ABSTRACT
Background: Peptic ulcer disease (PUD) is a prevalent health concern. Although proton pump inhibitors (PPIs), H2 receptor blockers, prostaglandin analogs, etc., are available as anti-ulcer agents, they have their own limitations. The clinical assessment of these medications revealed adverse effects, relapse frequency, and tolerance development, raising doubts about their effectiveness. Thus, there is a need to search for newer synthetic and herbal formulations that have fewer side effects and improved efficacy. Emblica officinalis (EO) or amla has shown to have antioxidant and anti- secretory properties; hence, it was chosen for the study. Aims and Objectives: (1) The aim of this study was to screen the anti-ulcer activity of EO aqueous fruit extract in non-steroidal anti-inflammatory drug-induced peptic ulcer models of albino rats and (2) to compare the anti-ulcer effect of EO aqueous fruit extract with the standard drug omeprazole. Materials and Methods: Four groups comprising six albino rats each were formed. Group 1 (the control) received distilled water, followed by indomethacin 25 mg/kg orally. Group 2 (standard) received omeprazole 10 mg/kg, followed by indomethacin 25 mg/kg. Groups 3 and 4 received the aqueous extract of EO in 250 mg/kg and 500 mg/kg doses, respectively, followed by indomethacin at 25 mg/kg. After 1 h of indomethacin administration, the stomach was examined for ulceration. The severity score was determined to calculate the ulcer index (UI) and percentage inhibition. The results were analyzed statistically using the Mann–Whitney U-test (SPSS software version 22). Results: In the screening model mentioned above, the test agent at dosages of 250 mg/kg and 500 mg/kg body weight resulted in a significant decrease in total severity score, UI, and percentage inhibition as compared to the control group. The comparison of the results of the standard drug omeprazole with those of the test groups was statistically insignificant. Conclusion: The gastroprotective activity of amla (EO) may be due to its antioxidant and antisecretory properties. This study proves the gastroprotective action of EO.
ABSTRACT
Background: Peptic ulcer is a condition characterized by open sores resulting from excessive acid production in the stomach or digestive tract, causing damage to the mucosal lining. Tamarix gallica (TG), is traditionally known for its anti-inflammatory, antioxidant, antibacterial activity, etc. Objective: The scientific evidences based on its efficacy specifically for anti-ulcers activity are limited, hence, the study aimed to evaluate protective effect of TG against aspirin-induced peptic ulcers. Materials and Methods: Phytochemical screening was performed fol- lowed by assessment of protective effect of TG against aspirin induced toxicity in rats. Network biology and polypharmacology studies were performed to determine the possible molecular targets involved in pathophys- iology of ulcers. Results: The study revealed that the TG extract at high dose (500 mg/kg b.w.) significantly exhibits protective effect against aspirin induced ulcers via regulation of free acidity pepsin production, overall acidity via regulating antioxidant status (SOD, GSH, CAT, etc). Morphological studies revealed less damage with less disruption of the gastric mucosa layer having normal mucosal structure, no swelling or oedema was found in drug treated groups. Conclusion: Moreover, network biology and polypharmacology outcomes revealed that SOD2, CAT, EPO, IL10, EGF, TGFB1 etc. play a significant role in functional gastrointestinal-associated disease or peptic ulcer. Hence, the study concludes that TG polyphenols including phenols and flavonoids play an important role in alleviation of peptic ulcer or associated complication and thus demonstrating TG as a natural therapeutic regimen against ulcers in glance of nature.
