Small-diameter acellular porcine corneal stroma for peripheral corneal ulceration treatment

AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 eyes)with PCU between April 2018 and December 2020.All patients had PCU and underwent lamellar keratoplasty with SAPS.Observation indicators included preoperative and postoperative best-corrected visual acuity(BCVA)and transparency of SAPS.The infection control rate in the surgical eye-lesion area was also calculated.RESULTS:Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU.None of the patients experienced rejection after 6mo(18/18)and 12mo(16/16)of follow-up.The BCVA(0.47±0.30)at the 6mo followup after operation was significantly improved compared with the baseline(0.99±0.80),and the difference was statistically significant(Z=-3.415,P<0.05).The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo(Z=0,P=1).With time,the SAPS graft gradually became transparent.At the 6mo(18/18)and 12mo(16/16)follow-up,none of the patients had recurrent corneal infection.CONCLUSION:SAPS is clinically effective in the treatment of PCU,improving the patient’s BCVA and reducing the incidence of rejection after keratoplasty.

Helicobacterpylori virulence factors in duodenal ulceration:A primary cause or a secondary infection causing chronicity

Reports from countries with a high prevalence of Helicobacter pylori （H pylori） infection do not show a proportionately high prevalence of duodenal ulceration, suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of Hpylori infection and virulence factors. Although virulent strains of Hpylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pylori infection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, nonulcer dyspepsia or normal subjects in many countries, where the prevalence of both Hpylori infection and of virulence factors was high. In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low, only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.

Precise role of H pylori in duodenal ulceration

The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn’s disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.

Antibacterial Activity of Extracts from Zostera marina Against Pathogens of Apostichopus japonicus Skin Ulceration Disease

The purpose of this study was to investigate the antibacterial activity of extracts from Zostera marina against the pathogens of Apostichopus japonicus skin ulceration disease.When 95% ethanol (v/v) solvent was used to extract Zostera marina at 50℃,aqueous extract (ZA) showed obvious bacteriostatic effects on the tested bacterial strains (inhibition halo diameters between 8.23 mm and 13.62 mm),whereas the ethyl acetate extract (ZE) was almost inactive.The minimal inhibitory concentration (MIC) of ZA against four pathogens were homogeneous at 12.8 g L-1.ZA components were analyzed by thin layer chromatography (TLC) assay and six fractions were obtained.In another study,the six fractions showed inhibitory effects against the tested bacteria while their functions seemed to counteract the ZA activity.

Metabolomics analysis for skin ulceration syndrome of Apostichopus japonicus based on UPLC/Q-TOF MS

Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understand the pathogenesis of the disease,activities of superoxide dismutase(SOD),catalase(CAT),and level of malondialdehyde(MDA)in coelomic fluid were detected using the Assay Kit and metabolites in the body wall were assessed using ultra-performance liquid chromatography and quadrupole-time of flight mass spectrometry.The results indicated that level of MDA was increased during SUS compared with healthy individuals(P<0.01),but activities of SOD and CAT were reduced(P<0.05).In metabolomics analysis,metabolites,such as adenosine,choline,betaine aldehyde,palmitic acid,and taurine,were found to be upregulated and 2-oxoadipic acid,anthranilic acid(vitamin L1),thioetheramide-PC,cholesterol-3-sulfate,and pentadecanoic acid were downregulated(VIP>1 and P<0.1).Pathway enrichment analysis indicated most enrichment of KEGG pathways were mainly related to energy metabolism,immunity,and osmoregulation such as ABC transporters,glycine,serine and threonine metabolism,tryptophan metabolism and neuroactive ligand-receptor interaction.Our study reflected the difference in enzyme activity and metabolites between A.japonicus with SUS and those without,which will provide reference data for investigating SUS.

