Tuesday, 26 November 2013

Gastric Ulcers: Treatments In traditional Chinese medicine perspective

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
II. Gastric ulcers
Gastric ulcer, a type of peptic ulcer is defined as a condition of a localized tissue erosion in the lining the stomach.
F.3. In traditional Chinese medicine perspective
1. Acupuncture and moxibustion 
 Chief physician YANG Mei-liang is a famous doctor of TCM in China. He emphasizes general diagnosis and treatment, and he is good at applying spleen and stomach theory to clinical acupuncture and moxibustion treatment, accurate and proper prescription association and acupoint selection, so as to attain multi-effects of one acupoint, and special and strong results. His unique treatment style achieves excellent effect in treatment. The present paper introduces YANG’s clinical successful samples in acupuncture and moxibustion treatment of insomnia, ophthalmopathy, intestinal obstruction, gastric ulcer, metrorrhagia and metrostaxis, etc(47).
2. Adlay seeds
Adlay (Coix lachryma-jobi L. var. ma-yuen Stapf) seeds have long been used to treat warts, chapped skin, rheumatism, and neuralgia in traditional Chinese medicine (TCM). According to th study by National Taiwan University, ABE showed better antiproliferative activity, and 19 compounds were purified from AB in a further phenolic-compound-guided separation. Among the isolated compounds, caffeic and chlorogenic acids significantly suppressed the growth of AGS cells. In addition, the antiulcer activity of DA was examined in an indomethacin-induced gastric lesion model. The ulcer index (UI) and oxidative biomarkers in animals decreased, while the non-protein sulfhydryl (NPSH) groups were elevated when given DA(48).
3. Qifang Weitong Powder and omeprazole
In the study to observe the histological changes of gastric mucosa in patients with active gastric ulcer before and after treatment by Qifang Weitong Powder combined with omeprazole (QWP-Op), showed that QWP-Op therapy can improve the histological quality of ulcer healing and restore the morphological structure of gastric mucosa in patients with active gastric ulcer(49).
4. Kangyanling and Omeprazole 
The study of the curative effects of combined therapy with Kangyanling (KYL, a Chinese herbal preparation) and Omeprazole on post-burn digestive dysfunction, including 18 with acute stress gastrointestinal mucosal hemorrhagic lesion and 14 with toxic enteroparalysis, were treated by KYL plus Omeprazole, and the 20 patients in the control group, 11 with acute stress gastrointestinal mucosal hemorrhagic lesion and 9 with toxic enteroparalysis were treated with Omeprazole alone, showed that the pH value in gastric mucosa of both groups before therapy were all lower than the normal range, it raised after treatment in the treated group (P < 0.05), approaching to the normal range, but with no significant change in the control group. The total hemostatic rate and the anti-paralysis rate was 77.8% and 85.7% respectively in the treated group, and 45.5% and 0% in the control group, all shown statistical significance between groups (P < 0.05)(50).
5. Jian pi qing re hua yu recipe
In the study to investigate the effects of Jianpi Qingre Huayu Recipe in curing gastric ulcer and to preliminarily probe into its pathogenic mechanism, including fifty patients with gastric ulcer of Pi -insufficiency and stasis-heat syndrome type were assigned to the treated group (30 patients) and the control group (20 patients). showed that Comparison of the total effective rate on gastroscopic figure in the treated group and the control group (86.7% vs 80.0%) showed insignificant difference, but the cure rate and markedly effective rate in the former (50.0% and 20.0%) was higher than that in the latter (40.0% and 15.0%) respectively. Comparison of the total effective rate on TCM syndrome in the treated group and in the control group (96.7% vs 70.0%) showed insignificant difference, but the cure rate and markedly effective rate in the former (63.3% and 23.3%) was higher than that in the latter (50.0% and 20.0%) respectively. Serum levels of CD3+, CD4+, CD8+ got restored to normal range in the treated group after treatment but it was not so in the control group. IL-8 level in gastric mucosa was improved in both groups but the improvement in the treated group was better(51).
6. Jianwei Yuyang Granule
According to the study by Institute of Integrative Traditional Chinese and Western Medicine, Xiangya Hospital of Central South University, indicated that JYG, with its good clinical compliance, has favorable effects in relieving clinical symptoms, promoting endoscopic ulcer healing and HP clearance, decreasing the expression of IL-1beta mRNA and increasing the expression of bFGF, therefore, it could promote the recovering of gastric ulcer(52).
7. Other Chinese herbs include Abrus cantoniensis (Fabaceae), Saussurea lappa (Asteraceae) and Eugenia caryophyllata (Myrtaceae) were strongly inhibitory to all test strains (MICs: approximately 40 microg/ml), and Hippophae rhamnoides (Elaeagnaceae), Fritillaria thunbergii (Liliaceae), Magnolia officinalis and Schisandra chinensis (Magnoliaceae), Corydalis yanhusuo (Papaveraceae), Citrus reticulata (Rutaceae), Bupleurum chinense and Ligusticum chuanxiong (Apiaceae)(53).
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(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(47) http://www.ncbi.nlm.nih.gov/pubmed/18481724
(48) http://www.ncbi.nlm.nih.gov/pubmed/21517098
(49) http://www.ncbi.nlm.nih.gov/pubmed/17717919
(50) http://www.ncbi.nlm.nih.gov/pubmed/18476431
(51) http://www.ncbi.nlm.nih.gov/pubmed/17578313
(52) http://www.ncbi.nlm.nih.gov/pubmed/17717918
(53) http://www.ncbi.nlm.nih.gov/pubmed/15814268 

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