Therapeutic Evaluation of Recurrent Aphthous Ulcer with Integrated Traditional Chinese Medicine and Western Medicine

Objective: To observe the curative effects of Yiqing granule and Zhibai Dihuang pill combined with Oralpolin gel on recurrent aphthous ulcer. Methods: 150 patients with mild recurrent aphthous ulcer were classified as excessive internal heat type and deficiency internal heat type by traditional Chinese medicine theory. Then, they were randomly divided into the positive control group (thalidomide group), the trial group (Yiqing granule group/Zhibai Dihuang pill group), and the negative control group (topical medication group). All the patients in every group used Oralpolin gel. Additionally, the patients in the positive control group took thalidomide tablets orally and those in the trial group orally took proprietary Chinese medicine (Yiqing granule/Zhibai Dihuang pill). The treatment lasted for 4 weeks. The curative effects were all evaluated according to the “RAU Efficacy Evaluation Trial Standard” which was formulated by the Professional Committee of Mucosal Diseases of Chinese Stomatological Association. Results: Of all the 150 patients involved in this medical experiment, 146 cases finished it, including 66 ones in the trial group, 36 ones in the positive control group, and 44 ones in the negative control group. The total drop-out rate was 2.7%. For the excessive internal heat type, the effective rates in the thalidomide group, the Yiqing granule group and the local medication group were 91.7%, 52.6% and 52.9% respectively in order. For the deficiency internal heat type, the effective rates in the thalidomide group, the Zhibai Dihuang pill group and the local medication group were 87.5%, 71.4% and 40% respectively in order. The clinical efficacy of the Zhibai Dihuang pill group was better than that of the local medication group and similar to that of the thalidomide group (P Conclusion: Zhibai Dihuang pill is significantly effective in the treatment for mild recurrent aphthous ulcer of deficiency internal heat type without severe adverse reactions.

RADIOIMMUNOASSAY OF SERUM FERRITIN LEVEL IN PATIENTS WITH RECURRENT APHTHOUS ULCERATION

The purpose of this study was to assess the correlation between iron deficiency and recurrent aphthous ulceration (RAU). Radioimmunoassay was used to examine the serum ferritin level (SFL) in 52 patients with RAU and in 54 controls. Both were divided into 2 groups in accordance with sex. The 36 female patients were subdivided into 3 age-groups as follows: 8 aged 22-24, 10 aged 25-34, and 18 aged 35-50 while the male patients were gathered as one single group aged 26-57. The subdivision was adapted similarly for the normal age-grouts. Although no significant difference in SFL was found between the male control and the male patient groups, differences between the female control and female patient groups showed highly significant which levels, with the ascendance of age, were P【0.001, P【0.005 and P【0.001, respectively. Also the difference between male and female control groups were significant (P【0.05). However, no significant differences in SFL were discovered among the 3 patient groups. 10 female patients with SFL【12ng/ml were tested with ferrous sulfate for one month, then their SFL was reexamined one week after the treatment. A highly significant difference in SFL was noted between the pre-ad post-treatment (P【0.001). 9 of them showed that the interval of recurrences were prolonged, the number of ulcers reduced, the pain less intensive and its duration shorter than those before the treatment. This study demonstrated that a singificant decrease in iron-storage occurred in female RAU patients. The authors concluded that the decrease SFL was possibly related to menstruation and child bearing.

Research Progress of Action Mechanism of Mongolian Medicine Hatageqi-7 in the Treatment of Recurrent Aphthous Ulcer

Based on Mongolian medical theory and modern pharmacology,literature on the main components and action mechanism of Hatageqi-7 in the treatment of recurrent aphthous ulcer is collected,sorted and summarized.The research hopes to provide certain basis for its clinical efficacy from theory.

Multidrug dissolvable microneedle patch for the treatment of recurrent oral ulcer

