ABSTRACT
BACKGROUND AND GOALS: Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. METHODS: Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. RESULTS: A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. CONCLUSIONS: The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.
Subject(s)
Hemostasis, Endoscopic , Hospital Mortality , Peptic Ulcer Hemorrhage , Humans , Male , Female , Aged , Retrospective Studies , United States/epidemiology , Middle Aged , Peptic Ulcer Hemorrhage/therapy , Peptic Ulcer Hemorrhage/epidemiology , Peptic Ulcer Hemorrhage/mortality , Hemostasis, Endoscopic/statistics & numerical data , Treatment Outcome , Duodenal Ulcer/epidemiology , Duodenal Ulcer/therapy , Duodenal Ulcer/complications , Health Resources/statistics & numerical data , Health Resources/economics , Stomach Ulcer/epidemiology , Stomach Ulcer/therapy , Stomach Ulcer/complications , Aged, 80 and over , Adult , Length of Stay/statistics & numerical dataABSTRACT
The detailed comorbidity patterns of community-dwelling older adults have not yet been explored. This study employed a network-based approach to investigate the comorbidity patterns of community-dwelling older adults living alone. The sample comprised a cross-sectional cohort of adults 65 or older living alone in a Korean city (n = 1041; mean age = 77.7 years, 77.6% women). A comorbidity network analysis that estimates networks aggregated from measures of significant co-occurrence between pairs of diseases was employed to investigate comorbid associations between 31 chronic conditions. A cluster detection algorithm was employed to identify specific clusters of comorbidities. The association strength was expressed as the observed-to-expected ratio (OER). As a result, fifteen diseases were interconnected within the network (OER > 1, p-value < .05). While hypertension had a high prevalence, osteoporosis was the most central disease, co-occurring with numerous other diseases. The strongest associations among comorbidities were found between thyroid disease and urinary incontinence, chronic otitis media and osteoporosis, gastric duodenal ulcer/gastritis and anemia, and depression and gastric duodenal ulcer/gastritis (OER > 1.85). Three distinct clusters were identified as follows: (a) cataracts, osteoporosis, chronic otitis media, osteoarthritis/rheumatism, low back pain/sciatica, urinary incontinence, post-accident sequelae, and thyroid diseases; (b) hyperlipidemia, diabetes mellitus, and hypertension; and (c) depression, skin disease, gastric duodenal ulcer/gastritis, and anemia. The results may prove valuable in guiding the early diagnosis, management, and treatment of comorbidities in older adults living alone.
Subject(s)
Anemia , Duodenal Ulcer , Gastritis , Hypertension , Osteoporosis , Otitis Media , Urinary Incontinence , Humans , Female , Aged , Male , Independent Living , Cross-Sectional Studies , Duodenal Ulcer/epidemiology , Home Environment , Comorbidity , Hypertension/epidemiology , Osteoporosis/epidemiology , Gastritis/epidemiology , Anemia/epidemiology , Otitis Media/epidemiology , Urinary Incontinence/epidemiologyABSTRACT
Infection by certain pathogens is associated with cancer development. We conducted a case-cohort study of ~2500 incident cases of esophageal, gastric and duodenal cancer, and gastric and duodenal ulcer and a randomly selected subcohort of ~2000 individuals within the China Kadoorie Biobank study of >0.5 million adults. We used a bead-based multiplex serology assay to measure antibodies against 19 pathogens (total 43 antigens) in baseline plasma samples. Associations between pathogens and antigen-specific antibodies with risks of site-specific cancers and ulcers were assessed using Cox regression fitted using the Prentice pseudo-partial likelihood. Seroprevalence varied for different pathogens, from 0.7% for Hepatitis C virus (HCV) to 99.8% for Epstein-Barr virus (EBV) in the subcohort. Compared to participants seronegative for the corresponding pathogen, Helicobacter pylori seropositivity was associated with a higher risk of non-cardia (adjusted hazard ratio [HR] 2.73 [95% CI: 2.09-3.58]) and cardia (1.67 [1.18-2.38]) gastric cancer and duodenal ulcer (2.71 [1.79-4.08]). HCV was associated with a higher risk of duodenal cancer (6.23 [1.52-25.62]) and Hepatitis B virus was associated with higher risk of duodenal ulcer (1.46 [1.04-2.05]). There were some associations of antibodies again some herpesviruses and human papillomaviruses with risks of gastrointestinal cancers and ulcers but these should be interpreted with caution. This first study of multiple pathogens with risk of gastrointestinal cancers and ulcers demonstrated that several pathogens are associated with risks of gastrointestinal cancers and ulcers. This will inform future investigations into the role of infection in the etiology of these diseases.
