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Zetner D, Rasmussen IR, Frykman CP, Jensen LR, Jensen RJ, Possfelt-Møller E, Taudorf M, Penninga L. Risk factors for rebleeding and mortality following prophylactic transarterial embolization for patients with high-risk peptic ulcer bleeding: a single-center retrospective cohort study. Surg Endosc 2024; 38:2010-2018. [PMID: 38413471 PMCID: PMC10978705 DOI: 10.1007/s00464-024-10709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND To investigate factors associated with risk for rebleeding and 30-day mortality following prophylactic transarterial embolization in patients with high-risk peptic ulcer bleeding. METHODS We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization. RESULTS We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395-6.579) and 30-day overall mortality by 3.262 (1.252-8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088-5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243-5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure. CONCLUSIONS Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention.
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Affiliation(s)
- Dennis Zetner
- Department of Radiology, North Zealand Hospital, Copenhagen University Hospital, Hilleroed, Denmark.
| | - Ida Roost Rasmussen
- Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Lasse Rehné Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruben Juul Jensen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Possfelt-Møller
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Vakil N. Endoscopic Diagnosis, Grading, and Treatment of Bleeding Peptic Ulcer Disease. Gastrointest Endosc Clin N Am 2024; 34:217-229. [PMID: 38395480 DOI: 10.1016/j.giec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Peptic ulcer bleeding is a major cause for hospital admissions and has a significant mortality. Endoscopic interventions reduce the risk of rebleeding in high-risk patients and several options are available including injection therapies, thermal therapies, mechanical clips, hemostatic sprays, and endoscopic suturing. Proton-pump inhibitors and Helicobacter pylori treatment are important adjuncts to endoscopic therapy. Endoscopic therapy is indicated in Forrest 1a, 1b, and 2a lesions. Patients with Forrest 2b lesions may do well with proton-pump inhibitor therapy alone but can also be managed by removal of the clot and targeting endoscopic therapy to the underlying lesion.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Zhang YH, Xu ZH, Ni SS, Luo HX. Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children. World J Gastroenterol 2024; 30:705-713. [PMID: 38515948 PMCID: PMC10950618 DOI: 10.3748/wjg.v30.i7.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The detection rate of peptic ulcer in children is improving, with development of diagnostic procedures. Gastroscopy is the gold standard for the diagnosis of peptic ulcer, but it is an invasive procedure. Gastrointestinal contrast-enhanced ultrasonography (CEUS) has the advantages of being painless, noninvasive, nonradioactive, easy to use, and safe. AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children. METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022. All children were examined by routine ultrasound, gastrointestinal CEUS, and gastroscopy. The pathological results of gastroscopy were taken as the gold standard. Routine ultrasonography was performed before gastrointestinal CEUS. Conventional ultrasound showed the thickness of the gastroduodenal wall, gastric peristalsis, and the adjacent organs and tissues around the abdominal cavity. Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall; the size, location and shape of the ulcer; gastric peristalsis; and adjacent organs and tissues around the abdominal cavity. The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS. All children received informed consent from their guardians for CEUS. This study was reviewed and approved by the hospital medical ethics committee. RESULTS Among the 43 children, 17 (15 male, 2 female) were diagnosed with peptic ulcer by gastroscopy. There were 26 children with nonpeptic ulcer. There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound. The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1% (34/43), which was significantly different from that of gastroscopy (P = 0.033). It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low. Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS. The diagnostic coincidence rate of peptic ulcer in children was 95.3% (41/43). There was no significant difference between CEUS and gastroscopy (P = 0.655). It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high. CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children, and can be used as a preliminary examination method.
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Affiliation(s)
- Yu-Hua Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhi-Hua Xu
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Shuang-Shuang Ni
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Hong-Xia Luo
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Fischbach W, Bornschein J, Hoffmann JC, Koletzko S, Link A, Macke L, Malfertheiner P, Schütte K, Selgrad DM, Suerbaum S, Schulz C. Update S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS). Z Gastroenterol 2024; 62:261-321. [PMID: 38364851 DOI: 10.1055/a-2181-2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
| | - Jan Bornschein
- Translational Gastroenterology Unit John, John Radcliffe Hospital Oxford University Hospitals, Oxford, United Kingdom
| | - Jörg C Hoffmann
- Medizinische Klinik I, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Deutschland
| | - Sibylle Koletzko
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU-Klinikum Munich, Munich, Deutschland
- Department of Paediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Alexander Link
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Lukas Macke
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
| | - Kerstin Schütte
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken Marienhospital Osnabrück, Osnabrück, Deutschland
| | - Dieter-Michael Selgrad
- Medizinische Klinik Gastroenterologie und Onkologie, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Deutschland
- Klinik für Innere Medizin 1, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Sebastian Suerbaum
- Universität Munich, Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Munich, Deutschland
- Nationales Referenzzentrum Helicobacter pylori, Pettenkoferstr. 9a, 80336 Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
| | - Christian Schulz
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
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Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, Kitic I, Mijovic T, Sarajlija A. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023; 29:6095-6110. [PMID: 38186684 PMCID: PMC10768410 DOI: 10.3748/wjg.v29.i47.6095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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Affiliation(s)
- Marija Kocic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragan Prokic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Kitic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Adrijan Sarajlija
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
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Vanhoenacker C, Hufkens E, Laenen A, Bonne L, Claus E, Peluso J, Demedts I, Laleman W, Wilmer A, Maleux G. Factors influencing outcome of angiographic embolization for gastroduodenal hemorrhage related to peptic ulceration. Eur J Radiol 2023; 166:110970. [PMID: 37463549 DOI: 10.1016/j.ejrad.2023.110970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Long-term outcome and prognostic factors of transcatheter embolization for gastroduodenal peptic ulcer bleeding are unknown. This study was conducted to evaluate the clinical outcome and factors associated with early recurrent bleeding and 30-day mortality of transcatheter arterial embolization (TAE) for severe, upper gastroduodenal hemorrhage associated with peptic ulcer and refractory to medical and endoscopic therapy. METHODS A monocenter, retrospective study from 2005 to 2020 including 76 consecutive patients who underwent TAE as first-line therapy for bleeding gastroduodenal peptic ulcers refractory to endoscopic therapy. Patient demographics, endoscopy findings, co-morbidities and interventional procedure findings were recorded. The outcome measures were technical and clinical success, procedure related complications, recurrent bleeding, length of hospital stay, 30-day mortality and overall survival. RESULTS The technical success rate was 96% and the clinical success rate was 65,8%. The rebleeding and 30-day mortality rate were 30,7% and 22,4% respectively. A higher international normalized ratio (INR) was a statistically significant risk factor for 30-day mortality (OR, 7.15; 95% CI, 1.67-30.70; p = 0.008). The mean overall survival was 3.76 years (1.16---5.09; 95% CI); a lower Charlson Comorbidity Index (CCI) and a lower Rockall score were significantly associated with a longer overall survival (HR, 1.24; 95% CI, 1.14-1.35; p = 0.0001; HR, 1.32; 95% CI, 1.10-1.59; p = 0.003) respectively. Early rebleeding was significantly associated with a lower overall survival (HR, 2.72; 95% CI, 1.57-4.71; p = 0.0004). CONCLUSION A higher INR was a significant risk factor with a higher 30-day mortality. A lower CCI, a lower Rockall score and the absence of early rebleeding were significantly associated with a longer overall survival.
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Affiliation(s)
- Charlotte Vanhoenacker
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Eva Hufkens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven,Herestraat 49, 3000 Leuven, Belgium.
| | - Annouschka Laenen
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, Kapucijnenvoer 35, 3000 Leuven, Belgium.
| | - Lawrence Bonne
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Eveline Claus
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Jo Peluso
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Ingrid Demedts
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven,Herestraat 49, 3000 Leuven, Belgium.
