A Review of the Role of Flavonoids in Peptic Ulcer (2010-2020).

Peptic ulcers are characterized by erosions on the mucosa of the gastrointestinal tract that may reach the muscle layer. Their etiology is multifactorial and occurs when the balance between offensive and protective factors of the mucosa is disturbed. Peptic ulcers represent a global health problem, affecting millions of people worldwide and showing high rates of recurrence. Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most important predisposing factors for the development of peptic ulcers. Therefore, new approaches to complementary treatments are needed to prevent the development of ulcers and their recurrence. Natural products such as medicinal plants and their isolated compounds have been widely used in experimental models of peptic ulcers. Flavonoids are among the molecules of greatest interest in biological assays due to their anti-inflammatory and antioxidant properties. The present study is a literature review of flavonoids that have been reported to show peptic ulcer activity in experimental models. Studies published from January 2010 to January 2020 were selected from reference databases. This review refers to a collection of flavonoids with antiulcer activity in vivo and in vitro models.

Clinical, Endoscopic, and Histologic Findings at the Distal Esophagus and Stomach Before and Late (10.5 Years) After Laparoscopic Sleeve Gastrectomy: Results of a Prospective Study with 93% Follow-Up.

OBJECTIVE: Perform a prospective study based on sequential clinical, endoscopic, and histologic evaluations of the foregut late after laparoscopic sleeve gastrectomy (LSG) in obese patients. After LSG, several studies have suggested an increase in the incidence of clinical gastroesophageal reflux (GERD) while others have reported an improvement but based mainly on clinical questionnaires. METHODS: Prospective study of 104 consecutive patients submitted to LSG. Several postoperative endoscopic and histologic evaluations of the esophagogastric junction (EGJ) and the gastric tube (GT) were performed and correlated with symptomatic findings. RESULTS: According to clinical preoperative findings, patients were divided into non-refluxers (Group I) and refluxers (Group II). Seven patients were unreachable, leaving 97 (93%) for late evaluation. Among Group I, 58.5% developed de novo GERD, while in Group II just 13.6% showed the disappearance of them. Endoscopic evaluations showed progressive deterioration of the EGJ in Group I, with the development of erosive esophagitis (EE), hiatal hernia (HH), and dilated cardia in a large proportion of them. In the GT, the presence of bile was seen in 40%, and an open immobile pylorus was detected in 82%. Short-segment Barrett's esophagus (BE) appeared in 4%. CONCLUSIONS: Patients submitted to LSG showed a significant and progressive increase in the presence of "de novo" GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a "pro-reflux" surgical procedure, which should be continuously evaluated late after surgery.

Tratamiento endoscópico del sangrado digestivo alto por úlcera péptica / Endoscopic treatment of the high digestive bleeding by peptic ulcer

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).

SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).

Nuevos retos en el tratamiento de la infección por helicobacter pylori / New challenges in the treatment of the infection for helicobacter pylori

RESUMEN La infección por helicobacter pylori afecta aproximadamente al 50% de la población mundial, es causante de gastritis crónica, úlcera péptica, cáncer gástrico y linfoma del tejido linfoide asociado a la mucosa. Desde su descubrimiento, la erradicación ha sido uno de los más importantes retos en Gastroenterología. En muchos países se desconoce la prevalencia de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente se utilizan, y por no realizar pruebas de rutina que verifican su erradicación en la práctica diaria, se ignora la efectividad de los esquemas prescritos. El incremento progresivo de la resistencia a la claritromicina y metronidazol, unido a una ausencia de antibioticoterapia alternativa, desafía la capacidad para eliminar de manera efectiva a ésta bacteria. El subcitrato de bismuto ha resurgido y su adición en la terapia ha permitido aumentar las tasas de curación por encima del 90%. Actualmente se invoca que para mejorar la eficacia en el tratamiento se debe combinar una supresión potente del ácido gástrico en tratamientos combinados cuádruples con una duración de 14 días, para la mayoría de los casos. La adherencia al tratamiento es crucial para obtener buenos resultados terapéuticos (AU).

