Anti-inflammatory activity of probiotic Bifidobacterium: Enhancement of IL-10 production in peripheral blood mononuclear cells from ulcerative colitis patients and inhibition of IL-8 secretion in HT-29 cells

AIM: To determine the anti-inflammatory activity of probiotic Bifidobacteria in Bifidobacteria-fermented milk (BFM) which is effective against active ulcerative colitis (UC) and exacerbations of UC, and to explore the immunoregulatory mechanisms. METHODS: Peripheral blood mononuclear cells (PBMNC) from UC patients or HT-29 cells were co-cultured with heat-killed probiotic bacteria or culture supernatant of Bifidobacterium breve strain Yakult (BbrY) or Bifidobacterium bifidum strain Yakult (BbiY) to estimate the amount of IL-10 or IL-8 secreted. RESULTS: Both strains of probiotic Bifidobacteria contained in the BFM induced IL-10 production in PBMNC from UC patients, though BbrY was more effective than BbiY. Conditioned medium (CM) and DNA of both strains inhibited IL-8 secretion in HT-29 cells stimulated with TNF-α, whereas no such effect was observed with heat- killed bacteria. The inhibitory effect of CM derived from BbiY was greater than that of CM derived from BbrY. DNAs of the two strains had a comparable inhibitory activity against the secretion of IL-8. CM of BbiY induced a repression of IL-8 gene expression with a higher expression of IκB-ζ mRNA 4 h after culture of HT-29 cells compared to that in the absence of CM.CONCLUSION: Probiotic Bifidobacterium strains in BFM enhance IL-10 production in PBMNC and inhibit IL-8 secretion in intestinal epithelial cells, suggesting that BFM has anti-inflammatory effects against ulcerative colitis.

The Relationship between Antioxidant and Anti-Ulcer Activities in Saudi Honey Samples Harvested from Various Regions in Different Seasons

The main chemical components of 13 Saudi honey samples (composed of winter and summer honeys) were identified according to anti-ulcer and antioxidant activity by using phytochemical and chromatographic analyses. Phytochemical screening of ethyl acetate and water extracts was used to detect the presence of carbohydrates, flavonoids, amino acids, and phenolic acids. High-performance liquid chromatography (HPLC) of sugar contents was used to detect the presence of galactose in all of the honey samples. The other detected sugars were sucrose, fructose, and arabinose. Fifteen amino acids were detected in all of the honey samples: Prolin is dominant in all of the honey samples. The citric acid and tartaric acids of winter and summer honey were also detected, in addition to faint traces of free oxalic acid. Both samples were tested for amino acids, phenolic compounds, and sugars. The most crucial result derived in this study is the effect of summer honey on ulcers. The anti-ulcer activities were also evaluated, showing that oral administration of the honey samples reduced the intensity of ulcer scores when compared to the control group. Similarly, there was a highly significant reduction in the values of the ulcer indices and areas in rats that received the same sample (P < 0.05 and P < 0.01) in comparison with those of the ulcer control rats. Finally, the antioxidant activity of the honey samples was evaluated, revealing a proportional relationship between the anti-oxidant and anti-ulcer activities. The results of this study could be reached that the effectiveness of honey as an anti-ulcer increase with the increasing its antioxidant activities.

Helicobacter pylori-negative,non-steroidal anti-inflammatory drug:Negative idiopathic ulcers in Asia

Since the discovery of Helicobacter pylori(H.pylori)infection in the stomach,the bacteria infection and non-steroidal anti-inflammatory drugs(NSAIDs)use had been considered to be the 2 main causes of peptic ulcers.However,there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors;these are termed idiopathic peptic ulcers.Such trend was firstly indicated in 1990s from some reports in North America.In Asia,numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s,but in the2000s,multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%,indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years.While a decline in H.pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers,it is also possible that the absolute number of idiopathic ulcer cases has increased.Advanced age,serious systemic complication,and psychological stress are considered to be the potential risk factors for idiopathic ulcers.Management of idiopathic ulcers is challenging,at present,because there is no effective preventative measure against recurrence in contrast with cases of H.pylori-positive ulcers and NSAIDs-induced ulcers.As it is expected that H.pylori infection rates in Asia will decline further in the future,measures to treat idiopathic ulcers will also likely become more important.

