Esophageal Injury by Apple Cider Vinegar Tablets and Subsequent Evaluation of Products

Vinegar: A functional ingredient for human health

Vinegar is a well-known natural food product derived from alcoholic and subsequently acetous fermentation of carbohydrate-rich foods. Vinegar is widely used in the food industry; domestically for pickling vegetables and fruits, and as an ingredient in condiments like salad dressings, ketchups, and mayonnaise; and traditionally as a food seasoning and preservative. Historically, vinegar has been used for medicinal purposes such as a cure for stomach aches, wounds, burns, rashes, and oedema conditions. Different types of vinegar are found worldwide such as rice, black, balsamic, grain, and fruit vinegars. These are produced from different raw materials, and using different fermentation methods to give unique tastes and flavours. Vinegar, while enhancing physiological functions such as lipid metabolism, blood glucose level control, and body weight management, also possesses anticancer, antibacterial, antioxidant, and anti-infection properties. It is considered as a good source material for many bioactive compounds including organic acids, melanoidins, polyphenols, ligustrazine, and tryptophol. The pharmacological and metabolic benefits of vinegar are believed to be due to these bioactive compounds present in vinegar. Acetic acid (CH3COOH) is the essential component of vinegar; it is slightly volatile and has a strong and sour aroma and flavour. Regular consumption of vinegar-containing foods is considered important for keeping many life-style related diseases like diabetes, hypertension, hyperlipidaemia, cancers, and obesity in check. Therefore, the present review aims at highlighting the health benefits associated with vinegar consumption for the physiological well-being of an individual.

Corrosive Esophageal Injury due to a Commercial Vinegar Beverage in an Adolescent

Although gastroesophageal damage is commonly induced by accidental drinking of a strong acid or alkali, damage due to the consumption of a vinegar beverage is not well known. We report a case of corrosive esophageal ulcer found in an adolescent consuming a vinegar drink daily. A 15-year-old male visited the emergency room presenting with hematemesis and severe epigastric pain. Multiple longitudinal ulcers, concurrent mucosal hemorrhage, and denuded mucosa were noted in the whole of the esophagus via an endoscopic examination. He had been drinking a vinegar beverage daily without sufficient dilution. The patient was treated with corticosteroid, antibiotic therapy, and mucosa protecting alginate medication and was asked to fast for a week. The follow-up endoscopy showed improvement of the esophageal injuries. Overall, continuous consumption of a vinegar beverage can result in acidic burns and destruction of the surface of the upper gastrointestinal tract. Therefore, vinegar beverages should be considered as corrosive agents.

Popular Remedies for Esophageal Symptoms: a Critical Appraisal

PURPOSE OF REVIEW

Popular remedies are of ongoing interest to patients experiencing common esophageal symptoms, particularly as typical pharmacologic interventions have been subject to increased scrutiny. Herein we summarize the available data regarding potential risks and benefits of several such remedies.

RECENT FINDINGS

With emphasis on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and diverse physiologic mechanisms underlying a variety of complementary and alternative modalities, including dietary manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (rikkunshito, STW 5, slippery elm, licorice, and peppermint oil, among others). A substantial gap persists between anecdotal and empirical understandings of the majority of non-pharmacologic remedies for esophageal symptoms. This landscape of popular treatments nevertheless raises several interesting mechanistic hypotheses and compelling opportunities for future research.

An evaluation of the adhesion of solid oral dosage form coatings to the oesophagus

There is a requirement for the development of oral dosage forms that are adhesive and allow extended oesophageal residence time for localised therapies, or are non-adhesive for ease of swallowing. This study provides an initial assessment of the in vitro oesophageal retention characteristics of several widely utilised pharmaceutical coating materials. To this end, a previously described apparatus has been used to measure the force required to pull a coated disc-shaped model tablet across a section of excised oesophageal tissue. Of the materials tested, the well-studied mucoadhesive polymer sodium alginate was found to be associated with significant oesophageal adhesion properties that was capable of 'self-repairing'. Hydroxypropylmethylcellulose exhibited less pronounced bioadhesive behaviour and blending this with plasticiser or with low molecular weight polymers and surfactants did not significantly affect this. Low molecular weight water soluble polymers, were found to behave similarly to the uncoated glass control disc. Polysorbates exhibited bioadhesion behaviour that was majorly influenced by the nature of the surfactant. The insoluble polymer ethylcellulose, and the relatively lipophilic surfactant sorbitan monooleate were seen to move more readily than the uncoated disc, suggesting that these may have a role as 'easy-to-swallow' coatings.

An in vitro model for the evaluation of the adhesion of solid oral dosage forms to the oesophagus

Adhesion of solid oral dosage forms to the oesophagus can be a disadvantage when delivering drugs that may cause oesophageal damage, or can be an advantage when developing localised therapies for this region. In this study, apparatus to investigate coatings that may influence oesophageal retention was developed and evaluated. The apparatus incorporated a section of porcine oesophageal mucosa held flat by the application of a gentle vacuum and kept moist by the application of a simulated saliva solution. The resistance to the application of more physiologically relevant shear stresses was evaluated. Using a range of materials it was found that differences in oesophageal adhesion could be identified. Materials like sodium alginate were highly adhesive and had a tendency to re-adhere while paraffin waxes showed no adhesion. The rapid loss of the polymer coat from the surface for water swellable materials was identified as an issue.

Effects of apple cider vinegars produced with different techniques on blood lipids in high-cholesterol-fed rats

Red delicious apples were used to produce natural apple cider with and without inclusion of maceration. Traditional surface and industrial submersion methods were then applied to make vinegar from apple ciders. Apple cider vinegar samples produced with inclusion of maceration in the surface method had the highest total phenolic content, chlorogenic acid, ORAC, and TEAC levels. Cholesterol and apple vinegar samples were administered using oral gavage to all groups of rats except the control group. Apple cider vinegars, regardless of the production method, decreased triglyceride and VLDL levels in all groups when compared to animals on high-cholesterol diets without vinegar supplementation. Apple cider vinegars increased total cholesterol and HDL and LDL cholesterol levels and decreased liver function tests when compared to animals on a high-cholesterol diet without vinegar supplementation. A high-cholesterol diet resulted in hepatic steatosis. VSBM and VSB groups significantly decreased steatosis.