Advertisement

Esophagus

pp 1–10 | Cite as

Evaluation of the efficacy of Hypericum perforatum (St. John’s wort) oil in the prevention of stricture due to esophageal corrosive burns

  • Mustafa Alper AkayEmail author
  • Mustafa Akduman
  • Ahmet Çağrı Tataroğlu
  • Ceyla Eraldemir
  • Tuğba Kum
  • Çiğdem Vural
  • Gülşen Ekingen Yıldız
Original Article
  • 14 Downloads

Abstract

Background/purpose

The inflammatory response that follows the caustic burns results in fibrosis on the esophageal wall leading to esophageal stricture, dysphagia, and malnutrition. The controversy over the use of corticosteroids warrants alternative therapeutic interventions. We investigated the effect of extracts from St. John’s wort (SJW) with known wound-healing activity on stricture formation in rat esophageal injury models.

Methods

Five experimental groups were involved: sham group with no injury, control group with injury without treatment, and three different treatment groups (methylprednisolone, SJW extract, and combination of the two). Histopathological examination of esophageal damage and collagen accumulation, stenosis index, and tissue hydroxyproline levels were used to assess stricture and the effect of treatments.

Results

There was a significant weight loss in all groups except for those without injury and those treated with SJW extract, the latter gained weight albeit not significant. Stenosis index was increased in all groups compared to sham but not significantly in those treated with SJW extract. Histopathological and biochemical analyses produced mixed results.

Conclusions

Some of the experimental indicators such as weight gain and stenosis index suggested the treatment of esophageal injury models using extracts of St. John’s wort effective while other histopathological indicators show no significant benefit.

Keywords

Corrosive burns Esophageal stricture St. John’s wort Stenosis 

Notes

Acknowledgements

I want to give special thanks to Prof. Dr. Canan Baydemir (Kocaeli University Faculty of Medicine, Department of Biostatistics) and Dr. Sibel Balcı (Kocaeli University Faculty of Medicine, Department of Biostatistics) for statistical analysis and revisions.

Funding

This study was funded by Kocaeli University Scientific Research Project Unit Quick Support Fund.

Compliance with ethical standards

Ethical Statement

All applicable international, national, and institutional guidelines for the care and use of animals were followed. We took ethical approval from Kocaeli University Clinical Research Ethics Committee.

Conflict of interest

Mustafa Alper Akay declares that he has no conflict of interest. Mustafa Akduman declares that he has no conflict of interest. Ahmet Çağrı Tataroğlu declares that he has no conflict of interest. Ceyla Eraldemir declares that she has no conflict of interest. Tuğba Kum declares that she has no conflict of interest. Çiğdem Vural declares that she has no conflict of interest. Gülşen Ekingen Yıldız declares that she has no conflict of interest.

Supplementary material

10388_2019_671_MOESM1_ESM.png (1.4 mb)
Supplementary material 1 (PNG 1443 kb)