Protective effects of amphetamine on gastric ulcerations induced by indomethacin in rats

AIM: To study the effects of amphetamine, an indirect- acting adrenomimetic compound on the indomethacin- induced gastric ulcerations in rats. METHODS: Male Wistar-Bratislava rats were randomly divided into four groups: Group 1 (control), received an ulcerogenic dose of indomethacin (50 μmol/kg) and Groups 2, 3 and 4, treated with amphetamine (10, 25 and 50 μmol/kg). The drug was administered simulta- neously with indomethacin and once again 4 h later. The animals were sacrificed 8 h after indomethacin treatment. The stomachs were opened and the inci- dence, the number of lesions and their severity were evaluated. The results were expressed as percentage and as mean ± standard error (mean ± SE). RESULTS: The incidence of ulceration in the control group was 100%. Amphetamine, at doses of 10, 25 and 50 μmol/kg, lowered the incidence to 88.89%, 77.78% and 37.5% respectively. The protection ratio was posi- tive: 24.14%, 55.17% and 80.6% respectively. The total number of ulcerations/rat was 12.44 ± 3.69 in the con- trol group. It decreased to 7.33 ± 1.89, 5.33 ± 2.38 and 2.25 ± 1.97 under the effects of the above-mentioned doses of amphetamine. CONCLUSION: Amphetamine affords a significant dose-dependent protection against the indomethacin- induced gastric ulcerations in rats. It is suggested that the adrenergic system is involved in the gastric mucosa protection.

Atorvastatin-induced severe gastric ulceration: A case report

A 41-year-old man presented with severe gastric ulceration 3 mo after beginning treatment with atorvastatin 20 mg once daily for hypercholesterolemia. The patient was not taking any ulcerogenic drugs and had no evidence of Helicobacter pylori infection. Proton pump inhibitor therapy was initiated and atorvastatin was replaced by simvastatin with complete resolution of gastrointestinal symptoms. To our knowledge, this is the first report of atorvastatin-induced gastric ulceration,which should be looked for in patients who develop abdominal pain while on this drug.

Management of corneal ulceration with a moisture chamber due to temporary lagophthalmos in a brain injury patient:A case report

BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident.She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye.Within 6 d,her consciousness improved considerably;at which time,exposure keratopathy occurred and worsened to corneal ulceration.Lubricating gel,antibiotic ointment,and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy.Instead of tarsorrhaphy,a moisture chamber was applied which successfully controlled the corneal ulceration.The moisture chamber was discontinued when complete eyelid closure recovered a week later.CONCLUSION A moisture chamber may be an effective,noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.

Epstein-Barr Virus Upper Gastrointestinal Tract Mucocutaneous Ulceration in a Renal Transplant Recipient with Leucopenia and Hypogammaglobulinaemia

Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.

Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

Colonic ulcerations may predict steroid-refractory course in patients with ipilimumab-mediated enterocolitis

AIM To investigate management of patients who develop ipilimumab-mediated enterocolitis, including association of endoscopic findings with steroid-refractory symptoms and utility of infliximab as second-line therapy.METHODS We retrospectively reviewed all patients at our centerwith metastatic melanoma who were treated with ipilimumab between March 2011 and May 2014. All patients received a standard regimen of intravenous ipilimumab 3 mg/kg every 3 wk for four doses or until therapy was stopped due to toxicity or disease progression. Basic demographic and clinical data were collected on all patients. For patients who developed grade 2 or worse diarrhea(increase of 4 bowel movements per day), additional data were collected regarding details of gastrointestinal symptoms, endoscopic findings and treatment course. Descriptive statistics were used.RESULTS A total of 114 patients were treated with ipilimumab during the study period and all were included. Sixteen patients(14%) developed ≥ grade 2 diarrhea. All patients were treated with high-dose corticosteroids(1-2 mg/kg prednisone daily or equivalent). Nine of 16 patients(56%) had ongoing diarrhea despite highdose steroids. Steroid-refractory patients received one dose of intravenous infliximab at 5 mg/kg, and all but one had brisk resolution of diarrhea. Fourteen of the patients underwent either colonoscopy or sigmoidoscopy with variable endoscopic findings, ranging from mild erythema to colonic ulcers. Among 8 patients with ulcers demonstrated by sigmoidoscopy or colonoscopy, 7 patients(88%) developed steroidrefractory symptoms requiring infliximab. With a median follow-up of 264 d, no major adverse events associated with prednisone or infliximab were reported.CONCLUSION In patients with ipilimumab-mediated enterocolitis, the presence of colonic ulcers on endoscopy was associated with a steroid-refractory course.

