A Review on Herbal Drugs Used in the Treatment of Peptic Ulcer.

BACKGROUND: An ulcer is a condition characterized by inflammation, irritation, or erosion in the mucosal lining of the stomach or duodenum. Hence, peptic ulcer is the ulcer of both the stomach and the duodenum. 10% of the world's population is affected by chronic peptic ulcers. The formation of peptic ulcers depends on gastric juice pH and the decrease in mucosal defenses. Nonsteroidal antiinflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection are the two significant factors disrupting mucosal resistance to injury. Indian herbal plants are exceptional for their ethnic, ethnobotanical, and ethno-pharmaceutical use. In this review, attempts have been made to gain information regarding some plants that may be used to treat or prevent peptic ulcers. The ultimate goal of peptic ulcer disease treatment is to reduce pain, cure ulcers, and prevent recurrence. OBJECTIVE: The aim of the study was to gain knowledge about several common medicinal plants employed in Ayurveda or contemporary science for the treatment or prevention of peptic ulcers and some natural and simple approaches to cure ulcers using readily available herbs. METHODS: The literature search was carried out using search engines, like Google Scholar, Scopus, PubMed, Medline, Springer, etc. Results: The extensive literature search showed natural herbs to have potential anti-ulcer activity, including cabbage, bananas, liquorice, fenugreek, garlic, Terminalia chebula, Acacia arabica, Aegle marmelos, Aloe vera, Allium sativum, Plantago ispagula, Mimosa pudica, Annona squamosa, Azadirachta indica, and Galega purpurea. CONCLUSION: This study concluded several medicinal plants to effectively prevent or cure peptic ulcers caused by a variety of factors, including H. pylori, aspirin, indomethacin, alcohol, and others.

A comparative study of the common complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicines.

Osteoarthritis is the most common form of arthritis worldwide and progression of arthritis may lead to secondary complications. Osteoarthritis is the degradation of joint tissues from the effects of injury, grinding sensation and inflammation. There are three main systems of medicine including allopathic, homeopathic and herbal system for the treatment of osteoarthritis. Plants are the basis for traditional medicine which is still widely practiced today. The objective of the present study is to find out the complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicine. This study was conducted in Karachi from January 2019 to January 2020. Allopathic, Homeopathic and Herbal practitioners were consulted in the study (n=600, with= 200 in each study group). Data was analyzed by SPSS 22 version. Finding of the study suggest that after the treatment with allopathic medicines orthopaedician, family physician or rheumatologist / internal medicine specialist, there was no significant difference in complaints (Chi-square =0.598, p=0.742). Moreover, there was no significant difference in complications (Chi-square = 0.039, p=0.981). While treatment with homeopathic medicines either by orthologist or family physician significant difference in complaints were observed (Chi-square =4.86, p=0.027). The patient visiting family physicians have higher number of complications than orthologists. While treatment with herbal medicines either by orthologists or family physician there was significant difference in complaints. (Chi-square =5.404, p=0.020). The study reveals that there is no significant difference of complaints and complications in allopathic systems of medicine when treating osteoarthritis, while it is significant for homeopathic and herbal medicine.

Screening and Preponderance of Peptic Ulcer and its Contributing Risk Factors Among Basrah City Residents in Iraq.