Recurrent oral ulcer is a painful oral mucosal disorder that affects 20%of the world’s population.The lack of a radical cure due to its unknown underlying cause calls for innovative symptomatic treatments.This work reports a hyaluronic acid-based dissolvablemicroneedle patch(ROUMNpatch,short for recurrent oral ulcer microneedle)loaded with dexamethasone acetate,vitamin C and tetracaine hydrochloride for the treatment of recurrent oral ulcers.The ROUMN patch shows enhancement in both the anti-inflammatory effect elicited by dexamethasone and the pro-proliferation effect of vitamin C.In vitro experiments show that ROUMN has a higher efficiency in suppressing lipopolysaccharide(LPS)-induced interleukin-6(IL-6)expression than dexamethasone alone.Cell proliferation and migrationwere also significantly promoted byROUMNcompared to vitamin C alone.The healing-promoting effect of ROUMN was also verified in vivo using an acetic acid-cauterized oral ulcer model in rats.ROUMN as a treatment accelerated the healing process of oral ulcers,shortening the total healing time to 5 days compared with the 7 days required by treatment using watermelon frost,a commonly used over-the-counter(OTC)drug for oral ulcers.The rapid dissolution of the hyaluronic acid-based microneedles and the superior healing-promoting effect of the drug combination could lead to a broad application prospect of the ROUMN patch in the treatment of recurrent oral ulcers.

Test Case Analysis Application of Jiawei-yinhuo Soup the Treatment of Recurrent Oral Ulceration

Recurrent oral ulceration,which is small but not easy to cure,seriously affects the quality of life of the patients.This paper analyzes professor Wang Xiaoyan's application of Yinhuotanghuacai to treat oral ulcer with floating of yang in deficiency condition,which can significantly improve the clinical symptoms of patients and improve the quality of life of patients.

The Clinical Effects of Allantoin Powder for Gargle on Periodontal Diseases and Aphthous Ulcer

A newly developed mouthrinse, Allantoin Powder for Gargle, was clinically investigated. The compound of this agent is mainly allantoin, which is believed easy to penetrate into gingival sulcus and periodontal pockets as well as other places (such as tongue, soft palate, etc.) where it is inconvenient to use medication, 219 patients with various diseases of oral cavity were investigated in the double blind randomlized placebo controlled study. It was observed that apparent efficient rates of the experimental mouthrinse on periodontitis and marginal gingivitis were 81.25% and 56.86% respectively; and the efficient rate of it on aphthous ulcer was 68.57%. The data show that this agent has effective as an adjuctive on the treatments of periodontal diseases and aphthous ulcer.

Enhancing ulcerative colitis treatment with traditional Chinese medicine

Inflammatory bowel disease,particularly ulcerative colitis(UC),poses significant treatment challenges due to its chronic nature and potential for severe complications.This editorial reviews a recent network meta-analysis that evaluated the efficacy of and highlighted the superior outcomes achieved by combining each of five traditional Chinese medicine(TCM)formulations with mesalazine for the adjuvant treatment of UC.Clinical outcomes included enhanced mucosal healing,improved quality of life,and reduced recurrence rates.Additionally,the combination therapy resulted in a lower incidence of adverse reactions compared with mesalazine monotherapy.Despite these promising results,limitations such as variability in study quality and TCM dosage highlight the need for further highquality,large-sample,multicenter randomized controlled trials.This editorial underscores the potential of TCM in enhancing UC management and calls for more rigorous research to substantiate these findings and refine clinical guidelines.

Evaluation of a Newly Developed Laser Pen as a Home Care Device for Pain Reduction of Recurrent Aphthous Stomatitis (Preliminary Study)

Objective: The aim of this survey is to evaluate the effect of a new developed laser pen as a home care device for patients’ pain reduction with recurrent aphthous stomatitis. Background data: Recurrent aphthous stomatitis (RAS) is one of the most common and painful ulcers in the oral cavity. Low Level Laser Therapy (LLLT) has been used successfully for reducing pain and healing time in comparison with corticosteroids and placebo in some studies. But these treatments are done in the clinics and it seems that there is no report of the laser treatment as a home care device up to this study. Methods: This was a prospective, randomized trial pilot study. Thirty patients with RAS were divided into three similar groups. The group one (n = 10) was treated with a diode laser, 660 nm, 40 mw, continuous wave, 1.2 J, 6 J/cm2, for five consecutive days (twice per day, 30 seconds each session). The second group (n = 10) was treated with a topical triamcinolone (adcortyl in orabase) ointment four times per day and the third group (n = 10) was treated with placebo (red light pen) the same way as Group 1. All the patients were evaluated with a Visual Analogue Scale (VAS) before and after treatment on the consecutive days. The data was analysed by one way ANOVA and PostHoc tests. Results: The results show that the laser pen and triamcinolon in orabase ointment have similar results and both have better results than placebo in the control of the recurrent aphthous stomatitis pain (p value: 0.001). Conclusion: In this clinical pilot study the laser pen as a home care device seems to be useful for the treatment of RAS.

