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Li P, Li Z, Linghu E, Ji J. Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer. Chin Med J (Engl) 2024; 137:887-908. [PMID: 38515297 PMCID: PMC11046028 DOI: 10.1097/cm9.0000000000003101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Gastric cancer is one of the most common malignant tumors in the digestive system in China. Few comprehensive practice guidelines for early gastric cancer in China are currently available. Therefore, we created the Chinese national clinical practice guideline for the prevention, diagnosis, and treatment of early gastric cancer. METHODS This clinical practice guideline (CPG) was developed in accordance with the World Health Organization's recommended process and with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) in assessing evidence quality. We used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guidelines to ensure completeness and transparency of the CPG. RESULTS This CPG contains 40 recommendations regarding the prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer based on available clinical studies and guidelines. We provide recommendations for the timing of Helicobacter pylori eradication, screening populations for early gastric cancer, indications for endoscopic resection and surgical gastrectomy, follow-up interval after treatment, and other recommendations. CONCLUSIONS This CPG can lead to optimum care for patients and populations by providing up-to-date medical information. We intend this CPG for widespread adoption to increase the standard of prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer; thereby, contributing to improving national health care and patient quality of life.
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Affiliation(s)
- Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Ziyu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
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Antiperistaltic effect and safety of L-menthol for esophagogastroduodenoscopy in the elderly with contraindication to hyoscine-N-butylbromide. Sci Rep 2022; 12:10418. [PMID: 35729250 PMCID: PMC9213511 DOI: 10.1038/s41598-022-14693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/10/2022] [Indexed: 11/08/2022] Open
Abstract
Hyoscine-N-butylbromide (HBB) is the most used antiperistaltic agent during esophagogastroduodenoscopy (EGD). However, almost half of the elderly have a contraindication to HBB. We aimed to evaluate l-menthol’s antiperistaltic effect and safety for EGD in the elderly with contraindication to HBB. This prospective, randomized, double-blind, placebo-controlled study screened 86 elderly patients (≥ 65 years old) scheduled to undergo EGD, and 52 of them with contraindication to HBB were enrolled. The participants were randomized to receive l-menthol (n = 26) or a placebo (n = 26), which was locally sprayed on the gastric antrum endoscopically. The proportion of patients with no or mild peristalsis after medication and at the end of EGD was significantly higher in the l-menthol group (76.9%) than in the placebo group (11.5%, p < 0.001). l-Menthol administration significantly reduced peristaltic grade, improved contraction parameters, and eased intragastric examination relative to the placebo (p < 0.001, respectively). Hemodynamic changes, adverse events, and discomfort levels of patients were similar between the two groups. l-Menthol is an effective and safe alternative antiperistaltic medication for EGD in elderly patients with contraindication to HBB. Further large, randomized trials are required to clarify whether l-menthol can lead to better detection yield in the elderly. Clinical trial registration: The study was registered at ClinicalTrials.gov (NCT04593836).
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Kim SY, Park JM, Cho HS, Cho YK, Choi MG. Assessment of Cimetropium Bromide Use for the Detection of Gastric Neoplasms During Esophagogastroduodenoscopy. JAMA Netw Open 2022; 5:e223827. [PMID: 35319761 PMCID: PMC8943631 DOI: 10.1001/jamanetworkopen.2022.3827] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Esophagogastroduodenoscopy (EGD) is a common procedure used to examine upper gastrointestinal diseases. Although cimetropium bromide and other antispasmodic agents are commonly administered as premedication to inhibit peristalsis during EGD examination, there are few data regarding the benefits of cimetropium bromide for the detection of gastric neoplasms. OBJECTIVE To