BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the d...BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.AIM To identify predictive factors for early diagnosis and treatment,and the association between the diagnosis and maternal/neonatal outcomes.METHODS We searched PubMed,PubMed Central,and Google Scholar.Articles were analyzed following preferred reporting items for systematic reviews and metaanalysis.The search items included:‘ulcer’,‘PUD’,‘pregnancy’,‘puerperium’,‘postpartum’,‘gravid’,‘labor’,‘perforated ulcer’,‘stomach ulcer’,‘duodenal ulcer’,‘peptic ulcer’.Additional studies were extracted by reviewing reference lists of retrieved studies.We included all available full-text cases and case series.Demographic,clinical,obstetric,diagnostic and treatment parameters,and outcomes were collected.RESULTS Forty-three cases were collected.The mean maternal age was 30.9 years;36.6%were multiparous,and 63.4%were nulliparous or primiparous,with multiparas being older than primiparas.Peptic ulcer perforated in 44.2%of postpartum and 55.8%of antepartum patients.Antepartum PPU incidence increased with advancing gestation 2.3%in the first,7%in the second,and 46.5%in the third trimester.The most common clinical findings were abdominal tenderness(72.1%),rigidity(34.9%),and distension(48.8%).Duodenal ulcer predominated(76.7%).In 79.5%,the time from delivery to surgery or vice versa was>24 hours.The maternal mortality during the third trimester and postpartum was 10%and 31.6%,respectively.The trimester of presentation did not influence maternal mortality.The fetal mortality was 34.8%,with all deaths in gestational weeks 24-32.CONCLUSION Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum.Early intervention reduced fetal mortality but without influence on maternal mortality.Maternal mortality did not depend on the use of X-ray imaging,perforation location,delivery type,trimester of presentation,and maternal age.Explorative laparoscopy was never performed during pregnancy,only postpartum.展开更多
Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affec...Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affected sites.Bletilla striata,a traditional Chinese medicinal herb,contains diverse chemical constituents and exhibits multiple pharmacological effects.As a key component in various traditional Chinese medicine compound formulations,it has demonstrated notable clinical efficacy.Moreover,it has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases.This paper systematically elaborates on the clinical efficacy and mechanisms of action of Bletilla striata in the treatment of PUs,drawing from ancient medical literature and traditional formula applications to provide support for clinical use.展开更多
Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enro...Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enrolled in this study between January 2022 and December 2024.Using the envelope method for randomization,the patients were divided into two equal groups:a control group administered standard triple therapy and an observation group that received the same triple therapy supplemented with rebamipide.The clinical efficacy,gastric mucosal morphology(mucosal thickness,gland density,active inflammatory cell infiltration,chronic inflammatory cell infiltration),and pepsinogen I/II were compared between the two groups.Results:The total effective rate in the observation group was significantly higher than that in the control group,with a statistically significant difference(p<0.05).After treatment,the scores of all items in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group,with statistically significant differences(p<0.05).After treatment,the ratios in both groups were significantly higher than those before treatment,and the ratio in the observation group was significantly higher than that in the control group,with statistically significant differences(p<0.05).Conclusion:Rebamipide combined with triple therapy can significantly improve the treatment efficacy of senile peptic gastric ulcers,effectively improve the histological status of the gastric mucosa,and promote the recovery of gastric mucosal function,with superior efficacy compared to triple therapy alone.展开更多
BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenou...BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.展开更多
BACKGROUND Nonoperative management(NOM)is a promising therapeutic modality for patients with perforated peptic ulcer(PPU).However,the risk factors for poor efficacy and adverse events of NOM are a concern.AIM To inves...BACKGROUND Nonoperative management(NOM)is a promising therapeutic modality for patients with perforated peptic ulcer(PPU).However,the risk factors for poor efficacy and adverse events of NOM are a concern.AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM.METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018.Of these 272 patients,50 converted to emergency surgery due to a lack of improvement(surgical group)and 222 patients were included in the NOM group.The clinical data of these patients were collected.Baseline patient characteristics and adverse outcomes were compared between the two groups.Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU.RESULTS Adverse outcomes were observed in 71 patients(32.0%).Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU.CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes,and can be used for risk stratification in patients with PPU.展开更多
