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ISSN NO.

2456-4400
I Int J Med Lab Res 2017, 2(3):44-54

REVIEW ARTICLE INTERNATIONAL JOURNAL OF MEDICAL LABORATORY RESEARCH (IJMLR)

A REVIEW ON PHARMACOLOGICAL SCREENING OF ANTI ULCER AGENTS

Sai Datri Arige1, Lakshmana Rao A1


1
Department of Pharmaceutical Analysis, V. V. Institute of Pharmaceutical Sciences, Gudlavalleru, A.P.,
India.
Received:30 Sep, 2017/Revised:4 Oct, 2017/Accepted: 18 Oct, 2017
ABSTRACT: Ulcers are caused by imbalance between the gastro duodenal mucosal defensive factors
such as bicarbonate, mucus versus aggressive factors like acid and pepsin secretion. The drug treatment of
peptic ulcer has significantly brought down the morbidity and mortality and need of surgical interventions
which may be attributed to the advent of H2 blockers and proton pump inhibitors. These symptoms
frequently occur several hours following a meal, after the food leaves the stomach but while acid
production is still high. Instead of pain, some patients experience intense hunger or bloating. Many animal
models are using to induce ulcer to identify the antiulcer property of many new and existed drugs such as
Pyloras ligated rat, Stress ulcers, Histamine induced gastric ulcers, Cysteamine induced duodenal ulcers
and Dulcerozine induced duodenal ulcers.
KEYWORDS: Peptic ulcer, duodenal ulcer and inflammation.

INTRODUCTION:

Gastro-intestinal disorders 1 are one of the severe acid and pepsin. There are several causes
classes of human ailments causing maximum smoking, H.pylori infection, ingestion of drugs
discomfort, morbidity and mobility. Peptic ulcer and chemicals. Especially consumption of
2-3
is one such GIT disorder. Peptic ulcer is alcohol for a prolonged period, smoking of
considered as a major health problem, both in Cigarette, or chronic consumption of NSAIDs
terms of morbidity and mortality and it is very are causing peptic ulcers. The peptic ulcer is
common in the present day life of industrialized mainly caused because of irregulated acid
and civilized countries. Available statistical secretion in the body. The symptoms of peptic
reports indicate that10% or more of adult ulcer are: severe pain and irritation in the upper
population are affected within their life time and abdomen. If it is not treated properly, it may
peptic ulcer affects individuals invariably from result in perforations in the wall of the
20 to 60 years of age with males being gastrointestinal tract. Because of the severity of
predominantly affected. Peptic ulcer is benign the problem, now world is awaiting for the
lesion of gastric or duodenal mucosa occurring at treatment of it. Before going to do the treatment
a site where the mucosal epithelium is exposed on the human, we need to check the effects of the

Corresponding Author:
Sai Datri Arige
Department of Pharmaceutical Analysis, V.V. Institute of Pharmaceutical
Sciences, Gudlavalleru, A.P., India.

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drugs on animal to safe the human life from APPROACHES TO TREATMENT 10