investigate the association between the use of cimetropium bromide as premedication and gastric neoplasm detection rates during EGD examination. DESIGN, SETTING, AND PARTICIPANTS This propensity score-matched retrospective cohort study included 67 683 participants who received EGD screening at the Health Promotion Center of Seoul St. Mary's Hospital, The Catholic University of Korea, from January 2, 2010, to June 30, 2017. Data were analyzed from April 1 to December 30, 2021. EXPOSURES Participants were divided into 2 groups: those who received cimetropium bromide before EGD examination (intervention group) and those who did not (control group). MAIN OUTCOMES AND MEASURES Gastric neoplasm detection rates. RESULTS Among 67 683 participants, the mean (SD) age was 48.6 (10.8) years, and 36 517 participants (54.0%) were male; all participants were Asian (a racially homogenous population). Of those, 28 280 participants (41.8%; mean [SD] age, 50.3 [10.6] years; 57.8% male) received cimetropium bromide, and 39 403 participants (58.2%; mean [SD] age, 47.4 [10.8] years; 51.2% male) did not. Propensity score matching based on confounding variables yielded 41 670 matched participants (20 835 pairs). Detected lesions included 52 dysplasias (0.12%), 40 early cancers (0.10%), 7 advanced cancers (0.02%), and 3 lymphomas (0.01%). Gastric neoplasm detection rates were significantly higher in the intervention group (63 participants [0.30%]) vs the control group (39 participants [0.19%]; P = .02). A significant difference in the combined detection rate of dysplasia and early gastric cancer was found between those in the intervention group (57 participants [0.27%]) vs the control group (35 participants [0.17%]; P = .02). For small gastric lesions (<1 cm), those who received cimetropium bromide had higher detection rates (24 participants [0.12%]) than those who did not (11 participants [0.05%]; P = .03). Lesions in the gastric body were detected significantly more often in the intervention group (34 participants [0.16%]) vs the control group (15 participants [0.07%]; P = .007). In multivariate analyses involving all 67 683 participants, the use of cimetropium bromide was more likely to detect gastric neoplasms compared with nonuse (odds ratio, 1.42; 95% CI, 1.04-1.95; P = .03). CONCLUSIONS AND RELEVANCE In this study, the use of cimetropium bromide as premedication was significantly associated with increased gastric neoplasm detection rates during EGD screening, and lesions in the gastric body were detected more frequently among those who received cimetropium bromide compared with those who did not. These findings suggest that cimetropium bromide may be considered as premedication before EGD examination among individuals with no contraindications.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, Myoungji Hospital, Hanyang University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea
- Graduate School, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Myung Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Photomedicine Research Institute, Seoul, Republic of Korea
| | - Hyun Sun Cho
- Department of Health Promotion Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu Kyung Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Photomedicine Research Institute, Seoul, Republic of Korea
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l-Menthol increases extracellular dopamine and c-Fos-like immunoreactivity in the dorsal striatum, and promotes ambulatory activity in mice. PLoS One 2021; 16:e0260713. [PMID: 34847183 PMCID: PMC8631625 DOI: 10.1371/journal.pone.0260713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 01/12/2023] Open
Abstract
Similar to psychostimulants, the peripheral administration of menthol promotes mouse motor activity, and the neurotransmitter dopamine has been suggested to be involved in this effect. The present study aimed to elucidate the effects of l-menthol on parts of the central nervous system that are involved in motor effects. The subcutaneous administration of l-menthol significantly increased the number of c-Fos-like immunoreactive nuclei in the dorsal striatum of the mice, and motor activity was promoted. It also increased the extracellular dopamine level in the dorsal striatum of the mice. These observations indicated that after subcutaneous administration, l-menthol enhances dopamine-mediated neurotransmission, and activates neuronal activity in the dorsal striatum, thereby promoting motor activity in mice.
