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1.
Medicine (Baltimore) ; 99(18): e20030, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358382

RESUMO

INTRODUCTION: Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain-Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. PATIENT CONCERNS: A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. DIAGNOSES: DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. INTERVENTIONS: The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. OUTCOMES: Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. CONCLUSION: PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.


Assuntos
Gastrite/complicações , Síndrome de Guillain-Barré/complicações , Linfoma não Hodgkin/complicações , Infecções por Pseudomonas/complicações , Neoplasias Gástricas/complicações , Idoso , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/patologia , Masculino , Condução Nervosa , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia
2.
Medicine (Baltimore) ; 99(5): e18927, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000406

RESUMO

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Gastrite/diagnóstico , Gastrite/epidemiologia , Dor Abdominal/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/tratamento farmacológico , Náusea/epidemiologia , Náusea/etiologia , Prognóstico , Estudos Retrospectivos , Estômago/diagnóstico por imagem , Estômago/patologia , Centros de Atenção Terciária , Vômito/diagnóstico , Vômito/tratamento farmacológico , Vômito/epidemiologia , Vômito/etiologia
3.
Life Sci ; 239: 117064, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31734260

RESUMO

AIMS: Currently, chronic gastritis is a high incidence of digestive diseases, along with loss of appetite, abdominal pain and diarrhea. Baicalin belongs to the major bioactive flavonoids compounds from Scutellariae Radix, it exhibited anti-inflammatory and anti-bacteria activities. Nonetheless, the protective effects of baicalin on ethanol-induced gastritis have not been completely clarified. Our study was designed to evaluate the protective activity of baicalin on ethanol-induced chronic gastritis. MAIN METHODS: Rat with chronic gastritis model was induced by the administration of 56% ethanol for four weeks. Baicalin (50 and 100 mg/kg) were orally administered for seven days to evaluate its curative effect, respectively. The production of TNF-α, interleukin (IL)-8, IL-1ß, NO, ET-1, PGE2, LDH and COX-2 were determined by ELISA. The activities of Akt, p-Akt, IκBα, p-IκBα, NF-κBp65 and NF-κBp-p65 were tested by western blot. Immunofluorescence staining was employed to assess the location of NF-κBp65. KEY FINDINGS: The changes of the histopathological analysis and the levels of NO, ET-1, PGE2, LDH and COX-2 demonstrated that baicalin treatment ameliorated ethanol-induced gastritis. ELISA analysis showed that baicalin inhibited the levels of TNF-α, IL-8 and IL-1ß. Besides, Akt, p-Akt, IκBα, p-IκBα, NF-κBp65 and NF-κBp-p65 expression were significantly suppressed by baicalin. Meanwhile, baicalin suppressed the translocation of NF-κBp65 to the cell nucleus through immunofluorescence staining, molecular docking analysis showed that baicalin had affinity with Akt and NF-κBp65. SIGNIFICANCE: All results demonstrated that baicalin effectively alleviated chronic gastritis via suppressing the levels of inflammatory regulators and inhibiting Akt/NF-κB activation.


Assuntos
Flavonoides/farmacologia , Gastrite/tratamento farmacológico , Animais , Anti-Inflamatórios/farmacologia , Citocinas/metabolismo , Modelos Animais de Doenças , Etanol/efeitos adversos , Etanol/farmacologia , Flavonoides/metabolismo , Gastrite/prevenção & controle , Masculino , NF-kappa B/metabolismo , Substâncias Protetoras/farmacologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Sprague-Dawley , Scutellaria baicalensis , Transdução de Sinais/efeitos dos fármacos , Fator de Transcrição RelA/metabolismo
4.
Medicine (Baltimore) ; 98(46): e17697, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725612

