Phlegmonous gastritis: a case series

Background Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. Case presentation Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. Conclusion In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.

Effects of Xiang Sha Yang Wei Wan on Ethanol-Induced Gastric Ulcer in Sprague Dawley Rats: a Histological Study

Introduction: Xiang Sha Yang Wei Wan (XSYWW) is a Chinese traditional medicine that is used for gastrointestinal disorders, specifically gastric ulcer in many countries of South-East Asia. The aim of the study was to evaluate the potential effects of XSYWW on ethanol-induced gastric ulcer in rats by means of histological Study. On a similar basis of treatment, ranitidine, a conventional medication was used as gold standard. Methods: Fifty five male Sprague-Dawley rats (250-300 gm) were divided into four groups. Group I (ethanol treated group) was the control group and gastric ulcers were induced by administering 100% ethanol (1 ml/200 g). Group II (Pre-treatment group) was divided into two subgroups; they were orally fed with 1.0 gm/kg and 2.0 gm/kg respectively of XSYWW solution. Thirty minutes later they were administered with absolute ethanol as in group I. Group III, was given an oral dose of 2gm/kg of XSYWW solution after one hour of ethanol administration. Group IV was given an oral dose of 200mg/kg ranitidine solution after one hour of ethanol administration. Five rats from groups I, III and IV were sacrificed on day 1, 2 and 3 while the animals of group II were sacrificed one hour after ethanol administration. Results: Histological study of the stomachs from ethanol treated rats showed multiple ulcers of various depths that reached the muscularis and the serosa. Conclusion: Pre or post-treated rats with XSYWW showed that XSYWW has protective effect against ethanol-induced gastric mucosal lesion. However, there was a faster and more complete healing process in the ranitidine treated group when compared to the XSYWW treated subjects.

The Intervention of tert-Butylhydroquinone Protects Ethanol-Induced Gastric Ulcer in Type-II Diabetic Rats: Role of Nrf2 pathway

Ethanol consumption increases the prevalence of gastric ulcer (GU) in rats with type 2 diabetes (T2D). Induction of GU by absolute ethanol (5 mL/kg or 3.94 g/kg) in the animal model resembles human ulcer characteristics. The aim was to investigate the role of the Nrf2 pathway in the treatment of GU in diabetic condition. The rats were exposed to absolute ethanol before one hour of sacrifice and T2D was induced by combined exposure of high-fat diet and low dose streptozotocin. Pre-treatment of tBHQ (25 and 50 mg/kg), metformin (500 mg/kg) and omeprazole (20 mg/kg) were given once daily for last three consecutive weeks. In ethanol-exposed diabetic rats, pretreatment with tBHQ, omeprazole, and metformin reduced gastric mucosal lesion, ulcer index, histological alterations, MDA level and apoptosis. Further, the intervention of tBHQ, omeprazole and metformin improved the integrity of the stomach mucosa, glutathione, gastric pH, collagen and goblet cells. tBHQ treatment improved ethanol-induced alterations of Nrf2, catalase, HSP70, NF-κB and endothelin-1 expressions in diabetic rats. In diabetic conditions, the incidence of GU is increased due to elevated levels of ROS, inflammatory mediators, depleted levels of cellular antioxidants, altered gastric parameters. The tBHQ intervention could be a rational strategy to protect these changes.

Research on the structural characteristics of a novel Chinese Iron Yam polysaccharide and its gastroprotection mechanism against ethanol-induced gastric mucosal lesion in a BALB/c mouse model

The overall experimental design of this work to research the structural characteristics of a Chinese Iron Yam polysaccharide and its gastroprotection mechanism against ethanol-induced gastric mucosal lesion in a BALB/c mouse model was reported.