disaster of the drugs. This review describes such Reduction of gastric acid secretion
animal screening models for anti-ulcer drugs. Neutralization of gastric acid
Ulcer protective
PHYSIOLOGY OF GASTRIC ACID Anti H. Pylori drugs
5-8
SECRETION
 Gastric acid secretion is a complex, PHYTO-CHEMICALS USED IN THE
continuous process in which multiple central TREATMENT OF PEPTIC ULCER 11-15
and peripheral factors contribute to a  Allophylus serratus Kurz is commonly
common endpoint: the secretion of H+ by known as Tippani. It belongs to the family
parietal cells. Sapindaceae.
 Neuronal (acetylcholine (Ach)), paracrine  Aloe vera (L.) Burm.f. is commonly known
(histamine), and endocrine (gastrin) factors as Aloe. It belongs to the family
all regulate acid secretion. Xanthorrhoeaceae.
 Their specific receptors (M3, H2 and CCK2  Curcuma longa L. is commonly known as
receptors respectively) are on the basolateral Turmeric and also a household remedy for
membrane of parietal cells in the body and biliary disorders, anorexia, cough, diabetic
fundus of the stomach. wounds, hepatic disorders, rheumatism and
 The H2 receptor is a GPCR that activates the sinusitis which belongs to the family
Gs – adenyl cyclase - cyclic AMP-PKA Zingiberaceae.
pathway.  Butea frondosa Roxb. is commonly known
 ACh and gastrin signal through GPCRs that  as Flame of the forest .The plant is
couple to the Gq protein-coupled - inositol distributed throughout India and belongs to
1,4,5-trisphosphate - Ca2+ pathway in the family Fabaceae.
parietal cells.  Capsicum annuum L. is commonly known
 In parietal cells, the cyclic AMP and the Ca2+ as Chilli pepper and it is most widely
- dependent pathways activate H+, K+ - cultivated throughout the world. It belongs to
ATPase (the proton pump), which exchanges the family Solanaceae.
hydrogen and potassium ions across the  Carica papaya Linn. is commonly known as
parietal cell membrane. Papaya. It belongs to the family Caricaceae.
 Cissus quadrangularis L. is a succulent
REGULATION OF ACID SECRETION IN plant of family Vitaceae.
THE BODY 9  Desmostachya bipinnata (L.) Stapf is
Fig. 1: Regulation of acid secretion in the body commonly known as Saved gram belongs to
the family Gramineae.
 Excoecaria agallocha L. is commonly
known as Milky mangrove belonging to the
family Euphorbiaceae
 Glycyrrhiza glabra L., is a sweet, moist,
soothing, flavoring herb commonly known
as Liquorice belonging to the family
Fabaceae.

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SCREENING OF ANTI ULCER AGENTS 12 o Indomethacin and histamine


Requirements of an ideal model induced duodenal ulcer in rats
 Should be simple, reproducible & AMP; o Histamine induced duodenal ulcers
allow for easy quantification of results. in guinea pigs
 Should induce characteristic ulceration in
specific locations. ISOLATED WHOLE STOMACH
 Should involve different mechanisms by PREPARATION
which ulceration is produced. This method is used for evaluation of H2 –
 Ulcers produced should not spontaneously receptor antagonists.
heal during observation period. PROCEDURE:
Immature Wistar rats weighing around 40 g are
IDEAL ANIMAL FOR SCREENING ANTI taken for the procedure. Anaesthetize the rats
ULCER AGENTS 16 with 30 mg/kg pentobarbitone administered
Majorly used animal model is rats because of intra-peritoneally. The abdomen is opened and
continuous secretion of acid, glandular esophagus is ligated close to the stomach. An
portion of rat stomach analogous to body of incision is made in the rumen of the stmach and
stomach in man both anatomically and the contents are washed out with warm Krebs-
functionally and being omnivorous resembles Henseleit solution. A second incision is made at
man nutritionally. Along with rats, Guinea pigs the pyloric sphincter and polyethylene cannulae
are used when histamine is used to induce ulcers. are inserted and tied into the stomach via these
incisions. The stomach is dissected out. Place
ANIMAL MODELS FOR SCREENING 17-20 immediately into 10 ml organ bath containing
 Anti-secretory activity screening Kerbs-Henseleit solution at 37°C. The lumen of
o Isolated whole stomach the stomach is perfused at a rate of 1ml/min with
preparation modified Kerbs Henseleit solution (without
o GOSH and SHILD perfused rat Na2Co3 and KH2PO4) at 37°C. The effluent
stomach preparation perfusate from the stomach is passed over a
 Gastric anti-ulcer activity screening micro dual electrode. The change in pH is
o Pylorus ligation induced gastric converted to a function of H+ ion activity. The
ulcers in rats (Shay rat) test compounds or secretogogues are added in a
o Drug (NSAID ) induced gastric volume of 0.5 ml to the Kerb’s Henseliet
ulcers in rats solution bathing the serosal surface of the
o Ethanol induced gastric ulcers in stomach. After setting up the stomach
rats preparation, the basal H+ output is allowed to
o Acetic acid induced gastric ulcers stabilize, both under control and treated. Then
in rats measure secretogogue response by measuring the
o Stress induced ulcers in rats amount of acid secreted at peat response above
 Duodenal anti-ulcer activity screening the predicting basal level.
o Cysteamine induced duodenal The rate of acid secretion is measured and
ulcer in rats expressed as (H+) moles * 108 per minute
o Duclerozine induced duodenal Both solutions are gassed with carbogen (95%
ulcer in rats O2 and 5% CO2)