ABSTRACT
Objectives : Evaluate Proton Pump Inhibitors (PPI) utilization in a tertiary care hospital using questionnaire- based patient self-assessment of symptom control, Quality of Life (QoL), and PPI use and safety. Methods : This cross-sectional study included inpatients with a diagnosis of acid-peptic disease, Gastroesophageal Reflux Disease (GERD), or oesophagitis and those who were on oral or parenteral PPI therapy. Inpatients were categorized as those receiving long-term PPI therapy and those started on PPI therapy after admission. Demographic data from the inpatients,diagnosis, and comorbidities, were recorded. Self-administered questionnaires for symptom control, PPI use, adverse effects and QoL were completed by all patients. Details of prescribed drugs, their brands, dosage, and the route of drug administration were also recorded. Results : The study included 228 inpatients with ages ranging between 16-88 years. A total of 215 (94.30%) patients were on 40 mg Pantoprazole and received an intravenous administration once a day (132, 57.89%). Among patients who were prescribed PPI upon admission, moderate levels of abdominal and epigastric pain were reported. The mean QoL score among inpatients was 137.54 (34.78%). Most of the patients with heartburn or burning sensation in the chest were prescribed PPI (11, 47.83%). Conclusion : In the present study, patients were appropriately prescribed PPI for acid reflux or regurgitation and other acid-related symptoms. PPI was not overutilized as most of the patients maintained the prescribed dose of once every day and most of the patients did not report any adverse events. The patients also reported improved QoL with PPI use.
ABSTRACT
Surgery for peptic ulcer disease has since long become a thing of the past, in the era of proton pump inhibitors. Today, it is difficult to believe that these were common operations about 6-7 decades ago. Such has been the impact of proton pump inhibitors (PPI), that, surgery for peptic ulcer has been relegated to the realms of history. However, even in present day, in some rare clinical situations, surgeons may have to resort to surgery for patients suffering from peptic ulcer disease. Herein, we present our experience of laparoscopic surgical management of one of those rare clinical scenarios related to severe peptic ulcer disease. The clinical condition in discussion is gastric outlet obstruction caused by severe peptic ulcer disease in the first part of duodenum. We identified 8 patients (7 males and 1 female) who underwent laparoscopic vagotomy with gastrojejunostomy for benign gastric outlet obstruction, at our institution, operated upon by a single surgeon, between 2004 to 2023. All patients had undergone oesophago-gastro-duodenoscopy (OGD scopy), and contrast enhanced computerised tomography (CECT) of the abdomen. The patients were analysed for age, sex, symptoms, pre-operative evaluation, morbidity/mortality and functional outcomes. They were also reviewed to examine the length of stay, length of procedure, complications and recurrent symptoms on follow-up.
ABSTRACT
Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage
Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.
Subject(s)
Humans , Peptic Ulcer Perforation , Postoperative Complications , Omentum , Risk FactorsABSTRACT
Objective:To explore the effect of bismuth containing triple therapy on serum gastrin (Gas), transforming growth factor-α (TGF-α), and high-sensitivity C-reactive protein (hs-CRP) levels in children with Helicobacter pylori (Hp) positive peptic ulcers.Methods:A total of 96 children with Hp positive peptic ulcers admitted to the Second Hospital of Jiaxing from January 2020 to December 2021 were selected as the study subjects. They were randomly divided into two groups using the remainder of a random number table. The control group (48 cases) received treatment with omeprazole, clarithromycin, and amoxicillin, while the observation group (48 cases) received treatment with bismuth containing triple therapy (amoxicillin+ metronidazole+ bismuth potassium citrate). After 10 days of treatment, the clinical efficacy of the two groups was evaluated The improvement time of clinical symptoms, Hp conversion rate, serum indicators (Gas, TGF-α, hs-CRP) before and after treatment, and incidence of adverse reactions were observed.Results:The total effective rate and Hp conversion rate of the observation group were significantly higher than those of the control group [95.83%(46/48) vs 81.25%(39/48), 97.92%(47/48) vs 83.33%(40/48), P<0.05]. The improvement time of upper abdominal pain, heartburn, and acid reflux symptoms was significantly shorter than that of the control group (all P<0.05). After 10 days of treatment, the serum Gas and hs-CRP levels in both groups significantly decreased compared to before treatment (all P<0.05), and the observation group was lower than the control group after treatment ( P<0.05); The levels of TGF-α in both groups increased compared to before treatment (all P<0.05), and the observation group was higher than the control group after treatment ( P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups [4.17%(2/48) vs 2.08%(1/48), P>0.05]. Conclusions:The triple therapy with bismuth containing agents has a better therapeutic effect on children with Hp positive peptic ulcers, and can promote ulcer mucosal repair by improving inflammatory response, with good safety.