BACKGROUND: With the recent widespread use of over-the-counter drugs, there has been a noticeable increase in the occurrence of gastrointestinal discomfort and peptic ulcer disease. However, peptic ulcer is a highly complex disorder resulting from an imbalance between gastric destructive and protective factors. OBJECTIVE: To identify the risk factors of peptic ulcer disease. METHODS: This study was organized at Al-Basra teaching hospital and Al Sader teaching hospital in Basrah city, Iraq. Medical records and questionnaires were filled by patients undergoing diagnostic and therapeutic upper gastrointestinal endoscopies following their gastric discomfort complaints. Information related to patients, disease history, and medication history for six months prior to endoscopy procedures was collected. RESULTS: A total of 476 patients were identified, including 246 (51.7%) patients with endoscopically diagnosed peptic ulcers and 230 (48.3%) patients without peptic ulcers. The population was predominately male and there were significant differences between age groups. Smoking correlated with high relative risk; however, alcohol drinking had no significant role as a causative factor. The most extensively used drugs by patients who complained of peptic ulcers include NSAIDs, iron supplements, corticosteroids, and anti-platelet agents. A small number of patients were treated for hypertension and diabetes, which were correlated with peptic ulcer risks. The presence of H-pylori infections was significantly associated with peptic ulcer diagnosis. CONCLUSION: The risk of peptic ulcer disease appeared to increase with chronic medication use and smoking, which aggravate the contributing risk by H-pylori infections.

Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study.

INTRODUCTION: Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS: This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS: There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION: In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.

[Pathogenetic bases and efficacy of slow calcium channel blockers in the therapy of recurrent peptic ulcer disease associated with hypertension]. / Patogeneticheskie osnovy i effektivnost' primeneniya blokatorov medlennykh kal'tsievykh kanalov v terapii retsidiva yazvennoi bolezni, assotsiirovannoi s arterial'noi gipertoniei.

AIM: To clarify blood calcium concentrations (BCCs) as an indicator of the functional state of the calcium-regulating system in the concomitant course of recurrent peptic ulcer disease (PUD) and hypertension, by comparing with the severity of a ulcerous process, with changes in regional microcirculation, and with the functions of the stomach. To elucidate the pathogenetic justification for and clinical efficacy of slow calcium channel blockers (SCCBs) in the treatment of this comorbidity. SUBJECTS AND METHODS: In the case-control study, each patient with recurrent PUD and grade 1, Stage I hypertension (Group 1; n=23) corresponded to a recurrent PUD patient matched for sex, age, and ulcer site (Group 2, n=23). The complex of treatment for these patients included the SCCB nifedipine. A control group consisted of 56 recurrent PUD patients who received combination therapy without nifedipine. All the patients over time underwent clinical and endoscopic examinations and determinations of BCCs, indicators of gastric secretory and motor functions, and regional microcirculation in the gastroduodenal mucosal biopsy specimens. RESULTS: Recurrent PUD was present with a reliable BCC increase that was more substantial when it was associated with hypertension. Calcium imbalance was accompanied by changes in regional microcirculation and gastric secretory and motor functional indicators forming an acid peptic factor, as well as by hypermotor dyskinesia, which were more pronounced in patients with comorbidity. Incorporation of a SCCB into a complex of therapy for recurrent PUD to eliminate the pathogenic effect of blood calcium contributed to more rapid arrest of the clinical symptoms of a recurrence, to elimination of acute-phase microcirculatory disorders in the gastroduodenal zone, and to the recovery of gastric functional indicators. Elevated blood pressure was ruled out during the therapy of concomitant diseases. CONCLUSION: Incorporation of a SCCB into the combination therapy of recurrent PUD associated with hypertension is pathogenetically sound and clinically effective.

Risk factors and prevalence rate of restless legs syndrome among pregnant women in Taiwan.

BACKGROUND: The goal of this study was to assess the prevalence and clinical correlates of restless legs syndrome (RLS) among pregnant Taiwanese women. METHODS: We enrolled 461 pregnant women (18-45 years) admitted at Mackay Memorial Hospital for delivery from September 2010 to May 2011. The face-to-face questionnaire used to gather data included assessment of RLS diagnostic criteria, and questions related to RLS. RESULTS: The overall prevalence rate of RLS among the study participants was 10.4%; 2.8% were categorized as having chronic RLS. Participants without RLS reported higher folate and iron supplement consumption than those with RLS. Multivariate analysis revealed significant associations of RLS with anemia and peptic ulcer disease. Participants with transient RLS during pregnancy reported more regular coffee consumption before pregnancy, and better sleep latency, duration, and efficiency, than those with chronic RLS. Overall, 81.2% of RLS sufferers reported sleep disturbances. CONCLUSIONS: Our study revealed highly prevalent but poorly recognized RLS among Taiwanese pregnant women. The identification of predictors such as medical comorbidities, and protectors such as folate and iron supplements, is warranted for obstetric RLS. In most cases, symptoms began during the second or third trimester and resolved within a week after delivery. Restricted coffee consumption before pregnancy is encouraged, but further evidence is needed to support this recommendation.