Efficacy and safety of rabeprazole in non-steroidal anti-inflammatory drug-induced ulcer in Japan

AIM: To investigate the effi cacy and safety of rabepra-zole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan. METHODS: Subjects comprised patients undergoing NSAID treatment in whom upper gastrointestinal en-doscopy revealed an ulcerous lesion (open ulcer) with diameter ≥ 3 mm, who required continuous NSAID treatment. Endoscopies were performed at the start of treatment, during the treatment period, and at the conclusion (or discontinuation) of treatment. Findings were evaluated as size (maximum diameter) and stage based on the Sakita-Miwa classifi cation. An ulcer was regarded as cured when the "white coating" was seen to have disappeared under endoscopy. As criteria for evaluating safety, all medically untoward symptoms and signs (adverse events, laboratory abnormalities, accidental symptoms, etc.) occurring after the start of rabeprazole treatment were handled as adverse events.RESULTS: Endoscopic cure rate in 38 patients in the efficacy analysis (endoscopic evaluation) was 71.1% (27/38). Among those 38 patients, 35 had gastric ulcer with a cure rate of 71.4% (25/35), and 3 had duodenal ulcer with a cure rate of 66.7% (2/3). Three adverse drug reactions were reported from 64 patients in the safety analysis (interstitial pneumonia, low white blood cell count and pruritus); thus, the incidence rate for adverse drug reactions was 4.7% (3/64).CONCLUSION: The treatment efficacy of rabeprazole for NSAID-induced ulcer under continuous NSAID ad-ministration was confi rmed.

Anti-Ulcerogenic Activity of the Pomegranate Peel (<i>Punica granatum</i>) Methanol Extract

Pomegranate (Punica granatum L.) belongs to genera Punica and family Punicaceae. It is a herbal preparation that has been suggested as useful in the treatment of gastrointestinal disorders. However, to our knowledge, no study has been conducted to evaluate this therapeutic property. In the present study the antiulcerogenic effects of pomegranate peel methanol extract, was tested on male Wistar albino rats. Oral pretreatment with peel extracts (25, 50 and 100 mg/kg) for 15 days protected the gastric mucosa against the damage induced by indomethacin (50 mg/kg). The incidence of ulceration in the control group was 100%. The best results were found in a dosage of 50 mg/kg in sour summer cultivar which inhibited the peptic ulcerin comparison with indomethacin induced gastric ulcer group. Lowest ulcer index (5.4 ± 0.55), an apparent decrease in the infiltration of polymorphonuclear leukocytes and hemorrhage were observed after administration of sour summer extracts (50 mg/kg). In conclusion present study showed that pomegranate peel extract, especially sour summer, has curative potential as an antiulcer, possibly via its high antioxidant activity. These results from pomegranate peel extract can provide an extra income and may contribute about good nutritional values of this product.

Colonoscopy evaluation after short-term anti-tuberculosis treatment in nonspecific ulcers on the ileocecal area