Subject(s)
Duodenal Neoplasms , Duodenal Ulcer , Epstein-Barr Virus Infections , Gastrointestinal Neoplasms , Helicobacter Infections , Helicobacter pylori , Hepatitis C , Adult , Humans , Cohort Studies , Duodenal Ulcer/epidemiology , Duodenal Ulcer/complications , Ulcer/complications , Seroepidemiologic Studies , Epstein-Barr Virus Infections/complications , Herpesvirus 4, Human , Cardia , Hepatitis C/complications , Hepatitis C/epidemiology , Helicobacter Infections/complications , Helicobacter Infections/epidemiologyABSTRACT
Duodenal ulcer perforation, a frequent surgical emergency, needs simple closure with indirect Graham's Omentopexy which is effective with excellent results in majority of cases despite patients' late presentation. The objective of the study was to determine the frequency of postoperative complications of perforated duodenal ulcer, conducted in the Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, from March 20, 2018 to September 20, 2018. The study was a descriptive case series of 108 patients of both genders with perforated duodenal ulcer > 1 week old with ASA score I & II. Patients with trauma and comorbidities were excluded. The patients underwent laparotomy and peritoneal toilet, and after noting the site of perforation indirect Graham's Omentopexy was performed. Complications like duodenal fistula, peritonitis, and paralytic ileus, and patient's death within 10 days of surgery were noted. Age ranged from 18 to 50 years with mean age of 35.027±5.13 years, mean weight 71.120±12.77 kg, mean height 1.541 ±0.09 metres, mean BMI 29.975±4.99 kg/m2, and the mean duration of complaint was 4.194±1.30 weeks. Male predominance in 75 (69.4%) patients. Duodenal fistula was seen in 10 (9.3%) patients, peritonitis 12 (11.1%), paralytic ileus 14 (13%) and mortality was in 11 (10.2%) patients.
Subject(s)
Duodenal Ulcer , Fistula , Peptic Ulcer Perforation , Peritonitis , Humans , Male , Female , Adult , Infant , Duodenal Ulcer/complications , Duodenal Ulcer/epidemiology , Duodenal Ulcer/surgery , Risk Factors , Peptic Ulcer Perforation/epidemiology , Peptic Ulcer Perforation/surgery , Peptic Ulcer Perforation/complications , Peritonitis/complicationsABSTRACT
OBJECTIVES: Most research on duodenal ulcers has focused on bulbar ulcers; details on post-bulbar ulcers remain largely unknown. This study was conducted to determine the characteristics of patients with post-bulbar duodenal ulcers depending on their location. METHODS AND MATERIALS: We conducted a retrospective study of hospitalized patients newly diagnosed with duodenal ulcers on endoscopy at a tertiary referral center in Japan between April 2004 and March 2019. Five hundred fifty-one patients diagnosed with duodenal ulcers were extracted for analysis. RESULTS: Ulcers were observed only in the bulbus in 383 cases, only in the post-bulbar duodenum in 82 cases, and were co-existing in both areas in 86 cases. The Bulbar group had less comorbidities and was more likely to have atrophic gastritis, while the Post-bulbar and Co-existing groups were more likely to be admitted for non-gastrointestinal conditions. Regular acid suppressant use was more common in the post-bulbar group than in the Bulbar group. Bulbar ulcers were associated with a shorter length of stay relative to post-bulbar and co-existing ulcers, but ulcer location was not an independent predictor of length of stay. Patients with co-existing bulbar and post-bulbar ulcers have characteristics similar to those with post-bulbar ulcers alone. CONCLUSION: Patients with post-bulbar ulcers and those with co-existing bulbar and post-bulbar ulcers have different characteristics and outcomes relative to patients with bulbar ulcers.
