Gastritis (source from Dambro)
Inflammatory reaction in the stomach; typically involves the mucosa, seldom the full thickness of the stomach wall
•Patchy erythema of gastric mucosa: a common endoscopic finding; usually insignificant
•Erosive gastritis: a reaction to mucosal injury by a noxious chemical agent, e.g., drugs (especially NSAID's) or alcohol
•Reflux gastritis: a reaction to protracted reflux exposure to bile and pancreatic juice, usually associated with a defective pylorus; typically limited to the prepyloric antrum
•Hemorrhagic gastritis (stress ulceration): a reaction to hemodynamic disorder, eg, hypovolemia or hypoxia (as in shock). Also, very common in intensive care units (ICU).
•Infectious gastritis: commonly associated with Helicobacter pylori (possibly causative, maybe opportunistic); viral infection, usually as a component of systemic infection, is common; significant infection by other specific microbes is rare
•Gastric mucosal atrophy, sometimes called atrophic gastritis: frequent, in varying degrees, in the elderly; invariable in primary (pernicious) anemia
SIGNS AND SYMPTOMS:
•Nondescript epigastric distress, often aggravated by eating
•Anorexia
•Nausea, with or without vomiting
•Significant bleeding is unusual except in hemorrhagic gastritis
•Hiccups
CAUSES:
•Alcohol
•Aspirin and other nonsteroidal anti-inflammatory drugs
•Bile reflux
•Pancreatic enzyme reflux
•Stress (hypovolemia or hypoxia)
•Radiation
•Staphylococcus aureus exotoxins
•Bacterial infection (eg: Helicobacter pylori)
•Viral infection
•Pernicious anemia
•Gastric mucosal atrophy
•Portal hypertension gastropathy
RISK FACTORS:
•Age over 60
•Exposure to potentially noxious drugs or chemical agents
•Hypovolemia, hypoxia (shock)
•Candidal autoimmune
MEDICATIONS
DRUG(S) OF CHOICE:
•Antacids - best given in liquid form, 30 mL 1 hour after meals and at bedtime; useful mainly as an emollient
•H2 receptor antagonists e.g., cimetidine (Tagamet) - "priming" dose of 300 mg IV, then a steady infusion of 37.5-75 mg per hour, dissolved in the running fluid. Patients less severely ill - oral cimetidine 300 mg q6h (or ranitidine [Zantac] or famotidine [Pepcid] or nizatidine [Axid]). Not shown to be clearly superior to antacids.
•Sucralfate (Carafate) 1 g q4-6h on an empty stomach. Rationale uncertain, but empirically helpful.
•Prostaglandins, e.g., misoprostol (Cytotec), can help allay gastric mucosal injury, suggested dosage of 100-200 µg qid
•To eradicate H. pylori:
•"Triple therapy" is advised - bismuth (as Pepto-Bismol) 30 mL liquid or 2 tablets qid for 4 weeks plus metronidazole 250 mg qid for the first week, plus tetracycline 250 mg qid or amoxicillin 250 mg tid for 2-4 weeks
or
•"Dual therapy" with omeprazole 20 mg bid plus amoxicillin 500 mg qid for 2 weeks
•Short course therapy with 1 week of metronidazole, omeprazole, and clarithromycin bid - 90% effective
Contraindications: Hypersensitivity to the drug(s)
Precautions:
•If bismuth is prescribed, warn patient of black stools
•Refer to manufacturer's profile of each drug
Significant possible interactions: Refer to manufacturer's profile of each drug
For Herbal
curcuma longa
conteint: Azadichrain, asetiloksifuranil dekahidroterametil, oksiklopentanatolfuran asetat
farmacology, anti diabetic, anti diarchea, anti piretic, anti dispepsia
| Clinical Trials |
 | A review on suppression of tumor initiation, promotion and metastasis by curcumin, its dose-limiting toxicity at doses up to 10 g/day in human clinical trials indicated that curcumin has enormous potential in the prevention and therapy of cancer. Aggarwal 2003 | |
| | A phase 1 human trial with 25 subjects using up to 8000 mg of curcumin per day for 3 months demonstrated no toxicity from curcumin & it was found to be safe in six human trials and has demonstrated anti-inflammatory activity. Chainani-Wu 2003 | |
| | Oral administration of turmeric oil in 9 healthy volunteers revealed that there was no clinical, haematological, renal or hepatic-toxicity. However one case was dropped due to allergic skin rashes and another case due to inter-current infection. Joshi 2003 | |