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Compare the test and standard with that of the after the infusion and measure the inhibition of
control to access the anti-ulcer activity of the acid secretion and compare the results with that
drug. of standard.
GOSH AND SHILD PERFUSED RAT PYLORUS LIGATION INDUCED ULCERS
STOMACH PREPARATION IN RATS
This method is first demonstrated by Shay
PRINCIPLE: and co-workers in 1945. Pyloric ligation in rats
The anti-ulcer agent screening is done by leads to accumulation of gastric acid in the
continuous reading of acid secretion in the rat, stomach leading to acute gastric ulceration.
which is stimulated by histamine, acetylcholine
REQUIREMENTS:
and gastrine and that acid secretions can be
Albino Wistar Rats (150-200 g), Ether
blocked by anti-ulcer drugs.
(Anesthetic), Saline (control), Omeprazole
PROCEDURE: (standard), Test drug (3 different concentrations
Male Sprague Dawley or Wistar rats of weighing x, 2x, 4x), NaOH (0.01N), Topfer’s reagent
180 g are taken for the procedure. Prior to the (dimethyl amino azo benzene) and
experiment, starved the animal overnight by Phenolphthalein.
withdrawing the food. Group the rats randomly
PROCEDURE:
as four rats in a group. Anaesthetize the animals
Wistar albino rats of either sex weighing 150 –
with 25% urethane solution (0.6 ml/100 g, i.m.).
200 g are taken for the procedure. Rats fasted for
The body temperature is artificially stabilized by
24 hrs prior to pyloric ligation.
means of a heating coil using a rectal
Randomly divided into 5 groups of 10 animals
thermometer and also trachea is exposed and
each
cannulated for
Group I: Control vehicle
artificial respiration. The external jugular vein is
Group II: Standard drug (Omeprazole)
exposed and cannulated with polythene tubes
Group III: concentration of test drug
leveled at the tip. The abdomen is opened
Group IV: concentration of test drug
through midline incision, and pyloric end of the
Group V: concentration of test drug
stomach is cannulated. A polythene tube is
Drugs administered once for 2 days and 30 mins
passed down the oesphagus and tied in the
prior to ligation. Rats anesthetized with ether.
cervical region. The stomach is washed out
Pyloric ligation procedure:
thoroughly by passing distilled water to the tube.
o The abdomen is opened by a small midline
Perfuse the stomach with N/4000 sodium
incision.
hydroxide at a uniform rate. The concentration of
o Pyloric portion of stomach is slightly lifted
sodium hydroxide is adjusted so that the
out & ligated avoiding traction to pylorus or
perfusate under basal conditions has a pH. The
damage to its blood supply.
perfusate emerges out bathes the micro
o The stomach is replaced carefully and
electrodes which are directly connected to the pH
abdominal wall is closed by interrupted
meter. Changes in acid secretion are accessed by
sutures.
pH changes. The gastric secretion is stimulated
The drugs are administered subcutaneously
by continuous i.v. infusion of 100
immediately after pyrolus. Rats placed in
microgram/kg/hr of pentagastrin or 3 mg/kg/h of
separate cages and allowed to recover. After 19
histamine hydrochloride or 30 microgram/kg/h
hrs to pyloric ligation, animals sacrificed by
of carbachol. The test is injected either prior or
decapitation. Abdomen opened and stomach
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dissected out. Contents of the stomach collected inhibition of endogenous prostaglandin