Subject(s)
Duodenal Ulcer , Humans , Duodenal Ulcer/complications , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Ulcer , Retrospective Studies , Duodenum , Endoscopy, GastrointestinalABSTRACT
Background/objectives: To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent upper gastrointestinal endoscopy (UGIE) in the Zanzibar Archipelago, Tanzania. Methods: Between December 2013 and October 2021, a total of 3146 eligible participants were finally recruited in present retrospective cohort. Demographic information and endoscopic findings of each participant was retrieved. H. pylori infection was confirmed by rapid-urease test of gastric antral and body biopsies at endoscopy. Results: Among the recruited subjects, 1691 (53.76%) are females, remaining 1455 (46.24%) are males. The median age of this retrospective cohort was 40 years ranging from 8 to 97 years. The common identified endoscopic findings included gastro-duodenitis, normal endoscopic finding, peptic ulcer disease (PUD), esophagitis, esophagogastric varices, esophageal and gastric cancer, respectively. After adjustment for sex and age, a significant risk of gastric and/or duodenal ulcer (OR, 2.51; 95% CI, 1.82-3.48, P<0.001) and gastric cancer (OR, 3.49; 95% CI, 1.27-9.58, P=0.015) in H. pylori positive group was observed. Stratified analysis indicated a significant relationship between duodenal ulcer with younger age (adjusted OR, 0.98; 95% CI, 0.97-0.99, p = 0.002), and the presence of H. pylori (OR, 2.01; 95% CI, 1.12-3.91, p= 0.021). Conclusions: The present study revealed that gastro-duodenitis, PUD, and normal finding are the most common endoscopic diagnoses in Zanzibar. The presence of H. pylori is significantly associated with duodenal ulcer and gastric cancer.
Subject(s)
Duodenal Ulcer , Duodenitis , Esophageal Neoplasms , Helicobacter Infections , Helicobacter pylori , Peptic Ulcer , Stomach Neoplasms , Male , Female , Humans , Adult , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Retrospective Studies , Tanzania/epidemiology , Duodenitis/complications , Stomach Neoplasms/diagnosis , Stomach Neoplasms/epidemiology , Peptic Ulcer/epidemiology , Peptic Ulcer/complications , Endoscopy, Gastrointestinal , Helicobacter Infections/diagnosis , Helicobacter Infections/epidemiology , Helicobacter Infections/complicationsABSTRACT
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 14-85), 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 were significantly more likely to be diagnosed with DU than GU (54.7% vs. 33.9%, P = 0.016) while those >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.