RESUMO

Predicting Helicobacter pylori (Hp) status by endoscopic finding would be useful in recent clinical condition that the use of proton-pump inhibitors, anti-platelet, and anti-coagulant have become widespread. We aimed to elucidate the diagnostic accuracy of magnifying narrow-band imaging (M-NBI) endoscopy in distinguishing Hp status in patients with or without history of successful Hp eradication and compare this accuracy to the diagnostic accuracy of conventional white light (WL) endoscopy.Two hundred seven endoscopic examinations before and after Hp eradication were performed in prospective 163 patients. Endoscopic images by using the M-NBI and conventional WL were stored electronically and randomly allocated to 2 readers for evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed by reference to Hp status assessed by conventional clinical test.Sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the conventional WL was 72.2%, 75.5%, 72.2%, 75.5%, and 73.9% for the first reader; 86.6%, 57.3%, 64.1%, 82.9%, and 71.0% for the second reader. On the other hand, sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the M-NBI was 96.9%, 93.6%, 93.1%, 97.1%, and 95.2% for the first reader; 92.8%, 93.6%, 92.8%, 93.6%, and 93.2% for the second reader, respectively. The diagnostic accuracy of M-NBI was significantly higher than that of WL (P < .0001 for both readers). Inter-observer agreement of M-NBI (k = 0.83) was also better than that of WL (k = 0.53).M-NBI was capable of distinguishing Hp status before and after eradication therapy.


Assuntos
Endoscopia do Sistema Digestório/estatística & dados numéricos , Gastrite/diagnóstico por imagem , Infecções por Helicobacter/diagnóstico por imagem , Helicobacter pylori , Imagem de Banda Estreita/estatística & dados numéricos , Ampliação Radiográfica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório/métodos , Feminino , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Ampliação Radiográfica/métodos , Sensibilidade e Especificidade , Adulto Jovem
5.
Medicine (Baltimore) ; 98(45): e17777, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702630

RESUMO

RATIONALE: Phlegmonous gastritis is a rare bacterial infection of the gastric wall with high mortality. However, diagnosis of phlegmonous gastritis is difficult and standard treatment remains unestablished. PATIENT CONCERNS: We report a 33-year-old male patient with mixed-phenotype acute leukemia who developed acute phlegmonous gastritis during the neutropenia phase on induction chemotherapy and was successfully treated. DIAGNOSES: The patient was diagnosed with phlegmonous gastritis, which might be caused by Stenotrophomonas maltophilia on the basis of clinical manifestation, physical examination, enhanced computed tomography scan, histological finding, and microorganism culture of biopsied specimen in endoscopy. INTERVENTIONS: The patient was treated with gastrointestinal decompression and broad-spectrum antibiotics. OUTCOMES: He recovered from phlegmonous gastritis and received the 2nd cycle of chemotherapy with no complaint of abdominal discomfort. LESSONS: Early recognition and proper management including broad-spectrum antibiotics are key approaches to phlegmonous gastritis.


Assuntos
Antibacterianos/uso terapêutico , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Leucemia Aguda Bifenotípica/tratamento farmacológico , Adulto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Gastrite/diagnóstico por imagem , Humanos , Masculino , Neutropenia/induzido quimicamente , Stenotrophomonas maltophilia/isolamento & purificação , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-31594649

RESUMO

A causal relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia (FD) is well established in a subset of infected patients. In the Kyoto and Maastricht/Florence consensus reports H. pylori-associated dyspepsia is defined as an independent entity distinct from FD. H. pylori eradication is therefore the most cost-effective approach for infected patients with dyspeptic symptoms and superior to other medical therapies, such as Proton Pump Inhibitors. The therapeutic gain of H.pylori eradication for symptom relief compared to other therapeutic options is significant with the number needed to benefit of 12. Furthermore H.pylori cures chronic gastritis except in severe cases of atrophic gastritis and may prevent severe complications attributable to the infection. Several pathophysiological mechanisms are suggested for the generation of symptoms and are related to the distinct topographic expression and degree of gastric inflammation as well as changes of gastric acid secretion, gastrointestinal motility and visceral hypersensitivity.


Assuntos
Dispepsia/microbiologia , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Infecções por Helicobacter/diagnóstico , Inibidores da Bomba de Prótons/uso terapêutico , Dispepsia/tratamento farmacológico , Humanos , Inibidores da Bomba de Prótons/farmacologia
8.
Korean J Gastroenterol ; 74(3): 163-167, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554032

RESUMO

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm3) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Influenza Humana/diagnóstico , Adulto , Antivirais/uso terapêutico , Ascite , Colonoscopia , Ciclopentanos/uso terapêutico , Enterite/tratamento farmacológico , Enterite/etiologia , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinófilos/citologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/etiologia , Guanidinas/uso terapêutico , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X
9.
J Ethnopharmacol ; 245: 112161, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31419499