Role of dietary phospholipids and phytosterols in protection against peptic ulceration as shown by experiments on rats

Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable.It is higher in regions where the diet is based on milled rice,refined wheat or maize,yams,cassava,sweet potato,or green bananas,and is lower in regions where the staple diet is based on unrefined wheat or maize,soya,certain millets or certain pulses.Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against bothgastric and duodenal ulceration,including ulceration due to non-steroidal anti-inflammatory drugs(NSAIDs).It also promoted ulcer healing.The lipid from the pulse,Dolichos biflorus,horse gram which was highly protective was used to identify the fractions with protective activity in the lipid.The protective activity lay in the phospholipid,sterol and sterol ester fractions.In the phospholipid fraction phosphatidyl choline(lethicin) and phosphatidyl ethanolamine(cephalin) were predominant.In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol,stigmasterol,and an unidentified isomer of β-sitosterol.The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration,both singly and in combination.This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers.A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.

Genetic analysis is helpful for the diagnosis of small bowel ulceration

The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis(CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.

Measurement of prostaglandin metabolites is useful in diagnosis of small bowel ulcerations

BACKGROUND We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2 A1 gene(CEAS). Crohn's disease(CD) is a major differential diagnosis of CEAS, because these diseases share some clinical features. Therefore, there is a need to develop a convenient screening test to distinguish CEAS from CD.AIM To examine whether prostaglandin E major urinary metabolites(PGE-MUM) can serve as a biomarker to distinguish CEAS from CD.METHODS This was a transactional study of 20 patients with CEAS and 98 patients with CD.CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of SLCO2 A1. We measured the concentration of PGEMUM in spot urine by radioimmunoassay, and the concentration was compared between the two groups of patients. We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic(ROC) curve analysis.RESULTS Twenty Japanese patients with CEAS and 98 patients with CD were enrolled.PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD(median 102.7 vs 27.9 μg/g × Cre, P < 0.0001). One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS [95% confidence interval(CI) 3.2-16.7]. A logistic regression analysis revealed that the association was significant even after adjusting confounding factors(adjusted odds ratio 29.6, 95%CI 4.7-185.7). ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9 μg/g × Cre with 95.0% sensitivity and 79.6% specificity.CONCLUSION PGE-MUM measurement is a convenient, non-invasive and useful test for the distinction of CEAS from CD.

Difficult and complicated oral ulceration:an expert consensus guideline for diagnosis

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers,based on factors such as detailed clinical medical history inquiry,histopathological examination,and ulceration-related systemic diseases screening.Not only it can provide a standardized procedure of oral ulceration,but also it can improve the diagnostic efficiency,in order to avoid misdiagnosis and missed diagnosis.

Multifocal stenosing ulceration of the small intestine

Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration.Compared to Crohn's disease,the ulcers are not transmural and typically remain shallow,and involve only the mucosa and submucosa.The disorder seems to be localized in the jejunum and proximal ileum only,and not the distal ileum or colon.Only nonspecif ic inflammatory changes are present without giant cells or other typical features of granulomatous inflammation.Most patients present clinically with recurrent obstructive events that usually respond to steroids,surgical resection,or both.With the development of newer imaging modalities to visualize the small-intestinal mucosa,such as double-balloon enteroscopy,improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.

Healing property of the Piper betel phenol, allylpyrocatechol against indomethacin-induced stomach ulceration and mechanism of action

