease due to many reasons that include improper diet, spicy foods, late night meals, family history of ulcer disease and stress that worsen ulcer symptoms. Patient was at that level where an H. pylori infection needs to be cured. According to research, if symptoms of pepticulcer are not treated, this may lead to complications like bleeding, perforations, narrowing and obstruction.4 Pepticulcer patient can manage his symptoms by adhering to medications. Combination of antibiotic therapy and PPIs are given in an appropriate manner. Antibiotic resistance in some countries leads towards triple antibiotic therapy for better results.10 Lifestyle modifications along with adherence to medications are important. Spicy and late night meals should be avoided. Due to poor dietary habits and sedentary lifestyle patient faces difficulty in changing his routine. The patient is fond of spicy and fried food. Proper counselling improves the patient’s disease education and motivates to follow the instructions.
A pepticulcer is an open scar that develops on the inner lining of stomach, (a gastric ulcer) or the small intestine (a duodenal ulcer) both types are referred as pepticulcer diseases. The main cause of pepticulcer is faulty lifestyle such as improper diet, irregular meal timing  smoking,  alcohol,  stress,  consumption of NSAID  also H.pylori  infection and climatic changes.  Some common symptoms are abdominal pain, heart burn, indigestion, vomiting, and anorexia. But these conditions may suddenly lead to serious complications such as internal bleeding, haematemesis, melena, gastric- outlet obstruction and perforation.
Bleeding Peptic Ulcer Experience with Endoscopic Therapy ORIGINAL ARTICLE Bleeding Pe~tic Ulcer Experience with Endoscopic Therapy K Harjit, FRCS*, P Kandasami, FRCS**, H Hanafiah, FRCS*** *Department[.]
Medical practitioners are coming across many patients with vague abdominal pain and were treated as pepticulcer disease. As the Helicobacter pylori infection causes pepticulcer disease with its complications and can produce chronic gastritis which leads on to carcinoma of stomach. Hence, the H. pylori infection must be identified early and appropriate treatment must be given. As endoscopy biopsy requires endoscopist, pathologist and there is time delay in starting the treatment. The endoscopy not only costly, but also an invasive procedure. The aim of the study was to compare the endoscopic gastric mucosal biopsy and the serology test for H. pylori for confirmation of H. pylori infection and the suitable test for rural Indian population.
Results of this study indicate that SDS and SAS scores of patients in the comprehensive group were significantly better than those of the patients in the regular group. This suggests that comprehensive nursing can significantly reduce occurrence of negative emotions, such as anxiety and depression. The findings of this paper are consistent with the experimental results of Honda et al. in a study on comprehen- sive nursing applied to Alzheimer’s disease . The main reason for the difference in scores between the two groups was that the digestive tract ulcer was a chronic ulcer dis- ease. It was difficult to treat and had a long treatment period. In the long treatment pro- cess, due to a lack of awareness about the dis- ease and the pain caused by the disease, patients were prone to a number of negative emotions, including anxiety, restlessness, fear, and rage . Comprehensive nursing requires nurses to provide timely psychological counsel- ing to patients, explaining successful treatment cases and the normal symptoms of the dis- ease. This ensures that patients have a prelimi- nary understanding of the disease. These mea- sures help patients understand that it is not very difficult to overcome the disease. Thus, they are filled with hope for rehabilitation, as well as gaining confidence to fight the disease, checking the emergence of negative emotions. Due to the tension between doctors and pa- tients, patients are also prone to develop dis- trust for medical staffs and their suggestions Table 2. Comparison of clinical efficacy [n (%)]
Laparoscopy: Laparoscopic surgery offers several advantages. First of all a laparoscopic procedure serves as a minimal invasive diagnostic tool postoperative pain reduction, less consumption of analgesics ,reduction in hospital stay ,less wound infections, no burst abdomen and incisional hernia due to shorter scars and lower the incidence of postoperative ileus and chest infections (Ates, 2008 and Lau, 2005). The disadvantage of the laparoscopic approach are a prolonged operating time, higher incidence of re-operations due to leakage at the repair site and a higher incidence of intra- abdominal collection secondary to inadequate lavage (Ates, 2008; Lunevicius, 2005 and Lunevicius, 2005). The higher incidence of leakage might be caused by the difficulty of the laparoscopic suturing procedure. First of all this emphasizes the need for a dedicated laparoscopically trained surgeon to perform this procedure (Lau, 2002), some laparoscopic surgeons use omentopexy alone (Ates, 2008 and Lagoo, 2002). Laparoscopic repair of perforated pepticulcer was introduced in 1989 by Mouret who used fibrin glue and omentalpatch (Karanjia, 1993). A year later, Nathanson et al. described the suture repair of perforated pepticulcer (Bucher, 2007). Since then many efforts have been made to compare laparoscopic and open repair, laparoscopic repair is safe and effective procedure in selected patients, offering shorter operating time, less postoperative pain and shorter post-operative hospital stay (Bhogal, 2008 and Ates, 2007).