AIMS The relationship between Helicobacter pylori (Hp) and gastric epithelia in chronic gastritis and in petic ulcer was studied by transmission electron mi- croscopy (TEM). METHODS Seventy-five gastric antral biopsy ...AIMS The relationship between Helicobacter pylori (Hp) and gastric epithelia in chronic gastritis and in petic ulcer was studied by transmission electron mi- croscopy (TEM). METHODS Seventy-five gastric antral biopsy speci- mens from the patients examined by six other methods for Hp were fixed in glutaraldehyde and treated with tanin acid before OsO_4 staining than routinely prooessed for TEM studies (at least 4 semi- thin sections oriented for ultrathin sections in each sample). RESULTS The bacilli were detected by TEM within gastric mucosa in 53 of 55 patients infected with Hp. Ultrathin sections especially stained with tanin acid re- vealed clearly glycocalyx by which the bacillus was connected with the epithelium. As the bacilli grouped as colony and breed,the adjacent mucous cells degerated and characterized by erosion of the juxtalu- minal cytoplasm,vacuolation or blebs,even desqua- mation of cell. Evidence was accumulated to show that the baoilli were located in the lumen attracted neu- trophils which intended to migrate into intercellular space of epithelia or into the lumen to exert the effect of Hp phagocytosis. CONCLUSIONS The sensitivity and specificity of Hp diagnosis by TEM is respectively 96% and 95%. Tanin acid is suitable for the preservation of glycocalyx of cell. The colonized bacilli,usually with the wide periplasmic pools,contributed to the spectrum degen- eration of epithelia,including mucous neck cells. If Hp infection persists,the degeneration and regeneration of mucous neck cells alternatively carried on and ultimate- ly the generative stem cells were damaged,as the result,the chronic atrophy gastritis could occure.展开更多
Pro-inflammatory cytokines are produced in the gastric mucosa by inflammatory cells activated by chronic Helicobacter pylori (H. pylori) infection. Polymorphisms of these cytokine genes are associated with individual ...Pro-inflammatory cytokines are produced in the gastric mucosa by inflammatory cells activated by chronic Helicobacter pylori (H. pylori) infection. Polymorphisms of these cytokine genes are associated with individual differences in gastric mucosal cytokine mRNA level, which result in differences in gastric mucosal inflammation, acid inhibition and gastroduodenal disease risk in response to H. pylori infection. Although polymorphisms of interleukin (IL)-1B, IL-1RN and TNF-A have been reported to relate well with gastric cancer and peptic ulcer risk, those of IL-2, IL-4, IL-6 and IL-8 genes are unclear. In combined analyses using data from previous studies, we found that the risk of gastric non-cardia cancer development was significantly associated with IL-4-168 C allele (OR: 0.81, 95% CI: 0.69-1.00) and IL-4-590 T allele carrier status (0.61, 0.53-0.73), and IL-6-174 G/G genotype (2<Abstract>Pro-inflammatory cytokines are produced in the gastric mucosa by inflammatory cells activated by chronic Helicobacter pylori (H. pylori) infection. Polymorphisms of these cytokine genes are associated with individual differences in gastric mucosal cytokine mRNA level, which result in differences in gastric mucosal inflammation, acid inhibition and gastroduodenal disease risk in response to H. pylori infection. Although polymorphisms of interleukin (IL)-1B, IL-1RN and TNF-A have been reported to relate well with gastric cancer and peptic ulcer risk, those of IL-2, IL-4, IL-6 and IL-8 genes are unclear. In combined analyses using data from previous stud- ies, we found that the risk of gastric non-cardia cancer development was significantly associated with IL-4-168 C allele (OR: 0.81, 95% CI: 0.69-1.00) and IL-4-590 T allele carrier status (0.61, 0.53-0.73), and IL-6-174 G/G genotype (2.02, 1.31-3.10). In peptic ulcer development, IL-2-330 G and IL-4-590 T allele carriers had a significantly decreased risk (0.37, 0.27-0.50 and 0.58, 0.34-0.99, respectively). Moreover, IL-2, IL-4, IL-6 and IL-8 gene genotypes prevalence differs among popula- tions. The inflammatory cytokine gene polymorphisms (e.g. IL-4 -590 and IL-6 -572 for gastric cancer, and IL-4-590, IL-6-572 and IL-8-251 for peptic ulcer) have a more potent influence on development of gastroduo- denal diseases in Western than East Asian populations. These cytokine gene polymorphisms, as well as those of IL-1B, IL-1RN and TNF-A, may be used to identify groups at higher risk of gastric cancer and peptic ulcer, and those suitable for their prevention by H. pylori eradication therapy in Western populations..02, 1.31-3.10). In peptic ulcer development, IL-2-330 G and IL-4-590 T allele carriers had a significantly decreased risk (0.37, 0.27-0.50 and 0.58, 0.34-0.99, respectively). Moreover, IL-2, IL-4, IL-6 and IL-8 gene genotypes prevalence differs among populations. The inflammatory cytokine gene polymorphisms (e.g. IL-4 -590 and IL-6 -572 for gastric cancer, and IL-4-590, IL-6-572 and IL-8-251 for peptic ulcer) have a more potent influence on development of gastroduo-denal diseases in Western than East Asian populations. These cytokine gene polymorphisms, as well as those of IL-1B, IL-1RN and TNF-A, may be used to identify groups at higher risk of gastric cancer and peptic ulcer, and those suitable for their prevention by H. pylori eradication therapy in Western populations.展开更多
AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohor...AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohort study of all patients diag-nosed with benign perforated peptic ulcer.Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010.Ulcers with a malignant neoplasia diagnosis,verified by histology after biopsy or resection,were excluded.Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes(K25.1,K25.2,K25.5, K25.6,K26.1,K26.2,K26.5,K26.6).Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures(e.g.,JDA 60,JDA 61,JDH 70 and JDH 71)were performed to enable a complete identification of all patients.Patient demographics,presentation patterns and clinical data were retrieved from hospital records and surgical notes.Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS:In the study period,a total of 172 patients with PPU were identified.The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year(95%CI:5.6-7.6)and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year(95%CI:0.7-1.6).A non-significant decline in ad-justed incidence rate from 9.7 to 5.6 occurred during the decade.The standardized mortality ratio for the whole study period was 5.7(95%CI:3.9-8.2),while the total 30-d mortality was 16.3%.No difference in in-cidence or mortality was found between genders.However,for patients≥60 years,the incidence increased over 10-fold,and mortality more than 50-fold,compared to younger ages.The admission rates outside office hours were high with almost two out of three(63%) admissions seen at evening/night time shifts and/or during weekends.The observed seasonal variations in admissions were not statistically significant. CONCLUSION:The adjusted incidence rate,seasonal distribution and mortality rate was stable.PPU fre-quently presents outside regular work-hours.Increase in incidence and mortality occurs with older age.展开更多
AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoh...AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS.展开更多
Objective:To evaluate the clinical effects of psychological interventions and drug therapy against peptic ulcer.Methods:96 patients with peptic ulcer were divided into control group with Tagamet 800 mg per evening p.o...Objective:To evaluate the clinical effects of psychological interventions and drug therapy against peptic ulcer.Methods:96 patients with peptic ulcer were divided into control group with Tagamet 800 mg per evening p.o.and trial group with psychological intervention on the basis of drug treatment.Results:There were significant differences between the two groups(P【0.05), the trial group showed that the anxiety and depression cases declined obviously and effective rate of ulcer therapy was much higlier than control group.Conclusions:In sum,psychological intervention combined with drug therapy provides an effective method for ulcer treatment.展开更多
AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retro...AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retrospectively collected between January 2008 and December 2008.The differences were compared.RESULTS:Among all 448 cases,254(56.6%) and 194(43.4%) patients had gastric ulcers and duodenal ulcers respectively.Patients with gastric ulcers were younger than those with duodenal ulcers.Although more men existed,there was a female predominance in middle-aged cases.Patients with duodenal ulcers had a higher rate of Helicobacter pylori(H.pylori) infection(62.4% vs 43.3%,P = 0.001),and those with gastric ulcers owned a significantly higher amount of aspirin and nonsteroidal anti-inflammatory drug(NSAID) use(7.5% vs 1.5%,6.7% vs 2.1%,P = 0.001).Tobacco smoking and alcohol drinking had no different impact between these two groups.Proton-pump inhibitors and H2-receptor antagonists(H2RA) were effective,but significantly less so in cases with duodenal ulcers receiving H2RAs,or in those with H.pylori infection and a history of NSAID use.CONCLUSION:Patients with gastric ulcers had lower H.pylori infection but more aspirin or NSAID use.Antisecretory therapy was ineffective in gastric ulcers underwent H2RA treatment,and cases combined H.pylori infection and NSAID use.展开更多
