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
BACKGROUND: Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. AIMS: The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. METHODS: We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. RESULTS: Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel â§2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870). CONCLUSIONS: Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel â§2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.
Subject(s)
Duodenal Ulcer , Peptic Ulcer , Humans , Duodenal Ulcer/therapy , Peptic Ulcer Hemorrhage/therapy , Retrospective Studies , Risk Factors , Recurrence , AlbuminsABSTRACT
BACKGROUND: In the early stages of the coronavirus disease 2019 (COVID-19) outbreak, the most widely recognised symptoms of the disease were fever, cough, shortness of breath, myalgia, and fatigue. However, in addition to these symptoms, COVID-19 can cause systemic symptoms outside the lungs. Older patients with severe COVID-19 often require admission to the intensive care unit (ICU). Acute rectal ulcer bleeding, characterised by painless, profuse haematochezia, caused by solitary or multiple rectal ulcers, is one of the main causes of severe haematochezia in patients with COVID-19 in the ICU. However, recurrent duodenal ulcer bleeding followed by rectal ulcer bleeding has not previously been reported in older patients during ICU treatment for severe COVID-19. CASES PRESENTATION: Herein, we report the case of an 81-year-old woman admitted to the emergency department due to severe COVID-19 and transferred to the ICU 2 days later for treatment. During treatment in the ICU, the patient developed recurrent duodenal ulcer bleeding and underwent endoscopic electrocoagulation haemostasis and gastroduodenal artery embolisation. However, the night after the final haemostatic operation, due to rectal ulcer bleeding, the patient discharged bloody stools intermittently, which was effectively controlled using endoscopic electrocoagulation, topical medication, blood transfusion, and haemostatic drugs. CONCLUSIONS: To the best of our knowledge, this is the first report of duodenal ulcer bleeding followed by rectal ulcer bleeding in an older patient with severe COVID-19 infection. This report creates awareness for clinicians about the multiple and complex gastrointestinal symptoms that may occur during COVID-19 treatment.
Subject(s)
COVID-19 , Duodenal Ulcer , Female , Humans , Aged , Aged, 80 and over , Ulcer , Duodenal Ulcer/complications , Duodenal Ulcer/diagnosis , Duodenal Ulcer/therapy , COVID-19 Drug Treatment , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , CoughABSTRACT
Duodenal ulcer seriously affects the quality of life and life safety of children, but the pathogenesis of children with duodenal ulcer is still unclear. As an important second messenger in the body, Ca2+ participates in the physiological and pathological processes of various diseases. Therefore, transient receptor potential vanilloid type 4 (TRPV4) as one of the channels that mediate Ca2+ has attracted widespread attention in recent years. Here, we found that TRPV4 is highly expressed in children with duodenal ulcer and has good diagnostic value through specimens of children with duodenal ulcer, and animal experiments have proved that TRPV4 is also highly expressed in duodenal ulcer mice. In addition, TRPV4 can enhance intestinal permeability, thereby promoting further infiltration of inflammatory factors. In summary, these results indicate that TRPV4 is involved in the occurrence and development of duodenal ulcer. Therefore, this study provides the diagnostic and therapeutic value of TRPV4 in children with duodenal ulcer.
Subject(s)
Duodenal Ulcer , Gene Expression Regulation , Helicobacter Infections , Helicobacter pylori/metabolism , TRPV Cation Channels/biosynthesis , Adolescent , Animals , Child , Child, Preschool , Duodenal Ulcer/diagnosis , Duodenal Ulcer/metabolism , Duodenal Ulcer/microbiology , Duodenal Ulcer/therapy , Female , Helicobacter Infections/diagnosis , Helicobacter Infections/metabolism , Helicobacter Infections/microbiology , Helicobacter Infections/therapy , Humans , Male , MiceABSTRACT
BACKGROUND: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. METHODS: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. RESULTS: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. CONCLUSIONS: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.
Subject(s)
Duodenal Ulcer , Helicobacter Infections , Helicobacter pylori , Duodenal Ulcer/complications , Duodenal Ulcer/therapy , Duodenum , Humans , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Hemorrhage/therapy , Proportional Hazards Models , Retrospective Studies , Ulcer/complications , Ulcer/therapyABSTRACT
Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.