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven,Herestraat 49, 3000 Leuven, Belgium.
| | - Alexander Wilmer
- Department of General Internal Medicine, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Prosenz J, Stättermayer MS, Riedl F, Maieron A. Adherence to guidelines in patients with non-variceal upper gastrointestinal bleeding (UGIB) - results from a retrospective single tertiary center registry. Scand J Gastroenterol 2023; 58:856-862. [PMID: 36855301 DOI: 10.1080/00365521.2023.2183734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Guidelines for the management of upper gastrointestinal bleeding (UGIB) are regularly published, yet little is known concerning adherence to recommendations in practice. OBJECTIVES We aimed to assess adherence to European Society of Gastrointestinal Endoscopy (ESGE) recommendations in patients with non-variceal UGIB. MATERIALS AND METHODS All hospitalized patients with an esophagogastroduodenoscopy (EGD) performed due to suspected non-variceal UGIB at our department were included in a prospective registry. Data between 2018-2020 from this registry were retrospectively analyzed. Adherence to the 2015 ESGE bleeding and propofol sedation guidelines was assessed. Adherence to recommendations concerning preendoscopic (risk) evaluation, preendoscopic PPI, transfusion management, and endoscopic management of peptic ulcers was analyzed. RESULTS Among 1005 patients (mean age 70.4 years, 42.1% women) the most common bleeding etiologies were gastric or duodenal ulcers (16.8%), esophagitis/GERD (11.1%), and angiodysplasia (9.9%); mortality was 7.6%. Adherence to preendosopic risk evaluation was low, in 0% a Mallampati classification and in 37.5% an ASA scoring was documented. Preendoscopic PPI was started at 58.6%, and adherence to recommended transfusion management was >98%. Peptic ulcers were Forrest-graded in 72.8%. High-risk ulcers were treated appropriately in 77.9% and low-risk ulcers were not treated in 73.6%. Especially Forrest Ib ulcers were undertreated, with an adherence of 59.6%. Only 22/179 (12.3%) patients with peptic ulcers and early endoscopy were consistently managed according to ESGE recommendations. CONCLUSIONS Adherence to ESGE guidelines in patients with non-variceal UGIB is moderate to low, even at a tertiary university hospital. Strategies must be devised for guidelines to reach patients in everyday practice.
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Affiliation(s)
- Julian Prosenz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
| | - Marie-Sophie Stättermayer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Florian Riedl
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Maieron
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
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Kawaguchi K, Yoshida A, Yuki T, Shibagaki K, Tanaka H, Fujishiro H, Miyaoka Y, Yanagitani A, Koda M, Ikuta Y, Hamamoto T, Mukoyama T, Sasaki Y, Kushiyama Y, Yuki M, Noguchi N, Miura M, Ikebuchi Y, Yashima K, Kinoshita Y, Ishihara S, Isomoto H. A multicenter prospective study of the treatment and outcome of patients with gastroduodenal peptic ulcer bleeding in Japan. Medicine (Baltimore) 2022; 101:e32281. [PMID: 36626498 PMCID: PMC9750535 DOI: 10.1097/md.0000000000032281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Gastroduodenal peptic ulcers are the main cause of nonvariceal upper gastrointestinal bleeding (UGIB). We believe that recent advances in endoscopic techniques and devices for diagnosing upper gastrointestinal tract tumors have advanced hemostasis for UGIB. However, few prospective multicenter studies have examined how these changes affect the prognosis. This prospective study included 246 patients with gastroduodenal peptic ulcers treated at 14 participating facilities. The primary endpoint was in-hospital mortality within 4 weeks, and the secondary endpoints required intervention and refractory bleeding. Subsequently, risk factors affecting these outcomes were examined using various clinical items. Furthermore, the usefulness of the risk stratification using the Glasgow-Blatchford score, rockall score and AIMS65 based on data from the day of the first urgent endoscopy were examined in 205 cases in which all items were complete there are two periods. Thirteen (5%) patients died within 4 weeks; and only 2 died from bleeding. Significant risk factors for poor outcomes were older age and severe comorbidities. Hemostasis was required in 177 (72%) cases, with 20 cases of refractory bleeding (2 due to unsuccessful endoscopic treatment and 18 due to rebleeding). Soft coagulation was the first choice for endoscopic hemostasis in 57% of the cases and was selected in more than 70% of the cases where combined use was required. Rockall score and AIMS65 predicted mortality equally, and Glasgow-Blatchford score was the most useful in predicting the requirement for intervention. All scores predicted refractory bleeding similarly. Although endoscopic hemostasis for UGIB due to peptic ulcer had a favorable outcome, old age and severe comorbidities were risk factors for poor prognosis. We recommend that patients with UGIB should undergo early risk stratification using a risk scoring system.
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Affiliation(s)
- Koichiro Kawaguchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
- * Correspondence: Koichiro Kawaguchi, Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago City 683-8504, Japan (e-mail: )
| | - Akira Yoshida
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
- Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Kotaro Shibagaki
- Gastrointestinal Endoscopy, Shimane University Hospital, Izumo, Japan
| | - Hisao Tanaka
- Division of Gastroenterology, Tottori Red Cross Hospital, Tottori, Japan
| | - Hirofumi Fujishiro
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Youichi Miyaoka
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Atsushi Yanagitani
- Division of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Masaharu Koda
- Division of Gastroenterology, Yonago Medical Center, Yonago, Japan
| | - Yukihiro Ikuta
- Division of Gastroenterology, Hamada Medical Center, Hamada, Japan
| | | | | | - Yuichiro Sasaki
- Division of Gastroenterology, Sakaiminato Saiseikai General Hospital, Sakaiminato, Japan
| | | | - Mika Yuki
- Division of Internal Medicine, Izumo-City General Medical Center, Izumo, Japan
- Endoscopic Center, Izumo Tokushukai Hospital, Izumo, Japan
| | - Naoya Noguchi
- Division of Gastroenterology, Tottori Prefectural Kosei Hospital, Kurayoshi, Japan
| | - Masahiko Miura
- Division of Gastroenterology, Matsue City Hospital, Matsue, Japan
| | - Yuichiro Ikebuchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazuo Yashima
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
- Steel Hirohata Memorial Hospital, Himeji, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
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9
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Li X, He F, Tuo X, Qiu Y, Guo J, Wu Y, Meng X, Yang Z. Electroacupuncture ameliorates peptic ulcer disease in association with gastroduodenal microbiota modulation in mice. Front Cell Infect Microbiol 2022; 12:935681. [PMID: 36061878 PMCID: PMC9437313 DOI: 10.3389/fcimb.2022.935681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023] Open
Abstract
Peptic ulcer disease (PUD) is a common disease and frequently encountered in the clinic. Accumulating evidence suggests that PUD is associated with the gastrointestinal microbiota. Electroacupuncture (EA) is an improved version of acupuncture, which can improve the clinical effect by increasing the stimulation and delivering appropriate electrical pulses to needles. This method has been widely used in the treatment of peptic ulcer disease. However, its effect on gastrointestinal microbiota remains unclear. Therefore, in the present study, the ameliorative effect of EA was evaluated on the gastroduodenal mucosa, and the regulatory effect of the gastroduodenal microbiota was assessed in PUD mice. A total of 48 male Kun Ming mice were randomly divided into the following groups: normal control group (NC), PUD model group (PUD), Shousanli group (LI10), and Zusanli group (ST36) (n=12). The mice in groups LI10 and ST36 were treated with EA at LI10 and ST36, respectively. This intervention was continued for 7 days. Subsequently, we evaluated the morphological changes in the gastric and duodenal mucosa, and specific indices were measured, including the contents of serum dopamine (DA), the trefoil factor (TFF), and the vasoactive intestinal peptide (VIP). In addition, the gastric and duodenal microbiota were assessed via 16S ribosomal DNA sequencing. The results indicated that EA at LI10 or ST36 significantly reduced the injury of the gastroduodenal mucosa in PUD mice. The gastric microbial community structure of the groups LI10 and ST36 was similar to that of the NC group following comparison with the microbial community structure of the PUD model group. Moreover, the abundance of Firmicutes in the stomach was decreased, whereas that of Bacteroidetes was increased, and the abundance of Firmicutes in the duodenum was decreased. Furthermore, the microbial diversity and richness of the gastric microbiota in group LI10 were also significantly increased, and the serum dopamine and trefoil factor levels in group ST36 were significantly increased. Therefore, it is suggested that EA ameliorating PUD is in association with improving the levels of DA and TFF and regulating the relative abundances of Firmicutes and Bacteroidetes in the gastric microbiota.
