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A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Twenty-six days after admission, he experienced hematemesis despite improvement in his respiratory symptoms. Contrast-enhanced computed tomography revealed edematous stomach wall thickening with neither ischemic findings in the gastric wall nor obstruction of the gastric artery. Emergent esophagogastroduodenoscopy showed diffuse dark-red mucosa accompanied by multiple easy-bleeding, irregularly shaped ulcers throughout almost the whole stomach without active bleeding or visible vessels. The clinical course, including the endoscopic findings, progressed favorably with conservative treatment. COVID-19 pneumonia can present with acute gastric mucosal lesion, which may be induced by microvascular thrombosis due to COVID-19-related coagulopathy.
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COVID-19 , Anciano , Endoscopía del Sistema Digestivo , Hematemesis/diagnóstico , Hematemesis/etiología , Humanos , Masculino , SARS-CoV-2 , EstómagoRESUMEN
BACKGROUND: Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. CASE PRESENTATION: Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. CONCLUSION: In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.
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Gastritis , Abdomen , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Adulto , Antibacterianos/uso terapéutico , Gastritis/diagnóstico , Gastritis/tratamiento farmacológico , Humanos , Masculino , Adulto JovenRESUMEN
In Taiwan, Corchorus capsularis L. has long been cultivated and the leaves are consumed as edible vegetable. This study is to investigate the protection effect of extract of C. capsularis leaves (ECC) on ethanol-induced acute gastric mucosal lesion (AGML) in rats. The results of phytochemical determination in ECC for total polyphenol, flavonoid and polysaccharide were 59.88 ± 0.61 mg/g, 86.39 ± 18.0 mg/g and 320.89 ± 6.99 mg/g, respectively. ECC showed significant activity of 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging with IC50 of 0.25 mg/ml. In vivo studies, Sprague-Dawley (SD) rats were randomly divided into five groups: sham, vehicle (control) and low-, medium-, and high-dose ECC (LECC, MECC, HECC; 200, 400, and 1,000 mg/kg/day, respectively). ECC was able to decrease significantly the ulcer index (UI) caused by 80% ethanol in a dose dependent manner. There was no significant effect on growth trend and food intake rate after the administration of ECC in the experimental period. The serum lipid parameters in ECC groups revealed significant increase in glutathione peroxidase (GPx), superoxide dilmutase (SOD) and catalase (CAT), and a decrease in malondialdehyde (MDA). Significant amelioration on pathological lesion score was found in ECC groups compared with the control group (P<0.05). The overall results indicate that ECC has protective effects on ethanol-induced AGML in rats, which could be associated with its antioxidant activity.
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Corchorus/química , Extractos Vegetales/farmacología , Úlcera Gástrica/tratamiento farmacológico , Animales , Relación Dosis-Respuesta a Droga , Etanol/efectos adversos , Hojas de la Planta/química , Ratas Sprague-Dawley , Úlcera Gástrica/inducido químicamenteRESUMEN
BACKGROUND: Activation of substance P (SP) contributes to the development and maintenance of gastric lesions, but the mechanisms underlying the release of SP and SP-mediated damage to the gastric mucosa remain unknown. Transient receptor potential ankyrin 1 (TRPA1) is expressed in SP-positive neurons in the dorsal root ganglion (DRG) and stomach of rats. We hypothesized that water immersion restraint stress (WIRS) may activate and sensitize TRPA1 in DRG neurons, subsequently inducing the release of SP from DRG and stomach cells, causing the development of acute gastric mucosal lesions (AGML). METHODS: Changes in TRPA1 and SP expression in T8-11 DRG sensory neurons and the stomach in an AGML rat model were determined by reverse transcription polymerase chain reaction, western blotting and immunohistochemistry. The SP levels of serum and gastric mucosa were measured by using an enzyme-linked immunosorbent assay (ELISA). Gastric lesions were evaluated by histopathological changes. The TRPA1 antagonist HC-030031 and TRPA1 agonists allyl isothiocyanate were used to verify effect of TRPA1 and SP on AGML. RESULTS: SP and TRPA1 in the DRG and stomach were upregulated, and the serum and gastric mucosa levels of SP were increased after WIRS, which are closely associated with AGML. The release of SP was suppressed and AGML were alleviated following a selective TRPA1 antagonist HC-030031. TRPA1 agonists AITC increased release of SP and led to moderate gastric lesions. We confirmed that WIRS induced the release of SP in the DRG, stomach, serum and gastric mucosa, and in a TRPA1-dependent manner. CONCLUSIONS: Upregulated SP and TRPA1 in the DRG and stomach and increased serum and gastric mucosa SP levels may contribute to stress-induced AGML. TRPA1 is a potential drug target to reduce stress-induced AGML development in patients with acute critical illnesses. This study may contribute to the discovery of drugs for AGML treatment.
