• Journal of Yeungnam Medical Science
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• v.1 no.1
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• pp.179-183
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• 1984

In recent years, an increasing number of drugs have been reported to cause direct esophageal damage. More than 30 cases on tetracyclines induced esophageal ulcer have been reported since the first description of tetracycline induced esophageal ulcer by Bokey and Hugh in 1975. In Korea, only one case of doxycycline-induced esophageal ulcer has been reported. Authors have experienced 3 cases of esophageal ulcer probably caused by tetracyclines. The patients had taken their capsules just before going to bed with little fluid intake. About 6-8 hours later they had felt substernal burning sensation and epigastric discomfort. Gastrofiberscopy revealed relatively well demarcated circular ulcers on the mid esophagus. An esophagogram showed no apparent abnormality. Patients's symptomas became negligible with antacid treatment within 2-5 days. One of the causes of the esophageal ulcer is thought to be the delay in transit time of drugs and direct esophageal damage from mucosal contact when tablets are ingested in the recumbent position without an accompanying proper quantity of fluid. If only physicians endow patients with more concern about drug induced esophageal ulcer, they could find out more increasing number of drug induced esophageal ulcers by gastroscopic examination and thereby could prevent tetracycline induced esophageal ulcer.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.46-51
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• 1998

Treatment of esophageal perforation when diagnosed late remains controversial. Ten consecutive patients since 1990 were treated late(later than 24 hours) for esophageal perforation with primary repair. Four perforations were iatrogenic, 3 were spontaneous, 2 were foreign body aspiraton and 1 was trauma. The interval from perforation to operation was 116 hours in mean and 48 hours in median value. The principles of repair included (1) a local esophagomyotomy proximal and distal to the tear to expose the mucosal defect and intact mucosa beyond, (2) debridement of the mucosal defect and closure, (3) reapproximation of the muscle, and (4) adequate drainage. The repair was buttressed with parietal pleura or pericardial fat in 9 patients. Associated distal obstruction was treated with dilation and esophagomyotomy intraoperatively. There was one mortality and cause of death was massive gastric bleeding due to gastric ulcer on 33rd day after operation. Five patients had leak at the site of repair and these cases were treated completely with conservative treatment except a mortality case. In conclusion, in the absence of malignant or irreversible distal obstruction, meticulous repair of perforated esophagus and adequate drainage are preferred approach, regardless of the duration from the injury to the operation.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.859-864
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• 1987

The microwave tissue coagulator was originally used for hemostasis in the hepatic surgery, which is effectively applied in the endoscopic surgery such as the hemostasis of gastric ulcer or tumor bleeding, stenosis relieving of esophageal or rectal stenosis and tumor reduction in inoperable early cancer cases. We experienced the good result of the microwave tissue coagulation therapy in the patient with the restenosis of esophagogastrostomy. The patient was 67 year-old female, who was admitted due to the lye stricture of esophagus for 40 years. We made the lower esophagectomy and the esophagogastrostomy with the upper intact esophagus in the right thorax. But the restenosis occurred at the esophagogastrostomy site because of the polypoid mucosal protrusion at one month after operation. We applied the microwave tissue coagulator 3 times with 6 day interval under esophagoscopy and the good symptomatic and endoscopic relief was alleviated. We think that the microwave tissue coagulation is a very convenient and advisable method in the case of restenosis after esophageal surgery.

• The Korea Journal of Herbology
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• v.35 no.1
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• pp.57-68
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• 2020

Objective : The aim of present study was to clarify the effect of Areca Semen and Toosendan Fructus Mixture (AT-mix) on chronic reflux esophagitis (CRE) in rats. Methods : The antioxidant activity of AT-mix was measured through DPPH and ABTS radical scavenging activities in vitro. CRE was induced in SD rats (5 weeks, male) by ligating the border forestomach and granular portion with 2-0 silk and the duodenum near the pyloric portion was covered with 2-mm wide piece of 18-Fr Nélaton catheter. And then rats were treated AT-mix 200 mg/kg one daily for 14 days. The anti-oxidant and inflammatory protein levels were evaluated using western blotting. Results : Gross lesion of esophageal mucosa after AT-mix treatment showed a superior enhancement compared with that of CRE control rats. AT-mix treatment strongly reduced both DPPH and ABTS radical scavenging activities (DPPH, IC₅₀ 8.15±0.14 ㎍/mL; ABTS, IC₅₀ 24.69±0.03 ㎍/mL, repspectively). Levels of the NADPH oxidase subunit including NOX4 and p22^phox increased in CRE control rats. Otherwise, AT-mix treatment significantly reduced. The activation of Nuclear factor-erythroid 2-related factor 2 (Nrf2) led to significantly the up-regulation of HO-1. The inhibition of IκBα phosphorylation led to NF-κB inactivation. Subsequently, NF-κB inactivation significantly induced the decrease of COX-2, iNOS, TNF-α, and IL-6 protein expressions. Conclusion : Taken together, these results suggest that AT-mix treatment can attenuate the esophageal mucosal ulcer though inhibiting NF-κB pathway and enhancing Nrf2/HO-1 pathway. Thus, the additional mechanism study about AT-mix would need for the development as a safe herbal therapy for CRE.