Résumé Fond: L'ulcère gastro-duodénal (UIP) est courant dans le monde entier. Son incidence et sa prévalence ont diminué ces dernières années dans les pays développés et une tendance similaire a été observée dans de nombreuses régions d'Afrique, y compris au Nigeria. Avoir pour but: Fournir une mise à jour endoscopique sur l'ulcère peptique dans la savane du nord du Nigéria et comparer avec les rapports antérieurs de la région et les rapports récents du Nigéria, d'Afrique et du reste du monde. Méthodes: Les dossiers d'endoscopie gastro-intestinale supérieure de patients consécutifs diagnostiqués avec PUD entre janvier 2014 et septembre 2022 dans une unité d'endoscopie d'un établissement tertiaire du nord-ouest du Nigeria ont été récupérés et les données démographiques, les types d'ulcère peptique et leurs caractéristiques ont été extraits et analysés. Résultats: Sur une période de neuf ans, 171/1 958 (8,7 %) des patients ont reçu un diagnostic de PUD : âge moyen 48,8 ans (extrêmes 14 85), 68,4 % hommes, 70 % > 40 ans. 59,6 % étaient des ulcères gastriques (UG), 31,6 % des ulcères duodénaux (UD) et 8,8 % étaient les deux. L'âge moyen des patients avec GU était légèrement plus élevé que ceux avec DU (49,9 ans contre 46,6 ans, P = 0,29) ; les patients âgés de < 40 ans étaient significativement plus susceptibles d'être diagnostiqués avec DU que GU (54,7 % contre 33,9 %, P = 0,016) tandis que ceux de > 40 ans étaient significativement plus GU que DU (74,6 % contre 54,7 %, P = 0,016) . Il n'y avait pas de différences significatives entre les sexes entre GU et DU. Conclusion: La prévalence et le schéma du PUD dans la savane du nord du Nigéria ont changé - les patients étaient principalement des hommes et plus âgés, et les GU prédominaient. Mots-clés: Ulcère peptique, épidémiologie, Kaduna-Nigeria, Ulcère gastrique, Ulcère duodénal.
Subject(s)
Duodenal Ulcer , Peptic Ulcer , Stomach Ulcer , Humans , Male , Middle Aged , Adolescent , Young Adult , Adult , Aged , Aged, 80 and over , Female , Prevalence , Nigeria/epidemiology , Peptic Ulcer/epidemiology , Peptic Ulcer/diagnosis , Peptic Ulcer/etiology , Duodenal Ulcer/epidemiologyABSTRACT
AIM: To assess of the ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease (PUD), chronic gastritis and chronic duodenitis relative to the total number of people treated in the gastroenterological departments of the hospital in 20102019. MATERIALS AND METHODS: Data of the annual reports of the work of the hospital departments were studied retrospectively. RESULTS: The relative number of persons hospitalized for chronic duodenitis decreased 2.8 times (p0.001), but the proportion of patients with chronic gastritis did not tend to decrease. This is most likely due to diagnostic errors. The cases of hospitalization of persons with uncomplicated PUD decreased by 3.1 times (p0.001), the proportion of men with duodenal ulcer decreased by 6.3 times (p0.001), with gastric ulcer decreased 1.9 times (p0.01). The proportion of women hospitalized with duodenal ulcer decreased 2.3 times (p0.01). The number of hospitalized men with duodenal ulcer is 3.8 times more than females (p0.001). It can be explained by a decrease in social stressful influences and active anti-Helicobacter pylori therapy. CONCLUSION: Over the period of follow-up, the cases of hospitalization of patients with uncomplicated PUD decreased, primarily due to a decrease in the proportion of persons with ulcer of the duodenum and duodenitis, while the number of patients with chronic gastritis not undergoing modern examination did not have significant dynamics.
Subject(s)
Duodenal Ulcer , Duodenitis , Gastritis , Helicobacter Infections , Peptic Ulcer , Male , Humans , Female , Duodenitis/diagnosis , Duodenitis/epidemiology , Duodenitis/complications , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Gastritis/diagnosis , Gastritis/epidemiology , Retrospective Studies , Peptic Ulcer/diagnosis , Peptic Ulcer/epidemiology , Peptic Ulcer/complications , Hospitalization , Chronic Disease , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Helicobacter Infections/epidemiologyABSTRACT
BACKGROUND: Low-dose aspirin is a risk factor for peptic ulcer disease but previous, population-based cohort studies may have underestimated the low-dose aspirin risk because they did not use a new-user design. Gastrointestinal bleeding occurs more frequently early after initiation of low-dose aspirin therapy than in later years. AIM: To assess the associations of low-dose aspirin with gastric and duodenal ulcer incidence in prevalent- and new-user design. METHODS: Multivariate Cox regression models in the German ESTHER study (N = 7737) and the UK Biobank (N = 213,598) with more than 10 years of follow-up. RESULTS: In the prevalent-user design, there was no significant association between low-dose aspirin and gastric ulcer observed in both cohorts. Furthermore, low-dose aspirin was weakly, statistically significantly associated with prevalent duodenal ulcer in the UK Biobank (hazard ratio [95% confidence interval]: 1.27 [1.07-1.51]) but not in the ESTHER study (1.33 [0.54-3.29]). When restricting the exposure to only new users, the hazard ratios for incident gastric and duodenal ulcer disease were 1.82 [1.58-2.11] and 1.66 [1.36-2.04] in the UK Biobank, respectively, and 2.83 [1.40-5.71] and 3.89 [1.46-10.42] in the ESTHER study, respectively. CONCLUSIONS: This study shows that low-dose aspirin is an independent risk factor for both gastric and duodenal ulcers. The associations were not significant or weak in the prevalent-user design and strong and statistically significant in the new-user design in both cohorts. Thus, it is important to weigh risks against benefits when low-dose aspirin treatment shall be initiated and to monitor adverse gastrointestinal symptoms after the start of low-dose aspirin therapy.
