Role of dietary polyphenols in the management of peptic ulcer.

Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.

Hymenaea stigonocarpa Mart. ex Hayne: a Brazilian medicinal plant with gastric and duodenal anti-ulcer and antidiarrheal effects in experimental rodent models.

ETHNOPHARMACOLOGICAL RELEVANCE: Hymenaea stigonocarpa Mart. ex Hayne (Fabaceae) is a medicinal species commonly found in the Brazilian savannah. The stem bark of this medicinal plant, popularly known as "jatobá-do-cerrado", is widely used in tea form to treat gastric pain, ulcers, diarrhoea and inflammation, whereas its fruits pulp is edible. AIM OF THE STUDY: The aim of this study was to investigate the antidiarrheal and anti-ulcer effects of a methanolic extract derived from the stem bark (MHs) and diet with fruit pulp of H. stigonocarpa. MATERIALS AND METHODS: The antidiarrheal action of MHs was measured against the intestinal motility and diarrhoea induced by castor oil in mice. The preventive action of MHs (50, 100, 150 and 200mg/Kg, by oral route (p.o.)) against peptic ulcers was evaluated in experimental rodent models challenged with absolute ethanol, non-steroidal anti-inflammatory drugs (NSAIDs), ischemia-reperfusion (I/R) (200mg/Kg, p.o.) and cysteamine (200mg/Kg, p.o.). The main anti-ulcer mechanisms of action of MHs were analysed as follows: evaluation of the gastric juice parameters, assessment of mucus adherence to the gastric wall, determination of the role of nitric oxide (NO) and sulfhydryl compounds (SH), glutathione (GSH) levels and myeloperoxidase (MPO) activity. The healing effects from MHs (200mg/Kg) and diet with fruit pulp (10%) against gastric and duodenal ulcers induced by acetic acid were also evaluated by treating rats over 7 or 14 consecutive days of treatment. RESULTS: The phytochemical profile of MHs and fruit pulp indicated the presence of phenolic compounds (mainly flavonoids and condensed tannins). MHs (200mg/Kg, p.o.) displayed an antidiarrheal effect and were able to protect gastric mucosa against absolute ethanol (68% protection) and also against the injurious effect of NSAIDs (86% protection) when compared to the group treated with vehicle. These results were accompanied by the prevention of GSH depletion and an inhibition of MPO activity when compared to animals treated with vehicle (P<0.05). MHs markedly protected duodenal mucosa against injuries caused by cysteamine (98%) and also against I/R induced gastric ulceration (80%) when compared to the group treated with vehicle. Furthermore, MHs also prevented the GSH depletion of gastric mucosa relative to the control group treated with vehicle. NO appeared to be involved in this gastroprotective effect. MHs and diet with fruit pulp clearly demonstrated gastric healing actions after treatment for 7 (MHs - 53% inhibition) or 14 days (MHs - 60% inhibition and fruit pulp - 61% inhibition). Treatment with diet with fruit pulp for 7 days demonstrates a significant duodenal healing effect (71% inhibition) without any signs of toxicity. CONCLUSIONS: MHs clearly demonstrate antidiarrheal, gastroprotective and cicatrising effects in experimental gastric and duodenal ulcers, and the diet with fruit pulp displays duodenal healing effects. The observed effects may be associated with the antioxidant effect, which may be due the presence of condensed tannins and flavonoids in the bark and fruit of H. stigonocarpa.

[Peculiarities of diet therapy in children with duodenal ulcers associated with the genus Candida].

In children with relapsing DU in 50.8% cases there is a complicated disease course with Candida infection, as evidenced by the positive results of mycological examination of biopsy specimens of duodenal mucosa and detection of circulating Candida antigen in serum. The use in the complex therapy in children with DU associated with Candida species of instant New Zealand goat milk "Amalteya" leads to an overall therapeutic effect in 81.3% cases, which is manifested in the reduction of the duration of relapse 1.4 times prolongation of remission in 3 times and milder disease. Carried out in the dynamics fibrogastroduodenoscopy after treatment showed that 100% of the observed total endoscopic remission which is manifested in the disappearance of opalescent gray overlay on the bottom of the ulcer and ulcer epithelization.