OBJECTIVE: To evaluate the efficacy of Pistacia atlantica Desf. oleoresin essential oil on peptic ulcer(PU) and its antibacterial effect on metronidazole-resistant Helicobacter pylori, as well as chemi-cal composition...OBJECTIVE: To evaluate the efficacy of Pistacia atlantica Desf. oleoresin essential oil on peptic ulcer(PU) and its antibacterial effect on metronidazole-resistant Helicobacter pylori, as well as chemi-cal composition of the essential oil.METHODS: The essential oil was standardized using gas chromatography mass spectrometry(GC/MS) analysis. Acute toxicity of the essential oil was assessed in animal model. In vitro anti-Helicobacter pylori activity was performed through disc diffusion and minimum inhibitory concentration method. For gastroprotective assay, rats received Pistacia atlantica Desf. essential oil(25, 50 and 100 mg/kg orally) 1 h before induction of ulcer by ethanol.Macroscopic(ulcer index and protection rate) and microscopic examination were performed.RESULTS: The GC/MS analysis of the essential oil led to the identification of twenty constituents andα-pinene is predominant constituent. The essential oil was safe up to 2000 mg/kg. All Helicobacter pylori strains were susceptible to the essential oil and the MIC ranged from 275 to 1100 μg/m L. The ulcer index for treated groups was significantly reduced compared to control(P < 0.001) with EC50 value of 12.32 mg/kg. In microscopic examination, Pistacia atlantica attenuated destruction and necrosis of gastric tissue.CONCLUSION: Current study exhibited protective effect of standardized Pistacia atlantica essential oil against ethanol-induced gastric ulcer and its antibacterial activity on Helicobacter pylori. α-pinene might be the responsible agent.展开更多
AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced P...AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.展开更多
AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively ...AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.展开更多
AIM： To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS： This prospective, randomized, comparative tr...AIM： To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS： This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers （spurting or oozing） were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1：10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS： There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups （P 〈 0.05）. The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group （20.3%） than in the 30 （5.3%） and 40 mL （2.8 %） epinephrine groups （P 〈 0.01）. There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group （51/76） than in the 20 （2/76） and 30 mL （5/76） epinephrine groups （P 〈 0.001）. Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group （P 〈 0.01）. Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups （P 〈 0.01）.CONCLUSION： Injection of 30 mL diluted epinephrine （1：10000） can effectively prevent recurrent bleeding with a low rate of complications. The optimal injection volume of epinephrine for endoscopic treatment of an actively bleeding ulcer （spurting or oozing） is 30 mL.展开更多
AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospecti...AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.展开更多
OBJECTIVE: To investigate the effect of Banxia Xiexin decoction(BXD) on Helicobacter pylori(Hp)-related peptic ulcers(PUs) and the possible mecha-nism underlying BXD actions via the transforming growth factor-β/small...OBJECTIVE: To investigate the effect of Banxia Xiexin decoction(BXD) on Helicobacter pylori(Hp)-related peptic ulcers(PUs) and the possible mecha-nism underlying BXD actions via the transforming growth factor-β/small mothers against decapentaplegic(TGF-β/Smad) signaling pathway.METHODS: PU patients with cold-heat complex syndrome were randomly assigned to groups that received Chinese or Western medicines with 20 patients in each group. Serum was collected after 7 d of treatment. The healthy group included 20 individuals. Gastric mucosal epithelial cell line GES-1 was cultured in vitro and randomly divided into the following seven groups: control, model, healthy,Western Medicine, prior treatment, low dosage,and high dosage. After 72 h of treatment with the corresponding serum, the m RNA and protein expression levels of TGF-β1, Smad3, and Smad7 were measured by reverse transcription quantitative polymerase chain reaction and western blotting, respectively.RESULTS: The m RNA expression levels of TGF-β1 and Smad3 in GES-1 cells were increased after Hp introduction, and these increased levels were reduced by the BXD-containing serum. The protein levels of p-Smad3, but not TGF-β1 or Smad3, were significantly increased in Hp-treated GES-1 cells,and treatment with the BXD-containing serum markedly decreased the protein levels. Smad7 expression was significantly enhanced following treatment with the BXD-containing serum at transcriptional and protein levels in a dose-dependent manner.CONCLUSION: BXD regulates the TGF-β/Smad signaling pathway by inhibiting the expression of TGF-β1 and Smad3, and increasing the expression of Smad7.展开更多
Peptic ulcer disease(PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer(PPU) is a serious complication of PUD and patients with PPU ...Peptic ulcer disease(PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer(PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirtyday mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.展开更多
