Search Results (701)

Metronidazole is an antibiotic used to treat Helicobacter pylori, a bacterium responsible for chronic infections in humans that cause gastric inflammation, ulcers, and cancer. However, its long-term administration is limited by toxicity and increased resistance. In the search for more effective agents against H. pylori infection, molecular hybridization has now been applied to the synthesis of the new compound 3. Its structure connects the metronidazole moiety to pectolinarigenin, the latter obtained by acid hydrolysis of glycosylated flavonoids isolated from the plant Linaria reflexa Desf. The NOE effect supported the C-7 functionalization of 3, as evidenced by the energy-minimized DFT-calculated structure. The new molecule enriches the chemical space of known metronidazole–flavonoid analogs, among which the genistein derivative 2 was reported as the most active in inhibiting bacterial strains. The computational analysis of 2 and 3 compared with metronidazole as the reference has provided favorable data for both Absorption, Distribution, Metabolism, and Excretion (ADME) predictions and the probability of anti-H. pylori activity, besides rising docking evaluation on three specific targets and dynamics simulation as inhibitors of the flavodoxin enzyme. The results are promising for further in-depth biological investigation. Full article

Background: Helicobacter pylori is a globally prevalent gastric pathogen associated with chronic gastritis, peptic ulcer disease, and gastric adenocarcinoma. Its persistence within the gastric niche is strongly linked to biofilm formation, contributing to immune evasion and antibiotic therapy resistance. Methodology: In the present study, we investigated the antibiofilm potential of capsaicin, a natural phytochemical derived from Capsicum species, against H. pylori using experimental and computational approaches. Results: Capsaicin treatment significantly reduced biofilm biomass (up to 75.66 ± 4.00%), metabolic activity (up to 61.23 ± 6.88%), and cell surface hydrophobicity in a dose-dependent manner. Microscopic analyses revealed disrupted biofilm architecture and diminished extracellular polymeric substance at higher concentrations. Molecular docking analysis revealed that capsaicin interacts with target H. pylori proteins (GTP cyclohydrolase II, α-carbonic anhydrase, and urease) through stable hydrogen bonds and hydrophobic contacts. Molecular dynamics simulations further supported the stability of these complexes and demonstrated reduced structural fluctuations upon ligand binding. Free energy landscape analysis suggested ligand-induced conformational alterations in α-carbonic anhydrase, indicating possible structural effects associated with capsaicin interaction. Conclusions: Overall, the findings provide insight into the antibiofilm activity of capsaicin against H. pylori and highlight its potential as a natural adjunct strategy for combating biofilm-associated persistence and antimicrobial resistance. Full article

In ulcerative colitis (UC), the therapeutic efficacy of nanoparticle (NP)-based drug delivery systems is limited by premature drug release, uptake or degradation of NPs during their passage through the harsh gastrointestinal tract (GIT) environment, poor colon targeting, and rapid NP clearance caused by diarrhea symptoms. This study focused on designing an advanced spatiotemporally controlled nanohybrid hydrogel drug delivery system to overcome these challenges. We developed a pH- and temperature-responsive polysaccharide-based hydrogel composed of chitosan (CS), β-glycerol phosphate disodium salt pentahydrate (GP), hydroxypropyl cellulose (HPC), and collagen type I (Col I), designated as CS/HHPC/Col I-GP. The hydrogel exhibited a dense and uniform porous reticular structure, with an average pore diameter of 127.45 ± 2.22 μm. The equilibrium swelling ratio of the CS/HHPC/Col I-GP was determined to be 32.10 ± 1.11 g/g, indicating excellent swelling capacity and sustained structural stability over 6 h—making it suitable for sustained drug release in the intestinal tract. Then, the prepared curcumin nanoparticles (CurNPs) were encapsulated into the CS/HHPC/Col I-GP hydrogel to form the CS/HHPC/Col I-GP-CurNPs composite. The polysaccharide-based hydrogel shell of the formulation withstood harsh gastrointestinal conditions, enabled targeted adhesion to the colon, and was specifically degraded by colonic enzymes. The CurNPs released in the colon benefit from their negatively charged characteristics, enabling accumulation at the positively charged inflamed sites and achieving sustained Cur release. The results of the gastrointestinal digestion simulation experiment showed that the cumulative release of CS/HHPC/Col I-GP-CurNPs was only 12.33 ± 2.17% in simulated gastric fluid (SGF) and reached 96.91 ± 1.98% in simulated colonic fluid (SCF) after 60 h. Cell and animal experimental data confirmed that the formulation significantly alleviated colitis symptoms by modulating the repolarization of pro-inflammatory M1 macrophages to anti-inflammatory M2 phenotypes and deactivating the TLR4/MyD88/NF-κB pathway. Furthermore, the integrity of the intestinal mucosal barrier and the gut microbiota were enhanced. This study provides a promising strategy for the oral drug treatment of UC. Full article