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Meng F, Li W, Zhi F, Li Z, Xue Z, He S, Chen W, Chen Y, Xing X, Yao C, Wu Y, Zhang S. Antiperistaltic effect and safety of l-menthol oral solution on gastric mucosa for upper gastrointestinal endoscopy in Chinese patients: Phase III, multicenter, randomized, double-blind, placebo-controlled study. Dig Endosc 2021; 33:1110-1119. [PMID: 33527576 PMCID: PMC8596731 DOI: 10.1111/den.13941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The topical antispasmodic agent l-menthol is commonly used for gastric peristalsis suppression during diagnostic upper gastrointestinal (GI) endoscopy. We evaluated the efficacy and safety of a single dose l-menthol solution in suppressing gastric peristalsis during upper GI endoscopy in Chinese patients. METHODS In this phase III, multicenter, randomized, double-blind, placebo-controlled study (ClinicalTrials.gov: NCT03263910), 220 patients scheduled to undergo upper GI endoscopy at five Chinese referral centers received a single dose of either 160 mg of l-menthol (n = 109) or placebo (n = 111). Both treatments were sprayed endoscopically on the gastric mucosa. An independent committee evaluated the degree of gastric peristalsis (peristaltic score: grade 1-5). RESULTS At baseline, the proportion of patients with grade 1 peristalsis (no peristalsis) did not differ between the groups. The proportion of patients with grade 1 peristalsis post-treatment was significantly higher in the l-menthol group (40.37%, 44/109) versus the placebo group (16.22%, 18/111; P < 0.001); the difference between the groups was 24.15% (95% confidence interval: 12.67%-35.63%; P < 0.001). In the l-menthol group, 61.47% of patients had grade 1 peristalsis after endoscopy versus 24.55% in the placebo group (P < 0.001). The ease of intragastric examination correlated significantly with the grade of peristalsis. The incidence of adverse events was comparable between the groups (P = 0.340). CONCLUSIONS During upper GI endoscopy, a single dose of l-menthol solution (160 mg) sprayed on the gastric mucosa significantly attenuated gastric peristalsis versus placebo, thereby improving the visual stability without any safety concerns.
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Affiliation(s)
- Fandong Meng
- Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Wenyan Li
- Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Fachao Zhi
- Department of GastroenterologyNanfang Hospital of Southern Medical UniversityGuangzhouChina
| | - Zhaoshen Li
- Department of GastroenterologyChanghai Hospital Affiliated to the Second Military Medical UniversityShanghaiChina
| | - Zhanxiong Xue
- Department of GastroenterologyThe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Shuixiang He
- Department of GastroenterologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXianChina
| | - Weifeng Chen
- Department of GastroenterologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yingxuan Chen
- Department of GastroenterologyRenji Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Xiangbin Xing
- Department of GastroenterologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Chen Yao
- Department of Medical StatisticsPeking University First HospitalBeijingChina
| | - Yongdong Wu
- Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Shutian Zhang
- Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Abstract
In randomized controlled trials, L-menthol inhibits gastrointestinal peristalsis during endoscopy. Our goal was to quantitatively synthesize the available evidence to evaluate the efficacy and safety of L-menthol for gastrointestinal endoscopy.
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Ishiyama A, Namikawa K, Tokai Y, Yoshimizu S, Horiuchi Y, Yoshio T, Hirasawa T, Tsuchida T, Itoh F, Fujisaki J. Effect of spraying l-menthol on peristalsis resumption during endoscopic submucosal dissection of gastric tumors. JGH OPEN 2021; 5:653-657. [PMID: 34124381 PMCID: PMC8171147 DOI: 10.1002/jgh3.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Background and Aim l‐Menthol has smooth muscle‐relaxing and antiperistaltic effects. We examined its effectiveness against peristalsis resumption during endoscopic submucosal dissection (ESD) of gastric tumors. Methods We retrospectively examined clinical data of 485 patients (501 lesions) who underwent ESD for upper gastrointestinal tumors in 2017. We included 119 patients (127 lesions) in whom peristaltic movement resumed during ESD and l‐menthol was applied; 366 patients (374 lesions) without l‐menthol application were used as controls. Video recordings were reviewed to determine whether l‐menthol suppressed peristalsis resumption. Results In cases with l‐menthol application, 2 (2.9%), 36 (14.3%), and 89 (71.2%) lesions were found in the upper (U), middle (M), and lower (L) regions, respectively. In the control group, the corresponding values were 66 (17.6%), 215 (57.5%), and 93 (24.9%), respectively. l‐Menthol efficacy was observed in 116 of the 127 treated lesions (91.3%), over 90% of which were in the posterior wall of the U region, anterior wall and greater curvature of the M region, and anterior wall and lesser curvature of the L region. The most and least effective areas for l‐menthol application were the anterior wall of gastric antrum and posterior wall of the M region, respectively. The mean time from application to peristalsis inhibition was 8.7 s. No adverse effects were observed; perforation and secondary hemorrhage were not significantly different between the groups. Conclusion Direct l‐menthol application to the submucosal layer during mucosal resection affects smooth muscles and rapidly inhibits peristalsis resumption. Clinically, l‐Menthol can be used to suppress peristalsis recurrence during ESD, without adverse effects.
