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Mediators of gastric protection and ulcer healing; their pathophysiological role and measurements

Author(s): Stanisław J. Konturek | Peter C. Konturek | Iwona Brzozowska | Władysław Bielanski | Krzysztof Celiński | Thomas Brzozowski

Journal: Polish Gastroenterology
ISSN 1232-9886

Volume: 17;
Issue: 3;
Start page: 244;
Date: 2010;
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Keywords: prostaglandins | growth factors | gut hormones | nitric oxide | melatonin; gastroprotection | gastric lesions | gastric ulcerations

The stomach exhibits an unusual ability to protect itself against the damage by various noxious factors due to several lines of mucosal defense such as continuous mucus-alkaline secretion, efficient mucosal blood flow, rapid mucosal regeneration and mucosal cell restitution with healing of lesions and ulcerations. All these abilities were originally attributed to the generation and action of various arachidonic acid metabolites, especially prostaglandins (PG) of E and I series. Although PG were generally accepted as highly gastroprotective agents in animals, their protective activity has not been definitively confirmed in humans and, most important, their ulcer healing properties were described only when applied in large gastric inhibitory doses. Other gastroprotective agents acting independently from PG include nitric oxide (NO), generated from L-arginine by NO synthase, certain neuropeptides such as calcitonin-gene related peptides (CGRP) released from the terminals of sensory nerves, certain gut hormones including gastrin, cholecystokinin, ghrelin and numerous growth factors such as epidermal growth factor (EGF), transforming growth factors (TGF) and platelet-derived growth factors (PDGF). Most recently, melatonin, produced from L-tryptophan in pineal gland, has been found to be expressed and generated in gastric mucosa in larger quantities than in pineal gland and to exert strong local gastroprotective and ulcer healing properties, especially against gastric lesions induced by non-steroidal anti-inflammatory drugs (NSAID), both in animals and humans. Future studies should reveal whether gastroprotective agents of endogenous origin have potential in the maintenance of gastric mucosal integrity and acceleration of healing of gastric lesions and ulcerations in humans.
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