Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index.

BACKGROUND: Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication. METHODS: We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation. RESULTS: Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05-1.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39-509.67], p = 0.029) remained significantly related to the primary outcome. CONCLUSIONS: Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.

Wu Shan Shen Cha (Malus asiatica Nakai. Leaves)-Derived Flavonoids Alleviate Alcohol-Induced Gastric Injury in Mice via an Anti-Oxidative Mechanism.

Wu Shan Shen Cha is the leaf of Malus asiatica Nakai., a special type of tea that is consumed in the same way as green tea. To study the effect of Wu Shan Shen Cha-derived flavonoids (WSSCF) on lesions in the stomach, a 15% hydrochloric acid-95% ethanol (volume ratio 4:6) solution was used to induce gastric injury in mice. The degree of gastric injury was assessed using tissue specimens, and the effects of WSSCF on the serum levels of antioxidant enzymes were investigated. The results showed that WSSCF could alleviate the damage of the gastric mucosa and gastric wall caused by the hydrochloric acid-ethanol solution, decrease the tissue and serum levels of malondialdehyde (MDA) in mice with gastric injury, and increase the serum levels of superoxide dismutase (SOD) and glutathione (GSH). The results of quantitative polymerase chain reaction (qPCR) showed that WSSCF could increase the mRNA expression of Mn-SOD, Cu/Zn-SOD, catalase (CAT), endothelial nitric oxide synthase (eNOS), and neuronal nitric oxide synthase (nNOS) in tissue specimens from mice with gastric injury and decrease the expression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS). At the same time, the results of the high concentration of WSSCF (WSSCFH) group were closer to those of the drug (ranitidine) treatment group. Wu Shan Shen Cha-derived flavonoids had a good antioxidant effect, so as to play a preventive role in alcoholic gastric injury.

Polyphenols in Kuding tea help prevent HCl/ethanol-induced gastric injury in mice.

We conducted the present study to determine the gastric injury preventive effects of polyphenols in Kuding tea (KTPs) in Kunming (KM) mice through the inhibition of gastric-acid secretion and the protection of the gastric mucosa. Mice treated with a high concentration of Kuding tea polyphenols (HKTP) had lower serum levels of interleukin-6 (IL-6), IL-12, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), motilin (MOT), substance P (SP), and endothelin-1 (ET-1), and higher serum levels of somatostatin (SS) and vasoactive intestinal peptide (VIP) than did the mice in the control group. Serum and gastric tissue levels of nitrous oxide (NO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and GSH were higher in the HKTP-treated mice than in the control mice, but malondialdehyde (MDA) levels were lower in the HKTP-treated mice than in the control mice. The expression of occludin, epidermal growth factor (EGF), EGF receptor (EGFR), vascular endothelial growth factor (VEGF), nuclear factor of κ-light polypeptide gene enhancer in B-cells inhibitor-α (IκBα), Cu/Zn-SOD (cuprozinc-superoxide dismutase), Mn-SOD (manganese-superoxide dismutase), GSH-Px (glutathione peroxidase), neuronal nitric oxide synthase (nNOS), endothelial NOS (eNOS), messenger RNA (mRNA) and protein in gastric tissue was stronger in the HKTP-treated mice than in the control mice, while the expression of p38 mitogen-activated protein kinase (P38MAPK, or p38), nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), inducible NOS (iNOS), and cyclooxygenase-2 (COX-2) was weaker in the HKTP group than in the control group. And HKTP also could reduce the TNF-α, IL-1ß (interleukin-1 beta), and IL-6 mRNA expression in gastric injury mice. A high performance liquid chromatography (HPLC) assay showed that Kuding tea polyphenols (KTPs) contained chlorogenic acid, cryptochlorogenic acid, and isochlorogenic acids A, B, and C. These constituents contributed to the preventive effects of KTPs on gastric injury. According to these results, KTPs are a kind of active component that have a strong preventive effect on gastric injury.

Protective effects of polysaccharide from Dendrobium nobile against ethanol-induced gastric damage in rats.

Dendrobium nobile is a medicinal herb in traditional China and Southeast Asian countries. Employing a rat model of ethanol-induced gastric ulcer, we examined the protective effect of polysaccharide (JCP) extracted from Dendrobium nobile and explored the related mechanisms. Oral administration with 100mg/kg and 300mg/kg body weight JCP for days can significant prevent the formation of gastric ulcer. Moreover, JCP pretreatment could alleviate ethanol-induced histological damage, antioxidant activities, the level of epidermal growth factor, gastric concentration of prostaglandin E, and regulate the signaling pathways of mitogen-activated protein kinases and matrix metalloproteinases. This study investigated the ethanol-induced gastric ulcer protective effect of JCP for the first time, and elucidated that the protective mechanisms.

Is decompression illness possible during hyperbaric therapy? a case report.