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Affiliation(s)
- Akiyoshi Ishiyama
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Ken Namikawa
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Yoshitaka Tokai
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Shoichi Yoshimizu
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Yusuke Horiuchi
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Toshiyuki Yoshio
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Toshiaki Hirasawa
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Tomohiro Tsuchida
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
| | - Fumio Itoh
- Department of Gastroenterology St. Marianna University School of Medicine Kawasaki Japan
| | - Junko Fujisaki
- Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan
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Antispasmodic Effect of Essential Oils and Their Constituents: A Review. Molecules 2019; 24:molecules24091675. [PMID: 31035694 PMCID: PMC6539827 DOI: 10.3390/molecules24091675] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022] Open
Abstract
The antispasmodic effect of drugs is used for the symptomatic treatment of cramping and discomfort affecting smooth muscles from the gastrointestinal, billiary or genitourinary tract in a variety of clinical situations.The existing synthetic antispasmodic drugs may cause a series of unpleasant side effects, and therefore the discovery of new molecules of natural origin is an important goal for the pharmaceutical industry. This review describes a series of recent studies investigating the antispasmodic effect of essential oils from 39 plant species belonging to 12 families. The pharmacological models used in the studies together with the mechanistic discussions and the chemical composition of the essential oils are also detailed. The data clearly demonstrate the antispasmodic effect of the essential oils from the aromatic plant species studied. Further research is needed in order to ascertain the therapeutic importance of these findings.
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Pawłowska B, Feder-Kubis J, Telesiński A, Biczak R. Biochemical Responses of Wheat Seedlings on the Introduction of Selected Chiral Ionic Liquids to the Soils. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:3086-3095. [PMID: 30802050 DOI: 10.1021/acs.jafc.8b05517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In this study, new chiral ionic liquids (CILs) were obtained from the natural-origin material (1 R,2 S,5 R)-(-)-menthol. The physicochemical characteristics of the studied imidazolium salts were investigated. The obtained 3-ethyl-1-[(1 R,2 S,5 R)-(-)-menthoxy-methyl]imidazolium salts are nonvolatile, nonflammable, and stable in air, in contact with water, and in commonly used organic solvents. The influences of the obtained chiral salts on physiological and biochemical parameters were determined for wheat ( Triticum aestivum L.) seedlings. Both salts led to changes in plant metabolism, which resulted in decreased assimilation pigments, decreased fresh weight, and increased dry weight and proline in wheat seedlings. Moreover, the growth of the above-ground parts and roots was inhibited. Additionally, there was a drop in the potential and germination capacity of wheat seeds after using the highest concentrations of the ionic liquids. The salts caused oxidative stress in wheat seedlings, which was demonstrated by increased malondialdehyde content. In response, the plants engaged their defensive system against free oxygen radicals, which resulted in increased catalase and peroxidase activity and decreased H2O2 levels in the plants. There were no changes in the activity of superoxide dismutase. All of the changes observed in the levels of determined biomarkers of oxidative stress in the plants were linearly correlated with the increase in the concentrations of the chiral ionic liquids in the soil. The salt with hexafluorphosphate anion exhibited slightly higher toxicity toward wheat seedlings than the other salt. The CILs led to premature aging of plants, which was demonstrated by the increase in peroxidase activity and a decrease of chlorophyll in the seedlings. The experiment also showed good correlation between the increase in peroxidase activity and the decrease in chlorophyll level, which proves that the decrease in chlorophyll content resulted from not only the increase in CILs concentration in the soil but also the increased POD activity, which leads to the damage of chlorophyll particles.