Subject(s)
Duodenal Ulcer , Peptic Ulcer , Stomach Ulcer , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Aspirin/adverse effects , Duodenal Ulcer/chemically induced , Duodenal Ulcer/epidemiology , Gastrointestinal Hemorrhage/epidemiology , Humans , Peptic Ulcer/complications , Risk Factors , Stomach Ulcer/chemically induced , Stomach Ulcer/epidemiologyABSTRACT
OBJECTIVES: To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children. METHODS: A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups. RESULTS: A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05). CONCLUSIONS: Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Subject(s)
Duodenal Ulcer , Helicobacter Infections , Helicobacter pylori , Abdominal Pain , Child , Duodenal Ulcer/complications , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Endoscopy, Gastrointestinal/adverse effects , Female , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Humans , Male , Retrospective Studies , UlcerABSTRACT
BACKGROUND: The present study investigated the prevalence of Helicobacter pylori infection in peptic ulcer patients referred to the endoscopy departments in Khorramabad hospitals during 2013- 2016. METHODS: The early pool of the study included all patients who had been referred to the endoscopy department and whose endoscopic and pathology reports were available and complete. After recording endoscopic reports, 1224 peptic ulcer (gastric or duodenal ulcer) cases, in which biopsy assays were performed to examine the type of ulcer and the presence of Helicobacter pylori bacteria, were selected. Pathology reports were collected by referring to the pathology departments. The information in the pathology report, including demographic information, was included in a pre-designed questionnaire to match the endoscopic reports, the location of the pathology sample, and other details, including the presence or absence of Helicobacter pylori bacteria. Finally, the data were analyzed using SPSS, version 21. RESULTS: For all the 1224 patients studied, the mean age was 15.5 ± 17.5 years old. A total of 664 (54.2%) cases had gastric ulcers, 445 (36.4%) cases had duodenal ulcers, and 115 (9.4%) had both gastric and duodenal ulcers. Among gastric ulcer patients, 512 (65.7%) had a gastric ulcer in the antrum area, and 74.3% (579 patients) of the gastric ulcers were clean base type. CONCLUSION: The prevalence of infection was statistically significant in terms of the type, location, and number of peptic ulcers, including both gastric ulcer and duodenal ulcer.