Background/Objectives: In South Asia, the prevalence of Helicobacter pylori (H. pylori) infections may be as high as 60–80%, constituting a notable public health issue, with eradication strategies critical in reducing the H. pylori-associated disease burden. The aim of our study was to assess the knowledge, attitude, and practices (KAP) regarding the screening, treatment, and follow-up of H. pylori-induced gastric ulcers among physicians in Lahore, Pakistan. Methods: A self-administered, questionnaire-based cross-sectional study—including the development and validity assessment of a 24-item questionnaire—was carried out in two tertiary-care hospitals between January and May 2024. Statistical analyses (descriptive statistics, χ²-tests, binary logistic regression, and 95% confidence interval [95% CI]) were carried out using IBM SPSS 27.0. The study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Results: Among N = 385 participants, 57.9% were male, 60.0% were aged between 25 and 34 years, 59.5% worked in a public hospital, and 55.3% had <5 years of working experience. Of them, 32.9% had noted medical journals, while 27.0% reported online educational materials as their key sources of evidence-based information. Although 91.2% and 87.3% of physicians had good knowledge and attitude levels (≥50% score) pertaining to H. pylori-associated gastric ulcers, respectively. Participants aged 25–34 years (aOR: 0.217 [95% CI: 0.08–0.589]), who have <5 years of working experience (aOR: 0.328 [95% CI: 0.136–0.790]) and those working in public hospitals (aOR: 0.130 [95% CI: 0.048–0.352]) were less likely to show poor attitudes. Furthermore, 76.5% made it a routine to discuss the risk factors of H. pylori-induced ulcers with their patients, while 67.4% highlighted the importance of follow-up testing to confirm the eradication of H. pylori. Conclusions: Inconsistent and empirical treatment approaches, lack of routine screening, and inadequate follow-up practices may further compromise eradication efforts and contribute to antimicrobial resistance. Our findings emphasize the importance of targeted educational programs to address knowledge gaps, standardize practices, and enhance the appropriate management of H. pylori-induced gastric ulcers in Pakistan. Full article

This study aims to investigate the antioxidant, anti-inflammatory, and anti-ulcer properties of two newly isolated natural compounds (1–2) from the hydroalcoholic root extract of Tricholaena teneriffae L. Through bioassay-guided fractionation, two new natural compounds, xantenone and anthracenone, were isolated and characterized using 1D/2D NMR and mass spectrometry. While 6-hydroxy-3-methoxy-7H-benzo[de]anthracen-7-one (HK2) showed significant antioxidant activity, 11-hydroxy-12H-benzo[a]xanthen-12-one (HK1) exhibited only weak activity. However, both compounds demonstrated a gastroprotective effect in vivo, similar to that of omeprazole. In silico screening revealed that both molecules bind stably to the H⁺/K⁺-ATPase proton pump, suggesting a potential mechanism for inhibiting gastric acid secretion. In the ethanol-induced ulcer model, treatment with HK1 and HK2 significantly reduced inflammation, oxidative stress, gastric hypersecretion, and ulcer area, with HK2 showing greater efficacy. These results suggest that the active fraction of T. teneriffae root has anti-ulcer properties beyond its antioxidant effects, making it a promising natural source of gastroprotective agents. Full article