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Affiliation(s)
- Barbara Pawłowska
- The Faculty of Mathematics and Natural Sciences , Jan Dlugosz University in Czestochowa , 13/15 Armii Krajowej Av. , 42-200 Częstochowa , Poland
| | - Joanna Feder-Kubis
- Faculty of Chemistry , Wrocław University of Science and Technology , Wybrzeże Wyspiańskiego 27 , 50-370 Wrocław , Poland
| | - Arkadiusz Telesiński
- The Faculty of Environmental Management and Agriculture , West Pomeranian University of Technology , Juliusza Słowackiego st. 17 , 71-434 Szczecin , Poland
| | - Robert Biczak
- The Faculty of Mathematics and Natural Sciences , Jan Dlugosz University in Czestochowa , 13/15 Armii Krajowej Av. , 42-200 Częstochowa , Poland
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Chiu PWY, Uedo N, Singh R, Gotoda T, Ng EKW, Yao K, Ang TL, Ho SH, Kikuchi D, Yao F, Pittayanon R, Goda K, Lau JYW, Tajiri H, Inoue H. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68:186-197. [PMID: 30420400 DOI: 10.1136/gutjnl-2018-317111] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers. METHOD The Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement. RESULTS Risk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy. CONCLUSION This consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.
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Affiliation(s)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin and Modbury Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Takuji Gotoda
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Kenshi Yao
- Department of Endoscopy, University Chikushi Hospital, Fukuoka, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Shiaw Hooi Ho
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Fang Yao
- Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - James Y W Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
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Chumpitazi BP, Kearns G, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther 2018; 47:738-752. [PMID: 29372567 PMCID: PMC5814329 DOI: 10.1111/apt.14519] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/31/2017] [Accepted: 12/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Peppermint oil has been used for centuries as a treatment for gastrointestinal ailments. It has been shown to have several effects on gastrointestinal physiology relevant to clinical care and management. AIM To review the literature on peppermint oil regarding its metabolism, effects on gastrointestinal physiology, clinical use and efficacy, and safety. METHODS We performed a PubMed literature search using the following terms individually or in combination: peppermint, peppermint oil, pharmacokinetics, menthol, oesophagus, stomach, small intestine, gallbladder, colon, transit, dyspepsia, nausea, abdominal pain, and irritable bowel syndrome. Full manuscripts evaluating peppermint oil that were published through 15 July 2017 were reviewed. When evaluating therapeutic indications, only randomised clinical trials were included. References from selected manuscripts were used if relevant. RESULTS It appears that peppermint oil may have several mechanisms of action including: smooth muscle relaxation (via calcium channel blockade or direct enteric nervous system effects); visceral sensitivity modulation (via transient receptor potential cation channels); anti-microbial effects; anti-inflammatory activity; modulation of psychosocial distress. Peppermint oil has been found to affect oesophageal, gastric, small bowel, gall-bladder, and colonic physiology. It has been used to facilitate completion of colonoscopy and endoscopic retrograde cholangiopancreatography. Placebo controlled studies support its use in irritable bowel syndrome, functional dyspepsia, childhood functional abdominal pain, and post-operative nausea. Few adverse effects have been reported in peppermint oil trials. CONCLUSION Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.
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Affiliation(s)
| | - Gregory Kearns
- Arkansas Children’s Research Institute, Little Rock, AR, USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, Houston, TX, 77030
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Zorron Cheng Tao Pu L, Singh R. Topical antispasmodics during colonoscopy: do they have a role? Endosc Int Open 2017; 5:E408-E409. [PMID: 28573172 PMCID: PMC5451318 DOI: 10.1055/s-0043-106580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leonardo Zorron Cheng Tao Pu
- The University of Adelaide – School of Medicine,Lyell McEwin Hospital – Gastroenterology, Adelaide, South Australia,Corresponding author Leonardo Zorron Cheng Tao Pu The University of Adelaide – School of Medicine, North Terrace CampusAdelaideSouth Australia 5005Australia
| | - Rajvinder Singh
- The University of Adelaide – School of Medicine,Lyell McEwin Hospital – Gastroenterology, Adelaide, South Australia
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Liu SC, Lu HH, Cheng LH, Chu YH, Lee FP, Wu CC, Wang HW. Identification of the cold receptor TRPM8 in the nasal mucosa. Am J Rhinol Allergy 2016; 29:e112-6. [PMID: 26163239 DOI: 10.2500/ajra.2015.29.4202] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The transient receptor potential channel melastatin 8 (TRPM8) has been proposed to be a cold receptor. However, its distribution and physiologic role in the nose is not yet fully explored. OBJECTIVE We investigated the expression of TRPM8 in human nasal mucosa and its function when using the TRPM8 agonist. METHODS Immunohistochemistry was used to study TRPM8 receptors in the nasal mucosa from patients with and those without allergic rhinitis (AR). By using isometric contraction studies, we also tested the effectiveness of the TRPM8 agonist menthol on nasal mucosa. Changes in nasal mucosal contractility in