ABSTRACT
Objective:To investigate the expression levels and clinical significance of serum microRNA (miR) -155 and miR-135b-5p in patients with peptic ulcer complicated with Helicobacter pylori ( Hp) infection. Methods:A prospective study was conducted, and 263 patients with peptic ulcer were selected consecutively from July 2021 to February 2023 at the Affiliated Hospital of Jining Medical College. Among them, 146 cases were confirmed as Hp infection ( Hp infection group) and 117 cases were not complicated with Hp infection (non Hp infection group) by 14C breath test; type Ⅰ Hp infection was in 110 cases, and type Ⅱ Hp infection was in 36 cases by immunoblotting method. The serum expression levels of miR-155 and miR-135b-5p were detected by real-time fluorescence quantitative polymerase chain reaction, serum gastrin level was detected by radioimmunoassay method, and the serum pepsinogen (PG) Ⅰ and PG Ⅱ were detected by enzyme linked immunosorbent assay. The clinical data were recorded. Multivariate Logistic regression analysis was used to analyze the independent risk factors of Hp infection in patients with peptic ulcer; receiver operating characteristic (ROC) curve was used to analyze the efficacy of serum miR-155 and miR-135b-5p in diagnosis the Hp infection in patients with peptic ulcer. Results:The gastrin, PG Ⅰ, PG Ⅱ, ulcer bleeding rate and recurrence rate in Hp infection group were significantly higher than those in non Hp infection group: (108.47 ± 15.35) ng/L vs. (79.63 ± 10.58) ng/L, (295.41 ± 37.26) pg/L vs. (236.75 ± 29.17) pg/L, (44.08 ± 8.52) pg/L vs. (39.29 ± 6.74) pg/L, 25.34% (37/146) vs. 15.38% (18/117) and 21.92% (32/146) vs. 11.97% (14/117), and there were statistical differences ( P<0.01 or <0.05). The serum miR-155 and miR-135b-5p in Hp infection group were significantly higher than those in non Hp infection group (1.94 ± 0.63 vs. 0.95 ± 0.29 and 1.86 ± 0.57 vs. 1.03 ± 0.31), and there were statistical differences ( P<0.01). The serum miR-155 and miR-135b-5p in patients with typeⅠ Hp infection were significantly higher than those in patients with type Ⅱ Hp infection (2.05 ± 0.66 vs. 1.60 ± 0.54 and 1.97 ± 0.61 vs. 1.52 ± 0.45), and there were statistical differences ( P<0.01). Multivariate Logistic regression analysis result showed that serum miR-155, miR-135b-5p, gastrin and PG Ⅰwere independent risk factors of Hp infection in patients with peptic ulcer ( OR = 1.443, 1.436, 1.452 and 1.438; 95% CI 1.165 to 1.787, 1.146 to 1.799, 1.187 to 1.777 and 1.150 to 1.798; P<0.01). ROC curve analysis result showed that the area under the curve of serum miR-155 combined with miR-135b-5p in the diagnosis of Hp infection in patients with peptic ulcer was significantly greater than that of serum miR-155 and miR-135b-5p alone (0.907 vs. 0.839 and 0.836, Z = 2.57 and 2.81, P = 0.010 and 0.005). Conclusions:The serum levels of miR-155 and miR-135b-5p are high in patients with peptic ulcer complicated with Hp infection, and the combination of the two has high diagnostic value for Hp infection in patients with peptic ulcer.