AIM：To evaluate the protective activity of allylpyrocatechol （APC）, the major antioxidant constituent of Piper betel, against the indomethacin-induced stomach ulceration in the rat model and correlates with its antioxidative and mucin protecting properties.METHODS： Male Sprague-Dawley rats were divided into five groups. Normal control rats （group Ⅰ ） were given the vehicle oral dose of gum acacia in distilled water （1 mL per rat）; ulcerated control and treated rats （groups Ⅱ-V） were given a single dose of indomethacin （30 mg/kg body wt.）; group Ⅱ rats were sacrificed 4 h after indomethacin administration; groups Ⅲ-Ⅴ rats were given the vehicle （1 mL per rat） or APC （2 mg/kg body wt.） or misoprostol （1.43 μg/kg body wt.） once daily by oral intubation for 7 d starting from 4 h after the indomethacin administration. After 7 d, the stomach tissues were excised for histological examination and biochemical analysis. RESULTS： Treatment with APC （2 mg/kg body wt per day） and misoprostol （1.43 μg/kg body wt per day） for 7 d could effectively heal the stomach ulceration as revealed from the ulcer index and histopathological studies. Compared to the zero day ulcerated group, treatment with APC and misoprostol reduced the ulcer index by 93.4% and 85.4% respectively （P 〈 0.05）. Both APC and misoprostol accelerated ulcer healing observed in natural recovery （P 〈 0.05）, their respective healing capacities not being significantly different. The healing capacities of APC and misoprostol could be attributed to their antioxidant activity as well as the ability to enhance the rnucin content of the gastric tissues. Compared to the ulcerated untreated rats, those treated with APC and rnisoprostol showed near normal MDA levels, while the protein levels were 86% and 78% of the normal value respectively （P 〈 0.05）. Likewise, both APC and rnisoprostol increased the SOD, catalase, and rnucin levels significantly （P 〈 0.05）, the effect of APC being better. CONCLUSION： APC can protect indomethacin-induced gastric ulceration due to its antioxidative and mucin protecting properties.

Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions

AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomach. METHODS： In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients （415 women, 196 men, average age 60.5 years） with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSA/D-inducecl lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings. RESULTS： At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years （43.9%） or months （29.5%）. The most common indication for the use of these drugs was pain （64.3%）, and the most common indication for colonoscopy was bleeding （55.5%）. Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon （79.9%）. A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups. CONCLUSION： This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.

Esophageal ulceration complicating doxycycline therapy

AIM;TO report present state of iatrogenic drug-induced esophageal injury(DIEI)induced by medications in a private clinic. METHODS:Iatrogenic drug-induced esophageal injury (DIEI)induced by medications has been more frequently reported.In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population(median age 29 years). RESULTS:The most frequent presenting symptoms were odynophagia,retrosternal burning pain and dysphagia(94 %, 75 % and 56 %,respectively).The diagnosis was according to medical history and confirmed by endoscopy in all patients. Beside withdrawal of doxycycline,when feasible,all patients were treated with a proton-pump inhibitor(PPI)and a prokinetic.Thirty patients who reported to the clinic after treatment were improved within 1-7(median 1.7)days. CONCLUSION:Esophageal ulceration has to be suspected in younger patients with odynophagia,retrosternal burning pain and/or dysphagia during the treatment with doxycycline.

<i>In Vivo</i>Study of Healing Effects of Sida acuta Leaf Extracts on <i>Helicobacter pylori</i>Induced Ulceration in Mice

Helicobacter pylori is a human pathogen that is widely distributed and known to cause peptic ulcer, gastritis and gastric cancer. Treatment is usually by combination of acid inhibitory therapy and antibiotics because of drug resistance problems. Studies now focus on the use of medicinal plants for treatment of H. pylori induced ulcers because they are inexpensive and have limited side effects. This study was undertaken to determine the effects of cold water and ethanol extracts of Sida acuta leaves on H. pylori induced ulcer in mice. Oral administration with the aid of a feeding tube of 0.5 ml of 107 CFU/ml of H. pylori (Accession number LT799736) in phosphate buffer saline (pH 6.8) was used to induce ulcer in mice. Effects of various concentrations of cold water and ethanol extracts of S. acuta leaves on the ulcer parameters and histology examinations of stomach tissues of mice were investigated after 2 weeks of administration of extracts into the mice. Mice treated with clarithromycin served as positive control while mice administered with H. pylori but not treated served as negative control. One-way analysis of variance (ANOVA) was used for data analysis and results were considered significant if p < 0.05. Bacterial load of stomach tissue showed significant reduction from 15.4 × 106 CFU/ml to 3.5 × 106 CFU/ml and 2.6 × 106 CFU/ml for cold water and ethanol extracts respectively. Reduction in ulcer severity (2.00 ± 0.10 to 0.080 ± 0.05), ulcer index (8.50 ± 1.10 to 4.26 ± 0.03) and gastric volume (1.32 ± 0.12 to 0.54 ± 0.13) were observed. Histology of stomach tissues of mice treated with extracts revealed clear granulation indicating tissue repair and wound healing. S. acuta extracts were observed to enhance ulcer healing in a mice model.