Subject(s)
Duodenal Ulcer , Embolization, Therapeutic , Hemostasis, Endoscopic , Duodenal Ulcer/complications , Duodenal Ulcer/therapy , Endoscopy , Gastrointestinal Hemorrhage/etiology , Humans , Recurrence , Retrospective StudiesABSTRACT
BACKGROUND: Gastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described. METHODS: Using a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group. RESULTS: Most of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47-75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001). DISCUSSION: Unlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.
Subject(s)
Duodenal Ulcer , Peptic Ulcer Perforation , Stomach Ulcer , Adolescent , Adult , Aged , Duodenal Ulcer/complications , Duodenal Ulcer/therapy , Humans , Inpatients , Japan/epidemiology , Male , Middle Aged , Peptic Ulcer Perforation/therapy , Postoperative Complications , Stomach Ulcer/therapy , Young AdultABSTRACT
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
Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.
Subject(s)
Humans , Duodenal Ulcer/therapy , Embolization, Therapeutic , Endoscopy , Gastrointestinal Hemorrhage/etiology , Hemostasis, Endoscopic , Recurrence , Retrospective StudiesSubject(s)
Duodenal Obstruction/therapy , Duodenal Ulcer/therapy , Endoscopy, Digestive System , Esophageal Stenosis/surgery , Gallstones/therapy , Hemostasis, Endoscopic , Lithotripsy , Peptic Ulcer Hemorrhage/therapy , Aged, 80 and over , Cholelithiasis/complications , Dilatation , Duodenal Obstruction/diagnosis , Duodenal Obstruction/etiology , Duodenal Ulcer/complications , Esophageal Stenosis/complications , Female , Gallstones/complications , Gastroscopes , Humans , Incidental Findings , Intestinal Fistula/complications , Peptic Ulcer Hemorrhage/complicationsSubject(s)
Diet , Duodenoscopy/methods , Gastroscopy/methods , Peptic Ulcer/diagnosis , Peptic Ulcer/epidemiology , Proton Pump Inhibitors/administration & dosage , Adult , Aged , Biopsy, Needle , Duodenal Ulcer/diagnosis , Duodenal Ulcer/epidemiology , Duodenal Ulcer/therapy , Education, Medical, Continuing , Female , Healthy Lifestyle , Humans , Immunohistochemistry , Male , Middle Aged , Peptic Ulcer/therapy , Prevalence , Prognosis , Risk Assessment , Severity of Illness Index , Stomach Ulcer/diagnosis , Stomach Ulcer/epidemiology , Stomach Ulcer/therapyABSTRACT
We report a case of a patient with renal cell carcinoma on pazopanib, who presented with severe upper gastrointestinal bleeding. Endoscopy showed a giant bulbar ulcer with a visible vessel of 4 mm. Due to unavailability of surgical rescue backup, large calibre vessel treatment was delayed. Endoscopy was repeated after 48 hours and showed a reduction in the vessel diameter. Endoscopic adrenalin injection and electrocoagulation were performed. However, the vessel increased in size and became pulsatile. The patient was operated, confirming a giant bulbar ulcer penetrating the pancreas with active bleeding from the gastroduodenal artery. Pazopanib therapy was suspended, and the patient is asymptomatic. Antiangiogenic treatment has been associated with gastrointestinal bleeding, perforation and fistulisation. Although we cannot confirm the causal association between the penetrating ulcer and pazopanib, the absence of Helicobacter pylori infection or non-steroidal anti-inflammatory drugs, and the reported cases of gastrointestinal bleeding during these therapies favour a possible association.