[Influence of a diet with the heightened protein on clinical characteristics of workers of the chemical enterprise with gastric ulcer and duodenal ulcer].

Research of influence of differentiated dietary therapy in a complex with antiulcer actions on dynamics of return development of clinical displays of disease at 117 patiens with gastric ulcer and duodenal ulcer, working on the chemical enterprise is studied. There are objective data testifying that at purpose of a diet with the increased quantity of fiber, results in essentially improve treatment of disease, especially in groups of the patients who treated during work and were exposed to combined action of connections of nitrogen and organic solvents.

[Treatment of patients with ulcer at an outpatient facility]. / Opyt lecheniia bol'nykh iazvennoi bolezn'iu v ambulatornykh usloviiakh.

The most frequent affection of digestive apparatus is the ulcerative disease. Ulcerative duodenal or gastric affection irrespective of its localization is a chronic cyclic recidivating disease of whole organism. It affects mainly an active able-bodied age and often results in heavy course and physical disability. The complicated forms of ulcerative disease--bleeding, perforation, stenosis--require the surgical intervention.

[Effectiveness of beta-carotene for treatment of erosive ulcerative changes in gastric and duodenal mucosa in children with chronic glomerulonephritis]. / Otsenka éffektivnosti primeneniia beta-karotina pri érozivno-iazvennykh izmeneniiakh slizistoi obolochki zheludka i dvenadtsatiperstnoi kishki u detei s khronicheskim glomerulonefritom.

The peptic ulcer of stomach and duodenum are the more often occuring complications of steroid treatment in children with chronic glomerulonephrite. Dinamic investigation has shown that the using of beta-carotin oily solution in therapy of this complications increases the efficiency of traditional treatment. It has been shown that beta-carotene administration speeds the reparation of stomach and duodenum ulcers, saves adequate serum concentration of beta-carotene and retinol. The data obtained demonstrate that beta-carotene administration in the complex therapy of chronic glomerulonephrite patient with gastroenteropathy should be recommended.

Dry meals--physiological approach to management of duodenal ulcer.

Two hundred and twenty endoscopically proved cases of duodenal ulcer were studied in a double blind manner by dividing them into control and study groups and following them up for one year. All patients were given ranitidine 150 mg bd for 3 months. Additionally, the study group patients were asked to take dry meals (they were allowed their normal diet but asked not to take water from 1 hour before meals to 1 hour after meals) for one year. The two groups of patients were compared. The recurrence rate at one year was lower in the study group. Nausea/vomiting at the time of recurrence was also significantly lower in the study group (p < 0.02). Relief in symptoms, especially nausea/vomiting and dyspepsia was also seen to be better in the study although the difference was not statistically significant. The fall in recurrence rate observed as a result of this simple regime is very encouraging.

[Optimization of dietary fat composition in erosive and ulcerative diseases of the gastroduodenal area]. / Optimizatsiia zhirovoi chasti ratsiona pri érozivno-iazvennykh porazheniiakh gastroduodenal'noi zony.

Fish oil preparation "Polyen" was used for treatment 21 patients with ulcerative diseases of the stomach or duodenum. The cicatrization of ulcer was diagnosed in 85% of patients treated by "Polyen" and in 60% of those who did not take fish oil. "Polyen" influenced fatty acid composition of erythrocyte membranes and lipid peroxidation. Authors draw a conclusion that omega-3 PUFA's can stimulate the reparative processes.

Effect of wheat fibre supplements on duodenal ulcer recurrence.

In the present study the prophylactic effect of concentrated wheat fibre on duodenal ulcer recurrence was evaluated. Eleven grams of fibre (Fiberform) or placebo was added to an ordinary Norwegian diet for 1 year after endoscopic healing of duodenal ulcer. The ulcer recurrence rates were 84% (31 of 37 patients) in the fibre-supplemented group and 85% (30 of 36 patients) in the placebo group (NS). The effect on ulcer symptoms was similar in both groups. Side effects were infrequently seen. A concentrated wheat fibre supplement seems to have no preventive effect when given to duodenal ulcer patients living on a traditional Norwegian diet.

