Topical application of glycyrrhizin preparation ameliorates experimentally induced colitis in rats

AIM:To examine the efficacy of glycyrrhizin preparation(GL-p) in the treatment of a rat model of ulcerative colitis(UC).METHODS:Experimental colitis was induced by oral administration of dextran sodium sulfate.Rats with colitis were intrarectally administered GL-p or saline.The extent of colitis was evaluated based on body weight gain,colon wet weight,and macroscopic damage score.The expression levels of pro-inflammatory cytokines and chemokines in the inflamed mucosa were measured by cytokine antibody array analysis.The effect of GL-p on myeloperoxidase(MPO) activity in the inflamed mucosa and purified enzyme was assayed.RESULTS:GL-p treatment significantly ameliorated the extent of colitis compared to sham treatment with saline.Cytokine antibody array analysis showed that GL-p treatment significantly decreased the expression levels of pro-inflammatory cytokines and chemokines,including interleukin(IL)-1β,IL-6,tumor necrosis factor-α,cytokine-induced neutrophil chemoattractant-2,and monocyte chemoattractant protein-1 in the inflamed mucosa.Furthermore,GL-p inhibited the oxidative activity of mucosal and purified MPO.CONCLUSION:GL-p enema has a therapeutic effect on experimental colitis in rats and may be useful in the treatment of UC.

Analysis of ABC (D) stratification for screening patients with gastric cancer

AIM:To evaluate the value of ABC(D) stratification [combination of serum pepsinogen and Helicobacter pylori(H.pylori) antibody]of patients with gastric cancer.METHODS:Ninety-five consecutive patients with gastric cancer were enrolled into the study.The serum pepsinogenⅠ(PGⅠ) /pepsinogenⅡ(PGⅡ) and H.pylori antibody levels were measured.Patients were classified into five groups of ABC(D) stratification according to their serological status.Endoscopic findings of atrophic gastritis and histological differentiation were also analyzed in relation to the ABC(D) stratification.RESULTS:The mean patient age was(67.9±8.9) years.Three patients(3.2%) were classified into group A,7 patients(7.4%) into group A',27 patients(28.4%) into group B,54 patients(56.8%) into group C,and 4patients(4.2%) into group D,respectively.There were only three cases in group A when the patients taking acid proton pump inhibitors and those who had undergone eradication therapy for H.pylori(group A') were excluded.These three cases had mucosal atrophy in the grey zone according to the diagnostic manual of ABC(D) stratification.Histologically,the mean age of the patients with well differentiated adenocarcinoma was significantly higher than that of the patients with poorly differentiated adenocarcinoma(P<0.05) .There were no differences in the pattern of atrophy in the endoscopies between the well differentiated and poorly differentiated groups.CONCLUSION:ABC(D) stratification is a good method for screening patients with gastric cancers.Endoscopy is needed for grey zone cases to check the extent of mucosal atrophy.

Analysis of colonoscopic perforations at a local clinic and a tertiary hospital

AIM:To define the clinical characteristics,and to assess the management of colonoscopic complications at a local clinic.METHODS:A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010.Data obtained from a tertiary hospital in the same region were also analyzed.The underlying conditions,clinical presentations,perforation locations,treatment types(operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared.RESULTS:A total of 10 826 colonoscopies,and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies,and 7787 therapeutic procedures were performed at the tertiary hospital.The clinic had no perforations during diagnostic colonoscopy and 8(0.3%) perforations were determined to be related to therapeutic procedures.The perforation rates in each therapeutic procedure were 0.06%(1/1609) in polypectomy,0.2%(2/885) in endoscopic mucosal resection(EMR),and 3.8%(5/131) in endoscopic submucosal dissection(ESD).Perforation rates for ESD were significantly higher than those for polypectomy or EMR(P < 0.01).All of these patients were treated conservatively.On the other hand,three(0.01%) perforation cases were observed among the 24 361 diagnostic procedures performed,and these cases were treated with surgery in a tertiary hospital.Six perforations occurred with therapeutic endoscopy(perforation rate,0.08%;1 per 1298 procedures).Perforation rates for specific procedure types were 0.02%(1 per 5500) for polypectomy,0.17%(1 per 561) for EMR,2.3%(1 per 43) for ESD in the tertiary hospital.There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital.The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital.No procedure-related mortalities occurred.Performing closure with endoscopic clipping reduced the C-reactive protein(CRP) titers.The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping,respectively(P < 0.05).An operation is indicated in the presence of a large perforation,and in the setting of generalized peritonitis or ongoing sepsis.Although we did not experience such case in the clinic,patients with large perforations should be immediately transferred to a tertiary hospital.Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained.CONCLUSION:It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.