References

  1. 1.
    Kluger Y, Ishay OB, Sartelli M, Katz A, Ansaloni L, Gomez CA, et al. Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg. 2015;10:48–55.CrossRefGoogle Scholar
  2. 2.
    Karaca G, Aydin O, Pehlivanli F, Altunkaya C, Uzun H, Güler O. Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats. Ann Surg Treat Res. 2017;92:396–401.CrossRefGoogle Scholar
  3. 3.
    Millar AJ, Cox SG. Caustic injury of the oesophagus. Pediatr Surg Int. 2015;31:111–21.CrossRefGoogle Scholar
  4. 4.
    Spiegel JR. Caustic injuries of the esophagus. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 742–52.CrossRefGoogle Scholar
  5. 5.
    Krey H. On treatment of corrosive lesions in the esophagus: experimental study. Acta Otolaryngol Suppl. 1952;102:1–49.Google Scholar
  6. 6.
    Lake JM, Wong RKH. Esophageal Strictures. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 540–9.CrossRefGoogle Scholar
  7. 7.
    Katzka DA. Caustic injury to the esophagus. Curr Treat Options Gastroenterol. 2001;4:59–66.CrossRefGoogle Scholar
  8. 8.
    Karaman I, Koç O, Karaman A, Erdoğan D, Çavuşoğlu YH, Afşarlar ÇE, et al. Evaluation of 968 children with corrosive substance ingestion. Indian J Crit Care Med. 2015;19:714–8.CrossRefGoogle Scholar
  9. 9.
    Ashcraft KW, Padula RT. The effect of dilute corrosives on the esophagus. Pediatrics. 1974;53:226–32.Google Scholar
  10. 10.
    Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Gastroenterology. 1989;97:702–7.CrossRefGoogle Scholar
  11. 11.
    Erdoğan E, Eroğlu E, Tekant G, Yeker Y, Emir H, Sarimurat N, et al. Management of esophagogastric corrosive injuries in children. Eur J Pediatr Surg. 2003;13:289–93.CrossRefGoogle Scholar
  12. 12.
    Arévalo-Silva C, Eliashar R, Wohlgelernter J, Elidan J, Gross M. Ingestion of caustic substances: a 15-year experience. Laryngoscope. 2006;116:1422–6.CrossRefGoogle Scholar
  13. 13.
    Thomas MO, Ogunleye EO, Somefun O. Chemical injuries of the oesophagus: aetiopathological issues in Nigeria. J Cardiothorac Surg. 2009;4:56–60.CrossRefGoogle Scholar
  14. 14.
    Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean Region: a systematic review. BMC Public Health. 2010;10:83–92.CrossRefGoogle Scholar
  15. 15.
    Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, et al. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg. 2015;10:44–53.CrossRefGoogle Scholar
  16. 16.
    Cole S, Lerner D. Caustic ingestions in children. Curr Pediatr Rep. 2018;6:50–6.CrossRefGoogle Scholar
  17. 17.
    Estrera A, Taylor W, Mills LU, Platt MR. Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach. Ann Thorac Surg. 1986;41:276–83.CrossRefGoogle Scholar
  18. 18.
    Broor SL, Raju GS, Bose PP, Lahoti D, Ramesh GN, Kumar A, et al. Long term results of endoscopic dilatation for corrosive esophageal strictures. Gut. 1993;34:1498–501.CrossRefGoogle Scholar
  19. 19.
    Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med. 1990;323:637–40.CrossRefGoogle Scholar
  20. 20.
    Howell JM, Dalsey WC, Hartsell FW, Butzin CA. Steroids for the treatment of corrosive esophageal injury. Am J Emerg Med. 1992;10:421–5.CrossRefGoogle Scholar
  21. 21.
    Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Combined use of steroid, antibiotics and early bougienage against stricture formation following caustic esophageal burns. J Cardiovasc Surg (Torino). 1999;40:307–10.Google Scholar
  22. 22.
    Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24:125–9.CrossRefGoogle Scholar
  23. 23.
    Usta M, Erkan T, Cokugras FC, Urganci N, Onal Z, Gulcan M, et al. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics. 2014;133:e1518–24.CrossRefGoogle Scholar
  24. 24.
    Berkovits RNP, Bos CE, Wijburg FA, Holzki J. Caustic injury of the oesophagus: sixteen years experience and introduction of a new model oesophageal stent. J Laryngol Otol. 1996;110:1041–5.CrossRefGoogle Scholar
  25. 25.
    Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956–2006. Clin Toxicol. 2007;45:402–8.CrossRefGoogle Scholar
  26. 26.
    Barnes J, Anderson LA, Phillipson JD. St John’s wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties. J Pharm Pharmacol. 2001;53:583–600.CrossRefGoogle Scholar
  27. 27.
    Schempp CM, Pelz K, Wittmer A, Schöpf E, Simon JC. Antibacterial activity of hyperforin from St John’s wort, against multiresistant Staphylococcus aureus and gram-positive bacteria. Lancet. 1999;353:2129.CrossRefGoogle Scholar
  28. 28.