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Affiliation(s)
- Xiaoshuang Li
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Feiyu He
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Xuan Tuo
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Yuanming Qiu
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Jingjing Guo
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Yiming Wu
- Eye Institute, School of Medicine, Xiamen University, Xiamen, China
| | - Xianjun Meng
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Zongbao Yang
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
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10
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Abbasi-Kangevari M, Ahmadi N, Fattahi N, Rezaei N, Malekpour MR, Ghamari SH, Moghaddam SS, Azadnajafabad S, Esfahani Z, Kolahi AA, Roshani S, Rezazadeh-Khadem S, Gorgani F, Naleini SN, Naderimagham S, Larijani B, Farzadfar F. Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990–2019. PLoS One 2022; 17:e0271284. [PMID: 35913985 PMCID: PMC9342757 DOI: 10.1371/journal.pone.0271284] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5−10% in the general population. Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. Quantifying and benchmarking health systems’ performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. Objective The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. Methods Data were derived from the Global Burden of Disease Study 1990–2019. Principal-Component-Analysis was used to combine age-standardized mortality-to-incidence-ratio, disability-adjusted-life-years-to-prevalence-ratio, prevalence-to-incidence-ratio, and years-of-life-lost-to-years-lived-with-disability-into a single proxy named Quality-of-Care-Index (QCI). QCI was used to compare the quality of care among countries. QCI’s validity was investigated via correlation with the cause-specific Healthcare-Access-and-Quality-index, which was acceptable. Inequities were presented among age groups and sexes. Gender Disparity Ratio was obtained by dividing the score of women by that of men. Results Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. High-income-Asia-pacific had the highest QCI, while Central Latin America had the lowest. QCI of high-SDI countries was 82.9 in 1990, which increased to 92.9 in 2019. The QCI of low-SDI countries was 65.0 in 1990, which increased to 76.9 in 2019. There was heterogeneity among the QCI-level of countries with the same SDI level. QCI typically decreased as people aged; however, this gap was more significant among low-SDI countries. The global Gender Disparity Ratio was close to one and ranged from 0.97 to 1.03 in 100 of 204 countries. Conclusion QCI of PUD improved dramatically during 1990–2019 worldwide. There are still significant heterogeneities among countries on different and similar SDI levels.
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Affiliation(s)
- Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- The Netherlands Cancer Institute(NKI), Amsterdam, Netherlands
| | - Sahba Rezazadeh-Khadem
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Nima Naleini
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
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11
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Yi X, Wang L, He Q, A R, Le Y. Acupoint catgut embedding for the treatment of peptic ulcers: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e25562. [PMID: 33879710 PMCID: PMC8078472 DOI: 10.1097/md.0000000000025562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Peptic ulcer (PU) is a common clinical disease of the digestive system, which can occur in all ages, gastric and duodenal ulcers are the most commonly seen PUs in clinical practice. The main manifestations are chronic and periodic rhythmic upper abdominal pain, accompanied by indigestion symptoms such as pantothenic acid, belching, and nausea. Serious complications such as bleeding, perforation, obstruction and canceration are easy to occur, endangering the life safety of patients. There are many ways to treat PU in clinic, and acupoint catgut embedding therapy has its unique advantages. Hence, our systematic review aims to evaluate the efficacy and safety of acupoint embedding therapy in the treatment of PU and to provide a reliable basis for physician. METHODS We will search electronic databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), China Biomedical Literature Database (CBM), and China Scientific Journals Database (VIP) from establishment to April 2021, and will manually searched the list of medical journals as a supplement. Two authors will screen the studies independently, as well as extract data information, and assess methodological quality through the Cochrane risk of bias (ROB) tool. The Stata software (Version 16.0) software will be used for statistical analysis. RESULTS By evaluating the current status of acupoint catgut embedding for Peptic ulcer disease, this study would prove the effectiveness and safety of acupoint embedding therapy, and will be published in a peer-reviewed journal. CONCLUSION This systematic review will provide a credible evidence-based for acupoint catgut embedding in the treatment of peptic ulcer. INPLASY REGISTRATION NUMBER INPLASY202130097.
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Affiliation(s)
- Xingqian Yi
- Jiangxi University of Traditional Chinese Medicine
| | - Li Wang
- Science and Technology College of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qingying He
- Jiangxi University of Traditional Chinese Medicine
| | - Rigun A
- Jiangxi University of Traditional Chinese Medicine
| | - Yimin Le
- Jiangxi University of Traditional Chinese Medicine
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12
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Rahman MM, Ghoshal UC, Kibria MG, Sultana N, Yusuf MA, Nahar S, Ahmed F, Rowshon AHM, Hasan M. Functional Dyspepsia, Peptic Ulcer, and Helicobacter pylori Infection in a Rural Community of South Asia: An Endoscopy-Assisted Household Survey. Clin Transl Gastroenterol 2021; 12:e00334. [PMID: 33878048 PMCID: PMC8052092 DOI: 10.14309/ctg.0000000000000334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Functional dyspepsia (FD), although commoner than organic dyspepsia (OD) in-hospital studies, community data, particularly from rural areas, are lacking. We performed a rural community study in Bangladesh with the primary aims to evaluate (i) the prevalence of uninvestigated dyspepsia (UD), FD, and OD and (ii) the risk factors for UD. METHODS This house-to-house survey was performed using a translated-validated enhanced Asian Rome III questionnaire and endoscopy with Helicobacter pylori tests, including genotyping. RESULTS Of 3,351/3,559 responders ([94.15%], age 40.41 ± 16.05 years, female 1924 [57.4%]), 547 (16.3%) had UD (female 346 [18%] vs male 201 [14%]; P = 0.002); 201 (6%), 88 (2.6%), and 258 (7.7%) had postprandial distress (PDS), epigastric pain syndromes (EPS) and PDS-EPS overlap, respectively. On multivariate analysis, age >50 years (adjusted odds ratio [AOR] 1.34 [1.07-1.68]), female sex (AOR 1.42 [1.17-1.74]), being married (AOR 1.57 [1.21-2.07]), lower family income (AOR 1.79 [1.43-2.26]), nonsteroidal anti-inflammatory drug use (AOR 7.05 [2.11-23.55]), previous acute gastroenteritis (AOR 5.42 [1.83-16]), and psychological distress (AOR 5.02 [2.87-8.76]) were risk factors for UD. Of 346/547 (63.25%) undergoing endoscopy, 232 (67.05%) and 114 (32.95%) had FD and OD (peptic ulcers [PU] 99 [28.61%] and erosive esophagitis 13 [3.76%]). About 53% of FD subjects had EPS-PDS overlap, 32% had PDS, and only 15% had EPS. H. pylori was detected in 266/342 (78%) dyspeptics (FD 173/230 [75.2%], vs OD 92/114 [82.1%], P = 0.169). DISCUSSION Sixteen percent, 11% and 5% of rural Bangladeshi Asian adults had UD, FD, and PU, respectively. One-third of UD subjects had OD, mostly PU.JOURNAL/cltg/04.03/01720094-202104000-00016/inline-graphic1/v/2021-04-15T161418Z/r/image-tiff.
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Affiliation(s)
- M. Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Md. Golam Kibria
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Nigar Sultana
- Department of Gastroenterology, Delta Medical College and Hospital, Dhaka, Bangladesh
| | - M. Abdllah Yusuf
- Department of Microbiology, National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Shamsun Nahar
- Laboratory Science and Service Division, icddr,b, Dhaka, Bangladesh
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - AHM Rowshon
- Department of Gastroenterology, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
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Kamada T, Satoh K, Itoh T, Ito M, Iwamoto J, Okimoto T, Kanno T, Sugimoto M, Chiba T, Nomura S, Mieda M, Hiraishi H, Yoshino J, Takagi A, Watanabe S, Koike K. Evidence-based clinical practice guidelines for peptic ulcer disease 2020. J Gastroenterol 2021; 56:303-322. [PMID: 33620586 PMCID: PMC8005399 DOI: 10.1007/s00535-021-01769-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023]
Abstract
The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcers, non-H. pylori, and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for H. pylori eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are H. pylori negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
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Affiliation(s)
- Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama, 700-8505, Japan.