AIM: To evaluate the eff icacy of colonoscopy follow-up after short-term anti-tuberculosis treatment in patients with nonspecific ulcers on ileocecal areas being suspicious of tuberculous colitis. METHODS: We prospectively analyzed the colonoscopic fi ndings before and after short term anti- tuberculosis treatment in 18 patients with nonspecifi c ulcers on the ileocecal area and compared them with 7 patients of confi rmed tuberculous colitis by acid-fast bacilli or caseating granuloma on colonic biopsy. RESULTS: Mean duration for short-term follow- up was 107.3 d with combined chemotherapy containing isoniazid, rifampicin, ethambutol and pyrazinamide. Seven patients with tuberculous colitis showed complete healing of active ulcers after short- term medication. After short-term anti-tuberculosis treatment, follow-up colonoscopy findings devided 18 patients with nonspecific ulcers into two groups by ulcer state. One is the "suspicious tuberculous colitis group" showing healing of ulcers and erosions and another is the "suspicious inflammatory bowel disease group" showing active ulcers with or without aggravation of the lesion. Finally, all 9 of the "suspicious tuberculous colitis group" were diagnosed as tuberculous colitis showing no recurrence of ulcers after termination of 9 mo of anti-tuberculosis medication. Patients of the "suspicious inflammatorybowel disease group" were f inally diagnosed as Crohn's disease or nonspecifi c colonic ulcers during long-term follow up. CONCLUSION: Follow-up colonoscopy shows a healing stage ulcer or scarring change without an active ulcer with just 2 mo to 3 mo of medication in patients with tuberculous colitis. Colonoscopy follow-up after short term anti-tuberculosis trial in patients with nonspecif ic ulcers on the ileocecal area is valuable in making early differential diagnosis of tuberculous colitis.

Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use

BACKGROUND Ulcerative colitis(UC)is an uncommon inflammatory bowel disease(IBD).However,its incidence has recently increased in South Korea.Moreover,UC diagnoses are frequently delayed,and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed;167 cases were excluded because the first symptom date was unknown.We evaluated the relationship between the prognosis and a diagnostic delay of 3,6,12,18,and 24 mo by comparing the prognostic factors[anti-tumor necrosis factor(TNF)-αuse,admission history due to acute flare-ups,frequent admission due to flare-ups,surgery associated with UC,and the clinical remission state at the latest followup]at each diagnostic interval.RESULTS The mean diagnostic interval was 223.3±483.2 d(median,69 d;75th percentile,195 d).Among the prognostic factors,anti-TNFαuse was significantly increased after a diagnostic delay of 24 mo.Clinical risk factors predictive of a 24-mo diagnostic delay were age<60 years at diagnosis[odd ratio(OR)=14.778,95%confidence interval(CI):1.731-126.121],smoking history(OR=2.688,95%CI:1.239-5.747,P=0.012),and misdiagnosis of hemorrhoids(OR=11.066,95%CI:3.596-34.053).Anti-TNFαuse was associated with extensive UC at diagnosis(OR=3.768,95%CI:1.860-7.632)and 24-mo diagnostic delay(OR=2.599,95%CI:1.006-4.916).CONCLUSION A diagnostic delay>24 mo was associated with increased anti-TNFαuse.Age<60 years at diagnosis,smoking history,and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.

Anti-ulcer potentials of phylum mollusca(tropical snail)slime

Objective:The effectiveness of the slimy substance in snail to regenerate and repair damaged areas on it body/shell lead to this investigation.Methods:The anti-ulcer’property of snail slime extracted from phylur mollusca(tropical snail) from the giant African snail Archachatina marginata(Fam.Arionidae) was investi gated using histamine,stress and indomethacin-induced ulcers.The solubility profile of extract was investiga ted in different solvents and at different temperatures.Chemical analysis was carried out to determine the type of constituents present in the slim,while acute toxicity test was carried out to evaluate its profile of toxicity The effect of the snail slim on gastrointestinal motility was investigated in mice,while the guinea pig ileum wa used to study the effect of the extract on contraction produced by acetylcholine and histamine.The snail slim contained copious quantity of protein,with varying amounts of simple sugars,carbohydrates and fats.Th slime was not soluble in most common solvents and increases in temperature,did not appear to increase its sol ubility.Results:The result further indicated that although the snail slime exhibited significant(P【0.05) an ti -ulcer induced by stress and histamine,it was most potent against ulcer induced by indomethacin.The snai slime potently inhibited gastrointestinal movement in mice in a dose-dependent manner;however,it was not a ble to inhibit contraction induced by acetylcholine and histamine in guinea pig ileum.Conclusion:The snai mucin possesses potent antiulcer properties without any toxic effect.The mechanism responsible for the anti-ul cer property may not be postulated with certainty but cytoprotective and anti-spasmodic activities are most likel to be involved.