Ethanol-induced gastric ulcer in rats and intervention of tert-butylhydroquinone: Involvement of Nrf2/HO-1 signalling pathway

Gastric ulcer (GU) is the most common health concern that occurs due to alcohol consumption, smoking and physiological stress. Ethanol-induced GU in animal model resembles the pathophysiology of human ulcer. The present study was designed to investigate the cytoprotective and anti-inflammatory properties of tert-butylhydroquinone (tBHQ), a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, against gastric mucosal damage induced by acute exposure of ethanol (5 ml/kg). The intervention of tBHQ (25 and 50 mg/kg, per os (po)) and omeprazole (20 mg/kg, po) was done for 10 consecutive days. Omeprazole was chosen as a standard drug because it is prescribed for the treatment of GU. Pretreatment of tBHQ decreased gastric mucosal lesion, ulcer index, apoptotic cells and lipid peroxidation level induced by ethanol. Furthermore, the intervention of tBHQ increased gastric mucosa integrity, pH, reduced glutathione, collagen and mucus-producing goblet cells. Intervention of tBHQ increased the expression of antioxidant markers such as Nrf2, haeme oxygenase-1 and catalase and decreased the expressions of inflammatory markers such as nuclear factor kappa-light-chain-enhancer of activated B cells and cyclooxygenase-2. The cytoprotective potential of tBHQ against gastric mucosal damage might be due to its ability to enhance cellular antioxidants and anti-inflammatory responses.

Dynamic observation and analysis of metabolic response to moxibustion stimulation on ethanol-induced gastric mucosal lesions (GML) rats

Background Gastric mucosal lesion (GML) is the initiating pathological process in many refractory gastric diseases. And moxibustion is an increasingly popular alternative therapy that prevents and treats diseases. However, there are few published reports about developing pathology of GML and therapeutic mechanism of moxibustion treatment on GML. In this study, we investigated pathology of GML and therapeutic mechanism of moxibustion treatment on GML. Methods The male Sprague-Dawley (SD) rats were induced by intragastric administration of 75% ethanol after fasting for 24 h and treated by moxibustion at Zusanli (ST36) and Liangmen (ST21) for 1 day, 4 days or 7 days. Then we applied 1H NMR-based metabolomics to dynamic analysis of metabolic profiles in biological samples (stomach, cerebral cortex and medulla). And the conventional histopathological examinations as well as metabolic pathways assays were also performed. Results Moxibustion intervention showed a beneficial effect on GML by modulating comprehensive metabolic alterations caused by GML, including energy metabolism, membrane metabolism, cellular active and neurotransmitters function. Conclusions Moxibustion can effectively treat gastric mucosal damage and effectively regulate the concentration of some related differential metabolites to maintain the stability of the metabolic pathway.

The Effect of Active Gambir (Uncaria gambir) Fraction on TNF-α Protein Expression and Lesion Size in Rats Induced Gastritis

Background: Gambir (Uncaria gambir) is empirically used to treat abdominal pain and vomittus caused by gastritis because of its anti-inflammatory effects, especially flavonoid. This study aims to determine the effect of active gambir fraction on TNF-α protein expression and wound size in white rats gastritis model. Methods: The research method used experimental study design in vivo with post test with control group design. Rats were divided randomly in 11 groups and were induced to be gastritis for 1 day. Group 1 (negative control) was given aquadest of 5 mL, group 2 (positive control) was administered ranitidine 10 mg/kgBW, groups 3, 4, and 5 were given n-hexane fraction, groups 6, 7 and 8 were given a water fraction, and groups of 9, 10, and 11 were given ethyl fractions with each group receives dose of 20, 40, and 80 mg/kgBW and all groups were treated for 3 days. Rats were dissected on 5th day for examination of gastric mucosal lesion size and performed ELISA expression of TNF-α expression of gastric mucosal tissue. The results of this study were assayed by SPSS 18. Results: The result of the research using Kruskal-Wallis test showed that there were significant differences (p <0.05) of the lesions size between the sample groups where control positive, ethyl fraction 20, 40, 80 mg/kgBW, and water fraction 20, 40 mg/kgBB had the gastric ​​mucosal lesion size differed significantly with the negative control group, while the TNF-α protein expression test using Kruskal-Wallis showed that there was a significant difference (p <0.05) TNF-α levels of all groups against the negative control. Conclusion: Active gambir fraction had a potention to reduce size of mucose gaster lesion and reduce expression of TNF-α protein. Keywords: Gambir – TNF-α – antiinflamatory – gastiritis