Survivors of primary gastric lymphoma (PGL) face a significantly elevated and persistent risk of developing second primary malignancies (SPMs), with gastric adenocarcinoma representing the most frequent SPM and standardized incidence ratios reaching up to 16-fold above the general population. This excess risk persists for decades after initial treatment and is associated with increased cause-specific mortality compared to matched primary cancers. Among patients with PGL, approximately 5% develop gastric cancer (with two-thirds being metachronous), and nearly 15% harbor precancerous lesions including atrophic gastritis, intestinal metaplasia, and dysplasia. Beyond gastric malignancies, survivors also experience elevated rates of extra-gastric SPMs, particularly digestive system tumors (43%), respiratory cancers (21%), and urinary tract malignancies (13%). Key risk factors include treatment with immunochemotherapy or radiotherapy, advanced age, male sex, advanced stage at diagnosis, ulcerative-type lymphoma morphology, and persistent Helicobacter pylori (HP) infection. Patients receiving combined chemoradiotherapy demonstrate the highest SPM risk, particularly for gastric and pancreatic cancers. These findings underscore the critical importance of lifelong, risk-adapted surveillance strategies integrating both hematology and gastroenterology follow-up. Annual endoscopic surveillance is recommended for high-risk patients, with intervals adjusted according to lymphoma histology, HP status, and the presence of precancerous gastric lesions. Mandatory HP eradication with confirmation of response is essential for reducing gastric cancer risk. Future research priorities include prospective, standardized studies to better quantify SPM risk, validation of molecular and microbiological biomarkers for individualized risk stratification, and development of predictive models to enable personalized surveillance protocols and improve long-term outcomes in this vulnerable population. Full article

Helicobacter pylori (H. pylori) infection is closely associated with the development of chronic gastritis, peptic ulcers, and gastric cancer, highlighting the importance of rapid and accurate detection for disease prevention and clinical management. In this study, a one-pot LAMP-CRISPR/Cas12b assay targeting the CagA gene was developed for H. pylori detection. First, the LAMP system was optimized by systematically screening key reaction components. Subsequently, a one-step LAMP-CRISPR/Cas12b detection platform was established through optimization of the ratio between the LAMP premix and CRISPR buffer, reaction temperature, Cas12b concentration, and ssDNA reporter concentration. Under optimal conditions, the assay achieved a detection limit of 3.14 × 10¹ copies/µL, representing a tenfold improvement in sensitivity compared with conventional LAMP and PCR assays (3.14 × 10² copies/µL). In addition, the entire detection process could be completed within 1 h. Validation using 17 culture-positive and 17 culture-negative samples demonstrated complete concordance with culture-based results, with no false-positive or false-negative detections observed. These findings indicate that the proposed platform possesses high sensitivity, excellent specificity, rapid turnaround, and operational simplicity, demonstrating strong potential for point-of-care testing and applications in resource-limited settings. Full article