ABSTRACT
Objective:To investigate the clinical effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding.Methods:A total of 150 patients with cerebral infarction complicated by stress-induced gastrointestinal bleeding who were admitted to the Intensive Care Unit of Lishui City People's Hospital from October 2020 to October 2021 were included in this study. These patients were randomly divided into a control group and an observation group using the random number table method, with 75 patients in each group. Patients in the control group received routine clinical treatment, while those in the observation group received endoscopic injection of norepinephrine in addition to routine clinical treatment. The hemostatic time, blood transfusion volume, and length of hospital stay were compared between the two groups. The stress index and inflammatory index were compared between the two groups before and after treatment. The hemostatic effect and adverse reactions were evaluated in each group.Results:The hemostatic time, blood transfusion volume, and length of hospital stay in the observation group were (16.16 ± 4.36) hours, (385.35 ± 41.28) mL, and (5.35 ± 1.28) days, respectively, which were significantly shorter or less than (27.27 ± 6.34) hours, (447.07 ± 32.07) mL, and (7.07 ± 2.07) days in the control group ( t = 12.50, 10.22, 6.12, all P < 0.001). After treatment, the levels of cortisol, norepinephrine, antidiuretic hormone, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α in the observation group were (288.33 ± 19.53) mmol/L, (29.17 ± 4.26) μg/L, (4.08 ± 1.08) mU/L, (38.27 ± 8.72) ng/L, (6.69 ± 1.35) μg/L, and (6.37 ± 1.51) mg/L, respectively, which were significantly lower than (327.22 ± 22.01) mmol/L, (39.32 ± 5.54) μg/L, (5.36 ± 1.22) mU/L, (51.24 ± 13.23) ng/L, (8.67 ± 2.29) μg/L, and (11.44 ± 3.13) mg/L in the control group ( t = 11.44, 12.57, 6.80, 7.08, 6.45, 12.63, all P < 0.001). The overall response rate of hemostasis in the observation group was 94.67% (71/75), which was significantly higher than 82.67% (62/75) in the control group ( χ2 = 5.37, P < 0.05). The incidence of adverse reactions in the observation group was 8.00% (6/75), which was slightly, but not significantly, lower than 14.67% (11/75) in the control group ( χ2 = 1.66, P > 0.05). Conclusion:Endoscopic injection of norepinephrine for the treatment of cerebral infarction complicated by stress-induced gastrointestinal bleeding can rapidly stop bleeding, effectively reduce inflammation,improve stress index, and be highly safe.
ABSTRACT
A peptic ulcer (PU) is common gastrointestinal disorder which is seen among many people. It is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or first few centimeters of duodenum (duodenal ulcer) that penetrates through the muscularis mucosae. Ulceration occurs when there is a disturbance of the normal equilibrium caused by either enhanced aggression or diminished mucosal resistance. It may cause by Helicobacter pylori infection, regular usage of non-steroidal anti-inflammatory’s, irregular food habits, stress, and gastric acid secretions. There are several synthetic medications available to treat ulcers. However, compared to herbal supplements, these medications are more expensive and likely to have more side effects. Various herbal medicines have traditionally been used to cure PU disease. The active phytochemical components of a single plant are insufficient to produce the desired therapeutic effects. Combination of two or more than two herbs is called polyherbal formulation. Polyherbal formulations are used to improve the therapeutic potential. The medicinal effect will be boosted and the toxicity will be reduced when various herbs are combined in appropriate ratios in the polyherbal formulation that this study is based on the herbs, polyherbal formulations (in treating PU), recent work, and patent on polyherbal formulations based on pharmacological activities.
ABSTRACT
Background: Perforation is a serious complication of PUD and patients with perforated peptic ulcer often carries high risk for morbidity and mortality. Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in moderate resource setting environment. Aim and objective was to evaluate the different pattern of risk factors, clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer. Methods: This was a hospital based prospective observational study conducted in the Department of general surgery at Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh. Total of 79 cases with diagnosis of perforated peptic ulcer treated were taken as sample size. A specially designed proforma was used to collect information on patients' demographics, symptoms, complications, duration of hospital stay and treatment outcome. Results: In present study male predominance was seen in peptic perforation cases 68.75% and M:F ratio was 2.2:1. Mortality rate was 17.71%. Mean hospital stay among survivors was 11.8 days and among non survivors 5.5±3.73 days. Most common risk factor seen was alcohol, smoking, peptic ulcer disease and NSAIDs ingestion. Whereas the most common presentation was abdominal pain, signs of peritonitis, abdominal distension. Cases with APCHE 2 score >21 had 90% mortality. Conclusions: The present study conclude that perforated PUD is a life-threatening disease with high morbidities and mortalities. Male predominance, smoking and alcohol consumption and pain in abdomen were the common characteristics. APACHE 2 score was useful in assessing the risk of mortality.