A 57-year-old woman was admitted to the intensive care unit in a state of severe hypotensive shock following a session of hyperbaric oxygen (HBO2) therapy. Shock was attributed to gastric barotrauma, which resulted in a massive venous gas embolism. Gastric barotrauma was attributed to the presence of a filled gastric band/cuff during the HBO2 therapy that prevented expanding gas from escaping on decompression. After deflation of the gastric band, two additional HBO2 sessions were performed and resulted in complete symptom resolution. Vasoactive drugs could be weaned, and the patient was discharged from hospital on Day Three with complete symptom resolution. Given the risk of gastric barotrauma and venous gas embolism, physicians should be aware of gastric band history before HBO2 therapy.

Schinus terebinthifolius raddi (anacardiaceae) no processo de cicatrização de gastrorrafias em ratos / Schinus terebinthifolius raddi (anacardiaceae) in the healing process of gastrorraphy in rats

RACIONAL: A gastrorrafia isolada ou associada ao uso de adesivos biológicos constituiu ao longo da história da cirurgia a forma usual de promover a cicatrização nas lesões gástricas e o uso de fitoterápicos tem sido cada vez mais empregado. OBJETIVO: Avaliar a cicatrização de ferida provocada no estômago de ratos com uso do extrato hidroalcoólico de Schinus terebinthifolius Raddi. MÉTODOS: Foram utilizados 60 ratos, adultos, machos, distribuídos em dois grupos: grupo aroeira e grupo controle, os quais foram subdivididos em três subgrupos de cinco animais conforme o momento das mortes dos animais (7, 14 e 21 dias). Todos os animais foram submetidos ao mesmo procedimento cirúrgico (lesão e rafia do estômago) diferindo apenas que os animais do grupo aroeira receberam dose diária de 100 mg/kg do extrato hidroalcoólico via gavagem enquanto o grupo controle recebeu solução salina isotônica. Os parâmetros avaliados foram: alterações macroscópicas e microscópicas, teste de resistência à insuflação de ar atmosférico e teste pela força de tração. RESULTADOS: Todos os animais demonstraram boa cicatrização da parede abdominal e das gastrorrafias, sem infecção e deiscência. Ambos os grupos apresentaram aderências à superfície das gastrorrafias com órgãos vizinhos. O teste de resistência por insuflação de ar atmosférico e força de tração mostraram maiores médias de pressão no 7º dia e de força de ruptura nos períodos estudados para o grupo aroeira. A intensidade da inflamação crônica revelou diferença estatisticamente significante nas variáveis proliferação fobrobrástica e colagenização. CONCLUSÃO: O uso do extrato hidroalcoólico de Schinus terebinthifolius Raddi acelerou a cicatrização do estômago de ratos.

BACKGROUND: Gastrorraphy, isolated or associated with the use of biological adhesives, was throughout the history of surgery the usual way to promote healing in gastric lesions and the use of herbal medicine has been increasingly more employed. AIM: To evaluate the wound healing in the stomach of rats with the use of the hydroalcoholic extract of Schinus terebinthifolius Raddi (aroeira). METHODS: Sixty rats, adult males, were divided into two groups: aroeira group and control group. Each one was subdivided into four subgroups of 15 animals (test groups). Each subdivided subgroup was also subdivided into three subgroups of five rats (deaths periods of 7, 14 and 21 days). All animals underwent the same surgical procedure (injury and stomach suture); animals in the aroeira group received daily dose of 100 mg/kg of hydroalcoholic extract via gavage while the control group received isotonic saline solution. Parameters evaluated were: macroscopic and microscopic changes, test for resistance to insufflation of atmospheric air and test for tensile strength. RESULTS: All animals had good healing of the abdominal wall and gastrorraphies without infection and dehiscence. Both groups had adhesions to the gastrorraphies surfaces with neighboring organs. The resistance test by insufflation of atmospheric air and tensile strength showed higher average of pressure on the 7th day and breaking strength in the time periods for the aroeira group. The intensity of chronic inflammation revealed statistically significant differences in the variables fibroblast proliferation and collagen. CONCLUSION: The use of hydroalcoholic extract of Schinus terebinthifolius Raddi accelerated the stomach healing in rats.

Schinus terebinthifolius Raddi (Anacardiaceae) in the healing process of gastrorraphy in rats.