Fresh Amniotic Membrane Transplantation Combined Lamellar Keratoplasty for Patients with Recurrent Mooren's Ulcer

Purpose: To investigate the possibility of amniotic membrane as an immunologicalinsulating band to reduce the recurrent frequency of Mooren's ulcer.Methods: Twelve cases(12 eyes)with recurrent Mooren's Ulcer were observed. Amongthem, 4 cases(4 eyes)were male and 8 cases(8 eyes) female, ranging in age between 26and 51 years[mean(41 ± 3)years]. Three eyes recurred once, 5 eyes twice, and 4 eyesthree before. Eleven of 12 cases (11/12 eyes)with frequently recurrent Mooren's ulcerunderwent lamellar keratoplasty combined amniotic membrane transplantation(AMT).One patient who had entire corneal ulceration accepted AMT alone.Results: Follow-up time is 12 to 29 months, [mean (23 ± 6) months]. Before AMT, therecurrent frequency of Mooren's Ulcer of all cases after corneal surgery was 1 ～ 7 months[mean(3 ± 2)months]. Nine of 12 eyes with lamellar keratoplasty combined AMT did notrecur within the observation period; 2 eyes recurred 11 months after the surgery. Threemonths postoperatively, neovascularization was observed, which made it nearly impossibleto decipher between amniotic membrane and its nearby conjunctiva, only at the junctionof the transplant can some trails be observed. One case with entire AMT alone showedgraft resolution and neovascularization in 1 month.Conclusion:AMT combined with lamellar keratoplasty and lesion excision may delayrecurrence of Mooren's Ulcer, reduce its recurrent frequency. Besides the effects ofdecreasing inflammation, it may have immunological insulating function as well. Thisconclusion should be proven by further clinical comparative study of much moresamples.

The Local Immunity of the Oral Cavity in Women with Recurrent Aphthous Stomatitis Associated with Urogenital Infection

This paper studied the dynamics of local immunity factors of the oral cavity in women with recurrent aphthous stomatitis against the background of urogenital infection. The research proves the maximum efficacy of hydroxyzine hydrochloride, aminodihydrophthalasindione sodium and Eplan used in multiple treatments of recurrent aphthous stomatitis in patients with urogenital infection as evidenced by a marked reduction in the coefficient of local immunity factors balance, which is observed as early as on day 7 of the therapy provided. Moreover, the findings show the growth of immunological parameters of oral fluid (lysozyme and SIgA), the normalization of the coefficient of local immunity factors balance in the treatment of recurrent aphthous stomatitis in women with urogenital infection, the improvement being observed 3 months after the treatment suggesting a favorable local immunity of the oral cavity.

Treatment of Recurrent Aphthous Stomatitis by 100% Topical Pumpkin Seed Oil

Background: Recurrent aphthous stomatitis (RAS) is a major oral health problem, where its etiopathogenesis is not well understood. Accordingly, its therapy whether topical or systemic can induce clearance, but the relapse rate is high. Objective: To use 100% topical pumpkin seed oil in RAS as it has many actions as anti-inflammatory and antioxidant effects. Patients and Methods: This single, blind, clinical, therapeutic trial was conducted in the Department of Dermatology-Baghdad Teaching Hospital, Baghdad, Iraq, during February 2015-August 2016. Twenty-five patients with RAS were included in this work. After full history and clinical examination, the clinical diagnosis was established. Oral clinical manifestation index score (OCMI) was carried out before, during and after stopping therapy to assess the different parameters of this score. 100% Topical pumpkin seed oil was given two times daily for 3 months during which short term assessment for each patient was done by using OCMI before, after 4 days and after 8 days of therapy in addition to assessing the mean size of largest diameter of ulcers in each visit to evaluate the therapeutic efficacy of the therapy, while long term assessment of the OCMI was done every month for 3 months after starting of the therapy to evaluate the prophylactic effect of the therapy. After 3 months, pumpkin seed oil was stopped and assessment of OCMI was done monthly for another 3 months to evaluate the remission action of pumpkin seed oil. Results: Twenty-five patients were included in this study: 15 (60%) males and 10 (40%) females. While their ages ranged from 9 - 60 (27.48 ± 11.97) years. The mean of OCMI before pumpkin seed oil therapy was ranged from 9 - 15 (12.96 ± 1.42), while after the therapy the mean started to decline to lower level within 4 days of therapy and was statistically significant (p < 0.0001) and continued to decline significantly till the end of third month of therapy (p < 0.0001). The percent reduction was 79.30% after 4 days of therapy and 94.38% after 8 days of therapy. After stopping therapy, the mean of OCMI started to increase, but it is remained statistically highly significant (p < 0.0001) at the end of third months after stopping therapy when it is compared with baseline mean of OCMI. Conclusion: Pumpkin seed oil had an effective therapeutic and prophylactic action against RAS, in addition, it induced remission for at least 3 months after stopping therapy. No local or systemic side effects were observed during the course of therapy.