• Korean Journal of Pharmacognosy
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• v.51 no.4
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• pp.349-359
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• 2020

Gastroesophageal reflux disease (GERD) is a disease that stomach contents continually refluxing, and is currently on the rise worldwide. The purpose of this study is to find natural materials that can reduce side effects and effectively treat chronic acid reflux esophagitis (CARE), one of GERD. First, the antioxidant activity was confirmed by varying the mixing ratio of Coptidis Rhizoma and Evodiae Fructus, which are effective against chronic reflux esophagitis. After, animal experiments were conducted using a 1:1 (CE) and 1:2 (CEE) combination ratio of Coptidis Rhizoma and Evodiae Fructus, which had the best antioxidant efficacy. Gross lesion of esophageal mucosa after CE or CEE treatment showed a superior enhancement compared with that of CARE control rats. Additionally, its inhibited MAPK phosphorylation and led NF-κB inactivation through the suppression of IκBα phosporylation by regulating Nrf2/Keap-1, and NF-κB inactivation induced reduced protein expressions including inflammatory mediators and cytokines. Moreover, its improved esophageal barrier function through upregulating protein expressions of tight junction protein, whereas downregulating protein expressions of MMPs. Taken together, a mixture of Coptidis Rhizoma and Evodiae Fructus can attenuate the esophageal mucosal ulcer by inhibiting MAPK and NF-κB pathway, and upregulating proteins associated with tight junction.

• The Korea Journal of Herbology
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• v.35 no.4
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• pp.25-36
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• 2020

Objective : Reflux esophagitis is a disease caused by the reflux of gastric acid and inflammation due to unstable gastroesophageal sphincter. The aim of the present study was to clarify the effect of Phellodendri Cortex (PC) on chronic reflux esophagitis (CRE) in rats. Methods : The anti-oxidant activity of PC was measured by total polyphenol, total flavonoid contents, 1, 1-diphenyl-2-picrylhydrazyl (DPPH), and 2, 2'-azinobis-3-ethyl-enzothiazoline-6-sulfonic acid (ABTS) radical scavenging activity. A CRE was established surgically in SD rats. And then CRE rats were treated with water or PC 200 mg/kg body weight for 14 days. Besides, the anti-oxidant and inflammatory protein levels were evaluated using western blotting. Results : PC reduced esophagus tissues injury. The total polyphenol (36.05 ± 0.25 mg/g) and total flavonoid (72.90 ± 0.61 mg/g) of PC showed a high content. PC strongly reduced radical scavenging activities (DPPH IC₅₀ 43.58 ± 1.54 ㎍/㎖; ABTS IC₅₀ 36.75 ± 0.35 ㎍/㎖). Moreover, reactive oxygen species (ROS) and peroxynitrite (ONOO^-) levels in serum, the protein expression of inducible nitric oxide synthases (iNOS) were significantly reduced. In addition, the protein expression of NADPH oxidases related to oxidative stress were significantly reduced in PC compared to CRE control. PC effectively reduced inflammatory factors including, TNF-α, and IL-6 via NF-κBp65 inactivation through the inhibition of p-IκBα and increased anti-oxidant enzyme such as HO-1, SOD, catalase, and GPx-1/2 via Nrf2 activation. Conclusions : Taken together, these results show that PC can alleviate the esophageal mucosal ulcer though the inhibition of NF-κB inflammatory and the enhancement of Nrf2 anti-oxidant pathway.

• Journal of Life Science
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• v.33 no.11
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• pp.923-935
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• 2023

Rubus crataegifolius (RC), Ulmus macrocarpa (UM), and Gardenia jasminoides (GJ) are well-known folk medicines in Asia used to treat various gastrointestinal disturbances. The present study evaluated the gastroprotective effect of LS-RUG-com, a mixture of commercially prepared powders of RC, UM, and GJ with a ratio of 3:1:2(w/w/w) against HCl/ethanol-induced gastritis, indomethacin-induced ulcers, and esophageal reflux-induced esophageal mucosal damage and Helicobacter pylori infections. In addition, TNF-α and IL-1β expressions were also determined and measured in esophageal tissue. As to HCl/ethanol-induced gastritis, the LS-RUG-com treatment at a dose of 150 mg/kg showed a remarkable anti-gastritis effect. Regarding indomethacin-induced gastric ulcers, the LS-RUG-com treatment had a significant anti-gastric ulcer effect. Furthermore, in the gastroesophageal reflux disease (GERD) model experiment, the LS-RUG-com treatment resulted in the histological recovery of stomach damage and mucosal injuries. Furthermore, the LS-RUG-com treatment led to an increase in gastric content pH, an increase in mucus protection, and a decrease in gastric pepsin output with a significant decrease in TNF-α and IL-1β. As to the Helicobacter pylori infected animal model, LS-RUG-com had a notable inhibitory effect on Helicobacter growth. The use of RC, UM, or GJ in isolation or the LS-RUG-com treatment as whole had good effects in terms of anti-oxidation, anti-neutralization, gastric acid secretion inhibition, and anti-lipid peroxidation, which supported the use of natural products as systemic gastric protective agents. Our results suggest that the LS-RUG-com might be a significant systemic gastroprotective agent that could be utilized for the treatment and/or protection from gastric disturbances and related damage.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.280-284
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• 2010

Background: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. Material and Method: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. Result: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. Conclusion: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.