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
| | - Kiichi Satoh
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiyuki Itoh
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masanori Ito
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Junichi Iwamoto
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tadayoshi Okimoto
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takeshi Kanno
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Mitsushige Sugimoto
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshimi Chiba
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Sachiyo Nomura
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Mitsuyo Mieda
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hideyuki Hiraishi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Junji Yoshino
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Atsushi Takagi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Sumio Watanabe
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Peptic Ulcer," the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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14
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Spiliopoulos S, Inchingolo R, Lucatelli P, Iezzi R, Diamantopoulos A, Posa A, Barry B, Ricci C, Cini M, Konstantos C, Palialexis K, Reppas L, Trikola A, Nardella M, Adam A, Brountzos E. Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study. Cardiovasc Intervent Radiol 2018; 41:1333-1339. [PMID: 29671058 DOI: 10.1007/s00270-018-1966-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/12/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the outcomes of transcatheter arterial embolization (TAE) for the treatment of peptic ulcer bleeding (PUB). MATERIALS AND METHODS This is a retrospective, multicenter study, which investigated all patients who underwent TAE for the treatment of severe upper gastrointestinal hemorrhage from peptic ulcers in five European centers, between January 1, 2012 and May 1, 2017. All patients had undergone failed endoscopic hemostasis. Forty-four patients (male; mean age 74.0 ± 11.1 years, range 49-94), with bleeding from duodenum (36/44; 81.8%) or gastric ulcer (8/44; 18.2%) were followed up to 3.5 years (range 2-1354 days). In 42/44 cases, bleeding was confirmed by pre-procedural CT angiography. In 50% of the cases, coils were deployed, while in the remaining glue, microparticles, gel foam and combinations of the above were used. The study's outcome measures were 30-day survival technical success (occlusion of feeding vessel and/or no extravasation at completion DSA), overall survival, bleeding relapse and complication rates. RESULTS The technical success was 100%. The 30-day survival rate was 79.5% (35/44 cases). No patients died due to ongoing or recurrent hemorrhage. Re-bleeding occurred in 2/44 cases (4.5%) and was successfully managed with repeat TAE (one) or surgery (one). The rate of major complications was 4.5% (2/44; one acute pancreatitis and one partial pancreatic ischemia), successfully managed conservatively. According to Kaplan-Meier analysis survival was 71.9% at 3.5 years. CONCLUSIONS TAE for the treatment of PUB was technically successful in all cases and resulted in high clinical success rate. Minimal re-bleeding rates further highlight the utility of TAE as the second line treatment of choice, after failed endoscopy.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - Riccardo Inchingolo
- Department of Radiological Sciences, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Radiology, Madonna delle Grazie Hospital, Matera, Italy
| | - Pierleone Lucatelli
- Vascular Interventional Radiology Unit, University of Siena, Viale Mario Bracci 53, 53100, Siena, Italy
| | - Roberto Iezzi
- Department of Radiological Sciences, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Alessandro Posa
- Department of Radiological Sciences, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bryan Barry
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Carmelo Ricci
- Vascular Interventional Radiology Unit, University of Siena, Viale Mario Bracci 53, 53100, Siena, Italy
| | - Marco Cini
- Vascular Interventional Radiology Unit, University of Siena, Viale Mario Bracci 53, 53100, Siena, Italy
| | - Chrysostomos Konstantos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Artemis Trikola
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Michele Nardella
- Institute of Radiology, Madonna delle Grazie Hospital, Matera, Italy
| | - Andreas Adam
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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15
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Borgqúist L, Lundell L, Lindgren S. [The paradigm shift for peptic ulcer disease]. Lakartidningen 2018; 115:E7UF. [PMID: 30040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Knowledge development and paradigm shift for peptic ulcer disease is described over a fifty-year period using four levels of knowledge that place demands on the healthcare organization. When medical knowledge reached a healing level, continuity became subordinate. However, accessibility to treatment became more important. An important task for future healthcare will be to define and create broader knowledge structures. Efficiency losses can occur when control instruments apply to medical problems at low levels of knowledge which are not mature for this.
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Affiliation(s)
- Lars Borgqúist
- IMH, Linköping university - Allmänmedicin Lund, Sweden IMH, Linköping university - Allmänmedicin Lund, Sweden
| | - Lars Lundell
- Karolinska institutet Department of Clinical Sciences Intervention and Technology - Stockholm, Sweden Karolinska Institutet Department of surgery - Stockholm, Sweden
| | - Stefan Lindgren
- Lund University - Clinical Sciences, Malmö Malmö, Sweden Lund University - Clinical Sciences, Malmö Malmö, Sweden
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Li C, Li J, Pan S, Zhang X, Li Y. [Clinical observation of peptic ulcer treated with acupuncture based on theory of "the compatibility of the five meridians" in Huxiang]. Zhongguo Zhen Jiu 2017; 37:799-804. [PMID: 29231336 DOI: 10.13703/j.0255-2930.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare the effects differences for peptic ulcer between acupuncture based on the theory of "the compatibility of the five meridians" in Huxiang and conventional western medication. METHODS Sixty patients with peptic ulcer of liver-stomach disharmony type (LSDT) and weakness of spleen and stomach type (WSST) were assigned into an observation group and a control group by block randomization according to syndrome differentiation.Finally,28 cases (17 with LSDT and 11 with WSST) in the observation group,29 cases (18 with LSDT and 11 with WSST) in the control group were included.In the observation group,patients with LSDT were treated with acupuncture at Zhongwan (CV 12),Taichong (LR 3),Xingjian (LR 2),Qimen (LR 14),Zusanli (ST 36),Gongsun (SP 4),Shaofu (HT 8),Jingqu (LU 8),Neiguan (PC 6); those with WSST,at Zhongwan (CV 12),Dadu (SP 2),Taibai (SP 3),Yinlingquan (SP 9),Zusanli (ST 36),Shaofu (HT 8), Taichong (LR 3),Yingu (KI 10),Taixi (KI 3),Taiyuan (LU 9) according to the theory of "the compatibility of the five meridians" in Huxiang.Reinforcing and reducing were according to syndrome differentiation.The treatment was given once a day with needle retained for 30 min,5 days a week,2 days at interval.In the control group,the conventional triple drugs (omeprazole,amoxicillin and clarithromycin) were prescribed orally for Hp positive patients,and omeprazole for Hp negative patients.All the patients were treated for 4 weeks.The clinical syndrome score,ulcer healing under gastroscope,anti-Hp infection and Hp negative conversion ratio rate were observed in the two groups before and after treatment as well as 1 month after treatment.The total effects were evaluated. RESULTS The syndrome scores after treatment and at 1 month ofter treatment decreased in the two groups (all P<0.05),while without significant difference between the two groups (both P>0.05).The scores within the group between the two syndromes showed no significance in the two groups (both P>0.05).The cure rates under gastroscope,anti-Hp infection rates and the total rates had no statistically significant difference between the two groups (all P>0.05).The Hp negative conversion ratio was 22.2%(4/18) in the observation group,which was worse than 52.6%(10/19) in the control group (P<0.05). CONCLUSIONS Acupuncture based on the theory of "the compatibility of the five meridians" in Huxiang for peptic ulcer can improve clinical symptoms,ulcer coalescence and anti-Hp infection,which is similar to conventional western medication.While the Hp negative conversion ratio is less than that of conventional western medicine.
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Affiliation(s)
- Cuiying Li
- the First Affiliated Hospital of Hunan University of CM, Changsha 410007, China
- Graduate School of Hunan University of CM, Changsha 410208
| | - Jinxiang Li
- the First Affiliated Hospital of Hunan University of CM, Changsha 410007, China.
| | - Shimin Pan
- the First Affiliated Hospital of Hunan University of CM, Changsha 410007, China
- Graduate School of Hunan University of CM, Changsha 410208
| | - Xi Zhang
- the First Affiliated Hospital of Hunan University of CM, Changsha 410007, China
- Graduate School of Hunan University of CM, Changsha 410208
| | - Ying Li
- the First Affiliated Hospital of Hunan University of CM, Changsha 410007, China
- Graduate School of Hunan University of CM, Changsha 410208
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Meng X, Qi S, Zeng Y. [Analyzation of expressive elements for clinical RCT of acupuncture and moxibustion:taking peptic ulcer as an example]. Zhongguo Zhen Jiu 2017; 37:761-767. [PMID: 29231552 DOI: 10.13703/j.0255-2930.2017.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To explore the expressive elements for the clinical randomized controlled trials of acupuncture and moxibustion so as to provide reference for them, taking peptic ulcer as an example. Sixty-six papers from 1996 to 2015 were collected in domestic and overseas databases, including China National Knowledge Infrastructure (CNKI), WANFANG, VIP, China Biology Medicine (CBM), PubMed, Web of Science, Sciencedirect, Springer, Wiley. The expression qualities were evaluated according to the Consolidated Standards of Reporting Trials (CONSORT) and the Standards for Reporting Interventions in Clinical Trials of Acupuncture(STRICTA). We consider that the reports are not sound, especially their preface, trial design and intervention.