Objective: Intraoperative biopsy in perforated gastric ulcers has traditionally been widely used to exclude the risk of malignancy. However, despite accumulating evidence in recent years indicating a low incidence of malignancy, it remains unclear to what extent this approach has been adopted by surgeons. This study aims to evaluate the attitudes of general surgeons in Türkiye toward intraoperative biopsy in perforated gastric ulcers and to identify the factors influencing this decision. Materials and Methods: A descriptive, cross-sectional, nationwide survey was conducted among actively practicing general surgeons in Türkiye. A total of 361 surgeons were included. The structured questionnaire addressed demographic data, biopsy practices in perforated gastric ulcers, preferred surgical approaches, and postoperative endoscopy planning. Multivariable logistic regression analysis was performed to determine factors associated with routine intraoperative biopsy. Results: The mean age of participants was 41.4 ± 10.3 years, and the mean duration of surgical experience was 12.8 ± 9.7 years. Only 34.07% of surgeons correctly estimated the current malignancy risk (<5%) in perforated gastric ulcers; 115 participants (28.3%) did not provide a quantitative estimate. Among respondents, 54.57% reported performing routine intraoperative biopsy, 41.55% reported performing selective biopsy, and 3.88% reported performing no biopsy. Surgeons performing routine biopsy were older (42.6 ± 10.1 vs. 39.8 ± 10.1 years, p = 0.01) and more experienced (14.3 ± 9.7 vs. 11.0 ± 9.2 years, p = 0.002). In multivariable logistic regression, age (OR 1.02, 95% CI 0.95–1.10, p = 0.608), surgical experience (OR 1.01, 95% CI 0.93–1.09, p = 0.820), and perceived malignancy risk (OR 1.02, 95% CI 0.99–1.05, p = 0.116) were not independent predictors of routine biopsy. Postoperative endoscopy was recommended by 87.53% of participants. Conclusions: Routine intraoperative biopsy for perforated gastric ulcers remains widely practiced in Türkiye despite the low malignancy rates reported in the contemporary literature. Surgeons’ biopsy decisions are largely influenced by perceived malignancy risk, experience, and traditional clinical approaches. These findings suggest that an evidence-based strategy relying on selective biopsy and planned postoperative endoscopy, rather than routine intraoperative biopsy, should be more effectively integrated into clinical practice. Full article

Background: The clinical significance of Helicobacter pylori (H. pylori) infection in acute non-variceal upper gastrointestinal bleeding (NVUGIB) remains uncertain, particularly regarding short-term outcomes beyond rebleeding. Methods: We conducted a single-center retrospective cohort study of consecutive adults admitted with acute NVUGIB to Hatyai Hospital, Thailand, between January 2016 and December 2020. H. pylori status was determined during the index hospitalization using rapid urease testing and/or histopathologic examination of gastric biopsy specimens obtained during upper gastrointestinal endoscopy. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, rebleeding, requirement of packed red blood cell transfusion, and length of hospital stay. Multivariable regression analyses were performed to adjust for potential confounders. Results: Among 933 patients, 289 (31.0%) were H. pylori-positive and 644 (69.0%) were H. pylori-negative. The H. pylori-positive group was younger, predominantly male, and had lower rates of cirrhosis and prior proton pump inhibitor use. They also more often had peptic ulcer bleeding and underwent earlier endoscopy. H. pylori positivity was independently associated with lower 30-day mortality (adjusted odds ratio 0.39, 95% confidence interval 0.18–0.84), but not with rebleeding, requirement of transfusion, or length of stay. Conclusions: H. pylori positivity was associated with lower short-term mortality in acute NVUGIB, although this finding may reflect baseline clinical differences rather than a direct effect on bleeding severity. Full article

Proton pump inhibitors (PPIs) serve as the primary treatment for acid-related disorders, such as gastroesophageal reflux disease and peptic ulcer disease. Although PPIs are regarded as the first-line medication for acid suppression, they have notable limitations, including the need for acid-mediated activation, a short half-life and duration of action, and metabolic variability. Zastaprazan is a newly developed potassium-competitive acid blocker (P-CAB) that competitively and reversibly inhibits acid production and secretion. Like other P-CABs, zastaprazan exhibits pharmacodynamic and pharmacokinetic properties that differs significantly from those of PPIs. These differences offer potential advantages, such as rapid, robust, and long-standing acid suppression, the lack of CYP2C19 metabolism, and no need for conversion into an active form. Completed clinical trials of zastaprazan have demonstrated comparable or superior efficacy to that of PPIs for the healing of erosive esophagitis and gastric ulcers without concerning safety signals. Notably, in erosive esophagitis, zastaprazan 20 mg demonstrated faster healing at week 4 compared to esomeprazole 40 mg, whereas in gastric ulcers, zastaprazan 20 mg achieved a 100% healing rate at 8 weeks compared to 97.1% with lansoprazole 30 mg. Zastaprazan is approved in the Republic of Korea for the treatment of erosive esophagitis and gastric ulcer and is undergoing phase III clinical trials for the prevention of non-steroidal anti-inflammatory drug-induced peptic ulcer and the treatment of non-erosive reflux disease. In this review, we summarize and discuss the pharmacology, efficacy, and safety of zastaprazan in acid-related disorders. Full article

