Gastric Cytoprotection as Basis of Gastrointestinal Mucosa Protection and Repair in Erosive Ulcerative Lesions of Various Aetiologies

Aim. Assessment of efficacy and the mechanism of action of gastrointestinal mucosa (GM) protection in current treatment settings with methylmethionine-sulfonium chloride (vitamin U) to illustrate its applicability in erosive ulcerative lesions of various aetiologies.Key points. Aside to damage prevention in exposure to aggressive agents, gastroprotection implies healing promotion under the preserved level of hydrochloric acid secretion. Prostaglandins (PG) and SH-antioxidants are key mediators of gastroprotection in acute and chronic damage. SH-containing endogenous substances (L-cysteine, D,L-methionine, GSH) and exogenous molecules (methylmethionine-sulfonium chloride (MMSC), N-acetylcysteine) prevent damage due to the ability to absorb/neutralise free radicals released in xenobiotic-triggered cell damage, inhibit TNF-α expression, reduce the aspirin-induced leukocyte-endothelium adhesion and stimulate mucin release. In experiment, MMSC prevented the ethanol-induced GM damage, stimulated mucin release and its redistribution on the GM surface; in clinical trials, MMSC effectively facilitated remission in duodenal ulcer.Conclusion. Preparations exerting a protective effect on gastroduodenal mucosa, such as methylmethionine-sulfonium chloride (vitamin U), may improve basic treatment settings and facilitate remission in erosive ulcerative lesions of upper gastrointestinal tract.

Stress Gastric Ulcers and Cytoprotective Strategies: Perspectives and Trends

Stress gastric ulceration is a clinical condition leading to morbidity/mortality and complex etiopathological factors are involved. Pharmacotherapy of such gastric mucosal lesions is not consistent and novel strategies are being explored. Targeting gastrointestinal factors have showed equivocal results and there is a possibility of involvement of extra-gastrointestinal factors. Stress is a highly interactive biological response in which the brain plays a key role. The involvement of brain substrates like the limbic system (amygdala, cortex, hippocampus) and behavioral traits has been investigated and research data has shown that the limbic brain-gut axis may be involved in the regulation of gastric mucosal integrity during stressful situations. The amygdaloid complex, its connections with other limbic structures and their neural networks act in tandem to contribute to both stress ulceration and gastroprotection. Complex neurotransmitter interactions in these areas involving biogenic amines and neuropeptides have been shown to modulate stress ulcerogenesis in experimental models. The immune system and brain-immune interactions also appear to play a decisive role in the genesis of such stress gastric lesions and the possibility of a brain-gut-immune axis has been proposed during stress gastric lesions. More recent studies have shown the involvement of oxidative stress and nitric oxide as well as their interactions during such stress gastric pathology, indicating the possible role of antioxidants and NO modulators as gastroprotective agents for stress ulceration. In view of the complex pathophysiology, multiple targets and lack of consistent therapeutic modalities, newer/alternative hypotheses are constantly emerging, which could be explored for effective treatment strategies aimed at gastric cytoprotection. Herbal agents with adaptogenic properties could be worth exploring in this regard as some of these phytopharmaceutical agents used in traditional medicine have been shown to exhibit gastric cytoprotection as part of their anti-stress profile. Further, their interactions with brain neurotransmitters and immune mechanisms and their relative safety could make them prospective leads for stress ulcer prophylaxis and treatment.

Gastric cytoprotection as a basis for defense and restoration of gastrointestinal mucosa in erosive-ulcerative lesions of different etiologies

Aim: to analyze the mechanism of action and effectiveness of gastrointestinal (GI) tract mucosa defense within the scope of latest treatment scheme using the example of MMSC (Vitamin U) and to present possibility of its use in erosive-ulcerative lesions of different etiologies.General findings:Conclusion: Medications, that exert protective effect on gastroduodenal mucosa, MMSC (vitamin U), particularly, could be used for the purpose of main treatment schemes fortification and remission maintaining in erosive-ulcera- tive damage of upper GI tract.

Pharmacological management: Pain relief

This chapter examines the pharmacological management of pain relief in musculoskeletal conditions. It reviews the analgesic ladder and oral drugs used in analgesia, including tricyclics and other antidepressants and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, topical therapies are discussed. The benefits, common side effects, cautions, and contraindications of drugs used to manage pain are included. There is also reference to the medications used in gastric cytoprotection as these are required to be co-prescribed with NSAIDs. Also included are aspects of patient assessment prior to treatment together with relevant patient information to ensure safe and effective pain relief.