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Affiliation(s)
- Xing Meng
- Journal Center, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shulan Qi
- Journal Center, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yi Zeng
- Journal Center, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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A letter to Sir Heneage Ogilvie. Ann R Coll Surg Engl 2017; 99:419-20. [PMID: 28660815 DOI: 10.1308/rcsann.2017.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tian Y, Yan YN, Guan HY, Ma JJ, Wang ZY, Ma HF, Xing ZH. [Systematic Evaluation and Meta-analysis on Acupuncture for Peptic Ulcer]. Zhen Ci Yan Jiu 2017; 42:275-282. [PMID: 29071989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To systematically evaluate the clinical efficacy of acupuncture for peptic ulcer. METHODS Randomized controlled trials of acupuncture for peptic ulcer were searched from China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Scientific and Technological Journals (VIP), China Biomedicine (CBM), PubMed and the Cochrane Library from the establishment time of databases to September, 2016. Data extraction and quality evaluation were implemented for the literature which met the inclusive criteria. The RevMan 5.3 software was used to make Meta-analysis. RESULTS Sixteen papers including 1 570 patients of peptic ulcer were included. The results of Meta-analysis showed that there was no statistical significance between acupuncture and western medicine in the effective rate, the healing rate of ulcer area and the HP negative rate (all P>0.05); the recurrence rate of acupuncture was significantly lower than that of western medicine[RR=0.35, 95%CI (0.14, 0.84), P<0.05]. Acupuncture plus western medicine was significantly different from simple western medicine in the effective rate, the healing rate of ulcer area and the recurrence rate[RR=1.20,95% CI (1.04, 1.38), P=0.01; RR=1.29, 95% CI (1.06, 1.58), P=0.01;RR=0.27, 95% CI (0.16, 0.45), P<0.00001]. The analysis of evidence grade (GRADE) pre-sented that the healing rate of ulcer area and the HP negative rate of acupuncture were "low grade", and others were "extremely low grade". CONCLUSIONS Acupuncture combined with western medicine has some advantages for peptic ulcer compared with the conventional western medicine, which needs further confirmation due to the lower evidence grade. Larger samples, randomized controlled trials with high quality are highly recommended.
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Affiliation(s)
- Yao Tian
- School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ya-Nan Yan
- Beijing Jingbei Vocational College, Beijing 101400
| | - Han-Yu Guan
- School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jia-Jia Ma
- School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhuo-Yu Wang
- School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Hui-Fang Ma
- School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Zhao-Hong Xing
- Department of Chinese Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020.
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Wang J, Cui Y, Wang J, Chen B, He Y, Chen M. [Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:425-431. [PMID: 28440524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the clinical epidemiology change trend of upper gastrointestinal bleeding (UGIB) over the past 15 years. METHODS Consecutive patients who was diagnosed as continuous UGIB in the endoscopy center of The First Affiliated Hospital of Sun-Yat University during the period from 1 January 1997 to 31 December 1998 and the period from 1 January 2012 to 31 December 2013 were enrolled in this study. Their gender, age, etiology, ulcer classification, endoscopic treatment and hospitalization mortality were compared between two periods. RESULTS In periods from 1997 to 1998 and 2012 to 2013, the detection rate of UGIB was 9.99%(928/9 287) and 4.49%(1 092/24 318)(χ2=360.089, P=0.000); the percentage of male patients was 73.28%(680/928) and 72.44% (791/1 092) (χ2=0.179, P=0.672), and the onset age was (47.3±16.4) years and (51.4±18.2) years (t=9.214, P=0.002) respectively. From 1997 to 1998, the first etiology of UGIB was peptic ulcer bleeding, accounting for 65.2%(605/928)[duodenal ulcer 47.8%(444/928), gastric ulcer 8.3%(77/928), stomal ulcer 2.3%(21/928), compound ulcer 6.8%(63/928)],the second was cancer bleeding(7.0%,65/928), and the third was esophageal and gastric varices bleeding (6.4%,59/928). From 2012 to 2013, peptic ulcer still was the first cause of UGIB, but the ratio obviously decreased to 52.7%(575/1092)(χ2=32.467, P=0.000)[duodenal ulcer 31.9%(348/1092), gastric ulcer 9.4%(103/1092), stomal ulcer 2.8%(30/1092), compound ulcer 8.6%(94/1092)]. The decreased ratio of duodenal ulcer bleeding was the main reason (χ2=53.724, P=0.000). Esophageal and gastric varices bleeding became the second cause (15.1%,165/1 092, χ2=38.976, P=0.000), and cancer was the third cause (9.2%,101/1 092, χ2=3.352, P=0.067). The largest increasing amplitude of the onset age was peptic ulcer bleeding [(46.2±16.7) years vs. (51.9±18.9) years, t=-5.548, P=0.000), and the greatest contribution to the amplitude was duodenal ulcer bleeding [(43.4±15.9) years vs. (48.4±19.4) years, t=-3.935, P=0.000], while the onset age of esophageal and gastric varices bleeding [(49.8±14.1) years vs. (48.8±13.9) years, t=0.458, P=0.648] and cancer [(58.4±13.4) years vs. (58.9±16.7) years, t=-0.196, P=0.845] did not change significantly. Compared with the period from 1997 to 1998, the detection rate of high risk peptic ulcer rebleeding (Forrest stage I(a, I(b, II(a and II(b) increased (χ2=39.958, P=0.000) in the period from 2012 to 2013. From 1997 to 1998, 54 patients underwent endoscopic treatment, and the achievement ratio of hemostasis was 79.6% (43/54). From 2012 to 2013, 261 patients underwent endoscopic treatment and the achievement ratio of hemostasis was 96.9%(253/261), which was significantly higher (χ2=23.287, P=0.000). Compared to the period from 1997 to 1998, more patients with variceal bleeding or non-variceal bleeding received endoscopic treatment in time (39.0% vs. 70.3%, χ2=51.930, P=0.000; 3.6% vs. 15.6%, χ2=62.292, P=0.000, respectively), and higher ratio of patients staging Forrest stage I(a to II(b also received endoscopic treatment in the period from 2012 to 2013 [27.4%(26/95) vs. 68.5%(111/162), χ2=40.739, P=0.000]. More qualified endoscopic hemostatic techniques were used, containing thermocoagulation (0 vs. 15.2%, χ2=79.518, P=0.000), hemostatic clip (0 vs. 55.9%, χ2=20.879, P=0.000), hemostatic clip combined with thermocoagulation (4.3% vs. 16.4%, χ2=5.154, P=0.023), while less single injection was used (87.1% vs. 6.2%, χ2=10.420, P=0.001), and single spraying for hemostasis was completely abandoned in the period from 2012 to 2013. The ratio of inpatients undergoing reoperation decreased obviously in the period from 2012 to 2013 [9.3%(86/928) vs. 6.0%(65/1092), χ2=7.970, P=0.005], while no significant difference was found in mortality during hospitalization between two periods. CONCLUSION Compared with the period from 1997 to1998, the mean onset age of UGIB increased, and the ratio of peptic ulcer bleeding decreased due to the reduction of duodenal ulcer bleeding, the detection rate of high risk peptic ulcer rebleeding increased, the cure rate of endoscopic treatment for UGIB increased, more reasonable and immediate hemostatic methods were used, but overall mortality did not change obviously in the period from 2012 to 2013.
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Affiliation(s)
| | | | | | | | | | - Minhu Chen
- Department of Endoscopy Center, Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
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Wu H, Zhong M, Zhou D, Shi C, Jiao H, Wu W, Chang X, Cang J, Bian H. [Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:393-397. [PMID: 28440519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
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Affiliation(s)
- Haifu Wu
- Department of General Surgery, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Ming Zhong
- Department of Critical Care Medicine, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Di Zhou
- Department of Anesthesiology, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chenye Shi
- Department of General Surgery, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Heng Jiao
- Department of General Surgery, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Wu
- Department of Critical Care Medicine, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xinxia Chang
- Department of Endocrinology, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Cang
- Department of Anesthesiology), Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hua Bian
- Department of Endocrinology, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China
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González-González JA, Monreal-Robles R, García-Compean D, Paz-Delgadillo J, Wah-Suárez M, Maldonado-Garza HJ. Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors. J Dig Dis 2017; 18:212-221. [PMID: 28205386 DOI: 10.1111/1751-2980.12459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- José A González-González
- Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Roberto Monreal-Robles
- Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Diego García-Compean
- Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Jonathan Paz-Delgadillo
- Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Martín Wah-Suárez
- Department of Internal Medicine, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Héctor J Maldonado-Garza
- Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
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Shi YY, Liu HF, Min M, Wang W, Li J, He CY, Du QP. Correlation analysis of mast cells and EGFR with endoscopic application of tissue glue for treatment of peptic ulcer healing. Eur Rev Med Pharmacol Sci 2017; 21:861-866. [PMID: 28272694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the impact of tissue glue on mast cells (MC) and epidermal growth factor receptor (EGFR) in rat peptic ulcer. MATERIALS AND METHODS SD rats were used to establish peptic ulcer model. Cimetidine gavage was adopted in the positive control, while cimetidine and endoscopic tissue glue therapy were applied in the experimental group. The ulcer inhibition rate and ulcer index were measured to evaluate healing quality. Real-time PCR was performed to test EGFR mRNA in the ulcer surrounded gastric mucosa. Immunohistochemistry was selected to determine MC quantity. HE staining and apoptosis detection were used to evaluate cell apoptosis. RESULTS Tissue glue significantly reduced MC number in the peptic ulcer rat compared with control with dose dependence (p < 0.05). Tissue glue significantly decreased ulcer area, and elevated ulcer index and inhibition rate (p < 0.05). EGFR mRNA in the mucosa markedly declined after modeling. Tissue glue upregulated EGFR mRNA to a certain extent (p > 0.05). Tissue glue induced MC apoptosis with dose dependence. CONCLUSIONS Endoscopic application of tissue glue accelerated ulcer mucosa healing via up-regulating EGFR mRNA, enhancing gastrointestinal mucous membrane regeneration and repair ability, and decreasing MC number.