文摘BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.AIM To identify predictive factors for early diagnosis and treatment,and the association between the diagnosis and maternal/neonatal outcomes.METHODS We searched PubMed,PubMed Central,and Google Scholar.Articles were analyzed following preferred reporting items for systematic reviews and metaanalysis.The search items included:‘ulcer’,‘PUD’,‘pregnancy’,‘puerperium’,‘postpartum’,‘gravid’,‘labor’,‘perforated ulcer’,‘stomach ulcer’,‘duodenal ulcer’,‘peptic ulcer’.Additional studies were extracted by reviewing reference lists of retrieved studies.We included all available full-text cases and case series.Demographic,clinical,obstetric,diagnostic and treatment parameters,and outcomes were collected.RESULTS Forty-three cases were collected.The mean maternal age was 30.9 years;36.6%were multiparous,and 63.4%were nulliparous or primiparous,with multiparas being older than primiparas.Peptic ulcer perforated in 44.2%of postpartum and 55.8%of antepartum patients.Antepartum PPU incidence increased with advancing gestation 2.3%in the first,7%in the second,and 46.5%in the third trimester.The most common clinical findings were abdominal tenderness(72.1%),rigidity(34.9%),and distension(48.8%).Duodenal ulcer predominated(76.7%).In 79.5%,the time from delivery to surgery or vice versa was>24 hours.The maternal mortality during the third trimester and postpartum was 10%and 31.6%,respectively.The trimester of presentation did not influence maternal mortality.The fetal mortality was 34.8%,with all deaths in gestational weeks 24-32.CONCLUSION Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum.Early intervention reduced fetal mortality but without influence on maternal mortality.Maternal mortality did not depend on the use of X-ray imaging,perforation location,delivery type,trimester of presentation,and maternal age.Explorative laparoscopy was never performed during pregnancy,only postpartum.
基金Supported by National Science and Technology Major Project,No.2024ZD0521002The Innovation Team Project of Traditional Chinese Medicine of Liaoning Province,No.LNZYYCXTD-CCCX-003+1 种基金General Program of the National Natural Science Foundation of China,No.82074296Construction Project of Inheritance Studios of Famous Chinese Medicine Experts in China,No.[2022]No.75.
文摘Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affected sites.Bletilla striata,a traditional Chinese medicinal herb,contains diverse chemical constituents and exhibits multiple pharmacological effects.As a key component in various traditional Chinese medicine compound formulations,it has demonstrated notable clinical efficacy.Moreover,it has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases.This paper systematically elaborates on the clinical efficacy and mechanisms of action of Bletilla striata in the treatment of PUs,drawing from ancient medical literature and traditional formula applications to provide support for clinical use.
文摘Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enrolled in this study between January 2022 and December 2024.Using the envelope method for randomization,the patients were divided into two equal groups:a control group administered standard triple therapy and an observation group that received the same triple therapy supplemented with rebamipide.The clinical efficacy,gastric mucosal morphology(mucosal thickness,gland density,active inflammatory cell infiltration,chronic inflammatory cell infiltration),and pepsinogen I/II were compared between the two groups.Results:The total effective rate in the observation group was significantly higher than that in the control group,with a statistically significant difference(p<0.05).After treatment,the scores of all items in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group,with statistically significant differences(p<0.05).After treatment,the ratios in both groups were significantly higher than those before treatment,and the ratio in the observation group was significantly higher than that in the control group,with statistically significant differences(p<0.05).Conclusion:Rebamipide combined with triple therapy can significantly improve the treatment efficacy of senile peptic gastric ulcers,effectively improve the histological status of the gastric mucosa,and promote the recovery of gastric mucosal function,with superior efficacy compared to triple therapy alone.
文摘BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.
文摘BACKGROUND Nonoperative management(NOM)is a promising therapeutic modality for patients with perforated peptic ulcer(PPU).However,the risk factors for poor efficacy and adverse events of NOM are a concern.AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM.METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018.Of these 272 patients,50 converted to emergency surgery due to a lack of improvement(surgical group)and 222 patients were included in the NOM group.The clinical data of these patients were collected.Baseline patient characteristics and adverse outcomes were compared between the two groups.Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU.RESULTS Adverse outcomes were observed in 71 patients(32.0%).Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU.CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes,and can be used for risk stratification in patients with PPU.
基金Supported by Science Foundation of Xiamen.No.95801.