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Viburnum pichinchense Benth. Mainly found in Ecuador and Colombia has been ethnopharmacologically utilized as a remedy for various female disorders with kidney inflammation and uterine relaxant. AIM OF THE STUDY: The pharmacological activity of Viburnum pichinchense has never been studied, therefore, this study explored anti-inflammatory activity of Viburnum pichinchense methanol extract (Vp-ME). MATERIALS AND METHODS: Anti-inflammatory activities of Vp-ME were evaluated in lipopolysaccharide (LPS)-stimulated RAW264.7 cells and HCl/EtOH-induced gastritis mice by MTT assay, nitric oxide (NO) production assay, semi-quantitative reverse-transcriptase-polymerase chain reaction (RT-PCR), luciferase reporter assay, Western blotting, and enzyme-linked immunosorbent assays (ELISA). Anti-inflammatory compounds in Vp-ME were identified by high performance liquid chromatography (HPLC). RESULTS: Vp-ME inhibited NO production in RAW264.7 cells stimulated with pam3CSK4, poly I:C or LPS and in LPS-stimulated peritoneal macrophages without cytotoxicity and downregulated mRNA expression of inflammatory enzymes, inducible NO synthase (iNOS) and cyclooxygenase-2 (COX-2) and pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and IL-6. The anti-inflammatory activity was accomplished by inhibiting nuclear factor-kappa B (NF-κB) transcriptional activation, upstream signaling molecules in the NF-κB pathway, and caspase-11 non-canonical inflammasome in RAW264.7 cells. Moreover, Vp-ME exhibited in vivo anti-inflammatory activity by ameliorating gastritis symptoms, inhibiting iNOS and IL-6 mRNA expression and IκBα activation in mice. HPLC analysis identified resveratrol, quercetin, luteolin, and kaempferol as the anti-inflammatory components in Vp-ME. CONCLUSION: This study demonstrated Vp-ME has the anti-inflammatory activity via targeting NF-κB and caspase-11 non-canonical inflammasome pathways in macrophage-mediated inflammatory responses, suggesting Vp-ME could be developed as anti-inflammatory ethnopharmacological remedies to prevent and treat inflammatory diseases.


Assuntos
Anti-Inflamatórios/farmacologia , Caspases Iniciadoras/metabolismo , Inflamassomos/metabolismo , NF-kappa B/genética , Extratos Vegetais/farmacologia , Viburnum , Animais , Anti-Inflamatórios/uso terapêutico , Ciclo-Oxigenase 2/genética , Citocinas/genética , Etanol , Gastrite/induzido quimicamente , Gastrite/tratamento farmacológico , Células HEK293 , Humanos , Ácido Clorídrico , Lipopolissacarídeos , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Metanol/química , Camundongos , Óxido Nítrico Sintase Tipo II/genética , Extratos Vegetais/uso terapêutico , Células RAW 264.7 , Solventes/química
10.
Mar Drugs ; 17(7)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248010

RESUMO

Infection with Helicobacter pylori is a critical cause of gastrointestinal diseases. A crucial host response associated with H. pylori infection includes gastric inflammation, which is characterized by a sustained recruitment of T-helper (Th) cells to the site of infection and distinct patterns of cytokine production. Adequate nutritional status, especially frequent consumption of dietary antioxidants, appears to protect against infection with H. pylori. The aim of the present study was to investigate whether astaxanthin (AXT) from shrimp cephalothorax may modulate cytokine release of splenocytes in H. pylori-infected mice (n = 60). Six- to eight-week-old female mice were divided into three groups (n = 20 per group) to receive a daily oral dose of 10 or 40 mg of AXT for six weeks. After six weeks, a trend toward interferon gamma (IFN-γ) upregulation was found (40 mg; p < 0.05) and a significant dose-dependent increase of interleukin 2 (IL-2) and IL-10 (both p < 0.05) was observed. These results suggest that AXT induces higher levels of IL-2 and a shift to a balanced Th1/Th2 response by increasing IFN-γ and augmenting IL-10. We concluded that AXT may influence the pattern of cytokines during H. pylori infection.