response to the application of the adrenergic agent methoxamine were also measured. We explored the effect of menthol on electrical field stimulation (EFS) induced nasal mucosal contractions. RESULTS TRPM8 immunoreactivity was present principally in the nasal cilia, epithelium, and subepithelium around the glands. Except for nerve fibers, no obvious TRPM8-immunoreactive cells were detected in connective tissues. The immunoreactivity revealed no significant difference between patients with AR and those without AR. Adding menthol had a negligible effect on the basal tension of the nasal mucosa, but higher doses of menthol had a significant spasmolytic effect on nasal mucosa precontracted with methoxamine. Menthol inhibited the spike contraction induced by EFS, even at low doses. CONCLUSIONS The finding of the TRPM8 immunoreactivity underlines the important physiologic role of the nose in temperature regulation, both in patients with allergy and those without allergy. Isometric contraction studies demonstrate the role of TRPM8 in regulating nasal patency and airway resistance. The antiadrenergic effect of menthol showed an effect apparently opposite that of clinical observations, that we usually feel decongested after menthol inhalation. The underlying mechanisms deserve further investigation, and the TRPM8 antagonists deserve consideration for treatment of rhinitis in a therapeutic trial.
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Affiliation(s)
- Shao-Cheng Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
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Ching HL, Hale MF, McAlindon ME. Current and future role of magnetically assisted gastric capsule endoscopy in the upper gastrointestinal tract. Therap Adv Gastroenterol 2016; 9:313-21. [PMID: 27134661 PMCID: PMC4830104 DOI: 10.1177/1756283x16633052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Capsule endoscopy first captivated the medical world when it provided a means to visualize the small bowel, which was previously out of endoscopic reach. In the subsequent decade and a half we continue to learn of the true potential that capsule endoscopy has to offer. Of particular current interest is whether capsule endoscopy has any reliable investigative role in the upper gastrointestinal tract. Much research has already been dedicated to enhancing the diagnostic and indeed therapeutic properties of capsule endoscopy. Specific modifications to tackle the challenges of the gut have already been described in the current literature. In the upper gastrointestinal tract, the capacious anatomy of the stomach represents one of many challenges that capsule endoscopy must overcome. One solution to improving diagnostic yield is to utilize external magnetic steering of a magnetically receptive capsule endoscope. Notionally this would provide a navigation system to direct the capsule to different areas of the stomach and allow complete gastric mucosal examination. To date, several studies have presented promising data to support the feasibility of this endeavour. However the jury is still out as to whether this system will surpass conventional gastroscopy, which remains the gold standard diagnostic tool in the foregut. Nevertheless, a minimally invasive and patient-friendly alternative to gastroscopy remains irresistibly appealing, warranting further studies to test the potential of magnetically assisted capsule endoscopy. In this article the authors would like to share the current state of magnetically assisted capsule endoscopy and anticipate what is yet to come.
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Affiliation(s)
| | - Melissa Fay Hale
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Mark Edward McAlindon
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
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Wang HW, Liu SC, Chao PZ, Lee FP. Menthol inhibiting parasympathetic function of tracheal smooth muscle. Int J Med Sci 2016; 13:923-928. [PMID: 27994497 PMCID: PMC5165685 DOI: 10.7150/ijms.17042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022] Open
Abstract
Menthol is used as a constituent of food and drink, tobacco and cosmetics nowadays. This cold receptor agonist has been used as a nasal inhalation solution in the daily life. The effect of menthol on nasal mucosa in vivo is well known; however, the effect of the drug on tracheal smooth muscle has been rarely explored. Therefore, during administration of the drug for nasal symptoms, it might also affect the trachea via oral intake or inhalation. We used our preparation to test the effectiveness of menthol on isolated rat tracheal smooth muscle. A 5 mm long portion of rat trachea was submersed in 30 ml Krebs solution in a muscle bath at 37ºC. Changes in tracheal contractility in response to the application of a parasympathetic mimetic agent were measured using a transducer connected to a Pentium III computer equipped with polygraph software. The following assessments of menthol were performed: (1) effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10-6 M methacholine as a parasympathetic mimetic; (3) effect of the drug on electrically induced tracheal smooth muscle contractions. Results indicated that addition of a parasympathetic mimetic to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of menthol at doses of 10-5 M or above elicited a relaxation response to 10-6 M methacholine-induced contraction. Menthol could also inhibit electrical field stimulation (EFS) induced spike contraction. However, it alone had a minimal effect on the basal tension of trachea as the concentration increased. We concluded that the degree of drug-induced tracheal contraction or relaxation was dose-dependent. In addition, this study indicated that high concentrations of menthol might actually inhibit parasympathetic function of the trachea.