文摘AIMS The relationship between Helicobacter pylori (Hp) and gastric epithelia in chronic gastritis and in petic ulcer was studied by transmission electron mi- croscopy (TEM). METHODS Seventy-five gastric antral biopsy speci- mens from the patients examined by six other methods for Hp were fixed in glutaraldehyde and treated with tanin acid before OsO_4 staining than routinely prooessed for TEM studies (at least 4 semi- thin sections oriented for ultrathin sections in each sample). RESULTS The bacilli were detected by TEM within gastric mucosa in 53 of 55 patients infected with Hp. Ultrathin sections especially stained with tanin acid re- vealed clearly glycocalyx by which the bacillus was connected with the epithelium. As the bacilli grouped as colony and breed,the adjacent mucous cells degerated and characterized by erosion of the juxtalu- minal cytoplasm,vacuolation or blebs,even desqua- mation of cell. Evidence was accumulated to show that the baoilli were located in the lumen attracted neu- trophils which intended to migrate into intercellular space of epithelia or into the lumen to exert the effect of Hp phagocytosis. CONCLUSIONS The sensitivity and specificity of Hp diagnosis by TEM is respectively 96% and 95%. Tanin acid is suitable for the preservation of glycocalyx of cell. The colonized bacilli,usually with the wide periplasmic pools,contributed to the spectrum degen- eration of epithelia,including mucous neck cells. If Hp infection persists,the degeneration and regeneration of mucous neck cells alternatively carried on and ultimate- ly the generative stem cells were damaged,as the result,the chronic atrophy gastritis could occure.
文摘Pro-inflammatory cytokines are produced in the gastric mucosa by inflammatory cells activated by chronic Helicobacter pylori (H. pylori) infection. Polymorphisms of these cytokine genes are associated with individual differences in gastric mucosal cytokine mRNA level, which result in differences in gastric mucosal inflammation, acid inhibition and gastroduodenal disease risk in response to H. pylori infection. Although polymorphisms of interleukin (IL)-1B, IL-1RN and TNF-A have been reported to relate well with gastric cancer and peptic ulcer risk, those of IL-2, IL-4, IL-6 and IL-8 genes are unclear. In combined analyses using data from previous studies, we found that the risk of gastric non-cardia cancer development was significantly associated with IL-4-168 C allele (OR: 0.81, 95% CI: 0.69-1.00) and IL-4-590 T allele carrier status (0.61, 0.53-0.73), and IL-6-174 G/G genotype (2<Abstract>Pro-inflammatory cytokines are produced in the gastric mucosa by inflammatory cells activated by chronic Helicobacter pylori (H. pylori) infection. Polymorphisms of these cytokine genes are associated with individual differences in gastric mucosal cytokine mRNA level, which result in differences in gastric mucosal inflammation, acid inhibition and gastroduodenal disease risk in response to H. pylori infection. Although polymorphisms of interleukin (IL)-1B, IL-1RN and TNF-A have been reported to relate well with gastric cancer and peptic ulcer risk, those of IL-2, IL-4, IL-6 and IL-8 genes are unclear. In combined analyses using data from previous stud- ies, we found that the risk of gastric non-cardia cancer development was significantly associated with IL-4-168 C allele (OR: 0.81, 95% CI: 0.69-1.00) and IL-4-590 T allele carrier status (0.61, 0.53-0.73), and IL-6-174 G/G genotype (2.02, 1.31-3.10). In peptic ulcer development, IL-2-330 G and IL-4-590 T allele carriers had a significantly decreased risk (0.37, 0.27-0.50 and 0.58, 0.34-0.99, respectively). Moreover, IL-2, IL-4, IL-6 and IL-8 gene genotypes prevalence differs among popula- tions. The inflammatory cytokine gene polymorphisms (e.g. IL-4 -590 and IL-6 -572 for gastric cancer, and IL-4-590, IL-6-572 and IL-8-251 for peptic ulcer) have a more potent influence on development of gastroduo- denal diseases in Western than East Asian populations. These cytokine gene polymorphisms, as well as those of IL-1B, IL-1RN and TNF-A, may be used to identify groups at higher risk of gastric cancer and peptic ulcer, and those suitable for their prevention by H. pylori eradication therapy in Western populations..02, 1.31-3.10). In peptic ulcer development, IL-2-330 G and IL-4-590 T allele carriers had a significantly decreased risk (0.37, 0.27-0.50 and 0.58, 0.34-0.99, respectively). Moreover, IL-2, IL-4, IL-6 and IL-8 gene genotypes prevalence differs among populations. The inflammatory cytokine gene polymorphisms (e.g. IL-4 -590 and IL-6 -572 for gastric cancer, and IL-4-590, IL-6-572 and IL-8-251 for peptic ulcer) have a more potent influence on development of gastroduo-denal diseases in Western than East Asian populations. These cytokine gene polymorphisms, as well as those of IL-1B, IL-1RN and TNF-A, may be used to identify groups at higher risk of gastric cancer and peptic ulcer, and those suitable for their prevention by H. pylori eradication therapy in Western populations.