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Ganglios Espinales/metabolismo , Úlcera Gástrica/patología , Estrés Psicológico/psicología , Sustancia P/metabolismo , Canal Catiónico TRPA1/metabolismo , Acetanilidas/farmacología , Animales , Modelos Animales de Enfermedad , Ganglios Espinales/citología , Ganglios Espinales/efectos de los fármacos , Mucosa Gástrica/inervación , Mucosa Gástrica/patología , Humanos , Isotiocianatos/farmacología , Masculino , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Purinas/farmacología , Ratas , Ratas Wistar , Úlcera Gástrica/sangre , Úlcera Gástrica/psicología , Estrés Psicológico/etiología , Sustancia P/sangre , Canal Catiónico TRPA1/agonistas , Canal Catiónico TRPA1/antagonistas & inhibidoresRESUMEN
OBJECTIVE:To study the protective effects of Polygonum hydropiper extract on acute gastric mucosal lesion (AGML)in rats. METHODS:48 rats were randomly divided into normal group(normal saline),model group(normal saline), positive group(ranitidine hydrochloride,0.05 g/kg),P. hydropiper extract low-dose,medium-dose and high-dose groups(2.7, 8.1,24.3 g/kg by crude drug),i.g. for consecutive 7 d,once a day. Except for normal group,other groups were given absolute ethyl alcohol to induce AGMI model after 1 h of last administration. 1.5 h after modeling,gastric mucosal lesion index of rats was calculated;the pathological changes of gastric tissue in rats were observed;nuclear factor E2 related factor 2(Nrf2)content and SOD activity in gastric tissue of rats were determined by ELISA. RESULTS:Compared with normal group,the gastric mucosa of model group was damaged obviously,there was blood capillary rupture in submucosa,gastric mucosal lesion index was increased significantly(P<0.01);Nrf2 content and SOD activity were significantly decreased in gastric tissue of rats(P<0.05 or P<0.01). Compared with model group,gastric mucosal lesion of rats was relieved to different extent;in positive group,P. hydropiper extract medium-dose and high-dose groups,gastric mucosal lesion index was decreased significantly(P<0.05),and Nrf2 content and SOD activity were increased significantly(P<0.05 or P<0.01). CONCLUSIONS:P. hydropiper extract has good protective effect on absolute ethyl alcohol-induce AGMI,the mechanism of which may be associated with raising Nrf2 content and enhancing SOD activity in gastric mucosal tissue.
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AIM:To observe the antiulcer effect of butyric acid and hydrogen , the main metabolites of Clos-tridium butyricum (C.butyricum), and to explore the underlying mechanism .METHODS: The mouse model of acute gastric mucosal lesion was prepared by gavage with ethanol .The mice were randomly divided into 4 groups:normal group , model group , butyric acid group and hydrogen group .The mice in butyric acid group and hydrogen group were given buty-rate and hydrogen prior to model establishment , respectively .Macroscopic observation of the pathological changes in gastric tissues was performed to evaluate the effect of the 2 metabolites of C.butyricum.Meanwhile, the mRNA expression levels of inflammatory factors, such as IL-12, RAN1 and MCP-1, were determined by RT-qPCR.The expression levels of apopto-sis-related proteins Bcl-2 and Bax were detected by immunohistochemical staining .RESULTS:The macroscopic observa-tion found that butyrate , not hydrogen , protected gastric mucosa .HE staining also showed that butyrate significantly attenu-ated the pathological damage of the gastric mucosa induced by ethanol .Compared with model group , the mRNA levels of inflammatory factors IL-12, RAN1 and MCP-1 in butyrate group significantly decreased (P<0.01).In butyrate group, the protein level of Bax was obviously decreased compared with model group (P<0.01), while the protein level of Bcl-2 was significantly increased ( P<0.01 ) .CONCLUSION: The gastric mucosa protective metabolite of C.butyricum may be butyric acid , not hydrogen .Butyric acid protects the gastric mucosa against ethanol-induced lesion by inhibiting the inflam- mation and reducing the expression ratio of Bax/Bcl-2.
