Ulus Travma Acil Cerrahi Derg. 2019; 25(4): 317-323 | DOI: 10.5505/tjtes.2018.58506

Korozif özefagus yanýklarýnda metilen mavisinin koruyucu ve anti-enflamatuvar etkisi: Deneysel çalýþma

Ceren Þen Tanrýkulu¹, Yusuf Tanrýkulu², Fahriye Kýlýnç³, Burak Bahadýr⁴, Murat Can⁵, Fürüzan Köktürk⁶, Ayþe Kefeli^7
1Saðlýk Bilimleri Üniversitesi, Konya Eðitim ve Araþtýrma Hastanesi, Acil Týp Anabilim Dalý, Konya
²KTO Karatay Üniversitesi, Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Konya
³Necmettin Erbakan Üniversitesi, Týp Fakültesi, Patoloji Anabilim Dalý, Konya
⁴Bülent Ecevit Üniversitesi, Týp Fakültesi, Patoloji Anabilim Dalý, Zonguldak
⁵Bülent Ecevit Üniversitesi, Týp Fakültesi, Biyokimya Anabilim Dalý, Zonguldak
⁶Bülent Ecevit Üniversitesi, Týp Fakültesi, Biyoistatistik Anabilim Dalý, Zonguldak
⁷Gaziosmanpaþa Üniversitesi, Týp Fakültesi, Gastroenteroloji Anabilim Dalý, Tokat

AMAÇ: Geliþmekte olan ülkelerde daha sýk görülen ve korozif madde yutulmasýna baðlý oluþan özefageal yanýklarý kýsa dönemde özefagus perforasyonuna ve uzun dönemde darlýk oluþmasýna neden olmaktadýr. Korozif özefagus yanýklarýnda tedavinin asýl amacý özefagusta darlýk oluþumunu önlenmektir. Biz, bu çalýþmada korozif özefagus yanýklarýnýn tedavisinde metilen mavisinin (MB) antienflamatuvar ve koruyucu etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada 28 sýçan kullanýldý ve sýçanlar rastgele dört eþit gruba ayrýldý; 1. grup (Sham), 2. grup (kontrol), 3. grup (topikal tedavi) ve 4. grup (topikal ve sistemik tedavi). Sham grubu hariç diðer gruplara özefageal yanýk oluþturmak için sodyum hidroksit (NaOH) verildi. Ek olarak, ikinci gruba normal salin, 3. gruba topikal metilen mavisi ve 4. gruba topikal ve sistemik metilen mavisi verildi.
BULGULAR: Hidroksiprolin seviyeleri her bir tedavi grubunda kontrol grubuna göre daha düþüktü (p=0.005 grup 3’e göre, p=0.00 grup 4’e göre). Tümör nekrozis faktör-α seviyelerine göre gruplar arasýnda fark yoktu. Tedavi gruplarýna ait stenoz indeksleri kontrol grubuna göre daha düþüktü (p=0.016 grup 3’e göre, p=0.015 grup 4’e göre). Histopatolojik hasar skoru kontrol grubu ile karþýlaþtýrýldýðýnda grup 4’te belirgin olarak daha düþüktü (p=0.05).
TARTIÞMA: Metilen mavisi korozif özefageal yanýklarýn neden olduðu doku hasarýný tedavi etmede ve özefageal stenozu önlemede etkilidir. Korozif özefageal yanýklardaki komplikasyon oranlarý yanýk esnasýnda kullanýlan metilen mavisi ile azaltýlabilir.

Anahtar Kelimeler: Metilen mavisi, korozif özefagus yanýðý; kostik yanýk; stenoz indeksi; TNF-α

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The protective and anti-inflammatory effect of methylene blue in corrosive esophageal burns: An experimental study

Ceren Þen Tanrýkulu¹, Yusuf Tanrýkulu², Fahriye Kýlýnç³, Burak Bahadýr⁴, Murat Can⁵, Fürüzan Köktürk⁶, Ayþe Kefeli^7
1Department of Emergency Medicine, Health Sciences University, Konya Training and Research Hospital, Konya-Turkey
²Department of General Surgery, KTO Karatay University Faculty of Medicine, Konya-Turkey
³Department of Pathology, Necmettin Erbakan University Faculty of Medicine, Konya-Turkey
⁴Department of Pathology, Bülent Ecevit University Faculty of Medicine, Zonguldak-Turkey
⁵Department of Biochemistry, Bülent Ecevit University Faculty of Medicine, Zonguldak-Turkey
⁶Department of Biostatistics, Bülent Ecevit University Faculty of Medicine, Zonguldak-Turkey
⁷Department of Gastroenterology, Gaziosmanpasa University Faculty of Medicine, Tokat-Turkey

BACKGROUND: In developing countries, esophageal burns are quite common. They are caused by the ingestion of corrosive substances that may lead to esophageal perforation in the short-term and stricture formation in the long-term. Prevention of stricture progression in the esophagus is the main aim of the treatment for corrosive esophageal burns. We aimed to investigate the protective and anti-inflammatory effects of methylene blue (MB) treatment on corrosive esophageal burns.
METHODS: Twenty-eight rats were used in the study and randomly divided into four equal groups; group 1 (Sham), group 2 (control), group 3 (topical treatment), and group 4 (topical plus systemic treatment). Except for group 1 (Sham group), all three groups received sodium hydroxide (NaOH) in order to generate esophageal burns. In addition, group 2 was given normal saline, group 3 topical MB, and group 4 topical and systemic MB.
RESULTS: Hydroxyproline levels were found to be lower in each of the treatment groups as compared to the control group (p=0.005 for group 3 and p=0.009 for group 4). There were no differences in the tumor necrosis factor-α (TNF-α) levels between the groups. The stenosis index (SI) in the treatment groups was also lower than the control group (p=0.016 for group 3 and p=0.015 group 4). The histopathologic damage score (HDS) was prominently lower in group 4 as compared to the control group (p=0.05).
CONCLUSION: MB is effective in treating tissue damage caused by corrosive esophageal burns and in preventing esophageal stenosis. Complication rates of corrosive esophageal burns may be decreased by using MB in the initial treatment stage.

Keywords: Caustic burn, corrosive esophageal burn; methylene blue; stenosis index; TNF-α.

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