|
1
|
Liu S, Luan Z, Wang T, Xu K, Luo Q, Ye S, Wang W, Dan R, Shu Z, Huang Y, Mequanint K, Fan C, Xing M, Yang S. Endoscopy Deliverable and Mushroom-Cap-Inspired Hyperboloid-Shaped Drug-Laden Bioadhesive Hydrogel for Stomach Perforation Repair. ACS NANO 2023; 17:111-126. [PMID: 36343209 DOI: 10.1021/acsnano.2c05247] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gastrointestinal tract perforation is a full-thickness injury that causes bleeding and fatal infection of the peritoneum. This condition worsens in an acidic gastric environment which interferes with the normal coagulation cascade. Current endoscopic clips to repair gastric perforations are ineffective, and metal or plastic occluders need secondary surgery to remove them. Herein, we report a self-expandable, endoscopy deliverable, adhesive hydrogel to block gastric perforation. We found the nanosilica coating significantly enhanced the adhesive strength even under a simulated strong acidic stomach environment. The developed device was disulfide cross-linked for the reducible degraded gel. By loading with vonoprazan fumarate (VF) and acidic fibroblast growth factor (AFGF), the hyperboloid-shaped device can have a sustained drug release to regulate intragastric pH and promote wound healing. The gel device can be compressed and then expanded like a mushroom when applied in an acute gastric perforation model in both rabbits and minipigs. By utilizing a stomach capsule robot for remotely monitoring the pH and by immunohistochemical analysis, we demonstrated that the compressible hyperboloid-shaped gel could stably block the perforation and promoted wound healing during the 28 days of observation. The real-time pH meter demonstrated that the gel could control intragastric pH above 4 for nearly 60 h to prevent bleeding.
Collapse
Affiliation(s)
- Shuang Liu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Zhaohui Luan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Tongchuan Wang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Kaige Xu
- Departments of Mechanical Engineering, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Qiang Luo
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Shaosong Ye
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Wei Wang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Ruijue Dan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Zhenzhen Shu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Yu Huang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Kibret Mequanint
- Department of Chemical and Biochemical Engineering, and School of Biomedical Engineering, The University of Western Ontario, London, OntarioN6A 5B9, Canada
| | - Chaoqiang Fan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing400037, China
| | - Malcolm Xing
- Departments of Mechanical Engineering, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing400037, China
| |
Collapse
|
|
2
|
Abstract
PURPOSE OF REVIEW Clostridium difficile is an intestinal infection associated with antibiotic use, commonly seen in patients with chronic medical issues. The purpose of this review is to discuss the association of C. difficile-associated diarrhea with use of proton pump inhibitors. RECENT FINDINGS Multiple medical factors predispose patients to C. difficile-associated diarrhea. Proton pump inhibitors, commonly used for gastric acid suppression, have been shown to have an association with C. difficile-associated diarrhea in both the outpatient and hospital setting. C. difficile-associated diarrhea also has been reported in the pediatric age range linked with proton pump inhibitor use. SUMMARY An association exists between C. difficile infection and proton pump inhibitor use. Treatment options exist for C. difficile-associated diarrhea, although judicious use of proton pump inhibitors and antibiotics, emphasis on hand washing, and appropriate use of patient isolation should be implemented as well.
Collapse
|