[Correlation between long-term proton pump ingibitor use, homocysteine and lipoproteins serum concentrations in patients with comorbidity of ischemic heart disease and acid peptic disease].

Present article is devoted to the study of the correlation between vitamin B12 serum level, hyperhomocysteinaemia and dyslipidemia. During research there were discovered that the lowest vitamin B12 serum level and the highest homocysteine serum level have been registrated in associated pathology (ischemic heart disease and acid peptic disease according to long-term proton pump inhibitor use) patients. It was shown evident correlation between that changes and dyslipidemia. Тhe complex therapy that includes parenteral B12 supplementation leads to more effective correction of hyperhomocysteinaemia and dyslipidemia in patients with comorbidity of ischemic heart disease and acid peptic disease with long-term use of proton pump inhibitors.

Etiology and treatment of childhood peptic ulcer disease in Taiwan: a single center 9-year experience.

BACKGROUND/PURPOSE: Peptic ulcer disease (PUD) in children is relatively rare as compared with adults. This study aimed to assess the etiology, clinical and histological characteristics, and treatment of PUD in children. METHODS: All children aged < 18 years with an endoscopic diagnosis of PUD were enrolled in a tertiary referral center. The demographic data, clinical, endoscopic, and histological findings were compared between patients with different causes of PUD. RESULTS: From 1234 endoscopic examinations, 67 (5.4%) children (median age, 11.4 years) with gastric ulcer (GU; n=27) or duodenal ulcer (DU; n=40) were included. Thirty-two (47.7%) of them had Helicobacter pylori infection and 11 (16.5%) had previous use of non-steroidal anti-inflammatory drugs (NSAIDs). Non-H. pylori, non-NSAID PUD was found in 24 (35.8%) patients. Children with H. pylori-related PUD had a significantly higher mean age, antral chronic inflammatory score, rate of familial PUD, and presence of DU and nodular gastritis than those with NSAID-related and non-H. pylori, non-NSAID PUD (p < 0.01). In contrast, children with NSAID-related PUD had a higher rate of upper gastrointestinal bleeding, associated with acute febrile disease, than those with H. pylori-related and non-H. pylori, non-NSAID PUD (p < 0.05). All but two patients with non-H. pylori, non-NSAID PUD were disease free after H. pylori eradication and proton pump inhibitor treatment for 1-2 months. CONCLUSION: In children, H. pylori-related PUD is associated with familial peptic ulcer and the presence of DU. However, short-term NSAID use is correlated highly with GU. The outcome of childhood PUD is good.

Bearing grudges and physical health: relationship to smoking, cardiovascular health and ulcers.