Assuntos
Antioxidantes/administração & dosagem , Crustáceos/química , Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Administração Oral , Animais , Modelos Animais de Doenças , Feminino , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/imunologia , Mucosa Gástrica/microbiologia , Gastrite/imunologia , Gastrite/microbiologia , Infecções por Helicobacter/imunologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori , Humanos , Interferon gama/imunologia , Interferon gama/metabolismo , Interleucina-10/imunologia , Interleucina-10/metabolismo , Interleucina-2/imunologia , Interleucina-2/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Baço/citologia , Baço/metabolismo , Células Th1/efeitos dos fármacos , Células Th1/imunologia , Xantofilas/administração & dosagem
11.
Helicobacter ; 24(4): e12590, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31124220

RESUMO

BACKGROUND: The eradication of Helicobacter pylori (H pylori) has been suggested to reduce the risk of gastric cancer, but its impact on the gut microbiota has attracted public attention. This study aimed to investigate the short-term and long-term effects of bismuth quadruple therapy on both gastric and fecal microbiota. METHODS: Ten asymptomatic young adults with H pylori-related gastritis were treated with bismuth quadruple therapy for 14 days, and 7 age-matched adults without H pylori infection were enrolled as healthy controls. Both fecal and gastric mucosa samples were collected from H pylori-positive patients at weeks 0, 6, and 26, while fecal samples were collected from healthy controls. The gastric and gut microbiota were analyzed by 16S rRNA gene sequencing. RESULTS: The structure of the gastric microbiota was significantly changed after the eradication of H pylori with increased alpha diversity over time. The relative abundance of H pylori sharply decreased from more than 70% to nearly 0% after treatment, while some beneficial bacteria, such as Lactobacillus and Bifidobacterium, were increased. The microbial diversity of gut microbiota was higher in H pylori-infected patients than in healthy controls, which tended to decrease after eradication. The potentially beneficial gut bacteria Blautia and Lachnoclostridium were enriched at week 26 compared to week 0, while the pathogenic Alistipes were depleted to a level close to that of the healthy controls. CONCLUSIONS: Bismuth quadruple therapy for H pylori eradication can restore the diversity of gastric microbiota with enrichment of beneficial bacteria. The composition of gut microbiota after H pylori eradication trends toward healthy status instead of becoming dysbiotic.


Assuntos
Antibacterianos/uso terapêutico , Doenças Assintomáticas/terapia , Microbioma Gastrointestinal/efeitos dos fármacos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/fisiologia , Adulto , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Bismuto/uso terapêutico , Feminino , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Infecções por Helicobacter/patologia , Humanos , Masculino , Adulto Jovem
12.
Medicine (Baltimore) ; 98(20): e15710, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096520

RESUMO

BACKGROUND: To systematically evaluate efficacy of traditional Chinese medicine (TCM) in treating chronic gastritis (CG). METHODS: Data sources from PubMed, Embase, Springer Link, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Biomedicine Database, and Wan-fang database were searched up to July 5, 2018. Review Manager software version 5.3, the Cochrane Collaboration's risk of bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation profiler software were conducted for this meta-analysis. RESULTS: Sixteen studies involving 1673 participants (906 vs 767) were included in this study. Pooled data showed significant statistical differences between TCM groups and current routine pharmacotherapy (RP) groups in overall clinical efficacy (odds ratio [OR] 4.65; 95% confidence interval [CI] 3.29, 6.56; P < .00001), efficacy under endoscopy (OR 2.46; 95% CI 1.12, 5.43; P = .03), stomach distension (mean difference [MD] -0.37; 95% CI -0.56, -0.19; P < .0001), stomachache (standardized MD [SMD] -0.80; 95% CI -1.45, -0.14; P = .02), and belching (SMD -2.00; 95% CI -3.80, -0.20; P = .03). However, acid regurgitation (SMD -0.71; 95% CI -1.69, 0.28; P = .16) and anorexia (SMD -0.75; 95% CI -2.30, 0.80; P = .35) showed no significant statistical differences between 2 groups. In addition, incidence of adverse reactions of TCM groups was lower than that of RP groups. CONCLUSION: Evidence from this meta-analysis suggests that TCM could be more efficacious than current RP in treating CG. But further standardized research of rigorous design should be needed to further validate its efficacy.


