Effect of prolonged and intermittent treatment on the clinical course of peptic ulcer.

OBJECTIVE: Introduction: The number of patients with peptic ulcer increases annually. According to published data, patients with peptic ulcer constitute about 15% of those hospitalized with gastrointestinal diseases. The aim: That is why we set the task to evaluate the methods of preventive treatment and to choose the most effective one. PATIENTS AND METHODS: Materials and methods: For this purpose, we selected 103 patients with peptic ulcer without severe exacerbations and complications from one region (main group) and 101 patients from another region (control group) for observations. Making diagnosis was based on the study of complaints, anamnestic data, physical examination of the patient, evaluation of the functional state of the gastroduodenal system, as well as the X-ray and endoscopic examination. The sources of the study were medical records of outpatients, control cards for dispensary surveillance, registers of temporary disability records, sick leave records and others. RESULTS: Results: Most patients, from both the main and control groups, who were on prophylactic treatment, noticed that they had an increased working capacity, normalized sleep, better appetite and fewer dyspeptic disorders. Patients in the main group for two years were on prolonged prophylactic treatment according to the method that we had developed. by us. Patients in the control group received an intermittent preventive treatment twice a year (in spring and autumn). In the complex of therapeutic measures the following were used: dietary recommendations, antacids, cholinolytics, multivitamins, etc. CONCLUSION: Conclusions: Prolonged prophylactic treatment is an effective means to combat exacerbations and complications of peptic ulcer and can be recommended for implementation in practice.

[Nutrition of patients with stomach acid-dependent pathology and inflammatory diseases of the urogenital system].

In work some, often meeting nosological forms urogenithal surgical diseases which last years frequently proceed against gastritises, stomach ulcer of a stomach and 12-perstnoj guts owing to increase of occurrence of the last are presented. For treatment various medicamentous schemes, which do-polnjajutsja rational diet-correction for the purpose of increase efficaci and qualities of treatment are used. The work purpose--to present features ratsional pathogenetic correctic a food at persons from an aggravation acid-deprndent to a pathology against constant reception prepara apropos urogenithal diseases.

Celiac-associated peptic disease at upper endoscopy: how common is it?

OBJECTIVE: Recently, several publications in adults have shown an increased incidence of non-Helicobacter pylori (HP), non-non-steroidal anti-inflammatory drug (NSAID) peptic disease (PD). There are only a few case reports linking celiac disease (CD) to PD. We therefore aimed to review our experience of CD presenting with PD. MATERIAL AND METHODS: We retrospectively reviewed all the endoscopies performed for children and young adults diagnosed with CD between 1 January, 2004 and 31 October, 2008. The diagnosis of CD was based on accepted guidelines. Patients with a doubtful diagnosis of CD were excluded. RESULTS: We had 240 patients with the diagnosis of CD. We had 29 (12.0%) patients [15 males (52%), 14 females (48%)] for whom the diagnosis of PD was ascertained. The age range was 1-50 years (mean 16.9 +/- 12.1 years). Twenty-three of the 29 patients (79%) were HP-negative. Duodenal PD was noted in 22 patients (76%) and 16 (73%) were HP-negative. Gastric PD was noted in eight patients (28%) and 7 (87%) were HP-negative. The PD group was significantly older at diagnosis (p < 0.001) compared to the whole CD group. CONCLUSIONS: PD is not uncommon in the presentation of CD. It is more likely to be found in the second decade of life. CD should be included in the differential diagnosis of patients with non-HP PD and we suggest routine CD serology and small bowel biopsy in patients with unexplained PD.

Is tramadol associated to bleeding peptic ulcer? A nationwide case-control study in hospitalized Swedish patients.