ABSTRACT The infection for helicobacter pylori affects approximately to the world population's 50%, it is causing of chronic gastritis, peptic ulcer, gastric cancer and linfoma associated to the mucous one. From their discovery, the eradication has been one of the most important challenges in Gastroenterología. In many countries the prevalencia of primary resistance is ignored from the microorganism to the different antibiotics that empirically they are used, and for not carrying out routine tests that verify its eradication in the daily practice, the effectiveness of the prescribed outlines it is ignored. The progressive increment of the resistance to the claritromicina and metronidazol, together to an absence of alternative antibioticotherapy, challenges the capacity to eliminate from an effective way to this bacteria. The bismuth subcitrato has resurged and its addition in the therapy has allowed to increase the cure rates above 90%. At the moment it is invoked that to improve the effectiveness in the treatment, that is should combine a potent suppression of the gastric acid in combined quadruple treatments with a duration of 14 days, for most of the cases. The adherence to the treatment is crucial to obtain therapeutic good results (AU).

Nuevos retos en el tratamiento de la infección por helicobacter pylori / New challenges in the treatment of the infection for helicobacter pylori

RESUMEN La infección por helicobacter pylori afecta aproximadamente al 50% de la población mundial, es causante de gastritis crónica, úlcera péptica, cáncer gástrico y linfoma del tejido linfoide asociado a la mucosa. Desde su descubrimiento, la erradicación ha sido uno de los más importantes retos en Gastroenterología. En muchos países se desconoce la prevalencia de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente se utilizan, y por no realizar pruebas de rutina que verifican su erradicación en la práctica diaria, se ignora la efectividad de los esquemas prescritos. El incremento progresivo de la resistencia a la claritromicina y metronidazol, unido a una ausencia de antibioticoterapia alternativa, desafía la capacidad para eliminar de manera efectiva a ésta bacteria. El subcitrato de bismuto ha resurgido y su adición en la terapia ha permitido aumentar las tasas de curación por encima del 90%. Actualmente se invoca que para mejorar la eficacia en el tratamiento se debe combinar una supresión potente del ácido gástrico en tratamientos combinados cuádruples con una duración de 14 días, para la mayoría de los casos. La adherencia al tratamiento es crucial para obtener buenos resultados terapéuticos.

ABSTRACT The infection for helicobacter pylori affects approximately to the world population's 50%, it is causing of chronic gastritis, peptic ulcer, gastric cancer and linfoma associated to the mucous one. From their discovery, the eradication has been one of the most important challenges in Gastroenterología. In many countries the prevalencia of primary resistance is ignored from the microorganism to the different antibiotics that empirically they are used, and for not carrying out routine tests that verify its eradication in the daily practice, the effectiveness of the prescribed outlines it is ignored. The progressive increment of the resistance to the claritromicina and metronidazol, together to an absence of alternative antibioticotherapy, challenges the capacity to eliminate from an effective way to this bacteria. The bismuth subcitrato has resurged and its addition in the therapy has allowed to increase the cure rates above 90%. At the moment it is invoked that to improve the effectiveness in the treatment, that is should combine a potent suppression of the gastric acid in combined quadruple treatments with a duration of 14 days, for most of the cases. The adherence to the treatment is crucial to obtain therapeutic good results.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Píloro doble: de lo cotidiano a lo extraordinario: reporte de caso y revisión de la literatura / Double pylorus: from the everything to the extraordinary: case report and literature review