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Affiliation(s)
- Y-Y Shi
- Department of Gastroenterology, Beijing Armed Police General Hospital, Beijing, China.
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Iijima K. [Gastrointestinal Diseases in the Era without Helicobacter pylori infection. Topics: IV. How Does the Etiology of Peptic Ulcers Change in Post-Helicobacter pylori Era?]. Nihon Naika Gakkai Zasshi 2017; 106:33-38. [PMID: 30179403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
OBJECTIVE Helicobacter pylori infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population. PARTICIPANTS/METHODS This paper is a case report and narrative review based on recent international epidemiologic studies and consensus conference recommendations identified in MEDLINE. RESULTS In the nations (mostly Asian) that send the largest number of students to the United States, the prevalence of H. pylori is generally 60% to 80%, whereas the prevalence in the United States is about 25%. The patterns of antibiotic resistance in those countries are also different than that in the general US population. CONCLUSIONS Health care providers should have a higher index of suspicion for Helicobacter infection among international students with dyspepsia and need to use a different treatment regimen than is standard for the general US population.
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Affiliation(s)
- James Randolph Hillard
- a Department of Psychiatry , Michigan State University Colleges of Medicine , East Lansing , Michigan , USA
| | - Suman Kashup
- b Olin Student Health Center, Michigan State University , East Lansing , Michigan , USA
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Abstract
Peptic ulcer disease is one of the most commonly encountered diseases in gastroenterology clinics. After the discovery of Helicobacter pylori by Warren and Marshall, it has been identified as the most important cause of peptic ulcer. Eradication of H. pylori markedly reduces the post-treatment recurrence rate of peptic ulcer. However, as human populations age, the incidence of cardiovascular and musculoskeletal diseases increases and consequent use of aspirin and non-steroidal anti-in-flammatory drugs increases. Thus causes and presenting patterns of peptic ulcer have changed. In this review, I describe new diagnostic and therapeutic strategies for peptic ulcer disease and explore future perspectives.
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Affiliation(s)
- Byung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Wirth HP. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease]. Praxis (Bern 1994) 2016; 105:693-697. [PMID: 27269775 DOI: 10.1024/1661-8157/a002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma.
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Meng X, Qi S. [Study of acupoints selection rule on peptic ulcer treated with acupuncture and moxibustion]. Zhongguo Zhen Jiu 2016; 36:437-441. [PMID: 27352513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the acupoints selection rules on peptic ulcer treated with acupuncture and moxibustion,so as to provide references for acupoints clinical selecting. METHODS Literature on clinical report and clinical study for peptic ulcer treated with acupuncture and moxibustion was retrieved in CNKI, WANFANG, VIP, CBM, PubMed, Web of Science and other databases from January 1, 2003 to August 31, 2014,and acupoints selecting rules were summarized according to syndromes and symptoms. RESULTS One hundred and ten articles were acquired, and acupoints the first to the fifth used were Zhongwan (CV 12), Zusanli (ST 36), Weishu (BL 21), Pishu (BL 20) and Neiguan (PC 6). The main acupoints were Zhongwan (CV 12) and Zusanli (ST 36). As to acupoints mainly selected in accordance with different syndromes: (1)Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6) were matched for the syndrome of deficiency cold in the spleen and the stomach. (2) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Geshu (BL 17) were combined for the syndrome of qi stagnation and blood stasis. (3) Weishu (BL, 21), Pishu (BL 20), Qimen (LR 14) for the syndrome of qi stagnation induced by liver depression. (4) Neiguan (PC 6) and Taichong (LR 3) for the syndrome of liver qi invading the stomach. (5) Weishu (BL 21) and Pishu (BL 20) for the syndrome of weakness of the spleen and the stomach. (6) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Gongsun (SP 4) for the syndrome of cold in the stomach. (7) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), San yinjiao (SP 6) for the syndrome of yin deficiency in the stomach. (8) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Yinlingquan (SP 9), Ganshu (BL 18) for the syndrome of phlegm and dampness stagnation. As for acupoints majorly selected according to different symptoms, (1) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Taichong (LR 3) were combined for acid regurgitation. (2) Weishu (BL 21), Neiguan (PC 6), Tianshu (ST 25), Gongsun (SP 4) were selected for abdominal distension. (3) Weishu (BL 21), Neiguan (PC 6), Liangqiu (ST 34), Gongsun (SP 4) for unbearable stomach pain. (4) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Qihai (CV 6), Gongsun (SP 4) for lacking in strength. CONCLUSION We treating peptic ulcer with acupuncture and moxibustion mainly choose Zhongwan (CV 12) and Zusanli (ST 36), and attach importance to acupoints selection based on syndrome and symptom differentiation.
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Abstract
BACKGROUND Refractory peptic ulcers are ulcers in the stomach or duodenum that do not heal after eight to 12 weeks of medical treatment or those that are associated with complications despite medical treatment. Recurrent peptic ulcers are peptic ulcers that recur after healing of the ulcer. Given the number of deaths due to peptic ulcer-related complications and the long-term complications of medical treatment (increased incidence of fracture), it is unclear whether medical or surgical intervention is the better treatment option in people with recurrent or refractory peptic ulcers. OBJECTIVES To assess the benefits and harms of medical versus surgical treatment for people with recurrent or refractory peptic ulcer. SEARCH METHODS We searched the specialised register of the Cochrane Upper GI and Pancreatic Diseases group, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015 to identify randomised trials and non-randomised studies, using search strategies. We also searched the references of included studies to identify further studies. SELECTION CRITERIA We considered randomised controlled trials and non-randomised studies comparing medical treatment with surgical treatment in people with refractory or recurrent peptic ulcer, irrespective of language, blinding, or publication status for inclusion in the review. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials and extracted data. We planned to calculate the risk ratio, mean difference, standardised mean difference, or hazard ratio with 95% confidence intervals using both fixed-effect and random-effects models with Review Manager 5 based on intention-to-treat analysis. MAIN RESULTS We included only one non-randomised study published 30 years ago in the review. This study included 77 participants who had gastric ulcer and in whom medical therapy (histamine H2 receptor blockers, antacids, and diet) had failed after an average duration of treatment of 29 months. The authors do not state whether these were recurrent or refractory ulcers. It appears that the participants did not have previous complications such as bleeding or perforation. Of the 77 included participants, 37 participants continued to have medical therapy while 40 participants received surgical therapy (antrectomy with or without vagotomy; subtotal gastrectomy with or without vagotomy; vagotomy; pyloroplasty and suture of the ulcer; suture or closure of ulcer without vagotomy or excision of the ulcer; proximal gastric or parietal cell vagotomy alone; suture or closure of the ulcer with proximal gastric or parietal cell vagotomy). Whether to use medical or surgical treatment was determined by participant's or treating physician's preference.The study authors reported that two participants in the medical treatment group (2 out of 37; 5.4%) had gastric cancer, which was identified by repeated biopsy. They did not report the proportion of participants who had gastric cancer in the surgical treatment group. They also did not report the implications of the delayed diagnosis of gastric cancer in the medical treatment group. They did not report any other outcomes of interest for this review (that is health-related quality of life (using any validated scale), adverse events and serious adverse events, peptic ulcer bleeding, peptic ulcer perforation, abdominal pain, and long-term mortality). AUTHORS' CONCLUSIONS We found no studies that provide the relative benefits and harms of medical versus surgical treatment for recurrent or refractory peptic ulcers. Studies that evaluate the natural history of recurrent and refractory peptic ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with recurrent or refractory peptic ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complications and gastric cancer (in gastric ulcers only) in recurrent and refractory peptic ulcers. In addition to complications related to treatment and disease, health-related quality of life and loss of productivity should also be measured.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Elena Pallari
- University College LondonDepartment of General Surgery4th Floor, Rockefeller Building21 University StreetLondonUKWC1E 6DE
- King's College London School of MedicineDivision of Cancer Studies, Cancer Epidemiology GroupGuy's Hospital, Great Maze PondResearch OncologyLondonUKSE1 6RT
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Satoh K, Yoshino J, Akamatsu T, Itoh T, Kato M, Kamada T, Takagi A, Chiba T, Nomura S, Mizokami Y, Murakami K, Sakamoto C, Hiraishi H, Ichinose M, Uemura N, Goto H, Joh T, Miwa H, Sugano K, Shimosegawa T. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol 2016; 51:177-94. [PMID: 26879862 DOI: 10.1007/s00535-016-1166-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/06/2016] [Indexed: 02/05/2023]
Abstract
The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.
