Gastroretentive drug delivery systems for the treatment of Helicobacter pylori

Indications and Findings of Upper Gastrointestinal Endoscopy at a District Hospital in Ghana: A Retrospective Study

Background and Aims

Gastrointestinal diseases are a significant global health issue, with symptoms from these conditions negatively affecting quality of life and causing substantial economic consequences. Esophagogastroduodenoscopy, also referred to as upper gastrointestinal endoscopy, is an important and safe procedure used for both diagnosis and treatment in the field of gastroenterology. This study sought to assess the characteristic clinical indications and endoscopic findings of individuals presenting at Methodist Hospital, Wenchi, Ghana.

Methods

A retrospective analysis was conducted by examining the medical records of patients who underwent upper gastrointestinal endoscopy from April 2023 to June 2024.

Results

Out of 405 patients who underwent upper gastrointestinal endoscopy during the study period, 396 were included in the subsequent analysis. The average age of patients was 43.7 years with a standard deviation of 16.6 and ranging from 12 to 100 years. Approximately 42.9% of the patients were males. Dyspepsia was the most common reason for upper gastrointestinal endoscopy (60.9%), followed by retrosternal chest pain (17.7%), heartburn (12.1%) and upper gastrointestinal bleeding (3.8%). Results of upper gastrointestinal endoscopy were normal in 15.2% of patients. The most prevalent pathologies of the esophagus, stomach and duodenum were gastroesophageal reflux disease (17.4%), gastritis (31.8%), and duodenitis (4.5%), respectively.

Conclusion

Dyspepsia was the primary indication for endoscopic evaluation of the upper gastrointestinal tract. The most prevalent pathological finding was gastritis, followed by gastroesophageal reflux disease, gastric ulcer, hiatal hernia and duodenitis. Esophagogastroduodenoscopy is an essential investigative tool for diagnosing upper gastrointestinal tract pathologies.

Oral Drug Delivery Systems Applied to Launched Products: Value for the Patients and Industrial Considerations

Drug delivery systems (DDS) control the amount, rate, and site of administration of drug substances in the body as well as their release and ADME (absorption, distribution, metabolism, excretion). Among the various types of DDS, amount-controlled DDS for solubilization and absorption increase the bioavailability. Time- and amount-controlled DDS are controlled release formulations classified as (1) membrane-type, (2) matrix-type, (3) osmotic-type, and (4) ion-exchange type. Timed-release formulations also control the time and amount of release and the absorption of drugs. Site- and amount-controlled DDS are characterized by colonic delivery and intestinal lymph-targeting to improve release and ADME of drug substances. Finally, site-, time-, and amount-controlled DDS are gastroretentive formulations and local delivery in the oral cavity to improve site retention, release, and ADME of drugs. DDS can enhance efficacy, reduce adverse effects, and optimize the dosing frequency of various drug products to increase patient value. This review focuses on patient value and industrial considerations of launched oral DDS. We provide a technological overview of candidate and marketed DDS, as well as the pros/cons of the technologies for industrialization with consideration to excipients, manufacturing, and storage stability. Moreover, to demonstrate the usefulness of the technology and support the selection and development of the best technologies for patients, we also describe patient value from clinical studies and analyses, particularly with regard to increased new medical options, higher efficacy, reduced adverse effects, reduced number of doses and clinic visits, easier administration, higher quality of life, greater adherence, and satisfaction.

The Potential Use of Antibiotics Against Helicobacter pylori Infection: Biopharmaceutical Implications

Helicobacter pylori (H. pylori) is a notorious, recalcitrant and silent germ, which can cause a variety of debilitating stomach diseases, including gastric and duodenal ulcers and gastric cancer. This microbe predominantly colonizes the mucosal layer of the human stomach and survives in the inhospitable gastric microenvironment, by adapting to this hostile milieu. In this review, we first discuss H. pylori colonization and invasion. Thereafter, we provide a survey of current curative options based on polypharmacy, looking at pharmacokinetics, pharmacodynamics and pharmaceutical microbiology concepts, in the battle against H. pylori infection.

Scope and Limitations of Current Antibiotic Therapies against Helicobacter pylori: Reviewing Amoxicillin Gastroretentive Formulations

Even though general improvement of quality of life has happened around the globe, statistics show that gastric cancer is still a very serious medical concern in some regions of the world. A big portion of malignant neoplasms that develop inside the stomach are linked to an infection of Helicobacter pylori; in fact, this pathogen has already been categorized as a group 1 carcinogen by the World Health Organization (WHO). Still, the efficacy of current anti-H. pylori therapeutic approaches is insufficient and follows a worrying decreasing trend, mainly due to an exponential increase in resistance to key antibiotics. This work analyzes the clinical and biological characteristics of this pathogen, especially its link to gastric cancer, and provides a comprehensive review of current formulation trends for H. pylori eradication. Research effort has focused both on the discovery of new combinations of chemicals that function as optimized antibiotic regimens, and on the preparation of gastroretentive drug delivery systems (GRDDSs) to improve overall pharmacokinetics. Regarding the last topic, this review aims to summarize the latest trend in amoxicillin-loaded GRDDS, since this is the antibiotic that has shown the least bacterial resistance worldwide. It is expected that the current work could provide some insight into the importance of innovative options to combat this microorganism. Therefore, this review can inspire new research strategies in the development of efficient formulations for the treatment of this infection and the consequent prevention of gastric cancer.