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AIM:To observe the antiulcer effect of butyric acid and hydrogen , the main metabolites of Clos-tridium butyricum (C.butyricum), and to explore the underlying mechanism .METHODS: The mouse model of acute gastric mucosal lesion was prepared by gavage with ethanol .The mice were randomly divided into 4 groups:normal group , model group , butyric acid group and hydrogen group .The mice in butyric acid group and hydrogen group were given buty-rate and hydrogen prior to model establishment , respectively .Macroscopic observation of the pathological changes in gastric tissues was performed to evaluate the effect of the 2 metabolites of C.butyricum.Meanwhile, the mRNA expression levels of inflammatory factors, such as IL-12, RAN1 and MCP-1, were determined by RT-qPCR.The expression levels of apopto-sis-related proteins Bcl-2 and Bax were detected by immunohistochemical staining .RESULTS:The macroscopic observa-tion found that butyrate , not hydrogen , protected gastric mucosa .HE staining also showed that butyrate significantly attenu-ated the pathological damage of the gastric mucosa induced by ethanol .Compared with model group , the mRNA levels of inflammatory factors IL-12, RAN1 and MCP-1 in butyrate group significantly decreased (P<0.01).In butyrate group, the protein level of Bax was obviously decreased compared with model group (P<0.01), while the protein level of Bcl-2 was significantly increased ( P<0.01 ) .CONCLUSION: The gastric mucosa protective metabolite of C.butyricum may be butyric acid , not hydrogen .Butyric acid protects the gastric mucosa against ethanol-induced lesion by inhibiting the inflam- mation and reducing the expression ratio of Bax/Bcl-2.
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OBJECTIVE: To observe the influence of electroacupuncture (EA) at lower he-sea points of stomach, large intestine, small intestine and gallbladder on interleukin-1ß (IL-1ß), high mobility group protein 1 (HMGB 1) and alpha 7 nicotinic acetylcholine receptor (nAchR α7) in rats with acute gastric mucosal lesion (AGML), so as to explore whether there is relative specificity in treating gastric viscera disease by stimulating Zusanli (ST 36). METHODS: Sixty healthy SD rats were randomly assigned into a blank group, a model group, a Zusanli group, a Shangjuxu group, a Xiajuxu group and a Yanglingquan group, ten rats in each one (half male and half female). The WRS method was applied to induce the AGML model except the rats in the blank group. The rats in the blank group were treated with routine diet; the rats in the model group were treated with immobilization at rat platform, 30 min per time; the rats in the Zusanli group, Shangjuxu group, Xiajuxu group and Yanglingquan group were treated with acupuncture and connected with EA device (dilatational wave 10 Hz/50 Hz, positive electrode on the left side and negative electrode on the right side, intensity was appropriate when rat hind leg slightly shook), 30 min per time. The treatment was given once a day. After consecutive 10-day treatment, the gastric tissue was collected and the damage of gastric mucosa was evaluated; ELISA method was applied to measure the content of serum IL-1ß and tissue HMGB 1; the Western blot method was applied to measure the expression of nAchR α7 receptor. RESULTS: (1) Compared with the model group, the ulcer index (UI) of gastric mucosa, serum IL-1ß and tissue HMGB 1 were lower, and the expression of nAchR α7 was increased in the remaining groups (P<0.05, P<0.01). (2) Compared with the Zusanli group, the UI of gastric tissue, serum IL-1ß and tissue HMGB 1 were higher in the Shangjuxu group, Xiajuxu group and Yanglingquan group (P<0.05, P<0.01), and the expression of nAchRα7 was reduced in the Yanglingquan group (P<0.01). CONCLUSIONS: (1) EA at digestive system-related lower he-sea points, through IL-1ß, HMGB 1 and nAchR α7, could regulate immune response, lighten inflammatory reaction and reduce mucosal injury, which could realize the intervention effect on AGML rats. (2) From the comparison, it is concluded the intervention effect of Zusanli group is superior to the other groups, partly indicating the relative specificity between Zusanli and stomach.
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Puntos de Acupuntura , Electroacupuntura , Proteínas HMGB/metabolismo , Interleucina-1beta/metabolismo , Receptores Colinérgicos/metabolismo , Úlcera Gástrica/terapia , Animales , Femenino , Vesícula Biliar , Inmovilización , Intestino Grueso , Intestino Delgado , Masculino , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , EstómagoRESUMEN
Objective To investigate the role of TRPV1 in exacerbation of gastric mucosal injury in a rat water immersion restraint stress (WIRS) model by acute postoperative pain. Methods Thirty Wistar rats were randomly divided into normal controlled group (N group, n=10), WIRS model group (WIRS group, n=10) and surgery after WIRS group (WS group, n = 10). The general extent of gastric mucosal injury was observed and assessed for gastric mucosal ulcer index (UI), intragastric pH and serum SOD/MDA ratio were measured and the expression of TRPV1 mRNA in gastric mocusal was accessed by Real-time Quantitative PCR. Immunohistochemistry was performed to detect the mean density of TRPV1. Results Compared with NC group, WIRS group showed obvious gastric mocusal injure with higher UI , lower values of intragastric pH serum SOD/MDA ratio and TRPV1 (P<0.05). The treatment with surgery after onset of WIRS significantly aggravated the gastric mucusal erosion and hemorrhage, with UI increased (P < 0.05), the value of intragastric pH, serum SOD/MDA ratio and TRPV1 further reduced (P < 0.05). Meanwhile, TRPV1 was inversely correlated with UI, and positively associated with intragastric pH and serum SOD/MDA ratio. Conclusion TRPV1 expression in gastric mocusal of AMGL model is inhibited by acute postoperative pain. TRPV1 may involve in the exacerbation of gastric mucosal injury in WIRS model by acute postoperative pain.