Assuntos
Mucosa Gástrica/efeitos dos fármacos , Gastrite/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Doença Crônica , Endoscopia do Sistema Digestório/métodos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Gastrite/diagnóstico por imagem , Gastrite/patologia , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
13.
J Ethnopharmacol ; 238: 111848, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-30951845

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Canarium subulatum Guillaumin is an herbal medicinal plant native to Southeast Asia. Ethnopharmacological evidence suggests that plants of the genus Canarium cure a variety of inflammatory diseases. AIM OF THE STUDY: The pharmacological mechanisms of C. subulatum Guillaumin remain poorly understood. In this study, we investigate inflammatory mechanisms and target molecules using C. subulatum Guillaumin methanol extract (Cs-ME) in inflammatory reactions managed by macrophages. MATERIALS AND METHODS: To identify the anti-inflammatory activities of Cs-ME, lipopolysaccharide (LPS)-stimulated macrophages and a murine HCl/EtOH-induced gastritis model were chosen. The luciferase reporter gene assay, Western blot analysis, overexpression strategy, and the cellular thermal shift assay (CETSA) were employed to investigate the molecular mechanisms and target enzymes of Cs-ME. The active ingredients of this extract were also determined by HPLC. RESULTS: Released levels of nitric oxide (NO) and mRNA expression levels of iNOS and IL-6 were downregulated by Cs-ME without exhibiting cytotoxicity. This extract inhibited MyD88-induced promoter activity and the nuclear translocation of nuclear factor (NF)-κB. Moreover, we found that Cs-ME reduced the phosphorylation of NF-κB upstream signaling molecules including IκBα, IKKα/ß, Src, and Syk in LPS-stimulated macrophage-like RAW264.7 cells. The results of Western blot and CETSA confirmed that Src and Syk are anti-inflammatory targets of Cs-ME. In addition, orally injected Cs-ME alleviated HCl/EtOH-induced gastric ulcers in mice. HPLC analysis indicated that quercetin, luteolin, and kaempferol are major active components of this extract with anti-inflammatory activity. CONCLUSIONS: Cs-ME exhibits anti-inflammatory effects in vitro and in vivo by targeting Src and Syk in the NF-κB signaling pathway. Consequently, Cs-ME could be developed as an anti-inflammatory herbal medicine.


Assuntos
Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Burseraceae , Gastrite/tratamento farmacológico , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Animais , Etanol , Gastrite/induzido quimicamente , Gastrite/genética , Gastrite/metabolismo , Células HEK293 , Humanos , Ácido Clorídrico , Interleucina-6/genética , Lipopolissacarídeos/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , NF-kappa B/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo II/genética , Células RAW 264.7 , Transdução de Sinais/efeitos dos fármacos , Quinase Syk/metabolismo , Quinases da Família src/metabolismo
14.
Int J Mol Sci ; 20(8)2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-31003453

RESUMO

BACKGROUND: Helicobacter pylori (H. pylori) eradication therapy may improve gastric atrophy and intestinal metaplasia, but the results of previous studies have not always been consistent. The aim of this study was to compare the histological changes of intestinal metaplasia and gastric atrophy among the use of acid-suppressing drugs after H. pylori eradication. METHODS: A cohort of 242 patients who underwent successful eradication therapy for H. pylori gastritis and surveillance endoscopy examination from 1996 to 2015 was analyzed. Changes in the histological scores of intestinal metaplasia and atrophy according to drug use (proton-pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and non-acid suppressant use) were evaluated in biopsies of the antrum and corpus using a generalized linear mixed model in all patients. RESULTS: The mean follow-up period and number of biopsies were 5.48 ± 4.69 years and 2.62 ± 1.67 times, respectively. Improvement in the atrophy scores of both the antrum (p = 0.042) and corpus (p = 0.020) were significantly superior in patients with non-acid suppressant drug use compared with those of PPI and H2RA use. Metaplasia scores in both the antrum and corpus did not improve in all groups, and no significant differences were observed among groups in the antrum (p = 0.271) and corpus (p = 0.077). CONCLUSIONS: Prolonged acid suppression by PPIs or H2RAs may limit the recovery of gastric atrophy following H. pylori eradication.


Assuntos
Atrofia/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Atrofia/microbiologia , Atrofia/fisiopatologia , Atrofia/prevenção & controle , Endoscopia , Feminino , Ácido Gástrico/metabolismo , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/microbiologia , Mucosa Gástrica/fisiopatologia , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Gastrite/fisiopatologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori/metabolismo , Helicobacter pylori/patogenicidade , Humanos , Intestinos/efeitos dos fármacos , Intestinos/microbiologia , Intestinos/fisiopatologia , Masculino , Metaplasia/tratamento farmacológico , Metaplasia/microbiologia , Metaplasia/fisiopatologia , Pessoa de Meia-Idade
15.
Dig Dis Sci ; 64(8): 2231-2241, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30982212