Relationship and significance between anti-b2-glycoproteinⅠantibodies and platelet activation state in patients with ulcerative colitis

AIM:To study the relationship between anti-b2-glycoprotein Ⅰ (ab2GPⅠ) antibodies and platelet activation state in patients with ulcerative colitis (UC) and its significance. METHODS:Peripheral blood samples were collected from 56 UC patients (34 males and 22 females, aged 43.5 years, range 21-66 years), including 36 at active stage and 20 at remission stage, and 25 sex-and age-matched controls. The level of ab2GPⅠ was measured by ELISA. The platelet activation markers, platelet activation complex-Ⅰ (PAC-Ⅰ) and P-selectin (CD62P) were detected by flow cytometry. RESULTS:The A value for IgG ab2GPⅠ in the active UC group was 0.61 ± 0.13, significantly higher than that in the remittent UC and control groups (0.50 ± 0.13 and 0.22 ± 0.14, P < 0.01). There was a significant difference between the two groups (P < 0.01). The A value for IgM ab2GPⅠ in the active and remittent UC groups was 0.43 ± 0.13 and 0.38 ± 0.12, significantly higher than that in the control group (0.20 ± 0.12, P < 0.01). However, there was no significant difference between the two groups (P > 0.05). The PAC-Ⅰ positive rate for the active and remittent UC groups was 30.6% ± 7.6% and 19.6% ± 7.8% respectively, significantly higher than that for the control group (6.3% ± 1.7%, P < 0.01). There was a significant difference between the two groups (P < 0.01). The CD62P positive rate for the active and remittent UC groups was 45.0% ± 8.8% and 31.9% ± 7.8% respectively, significantly higher than that for the control group (9.2% ± 2.7%, P < 0.01). There was a significant difference between the two groups (P < 0.01). In the active UC group, the more severe the state of illness was, the higher the A value for IgG ab2GPⅠ was, and the positive rate for PAC-I and CD62P was positively correlated with the state of illness (Fab2GPⅠ = 3.679, P < 0.05;FPAC-I (%) = 5.346, P < 0.01;and FCD62P (%) = 5. 418, P < 0.01). Meanwhile, in the same state of illness, the A value for IgG ab2GPⅠ was positively correlated to the positive rates for PAC-I and CD62P. CONCLUSION:ab2GPⅠ level, platelet activation state and their relationship of them are closely correlated with the pathogenesis and development of UC.

Predictors of response to anti-tumor necrosis factor therapy in ulcerative colitis

Ulcerative colitis(UC) is an immune-mediated, chronic inflammatory disease of the large intestine. Its course is characterized by flares of acute inflammation and periods of low-grade chronic inflammatory activity or remission. Monoclonal antibodies against tumor necrosis factor(anti-TNF) are part of the therapeutic armamentarium and are used in cases of moderate to severe UC that is refractory to conventional treatment with corticosteroids and/or immunosuppressants. Therapeutic response to these agents is not uniform and a large percentage of patients either fail to improve(primary non-response) or lose response after a period of improvement(secondary non-response/loss of response). In addition, the use of anti-TNF agents has been related to uncommon but potentially serious adverse effects that preclude their administration or lead to their discontinuation. Finally, use of these medications is associated with a considerable cost for the health system. The identification of parameters thatmay predict response to anti-TNF drugs in UC would help to better select for patients with a high probability to respond and minimize risk and costs for those who will not respond. Analysis of the major clinical trials and the accumulated experience with the use of anti-TNF drugs in UC has resulted to the report of such prognostic factors. Included are clinical and epidemiological characteristics, laboratory markers, endoscopic indicators and molecular(immunological/genetic) signatures. Such predictive parameters of long-term outcomes may either be present at the commencement of treatment or determined during the early period of therapy. Validation of these prognostic markers in large cohorts of patients with variable characteristics will facilitate their introduction into clinical practice and the best selection of UC patients who will benefit from anti-TNF therapy.