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Carcinoma, Renal Cell/drug therapy , Duodenal Ulcer/pathology , Gastrointestinal Hemorrhage/chemically induced , Pancreas/pathology , Pyrimidines/adverse effects , Sulfonamides/adverse effects , Angiogenesis Inhibitors/administration & dosage , Duodenal Ulcer/diagnostic imaging , Duodenal Ulcer/therapy , Electrocoagulation , Endoscopy , Gastrointestinal Hemorrhage/therapy , Gastroplasty , Humans , Indazoles , Melena , Middle Aged , Pancreas/diagnostic imaging , Proton Pump Inhibitors/therapeutic use , Pylorus/pathology , Pyrimidines/administration & dosage , Sulfonamides/administration & dosage , Syncope , Treatment OutcomeABSTRACT
BACKGROUND AND AIMS: Although various methods are used in the treatment of peptic ulcer bleeding, there is not a standard recommended approach. The choice depends on multiple factors such as location of the ulcer, clinical experience of the endoscopist, and local facilities of the clinic. We aimed to compare the efficacy of monopolar hemostatic forceps soft coagulation (MHFSC) and hemoclips (HCs) in the treatment of peptic ulcer-related upper GI bleeding. METHODS: The study group included patients who had GI bleeding due to Forrest 1a, 1b, and 2a gastric or duodenal ulcers within 1 year. Patients with bleeding diathesis, history of gastrectomy, pregnancy, or younger than age 18 years were excluded. The remaining were randomized to MHFSC and HC treatment groups and compared in terms of clinical and endoscopic features, initial hemostasis success rates, recurrent bleeding rates within the first 7 days, time to achieve hemostasis, length of hospitalization stay, and adverse events. RESULTS: One hundred twelve patients were randomized to MHFSC (n = 56) and HC (n = 56) groups. There was no statistically significant difference between the groups with respect to demographic features, medications, underlying chronic diseases, location, and Forrest classification of the ulcers. The initial hemostasis success rate was 98.2% (55/56) in the MHFSC group and 80.4% (45/56) in the HC group (P = .004). Recurrent bleeding was detected in 2 patients in the MHFSC group (3.6%) and 8 patients in the HC group (17.7%; P = .04). The duration of endoscopic procedures (302 ± 87.8 vs 568 ± 140.4 seconds) and the length of hospital stay (3.50 ± 1.03 vs 4.37 ± 1.86 days) were significantly shorter in the MHFSC group. There were no adverse events in either group. CONCLUSIONS: MHFSC is more effective in achieving initial hemostasis compared with HCs in the treatment of peptic ulcer bleeding and provides a shorter procedure time and a lower recurrent bleeding rate.
Subject(s)
Duodenal Ulcer/therapy , Endoscopy, Digestive System/methods , Hemostasis, Endoscopic/methods , Peptic Ulcer Hemorrhage/therapy , Adult , Aged , Aged, 80 and over , Duodenal Ulcer/complications , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Peptic Ulcer Hemorrhage/etiology , Recurrence , Surgical Instruments , Time FactorsABSTRACT
In this case report a 48-year-old man presented with nausea and abdominal pain. Ten days prior he had been treated with an endoscopic epinephrine/saline injection for haemostasis of a bleeding duodenal ulcer and was discharged the following day. At readmission, an abdominal CT revealed severe gastric distention and a gastroscopy showed total duodenal obstruction. Subsequent post-contrast CT revealed that a massive intramural duodenal haematoma was the cause of the total duodenal occlusion. Also, acute pancreatitis was seen. The treatment was conservative, and follow-up gastroscopy showed total resolution of the haematoma.
