1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3. H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4. Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
IV. Upper gastrointestinal bleeding
Upper gastrointestinal bleeding (UGIB) is defined as hemorrhaging derived from a source proximal to the ligament of Treitz. It is life threatening and considered as medical emergency, which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment.
F.2. In herbal medicine perspective
a. Rhubarb is a small flower grouped with large compound leafy in the the genus Rheum, belonging to the family Polygonaceae. The herb has been used in traditional medicine as laxative agent, reduce inflammation and treat diarrhea, dysentery blood clots, tumor red and painful eyes abdominal-distention and/or pain blood in stool hemorrhoidal bleeding urination: burning sensation, absence of menses, etc. In the study of the effect of rhubarb on gastrointestinal (GI) perfusion in critical illness and hemorrhagic shocked rats, showed that in clinical study: The pH in septic patients was much lower than that in the control, whereas rhubarb could obviously elevate GI pH (P < 0.01). In addition, rhubarb also had a good effect on gastric hemorrhage caused by stress ulcer, the effectiveness was 73.4%. Animal study: Although the shocked rats were resuscitated completely, their GI perfusion was much lower than that in the control. Rhubarb could significantly improve the mucous membrane of GI and mesenterium perfusion (P < 0.01)(22).
Liquorice or liquorice roots has been used in traditional Chinese medicine over 4000 years as anti allergy, anti inflammation, anti ulcer, anti convulsion and to treat stomach weakness, tired and lack of strength, palpitation and short of breath, cough with abundance of phlegm, stomach and solar plexus pain, etc,. some studies indicated that gastric mucosal damage induced by giving 60 mg aspirin orally to rats was reduced by simultaneous administration of 100-500 mg deglycyrrhizinated liquorice. Human faecal blood loss induced by 975 mg aspirin orally three times a day was less when 350 mg deglycyrrhizinated liquorice was given with each dose of aspirin(23).
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