• The Korea Journal of Herbology
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• v.27 no.1
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• pp.51-58
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• 2012

Objectives : This study was performed to investigate effect of evodiae fructus on acute reflux esophigitis rat induced by pylorus and forestomach ligation operation. Methods : Twenty-four laboratory rats were divided four groups and each group had six rats ; normal intact group, acute reflux esophagitis (RE) control group, two experiment RE group treated extract of evodiae fructus 600 mg/kg (EEF600) and 300 mg/kg (EEF300). All rats was fasted for 18 hr but free water, we induced RE by pylorus and forestomach ligation operation. Intact group and RE control group rats were orally administered a distilled water and two experiment groups were orally administed with EEF 600 mg/5ml/kg and 300 mg/5ml/kg. One hour after, rats were anesthetized, intact group was cut the abdomen open and sutured with 2.0 silk thread. RE control group and EEF group were cut the abdomen open, ligated pyloric canal and forestomach with 2.0 silk thread and sutured. Six hour after the operation, rats were sacrified, collected bloods in the abdominal vein, disectted a esophagus and stomach. The stomach was washed a 1 ml PBS and the esophagus was cut longitudinally and pictured a innter mucosa area to research damages in esophagus. Results : The esophagic tissue damage percentage of reflux esophagitis rat was increased compared to that of normal intact group. But esophagic damage percentage of EEF 600 were significantly decreased compared to that of RE control group. But there was no difference on gastric juice pH between control RE, alpha-tocopherol administration rat group and EEF administration rat group. In esophagus of RE control rat, gastric damage occurred severely and injury percentage of mucosa were increased, but EEF 600 mucous inflammatory damage percentage was significantly compared to that of RE control group. Proinflammatory cytokines such as TNF-alpha, IL-1beta and IL-6 in serum on RE control group were markedly grew than those of intact rat, those of vechicle group treated with EEF 600 and EEF 300 were remarkably decreased compared to production of proinflammatory cytokine of RE control group. In microscopic observation, intact group rat had no hyperemia, mucous injury and exclusion, ulcer and edema. But it could showed mucosa damages, submucosa edema and ulcer in RE control. However, administration of EEF 600 and EEF 300 made esophagus have less inflammation and injury by gastric acid. Conclusions : The results suggest that antiinflammatory Effect of EEF could attenuate the severity of reflux esophagitis and prevent the esophageal mucosal damage, and validate its therapeutic use in esophageal reflux disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.2
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• pp.176-182
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• 2006

Purpose: The aim of this study was to investigate the spectrum of gastrointestinal mucosal lesions in the children presenting with short-term abdominal pain. Methods: Thirty one children with short term abdominal pain for less than 1 month from January 1995 to May 2004 who were examined using gastrointestinal (GI) endoscopy were reviewed retrospectively. Children presenting with acute abdominal pain unrelated to proper GI were excluded from this study. Results: Male patients were 16 and female were 15. Three patients were 1~5 years old, 15 were 6~10 years old, and 13 were 11~15 years old. The duration of the abdominal pain was less than 7 days in 23 patients, 10 days in 1, 20 days in 2, and 30 days in 4. The major accompanying symptoms were vomiting (15), diarrhea (4), melena (1), hematemesis (1), and fever (2). Using endoscopy, 6 patients were found to have hemorrhagic gastritis, 5 nodular gastritis, 4 duodenal ulcer, 3 gastric ulcer, 3 reflux esophagitis, 2 nodular duodenitis, 2 superficial gastritis, 2 erosive hemorrhagic duodenitis, 2 ulcerative colitis, 1 duodenogastric reflux, and 1 esophageal polyp. Helicobacter pylori (H. pylori) infection was positive in 10 patients. The age and sex ratio, duration of abdominal pain, site of abdominal pain, and duration of abdominal pain between H. pylori- positive and negative children were different. However, only the site of abdominal pain (epigastric) showed statistical significance. All symptoms improved with medication for the GI mucosal lesions noted by the endoscopic findings. Conclusion: The author suggests that GI endoscopy be one of the important first steps in examinations to find out diverse GI mucosal lesions in the patients with short-term abdominal pain. Additionally, the examinations for H. pylori infection are important for these patients, also.