Antecedentes: El píloro doble constituye un hallazgo endoscópico extremadamente raro, siendo más frecuente en pacientes que padecen enfermedad ulcerosa péptica. Corresponde a una comunicación anormal entre el antro gástrico y el bulbo duodenal, que puede llegar a requerir tratamiento quirúrgico. Caso clínico: Mujer de 86 años de edad con antecedentes de diabetes mellitus tipo 2, hipertensión arterial, así como ingesta crónica de AINE, portadora de enfermedad ácido-péptica de larga evolución con poca respuesta al manejo médico con bloqueadores H2, la cual presenta sangrado de tubo digestivo durante 5 días caracterizado por hematemesis y melena, así como pirosis, náuseas, sin pérdida ponderal; por este motivo se realiza endoscopia digestiva alta la cual reporta como hallazgos: gastritis erosiva crónica activa secundaria a AINE y asociada a Helicobacter pylori, así como píloro doble adquirido secundario a enfermedad ácido-péptica, sin evidencia de tumores u otras lesiones asociadas. Se inicia esquema de erradicación para H. pylori con amoxicilina y claritromicina durante 14 días, asociados a inhibidor de bomba de protones durante 6-8 semanas con buena respuesta al manejo médico. Discusión: El píloro doble adquirido es una rara complicación de úlcera péptica que puede ser asociada a otras enfermedades, AINE y a la colonización por H. pylori, por lo tanto el adecuado tratamiento consistirá en la corrección de esos factores.

Background: The double pylorus is an extremely rare endoscopic finding, being more frequent in patients suffering from peptic ulcer disease. It corresponds to an abnormal communication between the gastric antrum and the duodenal bulb, which may require surgical treatment. Clinical case: A 86-year-old woman with a history of type 2 diabetes mellitus, hypertension and chronic NSAID intake, a carrier of long-term peptic acid disease with poor response to medical management with H2 blockers. This presents digestive tube bleeding for 5 days characterized by hematemesis and melena, as well as heartburn, nausea, without weight loss, reason why high digestive endoscopy is performed, which reports as findings: active chronic erosive gastritis secondary to NSAIDs and associated with Helicobacter pylori, as well as acquired double pylorus secondary to peptic acid disease, without evidence of tumors or other associated lesions. Eradication scheme begins for H. pylori with amoxicillin and clarithromycin for 14 days, associated with a proton pump inhibitor for 6-8 weeks with good response to medical management. Discussion: The acquired double pylorus is a rare complication of peptic ulcer disease that can be associated with other diseases, NSAIDs and colonization by H. pylori, therefore the appropriate treatment will consist in the correction of these factors.

Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors.

OBJECTIVE: To analyze the clinical characteristics, outcomes and prognostic factors in elderly patients (aged 75 years and elder) with acute nonvariceal upper gastrointestinal bleeding (UGIB). METHODS: Consecutive patients admitted with acute nonvariceal UGIB who underwent upper gastrointestinal endoscopy were prospectively recruited and subdivided into two age-based groups, elderly (aged ≥75 years) and younger patients (<75 years). The patients' characteristics and outcomes were recorded. RESULTS: Altogether 1136 patients were included in the study, 276 (24.3%) aged ≥75 years. Peptic ulcers, gastroduodenal erosions and esophagitis represented the three most common endoscopic lesions found in 87.7% of the elderly patients compared with 80.8% in younger patients ( P = 0.008). Overall, the rebleeding rate (4.0% vs 3.3%, P = 0.568), need for blood transfusion (66.3% vs 61.0%, P = 0.122), surgery rate (1.2% vs 1.4%, P = 0.947) and in-hospital mortality (13.0% vs 10.0%, P = 0.157) were not different between the two groups. In elderly patients, serum albumin was the only predictive variable independently associated with mortality in the overall analysis (OR 5.867, 95% CI 2.206-15.604, P < 0.001) and in the subgroup patients with peptic ulcers (OR 5.230, 95% CI 2.099-13.029, P = 0.001). Elderly patients with serum albumin >23.5 g/L at admission presented a low mortality (negative predictive value 97.3%). CONCLUSIONS: Clinical evolution and mortality do not differ between the elderly and younger patients with acute nonvariceal UGIB. Serum albumin level at admission is a prognostic marker for mortality in elder patients.

