Efficacy of intralesional triamcinolone injection in the management of benign refractory esophageal strictures

Background: Endoscopic therapy is the mainstay in the treatment of esophageal strictures. Refractory strictures are difficult to treat with patients requiring frequent endoscopic therapy. Intralesional steroid injection combined with SG dilation has been reported to reduce the frequency of endoscopic dilation in such cases.Methods: Ten patients with benign esophageal strictures (corrosive 4, peptic 2, anastomotic 2, radiation-induced 2) were selected for this study. All of them had refractory esophageal stricture. They were being managed with intermittent endoscopic dilation by using Savary Gilliard dilators. All patients were treated by intralesional injections of triamcinolone acetonide 40 mg in a 4-quadrant fashion after SG dilation and were followed up for a period of 1 years. At each session, SG dilation was done followed by 4 injections (4 quadrants) at the proximal margin of the stricture. The interval between dilations and frequency of dilations were calculated before and after triamcinolone injections. A periodic dilation index (PDI) (number of dilations per month) before and after the triamcinolone injections was calculated.Results: The PDI decreased significantly from 1.7 before injection to 0.6 after injection. This effect was seen irrespective of the etiology of the stricture involved.Conclusions: Intralesional triamcinolone therapy is a useful and effective therapy for symptom relief in benign refractory esophageal strictures

Botany, chemistry, and pharmaceutical significance of Sida cordifolia: a traditional medicinal plant

Sida cordifolia Linn. belonging to the family, Malvaceae has been widely employed in traditional medications in many parts of the world including India, Brazil, and other Asian and African countries. The plant is extensively used in the Ayurvedic medicine preparation. There are more than 200 plant species within the genus Sida, which are distributed predominantly in the tropical regions. The correct taxonomic identification is a major concern due to the fact that S. cordifolia looks morphologically similar with its related species. It possesses activity against various human ailments, including cancer, asthma, cough, diarrhea, malaria, gonorrhea, tuberculosis, obesity, ulcer, Parkinson’s disease, urinary infections, and many others. The medical importance of this plant is mainly correlated to the occurrence of diverse biologically active phytochemical compounds such as alkaloids, flavonoids, and steroids. The major compounds include β-phenylamines, 2-carboxylated tryptamines, quinazoline, quinoline, indole, ephedrine, vasicinone, 5-3-isoprenyl flavone, 5,7-dihydroxy-3-isoprenyl flavone, and 6-(isoprenyl)- 3-methoxy- 8-C-β-D-glucosyl-kaempferol 3-O-β-D-glucosyl[1–4]-α-D-glucoside. The literature survey reveals that most of the pharmacological investigations on S. cordifolia are limited to crude plant extracts and few isolated pure compounds. Therefore, there is a need to evaluate many other unexplored bioactive phytoconstituents with evidences so as to justify the traditional usages of S. cordifolia. Furthermore, detailed studies on the action of mechanisms of these isolated compounds supported by clinical research are necessary for validating their application in contemporary medicines. The aim of the present chapter is to provide a detailed information on the ethnobotanical, phytochemical, and pharmacological aspects of S. cordifolia