AIMS: Tramadol, a widely used analgesic drug, inhibits the reuptake of noradrenaline and serotonin impairing the aggregation function of thrombocytes. However, the risk for severe bleeding has previously not been studied. The aim of the present study is to investigate the association between tramadol and bleeding peptic ulcer in the Swedish population. METHODS: In this register based case-control study based on the Swedish national patient registry and prescription drug registry, we included 18 306 patients hospitalized with a first-time diagnosis of bleeding peptic ulcer. For every case, 4 matched controls were included. To investigate the temporal aspects of tramadol induced bleeding ulcer, exposure was divided into patients with newly initiated and ongoing treatment. To explore a possible confounding by indication, the effect of codeine, a drug also prescribed for the treatment of moderate pain, but not known to affect thrombocyte function, was investigated. Univariable and multivariable logistic regression was used to analyse the association between tramadol use and bleeding ulcer. RESULTS: Tramadol was associated with an increased risk of bleeding ulcer (adjusted odds ratio (aOR) 2.1, 95% confidence interval: (2.0-2.3). The association was stronger for newly initiated treatment with tramadol 2.8 (2.5-3.2) and weaker for ongoing treatment 1.7 (1.6-1.9). Codeine was also associated with an increased risk of bleeding ulcer 1.9 (1.7-2.1) and this association was also stronger for newly initiated treatment with codeine 2.3 (2.0-2.6) and weaker for ongoing treatment 1.7 (1.5-1.9). CONCLUSION: Treatment with tramadol was associated with an increased risk of bleeding peptic ulcer. Most of this association may be mediated by factors related to the pain condition rather than the pharmacologic effect per se.

Body mass index and per capita income influence duodenal ulcer healing and H. pylori eradication whilst dietary factors play no part.

BACKGROUND: The role of dietary and sociodemographic factors in the healing of duodenal ulcer following H. pylori eradication remains undefined. AIM: To assess the role of diet, sociodemography and body mass index in the healing of duodenal ulcer and eradication of H. pylori. METHODS: A cross-sectional study consisting of 67 consecutive duodenal ulcer patients was undertaken. Sociodemographic factors studied included age, sex, occupation, educational status, religion, type of family, number of family members, per capita income and residence (urban vs. rural). Personal habits studied included alcohol consumption and smoking. Regular dietary intake over a two-month period was assessed using the food frequency questionnaire. All patients had documented H. pylori infection at the time of inclusion and received standard triple eradication therapy. Follow-up endoscopy and testing for H. pylori were done 4 weeks after completion of eradication therapy. RESULTS: The mean age of the 67 patients (60 male, 7 female) was 39.9+/-13.6 years. Healing of duodenal ulcer was documented in 51 patients. H. pylori infection was successfully eradicated in 31 patients but not in the other 36. There was no difference between the groups (Group A1: H. pylori eradicated, Group B1: H. pylori not eradicated) with regard to dietary and socio-demographic variables, except for BMI, which was significantly higher in patients in whom H. pylori had been eradicated. Per capita income was significantly higher in Group A2 (healed duodenal ulcer) as compared to Group B2 (duodenal ulcer not healed) while there was no difference in dietary and socio-demographic variables in these two groups. CONCLUSION: We found that higher body mass index and higher per capita income were associated with successful H. pylori eradication and duodenal ulcer healing, respectively, and that diet had no role to play in either. Further epidemiological studies from different parts of India and studies that control for Helicobacter pylori are required to establish predictive factors.

Use of Enteral Nutrition for Gastrointestinal Bleeding Prophylaxis in the Critically Ill: Review of Current Literature.

PURPOSE OF REVIEW: This review provides a comprehensive overview of the etiology of stress-related mucosal disease, current acid suppression therapy recommendations, and the role enteral nutrition may play in disease prevention. RECENT FINDINGS: Recent literature indicates enteral nutrition may prevent complications of stress-related mucosal disease by increasing splanchnic blood flow, enhancing gastrointestinal motility, and promoting cellular immunity and integrity through local nutrient delivery. Stress-related mucosal disease is a common complication of hospitalization in the critically ill which may lead to overt gastrointestinal bleeding and enhanced mortality. High-risk patients have historically been prescribed acid suppression therapy, though enteral nutrition may also have a role in disease mitigation.

[Nutrition of patients operated for complicated gastroduodenal ulcers at the early postoperative period].

