Painful perianal ulcers with nicorandil

McGettigan, Patricia; Ferner, Robin E.

doi:10.1136/bmj.m3351

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…Oral ulceration has been linked to a wide range of systemic medicines, with clinical manifestations ranging from superficial, nonspecific ulcerations to aphthous-like lesions or widespread mucosal erosions [ 3 ]. Nicorandil [ 4 , 5 ], captopril [ 6 ] and some nonsteroidal anti-inflammatory medicines can produce aphthous-like and nonspecific oral ulcers [ 7 ]. Oral ulcers can be classified as acute or chronic depending on their presentation and progress, with chronic ulcers lasting more than 14 days.…”

Section: Introductionmentioning

confidence: 99%

HPLC/MSn Profiling and Healing Activity of a Muco-Adhesive Formula of Salvadora persica against Acetic Acid-Induced Oral Ulcer in Rats

et al. 2021

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Salvadora persica L. (S. persica, Siwak) is an ethnic plant that is widely used for improving oral hygiene. This study aimed to provide a phytochemical profiling of S. persica ethyl acetate fraction (SPEAF) and to evaluate the healing activity of a muco-adhesive formula of the fraction against acetic acid-induced oral ulcers in rats. HPLC-ESI-QTOF-MS-MS analysis of SPEAF resulted in the tentative identification of 56 metabolites containing fatty acids (23%), urea derivatives (10.5%) and sulphur compounds (10%), in addition to several amides, polyphenols and organic acids (6.5%, 5% and 2%, respectively). For the first time, 19 compounds were identified from S. persica. In vitro and in vivo experiments indicated that the extract is non-toxic. SPEAF exhibited superior healing activities compared to both the negative and positive control groups on days 7 and 14 of tongue ulcer induction. This was confirmed by histopathological examinations of haematoxylin and eosin-stained (H&E) and Masson’s trichrome-stained tongue sections. Moreover, SPEAF showed potent anti-inflammatory activities, as evidenced by the inhibited expression of interleukin-6 (IL-6) and tumour necrosis alpha (TNF-α). Moreover, SPEAF exhibited potent antioxidant activity, as it prevented malondialdehyde (MDA) accumulation, reduced glutathione (GSH) depletion and superoxide dismutase (SOD) exhaustion. SPEAF significantly enhanced hydroxyproline tongue content and upregulated collagen type I alpha 1 (Col1A1) mRNA expression. SPEAF also improved angiogenesis, as shown by the increased mRNA expression of the angiopoietin-1 (Ang-1). In conclusion, S. persica has a wide range of secondary metabolites and ameliorates acetic acid-induced tongue ulcers in rats. This can be attributed, at least partly, to its anti-inflammatory, antioxidant, procollagen and angiogenic activities. These findings provide support and validity for the use of S. persica as a traditional and conventional treatment for oral disorders.

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Section: Introductionmentioning

confidence: 99%

HPLC/MSn Profiling and Healing Activity of a Muco-Adhesive Formula of Salvadora persica against Acetic Acid-Induced Oral Ulcer in Rats

et al. 2021

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“…It is far more common for patients to seek help from others, such as general practitioners, dermatologists or surgeons who may be less familiar with nicorandil. 9 The pathophysiology of nicorandil-induced ulceration and fistulation is yet to be determined. The most probable mechanism involves the accumulation of nicorandil's metabolites, nicotinic acid, and nicotinamide.…”

Section: Discussionmentioning

confidence: 99%

“…The case also illustrates the challenge of promptly identifying nicorandil's adverse effects as patients rarely present back to cardiology with their symptoms. It is far more common for patients to seek help from others, such as general practitioners, dermatologists or surgeons who may be less familiar with nicorandil 9 …”

Section: Discussionmentioning

confidence: 99%

“…When side effects are suspected it is important to stop nicorandil therapy promptly to limit patient harm. Discussions with cardiology regarding an alternative antianginal should not delay cessation of nicorandil 9 . A surgical case series has shown that stopping nicorandil resulted in improved healing of anal ulcers; whereas all surgical interventions to treat the ulcers were unsuccessful 16 .…”

Section: Discussionmentioning

confidence: 99%

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Nicorandil‐induced colovesical fistula in a patient with diverticular disease

Noyes

Mordi

Zeb

et al. 2021

Clinical Case Reports

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“…Universities and medical schools are struggling with the financial effects of covid-19 11. The business as usual of workforce planning, coping with emergency unit referrals, and drug side effects remains challenging enough 121314…”

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confidence: 99%

Covid-19: The fatal attraction of herd immunity

Abbasi¹

2020

BMJ

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Painful perianal ulcers with nicorandil

Cited by 5 publications

References 12 publications

HPLC/MSn Profiling and Healing Activity of a Muco-Adhesive Formula of Salvadora persica against Acetic Acid-Induced Oral Ulcer in Rats

HPLC/MSn Profiling and Healing Activity of a Muco-Adhesive Formula of Salvadora persica against Acetic Acid-Induced Oral Ulcer in Rats

Nicorandil‐induced colovesical fistula in a patient with diverticular disease

Covid-19: The fatal attraction of herd immunity

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