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Affiliation(s)
- Hsing-Won Wang
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, Republic of China;; Department of Preventive and Community Medicine, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, Republic of China;; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Pin-Zhir Chao
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, Republic of China
| | - Fei-Peng Lee
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, Republic of China
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16
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Mori A, Hachiya H, Yumura T, Ito S, Hayashi S, Nozaki M, Yoshida A, Ohashi N. l-Menthol sprayed on gastric mucosa causes edematous change. Endosc Int Open 2014; 2:E51-7. [PMID: 26135260 PMCID: PMC4423322 DOI: 10.1055/s-0034-1377172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/28/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND STUDY AIMS l-Menthol (LM), sprayed on the distal gastric mucosa, is a safe antispasmodic agent used during esophagogastroduodenoscopy (EGD). However, it seems to affect gastric mucosal endoscopic findings. Therefore, we evaluated whether LM causes specific changes and impacts the endoscopic morphology of gastric lesions. PATIENTS AND METHODS A total of 98 patients scheduled to undergo EGD were randomly assigned to receive LM solution (160 mg of 0.8 % LM added to 2.5 mL of indigo carmine [IC]; n = 49; LM group) or decuple-diluted IC solution without LM (n = 49; placebo group). We compared the incidence of specific mucosal changes and the difference in the endoscopic findings of several gastric lesions between these groups. RESULTS Annular-reticular - like mucosal changes appeared immediately after the administration of LM solution. This change was observed in 71.4 % of the LM group compared with 12.2 % of the placebo group (P < 0.01). In the placebo group, this change was observed in 14.7 % of subjects with atrophic gastritis compared with 6.7 % of those without atrophic gastritis (P = 0.39), whereas in the LM group, this change was observed in 84.8 % of subjects with atrophic gastritis compared with 43.8 % of those without atrophic gastritis (P < 0.01). Most early gastric cancers, erosions, and ulcers observed in this study became well demarcated after LM administration, although the incidence of gastric lesions did not differ significantly between the two groups. CONCLUSION LM changes the gastric mucosa into edematous mucosa, and this occurs more frequently in atrophic gastric mucosa than in pathologic lesions. LM may facilitate the demarcation of pathologic gastric lesions without intestinal metaplasia.
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Affiliation(s)
- Akihiro Mori
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
| | - Hiroki Hachiya
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
| | - Takayuki Yumura
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
| | - Shun Ito
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
| | | | - Masashi Nozaki
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
| | - Atsui Yoshida
- Ichinomiya Nishi Hospital – Gastroenterology, Ichinomiya, Japan
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Fujishiro M, Kaminishi M, Hiki N, Oda I, Fujisaki J, Uedo N, Kaise M, Tanabe S, Iguchi M, Matsuhashi N, Nomura S, Tajiri H, Yahagi N, Suzuki H. Efficacy of spraying l-menthol solution during endoscopic treatment of early gastric cancer: a phase III, multicenter, randomized, double-blind, placebo-controlled study. J Gastroenterol 2014; 49:446-54. [PMID: 23800946 DOI: 10.1007/s00535-013-0856-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 06/15/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The topical antispasmodic agent l-menthol is useful for inhibiting gastric peristalsis during diagnostic upper gastrointestinal endoscopy. However, it remains unclear whether l-menthol is similarly effective during therapeutic endoscopy, thereby improving treatment outcomes in a clinical setting. METHODS A total of 83 patients scheduled to undergo endoscopic treatment at 8 Japanese referral centers were randomly assigned to receive l-menthol or placebo. The degree of gastric peristalsis (peristaltic score: grade 1-5) was assessed by an independent committee. The primary outcome was the proportion of subjects in whom no or mild peristalsis (grade 1 or 2) was maintained throughout endoscopic treatment. Secondary outcomes were the duration of sustained response and the incidence of adverse drug reactions. RESULTS The proportion of patients with no or mild peristalsis was significantly higher in the l-menthol group (85.4 %, 95 % confidence intervals 70.8-94.4: 35/41 subjects) than in the placebo group (39.0 %, 24.2-55: 16/41; P < 0.001). The sustained response rates in the l-menthol and the placebo were, respectively, 90.0 and 39.6 % 30 min post-dose, and 79.9 and 35.7 % at the completion of the resection. The sustained response rates were significantly higher in the l-menthol group than in the placebo group (P < 0.001, log-rank test). The incidence of adverse drug reactions did not differ significantly between the two groups (P = 1.000). CONCLUSIONS During gastric endoscopic submucosal dissection, spraying l-menthol on the gastric mucosa significantly suppressed peristalsis, with minimal adverse drug reactions as compared with placebo. l-menthol solution might be useful for therapeutic endoscopy.