The investigation is based on an analysis of results of treatment of 102 patients after an emergency resection of the stomach for complicated gastroduodenal ulcers. The probe was inserted into the jejunum intraoperatively. The period of enteral probe nutrition (EPN) was 5-7 days. At the early postoperative period in patients who had undergone the emergency resection of the stomach EPN is an effective method of nutrition maintenance as compared with the infusion-transfusion therapy. The method is simple and open to general use, and is economically advantageous under conditions of any hospital.

Diet therapy in adult lactose malabsorption: present practices.

Three hundred twenty-three of 473 questionnaires sent to hospital dietitians in 50 states and Puerto Rico concerning diet therapy for adult lactose malabsorption were returned and analyzed. Only 42% of the responding dietitians stated that their hospital diet manuals contained a diet for adult lactose malabsorption, with less than 1% having a diet specific for patients with peptic ulcer disease and lactose malabsorption. Physicians in almost half of these hospitals rarely considered lactose malabsorption when prescribing a diet for patients with peptic ulcer disease or rarely modified diets for suspected lactose malabsorption. The responding dietitians supplied pertinent portions of their diet manuals in 99 instances, which was 72% of those having such diets. Many of the submitted diets were too rigid, frequently restricting foods that did not contain lactose. On the basis of the survey and a review of the literature, a more reasonable approach to the therapy of adult lactose malabsorption is suggested.

Diet and nutrition in ulcer disease.

In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patient's usual diet are recommended. Table 1 depicts a sample menu for chronic peptic ulcer disease. Frequent milk ingestion as previously prescribed is not encouraged. This is owing to the transient buffering effect and significant gastric acid secretion effect of milk. The fat content of milk has no influence on these effects. Spices, in particular black pepper, red pepper, and chili powder, may produce dyspepsia. One study shows red chili powder to have no detrimental effect on duodenal ulcer healing. It has also been proposed that daily pepper ingestion may have a beneficial adaptive cytoprotective response. While still controversial and under evaluation, peptic ulcer patients should avoid any spice that causes discomfort, especially during exacerbation of peptic disease. Currently, studies indicate that it is prudent to avoid alcohol. This is especially true for the concentrated forms, such as 40% (80 proof) alcohol. Coffee should be avoided on the basis of its strong acid secretagogue property. Coffee can induce dyspepsia. Whether noncoffee caffeine-containing beverages (tea, soft drinks) induce peptic ulcer is unknown, but they are acid secretion stimulators. Decaffeinated coffee has an acid stimulating effect as well. It is reasonable to have peptic ulcer patients restrict decaffeinated coffee and all caffeine-containing beverages. There appears to be no evidence to restrict dietary fiber. Some fiber-containing foods may possess factors that are protective against ulcer disease. According to the Mayo Clinic Diet Manual, previously recommended small frequent feedings have not been shown to be more effective than three meals per day in the treatment of chronic peptic ulcer disease. This reference cites authorities advising against extra feedings because of increased acid secretion and unnecessary complication of eating patterns. However, some patients claim to be relieved of symptoms with more frequent feedings, especially during acute phases. Citric acid juices may induce reflux and cause discomfort in selective patients. Stomach distention with large quantities of food should be discouraged. Although there is now little role for dietary therapy, one should note that bland and ulcer diets probably are not detrimental to most persons if they are used for a short time and may have some psychological benefit.(ABSTRACT TRUNCATED AT 400 WORDS)

Medical treatment of peptic ulcer disease.

Our understanding of PUD and its treatment has improved dramatically during the past 15 years. During this time, many new effective drugs have been approved by the FDA, and possibly even more potent and effective therapies are now being evaluated. The H2-blockers, sucralfate, and antacids heal over 90% of duodenal ulcers in 6 to 8 weeks, and H2-blockers heal about 80% of gastric ulcers by 8 weeks and over 90% by 12 weeks. The new, more potent pump blockers (omeprazole) promise to be even more effective drugs, even for the healing of patients who are taking NSAIDS. However, the potential hazards of marked, long-term acid suppression must still be evaluated. Maintenance therapy with H2-blockers or sucralfate, ideally used for patients who would otherwise have frequent symptomatic recurrences of duodenal ulcer disease or who have had complications, reduces the relapses, especially symptomatic relapses. Maintenance therapy with H2-blockers also seems to reduce the recurrences of GUD, but this use has not yet received FDA approval. Elimination of H. pylori infection with antibiotics may prove to reduce recurrent ulcer disease and negate the need for maintenance therapy. Colloidal bismuth subcitrate alone, which suppresses but does not eradicate H. pylori infection, seems to be an effective ulcer drug and may even reduce the rate of early recurrences. Effective ulcer therapy, especially if it prevents recurrent disease, may reduce the complications of PUD, but this expectation has yet to be established. The use of prophylactic cytoprotective prostaglandins (misoprostol) reduces the incidence of NSAID-induced GUD.