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Affiliation(s)
- Kiichi Satoh
- Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi, 329-2763, Japan.
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
| | - Junji Yoshino
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Taiji Akamatsu
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Toshiyuki Itoh
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Mototsugu Kato
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tomoari Kamada
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Atsushi Takagi
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Toshimi Chiba
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Sachiyo Nomura
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yuji Mizokami
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kazunari Murakami
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Choitsu Sakamoto
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hideyuki Hiraishi
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Masao Ichinose
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Naomi Uemura
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hidemi Goto
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Takashi Joh
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hiroto Miwa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kentaro Sugano
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for peptic ulcer", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
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Abstract
An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. The first step in treatment is to exclude common possible causes, including Helicobacter pylori infection, infection with other pathogens, ulcerogenic drugs, and uncommon diseases with upper gastrointestinal manifestations. When all known causes are excluded, a diagnosis of idiopathic peptic ulcer can be made. A patient whose peptic ulcer is idiopathic may have a higher risk for complicated ulcer disease, a poorer response to gastric acid suppressants, and a higher recurrence rate after treatment. Risk factors associated with this disease may include genetic predisposition, older age, chronic mesenteric ischemia, smoking, concomitant diseases, a higher American Society of Anesthesiologists score, and higher stress. Therefore, the diagnosis and management of emerging disease should systematically explore all known causes and treat underlying disease, while including regular endoscopic surveillance to confirm ulcer healing and the use of proton-pump inhibitors on a case-by-case basis.
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Affiliation(s)
- Chen-Shuan Chung
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsung-Hsien Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Correspondence to Yi-Chia Lee, M.D. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No.7, Chung Shan South Road, Zhongzheng Dist., Taipei 10002, Taiwan Tel: +886-2-23123456 ext.63351 Fax: +886-2-23412775 E-mail:
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Wang HM, Tsai WL, Yu HC, Chan HH, Chen WC, Lin KH, Tsai TJ, Kao SS, Sun WC, Hsu PI. Improvement of Short-Term Outcomes for High-Risk Bleeding Peptic Ulcers With Addition of Argon Plasma Coagulation Following Endoscopic Injection Therapy: A Randomized Controlled Trial. Medicine (Baltimore) 2015; 94:e1343. [PMID: 26266385 PMCID: PMC4616719 DOI: 10.1097/md.0000000000001343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A second endoscopic method together with injection therapy is recommended to treat high-risk bleeding peptic ulcers. This study investigated whether additional argon plasma coagulation (APC) treatment could influence hemostatic efficacy following endoscopic injection therapy to treat high-risk bleeding ulcers.From October 2010 to January 2012, eligible patients with high-risk bleeding ulcers were admitted to our hospital. They prospectively randomly underwent either APC therapy along with distilled water injection or distilled water injection alone. Episodes of rebleeding were retreated with endoscopic combination therapy. Patients in whom retreatment was ineffective underwent emergency surgery or transarterial embolization (TAE).A total of 116 enrolled patients were analyzed. The hemostatic efficacy in 58 patients treated with APC along with distilled water injection was compared with that in 58 patients treated with distilled water injection alone. The 2 treatment groups were similar with respect to all baseline characteristics. Initial hemostasis was accomplished in 56 patients treated with combined therapy, and 55 patients treated with distilled water injection therapy (97% vs 95%, P = 0.648). Bleeding recurred in 2 patients treated with combined therapy, and 9 patients treated with distilled water injection (3.6% vs 16%, P = 0.029). Treatment method was the only independent prognostic factor for recurrent bleeding (odds ratio 0.17; 95% confidence interval 0.03-0.84; P = 0.029). The 2 groups did not differ significantly in hospital stay, TAE, surgery, and mortality.Endoscopic therapy with APC following distilled water injection is more effective than distilled water injection alone for preventing rebleeding of peptic ulcer.
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Affiliation(s)
- Huay-Min Wang
- From the Division of Gastroenterology (H-MW, W-LT, H-CY, H-HC, W-CC, K-HL, T-JT, S-SK, W-CS, P-IH), Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei; and Department of Biological Sciences (H-HC), National Sun Yat-sen University, Kaohsiung, Taiwan
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Liu D, Guo M, Hu Y, Liu T, Yan J, Luo Y, Yun M, Yang M, Zhang J, Guo L. Effect of sanhuangwuji powder, anti-rheumatic drugs, and ginger-partitioned acupoint stimulation on the treatment of rheumatoid arthritis with peptic ulcer: a randomized controlled study. J TRADIT CHIN MED 2015; 35:273-80. [PMID: 26237830 DOI: 10.1016/s0254-6272(15)30097-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To observe the efficacy and safety of oral sanhuangwuji powder, anti-rheumatic drugs (ARDs), and ginger-partitioned acupoint stimulation at zusanli (ST 36) on the treatment of rheumatoid arthritis (RA) complicated by peptic ulcer. METHODS This prospective randomized controlled study included 180 eligible inpatients and outpatients randomly assigned to an ARD treatment (n.= 60), ginger-partitioned stimulation (n = 60), or combination treatment (n = 60). Patients assigned to the ARD group were given oral celecoxib, methotrexate, and esomeprazole. Patients assigned to the ginger-partitioned stimulation group were given ginger-partitioned acupoint stimulation at zusanli (ST 36) in addition to the ARDs. Patients in the combination treatment group were given oral sanhuangwuji powder, ginger-partitioned acupoint stimulation at susanli (ST 36), and ARDs. All patients were followed up for 2 months to evaluate clinical effects and safety. The study was registered in the World Health Organization database at the General Hospital of Chengdu Military Area Command Chinese People's Liberation Army (ChiCTR-TCC12002824). RESULTS The combination treatment group had significantly greater improvements in RA symptoms, laboratory outcomes, and gastrointestinal symptom scores, compared with the other groups (P < 0.05). The peptic ulcer healing rate in the combination treatment group was significantly greater than that in the ARD treatment group (χ2= 16.875, P < 0.05) and the ginger-partitioned stimulation group (χ2= 6.171, P < 0.05). CONCLUSION Combination treatment with ginger-partitioned acupoint stimulation at zusanli (ST 36), oral sanhuangwuji powder, and ARDs had a better clinical effect for RA with complicated peptic ulcer, compared with ARD treatmentalone or in combination with ginger-partitioned acupoint stimulation.
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36
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Engel GL. The psychosomatic approach as a prophylactic measure in the care of patients with peptic ulcer. Adv Psychosom Med 2015; 6:186-9. [PMID: 5211780 DOI: 10.1159/000391687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kao LT, Tsai MC, Lin HC, Pai F, Lee CZ. Weekly pattern of emergency room admissions for peptic ulcers: A population-based study. World J Gastroenterol 2015; 21:3344-3350. [PMID: 25805943 PMCID: PMC4363766 DOI: 10.3748/wjg.v21.i11.3344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/09/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate variations in the incidence of peptic ulcers (PUs) in Taiwan by day of the week within age subgroups.
METHODS: Ambulatory care data were retrieved from the Longitudinal Health Insurance Database 2000. There were 7204 subjects ≥ 18 years-old with an emergency room admission claim for the treatment of PUs, resulting in a total of 9234 emergency room visits for PUs between 2009 and 2011. Data was divided into the seven days of the week and an additional variable for holidays. One-way analysis of variance was used to examine associations among the daily mean number of PU emergency room admissions and holidays/weekends/weekdays.
RESULTS: One-way analysis of variance showed that there was a significant difference in emergency room admissions for PUs by the day of the week (P < 0.001), with admission more likely to occur on Sundays or holidays than weekdays within the total and working populations. The weekday patterns of admission were similar for the patients aged 18-64 years and ≥ 65 years of age. Holidays, followed by Sundays, had higher PU admissions than the mean daily PU emergency room admissions. Furthermore, inclusion of only those treated for PUs with hemorrhage or perforation, Sundays and holidays had higher mean emergency room admissions than other days. Inclusion of patients who diagnosed with Helicobacter pylori infection, only holidays had higher mean emergency room admissions than other days. Inclusion of patients who had been prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for over 30 d, Sundays and holidays had higher mean PU ER admissions than other non-holiday weekdays.
