In anatomy, the gastroduodenal artery is a small blood vessel in the abdomen.It supplies blood to the pylorus (distal part of the stomach) and the proximal part of the duodenum.It arises from the common hepatic artery and terminates in a bifurcation, when it splits into the right gastroepiploic artery and the anterior superior pancreaticoduodenal artery.

Crohns disease involving the gastric outlet and proximal duodenum, resulting in gastric outlet obstruction. Image on the right shows a view of the stricture as seen through a translucent dilating balloon, which has been inflated in the stricture.

1. Melatonin protection against ethanol-induced gastroduodenal injury was investigated in duodenumligated rats.
2. Melatonin, injected i.p. 30 min before administration of 1 ml of absolute ethanol, given by gavage, significantly decreased ethanol-induced macroscopic, histological and biochemical changes in the gastroduodenal mucosa.
3. Ethanol-induced lesions were detectable as haemorrhagic streaks. Ethanol administration damaged 36% and 25% of the total gastric and duodenal surface, respectively.

Melatonin treatment reduced ethanol-induced gastric and duodenal damage to 14% and 8%, respectively. When indomethacin was given together with ethanol, the gastric damaged area was 44% of the total surface, while the duodenal damaged area was 35%; melatonin administration reduced the damage to only 13% of the total gastric surface and to 12% of total duodenal surface.

4. Both stomach and duodenum of ethanol-treated animals showed polymorphonuclear leukocyte (PMN) infiltration. The number of PMN increased more than 600 and 200 times in stomach and duodenum, respectively, following ethanol administration. Melatonin treatment reduced ethanol-induced PMN infiltration by 38% in the stomach and 20% in the duodenum. In indomethacin-ethanol-treated rats, the number of PMN increased by 875% compared to control group in the stomach and by 264% in duodenum. Melatonin administration reduced the indomethacin-ethanol-induced PMN rise by 57% in the stomach and 40% in the duodenum.

5. Gastroduodenal total glutathione (tGSH) concentration and glutathione reductase (GSSG-Rd) activity were significantly reduced following ethanol and indomethacin-ethanol administration. Melatonin ameliorated both the decrease in tGSH concentration as well as the reduction of GSSG-Rd activity elicited by ethanol both in the stomach and duodenum; melatonin was effective against indomethacin-ethanol-induced damage only in the stomach.

6. Ethanol-induced gastroduodenal damage is believed to be mediated by the generation of free radicals. Recently, a number of in vivo and in vitro experiments have shown melatonin to be an effective antioxidant and free radical scavenger; thus, we conclude that the protection by melatonin against ethanol-induced gastroduodenal injury is due, at least in part, to its radical scavenging activity.

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Probiotics in the Treatment of Crohn’s Disease
Alterations in the bacterial milieu of the gut are common in Crohns disease. The use of various probiotic bacteria to promote a balance of appropriate intestinal flora has yielded mixed results. Mechanisms associated with the beneficial effects of probiotic therapy in Crohn’s Disease include:

(1) inhibition of pathogenic bacteria via growth suppression or epithelial binding
(2)  improved epithelial and mucosal barrier function; and
(3) altered immuno-regulation via stimulation of secretory IgA or reduction in TNF-alpha.

Saccharomyces boulardii
Plein et al demonstrated the efficacy of Saccharomyces boulardii (Sb) in a randomized, double-blind, placebo-controlled study of 20 Crohn’s Disease patients. Patients were given 250 mg Sb three times daily for 10 weeks and evaluated via bowel movement frequency and the CDAI index. Patients receiving Sb experienced a significant reduction in frequency of bowel movements (from 5.0 to 3.3 per day) and CDAI index (193 to 107) by week 10 of treatment.

Another study utilizing Saccharomyces boulardii therapy in 32 Crohn’s Disease patients demonstrated a significant benefit of a combination of Saccharomyces boulardii and mesalamine compared to mesalamine alone. Relapse in the mesalamine-only group was 37.5 percent at six months compared to only 6.25 percent in the mesalamine-plus Saccharomyces boulardii group.

E. coli (Nissle strain)
Pathogenic E. coli that adhere to and invade intestinal epithelial cells (IEC) have been isolated from ileal lesions of Crohns patients. Boudeau et al demonstrated the in vitro ability of a non-pathogenic E. coli strain (Nissle 1917) to prevent pathogenic E. coli strains from adhering to and invading IEC. When IEC were co-infected with probiotic Nissle strain and pathogenic E. coli, the Nissle strain exhibited a dose- and time-dependent adhesion to IEC, which prevented adhesion of various pathogenic E. coli strains by 78.0- 99.9 percent.

When IEC were pre-incubated with Nissle strain E. coli and pathogenic strains were added later, adhesion and invasion of pathogenic strains was inhibited by 97.2-99.9 percent. Malchow et al conducted a double-blind, randomized, placebo-controlled trial investigating the efficacy of E. coli Nissle strain 1917 for inducing and maintaining remission in 28 patients with colonic Crohns disease.

Patients were randomized to either 60 mg prednisolone daily (with a standard tapering schedule) plus twice daily doses of 2.5 x1010 probiotic Nissle strain E. coli (treatment group) or identical prednisolone therapy plus placebo (placebo group). The rate at which remission was achieved was comparable in both groups (85.7% for treatment patients versus 91.7% for placebo patients), but only 33.3 percent of patients in the E. coli treatment group relapsed at one year, compared to 63.6 percent in the placebo group.

Lactobacillus GG
Malin et al investigated the effect of oral Lactobacillus GG on the intestinal immunological barrier in a small study of 14 children with CD and seven control patients (hospitalized for investigation of abdominal pain but with no evidence of intestinal disease). Lactobacillus GG was administered to patients and controls at 1010 colony forming units mixed in liquid twice daily. Lactobacillus GG therapy significantly increased the IgA immune response in Crohns patients compared to controls, resulting in an improved mucosal barrier.

Another study of Lactobacillus GG demonstrated that administration in children with mildto- moderate stable Crohn’s Disease improved gut barrier function and clinical status after six months of therapy.228 However, a randomized, double-blind, placebo-controlled trial of 45 post-surgery Crohns patients given Lactobacillus GG for one year did not show it to be more effective than placebo in preventing disease recurrence.229