BACKGROUND: Personality traits are reported to be associated with a variety of medical comorbidities. Correlational studies report an association between 'bearing grudges' and medical conditions. We hypothesize persons reporting "bearing grudges for years" would be more likely to have medical comorbidities and test this hypothesis in an epidemiological sample. METHODS: The National Comorbidity Survey Replication is a probability sample of the US population designed to constitute a nationally representative sample (N = 9,882). Associations were measured in odds ratios (95% CI) and adjusted using logistic regression. Confounders included: gender, age, race, and smoking status. We tested the hypothesis on 14 following medical conditions: heart disease, high blood pressure, history of heart attack, asthma, diabetes, cancer, epilepsy, arthritis, neck problems, headaches, stroke, and ulcers. Significance levels were adjusted for multiple comparisons using the Bonferoni procedure. RESULTS: Positive and statistically significant associations were found, after adjusting for confounders and correcting for multiple comparisons, between bearing grudges and history of heart attack (odds ratio 2.1, 95% CI 1.5-2.9) and disease (1.6, 1.2-2.2); high blood pressure (1.5, 1.3-1.7), stomach ulcers (1.6, 1.3-1.9); arthritis (1.5, 1.3-1.9); back problems (1.6, 1.4-1.8); headaches (1.8, 1.6-2.1); and chronic pain (1.7, 1.4-2.1). No association was found with history of asthma, diabetes, epilepsy, allergies, stroke, and cancer. CONCLUSIONS: In a population-based survey, bearing grudges is associated with a history of pain disorders, cardiovascular disease, and stomach ulcers. These results point to the importance of psychosomatic research in medical settings.

[Rehabilitation treatment of patients with erosive-ulcerative lesions in the gastroduodenal system in sanatorium conditions].

The present study has demonstrated that the treatment of patients with erosive-ulcerative lesions in the gastroduodenal system at the stages of after-treatment and rehabilitation based on the combined application of natural curative factors and essential phospholipids makes to possible to increase the efficiency of therapy by 18-20% compared with control.

Proton pump inhibitors and hospital discharge rates for gastrointestinal events in Italy: a national ecological study.

BACKGROUND: Several meta-analyses have supported the efficacy of proton pump inhibitors (PPIs) both in the treatment of peptic ulcers and in the prevention of ulceration, perforation, and hemorrhage from the upper gastrointestinal tract. PPIs have been associated with reducing the risk for recurrent ulcer bleeding and ulcer-related surgery, but they have not been associated with reduced mortality rate. OBJECTIVES: The aim of the current analysis was to conduct a national ecological study exploring the relationship between the consumption of PPIs and hospital discharge rates for gastrointestinal events. We also analyzed the potential savings for the Italian National Health Service (INHS) obtained by a reduction in hospitalizations for gastrointestinal events. METHODS: Data provided by the Italian Ministry of Health allowed us to calculate the annual number of hospital discharge rates from 2000 to 2003 for gastrointestinal events and the national expenditure and consumption rates (expressed as defined daily doses [DDDs] per 1000 population per day) for histamine-2-receptor antagonists, prostaglandins, PPIs, and for other drugs prescribed for peptic ulcer and gastroesophageal reflux disease. RESULTS: The results of this study suggest that there was a statistically significant relationship between the rate of hospital discharge for gastrointestinal events and PPI consumption r = -0.99; P = 0.003). An estimated mean increase of 180.8% in the number of DDDs for PPIs was found among all Italian regions. This drug's consumption increase was associated with an increase of 61.1% in the drug expenditure for treatment of peptic ulcer and gastroesophageal reflux diseases. At the same time, there was a 23.3% reduction in hospital discharge rates for gastrointestinal events and a reduction of 24.5% in the expenditure sustained by INHS for reimbursement of diagnosis-related group tariffs. In Italy there was an absolute increase of 353 Euro million in the expenditure for gastroprotective drugs and a reduction of 39.6 million Euro in the expenditure for reimbursements due to hospitalization for gastrointestinal events. CONCLUSIONS: Based on the results of this study in the Italian population, an increase of PPI consumption was observed to coincide with a reduction of hospital admissions for gastrointestinal events. Although this was not a cost-effectiveness analysis, and some relevant societal costs were not considered, this study found that for each 1000 Euro spent for gastroprotective drugs a reduction of 112 Euro was observed in the expenditure for hospital admissions due to gastrointestinal events. This finding also suggests that there is room for improvement in the utilization of PPIs for public health protection in Italy.

Treatment options in knee osteoarthritis: the patient's perspective.