More than 90% of the individuals with pepticulcer disease complain to have abdominal pain the pain is typically burning in character and usually localised to epigastrium the real cause of pain is unclear the character of the pain is usually two to three hours after having a meal. Majority of the patients will have a severe pain which will make them to awake from sleep. Gastric ulceration pain usually occurs during food intake and the pain usually subsides after that. It does not awake the patient from sleep a careful history about pepticulcer disease, use of steroids and other anti secretary medication is indicator of the diagnosis. Signs and symptoms
The Danish health care system provides free and uncon- strained access for all citizens to general practitioners, pre- hospital emergency medical services, and hospitals . Thus, patients diagnosed with PPU/PUB or a FHQ diag- nosis can gain access to acute medical help either via gen- eral practitioners, through the Danish national emergency number 1-1-2, or by appearance at a hospital (which is rare). When people dial 1-1-2, they are connected to a healthcare professional in the EMCC. In the Central Denmark Region, the EMCC is staffed by registered nurses and paramedics with six weeks’ additional training in communication and use of the dispatch protocol Da- nish Index . This tool is designed to evaluate the se- verity and urgency of the patients’ conditions. It is divided into 37 symptom chapters (e.g. non-traumatic bleeding, stomach or back pain, traffic accident, etc.), each one sub- divided into 5 levels of decreasing emergency (A-E).
Pepticulcer perforation is relatively common in our institute. Patients will present to the emergency department with features of Perforative peritonitis such as abdominal pain ,guarding, rigidity and some patients present late with features of shock and hypovolemia and needed aggressive management for survival of the patient.So pepticulcer perforation is relatively causing economical burden on health care services, so that diagnosing the condition earlier will give good prognosis.
Although a perforated pepticulcer (PPU) is worsened consequence of pepticulcer disease (PUD), several clinical features and prognoses are dramatically different. One of the reasons is that symptoms of PPU vary over time and are classified into three phases. The first phase appears within 2 h of onset, and symptoms such as acute abdominal pain, tachycardia and peripheral coldness are typical of this stage. Then, a perforation releases the gastroduodenal contents into peritoneal cavity, causing chemical peritonitis. Severe pain stimulates sympathetic nerves, and tachycardia and peripheral coldness result.
effects as well as less clinical consequences (40.5% vs. 16.2%), while those with vacAs2 (35.1%) fails to induce cell vacuolation in-vitro. Strains carrying the s1ml mosaic combination of the gene vacA show higher levels of cytotoxic activity than s1m2 strains, whereas s2m2 strains do not secret the vacuolating cytotoxin. The m1vacA and m2vacA, which are mostly formed by isolates containing the s1/m1vacA and s1/ m2vacA genes, respectively; have different cell type specificities in cytotoxicity study (16). The vacAs1c genotype was dominant in this study (70.3%), but the vacA s1b subtype was not recognized. The presence of multiple organisms within a host may occur as a result of recombination procedures leading to genetic shift, however ongoing mutation inside a strain may leads to the formation of quasi species by genetic drift. Several genotypic markers such as cagA, vacA, s1a and iceA1 are related with an increased risk of disease (17). The iceA gene may be related with pepticulcer disease (18) while some studies have recommended a contrary association (19). The iceA1 genotype detected in 48.6% of our patients. This finding agrees with previous reports that the IceA1 allele was found more frequent than the IceA2 allele in Chinese, Japanese, Korean, Dutch and Thai Patients (10, 20-22). The iceA2 has been found to be main allele among American and Brazilian patients (19, 22). The prevalence rate for BabA2 in this study was 94.6%, which is higher than reports from Colombia 57% and Costa Rica 73.7%, but it is similar to results from Chilie 97.4% and Japan 96.8% (23-25). In a study from Isfahan, Iran, the incidence rate of babA2 was 71.6%. They reported there is no relationship between genotype and clinical outcomes (gastritis and PUD) (25). Most of the H. pylori strains in Asia are babA2 positive, surprisingly unrelated to clinical outcome (26). This study revealed a high prevalence of oipA genes (81.1%), which is in agreement with the prevalence of oipA genes strains in Bulgarian patients (27), but is far less than the data reported from Tunisia (90.8%) (5). In present survey the oipA gene was found in 62.5% of pepticulcer patients and 86.2% of non-ulcer dyspepsia. Significant correlations were observed between vacAs1/vacAs2 with cagA and cagE genotypes. On the other hand, we did not observe any correlation between vacAs1 and iceA1, iceA2, oipA and babA2 genotypes. No significant relationship was observed between vacA genotypes and the manifestations of pepticulcer diseases, which is in agreement with previous reports (28). Ribeiro et
In our study the Chinese had a significantly higher than expected prevalence of pepticulcer bleeding. However, unlike uncomplicated pepticulcer disease, the prevalence of bleeding pepticulcer in Malays was similar to the ethnic distribution of population. The study has demonstrated that bleeding pepticulcer is a disease of advanced age (over 60 years). In the elderly, the causes of bleeding include those that are unique to old age as well as that seen in the younger patients. Therefore the factors associated with pepticulcer bleeding differ from that of uncomplicated pepticulcer disease. This is may have contributed to the disparity in the prevalence of pepticulcer bleeding and pepticulcer disease in the Malays.