CONCLUSION: There is a higher incidence of emergency room admission for PUs on weekends than on weekdays for the total and working populations.
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Nahum LH. Peptic Ulcer Today. 1965. Conn Med 2015; 79:116-118. [PMID: 26244213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Based on the analysis of literature data and our own research, we have developed the original concept of etiology and pathogenesis of peptic ulcer disease. An analysis of the literature shows that none of the theories of pathogenesis of peptic ulcer disease does not cover the full diversity of the involved functions and their shifts, which lead to the development of ulcers in the stomach and the duodenum. Our neurogenic-genetic theory of etiology and pathogenesis of gastric ulcer and duodenal ulcer very best explains the cause-and-effect relationships in the patient peptic ulcer, allowing options for predominance in one or the other case factors of neurosis or genetic factors. However, it is clear that the only other: combination of neurogenic factor with genetically modified reactivity of gastroduodenal system (the presence of the target organ) cause the chronicity of the sores. The theory of peptic ulcer disease related to psychosomatic pathologies allows us to develop effective schema therapy, including drugs with psychocorrective action. On the basis of our theory of the role of Helicobacter pylori infection is treated as a pathogenetic factor in the development of peptic ulcer disease.
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Castillo Contreras O, Frisancho Velarde O. [The "Chaco": eatable medicinal clay in the Peruvian highlands and his properties in digestive diseases]. Rev Gastroenterol Peru 2015; 35:97-99. [PMID: 25875525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.
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Shapryns'kyĭ VO, Romanchuk VD, Koval' VM. [Tactics and results of treatment of acute hemorrhage in gastroduodenal erosive ulcers due to application of gastro-aggressive preparations]. Klin Khir 2014:10-13. [PMID: 25509425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Results of treatment of 238 patients, suffering an acute gastrointestinal hemorrhage, occurring on background of application of medicinal preparations, were adduced. The incidence rate for an acute medicinal ulcers of foregut was analyzed, as well as possibilities for their treatment.
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Maeng JH, Bang BW, Lee E, Kim J, Kim HG, Lee DH, Yang SG. Endoscopic application of EGF-chitosan hydrogel for precipitated healing of GI peptic ulcers and mucosectomy-induced ulcers. J Mater Sci Mater Med 2014; 25:573-582. [PMID: 24338378 DOI: 10.1007/s10856-013-5088-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/27/2013] [Indexed: 06/03/2023]
Abstract
The gastrointestinal (GI) endoscopy has become a standard diagnostic tool for GI ulcers and cancer. In this study we studied endoscopic application of epidermal growth factor-containing chitosan hydrogel (EGF-CS gel) for treatment of GI ulcer. We hypothesized that directional ulcer-coating using EGF-CS gel via endoscope would precipitate ulcer-healing. EGF-CS gel was directly introduced to the ulcer-region after ulceration in acetic acid-induced gastric ulcer (AAU) and mucosal resection-induced gastric ulcer (MRU) rabbit and pig models. The ulcer dimensions and mucosal thicknesses were estimated and compared with those in the control group. Healing efficacy was more closely evaluated by microscopic observation of the ulcer after histological assays. In the AAU model, the normalized ulcer size of the gel-treated group was 2.3 times smaller than that in the non-treated control group on day 3 after ulceration (P < 0.01). In the MRU model, the normalized ulcer size of the gel-treated group was 5.4 times smaller compared to that in the non-treated control group on day 1 after ulceration (P < 0.05). Histological analysis supported the ability of EGF-CS gel to heal ulcers. The present study suggests that EGF-CS gel is a promising candidate for treating gastric bleeding and ulcers.
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Affiliation(s)
- Jin Hee Maeng
- Utah-Inha DDS and Advanced Therapeutics Research Center, Incheon, 400-712, South Korea
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Iijima K, Kanno T, Koike T, Shimosegawa T. Helicobacter pylori-negative, non-steroidal anti-inflammatory drug: Negative idiopathic ulcers in Asia. World J Gastroenterol 2014; 20:706-713. [PMID: 24574744 PMCID: PMC3921480 DOI: 10.3748/wjg.v20.i3.706] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/07/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
Since the discovery of Helicobacter pylori (H. pylori) infection in the stomach, the bacteria infection and non-steroidal anti-inflammatory drugs (NSAIDs) use had been considered to be the 2 main causes of peptic ulcers. However, there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors; these are termed idiopathic peptic ulcers. Such trend was firstly indicated in 1990s from some reports in North America. In Asia, numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s, but in the 2000s, multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%, indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years. While a decline in H. pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers, it is also possible that the absolute number of idiopathic ulcer cases has increased. Advanced age, serious systemic complication, and psychological stress are considered to be the potential risk factors for idiopathic ulcers. Management of idiopathic ulcers is challenging, at present, because there is no effective preventative measure against recurrence in contrast with cases of H. pylori-positive ulcers and NSAIDs-induced ulcers. As it is expected that H. pylori infection rates in Asia will decline further in the future, measures to treat idiopathic ulcers will also likely become more important.
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Simonova ZG, Martusevich AK, Tarlovaskaia EI. [The course of coronary heart disease concurrent with peptic ulcer disease: clinical and pathogenetic aspects]. TERAPEVT ARKH 2014; 86:33-36. [PMID: 24754066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To make a comprehensive evaluation of the efficiency of eradication therapy in patients with coronary heart disease (CHD) concurrent with peptic ulcer disease (PUD). SUBJECTS AND METHODS The results of treatment were studied in 112 patients with CHD concurrent with PUD who were randomized into 3 groups: 1) adequate eradication therapy during treatment for CHD; 2) antisecretory therapy; 3) treatment for CHD only. The trend in the clinical symptoms of the diseases and the results of an exercise test were assessed. RESULTS After eradication therapy, Group 1 patients displayed a reduction in the frequency of angina attacks by 62.6% and weekly nitroglycerin needs by 70.4% and an increase in exercise tolerance by 45.3%. In Group 2 patients on antisecretory therapy, the similar indicators changed by 30.7, 21.2, and 26.5%, respectively. Group 3 patients showed no significant change in the study indicators. CONCLUSION The findings suggest that eradication therapy has a positive impact on the course of CHD, which manifests itself as an antianginal effect and hence a change in the clinical picture.
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Larichev AB, Maĭorov MI, Favstov SV, Shalop'ev AG. [Clinical-epidemiological aspects of gastric and duodenum ulcer]. Vestn Khir Im I I Grek 2014; 173:100-104. [PMID: 25055546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An analysis of reporting and statistical data showed the considerable changes in clinical-epidemiological indices of gastric and duodenum ulcer at the period from 1998 to 2012. The prevalence of the disease and the number of primary patients decreased in 2-3 times. The reduction of the rate of perforations and ulcerous bleeding had been observed. However, the authors noted, that a tendency of frequency of occurrence increased and efficacy indices reduced in the last years. The rate of postoperative lethality raised in the cases of perforated ulcer. On this basis, the authors recommend to reconsider the existing opinion about further extension of out-patient treatment of patients with given pathology.
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Kryshen' VP, Trofimov MV. [Dynamics of catecholamines in serum of patients with gastroduodenal ulcers complicated by hemorrhage]. Klin Khir 2013:14-16. [PMID: 24501980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The dynamics of the catecholamines content in the blood serum of the patients, suffering gastroduodenal ulcer, complicated by hemorrhage, was analyzed. The biggest raising of the investigated index level was observed in patients while presence of gastric cancer, complicated by hemorrhage. These changes correlate with the blood loss severity enhancement, the state of unstable endoscopic hemostasis, high activity of the inducible NO-synthase of the peri-ulceral zone mucosa. The data obtained permit to prognosticate the pathological process and to improve the treatment program.
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Sergeeva VV, Soshina AA, Parinov OV, Bobylev VA. [Applicability of the problem of peptic ulcer in modern gastroenterology, military-and-medical and medical-and-social assessment]. Voen Med Zh 2013; 334:8-12. [PMID: 23808197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The round-up article is devoted to the history of gastroenterology. The authors deal with a subject of aetiology, pathogenesis and treatment of diseases associated with destruction of mucous coat of GI tract. The main criteria of military-and-medical and medical-and-social assessment used in evaluation of patients with different forms of peptic ulcer are performed.
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Borodach AV. [Ulcer disease: the state of art]. Khirurgiia (Mosk) 2013:38-42. [PMID: 24300577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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