CHAPTER ONE
INTRODUCTION
Food starts to be digested and absorbed in the stomach, although absorption is mostly limited to water, alcohol and some drugs. The stomach is an expandable, muscular bag, and it keeps swallowed food inside it by contracting the muscular pyloric sphincter. Food can stay in the stomach for 2 hours or more. Food is broken down chemically, by gastric juice, and mechanically, by contraction of the three layers of smooth muscle in the muscular external layer. The broken up food at the end of this process is called chyme. Gastric juice is secreted by gastric mucosal glands, and contains hydrochloric acid, mucus, and proteolytic enzymes pepsin (which breaks down proteins), and lipase (which breaks down fats). It normally expands to hold about one litre of food. The stomach of a newborn human baby will only be able to retain about 30 millilitres (Sherwood and Lauralee 2007).When the stomach is empty, and not distended, the lining is thrown up into folds called rugae. After eating, these folds flatten, and the stomach is able to distend greatly. The stomach has three anatomical regions: cardiac, which contains mucous secreting glands (called cardiac glands) and is closest to the oesophagusfundus, the body or largest part of the stomach which contain the gastric (fundic) glands pyloric, which secretes two types of mucus, and the hormone gastrin (Brunicardi, Charles and Dana, 2010). When food enters the stomach, the stomach releases proteases (protein-digesting enzymes such as pepsin) and hydrochloric acid, which kills or inhibits bacteria and provides the acidic pH of two for the proteases to work (Kulkarni, 2012; Gore and Levine, 2007). Gastritis is inflammation of the stomach lining and is usually termed acute or chronic gastritis. The two major causes of gastritis are 1) a bacterium named Helicobacter pylorior (H. pylori) and 2) nonsteroidal anti-inflammatory drugs (NSAIDs) of which Indomethacin is a major example. Acute gastritis is a term covering a broad spectrum of entities that induce inflammatory changes in the gastric mucosa. In acute gastritis, the symptoms can be very severe although short-lived and easily treated or there may be no symptoms (asymptomatic). In chronic gastritis, the causes are usually more persistent and varied. Chronic gastritis develops gradually and the symptoms may continue for long periods of time. The inflammation may involve the entire stomach (eg, pangastritis) or a region of the stomach (eg, antral gastritis).However there are many other causes like other infectious agents, autoimmune problems, diseases like Crohn’s disease, sarcoidosis, and isolated granulomatosis gastritis. Epidemiologic studies reflect the widespread incidence of gastritis. In the United States, it accounts for approximately 1.8-2.1 million visits to doctors’ offices each year. It is especially common in people older than 60 years (Whebi, 2016). Although many individuals with gastritis may have no symptoms, both acute and chronic gastritis may have symptomssuch as:abdominal pain, nausea, vomiting, and occasionally, belching, bloating, loss of appetite and indigestion. Gastritis can be diagnosed by the patient’s symptoms and history and can be confirmed histologically by biopsy specimens taken at endoscopy(Davis, 2015).Non-steroidal anti-inflammatory drugs (NSAIDs)are one of the most commonly prescribed drugs in the world to treat pain and inflammation. The widespread use of non-steroidal anti-inflammatory drugs (NSAID) has meant that the adverse effects of these relatively safe drugs have become increasingly prevalent. Everyday about 30 million people consume NSAIDs (Regula et al., 2006). These drugs are gaining enormous interest for cancer therapy as well as they are potent inducers of apoptosis and inhibitors of cell proliferation. However, long term use of NSAIDs is associated with severe gastropathy that may arise from induction of gastric mucosal cell apoptosis. Research was carried among 180 NSAIDs assessed based on their perception and pattern of use of the drugs in view of their personally declared previously and diagnosed ailments. Resultsshowed 86% of the drug outfit managers had less than tertiary education with 59% of the sampled outfits being unregistered and unlicensed. 74% of the sample population procured their NSAIDs from sources where adequate pharmaceutical care is unlikely to be available in an observed situation where 79% have clinical conditions likely to be worsened by NSAID misuse.11.1 % of the respondents who are categorized as geriatrics ingest NSAIDs daily while over 23% of this class require more than two different NSAIDs at a time (Pallabet al., 2009; Nsel, 2016). Indomethacin is an example of non- steroidal drug. Indomethacin, a new drug for treating arthritic disorders, wasintroduced for clinical trial in 1962. It is chemically unrelatedto either corticosteroids or other anti-inflammatory compounds,and has an indole structure within its formula [1-(p-chlorobenzoyl)-5-methoxy-2-methylindol-3-acetic acid].Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate acute pain and inflammation, swelling, stiffness, and joint pain. (Alan, 2015). Studies showed that indomethacin is a valuable drug for the treatment of patients with various types of arthritis. Relapse when a dummy tablet or suppository is substituted is striking and sometimes suggests a”rebound effect.” Its use may enable corticosteroid therapy to be reduced in some patients and occasionally to be discontinued altogether. It is not yet known why oral indomethacin, like other analgesic or anti-inflammatory drugs, may injure the stomach. If the disturbance is due solely to local damage to the mucosa it should be avoided by rectal administration. Indomethacin maycause an increase in the hydrochloric-acid secretion(Holt and Hawkinst, 2005; Stack, Atherton, and Hawkey,2006).