Use of modified diets in nursing homes.

Randomly chosen medical charts of 212 elderly subjects in 11 nursing homes were reviewed to determine which characteristics of the subjects were most closely associated with their diet prescriptions. The chart reviews indicated that 104 (49.0%) of the 212 subjects had some type of nutrient-modified diet prescription. Eight patients who were tube fed were not included in subsequent analyses. Sodium restriction was the most common modification (60 [29.4%] of the remaining 204 patients) and calorie-controlled diets were also common (52 [25.5%] of the patients). Of the 55 patients with hypertension, 31 (56.4%) had no sodium restriction. Only 10% of all low-sodium diets limited sodium to 2 g per day. Of the 38 patients with diabetes, 7 (18.4%) had no prescription for calorie control, and there was no indication that increased dietary fiber was encouraged for diabetic patients. Only one of the 121 subjects with a diagnosis of coronary heart disease or atherosclerosis had a prescription for a cholesterol-lowering diet. Characteristics of the subjects not specifically related to diet or diagnosis, such as age, sex, duration of stay, and level of care, had no significant relationship to diet prescription. These findings suggest that the practitioners in our sample were not convinced of the efficacy of modified diets to control disease for most nursing home residents.

Peptic ulcer disease: current management in the elderly.

Pain is less frequently the initial complaint in the elderly; melena is a more frequent presentation of ulcer disease. Also, in case of a complication, signs and symptoms are less severe. If one decides to treat an elderly patient symptomatically--without the benefit of any diagnostic study--the patient should be followed closely. The physician should be satisfied that at least partial relief is occurring within the first few days.

The treatment of peptic ulcer.

Recent evaluation of the time honoured use of antacids and anticholinergics in the treatment of peptic ulcer disease has not revealed persuasive evidence of efficacy above that of placebo. New drugs becoming available as medical treatments of peptic ulcer disease, viz H2-receptor antagonists and E group prostaglandin analogues, show considerable promise but require more time for adequate evaluation. The surgical treatment of peptic ulcer disease has similarly evolved with the development of effective operations with minimal post surgical morbidity, but again await the test of time for adequate evaluation.

Peptic ulcer disease.

Patients with peptic ulcer disease are commonly seen by family physicians. The incidence of duodenal ulcer seems to be declining in the United States. Avoidance of inciting factors and the use of antacids and cimetidine are indicated in the treatment of duodenal ulcers. New histamine H2 receptor antagonists and site-specific mucosal barrier agents are now available. Gastric ulcer differs from duodenal ulcer in many ways, and gastric carcinoma must be considered in the differential diagnosis. Other important entities include Zollinger-Ellison syndrome, "stress" ulceration, and peptic ulcer disease in children.

Dietary therapy of gastrointestinal disorders.

Diet therapy is mandatory in only a very small number of GIT disorders. While the available evidence does not support its use in other conditions, many physicians will wish to make an individual decision regarding diet therapy according to the patient's symptoms, to the patient's attitudes and expectations and very importantly, to the financial and social implications of the diet in question.

Buffering capacity of some Nigerian food-substances.

The buffering capacity of some Nigerian local food substances was investigated using a modification of Toveys method (1974), Beans (red, and white), maize, rice (unprocessed with hull) and rice (unpolished) appeared to have high buffering capacity while yam, cassava and polished rice all showed weak buffering capacity. According to the analysis of Nigeria's foods and food-stuffs by Oyenuga, (1968)2 the former group of food substance incidentally have high phosphorus contents and relatively higher iron, calcium and protein contents. (The index of the buffering capacity is the number of millitres of acid that was mopped up before attaining pH 1.9). The buffering capacity was prominent at a higher pH range in the strong buffers than in the weak ones. This study would therefore encourage ulcer patients to eat more of beans especially the red type since it showed the greatest buffering capacity.