Therapeutic Role of Isotretinoin in the Management of Recurrent Aphthous Stomatitis (Single-Blind Controlled Therapeutic Study)

Background: Recurrent aphthous ulcer (RAS) is a common oral disease where its etiopathogenesis is not well elucidated. There was no effective curative therapy for this disease. Isotretinoin has been recently used in the treatment of Behcet’s disease. Objectives: To evaluate the efficacy and safety of isotretinoin in treating RAS and the long term remission of RAS. Patients and Methods: This single-blind controlled therapeutic study conducted in Department of Dermatology-Baghdad Teaching Hospital during February 2011-January 2012. Thirty patients with typical RAS were included in this work. Detailed history and full examination were done for all patients. They were given isotretinoin 20 mg orally once daily for three months to be seen on Day 14 firstly and then monthly to be assessed using the oral clinical manifestation index (OCMI). After isotretinoin was stopped three months later, patients were given placebo therapy for another 3 months. Results: The results of 30 treated patients were as follows: 17 (56.67%) males and 13 (43.33%) females with male to female ratio was 1.3:1. Their ages ranged from 12 - 60 (35.33 ± 12.06) years. The OCMI before isotretinoin therapy ranged from 7 - 17 (13.13 ± 2.55), while after therapy the mean started to decline to a lower level within the first 14 days (P = 0.103), and continued to decline significantly until the end of the first month of therapy (P = 0.023). Then the OCMI declined very significantly until the end of fourth month of therapy (P < 0.001). After that the mean started to increase until the end of the 5 months (with placebo) but it remained statistically significant compared with the baseline of mean of OCMI before treatment (P = 0.046). Then it continued to increase to become not significant at the end of 6 months of therapy (P = 0.107). Conclusion: Isotretinoin is an effective therapeutic and prophylactic promising remedy in treatment of RAS.

Effects of Zingiber officinalis (WILLD.)ROSC.Membranes on minor recurrent aphthous stomatitis: a randomized pragmatic trial

Objective:To evaluate the effects of dried ginger rhizome (DGR;Zingiber officinalis (WILLD.) ROSC.),prepared as a membrane,in minor recurrent aphthous stomatitis (miRAS)treatment and explore its mechanism of action by detecting changes in levels of epidermal growth factor (EGF) and tumor necrosis factor (TNF)-α in saliva.Methods:Fifty-nine miRAS patients were enrolled in this study.The number of participants in the dried ginger rhizome membrane (DGRM) group was 30,and 29 were in the placebo membrane (PM) group.Sixty sealed envelopes containing either type of membrane were coded randomly.Investigators and participants were blinded to group assignments.A visual analog scale (VAS) was used for pain,follow-up information for healing time,and enzyme-linked immunosorbent assays to measure the concentrations of EGF and TNF-α.Results:In terms of VAS,there was a significant difference between pre-and post-DGRM treatment (P <.001),but not so for the PM group (P >.05).A significant difference was observed in the healing time between the two groups (6.08 (2.712) vs.8.04 (2.142) days).The mean healing time in the DGRM group was shorter than that in the PM group (P <.05).In both groups,the salivary EGF concentration decreased significantly after treatment (P <.05),but the mean level in the DGRM group was significantly lower than that in the PM group (P <.05).The mean TNF-α level in both groups was increased significantly after treatment (P <.05),but patients who used DGRMs had a significantly lower level than that in the PM group (P <.05).Conclusion:The present study provides evidence that DGRMs are effective treatment for RAS.Dried ginger rhizome has obvious effects on pain relief,shortening of healing time,reducing the EGF level in saliva,and has an inhibitory effect on TNF-α release.