BACKGROUND: Gastrorraphy, isolated or associated with the use of biological adhesives, was throughout the history of surgery the usual way to promote healing in gastric lesions and the use of herbal medicine has been increasingly more employed. AIM: To evaluate the wound healing in the stomach of rats with the use of the hydroalcoholic extract of Schinus terebinthifolius Raddi (aroeira). METHODS: Sixty rats, adult males, were divided into two groups: aroeira group and control group. Each one was subdivided into four subgroups of 15 animals (test groups). Each subdivided subgroup was also subdivided into three subgroups of five rats (deaths periods of 7, 14 and 21 days). All animals underwent the same surgical procedure (injury and stomach suture); animals in the aroeira group received daily dose of 100 mg/kg of hydroalcoholic extract via gavage while the control group received isotonic saline solution. Parameters evaluated were: macroscopic and microscopic changes, test for resistance to insufflation of atmospheric air and test for tensile strength. RESULTS: All animals had good healing of the abdominal wall and gastrorraphies without infection and dehiscence. Both groups had adhesions to the gastrorraphies surfaces with neighboring organs. The resistance test by insufflation of atmospheric air and tensile strength showed higher average of pressure on the 7th day and breaking strength in the time periods for the aroeira group. The intensity of chronic inflammation revealed statistically significant differences in the variables fibroblast proliferation and collagen. CONCLUSION: The use of hydroalcoholic extract of Schinus terebinthifolius Raddi accelerated the stomach healing in rats.

Electrogastrography in experimental pigs: the influence of gastrointestinal injury induced by dextran sodium sulphate on porcine gastric erythromycin-stimulated myoelectric activity.

OBJECTIVES: Electrogastrography (EGG) is a non-invasive investigation of gastric myoelectrical activity. The aim of study was to evaluate the impact of erythromycin on EGG in gastrointestinal toxic injury induced by dextran sodium sulphate (DSS) in experimental pigs. METHODS: The experiments were carried out on 12 adult pigs (weighing 30-35 kg). EGG was recorded using Digitrapper equipment (Synectics Medical AB, Stockholm). Running spectrum activity was used for EGG evaluation. There were two groups of animals: Group I: 6 controls with erythromycin administration (1,600 mg intragastrically); Group II: 6 animals treated with DSS (for 5 days, 0.25 g/kg per day in a dietary bolus) followed by erythromycin administration. Baseline and subsequent six separate 30-minute EGG-recordings (from time 0 to 360 min) were accomplished in each animal. RESULTS AND CONCLUSION: A total of 84 records were analysed. Baseline dominant frequency of slow waves was fully comparable in both groups. In Group I, there was a significant increase in dominant frequency after erythromycin administration (maximum between 240-360 min). There was a flat non-significant and delayed increase in dominant frequency after erythromycin administration in Group II. The difference between Group I and II at particular time intervals was not significant but a diverse trend was evident. EGG recording enables us to register a gastric myoelectrical effect of prokinetic drugs. Erythromycin induced a significant increase in the dominant frequency of slow waves. DSS caused toxic injury to the porcine gastrointestinal tract responsible for the delayed and weaker myoelectrical effect of erythromycin in experimental animals.

Antisecretory actions of Baccharis trimera (Less.) DC aqueous extract and isolated compounds: analysis of underlying mechanisms.

ETHNOPHARMACOLOGICAL RELEVANCE: Baccharis trimera (Less.) DC. (Asteraceae) is a species native to South America used in Brazilian folk medicine to treat gastrointestinal and liver diseases, kidney disorders and diabetes. Previous studies from this laboratory confirmed the antacid and antiulcer activities of the plant aqueous extract (AE) in rat and mouse models. AIM OF THE STUDY: To investigate the mechanisms involved in the antacid action of AE and isolated compounds from Baccharis trimera. MATERIALS AND METHODS: AE was assayed in vivo in cold-restraint stress gastric ulcers and in pylorus-ligated mice. Nine fractions (F2-F10) previously isolated from AE were assayed in vitro on acid secretion measured as [(14)C]-aminopyrine ([(14)C]-AP) accumulation in rabbit gastric glands, and on gastric microsomal H(+), K(+)-ATPase preparations. Chlorogenic acids (F2, F3, F6, F7), flavonoids (F9), an ent-clerodane diterpene (F8) and a dilactonic neo-clerodane diterpene (F10) have been identified in these fractions. RESULTS: Intraduodenal injection of AE (1.0 and 2.0 g/kg) in 4h pylorus-ligated mice decreased the volume (20 and 50%) and total acidity (34 and 50%) of acid secretion compared to control values. Administered orally at the same doses AE protected against gastric mucosal lesions induced in mice by restraint at 4°C. Exposure of isolated rabbit gastric glands to fractions F8 (10-100 µM) and F9 (10-300 µg/ml) decreased the basal [(14)C]-AP uptake by 50 and 60% of control (Ratio=6.2±1.1), whereas the remaining fractions were inactive. In the presence of the secretagogues F2 and F4 (30-300 µg/ml) decreased the [(14)C]-AP uptake induced by histamine (His) with a 100-fold lower potency than that of ranitidine. F5 and F6 reduced the [(14)C]-AP uptake stimulated by carbachol (CCh), but they were 10 to 20-fold less potent than atropine. F8 (diterpene 2) and F9 (flavonoids) decreased both the His- and CCh-induced [(14)C]-AP uptake, whereas F10 (diterpene 1) was inactive against the [(14)C]-AP uptake stimulated by secretagogues. Diterpene 2 was the most active of all tested compounds being 7-fold less potent than ranitidine and equipotent to atropine in reducing acid secretion in vitro. This compound also reduced the gastric H(+), K(+)-ATPase activity by 20% of control, while the remaining fractions were inactive on the proton pump in vitro. CONCLUSIONS: The results indicate that Baccharis trimera presents constituents that inhibit gastric acid secretion by acting mainly on the cholinergic regulatory pathway. The plant extract also contains compounds that exert moderate inhibition of the histaminergic regulatory pathway of acid secretion and the gastric proton pump. Altogether these active constituents appear to provide effective inhibition of acid secretion in vivo, which may explain the reputed antiulcer activity of the plant extract.