[The reducing-diet therapy of chronic lesions of the gastroduodenal area]. / Rozvantazhuval'no-diietychna terapiia khronichnykh urazhen' hastroduodenal'noï zony.

The author summarizes the experience of UDT in 140 patients with chronic gastritis (53) and gastroduodenitis (87) and 46 with duodenal ulcer. It was found that chronic diseases of the gastroduodenal zone were characterized by changes in the hematological and biochemical indices of the blood against the background of altered immune reactivity and that UDT favoured their normalization.

[Treatment of duodenal ulcer associated with chronic gastric erosions]. / Lechenie iazvennoi bolezni dvenadtsatiperstnoi kishki, sochetaiushcheisia s khronicheskimi éroziiami zheludka.

Three groups of patients received chemotherapy for duodenal ulcer and associated chronic gastric erosion. Group I was treated by the drugs combination (methacin, almagel, gastrofarm, solcoseryl, tazepam, rudotel), group II received gastrocepin, group III venter. The results of duodenal ulcer healing were similar in all the groups, yet epigastric and/or pyloroduodenal pain was relieved more rapidly in groups II and III. The latter groups were also characterized by accelerated disappearance of fibrinous patches on the surface of the erosion.

[Clinico-biochemical evaluation of the effectiveness of diet therapy in gastroenterologic patients]. / Kliniko-biokhimicheskaia otsenka éffektivnosti dietoterapii gastroénterologicheskikh bol'nykh.

Dissimilar immunochemical, protein and vitamin parameters were found in blood of patients with gastroenterological diseases at the initial step of impairments under conditions of routine and special diets. Specific alterations in content of transferrin, haptoglobin, tocopherol as well as in glutathione peroxidase and glucose-6-phosphate dehydrogenase activities showed that compensatory mechanisms were maintained better under conditions of the special diet therapy.

[Serum pepsinogen I and duodenal ulcer disease]. / Pepsinógeno I sérico y enfermedad ulcerosa duodenal.

Duodenal ulcer is a common disease. It has always been said that it results from an imbalance between aggressive forces (HC1 and pepsin) and defensive forces that act on the mucosa. More attention has traditionally been paid to acid and relative less interest to pepsin. Two types of pepsinogen have been recognized as precursors of peptic activity in the lumen. Pepsinogen I has been more frequently implicated in ulcerogenesis. The aim of this review is to consider the different current pathophysiologic and clinical aspects, and to take into account its importance as a predictive and genetic marker in duodenal ulcer disease, which is always a challenge in the daily practice of gastroenterologists.

[The effect of diet with an increased amount of tyrosine on reparative processes in the duodenum]. / Vliianie ratsiona s povyshennym kolichestvom tirozina na reparativnye protsessy v dvenadtsatiperstnoi kishke.

It has been shown that the development of destructive lesions of the duodenal wall induced by stress action on the body of the experimental animal is attended by a decrease of the content of creatine phosphate and noradrenaline in homogenate of the duodenal tissue. The use of tyrosine, a precursor of catecholamine biosynthesis, both as a pharmacologic agent and as a component of rich in this amino-acid product-dried milk, resulted in normalization of the biochemical parameters studied and in significant diminution of destructive lesions of the duodenal wall.

Food intolerance in duodenal ulcer patients, non ulcer dyspeptic patients and healthy subjects. A prospective study.

In 50 duodenal ulcer out-patients and 50 non ulcer dyspeptic patients suffering from low to moderate epigastric painful symptoms the intolerance of 39 foods were significantly increased compared to a group of 50 healthy subjects. Food intolerance was not different between duodenal ulcer and non ulcer dyspeptic patients. Intolerance was related in the majority of nutrients to aversion and pain or to an increased incidence of aversion alone in patients and normals. In duodenal ulcer, coffee and fruit juice were associated with an elevated incidence of pain.