ABSTRACT
RESUMEN La úlcera péptica es menos frecuente en las embarazadas que en las mujeres no gestantes. Aunque rara vez se perfora durante el embarazo y aún menos frecuentemente durante el puerperio, está asociada con mayor riesgo de muerte materna. El uso de analgésicos no esteroideos y la infección por Helicobacter pylori están relacionados con su patogénesis. Debido a sus características clínicas durante el embarazo, la sepsis puerperal e íleo paralítico pueden retrasar el diagnóstico. Luego del parto, signos clínicos como taquicardia de reciente aparición, dolor abdominal y el aumento de la distensión deben sugerir el diagnóstico. Dado que las complicaciones pueden provocar morbilidad y mortalidad significativas durante el puerperio, la detección precoz y el tratamiento rápido son imperativos. El tratamiento de la úlcera péptica perforada durante el puerperio es el mismo que el de una situación quirúrgica abdominal urgente. Una reparación satisfactoria con parche omental suele sellar el defecto y evitar nuevas perforaciones. Se presenta un caso de úlcera péptica perforada durante el puerperio.
ABSTRACT Peptic ulcer is less frequent in pregnant women than in non-pregnant women. Although it rarely perforates during pregnancy and even less frequently during the puerperium, it is associated with an increased risk of maternal death. The use of nonsteroidal analgesic and Helicobacter pylori infection are related to its pathogenesis. Due to its clinical features during pregnancy, puerperal sepsis and paralytic ileus may delay diagnosis. After delivery, clinical signs such as new-onset tachycardia, abdominal pain, and increased distension should suggest the diagnosis. Since complications can cause significant morbidity and mortality during the puerperium, early detection and prompt treatment are imperative. Treatment of perforated peptic ulcer during the puerperium is the same as for an urgent abdominal surgical situation. Successful repair with omental patching usually seals the defect and prevents additional perforations. A case of perforated peptic ulcer during the puerperium is presented.
ABSTRACT
This research investigated the effect of Andrographis paniculata (AP) on oxidative stress following indomethacin-induced gastric ulcer in rats. A total of 20 male albino Wistar rats (150-180g) used for this study were grouped into four (n=5): 1, Negative Control; 2, Positive Control and 3, test group treated with normal chow, 20mg/kg indomethacin, 20 mg/kg indomethacin plus omeprazole at 20mg/kg and 20mg/kg indomethacin plus AP at 16.7 mg/kg respectively. After treatment period, estimation of oxidative stress parameters was carried out on the animals. The LD50 of aqueous extract of AP was 50mg/kg bw. Body weight change was significantly reduced in omeprazole treated group compared to all other groups while extract treated group had significantly increased body weight change. There was a significant increase in malondialdehyde (MDA) level of ulcer untreated group compared to other groups. The two treated groups had significantly reduced MDA compared to ulcer untreated group. There was a significant decrease in the levels of GPx and SOD of ulcer untreated group compared to control. Meanwhile, these were significantly increased in extract and omeprazole treated groups compared to ulcer untreated group. Catalase was significantly increased in all three groups when compared to control but its level was significantly increased in extract treated group compared to ulcer untreated and omeprazole treated groups. From this study, AP has proved to protect against oxidative stress implicated in the pathogenesis of ulcer. If this result is applicable to humans, further research and use of AP in ameliorating debilitating consequences of peptic ulcer should be encouraged.