BACKGROUND: The objectives of this study were to (1) examine patient treatment preferences for knee osteoarthritis, (2) determine the influence of specific medication characteristics on patients' choices, and (3) examine whether patient preferences are consistent with current practice. METHODS: A total of 100 consecutive patients with symptomatic knee osteoarthritis completed an interactive computer questionnaire administered during a face-to-face interview. We measured the relative impact of specific medication characteristics (including administration, risks, benefits, and cost) on patients' choice, and the percentage of patients preferring nonselective nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, glucosamine and/or chondroitin sulfate, opioid derivatives, and capsaicin across varying risks, benefits, and costs. RESULTS: Of the characteristics studied, variation in the risk of common adverse effects and gastrointestinal ulcer had the greatest impact on patients' choice. Assuming patients are responsible for the full cost of their medications, over 40% prefer capsaicin. Cyclooxygenase-2 inhibitors become patients' preferred choice only if they are described as being 3 times as effective as capsaicin and are covered by insurance. Nonselective NSAIDs are among the least preferred options across all simulations. CONCLUSIONS: When evaluating multiple alternatives, many older patients with knee osteoarthritis are willing to forgo treatment effectiveness for a lower risk of adverse effects. The patient treatment preferences derived in this study conflict with the current widespread use of nonselective NSAIDs in older patients with arthritis.

Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults.

BACKGROUND: No population based prospective cohort study has previously assessed the impact of multiple risk factors, including Helicobacter pylori infection, on the incidence of peptic ulcer disease (PUD). AIMS: To identify risk factors for PUD and estimate their relative impact on ulcer incidence. SUBJECTS: Random sample of 2416 Danish adults with no history of PU. METHODS: Sample members were interviewed in 1982 and 1994. PUs diagnosed within the observation period were verified through medical records. Information on psychosocial factors, lifestyle practices, and medication was obtained from a questionnaire completed at study entry. H pylori infection status was determined by ELISA. RESULTS: The main risk factors for PUD were H pylori infection (odds ratio 4.3 (95% confidence interval 2.2; 8.3)), tobacco smoking (3.8 (1.7; 9.8)), and use of minor tranquillisers (3.0 (1.4; 6.6)). Intake of non-steroid anti-inflammatory drugs did not affect the incidence of PUD (0.4 (0.1; 2.3)). In those with increased antibodies to H pylori, tobacco smoking (12.7 (2.8; 56.8)) and intake of spirits (2.4 (1.1; 5.4)) increased the risk of PUD whereas moderate leisure time physical activity (0.3 (0.2; 0.7)) protected against PUD. CONCLUSIONS: Tobacco smoking and H pylori infection are the main risk factors for PUD in Danish adults. Physical activity may protect against PUD in those infected with H pylori.

[Evolution of the sensitivity of 235 strains of Helicobacter pylori from 1995 to 1998 and impact of antibiotic treatment]. / Evolución de la sensibilidad de 235 cepas de Helicobacter pylori entre 1995 y 1998 e impacto del tratamiento antibiótico.

BACKGROUND: The aim of this study was to investigate the sensitivity of Helicobacter pylori to the antibiotics used in its eradication over a period of four years and to determine the influence of previous treatment on sensitivity. MATERIAL AND METHODS: During the period from 1995 to 1998 we determined the sensitivity of 235 consecutive Helicobacter pylori isolates to amoxicillin, metronidazole, clarythromycin and tetracycline by means of E-test methodology. The MIC values found were related with the prior use of eradicating treatment. RESULTS: The percentage of resistant strains were as follows: 23.5% to metronidazole, 12.9% to clarythromycin and 0.7% to tetracycline; none of the strains was resistant to amoxicillin. There were no significant changes in percentage of resistance to the drugs studied over the 4-year period. Resistance to metronidazole and clarythromycin was significantly higher (p 5 0.03 and p < 0.001 respectively) in strains isolated from patients who had received previous treatment. CONCLUSIONS: Monitorization of H. pylori sensitivity to the drugs used in its eradication is particularly important in patients who have undergone prior treatment.

