Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2019; 25(39): 5926-5935
Published online Oct 21, 2019. doi: 10.3748/wjg.v25.i39.5926
STW 5 is effective against nonsteroidal anti-inflammatory drugs induced gastro-duodenal lesions in rats
Mohamed T Khayyal, Walaa Wadie, Enas A Abd El-Haleim, Kawkab A Ahmed, Olaf Kelber, Ramy M Ammar, Heba Abdel-Aziz
Mohamed T Khayyal, Walaa Wadie, Enas A Abd El-Haleim, Department of Pharmacology, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
Kawkab A Ahmed, Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Cairo 12211, Egypt
Olaf Kelber, Ramy M Ammar, Heba Abdel-Aziz, Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, Darmstadt 64295, Germany
Ramy M Ammar, Department of Pharmacology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
Author contributions: Khayyal MT, Wadie W, Abd El-Haleim EA carried out the experimental study; Ahmed KA performed the histological part; Kelber O, Ammar RM, Abdel-Aziz H was responsible for planning of the study; all authors involved in writing and revising the manuscript.
Institutional animal care and use committee statement: The study was approved by the Ethical Committee for experimentation with laboratory animals (Faculty of Pharmacy, Cairo University) following the revised guidelines of the European Economic Community regulations (86/609/EEC) (Permit Number: PT 2292).
Conflict-of-interest statement: Mohamed T Khayyal reports grants from Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, during the conduct of the study; Olaf Kelber, Ramy M. Ammar, Heba Abdel-Aziz are employed by Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, Darmstadt, Germany; all other authors have no conflict of interest.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohamed T Khayyal, PhD, Professor, Department of Pharmacology, Faculty of Pharmacy, Cairo University, Kasr-El-Aini Street, Cairo 11562, Egypt. mtkhayyal@gmail.com
Telephone: +20-1-222102644 Fax: +20-2-37743491
Received: April 28, 2019
Peer-review started: April 28, 2019
First decision: July 22, 2019
Revised: August 16, 2019
Accepted: September 13, 2019
Article in press: September 13, 2019
Published online: October 21, 2019
Abstract
BACKGROUND

Proton pump inhibitors are often used to prevent gastro-intestinal lesions induced by nonsteroidal anti-inflammatory drugs. However, they are not always effective against both gastric and duodenal lesions and their use is not devoid of side effects.

AIM

To explore the mechanisms mediating the clinical efficacy of STW 5 in gastro-duodenal lesions induced by nonsteroidal anti-inflammatory drugs (NSAIDs), exemplified here by diclofenac, in a comparison to omeprazole.

METHODS

Gastro-duodenal lesions were induced in rats by oral administration of diclofenac (5 mg/kg) for 6 successive days. One group was given concurrently STW 5 (5 mL/kg) while another was given omeprazole (20 mg/kg). A day later, animals were sacrificed, stomach and duodenum excised and divided into 2 segments: One for histological examination and one for measuring inflammatory mediators (tumor necrosis factor α, interleukins-1β and 10), oxidative stress enzyme (heme oxygenase-1) and apoptosis regulator (B-cell lymphoma 2).

RESULTS

Diclofenac caused overt histological damage in both tissues, associated with parallel changes in all parameters measured. STW 5 and omeprazole effectively prevented these changes, but STW 5 superseded omeprazole in protecting against histological damage, particularly in the duodenum.

CONCLUSION

The findings support the therapeutic usefulness of STW 5 and its superiority over omeprazole as adjuvant therapy to NSAIDs to protect against their possible gastro-duodenal side effects.

Keywords: Diclofenac, STW 5, Omeprazole, Gastro-intestinal lesions, Inflammation

Core tip: The herbal preparation STW 5, clinically used in functional dyspepsia and irritable bowel syndrome, was compared to omeprazole in protecting against diclofenac- induced gastro-duodenal lesions in rats. Both drugs were effective in preventing changes in the level of inflammatory mediators (tumor necrosis factor α, interleukins-1β and 10), in the level of the oxidative stress enzyme, heme oxygenase-1, and the apoptotic regulator (B-cell lymphoma 2) in both stomach and duodenum. However, STW 5 was more effective than omeprazole in protecting against the histological damage. The results emphasize the potential usefulness of STW 5 and its superiority over omeprazole in protecting against gastro-duodenal lesions induced by nonsteroidal anti-inflammatory drugs.