    Süntar IP, Akkol EK, Yılmazer D, Baykal T, Kırmızıbekmez H, Alper M, et al. Investigations on the in vivo wound healing potential of Hypericum perforatum L. J Ethnopharmacol. 2010;127:468–77.CrossRefGoogle Scholar
  29. 29.
    Samadi S, Khadivzadeh T, Emami A, Moosavi NS, Tafaghodi M, Behnam HR. The effect of Hypericum perforatum on the wound healing and scar of cesarean. J Alternat Complement Med. 2010;16:113–7.CrossRefGoogle Scholar
  30. 30.
    Wölfle U, Seelinger G, Schempp CM. Topical application of St. Johnʼs wort (Hypericum perforatum). Planta Med. 2014;80:109–20.CrossRefGoogle Scholar
  31. 31.
    Lyles JT, Kim A, Nelson K, Bullard-Roberts AL, Hajdari A, Mustafa B, et al. The chemical and antibacterial evaluation of St. John’s wort oil macerates used in Kosovar traditional medicine. Front Microbiol. 2017;8:1639.CrossRefGoogle Scholar
  32. 32.
    Painter FM. Hypericum. Altern Med Rev. 1999;4:190–2.Google Scholar
  33. 33.
    Gehanno P, Guedon C. Inhibition of experimental esophageal lye strictures by penicillamine. Arch Otolaryngol. 1981;107:145–7.CrossRefGoogle Scholar
  34. 34.
    Liu AJ, Richardson MA. Effects of N-acetylcysteine on experimentally induced esophageal lye injury. Ann Otol Rhinol Laryngol. 1985;94:477–82.CrossRefGoogle Scholar
  35. 35.
    Yukselen V, Karaoglu AO, Yenisey C, Tuncyurek M, Ozutemiz O. Trimetazidine reduces the degree of fibrosis in alkali burns of the esophagus. J Ped Surg. 2005;40:505–9.CrossRefGoogle Scholar
  36. 36.
    Guven A, Gundogdu G, Sadir S, Topal T, Erdogan E, Korkmaz A, et al. The efficacy of ozone therapy in experimental caustic esophageal burn. J Pediatr Surg. 2008;43:1679–84.CrossRefGoogle Scholar
  37. 37.
    Berthet B, DiCostanzo J, Arnaud C, Choux R, Assadourian R. Influence of epidermal growth factor and interferon c on healing of oesophageal corrosive burns in the rat. Br J Surg. 1994;81:395–8.CrossRefGoogle Scholar
  38. 38.
    Türkyılmaz Z, Sönmez K, Karabulut R, Gülbahar Ö, Poyraz A, Sancak B, et al. Mitomycin C decreases the rate of stricture formation in caustic esophageal burns in rats. Surgery. 2009;145:219–25.CrossRefGoogle Scholar
  39. 39.
    Koltuksuz U, Mutuş HM, Kutlu R, Özyurt H, Çetin S, Karaman A, et al. Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats. J Pediatr Surg. 2001;36:1504–9.CrossRefGoogle Scholar
  40. 40.
    Ocakci A, Coskun O, Tumkaya L, Kanter M, Gurel A, Hosnuter M, et al. Beneficial effects of Ebselen on corrosive esophageal burns of rats. Int J Pediatr Otorhinolaryngol. 2006;70:45–52.CrossRefGoogle Scholar
  41. 41.
    Özçelık MF, Pekmezci S, Sarıbeyoğlu K, Ünal E, Gümüştaş K, Doğusoy G. The effect of halofuginone, a specific inhibitor of collagen type 1 synthesis, in the prevention of esophageal strictures related to caustic injury. Am J Surg. 2004;187:257–60.CrossRefGoogle Scholar
  42. 42.
    Benedi J, Arroyo R, Romero C, Martin-Aragon S, Villar AM. Antioxidant properties and protective effects of a standardized extract of Hypericum perforatum on hydrogen peroxide-induced oxidative damage in PC12 cells. Life Sci. 2004;75:1263–76.CrossRefGoogle Scholar
  43. 43.
    Nayak SB, Isik K, Marshall JR. Wound-healing potential of oil of Hypercium perforatum in excision wounds of male Sprague Dawley rats. Adv Wound Care. 2017;6:401–6.CrossRefGoogle Scholar
  44. 44.
    Kıyan S, Uyanikgil Y, Altunci YA, Cavusoglu T, Cetin Uyanikgil EO, Karabey F. Investigation of acute effects of Hypericum perforatum (St. John’s Wort-Kantaron) treatment in experimental thermal burns and comparison with silver sulfadiazine treatment. Ulus Travma Acil Cerrahi Derg. 2015;21:323–36.Google Scholar
  45. 45.
    Bustamante TF, de Arruda Lourenção PLT, Higa KL, da Silva APC, Ortolan EVP. The use of mitomycin C in caustic esophagitis in rats. Acta Cirúrgica Brasileira. 2013;28(2):136–41.CrossRefGoogle Scholar
  46. 46.
    Türkyilmaz Z, Sönmez K, Demirtola A, Karabulut R, PoyrazA Gülen S, Dinçer S, Başaklar AC, Kale N. Mitomycin C prevents strictures in caustic esophageal burns in rats. J Surg Res. 2005;123(2):182–7.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer 2019

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryKocaeli University Medical FacultyKocaeliTurkey
  2. 2.Republic of Turkey Ministry of HealthAnkaraTurkey
  3. 3.Department of BiochemistryKocaeli University Medical FacultyKocaeliTurkey
  4. 4.Department of PathologyKocaeli University Medical FacultyKocaeliTurkey

Personalised recommendations