Perinuclear anti-neutrophil cytoplasmic antibodies (p-anca) in chronic ulcerative colitis: Experience in a Mexican institution

瞄准：在墨西哥 ulcerative (UC ) 的一件样品估计流行和 p-ANCA 的临床的价值病人。方法：在一个未来的、同意 IRB 的协议， p-ANCA 与 UC 在 80 个病人被决定(吝啬的年龄， 32 +/- 12.9 年) 。疾病的严厉和延期被临床的方法决定，寻找有 p-ANCA 地位的一个统计协会。结果：p-ANCA 在 41 被检测(51%) 病人。疾病的严厉是统计上与他们的存在联系的唯一的临床的变量(P 【 0.0001；或 = 9；CI 95%= 3.2-24.7 ) 。结论：p-ANCA 的流行类似于在另外的国家报导了那。他们的存在被联系到 UC 严厉，但是比提供了没有更多的信息由临床的方法获得了。

消化内镜局部给药联合抗幽门螺杆菌四联疗法治疗胃溃疡出血的效果

目的:探讨消化内镜局部给药联合抗幽门螺杆菌四联疗法治疗胃溃疡出血的效果。方法:选取2021年11月—2023年12月中国人民解放军联勤保障部队第980医院收治的胃溃疡出血患者74例作为研究对象,采用随机抽签法分为试验组和对照组,各37例。对照组采用抗幽门螺杆菌四联疗法治疗,试验组在对照组基础上给予消化内镜局部给药。比较两组治疗效果。结果:试验组腹痛、腹胀、食欲不振缓解时间,胃灼烧、反酸消失时间,Hp根除时间,溃疡愈合时间短于对照组,差异有统计学意义(P<0.05);治疗后,两组炎性细胞浸润、炎症活动性、腺体形态、腺体密度、黏膜厚度评分低于治疗前,试验组低于对照组,差异有统计学意义(P<0.05);治疗后,两组胃动素水平高于治疗前,胃泌素、胆囊收缩素水平低于治疗前,试验组优于对照组,差异有统计学意义(P<0.05);试验组不良反应发生率低于对照组,差异有统计学意义(P=0.041)。结论:消化内镜局部给药联合抗幽门螺杆菌四联疗法治疗胃溃疡出血的效果较好,可缓解患者疾病症状,减轻胃溃疡程度,调节胃肠激素水平,安全性较高。

抗炎饮食联合粪便移植对溃疡性结肠炎患者肠道菌群多样性及耐受性的影响

目的探讨抗炎饮食联合粪便移植对溃疡性结肠炎(ulcerative colitis,UC)患者肠道菌群多样性及耐受性的影响。方法纳入2022年3月至2023年4月新疆医科大学第一附属医院150例UC患者,采用随机数字表法将患者分为饮食组、移植组和联合组,每组50例。饮食组予以抗炎饮食干预,移植组予以粪便移植治疗,联合组予以抗炎饮食联合粪便移植干预。8周后,比较三组UC缓解情况及肠道菌群多样性,并比较移植组与联合组粪便移植耐受性。结果联合组临床缓解为40.0%、内镜缓解率为32.0%,均显著高于饮食组、移植组(P<0.05),但黏膜愈合率三组间比较差异无统计学意义(P>0.05)。治疗后,联合组ace、chao、shannon指数均高于饮食组、移植组(P<0.05),且移植组均高于饮食组(P<0.05)。联合组粪便移植不良耐受性反应发热、食欲不振发生率低于移植组,腹痛联合组高移植组,但差异均无统计学意义(P>0.05)。结论抗炎饮食与粪便移植联合应用可有效提高UC患者肠道菌群多样性,促进患者临床及内镜缓解,且不增加粪便移植不耐受性反应。