[Possibility of using a protein enteral feeding preparation in the overall therapy of peptic ulcer in children]. / Vozmozhnost' primeneniia belkovogo énpita v kompleksnoi terapii iazvennoi bolezni u detei.

A protein-rich diet for children with peptic ulcer has been developed. The diet includes a new dietetic product--the proteinic enpit, prepared by the Institute of Nutrition of the AMS of the USSR. The effect of the diet in children with peptic ulcer at the time of exacerbation of the process was subjected to a complex study. This ration is shown to have a beneficial influence on basic symptoms of the affection, on the condition of the protein metabolism and reduces the period of the ulcerous defect cicatrization.

[Effect of a diet with an increased protein content on reparative processes in experimental ulcerous lesions of the gastric and duodenal mucosa]. / Vliianie diety s povyshennym soderzhaniem belka na reparativnye protsessy pri eksperimental'nykh iazvennykh porazheniiakh slizistoi obolochki zheludka i dvenadtsatiperstnoi kishki.

Experimental rats were subjected to an extreme action: 3-hour immobilization with simultaneous electrostimulation. A complete healing of erosion-ulcerous defects of the gastroduodenal mucosa was recorded in rats given diets with an increased (by 4 g) protein content (group I), on day 5. The mucosal affections in the rats receiving a standard ration still persisted. The content of creatine-phosphate in the gastric wall tissue, decreased under the extreme action, was rapidly recovered in group I rats, no changes in the proper fluorescence level of reduced NADH and flavoproteins were noted. In group II rats both parameters returned to normal only on day 5. Blood serum ceruloplasmin (CP) activity increased during first 3 days with a similar rate in both animal groups. However, in the following 2 days CP activity in group I rats became completely normal, while that in group II animals was still rising. The results of the study have shown that the diet with increased protein content stimulates epithelization of the gastroduodenal mucosa due to the improvement of the bioenergy processes in the gastroduodenal area, and to intensified adaptation potentialities of the body.

[Liver exocrine function in patients after gastrectomy for peptic ulcer]. / Vneshnesekretornaia funktsiia pecheni u bol'nykh posle rezektsii zheludka po povodu iazvennoi bolezni.

Exosecretory liver function was studied in patients after gastric resection for peptic ulcer. Disorders of the biochemical composition of the bile were discovered; they were manifested by disproportional formation and secretion of the basic components of the bile: cholic acid, cholesterol and phospholipids, which led to the shift in the bile components ratio and could promote their precipitation. Moreover, the lowering of the content of the basic components of the bile is likely to bring about a substantial derangement of the processes of fat digestion. Dietetic management of these patients exerted a beneficial effect on cholic acid secretion. However, in some patients with grave postoperative syndromes and disturbances in the hepatobiliary system, no noticeable positive results were obtained. The latter circumstance allows the conclusion about the necessity of placing such patients on prolonged treatment including bile expelling agents.

[Effectiveness of peptic ulcer diet therapy using rations containing whole mare's and camel's milk]. / Effektivnost' dietoterapii bol'nykh iazvennoi bolezn'iu ratsionami, soderzhashchimi tsel'noe kobyl'e i verbliuzh'e moloko.

Diets enriched with whole mare and camel's milk were used for the management of peptic ulcer patients. A total of 164 patients were examined. Of these, 59 received mare's milk, 40 camel and 65 cow's milk. On the basis of studying the time course of the clinical picture, secretory and motor functions of the stomach, as well as of the endoscopic appearance of the gastric and duodenal mucosa it was ascertained that apart from the improved clinical course of the disease, secretory and motor functions of the stomach there was a complete wound healing and remarkable decline of its size in 93, 90, and 70% of patients given mare, camel and cow's milk, respectively. Also, radiotelemetry was used to study the antacid properties of the milk types in question. The first two milk types have demonstrated more pronounced antacid properties.