Quality of ulcer healing in gastrointestinal tract:Its pathophysiology and clinical relevance

In this paper, we review the concept of quality of ulcer healing （QOUH） in the gastrointestinal tract and its role in the ulcer recurrence. In the past, peptic ulcer disease （PUD） has been a chronic disease with a cycle of repeated healing/remission and recurrence. The main etiological factor of PUD is Helicobacter pylori （H. pylorl~, which is also the cause of ulcer recur- rence. However, H. pylori-negative ulcers are pres- ent in 12%-20% of patients; they also recur and are on occasion intractable. QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated. Within the scars of healed ulcers, regenerated tissue is immature and with distorted architecture, suggesting poor QOUH. The abnormalities in mucosal regeneration can be the basis for ulcer recurrence. Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence. Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macro- phages, which in turn produce increased amounts of cytokines and chemokines, which attract neutrophils to the regenerated area. Neutrophils release proteolytic enzymes that destroy the tissue, resulting in ulcer re- currence. Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a defi- ciency and/or an imbalance of endogenous growth fac- tors. Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar. In addition to PUD, the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn＇s disease and ulcer- ative colitis.

Therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer

Objective:To explore the therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer.Methods:A total of 138 SD rats were selected to make rat models with gastric ulcer induced by acetic acid(24 rats with sham operation served as sham operation group),and were randomly divided into model group(n=30),western medicine group(n=30),traditional Chinese medicine(TCM) group(n=24) and combination group(combined western medicine and TCM group,n=30).Western medicine group was gavaged with omeprazole in the morning and with iso-volumetric distilled water in the afternoon;TCM group and TCM sham operation group were gavaged with iso-volumetric distilled water in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;combination group was gavaged with omeprazole in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;sham operation group and model group were gavaged with iso-volumetric distilled water both in the morning and afternoon.Ulcer indexes and degree of mucosal degree in rats at different time points after gavage were observed.Twentyeight days after gavage,interleukin(IL)-1β was given to induce ulcer recurrence so as to observe the recurrent severity and rate of ulcer in each group.Results:Compared with model group and western medicine group,treatment in combination group could prominently reduce the ulcer index of rats with peptic ulcer,and increase the healing rate and inhibition rate of peptic ulcer.After IL-1β-induced ulcer recurrence,combination group was significantly superior to model group and western medicine group in ulcer recurrent rate[50%(3/6) vs.100%(6/6)]and severity.Conclusions:Basic acid-suppression therapy combined with Qi-Replenishing and BloodActivating Formula can effectually improve the ulcer healing quality and reduce ulcer recurrence.

Short term effect of Salvia miltiorrhiza in treating rat acetic acid chronic gastric ulcer and long term effect in preventing recurrence

AIM To study the short term effect of Danshen ( Salvia miltiorrhiza ) on acetic acid induced chronic gastric ulcer in rats and its long term effect in preventing recurrence. METHODS Rats with acetic acid induced gastric ulcer were treated with Danshen and cimetidine for 30 days. Traditional gastric mucosal auto radiography and 3H TdR incorporation into gastric mucosa in vitro were employed to study the effects of Danshen in rat acetic acid induced chronic gastric ulcer, including ulcer index (UI), ulcer inhibitory rate (IR) and label rate (LR). RESULTS On the day 5, 30 and 126 of ulcer making, the UI in the Danshen group was obviously lower than that in the cimetidine group and the control group (42 3±3 9, 3 6±1 2, 4 4±2 3; 49 1±3 6, 5 9±1 4, 9 2±1 3; 61 0±3 8, 8 9±2 5, 12 4±2 4, respectively, P <0 01), the IR (%) in the Danshen group was obviously higher than that in the cimetidine group (31, 59, 64 8; 19, 33, 26, respectively), and the LR in the Danshen group was obviously higher than that in the cimetidine group and the control group (10 0±0 5, 16 2±0 8, 15 0±0 6; 9 0±0 5, 13 9±0 6, 10 8±0 7; 6 5±0 7, 10 1±0 5, 8 0±0 7, respectively, P <0 01). There was no obvious difference in UI in the Danshen group on day 30 as compared with that on day 126. CONCLUSION Danshen is effective in promoting ulcer healing and preventing recurrence. The mechanism of action is to strengthen the gastric mucosal barrier and to promote the gastric mucosal cell proliferation along the edge of the ulcer.