白刺叶提取物缓解溃疡性结肠炎及抗氧化作用评估

研究唐古特白刺叶对3%葡聚糖硫酸钠(DSS)诱导的溃疡性结肠炎小鼠的缓解作用及可能的作用机制.采用DSS诱导小鼠溃疡性结肠炎,用唐古特白刺叶提取物给予治疗,通过HE染色法、疾病活动指数(DAI)、结肠组织病理学评分、酶联免疫吸附测定法(ELISA)检测血清中炎性因子IL-6、IL-1β、TNF-α的水平,并采用HPLC-ESI-HRMS/MS对白刺叶提取物进行化学成分指认和鉴定,在化学成分的基础上,基于HepG-2细胞对活性氧(ROS)、谷胱甘肽转移酶(GSH)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)等抗氧化酶水平进行检测.与正常组比较,模型组结肠显著缩短,DAI评分显著增加,血清中IL-6、IL-1β、TNF-α水平(P<0.01)升高,在HepG-2细胞中,模型组活性氧(ROS)水平升高,GSH、SOD、CAT降低(P<0.05);与模型组比较,白刺叶提取物组小鼠DAI评分和血清中IL-6、IL-1β、TNF-α水平降低(P<0.01),溃疡性结肠炎症状减轻,且在HepG-2细胞中,白刺叶提取物组ROS水平降低,GSH、SOD、CAT水平升高(P<0.05).唐古特白刺叶对DSS诱导的溃疡性结肠炎具有治疗作用,其作用机制可能与降低炎症因子和活性氧水平,同时升高抗氧化酶密切相关.

戊己丸对吲哚美辛诱导大鼠胃溃疡的保护作用研究

目的 研究戊己丸对吲哚美辛诱导的大鼠胃溃疡的保护作用,并初步探索其可能的作用机制。方法 36只SD大鼠随机分为正常组、模型组、阳性对照组(奥美拉唑,20 mg/kg)、戊己丸低、中、高(2.52、5.04、10.08 g/kg生药量)剂量组,每组6只。各组大鼠灌胃相应药物或0.5%羧甲基纤维素钠(Carboxymethyl Cellulose, CMC-Na)水溶液,1次/d,连续7 d,于末次给药1 h后,除正常组外,其余各组均给予吲哚美辛(60 mg/kg)灌胃造模;6 h后处死大鼠,收集血清和胃组织。通过改良Guth法计算胃溃疡指数和溃疡抑制率,染色观察比较各组大鼠胃组织病理学变化;使用试剂盒测定胃组织中丙二醛(Malonaldehyde, MDA)、超氧化物歧化酶(Superoxide Dismutase, SOD)和环氧合酶1(Cyclooxygenase-1,COX-1),血清中一氧化氮(Nitric Oxide, NO)、肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)和白细胞介素-10(Interleukin-10,IL-10)的含量;TUNEL染色法比较各组大鼠胃组织细胞凋亡情况;免疫组化法测定胃组织中环氧合酶2(Cyclooxygenase-2,COX-2)、NF-κB(p65)蛋白的表达水平。结果 与正常组相比,模型组大鼠胃组织黏膜层、黏膜下层、肌层及浆膜部分结构受损,胃溃疡指数和胃组织细胞凋亡百分比显著升高(P<0.01);MDA、TNF-α、IL-6水平显著升高(P<0.01),COX-1、NO、IL-10和SOD水平显著降低(P<0.01);COX-2和NF-κB(p65)蛋白表达显著升高(P<0.01);与模型组相比,各给药组均能改善胃组织损伤状况;戊己丸中、高剂量组和奥美拉唑组均能显著降低(P<0.01)胃溃疡指数和升高溃疡抑制率,升高COX-1、NO、IL-10水平,降低MDA、COX-2、TNF-α、IL-6和NF-κB(p65)水平,各给药组均明显降低大鼠胃组织细胞凋亡百分比,其中戊己丸中剂量组表现出良好的作用。结论 戊己丸对吲哚美辛诱导的大鼠胃溃疡有明显的保护作用,其作用机制可能与改善氧化应激抑制、炎症反应和减少细胞凋亡有关。

