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Biological response modification of normal tissue reactions: Basic principles and pitfalls
Published in Michael C. Joiner, Albert J. van der Kogel, Basic Clinical Radiobiology, 2018
Local hypoxia in skin, by a pressure-induced reduction of blood flow, was one of the first instances where the radiobiological oxygen effect was described (see Chapter 17). Alternatively, in radiotherapy for head and neck tumours, ‘cryotherapy’, i.e. oral cooling, may be applied (51) and patients are asked to chew ice chips before irradiation, in order to reduce the blood flow in the oral mucosa via vasoconstriction. Experimental studies have also demonstrated mucoprotective effects of local administration of vasoconstricting drugs in the rectum and skin. If such approaches are considered, however, care must be taken to ensure that the target oxygenation and hence response, particularly of superficial tumours, is not affected.
Mucoprotective effect of Trigona propolis against hemorrhagic lesions induced by ethanol 99.5% in the rat’s stomach
Published in Robert Hofstra, Noriyuki Koibuchi, Suthat Fucharoen, Advances in Biomolecular Medicine, 2017
Studies of propolis conducted in various countries such as Brazil and India have suggested that propolis has a mucoprotective effect (Massignani et al., 2009; Pillai et al., 2010). To test propolis from Indonesia, the rats in group 2 were given Trigona propolis 300 mg/kg BW followed by ethanol 99.5% one hour later. The results showed a significant protective effect towards ethanol-induced mucosal irritation, in which the average number of hemorrhagic lesions and the length of the hemorrhagic line were 4 ± 1.16 and 43.29 ± 9.23, respectively. This is consistent with the result of the study conducted on Indian propolis (Pillai et al., 2010). Compared with the group fed with propylene glycol, it can be observed that Trigona propolis has an anti-ulcerogenic effect related to its cytoprotective activity, since it significantly reduced ethanol-induced ulcers. This effect was similar to the effect of ranitidine. From this study, it is found that Trigona propolis also has a comparatively similar effect to ranitidine in preventing hemorrhagic gastritis. Many studies have suggested that phytochemicals such as flavonoids and phenolic compounds, which are well known for their anti-ulcer activity and other antioxidant compounds, could be active in this experimental model to produce an anti-ulcerogenic effect (Pillai et al., 2010). Therefore, the observed ulcer preventive and ulcer curative effect of Trigona propolis may be partially due to its relative antioxidant activity.
The prevention of NSAID-induced gastric ulcers is a firmly established PPI indication
Published in Expert Review of Clinical Pharmacology, 2019
Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Edoardo Savarino
We thank very much the Authors of this letter [1], who emphasize the role of the mucoprotective agent rebamipide in protecting NSAID-induced upper and lower gastrointestinal complications. They state that PPIs are dangerous medications and, among their potential adverse events on many body organs, as recently reported in medical literature with added hyperbole, the frequent damage of the small bowel cannot be dismissed [2]. So, the beneficial use of PPIs in healing and preventing the formation of NSAID-induced gastric ulcers, largely documented in many clinical trials and meta-analyses [3–5], can be associated with the increase of NSAID enteropathy, which seems to be due to gram-negative intestinal dysbiosis [6]. The above Authors conclude that PPIs should not be administered to reduce the harm of NSAIDs on gastric mucosa and should be replaced by other agents, such as rebamipide, which has been shown to protect the whole gastroenteric mucosa [1].
Fluoropyrimidine-induced intestinal mucosal injury is associated with the severity of chemotherapy-related diarrhea
Published in Scandinavian Journal of Gastroenterology, 2019
Kazuhiro Ota, Toshihisa Takeuchi, Yuichi Kojima, Satoshi Harada, Haruhiko Ozaki, Noriaki Sugawara, Yuki Hirata, Toshifumi Yamaguchi, Tetsuji Terazawa, Kazuki Kakimoto, Takayuki Kii, Masahiro Goto, Kazuhide Higuchi
Serum DAO activity was decreased in 68.8% of our patients. Misoprostol is a prostaglandin analog that is reportedly effective for treating NSAID-induced small intestinal mucosal injuries [11]. This agent may also effectively compensate decreased prostaglandin production and improve mucosal integrity in patients with fluoropyrimidine-induced small intestinal mucosal defects. However, since misoprostol also causes diarrhea, it is necessary to monitor patients for worsening diarrhea when using this drug. Rebamipide, a gastric mucoprotective drug, is reportedly effective for preventing NSAID-induced gastrointestinal mucosal injury and acts by stimulating the production of prostaglandins and epidermal growth factor [12]. This medication and other gastric mucoprotective drugs might also effectively treat or prevent fluoropyrimidine-induced small intestinal mucosal injuries. As the presence of small intestinal mucosal breaks identified by capsule endoscopy correlated with diarrhea severity, the treatment for small intestinal mucosal breaks might reduce the symptoms of fluoropyrimidine-based chemotherapy-induced diarrhea.
Teprenone for the prevention of low-dose aspirin-induced gastric mucosal injury in Helicobacter pylori-negative patients
Published in Scandinavian Journal of Gastroenterology, 2019
Taned Chitapanarux, Nirush Lertprasertsuke, Acharaporn Kongnak
This was a prospective, randomized, double-blind, placebo-controlled study to evaluate the efficacy of teprenone for primary prevention of gastrointestinal injury due to LDA. The medication groups were defined as follows. The teprenone group was administered 150 mg (50 mg three times daily) of teprenone (Eisai Marketing Co., Ltd., Bangkok, Thailand) plus 100 mg of aspirin (Reckitt Benckiser Co., Ltd., Bangkok, Thailand) daily for 12 weeks, and the placebo group was given placebo capsules that were identical in appearance three times daily and 100 mg of aspirin daily for 12 weeks. After confirming the patients had no gastroduodenal ulcer on EGD, gastric mucosa was determined and endoscopically graded according to the Modified Lanza scores (MLS) (Table 1) [9]. Helicobacter pylori status was assessed in all patients by Pronto Dry-rapid urease test (Medical Instruments Corporation, Solothurn, Switzerland) and histological examination of antral and corpus biopsy specimens. Enrolled patients were randomly allocated to the teprenone group or the placebo group in a 1:1 proportion by using the computer-generated randomization list provided. Medications that could affect mucosal healing, such as PPIs, H2RAs and mucoprotective agents were prohibited during the study period. If a patient had gastrointestinal symptoms during the study period, a rescue medication (antacid tablet) was allowed up to three times a day at a standard dose. The extent of antacid consumption was recorded via daily diary and by counting the number of tablets dispensed and returned at the end of the study. After 12 weeks of the study, patients underwent EGD to evaluate the development of peptic ulcer and to determine the MLS. The patients were instructed to record their gastrointestinal symptoms immediately before and at 12 weeks of treatment, using the gastrointestinal symptom rating scale (GSRS). Gastric biopsy specimens and serum sample were collected at the start and at the end of the study.