in a centrifuge tube. Stomach opened along production leads consequent loss of gastric
greater curvature and ulcers observed under 10x mucosal defense, which in turns causes the
magnification. formation of ulcer. It is important model for
Ulcer index is calculated: 10/X (X = Total identifying drugs that could be effective in
mucosal area/ total ulcerated area) NSAID induced gastropathy.
Intensity of ulcers is scored as below
o 0 -normal stomach PROCEDURE:
o 1 - superficial mucosal erosion Wistar Rats weighing 150 -200 g are taken for
o 2 - deep ulcer the procedure. Rats fasted for 24 hrs in separate
o 3 - penetrated or perforated ulcer cages and randomly divided into 5 groups. The
Contents of the stomach analyzed for Volume, control, standard, test drug are administered once
pH, free acidity and total acidity (Titration of the daily for 2 days and 30 mins prior to
solution against 0.01N NaOH done using administration of ulcerogenic agent. Ulcerogens
Topfers reagent and phenolphthalein as administered by oral gavage. Rats sacrificed 4 -
indicators. Volume of NaOH which turns the 6hrs later. Ulcer index and analysis of stomach
solution to yellowish orange corresponds to free contents have done.
acidity. Titration is continued till solution turns
pink. The total volume of NaOH used up  Aspirin: Aspirin is suspended in 1%
corresponds to total acidity. Acidity (meq/l/100 carboxymethyl-cellulose in water(20mg/ml)
g) = (Vol of and administered the drug with a dose of
NaOH X Normality x 100)/0.1) and Mucin and 500mg/kg orally.
prostaglandin levels (estimated to detect  Phenylbutazone: It is administered in a
cytoprotective effects). similar fashion as aspirin in a dose of
100mg/kg, p.o.(suspension) or i.p.(solution).
INFERENCE:  Indomethacin: Indomethacin is
 Ulcer index of test drug compared with administered in a dose of 20mg/kg (4mg/ml
control group to detect anti-ulcer effect of dissolved in 0.1% Tween80 solution) p.o.
test drug. If present, it is compared with that
of standard group. ETHANOL INDUCED GASTRIC ULCER IN
 Other parameters help to infer the RATS
mechanism of ulcer protection.
Eg. Decrease in volume, free & AMP; total PRINCIPLE:
acidity: antisecretory action Rise in pH: acid Ethanol damages superficial epithelial layers &
neutralisng action Increase in mucin, PGs: AMP; inhibits prostaglandin release. An agent
cytoprotective effect. that protects against ethanol induced ulcers might
be cytoprotective & AMP; exert its action by
DRUG INDUCED ULCERS IN RATs stimulating release of endogenous prostaglandins
Generally gastric ulceration is produced in rats & AMP; mucin. However, anti-secretory agents
by certain drugs. The ability of the test drug to also are effective in this model.
protect against the ulceration is observed. Drugs
used for the induction of ulcer are NSAIDs like
Aspirin, Indomethacin and Ibuprofen. The

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ACETIC ACID INDUCED GASTRIC PROCEDURE:


ULCERS IN RATS Wistar rats of either sex of weighing 150 – 200 g
It is the model mimics the chronic pattern seen are taken for the procedure. Group the rats as
with peptic ulcer. each group contains 10 rats. The rats are fasted
for 24 hrs before starting the test. After the oral
PROCEDURE: administration of test drug or vehicle, the rats are
Male Donryv, Wistar or Sprague Dawley rats immobilized in the stress cage and they are
Weighing 250 – 300 g are taken for the immersed vertically to the level of the process in
procedure. Overnight fasted rats operated under a water bath at 22°C for 16 hrs. Remove the
ether anesthesia. Anterior & AMP; posterior animal from the water immersion and dry it.
walls of stomach clamped with forceps. 0.2 ml of Inject 30 mg/kg Evans Blue i.v. via tail vein.
40% acetic acid injected into clamped portion. After 10 min sacrifice the animals and remove
After 45 secs, acid removed. Deep round ulcers the stomach of the animal carefully. Filled it with
develop on the anterior & AMP; posterior walls. the 1% formalin and stored overnight. In the next
Respective treatments (control, standard and test) day, open the stomach with along a greater
started from 3rd to 10 th day. Rats sacrificed on curvature, washed in warm water and examined
10th day. Ulcers respond well to most anti ulcer under magnifying lens. Observe the longest
drugs like PPI, H2 blockers, cytoprotectives. diameters of the lesions, measure and summed
up to give the total lesion score in mm for each
STRESS INDUCED ULCER IN RATS animal, the mean count of each group is
Male Donryv, Wistar or Sprague Dawley rats calculated. Inhibition of lesion is shown as a
Weighing 250 – 300 g are taken for the control score. Statistically compare the data
procedure. Drugs (control, standard, test) obtained and give the results as such. The
administered once daily for 2 days & AMP; 30 restrain case and immersion in water produce the
mins prior to applying restraint. Fasted & AMP; stress in the rats that in turns increase the acid
lightly anesthetized rats placed on galvanized secretions in the rats and cause the ulcer to it.
steel window screen. Limbs are held together in
pairs & AMP; tightened with adhesives. After 24 CYSTEAMINE INDUCED DUODENAL
hrs, animal removed, sacrificed and degree of ULCER IN RATS
ulceration noted.
PRINCIPLE:
WATER IMMERSION INDUCED Cysteamine inhibits the alkaline mucus secretion
RESTRAINT ULCER from the Brunner’s glands in proximal
duodenum and stimulated gastric acid secretion
PRINCIPLE: rate. Gastric emptying also delayed and in terms
Generally exposure of rats to stress will increases serum gastrin concentration, which
decreases the acid secretion but there occur an leads to the formation of ulcer.
increase in secretion towards the pre-stress hours
when restrained animal is subjected to additional PROCEDURE:
water immersion. It is important model for Male Wistar or Sprague Dawley rats weighing
identifying drugs that could be effective in around 200 g are taken for the procedure.
gastropathy. Administer cysteamine Hcl of dose 280 mg/kg
orally tree times in a day on the first day of