Genetic and life-style determinants of peptic ulcer. A study of 3387 men aged 54 to 74 years: The Copenhagen Male Study.

BACKGROUND: In the Copenhagen Male Study men with the Lewis blood group phenotype Le(a+b-), non-secretors of ABH antigen, and men with the O or the A phenotype in the ABO blood group have been found to have a significantly higher lifetime prevalence of peptic ulcer than others. We investigated the importance of the association of these genetic markers, life-style factors, and social class with lifetime risk of peptic ulcer, testing specifically the hypothesis that the strength of the association of risk factors with peptic ulcer depends on genetic susceptibility. METHODS: Three thousand three hundred and forty-six white men 55-74 years old were included for study. From a questionnaire validated during an interview information was obtained about life-style factors and peptic ulcer history (gastric or duodenal). Potential non-genetic risk factors examined were smoking history, alcohol consumption, physical activity level, consumption of tea and coffee, and use of sugar in tea or coffee. RESULTS: Three hundred and eighty-four men (11.5%) had a history of peptic ulcer; 120 (3.6%) had had an operation due to peptic ulcer. Non-genetic peptic ulcer risk factors identified were ever having been a smoker, use of sugar in tea or coffee, abstention from tea consumption, and low social class. On the basis of these and the genetic factors, it was possible to identify a low-risk group (n = 142) with a lifetime prevalence of 4.2%, several intermediate-risk groups, and a high-risk group (n = 55) with a prevalence of 29%; the odds ratio with 95% confidence limits (OR) was 9.3 (3.4-25.3). Corresponding values with regard to operation were 1.4% and 20.0%; OR = 17.5 (3.7-82.0). Several significant interactions were found; for example, the use of sugar was associated with peptic ulcer risk only when interacting with genetic risk groups. CONCLUSIONS: Considering the role of Helicobacter pylori, it is interesting that the factors identified in this study were able to identify groups with extremely different lifetime risks. This finding and also the finding of strong interactions between genetic and life-style factors and between genetic factors and social class for the risk of peptic ulcer may have both public-health and clinical implications.

Características clinicoepidemiológicas de la ulcera gastroduodenal detectadas en consultorios de médicos de la familia / Clinical and epidemiological characteristics of gastric ulcer in the counselling of physician family

Se realizó un estudio descriptivo de 45 pacientes con úlcera doudenal pertenecientes a 3 consultorios de médicos de la familia, correspondientes al área de salud del Policlínicos Docentes "19 de Abril" en 1991. Encontramos la existencia de un bajo porcentaje de úlcera gastroduodenal con 2,2 por 100 habitantes, con un predominio en el sexo masculino, el grupo etáreo más afectado fue el de 45 a 54 años. Entre los factores relacionados con la aparición de la úlcera se encuentra la ingestión de café (82,2

), como hábito tóxico más frecuente; y la aspirina (31,1

) como medicamento ulcerogénico más usado. De acuerdo con la ocupación, los más afectados fueron los obreros (31,1

). El síntoma más referido fue la acidez (86,6

); el sangramiento digestivo alto fue complicación que más se encontró (20

). El examen complementario más usado para el diagnóstico fue la radiografía de estómago-duodeno, seguida de la gastroscopia; el tratamiento preferido fue el uso de los sedantes (AU)

Características clinicoepidemiológicas de la ulcera gastroduodenal detectadas en consultorios de médicos de la familia / Clinicoepidemiological characteristics of the gastric ulcer of the consulting of phycisians family