Gram y ureasa para el diagnóstico de helicobacter pylori en muestras gastroduodenales / Gram and urease for the diagnosis of helicobacter pylori in gastroduodenal samples

Fundamento: la afección gastroduodenal y el cáncer gástrico, son enfermedades cada día más frecuentes, donde el helicobacter pylori es el microorganismo responsable del número mayor de casos.Objetivo: determinar la presencia del helicobacter pylori en muestras de biopsias gastroduodenales a partir de la aplicación de las técnicas microbiológicas, prueba de ureasa y coloración de Gram.Métodos: se realizó un estudio descriptivo, transversal para determinar la presencia del helicobacter pylori en muestras de biopsias gastroduodenales, mediante técnicas microbiológicas en el Laboratorio de Microbiología del Hospital Clínico Quirúrgico Docente Saturnino Lora en la Provincia de Santiago de Cuba, en el año 2012.Resultados: del total de pacientes estudiados se encontró un predominio de 98 mujeres para un 66,6 porciento, dentro de los hábitos tóxicos evaluados el de mayor porcentaje fue el consumo de café 132 casos, 89,8 porciento, el síntoma más relevante encontrado fue la epigastralgia. Al aplicar las pruebas referidas en el estudio (prueba de ureasa y técnica coloración de Gram), se obtuvo un 66,7 porciento de muestras positivas con la prueba de ureasa y un 79,6 porciento por la coloración de Gram.Conclusiones: la morbilidad predominó en el sexo femenino en las edades comprendidas de 31 a 45 años, la coloración de Gram es más sensible que la prueba de ureasa, los pacientes con gastritis crónicas mostraron mayor positividad a helicobacter pylori(AU)

Background: gastroduodenal affection and gastric cancer are diseases which are more frequent every day. Helicobacter pylori is the responsible microorganism for the largest number of cases.Objective: to determine the presence of helicobacter pylori in grastroduodenal biopsy samples from the application of microbiological techniques: urease test and Gram staining.Methods: in 2012 a cross-sectional descriptive study was conducted to determine the presence of helicobacter pylori in gastroduodenal biopsy samples through microbiological techniques in the microbiology laboratory of Saturnino Lora hospital in Santiago de Cuba.Results: from the whole group of patients studied a predominance of 98 women that account for 66,6 percent was found. From the bad habits assessed the one with the highest percentage was coffee consumption, with 132 cases which represent 89.8 percent. The most notable symptom found was epigastralgia. After undergoing the referred tests of the study (urease test and Gram staining), 66,7 percent of positive samples with urease test and 79,6 percent with Gram staining were obtained.Conclusions: morbidity prevailed in female sex in the 31 to 45 age group. Gram staining is more sensitive than urease test. Patients with chronic gastritis showed gram-positive results to helicobacter pylori(AU)

[Spontaneous cholecystocutaneous fistula]. / Fístula colecistocutánea espontánea.

BACKGROUND: Spontaneous cholecystocutaneous fistula is defined as a gallbladder communication with the external environment through the abdominal wall rupture; the first reports were written in the seventeenth century by Thilesus. During the past 50 years 25 cases have been reported. CLINICAL CASE: We report a case of a 30-year-old woman presented with a five-year history of biliary colic, six months prior to medical assessment presents outlet of biliary material and gallstones spontaneously in the right upper quadrant. Fistulogram was performed without evidence of obstruction, subsequently cholecystectomy and resection of the fistula was performed. DISCUSSION: The biliary fistulas are an abnormal communication from the gallbladder into another surface, is a rare condition in our day as it only occurs in 10% of patients with gallbladder lithiasis; while spontaneous cholecystocutaneous fistula clinic is more than evident. It is imperative perform studies like ultrasound, tomography, and fistulogram. The mainstay of treatment is cholecystectomy, resection of the fistula and repair of abdominal wall defect. CONCLUSION: The incidence of cholecystocutaneous fistula today is minimal and it seems that the current trend is to become an entity anecdotal, the approach subcostal abdominal examination remains as the first choice. The laparoscopic approach is an option reserved for the experienced surgeon.

[Validation of the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding in a third level general hospital]. / Validación del score de Rockall en pacientes adultos mayores con hemorragia digestiva alta no variceal en un hospital general de tercer nivel.