Subject(s)
Duodenal Diseases/etiology , Hematoma/etiology , Hemostasis, Endoscopic/adverse effects , Acute Disease , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/therapy , Duodenal Obstruction/diagnostic imaging , Duodenal Obstruction/etiology , Duodenal Obstruction/therapy , Duodenal Ulcer/therapy , Epinephrine/administration & dosage , Epinephrine/adverse effects , Epinephrine/therapeutic use , Hematoma/diagnostic imaging , Hematoma/therapy , Humans , Injections/adverse effects , Male , Middle Aged , Pancreatitis/etiology , Pancreatitis/therapy , Saline Solution/administration & dosage , Saline Solution/adverse effects , Saline Solution/therapeutic use , Tomography, X-Ray ComputedABSTRACT
This article covers the issues related to the use of the natural and the preformed physical factors for the treatment and prevention of erosive-ulcerative lesions of the gastro-duodenal area. The existing schemes of their therapeutic treatment provide for the influence only on the separate components of the pathological process which does not allow to achieve the proper correction of the local organic and functional disturbances or the associated systemic disorders. In this context, the purpose of the present article is to demonstrate the importance of the inclusion of various physical factors into the therapeutic programs designed for the treatment of the inflammatory and erosive-ulcerative lesions of the upper digestive tract including the stomach and the duodenum. The present review is focused on the modern data available from the current publications in the scientific literature concerning the possibility and the effectiveness of the application of drinking mineral waters, balneotherapy, and pelotherapy in the combination with secondary prophylaxis and a variety of the rehabilitation modalities for the treatment of the patients presenting with the inflammatory and erosive-ulcerative lesions of the upper part of a digestive tube. It is concluded that these measures, taken together, can efficiently eliminate the said pathological conditions and correct the accompanying systemic disorders. The currently available methods of physical therapy can be not only supplementary to the generally accepted therapeutic modalities but also constitute their basis their basis.
Subject(s)
Duodenal Ulcer/therapy , Stomach Ulcer/therapy , Duodenal Ulcer/prevention & control , Humans , Mineral Waters , Physical Therapy Modalities , Stomach Ulcer/prevention & controlABSTRACT
AIM: To improve immediate results in patients with acute ulcerative gastroduodenal bleeding. MATERIAL AND METHODS: The study enrolled 91 patients with ulcerative gastroduodenal bleeding. RESULTS: Diagnostic and curative procedures should be related to hospital's equipment, specialists' qualification and comprehensive development and application of accepted tactical approaches. 20-year development of this protocol which includes original low-temperature irrigator of stomach and duodenal mucous membranes, objective choice of endoscopic hemostasis technique depending on bleeding source in gastroduodenal wall, early administration of proton pump inhibitors significantly increases efficacy and reliability of endoscopic hemostasis. It was followed by improved early outcomes: recurrent bleeding incidence was 4.2%, surgical activity decreased by 68% up to 13.2%, overall and postoperative mortality was 2.2% and 8.3% respectively.
Subject(s)
Hemostasis, Endoscopic , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/therapy , Clinical Protocols , Digestive System Surgical Procedures , Duodenal Ulcer/complications , Duodenal Ulcer/surgery , Duodenal Ulcer/therapy , Hospitalization , Humans , Peptic Ulcer Hemorrhage/surgery , Proton Pump Inhibitors/therapeutic use , Reproducibility of Results , Stomach Ulcer/complications , Stomach Ulcer/surgery , Stomach Ulcer/therapy , Therapeutic Irrigation , Treatment OutcomeABSTRACT
OBJECTIVE: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. MATERIAL AND METHODS: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. RESULTS: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. CONCLUSION: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications.
Subject(s)
Duodenal Ulcer/diagnostic imaging , Duodenitis/diagnostic imaging , Endoscopy, Gastrointestinal , Esophagitis/diagnostic imaging , Gastritis/diagnostic imaging , Helicobacter Infections/diagnostic imaging , Helicobacter pylori , Brazil/epidemiology , Child , Child, Preschool , Duodenal Ulcer/epidemiology , Duodenal Ulcer/therapy , Duodenitis/epidemiology , Duodenitis/therapy , Esophagitis/epidemiology , Esophagitis/therapy , Gastritis/epidemiology , Gastritis/therapy , Helicobacter Infections/epidemiology , Helicobacter Infections/therapy , Humans , Incidence , Infant , Retrospective Studies , Treatment OutcomeABSTRACT
Equine gastric ulcer syndrome (EGUS) primarily describes ulceration in the terminal esophagus, nonglandular squamous mucosa, glandular mucosa of the stomach, and proximal duodenum. EGUS is common in all breeds and ages of horses and foals. This article focuses on the current terminology for EGUS, etiologies and pathogenesis for lesions in the nonglandular and glandular stomach, diagnosis, and a comprehensive approach to the treatment and prevention of EGUS in adult horses and foals.