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experiment to the fed rats. For the treated 2 – Deep ulcer usually with transmural
animals: Administer the drugs before 30 min of 3 – Perforated or penetrated ulcer
first dose and again after 24 hrs on the second
day. The rats are sacrificed after 48hrs of the first APPLICATIONS:
dose of cysteamine Hcl. The duodenal ulcers are  The lesions developed are analogus to the
developed 2 -4 mm away from the pylorus on the clinical disease with respect to location and
anterior wall of the duodenum and frequently histology.
perforate the liver. A small ulcer present on the  The factors responsible for producing the
posterior wall (kissing ulcer) of the duodenum pathological changes are similar in man and
and it is invariably penetrates the pancreas. animal used.
The intensity of the duodenal ulcers is evaluated  The drugs effective against experimental
as 0 – No ulcer ulcer could be clinically useful.
1 – Superficial mucosal erosion  The method is dependable, reproducible and
2 – Deep ulcer usually with transmural easy to perform and results are obtained with
3 – Perforated or penetrated ulcer in 24hrs.
INDOMETHACIN AND HISTAMINE
APPLICATIONS: INDUCED DUODENAL ULCER IN RATS
 Suitable method for studying the
pathogenesis of duodenal ulcer PRINCIPLE:
 An effective method for anti-ulcerogenic A single administration of indomethacin and
regimes detection. subsequent dosing with histamine consistently
 Since some of such chemicals might have a produce lesions at the opposite site of the
role in the etiology of human duodenal ulcers mesenteric attached in the proximal duodenum of
as well, the structure activity conclusions rats. The development of duodenum lesions by
may helps in the identification of ulcerogenic indomethacin + histamine induction in rats is
chemicals in our diet and environment. due to both an increase in gastric secretion and
 an impairment of acid induced duodenal HCO3
DUCLEROZINE INDUCED DUODENAL secretion.
ULCER IN RATS PROCEDURE:
Wistar or Sprague Dawley rats weighing 150-
PROCEDURE: 200 g are taken for the procedure. Grouped rats
Male wistar or Sprague dawley rats weighing as such 6-8 rats must in a group. Fast the rats for
around 200 g are taken for the procedure. 24 hrs before the experiment with water ad
Duclerozine 300 mg/kg, suspended in 5% gum libitum. Administered 5 mg/kg Indomethacin s.c
acacia solution, is administered orally as a single and subsequently administered 40 mg/kg
dose. The drugs (test/standard) are given 30 min histamine dihydrochloride 3 times in a day at 2.5
prior to the administration of Duclerozine. The hours interval, beginning after 30 min of the
animals are sacrificed after 18 hr of indomethacin injection. Sacrifice the animal after
administration. 24 hrs of the procedure and observe it for ulcers.
Due to this combined treatment, two lesions are
SCORING: formed at the proximal duodenum and also few
0 – No ulcer lesions at corpus and antrum of the stomach.
1 – Superficial mucosal erosion Statistically compare the data of test and