Design of Mucoadhesive Nanostructured Polyelectrolyte Complexes Based on Chitosan and Hypromellose Phthalate for Metronidazole Delivery Intended to the Treatment of Helicobacter pylori Infections

Metronidazole (MT) is an important drug available for Helicobacter pylori infection treatment. However, in the past few years, this drug has presented effective reduction for infection control, one of the most important reasons is attributed to the reduction of retention time in the stomach environment. Mucoadhesive nanostructured polyelectrolyte complexes (nano PECs) based on chitosan (CS) and hypromellose phthalate (HP) were rationally developed using a full factorial design (21 × 21 × 31), for the incorporation of MT based on the enhancement of the antimicrobial potential against active Helicobacter pylori, in the stomach. Different mass ratios of CS:HP (w/w) were tested, reaching the most promising ratios of 1:0.1, 1:0.5, and 1:1, and two methods of polymers addition (pouring-I and drip-II) were also evaluated. From method I, the obtained particles presented a diameter in the range of 811-1293 nm (Z-average) and a polydispersity index (PDI) between 0.47 and 0.88. By method II, there was a significant reduction in diameter and PDI to 553-739 nm and 0.23 at 0.34, respectively. The drug incorporation also resulted in a reduction in the diameter and PDI of the nano PECs. All samples showed positive zeta potential, about 20 mV, and a high percentage of MT incorporation (±95%). The method factor presented a greater influence on the nano PECs characteristics. Interactions in the system constituents were indicated by the FTIR data. Nano PECs mucoadhesiveness was observed and the composition and charge density were responsible for this phenomenon. MT dissolution evaluation showed the similarity of the dissolution profiles of free and loaded MT, in which almost 100% of the drug was in the simulated gastric medium in 120 min of testing. The in vitro antimicrobial potential against H. pylori of loaded nano PECs were measured and the minimum inhibitory concentration observed for free MT was >2000 µg/mL, while for the incorporated MT lower values were observed, showing an increase in the encapsulated MT activity.

Indications and findings of upper gastrointestinal endoscopy in patients presenting to a District Hospital, Ghana

INTRODUCTION

Upper gastrointestinal (UGI) symptoms are among the commonest complaints for which patients seek medical attention. Characteristics of patients undergoing UGI endoscopy (UGIE) at the district hospital in Ghana are largely unknown. This study was to document the demographic characteristics, indications and endoscopic findings of patients undergoing UGIE at the district hospital in Ghana.

METHODS

This study used a cross-sectional design to consecutively recruit 371 patients referred to the Endoscopy Unit of the St. Dominic Hospital, Akwatia for UGIE. Demographic data and indications for the UGIE were recorded. Endoscopic findings per each participant were recorded. Helicobacter pylori (H. pylori) infection was confirmed by rapid-urease examination of gastric antral and body biopsies at endoscopy.

RESULTS

There were 159(42.9%) males out of the 371 patients. The age ranged from 4 to 94 years with a median age of 46 years. Dyspepsia was the commonest indication occurring in 282(76.0%) patients. The commonest endoscopic diagnosis was gastritis which occurred in 261(70.4%) patients. The prevalence of H. pylori obtained by immediate rapid-urease-campylobacter like- organism (CLO) test was 44.9%.

CONCLUSION

The main indication for UGIE in the studied patients was dyspepsia and most of these patients had gastritis on endoscopy. Only few patients had normal findings. The prevalence of H. pylori in this population was low compared with most of the previous studies done in the country. There is the need to establish more endoscopy centres within the district hospitals in the country and more health professionals trained to perform them.

A Review of the Novel Application and Potential Adverse Effects of Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are known as a class of pharmaceutical agents that target H⁺/K⁺-ATPase, which is located in gastric parietal cells. PPIs are widely used in the treatment of gastric acid-related diseases including peptic ulcer disease, erosive esophagitis and gastroesophageal reflux disease, and so on. These drugs present an excellent safety profile and have become one of the most commonly prescribed drugs in primary and specialty care. Except for gastric acid-related diseases, PPIs can also be used in the treatment of Helicobacter pylori infection, viral infections, respiratory system diseases, cancer and so on. Although PPIs are mainly used short term in patients with peptic ulcer disease, nowadays these drugs are increasingly used long term, and frequently for a lifetime, for instance in patients with typical or atypical symptoms of gastroesophageal reflux disease and in NSAID or aspirin users at risk of gastrotoxicity and related complications including hemorrhage, perforation and gastric outlet obstruction. Long-term use of PPIs may lead to potential adverse effects, such as osteoporotic fracture, renal damage, infection (pneumonia and clostridium difficile infection), rhabdomyolysis, nutritional deficiencies (vitamin B12, magnesium and iron), anemia and thrombocytopenia. In this article, we will review some novel uses of PPIs in other fields and summarize the underlying adverse reactions.