ABSTRACT
Introduction: Dyspepsia is a common condition presenting with epigastric pain that lasts at least a month and may develop peptic ulcers. Helicobacter pylori infection and lifestyle are the risk factors for peptic ulcers. So, the objective of this study was to identify the magnitude and status of Helicobacter pylori in dyspeptic patients. Material and Methods: This cross-sectional study included data from the endoscopy unit records among patients who had endoscopy for dyspepsia and biopsy taken from an antrum for the helicobacter pylori status, during June 1, 2020 and November 30, 2022 at Manmohan Memorial Medical College Teaching Hospital, Kathmandu, Nepal. Age, sex and status of histopathology findings were analyzed for association using Chi-square test and a p<0.05 was considered statistically significant. Results: Among 439 dyspeptic patients, 297 (67.7 %) had positive finding of PUD. In all investigated patients, H. pylori positive was 297(67.7%) and negative in 142(32.3 %). The mean age was 45.42 y (17 - 82), 267 (60.8%) males and 172 (39.2%) females, 33(7.5 %) had a gastric ulcer and 55(12.5%) had duodenal ulcer. Duodenal ulcers were seen in younger age (17-39 y) and gastric ulcer in older age (> 60 y) with p-value <0.0001. Gastric malignancies were found in 6 (1.4%). Conclusion: The occurrence of H. pylori with dyspeptic patients was high. Peptic ulcers were more common in young age and males than in females. Duodenal ulcers were more common than gastric for both sexes.
ABSTRACT
Gastroduodenal tuberculosis (TB) presenting as gastric outlet obstruction is rare and often misdiagnosed, it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. Gastro-duodenal involvement is rarer disease (1%) in abdominal TB. We report a case of a 43-year-old male with no evidence of pulmonary tuberculosis and retroviral infection with complaints of abdominal pain since 4 months and features of gastric outlet obstruction, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP) were suggestive of pneumobilia, and on endoscopy bilioenteric fistula was confirmed also features of pan gastritis and duodenitis with concentric wall thickening noted at D1 and D2, although histological examination of biopsies showed no evidence of malignancy or tuberculosis. The diagnosis was established after surgery, when a specimen of an enlarged lymph node was sent for histopathological examination (HPE) and GeneXpert showed the presence of giant cells and caseating granuloma. The surgery performed was Roux-en-Y gastrojejunostomy. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement. To the best of our knowledge this has been the first case reported as gastric outlet obstruction with bilioenteric fistula due to gastroduodenal tuberculosis.
ABSTRACT
Introducción: La úlcera gástrica perforada es la complicación ulcerativa más frecuente después del sangrado y la más grave de todas. A medida que se desarrolla el proceso inflamatorio la lesión gástrica evoluciona pasando por los siguientes estadíos: gastritis superficial, gastritis atrófica crónica, metaplasia intestinal, displasia y finalmente cáncer. En este proceso de evolución natural de la enfermedad radica la importancia de realizar una biopsia durante el abordaje quirúrgico de la úlcera gástrica perforada. Objetivos: Determinar la prevalencia de neoplasia en úlceras gástrica perforada en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo 2015-2020. Materiales y métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal con datos retrospectivos. Resultados: Se incluyeron 50 pacientes sometidos a cirugía por úlcera gástrica perforada. El promedio de edad fue 67,1 ±17,1 años, el 60% correspondían al sexo masculino; en el 94% se realizó reavivamiento de bordes y en el 6% antrectomía. Con respecto al diagnóstico anatomopatológico, en el 90% se confirmó proceso infamatorio, la prevalencia de neoplasia fue del 6% y en el total de los pacientes postoperados por úlcera gástrica perforada se constató un 46% de mortalidad. Conclusión: La prevalencia de neoplasia fue mínima en los pacientes sometidos a cirugía por úlcera gástrica perforada. Se identificó un alto porcentaje de mortalidad en los pacientes postoperados por úlcera gástrica perforada. El promedio de edad fue 67,1 años y predominó el sexo masculino. El procedimiento quirúrgico más frecuente fue el reavivamiento de bordes y el diagnóstico anatomopatológico más prevalente fue proceso inflamatorio.