Juniperus phoenicea L. is a popular plant in alternative medicine, particularly in the steppe and highland regions of western Algeria. The present study focuses on characterizing the essential oil of Juniperus phoenicea growing spontaneously in the Ain El Orak region of El Bayadh province, where it is a valuable resource. The essential oil yield obtained by hydrodistillation was 0.98%, and its characterization by GC-MS revealed 46 compounds, predominantly α-Terpinolene at 21.29%, Limonene at 14.68%, Terpinene 4-ol at 12.04%, β-Myrcene at 9.93%, and β-Pinene at 7.31%. The study of the anti-radical activity against DPPH showed an IC50 value of approximately 0.23 mg/mL. The evaluation of the anti-ulcer property on experimentally induced ulcers in mice through oral administration of ethanol demonstrated excellent protection of the gastric mucosa, with 48.07%, 54.87%, and 81.92% protection for doses of 50, 100, and 200 mg/kg, respectively, comparable to omeprazole at 72.40%. The hepatoprotective activity against toxicity induced by intraperitoneal injection of a 250 mg/kg dose of paracetamol in mice showed a protective effect expressed by the decrease in serum levels of AST (260.33 ± 9.69 IU/L) and ALT (56.22 ± 9.63 IU/L) to values comparable to the those of the physiological group, especially for the 300 mg/kg dose of the essential oil of J. phoenicea. Full article

Background: Helicobacter pylori remains a major cause of chronic active gastritis and a clinically relevant precursor of peptic ulcer disease and gastric neoplasia. Host-derived non-invasive biomarkers that reflect infection-related gastric inflammation are still insufficiently developed. This study evaluated the clinical relevance of fecal miR-146a in patients with H. pylori-associated gastritis. Methods: We conducted a prospective study over a 3-year period (2023–2025) at the County Clinical Emergency Hospital Sibiu, Romania. The study included 85 adults: 45 patients with confirmed H. pylori-associated gastritis and 40 controls. Demographic, clinical, inflammatory, endoscopic, histopathological, and molecular data were analyzed. Continuous variables were compared using the Mann–Whitney U test and categorical variables using the chi-square or Fisher’s exact test. Multivariable analysis was performed using Firth’s penalized logistic regression. Results: Patients with H. pylori-associated gastritis showed significantly higher fecal miR-146a expression than controls (2.05 [1.77–2.37] vs. 0.88 [0.77–0.99], p < 0.001). They also had higher CRP, ESR, WBC, abdominal pain scores, and a greater burden of endoscopic and histopathological abnormalities. In both multivariable models, fecal miR-146a remained the only significant variable associated with disease status. Conclusions: Fecal miR-146a is markedly elevated in H. pylori-associated gastritis and may represent a promising non-invasive biomarker of infection-related gastric inflammation. Larger prospective studies are needed for validation. Full article