Plantain (Musa spp.) occupies a strategic position for rapid food production in Nigeria. It is ranked third among starchy staples. The country’s output doubled in the last 20 years. Production, which is concentrated in the Southern part of the country,Plantain production in Africa is estimated at more than 50% of worldwide production. The majority (82%) of plantains in Africa are produced in the area stretching from the lowlands of Guinea and Liberia to the central basin of the Democratic Republic of Congo. West and Central Africa contribute 61 and 21%, respectively. It is estimated that about 70 million people in West and Central Africa derivemore than 25% of their carbohydrates from plantains, making them one of the most important sources of food energy throughout the African lowland humid forest zone (Stover and Simmonds, 2007). Plantain pulp is an important source of carbohydrate to man. The dry matter consists mainly starch most of which is found in the peel. Seventy two percent of this starch is converted to simple sugars (glucose and fructose) on ripening. Studies show that plantain contains calcium and phosphorus and other nutritive minerals. Plantain banana (M. sapientum var. paradisiaca, MS) has also been shown to possess ulcer healing activity. Plantain banana also favoured wound healing which could be due to its antioxidant effect from recent research.Various preparations of dried unripe plantain banana were found to be anti-ulcerogenic against aspirin-induced ulceration in the rat and were effective both as a prophylactic treatment and in healing ulcers already induced by aspirin. Ripe fruit bananas were inactive. The active factor(s) were water soluble and were concentrated by extraction to approximately three hundred times that in the dried banana powder. The anti-ulcerogenic action of banana preparations appears to be due to their ability to stimulate the growth of gastric mucosa (Best,Lewis and Nasser, 2004). Extensive investigations regarding anti-ulcerogenic and ulcer healing activities of plantain banana have been carried out for the past 30 years. Multicenteric trial has shown plantain banana to be helping in early healing of ulcer dyspepsias and delaying ulcer recurrences (Agarwal et al., 2009).
1.1 JUSTIFICATION
Nonsteroidal anti-inflammatory drugs (NSAID) are being increasingly recognized as a cause of gastrointestinal bleeding. Indomethacin being a Nonsteroidal anti-inflammatory drugs, it is one of the most frequent and active treatment for patients with various types of arthritis.The continuous use of this drug could have diverse effect on the individuals that use them. This study tries to find out the side-effect of this drug on the stomach. It is not yet known why oral indomethacin, like other analgesic or anti-inflammatory drugs, may injure the stomach. (Stack et al., 2006). Histologic findings from this research could also assistin understanding the process that leads to injury of the stomach which will lead to more accurate diagnosis of gastric inflammations. A therapeutic agent should ideally improve one or more of healing process without producing deleterious side effects. Plant products are potential agents for healingand largely preferred because of their widespread availability, non-toxicity, absence of unwanted side effects and their crude effective preparations.Plant flavonoids have been found to demonstrate gastroprotective and gastric ulcer healing properties Kelly et al., (2008). Plantain which is a plant product that contains flavonoidsthus was chosen for this study.Hence the study “The histological studies on plantain attenuated indomthacin induced gastric injury in albino wistar rat”.
1.2 AIM
- To study the histological effect of plantain attenuated indomethacininduced gastric injury.
1.3 OBJECTIVES
- To investigate tissue changes on the stomach as a result of indomethacin abuse on albino rats.
- To evaluate the anti-ulcerogenic effect of Plantain (Musa ) on gastric injury.
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