Introduction: Perforated gastric ulcer is the most frequent ulcerative complication after bleeding and the most serious of all; as inflammation progresses, gastric lesion evolves, beginning with superficial gastritis, then chronic atrophic gastritis, intestinal metaplasia, dysplasia, and finally cancer; hence the importance of performing a biopsy in the surgical approach of perforated gastric ulcer. Objectives: To determine the prevalence of neoplasia in perforated gastric ulcers in the General Surgery service of the Hospital Central del Instituto de Previsión Social in the period 2015-2020. Materials and methods: An observational descriptive cross-sectional study with retrospective data was carried out. Results: 50 patients who underwent surgery for perforated gastric ulcer were included. The average age was 67.1 ± 17.1 years, 60% were male; 94% underwent edge revival and 6% antrectomy. Regarding the anatomopathological diagnosis, 90% confirmed the inflammatory process, the prevalence of neoplasia was 6%, and in the total number of postoperative patients for perforated gastric ulcer, 46% mortality was confirmed. Conclusion: The average age was 67.1 years and the male sex predominated. The most frequent surgical procedure was edge revival and the most prevalent pathological diagnosis was inflammatory process. The prevalence of neoplasia was minimal in patients undergoing surgery for perforated gastric ulcer. A high percentage of mortality was identified in postoperative patients for perforated gastric ulcer.
Subject(s)
Stomach Ulcer , Neoplasms , General Surgery , BiopsyABSTRACT
Background: Peptic ulcer perforation is one of the severe complications of peptic ulcer disease (PUD). Patients with perforated peptic ulcers usually are presented by the acute abdomen. In some studies, substance abuse is one of the peptic ulcer risk factors. Our study aimed to evaluate the frequency of substance abuse in patients with perforated peptic ulcers referred to Ardabil city hospital from January 2020 until March 2021.Methods: This descriptive cross-sectional study was done on 60 patients with peptic ulcer perforation in Ardabil city hospital from January 2020 until March 2021. Data collected by a checklist and analyzed by statistical methods in SPSS version 25.Results: Of all patients, 13 patients (19.7%) had substance abuse and all of them were male. Of all 13 patients with substance abuse, 9 (69.2%) had opium use.Conclusions: The results showed that substance abuse among patients with peptic ulcer perforation, can be consider as a possible risk factor for peptic ulcer perforation, but more studies should perform to identify the effective factors and variables that can be main role in peptic ulcer perforation in patients.
ABSTRACT
SUMMARY OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.
ABSTRACT
Background: Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria. Aim: This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world. Methods: Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed. Results: Over a 9 year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 1485), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged 40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU. Conclusion: The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed patients were predominantly male and older, and GU predominated.
Subject(s)
Humans , Male , Female , Peptic Ulcer , Duodenal UlcerABSTRACT
Due to the difficult eradication of Helicobacter pylori caused by gradual increase of antibiotic resistance, the widespread use of nonsteroidal anti‑inflammatory drugs, and the common use of antithrombotic therapy in the aging population, the diagnosis and treatment of peptic ulcer are more challenging than ever. To further explore a new model of diagnosis and treatment of peptic ulcer in accordance with our national conditions, the Editorial Board of Chinese Journal of Digestion organized an expert committee to develop a new version of the consensus based on "Standardized diagnosis and treatment of peptic ulcer (2016, Xi′an)". The consensus has 30 statements, divided into 9 parts, covering the definition, clinical manifestations, pharmacological treatment, treatment of complications, and prevention of peptic ulcer.
ABSTRACT
El objetivo de este artículo de actualización tiene como objetivo hacer referencia acerca de la Ulcera péptica, una de las patologías muy frecuente en el sistema digestivo que afecta la mucosa gástrica o intestinal, cuya patogenia es multifactorial y cuyas complicaciones pueden ser graves, requiriendo un adecuado manejo y tratamiento hospitalario. Esta revisión hace referencia a los factores patogénicos más frecuentes, la fisiopatología, el abordaje clínico y su tratamiento, haciendo énfasis en la terapia farmacológica, en la que se hace una revisión sucinta y completa de todas sus propiedades farmacológicas.
The objective of this update article aims to refer to peptic ulcer, one of the very common pathologies in the digestive system affecting the gastric or intestinal mucosa, whose pathogenesis is multifactorial and whose complications can be serious, requiring adequate management and hospital treatment. This review refers to the most frequent pathogenic factors, pathophysiology, clinical approach and their treatment, emphasizing pharmacological therapy, in which a succinct and complete review of all its pharmacological properties is made.