Background: Gastric cancer remains one of the leading causes of cancer-related mortality worldwide, underscoring the need for more effective diagnostic strategies. This study aims to use annotated digitized histological slides of gastric cancer and precancerous lesions to develop artificial intelligence algorithms for the diagnosis of gastric lesions. Materials and Methods: We developed a deep learning tool using a training cohort of 970 digitized gastric biopsy slides. Convolutional neural networks (CNNs) were trained for histological recognition and ICD-10 code assignment. The model was validated on an independent test cohort of 250 cases, with expert consensus as the reference standard. Performance was assessed using sensitivity, specificity, and Cohen’s kappa. Survival analysis used Kaplan–Meier, log-rank tests (SPSS 16.0; p < 0.05 significant). Results: Analysis of the training cohort led to a scoring system predicting fatal outcomes based on age and morphology (high-grade component > 70%, ulceration, absence of metaplasia/dysplasia). High-risk patients (4–5 points) had significantly worse survival than low-risk patients (0–3 points) (Log Rank = 14,754; p < 0.0001). One-year survival was 71% (low-risk) vs. 40% (high-risk); mean survival was 19.2 vs. 11.3 months. In the test cohort, the AI algorithm demonstrated 79.6% sensitivity and 86.7% specificity (p < 0.0001) for differentiating malignant from benign gastric lesions. Conclusions: A system combining AI-based analysis with a prognostic scoring model has been developed to reduce diagnostic errors and improve risk stratification in gastric cancer pathology. Full article

Background: Endoscopic submucosal dissection (ESD) is widely used for the treatment of gastric neoplasia; however, the large artificial ulcer created during the procedure requires several weeks to heal. Although proton pump inhibitors (PPIs) are routinely administered after ESD, evidence comparing individual PPIs for artificial ulcer healing in real-world practice remains limited. This study compared the effectiveness of oral ilaprazole and oral esomeprazole as maintenance therapy after gastric ESD. Methods: This retrospective single-center study included patients who underwent gastric ESD between January 2020 and December 2024. All patients received intravenous PPI therapy for two days after ESD and were subsequently prescribed either oral ilaprazole 20 mg once daily or esomeprazole 40 mg once daily for 8 weeks. The primary outcome was complete artificial ulcer healing at 8 weeks. The secondary outcome was post-discharge delayed bleeding. Results: A total of 229 patients were analyzed (147 in the esomeprazole group and 82 in the ilaprazole group). The overall 8-week ulcer healing rate was 94.3%, with no significant difference between the ilaprazole and esomeprazole groups (97.5% vs. 92.5%, p = 0.114). In multivariate analysis, artificial ulcer size ≥ 30 mm was the only independent predictor of incomplete ulcer healing (odds ratio 20.850, 95% confidence interval 1.884–230.712, p = 0.013). Post-discharge delayed bleeding occurred in 8 patients (3.4%), all in the esomeprazole group (p = 0.032). No treatment-related adverse events were observed. Conclusions: Ilaprazole demonstrated ulcer-healing efficacy comparable to esomeprazole after gastric ESD. Artificial ulcer size ≥ 30 mm was the principal determinant of delayed healing, whereas the treatment group was not independently associated with healing outcomes. Ilaprazole may be considered a reasonable maintenance PPI option in routine post-ESD management. Full article

Background and Objectives: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed metabolic and bariatric surgeries worldwide. Marginal ulcers (MU) are a common complication following RYGB, yet their pathophysiology and the contributing risk factors to their development are not fully understood. Materials and Methods: This retrospective cohort study examined patients who underwent RYGB between January 2008 and December 2023, with 1 to 5 years of follow-up. Data collected included patient- and procedure-related risk factors, as well as postoperative MU events. Statistical analysis methods included the independent samples t-tests, multivariate regression, and Cox regression analyses. Results: Our final cohort included 2106 patients and was predominantly female (80.5%), with a mean age of 47.8 ± 12.1 years and body mass index (BMI) of 45.5 ± 7.5 kg/m². MU occurred in 241 (11.4%) patients, with a mean time to occurrence of 4.5 ± 0.02 years. History of smoking (HR = 1.87, p < 0.001) and gastroesophageal reflux disease (HR = 2.36, p < 0.001) significantly increased hazard for MU, while proton pump inhibitor use (HR = 0.18, p < 0.001) was associated with reduced hazard. Aspirin exposure, regardless of dose and chronicity, did not impact MU. Conclusions: Our findings highlight the importance of preoperative assessment and counseling in patients planning to undergo RYGB. Patient-related factors should guide postoperative monitoring and prophylaxis of MU, as this remains a debated topic amongst experts. Full article