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standard then conclude the activity of the test. expressed as unit (U) of SOD activity/mg
The standards for treating duodenum and antrum protein.
ulcers are oral cimetidine and 16, 16 – Estimation of mucosal glycoprotein’s:
dimethylprostaglanin E2 in a dose dependent Sample of gastric mucosal scraping is
manner and also for corpus ulcer is cimetidine. homogenised in distilled water and treated with
HISTAMINE INDUCED DUODENAL 90% ethanol and are subjected for the estimation
ULCERS IN GUINEA PIGS of carbohydrates and proteins using the methods
described above for gastric juice contents.
PROCEDURE: Statistical analysis was done by student’s t-test.
Guinea pigs fasted for 48 hrs are taken for Estimation of free acidity and total acidity:
the procedure. Drugs (control, standard and test) One ml of gastric juice is pipette into 100 ml
given once daily for 2 days & AMP; before 30 conical flask, added 2 to 3 drops of topfer’s
mins to drug, administrate histamine. Ulceration reagent and treated with 0.01 N sodium
induced by injecting 1 ml of histamine solution hydroxide until all traces of red colour
intraperitoneally. Promethazine 5 mg injected disappears and the colour of the solution turns to
intraperitoneally 15 mins before and after yellowish orange. The volume of the alkali added
histamine. Animals sacrificed after 4 hrs. Degree was noted. This volume corresponds to free
of ulceration & AMP; gastric contents assessed. acidity. Then 2 to 3 drops of phenolphthalein
solution is added and titration is continued until a
ESTIMATION OF PARAMETERS: definite red tinge reappears. Again the total
Estimation of free radical generation: The volume of alkali added is noted. Acidity is
fundic part of the stomach is homogenised (5%) calculated by: Acidity = Volume of NaOH ×
in ice cold 0.9% saline with a Potter-Elvehzem Normality of NaOH × 100 / 0.1 × meq/L/100
glass homogeniser for 30 second. The gm.
homogenate is then centrifuged at 800× g for 10 Estimation of DNA in gastric mucosa: DNA
min followed by centrifugation of the and protein are estimated in the gastric fundal
supernatant at 12000× g for 15 min and the mucosal scrap homogenised in 2.5 ml of ice
obtained mitochondrial fraction is used for the cooled 0.6N perchloric acid (PCA). The
following estimation. Statistical analysis was concentration of DNA is expressed as µg
done by student’s t-test. DNA/mg protein.
Lipid peroxides (LPO): LPO product Estimation of glandular weights of
malondialdehyde (MDA) is estimated using 1, 1, stomach: The weight of the glandular portion of
3, 3-tetraethoxypropane as the standard and is stomach is calculated by subtracting the weight
expressed as n mol/mg protein. of the whole stomach minus rumen and is
Super oxide dismutase (SOD) activity: expressed as mg/100 g body weight of the
Inhibition of reduction of nitro blue tetrazolium animals. Statistical analysis was done by
(NBT) to blue coloured Formosan in presence of student’s t-test.
phenazine methasulphate (PMS) and NADH is Estimation of Ulcer index (Ui):
measured at 560 nm using n-butanol as Ui = mean degree of ulceration × % group of
blank. One unit of enzyme activity is defined as ulceration /100
the amount of enzyme that inhibits rate of %inhibition = (ulcer index in control - ulcer
reaction by 50% in one min under the define index in test) ulcer index in control x 100
assay condition and the results have been

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Estimation of gastrin: In order to determine the suggested that the above mentioned all types of
gastrin levels in plasma, blood is collected by induced models procedure meets the established
cardiac puncture, centrifuged, and the plasma is criteria for a useful experimental ulcer model and
analysed for gastrin levels with double-antibody thus represents a viable research tool [22]. The
liquid phase radioimmunoassay. natural and synthetic products can be
Histological studies: scientifically evaluated to establish therapeutic
Gastric tissue samples from each group were efficacy by the above mentioned techniques.
fixed in 10% formalin for 24 h. The formalin
fixed specimens are embedded in paraffin and REFERENCE:
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Int J Med Lab Res 2017, 2(3): 32-41

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CONFLICT OF INTEREST: Authors declared no conflict of interest

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Cite of article: Arige S D, Lakshmana Rao A, A Review On Pharmacological Screening Of Anti-Ulcer
Agents . Int. J. Med. Lab. Res. 2017, 2(3): 32-42

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