Dr. Avinash Shanker

SOOKTYN
In Management Of Acid Peptic Disorder
Dr. Avinash Shankar

Abstract

Clinical efficacy of Sooktyn an indigenous drug evaluated and compared with presently used histamine 2 receptor blocking agent Rantidine reveals - therapeutic superiority ofSooktyn over histamine 2 receptor blocking agent, i.e.92% patients on Sooktyn achieved 100% cure of the disease while only 86% patients on Rantidine.

No patient on Sooktyn needed any adjuvant thera­peutic aid though 69% patients on Rantidine needed mild laxative to alleviate constipation & its sequelae.

No patient on Sooktyn showed any recurrence or relapse in 6 months of post therapy follow up while 26% patients on Rantidine had recurrence or withdrawal effect and they too responded well to Sooktyn therapy.

Introduction

Eructation, heart burn, pain in abdomen with nocturnal exacerbation and radiation to back are the commonest com­plaints encountered in day to day practice irrespective of socio­-economic status & sex. The above manifestations are due to acid-peptic disorder for which there is a wide ranged therapeutic armamentarium i.e. from antacid to recent hista­mine 2 receptor blocking agent, Rantidine. But failure to achieve permanent cure & recurrence of the symptoms with the present therapeutic agents & surgical interventioncom­pelled us to study such drugs which regulate gastric acid secretion rather than suppress acid secretion and alsoprotects mucosal lining and potentiate mucosal immunity.

Hence considering frequent recurrence of the symptoms, withdrawal effect of present therapeutic regimen, cost of therapy& socio-economic status of the patient, an indigenous drugSOOKTYN whose efficacyin hyperchlorhydria managementis well documented 1,2,3&4 hasbeen comparatively evaluatedfor its clinical efficacy &safety margin inmanagement ofAcid peptic disease as compared to histamine 2 receptorblocking agent Ranitidine.

 

 

Material & Method

200 patients of age group 25 yrs to 55 yrs presenting with complaints suggestive of Acid peptic disorder attending gastro-enterology clinic of RA. Hospital & Research Centre, Warisaliganj ( Nawada ) during Aug. 88 to Dec. 88 were selected for evaluation of clinical efficacy & safety margin of the drug SOOKTYN as compared to H2 receptor block­ing agent Rantidine.

Sooktyn contains the following

 

Each tablet of Sooktyn contains in mg.:

Sookty Bhasma (Ostrea Gryphoides)                              122.5 mg.

Kapur kachali (Hedychium spicatum)                               80.0 mg.

Jatamansi (Nardostachya jatamansi)                                40.0 mg.

Ganthoda (Valeriana wallichii)                                          30.0 mg.

Khurasanj ajmo (Hyocymus niger)                                   30.0 mg.

Kei pan rakh (Musa saientum salt)                                    30.0 mg.

Vacha (Acorus calamus)                                                     l0.0 mg.

Dhaturana pan (Datura stramonium)                                5.0 mg.

Criteria for selection of patients

1.           Patient having pain in epigastrium varying with food &vomiting.

2.           Nocturnal pain waking up.

3.           Patient with acute exacerbation.

4.           Patient with pathological investigation suggestive of Acid peptic disorder.

All the patients selected were such or had undergone augmented Histamine test, Barium meal examination, Gastro­scopy and confirmed cases were classified in two groups A &Bcomprising of 100 cases in each.

Group A patients were administered Sooktyn as perfollowing dose schedule.
Sooktyn2 tab three times daily _1/2hr. after food for 3 months.
Group Bwere administered H2 receptor blockingagent Rantidine 150 mg. morning & evening with other supportive therapeutic aid. Patients were followed up for 6 months at weekly intervals & improvement recorded and checked for any relapse or recurrence as per following index of assessment.

 

Subjective Improvement Score

1.       Subsidence of epigastric pain &dyspepsia.

2.       Disappearance of heart burn & acid regurgitation.

3.       Prolonged pain free interval.

4.       Relief from nocturnal pain.

5.       Ability to return to routine work.

Clinical improvement scores

1.    Disappearance of tenderness in the epigastric region &rt.hypochondrium.

2.    Improvement of patient's general condition.

3.    Increase in weight.

 

Safety margin assessed as

1.      Post therapy constipation

2.       Indigestion

Augmented Histamine test, Barium X-ray and Gastroscopy were repeated in all the patients under study after 1 month of drug administration.

 

Clinical response was graded as

Grade - I Complete disappearance of signs & symptoms. No recurrence of symptoms during 6 months of post therapyfollowup. Augmented Histamine Test showing significant reduction of basal acid secretion. Disappearance of ulcer crater on Endoscopy or Ba. meal X-ray.

Grade-11          Good subjective improvement. Reduction of basal acid secretion. Persistence of ulcer crater, Recurre­nce of symptoms after treatment withdrawal.

          Grade-III       Subjective improvement. Persistence of ulcer crater.No reduction of
                                  basal acid secretion, Recurrence on treatment withdrawal.

 

 

TABLE
Shows comparative clinical evaluation

	Particulars	Group A	Group B
1.	Clinical response Grade 1 Grade II	92% 8%	86% 14%
2.	Untoward effect during therapy	None	69%
3.	Recurrence on treatment withdrawal	None	26%
4.	Post Therapy Status Constipation Giddiness Abdominal Distension	None None None	38% 10% 2%

 

 

 

Observations and Result

92% &8%patients on Sooktyn therapy showed Grade 1 &GradeII recovery whereas 86% & 14% patients onRantidine showed grade I & grade II recovery respectively.

69 patients of group B ( Pt. on Rantidine ) complained of constipation and increase of pain after 4 hrs of food, uneasiness and abdominal distension which relieved on mild laxative &'carminative ( DIGEX) administration whereas none of group A needed any additional therapeutic aid.

None of group A relapse of the whereas 26% patients of group B had recurrence after 3 months of withdrawal of therapy but responded with Sooktyn showing grade I recovery.

In post therapy followup none of group A needed any therapy whereas 50% Patients on Rantidine needed therapy for heaviness in abdomen giddiness.

Disscussions :

Gastric acid secretion & mucosa resistance are two factors which determine the ulcer development.

Present therapeutic regimen either suppresses acid secretion or neutralises the acid present in stomach, hence recurrence and worsening of the disease is most common.

Present study reveals-

Patient of acid peptic disorder on Sooktyn show better clinical response than patients on H2 receptor blocking agent Rantidine - without any relapse or untoward effects during therapy & 6 months of post therapy follow up.

This clinical supermacy can be attributed to-

 

Sooktynregularizes the gastric -acid secretion & increases the mucosal resistance rather than suppression of acid secretion by receptor block.

In addition Sooktyn also improves the intestinal juice secretion and aids normal absorption hence prevent post gaseous reflex hyperchlorhydria.

References

1. Rangabhashyam, N. and Durai Raj, K. V. Sooktynan indigenous drugin management of
duodenal ulcer. Antiseptic, 1977 74:1 ,pp 27-29.

2. S. W. Trivedi, Clinical trial of Sooktyn, an ayurvedic formulation in treatment of hyperchlorhydria, The Indian

Practitioner, XXX VIII/7 1985, PP 641-643.

3. Sardesai H V &Manek B Desai, Sooktyn an ayurvedic drug in hyperacidity syndrome. Mah. Med. Jr 1965 12:3,  

   pp 267-269.

4. Venugopalan. S &Rajachandrasekharan, Sooktyn in peptic ulcer, 54^th All India Medical Cont. 26-31, Dec 78.

5. Grossman, M. I. & others: A new look atpepticulcer, Ann, Intern. Med, 84:5, 1976.