OBJECTIVE: To validate the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding, in terms of mortality and recurrent bleeding at 30 days follow-up. MATERIAL AND METHODS: Patients older than 60 year-old, with non variceal upper gastrointestinal bleeding demonstrated by endoscopy, who were attended in a third level general hospital from June 2009 to June 2013, were included. Data was analyzed with the ROC (Receiver Operating Characteristic) curve. The area under curve was obtained to assess the Rockall score. RESULTS: One hundred ninety patients were included, 64.2% were males, with an average age of 74 years old. Overall mortality was 16.8% and respiratory failure with second bleeding episode was the most common cause of death (34.3% and 31.3% respectively). 5.52% of patients presented a second bleeding episode. A transfusion of more than 2 blood-packs was needed in the 24.7% of the patients. The area under ROC curve using the Rockall score was 0,76 (IC: 0.68-0.84) for mortality risk, 0.71 (IC: 0.55-0.88) for the risk of rebleeding and 0.66 (IC: 0.58-0.74) for needing a more than 2 blood-packs transfusion. CONCLUSIONS: Rockall score is a good predictor for mortality and rebleeding during the 30 day-period after a non-variceal bleeding episode in elderly patients. The best sensibility and specificity was obtained with the scores of 5 and 6, respectively.

Caracterización de úlceras gástricas y duodenales / Characterization of gastric and duodenal ulcers

La úlcera péptica es una lesión en la mucosa gastrointestinal (estómago o duodeno) que se extiende más allá de la muscularis mucosae y que permanece como consecuencia de la actividad de la secreción ácida del jugo gástrico. Objetivo: describir las características epidemiológicas y clínicas de las úlceras gástricas y duodenales en pacientes que acudieron al servicio de videoendoscopías del Centro Médico Alta Tecnología Hernando Dionisio Amaya Benavides de Tucupita en Venezuela, en el periodo 2010-2013. Material y métodos: se realizó un studio descriptivo de corte transversal. Se revisaron 1972 expedientes de pacientes mayores de 15 años, procedentes de instituciones médicas de Barrio Adentro, estatales y privadas, que acudieron al servicio de videoendoscopía del Centro Médico de Alta Tecnología Hernando Dionisio Amaya Benavides de Tucupita, en el periodo 2010-2013. Se estudiaron variables demográficas y clínicas. Resultados: la morbilidad por úlceras pépticas resultó de 9,83%, diagnosticado en 105 pacientes, con mayor frecuencia en el sexo masculino en edades comprendidas entre 45 y 54 años. La principal procedencia en el caso de las úlceras gástricas es de los consultorios médicos populares (CMP), presente en 36 pacientes; en el caso de las duodenales, los procedentes de servicios estatales. La porción más afectada por úlceras gástricas en estómago fue el antro, con 110 úlceras diagnosticadas (94%) y en el duodeno, cara anterior del bulbo, con 51 úlceras de las registradas en esta porción (50%). Conclusiones: la úlcera gástrica es más frecuente que la duodenal, la epigastralgia constituyó el síntoma principal que motivó el estudio en los pacientes ulcerosos. La labor de enfermería contribuye a la realización efectiva en el servicio de videoendoscopía.

Peptic ulcer is an injury to the gastrointestinal mucosa (stomach and duodenum) extending beyond the muscularis mucosae and which remains as a result of the activity of acid secretion in the gastric juice. Objetive: To describe the epidemiological and clinical characteristics of gastric and duodenal ulcers in patients who attended the service videoendoscopias Medical Center of High Technology Dionisio Hernando Amaya Benavides Tucupita in Venezuela, in the 2010 period features-2013. Material and methods: Came on descriptive cross-sectional study. 1972 records of patients older than 15 years, from Barrio Adentro medical institutions, state and private, who atttended the service of High Technology videoendoscopy Dionisio Hernando Amaya Benavides Tucupita in 2010-2013 Medical Center were reviewed. Demographic and clinical variables were studied. Results: Peptic ulcer morbidity was 9.83%, diagnosed in 105 patients, most often in men aged between 45 and 54 years. The main origin in the case of gastric ulcers is popular medical practices (CMP), present in 36 patients; in case of duodenal, those from government services. The most affected by gastric ulcers in stomach antrum portion was with 110 diahgnosticadas ulcers (94%) and in the duodenum, anterior bulb with 51 ulcers recorded in this portion (50%). Conclusions: Gastric ulcer is more frequent than duodenal, epigastric pain was the main symptom that motivated the study ulcer patients. The nursing work contributes to the effective realization of videoendoscopy service.

