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Published in: Esophagus 4/2019

01-10-2019 | St. John's Wort | Original Article

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

Authors: Mustafa Alper Akay, Mustafa Akduman, Ahmet Çağrı Tataroğlu, Ceyla Eraldemir, Tuğba Kum, Çiğdem Vural, Gülşen Ekingen Yıldız

Published in: Esophagus | Issue 4/2019

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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.
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Literature
1.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
2.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
4.
go back to reference Spiegel JR. Caustic injuries of the esophagus. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 742–52.CrossRef Spiegel JR. Caustic injuries of the esophagus. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 742–52.CrossRef
5.
go back to reference Krey H. On treatment of corrosive lesions in the esophagus: experimental study. Acta Otolaryngol Suppl. 1952;102:1–49.PubMed Krey H. On treatment of corrosive lesions in the esophagus: experimental study. Acta Otolaryngol Suppl. 1952;102:1–49.PubMed
6.
go back to reference Lake JM, Wong RKH. Esophageal Strictures. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 540–9.CrossRef Lake JM, Wong RKH. Esophageal Strictures. In: Richter JE, Castell DO, editors. The esophagus. Oxford: Wiley-Blackwell; 2012. p. 540–9.CrossRef
7.
8.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
9.
go back to reference Ashcraft KW, Padula RT. The effect of dilute corrosives on the esophagus. Pediatrics. 1974;53:226–32.PubMed Ashcraft KW, Padula RT. The effect of dilute corrosives on the esophagus. Pediatrics. 1974;53:226–32.PubMed
10.
go back to reference Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Gastroenterology. 1989;97:702–7.CrossRefPubMed Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Gastroenterology. 1989;97:702–7.CrossRefPubMed
11.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
12.
go back to reference Arévalo-Silva C, Eliashar R, Wohlgelernter J, Elidan J, Gross M. Ingestion of caustic substances: a 15-year experience. Laryngoscope. 2006;116:1422–6.CrossRefPubMed Arévalo-Silva C, Eliashar R, Wohlgelernter J, Elidan J, Gross M. Ingestion of caustic substances: a 15-year experience. Laryngoscope. 2006;116:1422–6.CrossRefPubMed
13.
14.
15.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
16.
go back to reference Cole S, Lerner D. Caustic ingestions in children. Curr Pediatr Rep. 2018;6:50–6.CrossRef Cole S, Lerner D. Caustic ingestions in children. Curr Pediatr Rep. 2018;6:50–6.CrossRef
17.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
18.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
19.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
20.
go back to reference Howell JM, Dalsey WC, Hartsell FW, Butzin CA. Steroids for the treatment of corrosive esophageal injury. Am J Emerg Med. 1992;10:421–5.CrossRefPubMed Howell JM, Dalsey WC, Hartsell FW, Butzin CA. Steroids for the treatment of corrosive esophageal injury. Am J Emerg Med. 1992;10:421–5.CrossRefPubMed
21.
go back to reference 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. 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.
22.
go back to reference Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24:125–9.CrossRefPubMed Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24:125–9.CrossRefPubMed
23.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
24.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
25.
go back to reference 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.CrossRef 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.CrossRef
26.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
27.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
28.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
29.
go back to reference 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.CrossRef 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.CrossRef
30.
go back to reference Wölfle U, Seelinger G, Schempp CM. Topical application of St. Johnʼs wort (Hypericum perforatum). Planta Med. 2014;80:109–20.CrossRefPubMed Wölfle U, Seelinger G, Schempp CM. Topical application of St. Johnʼs wort (Hypericum perforatum). Planta Med. 2014;80:109–20.CrossRefPubMed
31.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
32.
go back to reference Painter FM. Hypericum. Altern Med Rev. 1999;4:190–2. Painter FM. Hypericum. Altern Med Rev. 1999;4:190–2.
33.
go back to reference Gehanno P, Guedon C. Inhibition of experimental esophageal lye strictures by penicillamine. Arch Otolaryngol. 1981;107:145–7.CrossRefPubMed Gehanno P, Guedon C. Inhibition of experimental esophageal lye strictures by penicillamine. Arch Otolaryngol. 1981;107:145–7.CrossRefPubMed
34.
go back to reference Liu AJ, Richardson MA. Effects of N-acetylcysteine on experimentally induced esophageal lye injury. Ann Otol Rhinol Laryngol. 1985;94:477–82.CrossRefPubMed Liu AJ, Richardson MA. Effects of N-acetylcysteine on experimentally induced esophageal lye injury. Ann Otol Rhinol Laryngol. 1985;94:477–82.CrossRefPubMed
35.
go back to reference 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.CrossRef 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.CrossRef
36.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
37.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
38.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
39.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
40.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
41.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
42.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
43.
go back to reference 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.CrossRef 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.CrossRef
44.
go back to reference 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.PubMed 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.PubMed
45.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
46.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
Metadata
Title
Evaluation of the efficacy of Hypericum perforatum (St. John’s wort) oil in the prevention of stricture due to esophageal corrosive burns
Authors
Mustafa Alper Akay
Mustafa Akduman
Ahmet Çağrı Tataroğlu
Ceyla Eraldemir
Tuğba Kum
Çiğdem Vural
Gülşen Ekingen Yıldız
Publication date
01-10-2019
Publisher
Springer Singapore
Keyword
St. John's Wort
Published in
Esophagus / Issue 4/2019
Print ISSN: 1612-9059
Electronic ISSN: 1612-9067
DOI
https://doi.org/10.1007/s10388-019-00671-2

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