文摘AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohort study of all patients diag-nosed with benign perforated peptic ulcer.Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010.Ulcers with a malignant neoplasia diagnosis,verified by histology after biopsy or resection,were excluded.Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes(K25.1,K25.2,K25.5, K25.6,K26.1,K26.2,K26.5,K26.6).Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures(e.g.,JDA 60,JDA 61,JDH 70 and JDH 71)were performed to enable a complete identification of all patients.Patient demographics,presentation patterns and clinical data were retrieved from hospital records and surgical notes.Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS:In the study period,a total of 172 patients with PPU were identified.The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year(95%CI:5.6-7.6)and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year(95%CI:0.7-1.6).A non-significant decline in ad-justed incidence rate from 9.7 to 5.6 occurred during the decade.The standardized mortality ratio for the whole study period was 5.7(95%CI:3.9-8.2),while the total 30-d mortality was 16.3%.No difference in in-cidence or mortality was found between genders.However,for patients≥60 years,the incidence increased over 10-fold,and mortality more than 50-fold,compared to younger ages.The admission rates outside office hours were high with almost two out of three(63%) admissions seen at evening/night time shifts and/or during weekends.The observed seasonal variations in admissions were not statistically significant. CONCLUSION:The adjusted incidence rate,seasonal distribution and mortality rate was stable.PPU fre-quently presents outside regular work-hours.Increase in incidence and mortality occurs with older age.
文摘AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS.
基金Supported by Summer studentships(2010,2011,and 2012)by Alberta Innovates-Health Solutions.Alexandra Frolkis is funded by an Alberta Innovates-Health Solutions studentship to Samuel QuanA New Investigator Award from the Canadian Institute of Health Research and a Clinical Investigator Award from Alberta Innovates-Health Solutions to Dr.MyersA New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from Alberta Innovates-Health Solutions to Dr.Kaplan
文摘AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).
基金Key Scientific and Technogical Projects of Hainan(090209, adxm20100043)National Nature Science Fandation 30860082.81260209+1 种基金Seientifie and Technological Projects of Hainan Provincial Department of Health Qiong H2009-7,Qiong H2009-11 and Qiong H2010-M-38Nature Science Fundation of Hainan Province 30853
文摘Objective:To evaluate the clinical effects of psychological interventions and drug therapy against peptic ulcer.Methods:96 patients with peptic ulcer were divided into control group with Tagamet 800 mg per evening p.o.and trial group with psychological intervention on the basis of drug treatment.Results:There were significant differences between the two groups(P【0.05), the trial group showed that the anxiety and depression cases declined obviously and effective rate of ulcer therapy was much higlier than control group.Conclusions:In sum,psychological intervention combined with drug therapy provides an effective method for ulcer treatment.
文摘AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retrospectively collected between January 2008 and December 2008.The differences were compared.RESULTS:Among all 448 cases,254(56.6%) and 194(43.4%) patients had gastric ulcers and duodenal ulcers respectively.Patients with gastric ulcers were younger than those with duodenal ulcers.Although more men existed,there was a female predominance in middle-aged cases.Patients with duodenal ulcers had a higher rate of Helicobacter pylori(H.pylori) infection(62.4% vs 43.3%,P = 0.001),and those with gastric ulcers owned a significantly higher amount of aspirin and nonsteroidal anti-inflammatory drug(NSAID) use(7.5% vs 1.5%,6.7% vs 2.1%,P = 0.001).Tobacco smoking and alcohol drinking had no different impact between these two groups.Proton-pump inhibitors and H2-receptor antagonists(H2RA) were effective,but significantly less so in cases with duodenal ulcers receiving H2RAs,or in those with H.pylori infection and a history of NSAID use.CONCLUSION:Patients with gastric ulcers had lower H.pylori infection but more aspirin or NSAID use.Antisecretory therapy was ineffective in gastric ulcers underwent H2RA treatment,and cases combined H.pylori infection and NSAID use.