Vulnerabilidad al estrés en pacientes con enfermedad ulcerosa péptica / Vulnerability to stress in patients with peptic ulcer illness

Introducción: el estrés es considerado una reacción o respuesta no específica del organismo o cualquier cambio engendrado en este por el impacto de acontecimientos importantes. Método: se realizó una investigación descriptiva, correlacional, de corte transversal y cuantitativa, con un diseño no experimental con el. Objetivo: de evaluar la vulnerabilidad al estrés en una muestra seleccionada de manera intencional de 70 sujetos, todos diagnosticados con enfermedad ulcerosa péptica, por endoscopias recientes (menos de seis meses), que asistieron a la consulta de Gastroenterología del Policlínico "Efraín Mayor" del municipio Cotorro, en el periodo de enero a marzo de 2013. Resultados: se encontró que el 85,7 por ciento de la muestra son no vulnerables al estrés, predominó el sexo femenino en el estudio, siendo el tabaco y el café los hábitos tóxicos más frecuentes en la población estudiada. La ansiedad como rasgo y como estado, predominaron a un nivel bajo y medio. Conclusiones: se recomendó repetir estudio similar en otra área de salud del municipio Cotorro y otros estudios con variables: Estilos de vida, afrontamientos y apoyo social, en su relación a la vulnerabilidad al estrés, además de realizar estrategia de intervención educativa en los pacientes estudiados(AU)

Introduction: stress is considered as unspecific reaction or response of the human body to any change that it breeds as a result of the impact of significant events. Method: adescriptive, cross-sectional, quantitative and correlational study was carried out, with non-experimental design. Objective: to evaluate the vulnerability to stress in patients with peptic ulcer illness in an intentionally selected sample of 70 patients, all diagnosed with peptic ulcer illness through recent endoscopies (less than six months). These patients had been attended to in the gastroenterology service of "Efraín Mayor" polyclinics in Cotorro municipality from January to March 2013. Results: it was found that 85.7 percent of the sample were vulnerable to stress, females prevailed and smoking and coffee were the predominated toxic habits in the studied population. Anxiety as trait and emotional state predominated at low and middle levels. Conclusions: it was recommended to conduct a similar study in another health area of Cotorro municipality and to perform other studies with the following variables: Lifestyles, coping styles and social support, in their relationship to vulnerability to stress, in addition to implementing an educational intervention strategy aimed at the studied patients(AU)

Resultados en el tratamiento quirúrgico de la úlcera gastroduodenal perforada / Results of surgical treatment of perforated peptic ulcer

Fundamento: En la actualidad el tratamiento de la úlcera gastroduodenal perforada ha experimentado importantes cambios; pues no sería indicado la cirugía antisecretora ni resectiva, ya que se puede conseguir el mismo efecto con los inhibidores de la bomba de protones y con la erradicación del Helicobacter pylori. La recidiva es infrecuente, aunque en ocasiones con la cirugía no definitiva los síntomas reaparecen y hasta surgen nuevas perforaciones. Objetivo: Describir los resultados obtenidos en el tratamiento quirúrgico de la úlcera gastroduodenal perforada. Métodos: La investigación fue desarrollada en el Servicio de Cirugía General del Hospital Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, entre enero del año 2008 y mayo del año 2009, realizándose un estudio descriptivo sobre una serie de 55 casos con diagnóstico de úlcera gastroduodenal perforada, que fueron intervenidos quirúrgicamente. Resultados: El 31,2 por ciento de los pacientes que presentaron úlcera gastroduodenal, había recibido previamente terapia anti Helicobacter pylori, siendo la perforación el debut de la enfermedad en el 45,5 por ciento de los casos. A pesar de presentar como antecedente alguna enfermedad digestiva, el 41,7 por ciento de estos pacientes consumía algún tipo de medicamento ulcerogénico. Las técnicas quirúrgicas más utilizadas fueron las no definitivas, predominando la sutura y epiploplastia no pediculada (78,2 por ciento). Se encontró persistencia de la úlcera en el 20,0 por cientp de los pacientes a los que se pudo dar seguimiento.Conclusión: Después de tres meses de evolución, algunos de los pacientes operados con una técnica quirúrgica no definitiva y terapia anti-Helicobacter pylori no resolvieron su problema de salud(AU)