Intravenous proton pump inhibitors for peptic ulcer bleeding:Clinical benefits and limits

Peptic ulcer bleeding is a common disease and recurrent bleeding is an independent risk factor of mortality.Infusion with proton pump inhibitors(PPIs) prevents recurrent bleeding after successful endoscopic therapy.A gastric acidic environment of less than pH 5.4 alters coagulation function and activates pepsin to disaggregate platelet plugs.Gastric acid is secreted by H+,K+-ATPase,naming the proton pump.This update review focuses on the mechanism and the role of PPIs in the clinical management of patients with peptic ulcer bleeding.An intravenous omeprazole bolus followed by high-dose continuous infusion for 72 h after successful endoscopic therapy can prevent the recurrent bleeding.In the Asian,however,the infusion dosage can possibly be diminished whilst preserving favorable control of the intragastric pH and thereby still decreasing rates of recurrent bleeding.Irrespective of the infusion dosage of PPIs,rates of recurrent bleeding remain high in patients with co-morbidities.Because recurrent peptic ulcer bleeding may be prolonged in those with co-morbidities,a lowdose infusion of IV PPIs for up to 7-day may result in better control of recurrent bleeding of peptic ulcers.Due to the inter-patient variability in CYP2C19 genotypes,the infusion form of new generation PPIs,such as esomeprazole,should be promising for the prevention of recurrent bleeding.This article offers a comprehensive review of clinical practice,highlighting the indication,the optimal dosage,the duration,and the potential limitation of PPIs infusion for peptic ulcer bleeding.

Candida-associated gastric ulcer relapsing in a different position with a different appearance

An 87-year-old,Japanese woman was shown to have a submucosal tumor-like lesion with a deep,central ulceration covered with thick,whitish exudate in the stomach.Biopsy showed Candida tropicalis but not Helicobacter pylori(H.pylori).She had no predisposing factors or history of peptic ulcers nor had taken non-steroidal anti-inflammatory drugs(NSAIDs),diagnosed with Candida-associated gastric ulcer.Though cured of the lesion,she developed another ulcer in a different position,in which Candida was demonstrated but H.pylori was undetectable.This is the first case of recurrent Candida-associated gastric ulcer in the world.Detected in both the original and recurrent lesions in an H.pylori-negative patient with no antecedent ulcers who had not taken NSAIDs,Candida is considered,contrary to the prevailing opinion,to play an etiologic role in ulcer formation.

Laparoscopic Management of Perforated Peptic Ulcer: Simple Closure or Something More?

Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2 - 6 hours from the onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40 - 100 min for the Graham patch repair and 120 - 155 min for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch” group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

Efficacy and safety of Sijunzi Decoction for peptic ulcers: A systematic review and meta-analysis

Objective:To investigate the therapeutic efficacy and safety of Sijunzi Decoction (SJZD) for peptic ulcers (PUs) through the assessment of randomized controlled tHals (RCTs).Methods:Five English and four Chinese databases were systematically searched to identify eligible RCTs that investigated the effect of SJZD for PUs.SJZD was used either independently or concomitantly with routine anti-ulcer treatments and compared with no intervention,placebo,or conventional therapy.Outcomes evaluated included ulcer healing,symptom improvement,Helicobacter pylori (Hp) eradication,ulcer recurrence,and adverse reactions.Statistical analysis and risk of bias was evaluated by Revman 5.3.Results:Fourteen trials involving 1476 participants fulfilled the selection criteria.All trials were presented with a high risk of bias.Analyses showed that modified SJZD had significant benefit on ulcer healing compared with ranitidine and sucralfate and triple therapy with omeprazole,amoxicillin and clarithromycin.Compared with this omeprazole triple therapy and therapy using pantoprazole,the addition of modified SJZD was superior.Regarding symptom improvement,modified SJZD was significantly better than ranitidine and sucralfate and had an added benefit when supplemented with either of two omeprazole triple therapies (omeprazole,amoxicillin and clarithromycin,and omeprazole,levofloxacin and furazolidone) or pantoprazole.Furthermore,modified SJZD had a favorable effect on Hp eradication compared with cimetidine and additional benefit was noted when complemented with either of the two omeprazole triple therapies or therapy consisting of omeprazole and amoxicillin.Modified SJZD was superior at reducing ulcer recurrence among healed patients compared with cimetidine.Modified SJZD with triple-drug regimen comprising omeprazole,amoxicillin and clarithromycin was also found to be more effective at reducing ulcer relapse compared with the triple therapy alone.No serious adverse events were reported.Conclusion:Modified SJZD,used independently or as a complementary treatment to conventional ulcer-healing treatments,promoted PU healing,alleviated symptoms,eradicated Hp,and reduced ulcer relapse.Modified SJZD was relatively safe.However,rigorous randomized controlled trials are required to provide further support for these effects because of the high risk of bias and limited sample size of the included trials.