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<p><b>OBJECTIVE</b>To observe the influence of electroacupuncture (EA) at lower-sea points of stomach, large intestine, small intestine and gallbladder on interleukin-1β (IL-1β), high mobility group protein 1 (HMGB 1) and alpha 7 nicotinic acetylcholine receptor (nAchR α7) in rats with acute gastric mucosal lesion (AGML), so as to explore whether there is relative specificity in treating gastric viscera disease by stimulating Zusanli (ST 36).</p><p><b>METHODS</b>Sixty healthy SD rats were randomly assigned into a blank group, a model group, a Zusanli group, a Shangjuxu group, a Xiajuxu group and a Yanglingquan group, ten rats in each one (half male and half female). The WRS method was applied to induce the AGML model except the rats in the blank group. The rats in the blank group were treated with routine diet; the rats in the model group were treated with immobilization at rat platform, 30 min per time; the rats in the Zusanli group, Shangjuxu group, Xiajuxu group and Yanglingquan group were treated with acupuncture and connected with EA device (dilatational wave 10 Hz/50 Hz, positive electrode on the left side and negative electrode on the right side, intensity was appropriate when rat hind leg slightly shook), 30 min per time. The treatment was given once a day. After consecutive 10-day treatment, the gastric tissue was collected and the damage of gastric mucosa was evaluated; ELISA method was applied to measure the content of serum IL-1β and tissue HMGB 1; the Western blot method was applied to measure the expression of nAchR α7 receptor.</p><p><b>RESULTS</b>(1) Compared with the model group, the ulcer index (UI) of gastric mucosa, serum IL-1β and tissue HMGB 1 were lower, and the expression of nAchR α7 was increased in the remaining groups (<0.05,<0.01). (2) Compared with the Zusanli group, the UI of gastric tissue, serum IL-1β and tissue HMGB 1 were higher in the Shangjuxu group, Xiajuxu group and Yanglingquan group (<0.05,<0.01), and the expression of nAchRα7 was reduced in the Yanglingquan group (<0.01).</p><p><b>CONCLUSIONS</b>(1) EA at digestive system-related lower-sea points, through IL-1β, HMGB 1 and nAchR α7, could regulate immune response, lighten inflammatory reaction and reduce mucosal injury, which could realize the intervention effect on AGML rats. (2) From the comparison, it is concluded the intervention effect of Zusanli group is superior to the other groups, partly indicating the relative specificity between Zusanli and stomach.</p>
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OBJECTIVE: To investigate the prevalence and risk factors of upper gastrointestinal bleeding (UGIB) in patients with severe acute pancreatitis (SAP). METHODS: Altogether 101 patients were admitted to the Department of Gastroenterology, Changhai Hospital, Second Medical Military Hospital from July 2006 to June 2010 due to SAP. Their prevalence and risk factors of UGIB were retrospectively analyzed. RESULTS: In total, 18 (17.8%) patients developed UGIB and 13 received endoscopic examination, which yielded six cases of acute gastric mucosal lesions (AGML), five of peptic ulcers (PU) and two of pancreatic necrotic tissue invading the duodenal bulb and presenting as multilesion, honeycomb-like ulcer. The mortality rate of UGIB patients was much higher than that of non-UGIB patients (44.4% vs 10.8%, P = 0.0021). Univariate analysis revealed that the risk factors for UGIB included the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, computed tomography severity index (CTSI), Ranson score, arterial blood pH and PaO2 , serum blood urea nitrogen and creatinine concentrations, platelet count, shock, sepsis and organ failure, mechanical ventilation, heparinized continuous renal replacement therapy and total parenteral nutrition. Multivariate logistic regression revealed that APACHE II score and CTSI were significant risk factors while PaO2 was the protective factor for UGIB in SAP. CONCLUSIONS: UGIB is a common complication with poor prognosis due mainly to PU and AGML. Patients having SAP with high APACHE II scores and CTSI or low PaO2 should be considered to be at high risk for UGIB.