| | [Advances in the clinical application and experimental study of Curcurma zedoaria oil preparations]. [Article in Chinese]. Li 2003 | |
| | Among three Curcuma species, C. aromatica had a repellent activity against Armigeres subalbatus, Culex quinquefasciatus, Cx. Tritaeniorhynchus. and also against Ae. Togoi and was found to be free from dermal irritation when applied to human skin. Pitasawat 2003 | |
| | The herbal eye drop Ophthacare which contains Curcuma longa along with seven other herbs was well tolerated by the patients with various ophthalmic disorders and no side effects were observed in a multicentre clinical trial conducted. Biswas 2001 | |
| | Hepatic arterial infusion of Embolized Curcuma Aromatic oil in 32 primary liver cancer patients when compared to transcatheter artery chemoembolization (TACE) revealed that Curcuma oil was superior than TACE with longer survival time & milder myelo-suppression.[Article in Chinese]. Cheng 2001 | |
| | A study of Phase I clinical trial of curcumin in 25 patients with high-risk or pre-malignant lesions revealed that it was not toxic to humans up to 8,000 mg/day when taken by mouth for 3 months and can be used in the chemoprevention of cancer. Cheng 2001b | |
| | In vitro addition of 1 microM curcumin to blood from healthy volunteers, reduced the lipopolysaccharide-induced cyclooxygenase-2 protein levels and concomitant prostaglandin E(2) product by 24% and 41%, respectively. Plummer 2001 | |
| | Oral dose of 2 capsules (300 mg) of turmeric 5 times daily given to 45 patients with peptic ulcer symptoms resulted into the absence of ulcers in 48% (12 cases) after 4 weeks and 76% (Nineteen cases) after 12 weeks of treatment. Prucksunand 2001 | |
| | [An hydroalcoholic extract of Curcuma longa lowers the abnormally high values of human-plasma fibrinogen.] Ramirez Bosca 2000 | |
| | The efficacy of curcumin on chronic anterior uveitis and recurrences following treatment in 18 patients are comparable to corticosteroid therapy which is presently the only available standard treatment for this ophthalmic condition. Lal 1999 | |
| | Clinical development plan: curcumin. NCI 1996 | |
| | Curcuma longa Linn. in the treatment of gastric ulcer comparison to liquid antacid: a controlled clinical trial. Kositchaiwat 1993 | |
 | An Ayurvedic formulation containing Curcuma longa, when evaluated by double-blind study in 20 patients of rheumatoid arthritis revealed pain relief, decreased morning stiffness, Ritche articular index and joint score, drop in erythrocyte sedimentation rate and 9/20 patients showed seroconversion. Kulkarni 1992 | |
| | 10 healthy people, receiving 500 mg of curcumin per day for 7 days, had a decrease in serum lipid peroxides (33%), increase in HDL Cholesterol (29%), and a decrease in total serum cholesterol (11.63%). Soni 1992 | |
| | Randomized, double-blind trial of 116 patients with dyspepsia found 87% improvement with Curcuma domestica vs. 53% in placebo group. Thamlikitkul 1989 | |
| | An ethanol extract of turmeric or a curcumin ointment provided symptomatic relief in patients with external cancerous lesions. Only 1 of the 62 patients had an adverse reaction. Kuttan 1987 | |
| | Phenylbutazone or curcumin provided better anti-inflammatory response than placebo. Satoskar 1986 | |
| Observational Studies/Case Reports |
| | Contact allergy to tetrahydrocurcumin. Lamb 2003 | |
| | Clinical efficacy of curcumin, at 375 mg/3times/day orally for 6-22 months in eight patients was reported in the treatment of patients with idiopathic inflammatory orbital pseudotumours. Four out of Five patients who completed the study recovered fully with no side effects. Lal 2000 | |
| | Submucous fibrosis patients orally taking 600 mg turmeric oil mixed with 3 gm turmeric ethanol extract per day for 3 months had decreased number of micronucleated cells both in exfoliated oral mucosal cells and in circulating lymphocytes Hastak 1997 | |
| | Forty cases of fistula in ano were treated with an Ayurvedic remedy ?Kshara Sutra? i.e. insertion of a thread impregnated with milk of Euphorbia neri-folic and powder of Rhizomes of Curcuma longa with 95% cure rate. Faujdar 1981 | |