Background: At present, treatment of perforated peptic ulcer has undergone major changes. A vagotomy or resective surgery is no longer the first treatment of choice, since proton-pump inhibitors and Helicobacter pylori eradication can produce the same effect. Recurrence is rare, although when definitive surgery is not performed, symptoms may return and new perforations may occur.Objective: To describe the results of surgical treatment of perforated peptic ulcer. Methods: The research was conducted at the Department of General Surgery of the University Hospital Dr. Gustavo Aldereguía Lima in Cienfuegos, from January 2008 to May 2009. It consists of a case series study including 55 patients diagnosed with perforated peptic ulcer who underwent surgery.Results: 31.2 percent of the patients with peptic ulcer had previously undergone anti Helicobacter pylori therapy; perforation was the debut of the disease in 45.5 percent of cases. Despite presenting gastrointestinal illness as medical history, 41.7 percent of these patients were taking some type of ulcerogenic drugs. The most frequently used surgical techniques were nondefinitive, prevailing suture and non-pedunculated omentoplasty (78.2 percent). Persistent ulcer was found in 20.0 percent of patients who could be followed up. Conclusion: After three months of evolution, some of the patients operated on with a on definitive surgical technique and anti-Helicobacter pylori therapy did not overcome their health problem(AU)

Caracterización de pacientes con úlceras pépticas negativas a Helicobacter pylori / Characterization of patients with helicobacter pylori-negative peptic ulcers

Fundamento: la proporción de úlceras negativas a Helicobacter pylori está aumentando. El tratamiento con antinflamatorios no esteroideos y otras drogas ulcerogénicas juega un papel importante. Objetivo: caracterizar pacientes con úlcera péptica negativa a Helicobacter pylori. Métodos: estudio de serie de casos en pacientes atendidos en el Servicio de Gastroenterología del Hospital Hermanos Ameijeiras, en el año 2009. Se estudiaron variables demográficas, epidemiológicas, clínicas, endoscópicas e histológicas. Se analizó media y desviación estándar; se utilizaron las pruebas t-Student, Chi-cuadrado y regresión logística.Resultados: se diagnosticaron 269 úlceras gástricas, 239 duodenales y 41 combinadas; 115 casos negativos a Helicobacter pylori y 434 positivos. Los antinflamatorios no esteroideos se asociaron en un 33, 9 por ciento a los casos sin H. pilory y 22, 8 por ciento a los positivos. El síndrome ulceroso se presentó en 47 por ciento y 45 por ciento en ambos grupos. Se localizaron en el bulbo todas las úlceras duodenales negativas a H. pilory, y 96, 6 por ciento de las positivas. El antro fue la localización gástrica más frecuente (92, 3 por ciento negativos; 90, 5 por ciento positivos). En el duodeno predominaron las úlceras múltiples negativas y en el estómago las dobles negativas. La gastritis antral predominó (73, 0 por ciento H. pilory negativos), el grado de actividad fue mayor en los positivos (97, 0 por ciento) y la metaplasia intestinal fue similar para ambos grupos.Conclusiones: en pacientes con úlcera gastroduodenal negativa a H. pilory debe tenerse en consideración a los antinflamatorios no esteroideos como uno de los principales factores asociados a esta entidad(AU)