RESUMO

BACKGROUND: Eosinophilic gastroenteritis (EGE) is a rare, chronic inflammatory condition of the gastrointestinal tract. Little is known about its natural history and treatment outcomes. The aims of our analysis were to describe clinical presentation, response to current medical treatments, and to evaluate the response of refractory EGE to anti-integrin therapy. METHODS: Patients with confirmed diagnosis of EGE fulfilling the diagnostic criteria: (1) the presence of gastrointestinal symptoms, (2) dense eosinophilic infiltration of the gastrointestinal mucosa, and (3) exclusion of other conditions leading to gastrointestinal eosinophilia were included in this analysis. In patients non-responding to corticosteroids and/or anti-TNF treatment the integrin blocker vedolizumab was used. RESULTS: EGE patients (n = 22) were predominantly female (63%) with a median age at diagnosis of 41.5 years. The most frequent symptoms were abdominal pain (100%), diarrhea (59%), nausea/vomiting (36%), and bloating (27%). No pathognomonic endoscopic alterations were found. Eosinophilic infiltration was observed in the majority of patients in more than one segment. Patients were treated with systemic steroids, topical, and enteral release steroids in 21/22 (95%) patients, proton pump inhibitors in 7/22 (32%), TNFα inhibitors in 3/22 (14%), and vedolizumab in 4/22 (18%) patients. In 3/4 of steroid-refractory patients vedolizumab induced a clinical and histological improvement. CONCLUSIONS: The combination of highly variable clinical presentation, subtle endoscopic abnormalities, and involvement of several GI segments undermines the difficulty to diagnose EGE and the need for structured biopsy sampling. Corticosteroids were efficient in the majority of patients to induce remission. Response to the integrin blocker vedolizumab suggests further assessment in refractory cases.


Assuntos
Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Enterite/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Gastrite/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Adolescente , Corticosteroides/efeitos adversos , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Criança , Enterite/diagnóstico , Enterite/imunologia , Eosinofilia/diagnóstico , Eosinofilia/imunologia , Feminino , Gastrite/diagnóstico , Gastrite/imunologia , Fármacos Gastrointestinais/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Am J Gastroenterol ; 114(6): 984-994, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31008735

RESUMO

OBJECTIVES: The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS: In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS: Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS: In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite/epidemiologia , Enterite/epidemiologia , Eosinofilia/epidemiologia , Eosinófilos/patologia , Gastrite/epidemiologia , Gastroenterite/epidemiologia , Fármacos Gastrointestinais/uso terapêutico , Mucosa Intestinal/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Colite/diagnóstico , Colite/tratamento farmacológico , Comorbidade/tendências , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Seguimentos , Previsões , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Acta Gastroenterol Belg ; 82(1): 5-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888747

RESUMO

BACKGROUND: Eosinophilic gastroenteritis (EG) is uncommon disease, and the pathogenesis of this disease have yet to be fully clarified. AIM: This study was to describe the clinical manifestations, endoscopic features and treatment outcomes of a cohort of patients with EG. METHOD: This retrospective study was included 28 consecutive patients who were diagnosed EG between January 2011 and December 2015 in Taizhou Hospital. The patients' clinical manifestations, endoscopic features and treatment outcomes were reviewed from a prospectively maintained database. RESULTS: Twenty-eight patients with EG were enrolled in the study (median age 54 years). The main symptoms were abdominal pain (78.6%), abdominal distension (50.0%), nausea and vomiting (28.6%) and diarrhea (25.0%). Laboratory examinations showed the elevation of blood eosinophil count (85.7%), serum IgE (71.4%). Endoscopic findings included small patchy mucosal erythema or erosions (75.0%), mucosal fold thickening (17.9%), submucosal nodules (21.4%), small gastroduodenal ulcers (14.3%). Twenty patients were treated and responded to prednisolone but five patients (25.0%) relapsed during the follow-up. The other 8 patients were treated with loratadine, proton pump inhibitors and dietary modification, 5 patients had clinical resolution during the follow-up. The other 3 patients did not achieve clinical remission, and then were given prednisone treatment. CONCLUSION: For some patients with gastrointestinal symptoms and peripheral eosinophilia, a high suspicion of EG is necessary and multiple endoscopic examinations might be helpful in diagnosis of EG. Most patients with EG could achieve remission after with the treatment of steroid or dietary elimination therapy.


