An experimental study was performed to investigate the efficacy of ketotifen, which is a mast cell stabilizer and histamine H(1)-receptor antagonist, on the prevention of stricture development after esophageal caustic injuries in the rat. Caustic esophageal burn was created by applying 37.5% NaOH to the distal esophagus. Forty rats were divided into four equal groups. Group A (sham) animals were uninjured. Group B rats were injured but untreated. Group C rats were injured and received ketotifen (1 mg/kg/day) via the oral route. Group D rats were injured and received ketotifen (1 mg/kg/day) via the intraperitoneal route. Efficacy of the treatment was assessed on day 28 by measuring the stenosis index and histopathologic damage score and biochemically by determining tissue hydroxyproline content. The stenosis index in group B (0.93+/-0.22) was significantly increased compared with group A (0.39+/-0.06, p <0.05), group C (0.42+/-0.09, p <0.05), and group D (0.35+/-0.07, p <0.05). The hydroxyproline level ( micro g/mg wet tissue) was significantly increased in group B (1.31+/-0.08, p <0.05) compared with group A (0.69+/-0.16, p <0.05), group C (1.06+/-0.16, p <0.05), and group D (0.95+/-0.12, p <0.05). In group B the histopathologic damage score was significantly higher than in groups C ( p<0.05) and D ( p<0.05). There was no significant difference between group C and group D in terms of all parameters evaluated. Treatment with ketotifen decreased tissue hydroxyproline levels, histological damage, and the stenosis index. We conclude that ketotifen has a preventive effect in the development of fibrosis in an experimental model of corrosive esophagitis in rats.
At non-toxic doses, colchicine was not effective in the treatment of alkaline esophageal burn in rats. Colchicine-like molecules with less adverse effects or colchicine itself in titrated doses may be hopeful in preventing the development of fibrosis in the alkaline burns of the esophagus.
Type I gastric carcinoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-111 octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors < 1 cm in size may benefit from endoscopic polypectomy.
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