Prevention of ethanol-induced gastric lesions in rats by wu-bei-san.

The effects of Wu-Bei-San (WBS) and its components Wu-Tsi-Ku (WTK) and Bei-Mu (BM) on gastric lesions induced by necrotizing agents were investigated in rats. Oral administration of WBS or WTK, but not BM, dose-dependently prevented gastric lesions induced by ethanol. Moreover, the gastric protective action of WTK was potentiated by simultaneous administration of BM under the same experimental conditions. Pretreatment with indomethacin, which is a prostaglandin synthesis inhibitor and idoacetamide, which is a sulfhydryl blocker did not influence the inhibited ethanol lesion of WBS. Gastric lesions induced by acidified aspirin were prevented by both WBS and calcium carbonate, which is a major constituents of WTK. However, pretreatment with calcium carbonate did not affect the gastric lesions induced by ethanol. These results indicate protective action of WBS on the gastric mucosa through both acid neutralization and cytoprotection, although more work is needed to clarify the role of WBS in cytoprotection.

Efectos del aloe barbadensis sobre las lesiones y la secreción gástricas producidas por etanol y estrés en ratas / Effect of aloe barbadensis on lesions and gastric secretion produced by ethanol and stress in rats

Se estudia el efecto de extractos de Aloe barbadensis sobre las lesiones gástricas producidas por 2 modelos de úlcera gástrica experimental en ratas. Se usaron 2 extractos, uno preparado en dosis de 10 y 20 mg y otro preparado en dosis de 12,5 y 25 mg sobre las lesiones gástricas producidas por los modelos de etanol y de estrés por inmovilización más frio. También se estudió la secreción gástrica. Las dosis de 20 mg produjo frente al efecto dañino del etanol una discreta disminuciòn del número de lesiones así como una disminuciòn significativa del índice de lesión. La administración de las dosis de 25 mg provocó frente al daño del etanol una disminucion significativa, tanto del número como de la severidad de las lesiones. La dosis de 12,5 mg no protegió a la mucosa de la acción del etanol. La administración por vía intraperitoneal de este extracto no protegió la mucosa gástrica del daño producido por el estrés por inmovilización más frio y produjo una disminuciòn de la acidez total y un aumento del pH del jugo gástrico significativos, mientras que la administraciòn por vía oral produjo una disminuciòn significativa tanto del número de lesiones como del índice de lesión y no ocasionó modificaciones en la secreción gástrica

Efectos del aloe barbadensis sobre las lesiones y la secreción gástricas producidas por etanol y estrés en ratas / Effect of aloe barbadensis on lesions and gastric secretion produced by ethanol and stress in rats

Se estudia el efecto de extractos de Aloe barbadensis sobre las lesiones gástricas producidas por 2 modelos de úlcera gástrica experimental en ratas. Se usaron 2 extractos, uno preparado en dosis de 10 y 20 mg y otro preparado en dosis de 12,5 y 25 mg sobre las lesiones gástricas producidas por los modelos de etanol y de estrés por inmovilización más frio. También se estudió la secreción gástrica. Las dosis de 20 mg produjo frente al efecto dañino del etanol una discreta disminuciòn del número de lesiones así como una disminuciòn significativa del índice de lesión. La administración de las dosis de 25 mg provocó frente al daño del etanol una disminucion significativa, tanto del número como de la severidad de las lesiones. La dosis de 12,5 mg no protegió a la mucosa de la acción del etanol. La administración por vía intraperitoneal de este extracto no protegió la mucosa gástrica del daño producido por el estrés por inmovilización más frio y produjo una disminuciòn de la acidez total y un aumento del pH del jugo gástrico significativos, mientras que la administraciòn por vía oral produjo una disminuciòn significativa tanto del número de lesiones como del índice de lesión y no ocasionó modificaciones en la secreción gástrica