Assuntos
Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Dor Abdominal/etiologia , Adulto , Idoso , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia
19.
MMW Fortschr Med ; 161(Suppl 4): 15-19, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30895511

RESUMO

BACKGROUND: About 5% of all GP consultations are made for symptoms of functional dyspepsia. The definition of functional dyspepsia is in a state of flux, pathophysiology is poorly understood, and current diagnostic and therapeutic algorithms are not available. AIM: Evaluation of the frequency and the practical procedure in the diagnosis and therapy of functional dyspepsia in German GP surgeries. METHOD: Family physicians working in Germany (general practitioners, primary care internists) were contacted via postal survey. The frequency of patients with functional dyspepsia per week, the symptom spectrum complained of and the therapy strategy were inquired. RESULTS: Data from 322 doctors from all over Germany could be evaluated. The majority of physicians cared for 6-10 RMS patients per week (44.1%). The most common symptoms reported by patients were postprandial fullness (81.7%), epigastric pain or burning (77.3%) and regurgitation (75.0%). Heartburn (50.0%), nausea/vomiting (42.5%) and premature satiety (15.8%) were reported less frequently. The most commonly prescribed drugs were phytotherapeutics (88.2%), proton-pump inhibitors (PPI, 73.6%) and prokinetics (61.5%). The frequency of prescribing antacids, digestive enzymes of the stomach and pancreas was 10-20%. There was a trend towards symptom-dependent differential therapy: phytotherapeutics and prokinetics in postprandial fullness and premature satiety, PPI in epigastric pain/burning. The treatment failure rate was estimated at 21-40%. For further diagnostics patients are often referred to gastroenterologists and psychotherapists. CONCLUSION: Functional dyspepsia is common in primary care practice. Current recommendations for diagnosis and differential therapy are often not implemented. The rate of treatment failure is considerable.


Assuntos
Dispepsia , Gastrite , Atenção Primária à Saúde , Dispepsia/diagnóstico , Dispepsia/tratamento farmacológico , Feminino , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Alemanha , Humanos , Masculino , Inibidores da Bomba de Prótons/uso terapêutico
20.
Biomed Res Int ; 2019: 8759708, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30906783

RESUMO

Rubus crataegifolius (black raspberry, RF), Ulmus macrocarpa (elm, UL), and Gardenia jasminoides (cape jasmine, GJ) are well known for hundreds of years as folk medicines in China and Korea to treat various gastrointestinal disturbance. The present study evaluated the gastroprotective effects of these plants either single or in combination against HCl/EtOH-induced gastritis and indomethacin-induced ulcer in rat model. Stomach ulcer was induced by oral ingestions of HCl/EtOH or indomethacin. Treatment with RF, UL, and GJ separately or in combination was done 1 h before ulcer induction. On HCl/EtOH-induced gastritis RF, UL, and GJ at a dose of 150 mg/kg showed comparable antigastritis effect (less than 50% inhibition) with lesion index of 94.97±8.05, 108.48±11.51, and 79.10±9.77 mm compared to cimetidine (45.33±23.73 mm). However, the combination of RF, UL, and GJ at a dose of 150 mg/kg with a ratio of 50:50:50 showed remarkable antigastritis effect with 77% inhibition. The observed lesion index at a ratio of 50:50:50 was 23.34±9.11 mm similar to cimetidine (18.88±19.88 mm). On indomethacin-induced ulcer, RF and GJ showed 38.28% and 51.8% inhibition whereas UL showed around 17.73% inhibition at 150 mg/kg. Combination of RF, UL, and GJ at 150 mg/kg showed strong antigastritis effect with 83.71% inhibition. These findings suggest strong gastroprotective effect of combined extract. In addition, these plants showed significant antioxidant activity in DPPH scavenging assay and antilipid peroxidation activity. Combination of black raspberry, elm, and cape jasmine might be a significant systemic gastroprotective agent that could be utilized for the treatment and/or protection of gastritis and gastric ulcer.


Assuntos
Mucosa Gástrica/lesões , Gastrite/tratamento farmacológico , Extratos Vegetais/farmacologia , Folhas de Planta/química , Úlcera Gástrica/tratamento farmacológico , Animais , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patologia , Gastrite/metabolismo , Gastrite/patologia , Indometacina/efeitos adversos , Indometacina/farmacologia , Masculino , Fitoterapia/métodos , Extratos Vegetais/química , Ratos , Ratos Sprague-Dawley , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/metabolismo , Úlcera Gástrica/patologia
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