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Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Pancreatitis/complicaciones , Enfermedad Aguda , Adulto , Anciano , Análisis de los Gases de la Sangre , Nitrógeno de la Urea Sanguínea , Creatinina/sangre , Femenino , Mucosa Gástrica/patología , Hemorragia Gastrointestinal/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Páncreas/patología , Pancreatitis/sangre , Nutrición Parenteral Total/efectos adversos , Úlcera Péptica/etiología , Recuento de Plaquetas , Prevalencia , Fármacos Renales/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Sepsis/etiología , Índice de Severidad de la Enfermedad , Choque/etiología , Tomografía Computarizada por Rayos X , Tracto Gastrointestinal Superior/patología , Ventiladores Mecánicos/efectos adversosRESUMEN
Objective To discuss the therapy for acute gastric mucosal lesion(AGML)after pericardial devascularization of advanced schistosomiasis. Methods Fifteen advanced schistosomiasis patients with AGML after pericardial devascularization re-ceived supporting therapy,reducing stomach acid and protecting gastric mucosa therapy,reducing gastric blood flow therapy,en-doscopic spraying topical hemostatic agents or electric coagulation therapy,etc. Results After pericardial devascularization of ad-vanced schistosomiasis,15 patients occurred AGML,and among which,10 cases occurred from 8 to 14 days,and the shortest pe-riod was 5 days and the longest was 23 days. Among the 15 patients,13 patients were cured(86.7%),and 2 died. Conclusion The comprehensive therapy including supporting therapy,reducing gastric acid and protecting gastric mucosa,and endoscopic he-mostasis is effective in the treatment of AGML.
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OBJECTIVES: This study was designed to investigate the protective effects of Atractylodis Rhizoma pharmacopuncture (ARP) against acute gastric mucosal lesions induced by compound 48/80 in rats. METHODS: The ARP was injected in Joksamni (ST36) and Jungwan (CV12) 1 hr before treatment with compound 48/80. The animals were sacrificed under anesthesia 3 hrs after treatment with compound 48/80. The stomachs were removed, and the amounts of gastric adherent mucus, gastric mucosal hexosamine, thiobarbituric acid reactive substances (TBARS), xanthine oxidase (XO), and superoxide dismutase (SOD) were measured. Also, histological examination were performed. RESULTS: Gastric adherent mucus, gastric mucosal hexosamine and histological defects of gastric mucosa declined significantly after ARP treatment. Changes in gastric mucosal TBARS were also reduced by ARP treatment, but this result was not statistically significant. ARP treatment did not change the XO and the SOD activities. CONCLUSIONS: ARP showed protective effects for acute gastric mucosal lesions induced by compound 48/80 in rats. These results suggest that ARP may have protective effects for gastritis.
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Objective To discuss the effect of growth hormone(GH) on acute gastric mucosal lesion(AGML) in rats.Methods 120 Wistar rats were divided into four groups randomly: blank control group(n=8),simple model group(n=32),model+rhGH group(n=40) and model+cimetidine group(n=40).Animal models of AGML were set up through soak and tie of rats.GH was injected to the rats in experimental groups,while cimetidine was used in the positive control group.Morphologic changes of rat gastric mucosa in each group were observed and compared on different days(0,4,8,12 d) after stress through gross looking,light microscope,and electron microscope.Ulcer index(UI),secretion amount of gastric acid,pH value and gastric mucosal were compared.Results Compared with blank control and model+cimetidine groups,the histomorphologic changes of gastric mucosa were obviously alleviated in model+rhGH group: only part of epithelial cells swelled,red blood cells were seldom seen,neutrophils infiltration reduced obviously,no remarkable changes were observed in the submucosal tissue.Mucosal cells were in good state and degeneration were seen in only a few cells under the electronic microscope.In addition,UI and the degree of gastric mucosal atrophy in model+rhGH group were lower than that in control group significantly(P
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Objective The aim of this study was to investigate the relationship of gastric mucosal lesions and the parietal oxyntic function in rats under stress as a result of seawater-immersion after open abdominal injury. Methods Thirty-two SD rats were subjected to open abdominal injury followed by seawater immersion. The animals were randomly divided into four groups: control, 1h, 2h, 3h stress for 1h, 2h, and 3h groups. The pH value of gastric juice and gastric mucosal ulcer index (UI) were measured. The gastric mucosal lesions were observed with light microscopy, and the ultrastructural changes in parietal cells were observed by transmission electron microscopy. Results There was a significantly negative relationship between UI and pH value (r=-0.70,P