Subject(s)
Duodenal Ulcer , Helicobacter Infections , Helicobacter pylori , Peptic Ulcer , Stomach Ulcer , Adolescent , Adult , Duodenal Ulcer/epidemiology , Endoscopy, Gastrointestinal , Helicobacter Infections/epidemiology , Hospitals, Urban , Humans , Iran/epidemiology , Peptic Ulcer/epidemiology , Peptic Ulcer/microbiology , Peptic Ulcer/pathology , Stomach Ulcer/epidemiology , Stomach Ulcer/microbiology , Young AdultABSTRACT
INTRODUCTION: Obesity is a well-known risk factor for a variety of gastrointestinal disorders (GID). Helicobacter pylori is associated with different GID, such as gastric cancer and chronic gastritis. In this study, we investigated the prevalence of dominant genotypes in H. pylori isolated from obese patients diagnosed with gastric ulcer, duodenal ulcer, and gastric cancer. METHODS: A total of 222 H. pylori-positive samples were collected from patients with obesity. GID and gastric cancer were identified by endoscopy and histopathology, respectively. Three biopsy specimens from the gastric antrum were obtained from each patient for culture tests, histological examination, and identification of vacuolating cytotoxin A (vacA) (vacA s1, vacA s2, vacA m1, vacA m2, vacA s1m1 vacA s1m2, vacA s2m1, and vacA s2m2), cagA, cagE, iceA1, oipA, dupA, and babA2 using polymerase chain reaction. RESULTS: vacA, cagE, cagA, iceA1, oipA, dupA, and babA2 genes were detected in 222 (100%), 171 (77%), 161 (72.5%), 77 (34.6%), 77 (34.6%), 137 (61%), and 69 (31%) patients with obesity, respectively. Our findings revealed that vacA, iceA1, oipA, and babA2 were significantly associated with a higher risk of GID, while cagE, cagA, and dupA indicated no correlation with the development of GID. Also, in the combination of s- and m-region genotypes, s1m2 (79%) was the most frequently identified genotype in patients with obesity. A significant association was also found between cagA and the presence of vacA genotypes (except for vacA m1 and babA2). CONCLUSIONS: This study indicated the high prevalence of different virulence genes in H. pylori isolated from obese patients and supported the significant role of H. pylori in the development of GID.
Subject(s)
Duodenal Ulcer , Helicobacter Infections , Helicobacter pylori , Stomach Neoplasms , Stomach Ulcer , Antigens, Bacterial/genetics , Bacterial Proteins/genetics , Duodenal Ulcer/complications , Duodenal Ulcer/epidemiology , Duodenal Ulcer/genetics , Genotype , Helicobacter Infections/complications , Helicobacter Infections/epidemiology , Helicobacter Infections/genetics , Helicobacter pylori/genetics , Humans , Obesity/complications , Obesity/genetics , Stomach Neoplasms/epidemiology , Stomach Neoplasms/genetics , Stomach Ulcer/complications , Stomach Ulcer/epidemiology , Stomach Ulcer/geneticsABSTRACT
OBJECTIVES@#To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.@*METHODS@#A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups.@*RESULTS@#A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05).@*CONCLUSIONS@#Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Subject(s)
Child , Female , Humans , Male , Abdominal Pain , Duodenal Ulcer/epidemiology , Endoscopy, Gastrointestinal/adverse effects , Helicobacter Infections/diagnosis , Helicobacter pylori , Retrospective Studies , UlcerABSTRACT
BACKGROUND: While duodenal ulcer (DU) and gastric cancer (GC) are both H. pylori infection-related diseases, individuals with DU are known to have lower risk for GC. Many epidemiological studies have identified the PSCA rs2294008 T-allele as a risk factor of GC, while others have found an association between the rs2294008 C-allele and risk of DU and gastric ulcer (GU). Following these initial reports, however, few studies have since validated these associations. Here, we aimed to validate the association between variations in PSCA and the risk of DU/GU and evaluate its interaction with environmental factors in a Japanese population. METHODS: Six PSCA SNPs were genotyped in 584 DU cases, 925 GU cases, and 8,105 controls from the Japan Multi-Institutional Collaborative Cohort (J-MICC). Unconditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the SNPs and risk of DU/GU. RESULTS: PSCA rs2294008 C-allele was associated with per allele OR of 1.34 (95% CI, 1.18-1.51; P = 2.28 × 10-6) for the risk of DU. This association was independent of age, sex, study site, smoking habit, drinking habit, and H. pylori status. On the other hand, we did not observe an association between the risk of GU and PSCA SNPs. CONCLUSIONS: Our study confirms an association between the PSCA rs2294008 C-allele and the risk of DU in a Japanese population.