Background: the rate of Helicobacter pylori-negative ulcers is increasing. Treatment with nonsteroidal anti-inflammatory drugs and other ulcerogenic drugs plays a significant role. Objective: to characterize patients with Helicobacter pylori-negative peptic ulcer. Methods: a case series study of patients attended by the Gastroenterology Service of the Hermanos Ameijeiras Hospital was conducted in the year 2009. Demographic, epidemiological, clinical, endoscopic and histological variables were studied. Mean and standard deviation were analyzed; logistic regression, t-Student and Chi-square tests were used. Results: A total of 269 gastric ulcers, 239 duodenal ulcers and 41 combined were diagnosed; 115 cases were Helicobacter pylori-negative and 434 were positive. Nonsteroidal anti-inflammatory drugs were associated with 33,9 percent of H. pylori-negative patients and 22.8 percent of the positive patients. Ulcerative syndrome occurred in 47 percent and 45 percent in both groups. All H. pylori-negative duodenal ulcers were located in the duodenal bulb as well as 96, 6 percent of the positive. The antrum was the most common location for gastric ulcerations (92.3 percent negative; 90.5 percent positive). Multiple ulcers predominated in the duodenum while double ulcers prevailed in the stomach, all negative for H.pylori. Antral gastritis predominated (73. 0 percent H. pilory- negative), the level of activity was higher in the positive cases (97. 0 percent) and intestinal metaplasia was similar for both groups.Conclusions: in patients with H. pylori-negative peptic ulcer, non-steroidal anti-inflammatory drugs should be taken into consideration as one of the main factors associated with this entity(AU)

Different risk factors influence peptic ulcer disease development in a Brazilian population.

AIM: To investigate age, sex, histopathology and Helicobacter pylori (H. pylori) status, as risk factors for gastroduodenal disease outcome in Brazilian dyspeptic patients. METHODS: From all 1466 consecutive dyspeptic patients submitted to upper gastroscopy at Hospital das Clinicas of Marilia, antral biopsy specimens were obtained and subjected to histopathology and H. pylori diagnosis. All patients presenting chronic gastritis (CG) and peptic ulcer (PU) disease localized in the stomach, gastric ulcer (GU) and/or duodenal ulcer (DU) were included in the study. Gastric biopsies (n = 668) positive for H. pylori by rapid urease test were investigated for vacuolating cytotoxin A (vacA) medium (m) region mosaicism by polymerase chain reaction. Logistic regression analysis was performed to verify the association of age, sex, histopathologic alterations, H. pylori diagnosis and vacA m region mosaicism with the incidence of DU, GU and CG in patients. RESULTS: Of 1466 patients submitted to endoscopy, 1060 (72.3%) presented CG [male/female = 506/554; mean age (year) ± SD = 51.2 ± 17.81], 88 (6.0%) presented DU [male/female = 54/34; mean age (year) ± SD = 51.4 ± 17.14], and 75 (5.1%) presented GU [male/female = 54/21; mean age (year) ± SD = 51.3 ± 17.12] and were included in the comparative analysis. Sex and age showed no detectable effect on CG incidence (overall χ² = 2.1, P = 0.3423). Sex [Odds ratios (OR) = 1.8631, P = 0.0058] but not age (OR = 0.9929, P = 0.2699) was associated with DU and both parameters had a highly significant effect on GU (overall χ² = 30.5, P < 0.0001). The histopathological results showed a significant contribution of ageing for both atrophy (OR = 1.0297, P < 0.0001) and intestinal metaplasia (OR = 1.0520, P < 0.0001). Presence of H. pylori was significantly associated with decreasing age (OR = 0.9827, P < 0.0001) and with the incidence of DU (OR = 3.6077, P < 0.0001). The prevalence of m1 in DU was statistically significant (OR = 2.3563, P = 0.0018) but not in CG (OR = 2.678, P = 0.0863) and GU (OR = 1.520, P= 0.2863). CONCLUSION: In our population, male gender was a risk factor for PU; ageing for GU, atrophy and metaplasia; and H. pylori of vacA m1 genotype for DU.