老年胃溃疡患者经益生菌联合抗Hp方案治疗的可行性及对肠道菌群分布的影响研究

目的 探究益生菌联合抗幽门螺杆菌(Hp)方案治疗老年胃溃疡患者的可行性及对肠道菌群分布的影响。方法 60例老年胃溃疡患者,采用计算机随机分组为观察组和对照组,每组30例。观察组患者经益生菌联合抗Hp方案治疗,对照组患者应用抗Hp方案治疗。比较两组患者的肠道菌群分布、不良反应发生率和复发率。结果 治疗前,两组患者肠杆菌、酵母菌以及双歧杆菌比较,差异无统计学意义(P>0.05);观察组患者治疗14 d后肠杆菌(7.98±0.12)lgCFU/g、酵母菌(8.86±0.38)lgCFU/g、双歧杆菌(8.24±0.38)lgCFU/g均高于对照组的(7.65±0.16)、(8.52±0.29)、(7.68±0.42)lgCFU/g,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组复发率为3.33%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论 改善老年胃溃疡患者的干预方式时,选择经益生菌联合抗Hp方案治疗具有明显疗效,有助于改善患者的肠道菌群,减少溃疡复发。

芩连愈疡汤联合NSAIDs对十二指肠溃疡的治疗效果分析

目的探讨芩连愈疡汤联合非甾体类抗炎药物(NSAIDs)对十二指肠溃疡的治疗效果及对胃蛋白酶Ⅰ(PGⅠ)、人β2防御素2(HBD-2)的影响。方法选取2020年8月—2023年5月甘肃省白银市中心医院收治的80例十二指肠溃疡患者作为研究对象,应用随机数表法将其分为观察组与对照组,每组40例。对照组采取常规四联疗法进行治疗,并应用布洛芬进行镇痛治疗,观察组在对照组基础上增加芩连愈疡汤治疗。比较两组患者临床疗效、治疗前后中医证候积分变化,并比较PGⅠ、HBD-2表达水平。结果观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者腕腹疼痛或痞满、恶心、纳呆、小便短黄、口干不欲饮、口苦相关中医证候积分比较,差异无统计学意义(P>0.05);治疗后;两组患者腕腹疼痛或痞满、恶心、纳呆、小便短黄、口干不欲饮、口苦相关中医证候积分均降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者PGⅠ、HBD-2水平比较,差异无统计学意义(P>0.05);治疗后,两组患者PGⅠ、HBD-2水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论芩连愈疡汤联合NSAIDs对十二指肠溃疡治疗效果显著,可减轻患者临床症状,降低炎症反应,改善肠胃功能。