基金Tehran University of Medical Sciences(TUMS,Evaluation of the Effect of P.atlantica on Ethanol-Induced Gastric Ulcer in Rats,No.94018627690)
文摘OBJECTIVE: To evaluate the efficacy of Pistacia atlantica Desf. oleoresin essential oil on peptic ulcer(PU) and its antibacterial effect on metronidazole-resistant Helicobacter pylori, as well as chemi-cal composition of the essential oil.METHODS: The essential oil was standardized using gas chromatography mass spectrometry(GC/MS) analysis. Acute toxicity of the essential oil was assessed in animal model. In vitro anti-Helicobacter pylori activity was performed through disc diffusion and minimum inhibitory concentration method. For gastroprotective assay, rats received Pistacia atlantica Desf. essential oil(25, 50 and 100 mg/kg orally) 1 h before induction of ulcer by ethanol.Macroscopic(ulcer index and protection rate) and microscopic examination were performed.RESULTS: The GC/MS analysis of the essential oil led to the identification of twenty constituents andα-pinene is predominant constituent. The essential oil was safe up to 2000 mg/kg. All Helicobacter pylori strains were susceptible to the essential oil and the MIC ranged from 275 to 1100 μg/m L. The ulcer index for treated groups was significantly reduced compared to control(P < 0.001) with EC50 value of 12.32 mg/kg. In microscopic examination, Pistacia atlantica attenuated destruction and necrosis of gastric tissue.CONCLUSION: Current study exhibited protective effect of standardized Pistacia atlantica essential oil against ethanol-induced gastric ulcer and its antibacterial activity on Helicobacter pylori. α-pinene might be the responsible agent.
文摘AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.
文摘AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
文摘AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.
文摘AIM： To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS： This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers （spurting or oozing） were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1：10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS： There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups （P 〈 0.05）. The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group （20.3%） than in the 30 （5.3%） and 40 mL （2.8 %） epinephrine groups （P 〈 0.01）. There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group （51/76） than in the 20 （2/76） and 30 mL （5/76） epinephrine groups （P 〈 0.001）. Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group （P 〈 0.01）. Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups （P 〈 0.01）.CONCLUSION： Injection of 30 mL diluted epinephrine （1：10000） can effectively prevent recurrent bleeding with a low rate of complications. The optimal injection volume of epinephrine for endoscopic treatment of an actively bleeding ulcer （spurting or oozing） is 30 mL.
文摘AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.
基金Supported by the National Natural Science Foundation of China(Intervention of Serum with Banxia Xiexin Decoction in Human Gastric Epithelial Cells Co-cultured with Helicobacter pylori in vitro Based on the TGF-β/Smad Signaling Pathway and Epigenetics,No.81403331Research on the Mechanism of Compound Prescription of Chinese Traditional Medicine Regulating the Endocannabinoid System in Non-alcoholic Steatohepatitis,No.81503529+2 种基金Mechanism of Chlorogenic Acid and Geniposide in NASH by Regulating Kupffer Cell Polarization Based on the Gut-liver Axis,No.81673660)the Natural Science Foundation of Fujian Province(Intervention of Serum with Soothing Liver and Invigorating Spleen Recipe in Hep G2.2.15 Cells via the JAK2-STAT3Signaling Pathway,No.2014J01363)the Pilot Project of Science and Technology of Fujian Province(Study of Compound Prescription of Chinese Traditional Medicine for Fibrosis Based on the Endocannabinoid System,No.2016D012)
文摘OBJECTIVE: To investigate the effect of Banxia Xiexin decoction(BXD) on Helicobacter pylori(Hp)-related peptic ulcers(PUs) and the possible mecha-nism underlying BXD actions via the transforming growth factor-β/small mothers against decapentaplegic(TGF-β/Smad) signaling pathway.METHODS: PU patients with cold-heat complex syndrome were randomly assigned to groups that received Chinese or Western medicines with 20 patients in each group. Serum was collected after 7 d of treatment. The healthy group included 20 individuals. Gastric mucosal epithelial cell line GES-1 was cultured in vitro and randomly divided into the following seven groups: control, model, healthy,Western Medicine, prior treatment, low dosage,and high dosage. After 72 h of treatment with the corresponding serum, the m RNA and protein expression levels of TGF-β1, Smad3, and Smad7 were measured by reverse transcription quantitative polymerase chain reaction and western blotting, respectively.RESULTS: The m RNA expression levels of TGF-β1 and Smad3 in GES-1 cells were increased after Hp introduction, and these increased levels were reduced by the BXD-containing serum. The protein levels of p-Smad3, but not TGF-β1 or Smad3, were significantly increased in Hp-treated GES-1 cells,and treatment with the BXD-containing serum markedly decreased the protein levels. Smad7 expression was significantly enhanced following treatment with the BXD-containing serum at transcriptional and protein levels in a dose-dependent manner.CONCLUSION: BXD regulates the TGF-β/Smad signaling pathway by inhibiting the expression of TGF-β1 and Smad3, and increasing the expression of Smad7.
文摘Peptic ulcer disease(PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer(PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirtyday mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.