Subject(s)
Duodenal Ulcer/genetics , Neoplasm Proteins/genetics , Polymorphism, Single Nucleotide/genetics , Adult , Antigens, Neoplasm , Cohort Studies , Cross-Sectional Studies , DNA, Neoplasm/metabolism , Duodenal Ulcer/epidemiology , Duodenal Ulcer/microbiology , Female , GPI-Linked Proteins/genetics , GPI-Linked Proteins/metabolism , Gene Expression Regulation, Neoplastic , Genetic Markers , Genetic Predisposition to Disease , Genotype , Helicobacter Infections/complications , Helicobacter Infections/epidemiology , Helicobacter pylori , Humans , Immunoglobulin G/blood , Japan/epidemiology , Male , Middle Aged , Neoplasm Proteins/metabolism , Risk FactorsABSTRACT
INTRODUCTION: The incidence of peptic ulcer disease (PUD) has been decreasing over time with Helicobacter pylori eradication and use of acid-suppressing therapies. However, PUD remains a common cause of hospitalization in the United States. We aimed to evaluate contemporary national trends in the incidence, treatment patterns, and outcomes for PUD-related hospitalizations and compare care delivery by hospital rurality. METHODS: Data from the National Inpatient Sample were used to estimate weighted annual rates of PUD-related hospitalizations. Temporal trends were evaluated by joinpoint regression and expressed as annual percent change with 95% confidence intervals (CIs). We determined the proportion of hospitalizations requiring endoscopic and surgical interventions, stratified by clinical presentation and rurality. Multivariable logistic regression was used to assess independent predictors of in-hospital mortality and postoperative morbidity. RESULTS: There was a 25.8% reduction (P < 0.001) in PUD-related hospitalizations from 2005 to 2014, although the rate of decline decreased from -7.2% per year (95% CI: 13.2% to -0.7%) before 2008 to -2.1% per year (95% CI: 3.0% to -1.1%) after 2008. In-hospital mortality was 2.4% (95% CI: 2.4%-2.5%). Upper endoscopy (84.3% vs 78.4%, P < 0.001) and endoscopic hemostasis (26.1% vs 16.8%, P < 0.001) were more likely to be performed in urban hospitals, whereas surgery was performed less frequently (9.7% vs 10.5%, P < 0.001). In multivariable logistic regression, patients managed in urban hospitals were at higher risk for postoperative morbidity (odds ratio 1.16 [95% CI: 1.04-1.29]), but not death (odds ratio 1.11 [95% CI: 1.00-1.23]). DISCUSSION: The rate of decline in hospitalization rates for PUD has stabilized over time, although there remains significant heterogeneity in treatment patterns by hospital rurality.