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Affiliation(s)
- Mitsuhiro Fujishiro
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
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Stea S, Beraudi A, De Pasquale D. Essential oils for complementary treatment of surgical patients: state of the art. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:726341. [PMID: 24707312 PMCID: PMC3953654 DOI: 10.1155/2014/726341] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/17/2014] [Indexed: 11/22/2022]
Abstract
Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated. The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for the treatment of infections, especially for tea tree oil, although current results are still inconclusive. It should also be considered that although they are, allergic reactions and toxicity can occur after oral ingestion. Therefore, while rigorous studies are being carried out, it is important that the therapeutic use of essential oils be performed in compliance with clinical safety standards.
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Affiliation(s)
- Susanna Stea
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alina Beraudi
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Prometeo Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Dalila De Pasquale
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Prometeo Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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Noriyasu A, Konishi T, Mochizuki S, Sakurai K, Tanaike Y, Matsuyama K, Uezu K, Kawano T. Menthol-enhanced cytotoxicity of cigarette smoke demonstrated in two bioassay models. Tob Induc Dis 2013; 11:18. [PMID: 24001273 PMCID: PMC3848596 DOI: 10.1186/1617-9625-11-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/31/2013] [Indexed: 01/11/2023] Open
Abstract
Background Cigarette smoke is harmful to human health at both cellular and genetic levels. Recently, a unique bioassay for smoke cytotoxicity using air pollution-sensitive plant cells (tobacco) has been proposed. Methods Model plant cells (tobacco Bel-W3 cells) and human cells (alveolar epithelial A549 cells) suspended in fresh culture media were exposed to cigarette smoke sampled after lighting the tip of cigarettes (with vs. without menthol capsules) which were attached to a glass pipe connected to the cell-containing plastic tubes. Control cultures were also assessed. Results After exposing tobacco plant cells to cigarette smoke, cell death occurred in a dose-dependent manner. Cell death was significantly enhanced by mentholated smoke, while menthol alone was shown to be inert suggesting that menthol synergistically contributes to the enhancement of cell death, initiated by smoke-associated compounds. The enhanced toxicity of mentholated smoke was confirmed in human alveolar epithelial A549 cells. Conclusions Cigarette smoke cytotoxicity leading to cell death assessed in plant and human model cells was enhanced by menthol. Further research into these findings is encouraged.
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Affiliation(s)
- Atsuko Noriyasu
- Faculty of Environmental Engineering, University of Kitakyushu, Kitakyushu, Japan.
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Menthol toxicity: an unusual cause of coma. Case Rep Med 2012; 2012:187039. [PMID: 23251165 PMCID: PMC3521632 DOI: 10.1155/2012/187039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/17/2022] Open
Abstract
The US Food and Drug Administration (FDA) consider menthol an effective substance, which help in common cold symptoms and labeled to have low toxicity profile. Direct exposure to high menthol amount has been reported in animal; but no studies have been done to show the effect of menthol on long-term use in humans. Up to our knowledge we are reporting a rare case of chronic exposure to significant amount of menthol associated with cutaneous, gastrointestinal and neurological manifestations.
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