石榴皮提取物通过抑制炎症和氧化应激改善小鼠结肠炎

目的探讨石榴皮提取物(pomegranate peel extract,PPE)对溃疡性结肠炎(ulcerative colitis,UC)的治疗作用及机制。方法采用分光光度法测定PPE中总酚含量,高效液相色谱法分析PPE中主要成分。将24只雌性C57BL/6小鼠随机分为4组:正常组、模型组、PPE低剂量组和PPE高剂量组,每组6只。除正常组外,其他3组小鼠连续7 d给予含3%的葡聚糖硫酸钠(dextran sulfate sodium,DSS)饮用水诱导UC模型。从DSS造模给药第1天起,正常组和模型组每日以蒸馏水灌胃,PPE各组分别给予200 mg/kg和400 mg/kg的PPE灌胃,1次/d,连续10 d。通过记录体质量、疾病活动指数(DAI)、结肠长度和结肠组织病理学变化评估UC的严重程度。采用实时定量PCR(real-time quantitative,RT-qPCR)检测小鼠结肠组织中肿瘤坏死因子-α(TNF-α)、白细胞介素17A(IL-17A)、干扰素γ(IFN-γ)的mRNA相对表达水平,试剂盒法检测丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)活性。结果PPE中总酚含量为(295.76±3.15)mg/g,主要成分为没食子酸、安石榴苷及鞣花酸。与正常组比较,模型组小鼠的体质量降低、结肠缩短、DAI指数和组织病理评分增加(P<0.01),TNF-α、IL-17A、IFN-γ和MDA的表达水平增加(P<0.05),SOD和GPX活性降低(P<0.01)。与模型组比较,PPE低剂量组和高剂量组小鼠的体质量和结肠长度增加、DAI指数和组织病理评分降低(P<0.05),小鼠结肠组织中TNF-α、IL-17A、IFN-γ和MDA的表达水平降低(P<0.05),GPX活性增加(P<0.05),SOD差异无统计学意义(P>0.05)。结论PPE可以通过抗炎和抗氧化活性改善DSS诱导的小鼠溃疡性结肠炎。

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

This article reviews the latest developments in understanding the pathogenesis, detection and treatment of small intestinal damage and bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs). With improvements in the detection of NSAID-induced damage in the small intestine, it is now clear that this injury and the associated bleeding occurs more frequently than that occurring in the stomach and duodenum, and can also be regarded as more dangerous. However, there are no proven-effective therapies for NSAID-enteropathy, and detection remains a challenge, particularly because of the poor correlation between tissue injury and symptoms. Moreover, recent studies suggest that commonly used drugs for protecting the upper gastrointestinal tract (i.e., proton pump inhibitors) can significantly worsen NSAID-induced damage in the small intestine. The pathogenesis of NSAID-enteropathy is complex, but studies in animal models are shedding light on the key factors that contribute to ulceration and bleeding, and are providing clues to the development of effective therapies and prevention strategies. Novel NSAIDs that do not cause small intestinal damage in animal models offer hope for a solution to this serious adverse effect of one of the most widely used classes of drugs.

Azithromycin in a triple therapy for H.pylori eradication in active duodenal ulcer

AIM：To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole,which is still widely used in Russia,andB)azithromycin amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication.METHODS:100 patients with active duodenal ulcer were includid in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A)metronidazole500mg bid,amoxicillin1gbid and omeprazole 20mg bid(OAM,n=50)andB)azithromycin1g od for the first3days(total dose3g).amoxicillin 1g bid and first 3days(total dose3g).amoxicillin 1g bid and omeprazole20mg bid(OAA,n=50).Omeprazole 20mg od was given after the eradication course as a monotherapy for three weeks ,The control endoscopy was performed8 weeks after the entry,H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test.RESULTS:97 patients completed the study according to the protocol(1patient of the OAM group did not come to the control endoscopy.2patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in48patients of the OAM group(96%;CI90.5-100%)and in 46patients of the OAAgroup(92%;CI89.5-94.5%)(p=ns).H.pylori infection was eradicated in 15out of 50patients with OAM(30%;CI17-43%)and in36out of 50patients treated with OAA(72%,CI59-85%)(P<0.001)-IПanalysis.CONCLUSION:The triple therapy with omeprazole,amoxicillin and metronidazole failed to eradicateH.pylori in the majorty of patients,which is an essential argument to withdraw this regimen out of the national recommendations,Macrolide with amoxicillin are preferable to achieve higher eradication rates.Azitromycin(1g od for the first3days)can be considered as a successful component of the triple PPI-based regimen.