Se realizó un estudio descriptivo de 45 pacientes con úlcera doudenal pertenecientes a 3 consultorios de médicos de la familia, correspondientes al área de salud del Policlínicos Docentes "19 de Abril" en 1991. Encontramos la existencia de un bajo porcentaje de úlcera gastroduodenal con 2,2 por 100 habitantes, con un predominio en el sexo masculino, el grupo etáreo más afectado fue el de 45 a 54 años. Entre los factores relacionados con la aparición de la úlcera se encuentra la ingestión de café (82,2 por ciento ), como hábito tóxico más frecuente; y la aspirina (31,1 por ciento ) como medicamento ulcerogénico más usado. De acuerdo con la ocupación, los más afectados fueron los obreros (31,1 por ciento ). El síntoma más referido fue la acidez (86,6 por ciento ); el sangramiento digestivo alto fue complicación que más se encontró (20 por ciento ). El examen complementario más usado para el diagnóstico fue la radiografía de estómago-duodeno, seguida de la gastroscopia; el tratamiento preferido fue el uso de los sedantes

Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study.

OBJECTIVE: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. DESIGNS: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. SETTING: A multidisciplinary ICU from a tertiary care referral center. PATIENTS: Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition. INTERVENTIONS: On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs). MAIN RESULTS: The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant. CONCLUSIONS: Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.

Aspirin use and chronic diseases: a cohort study of the elderly.

OBJECTIVE: To evaluate the associations between the use of aspirin and the incidences of cardiovascular diseases, cancers, and other chronic diseases. DESIGN: Postal questionnaire survey to elicit details of aspirin use. SETTING: Californian retirement community. SUBJECTS: All 22,781 residents of the community (white, affluent, and well educated) were sent a questionnaire that included questions on medical history and the use of drugs such as analgesics, laxatives, and vitamin supplements. In all 61% responded (13,987, 8881 women and 5106 men; median age 73). They formed the cohort that was followed up for 6 1/2 years using discharge summaries from three hospitals serving the area and death certificates from the health department. Only 13 respondents were lost to follow up but seemed not to have died. MAIN OUTCOME MEASURES: Incidences of cardiovascular diseases, cancers, gastrointestinal bleeding, ulcers, and cataracts were compared in participants who did and did not take aspirin daily. RESULTS: Age adjusted incidences were computed with an internal standard and five age groups. By 1 January 1988 there had been 25 incident cases of kidney cancer among all participants; 341 incident cases of stroke, 253 of acute myocardial infarction, 220 of ischaemic heart disease, and 317 of other heart disease were reported among respondents without a reported history of angina, myocardial infarction, or stroke. The incidence of kidney cancer was raised among those who took aspirin daily compared with those who did not take it, although the increase was significant only in men (relative risks = 6.3, 95% confidence interval 2.2 to 17, for men and 2.1, 0.53 to 8.5, for women). Those who took aspirin daily showed no increased risk of any other cancer, except colon cancer for both sexes combined (relative risk = 1.5, 1.1 to 2.2). The risk of acute myocardial infarction was reduced slightly among regular users of aspirin in men but not women. The risk of ischaemic heart disease was almost doubled in those who took aspirin daily compared with non-users (relative risks = 1.9, 1.1 to 3.1, for men and 1.7, 1.1 to 2.7, for women). Small, non-significant increased risks of stroke were observed in both sexes. CONCLUSION: The daily use of aspirin increased the risk of kidney cancer and ischaemic heart disease.

Campylobacter pylori and gastroduodenal ulcer disease. A prospective study in a Swedish population.

In a consecutive prospective series of 208 Swedish primary peptic ulcer patients, 146 gastric, 55 duodenal and 7 in both sites, gastroduodenitis was found in 97.6% of the cases. The mucosal inflammation was associated with CP in 87% and 91% of the gastric and duodenal ulcer cases respectively. No significant correlation was found between CP colonisation and the type or severity of mucosal inflammation. Gastric metaplasia was present in only 8% of 48 bulbar ulcer cases. Ulcer healing and eradication of CP was achieved in 52% of patients treated with bismuth subnitrate in combination with erythromycin or according to the triple approach.