Effects of hydrotalcite combined with esomeprazole on gastric ulcer healing quality: A clinical observation study

Abstract

Aim: To evaluate the effects of hydrotalcite combined with esomeprazole on gastric ulcer healing quality.

Methods: Forty-eight patients diagnosed with gastric ulcer between June 2014 and February 2016 were randomly allocated to the combination therapy group or monotherapy group. The former received hydrotalcite combined with esomeprazole, and the latter received esomeprazole alone, for 8 wk. Twenty-four healthy volunteers were recruited and acted as the healthy control group. Endoscopic ulcer healing was observed using white light endoscopy and narrow band imaging magnifying endoscopy. The composition of collagen fibers, amount of collagen deposition, expression of factor VIII and TGF-β1, and hydroxyproline content were analyzed by Masson staining, immunohistochemistry, immunofluorescent imaging and ELISA.

Results: Following treatment, changes in the gastric microvascular network were statistically different between the combination therapy group and the monotherapy group (P < 0.05). There were significant differences (P < 0.05) in collagen deposition, expression level of Factor VIII and TGF-β1, and hydroxyproline content in the two treatment groups compared with the healthy control group. These parameters in the combination therapy group were significantly higher than in the monotherapy group (P < 0.05). The ratio of collagen I to collagen III was statistically different among the three groups, and was significantly higher in the combination therapy group than in the monotherapy group (P < 0.05).

Conclusion: Hydrotalcite combined with esomeprazole is superior to esomeprazole alone in improving gastric ulcer healing quality in terms of improving microvascular morphology, degree of structure maturity and function of regenerated mucosa.

Keywords: Esomeprazole; Gastric ulcer; Hydrotalcite; Quality of ulcer healing.

Figure 1

White light endoscopic assessment of ulcer healing quality. A: Combination therapy before and after treatment; B: Monotherapy before and after treatment; C: Healthy control group. Both the combination therapy and monotherapy groups had high quality ulcer healing.

Figure 2

Gastric pits and microvascular morphology by narrow band imaging magnifying endoscopy. A: Combination therapy before and after treatment; B: Monotherapy before and after treatment; C: Healthy control group. With regeneration of the gastric mucosal epithelium, the gastric pits and microvascular network were reconstructed. Both the combination therapy and monotherapy groups had improved gastric pit morphology after treatment, which was similar to normal mucosal tissue. However, the percentage of regular microvascular network was much higher.

Figure 3

Gastric mucosal fibrosis was evaluated by Masson’s trichrome staining in a 200 × field. Blue-stained signals represent fibrosis. A: Combination therapy before and after treatment; B: Monotherapy before and after treatment; C: Healthy control group. The area of collagen fiber deposition in the combination therapy group was significantly larger than that in the monotherapy group after treatment, and was similar to that in normal mucosal tissue.

Figure 4

Expression of collagen I and III was analyzed using immunofluorescent staining in a 200 × field. Nuclei were stained blue, collagen I stained red, collagen III stained green, and the overlap of collagen I and collagen III stained yellow. A: Results of combination therapy before and after treatment; B: Results of monotherapy before and after treatment; C: Results in the healthy control group. The deposition area of collagen I and III in the combination therapy group after treatment was similar to that in the normal control group.

Figure 5

Expression of FactorVIII was analyzed using immunohistochemical staining in a 200 × field. Yellow-stained signals in the cytoplasm and (or) cell membrane represent positive cells. A: Results of combination therapy before and after treatment; B: Results of monotherapy before and after treatment; C: Results in healthy control group. The expression of FactorVIII in the combination therapy group after treatment was significantly higher than that in the monotherapy and healthy control groups.

Figure 6

Expression of TGF-β1 was analyzed using immunohistochemical staining in a 200 × field. Yellow-stained signals in the cytoplasm and (or) cell membrane represent positive cells. A: Results of combination therapy before and after treatment; B: Results of monotherapy before and after treatment; C: Results in the healthy control group. The expression of TGF-β1 in the combination therapy group was significantly higher than that in the monotherapy group, and similar to that in the healthy control group.