Subject(s)
Healthcare Disparities/statistics & numerical data , Hospitalization/trends , Hospitals, Rural/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Peptic Ulcer Hemorrhage/epidemiology , Peptic Ulcer/epidemiology , Aged , Aged, 80 and over , Duodenal Ulcer/epidemiology , Duodenal Ulcer/therapy , Endoscopy, Digestive System/statistics & numerical data , Female , Health Status Disparities , Helicobacter Infections/drug therapy , Helicobacter pylori , Hemostasis, Endoscopic/statistics & numerical data , Hospital Mortality/trends , Humans , Incidence , Logistic Models , Male , Middle Aged , Odds Ratio , Peptic Ulcer/therapy , Peptic Ulcer Hemorrhage/therapy , Peptic Ulcer Perforation/epidemiology , Peptic Ulcer Perforation/therapy , Rural Population/statistics & numerical data , Stomach Ulcer/epidemiology , Stomach Ulcer/therapy , United States/epidemiology , Urban Population/statistics & numerical dataABSTRACT
The prevalence of peptic ulcer diseases has decreased over the past decades. The contribution of Helicobacter pylori to these changes has not been clearly delineated. Two cohorts of patients receiving esophagogastroduodenoscopy examination together with urease test were enrolled, 1 from year 2001 (nâ¯=â¯1030), the other from year 2019 (nâ¯=â¯600). The prevalence changes of peptic ulcer diseases as well as the associated clinical factors were analyzed. An independent cohort of gastric biopsy samples (nâ¯=â¯151) positive for H. pylori were retrieved for ureC gene genotype analysis. Comparison between the patients recruited from 2001 and 2019 revealed significant decrease in H. pylori infection (P < 0.001), duodenal ulcer prevalence (P < 0.001) and gastric ulcer prevalence (P < 0.001). Multivariate analysis showed that the decreases of these factors were independent (adjusted P < 0.001 for all). Intriguingly, in H. pylori positive patients, the prevalence of duodenal ulcer still decreased with year (P < 0.001), which was not found in gastric ulcer (Pâ¯=â¯0.345). Genetic analysis of H. pylori urease gene showed that MboI-restriction fragment length polymorphism-defined genotype 3 UreC was significantly more prevalent in gastric ulcer patients than in others (Pâ¯=â¯0.022). Independent decreases of H. pylori infection, gastric ulcer and duodenal ulcer over decades were found. In H. pylori positive patients, duodenal ulcer prevalence decreased overtime while gastric ulcer prevalence remained unchanged. Gastric ulcer/cancer had a higher prevalence of MboI-defined genotype 3 UreC gene.
Subject(s)
Helicobacter Infections/epidemiology , Helicobacter pylori/genetics , Peptic Ulcer/epidemiology , Peptic Ulcer/microbiology , Adult , Aged , Deoxyribonucleases, Type II Site-Specific , Duodenal Ulcer/drug therapy , Duodenal Ulcer/epidemiology , Duodenal Ulcer/microbiology , Female , Genotype , Helicobacter Infections/microbiology , Helicobacter pylori/enzymology , Humans , Male , Middle Aged , Peptic Ulcer/drug therapy , Polymorphism, Restriction Fragment Length , Proton Pump Inhibitors/therapeutic use , Stomach Ulcer/drug therapy , Stomach Ulcer/epidemiology , Stomach Ulcer/microbiology , Urease/geneticsABSTRACT
Helicobacter pylori (H. pylori) is a microaerophilic, Gram-negative, human gastric pathogen found usually in the mucous lining of stomach. It infects more than 50% of the world's population and leads to gastroduodenal diseases. The outcome of disease depends on mainly three factors: Host genetics, environment and bacterial factors. Among these, bacterial virulence factors such as cagA, vacA are well known for their role in disease outcomes. However, based on the global epidemiological results, none of the bacterial virulence (gene) factors was found to be associated with particular diseases like duodenal ulcer (DU) in all populations. Hence, substantial importance has been provided for research in strain-specific genes outside the cag pathogenicity island, especially genes located within the plasticity regions. dupA found within the plasticity regions was first demonstrated in 2005 and was proposed for duodenal ulcer development and reduced risk of gastric cancer in certain geographical regions. Due to the discrepancies in report from different parts of the world in DU development related to H. pylori virulence factor, dupA became an interesting area of research in elucidating the role of this gene in the disease progression. In this review, we shed light on the detailed information available on the polymorphisms in dupA and their clinical relevance. We have critically appraised several pertinent studies on dupA and discussed their merits and shortcomings. This review also highlights dupA gene as an important biomarker for DU in certain populations.
Subject(s)
Duodenal Ulcer , Helicobacter Infections , Helicobacter pylori , Stomach Neoplasms , Antigens, Bacterial/genetics , Bacterial Proteins/genetics , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Helicobacter Infections/epidemiology , Helicobacter pylori/genetics , Humans , Virulence Factors/geneticsABSTRACT
BACKGROUND: The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease. AIM: To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years. METHODS: This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades. RESULTS: Two hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades. CONCLUSION: Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.