A COMPREHENSIVE APPROACH TO THE TREATMENT OF PEPTIC ULCER DISEASE: COOPERATION OF A GASTROENTEROLOGIST, AN ENDOSCOPIST AND A SURGEON

Helicobacter pylori infection is very common worldwide, and about 10%-16% of these patients develop peptic ulcer disease. However, there is limited research on the impact of H. pylori eradication and peptic ulcer disease treatment sequencing. We conducted a retrospective study of adult patients diagnosed with H. pylori infection and peptic ulcer disease between October 2020 and April 2021 at our center. Data on primary treatment outcomes, including H. pylori eradication and peptic ulcer disease healing, were collected, and factors that may influence treatment outcomes were analyzed. A total of 306 patients were included in this study. The sequence of H. pylori eradication and peptic ulcer disease treatment did not significantly affect the outcomes of H. pylori eradication and peptic ulcer disease healing. In addition, patient age, peptic ulcer disease type, clinic type and treatment regimen (including choice of proton pump inhibitor) had no significant impact on H. pylori eradication. However, patient gender and the choice of antibiotic combination proved to be key factors, as eradication rates were lower in female patients compared to males, and the combination of levofloxacin and clarithromycin was the least effective in eradicating H. pylori. Regarding peptic ulcer disease healing, the peptic ulcer disease type was an important influencing factor, since gastric ulcers being more likely to get cured completely compared to duodenal ulcers. The sequence of H. pylori eradication and peptic ulcer disease treatment does not significantly affect the primary outcomes. Patient gender and the choice of antibiotic combination are important factors in H. pylori eradication, whereas peptic ulcer disease type plays a key role in ulcer healing.

Ulcère duodénal perforé : traitement cœlioscopique de la perforationet de la maladie ulcéreuse

To evaluate the consumption and safety of H(2)-receptor antagonists after switching ranitidine and famotidine to over-the-counter (OTC) status. The Finnish drug consumption data, based on the sales of medicines, and the national register for adverse drug reactions (ADRs) from 1990 to 2003 were used. We studied the consumption of H(2)-receptor antagonists, proton pump inhibitors, sucralfate and antacids (A02BA, A02BC, A02BX02 and A02A, respectively, according to the Anatomical Therapeutic Chemical [ATC] classification). We compared the ADRs of H(2)-receptor antagonists with proton pump inhibitors. The total consumption of medicines for the treatment of peptic ulcer disease and gastro-oesophageal reflux disease increased more than 2-fold from 1990 to 2003 (from 12.8 daily defined doses [DDD]/1000 inhabitants/day to 29.6 DDD/1000 inhabitants/day). Initially, switching ranitidine and famotidine to OTC status in 1996 increased their consumption. Since 1998, proton pump inhibitors have been the most commonly used drug group for the treatment of peptic ulcer and gastro-oesophageal reflux disease in Finland. In 2003, the consumption of proton pump inhibitors was 75% (22.2 DDD/1000 inhabitants/day) of the total consumption of drugs for the treatment of peptic ulcer and gastro-oesophageal reflux disease. Switching ranitidine and famotidine to OTC status did not affect the number of reported adverse reactions to these drugs. According to information collected from the Finnish consumption and ADR databases, H(2)-receptor antagonists are very often used in self-medication and they do not have serious adverse effects. However, the total number of reports concerning these ATC groups in the national ADR database is not very high, and therefore patient-based surveys are needed to verify this finding.

Etiology and Treatment of Childhood Peptic Ulcer Disease in Taiwan: A Single Center 9-Year Experience

Introduction: The surgical treatment of perforated peptic ulcer disease has evolved in parallel to advances in medical treatment of Peptic Ulcer Disease. Objective: To investigate the feasibility of ERAS (Enhanced Recovery after Surgery) Pathways in patients undergoing emergency repair for Perforated peptic ulcer disease. Materials and methods: Institutional based prospective analytical study. Indoor patients in Dept. of General Surgery in Medical College and Hospital Kolkata. January 2019 to June 2020. Study was conducted for 18 months.14 months was provided for data collection. Next 2 months for statistical analysis and another 2 months for thesis writing and submission. Conclusion: ERAS pathway (with some modications) seems to be safe and feasible in a highly selected subset of patients undergoing emergency Omental grahams patch repair of Perforated Peptic Ulcer Disease

Intensive treatment with calcium-containing antacids and milk first was used in the early 20th century for the treatment of peptic ulcer disease and sometimes was associated with toxicity, eventually known as the milk alkali syndrome. Despite the introduction of H2 blockers and proton pump inhibitors for the treatment of peptic ulcer disease, the milk alkali syndrome continues to occur but is seen more frequently in older women who are receiving treatment for osteoporosis. The milk alkali syndrome provides a unique opportunity to discuss calcium homeostasis in a setting in which the primary calcium regulatory hormones, parathyroid hormone (PTH) and calcitriol, are not overtly abnormal. A thorough understanding of the pathophysiology of the milk alkali syndrome, including its generation and maintenance, requires knowledge of intestinal calcium absorption, bone influx and efflux of calcium, and renal calcium excretion and also how these processes change with age. In this review, the pathophysiology of the milk alkali syndrome is discussed in light of recent advances in our understanding of calcium homeostasis, particularly the role of the calcium-sensing receptor (CaSR) and epithelial calcium channels that are present in various tissues such as the parathyroid gland, kidney, and intestine. The contributions of alkalosis, per se , to the generation and maintenance of hypercalcemia are discussed in detail. Almost 100 years ago, Sippy (1) developed a calcium-laden milk and antacid regimen for the treatment of peptic ulcer disease. His rationale was to neutralize the hyperacidity that was deemed responsible for peptic ulcer disease. The Sippy regimen was used for the treatment of peptic ulcer disease, a disorder that was most common in middle-aged men, until the 1970s, when nonantacid treatment first was introduced (2–4). The original recommendation by Sippy consisted of the hourly administration of milk and cream together with what became known as …

Colloidal bismuth subcitrate (CBS) possesses at least equal efficacy with histamine H2-receptor antagonist drugs in the treatment of peptic ulcer disease. However, CBS has the advantage of slower ulcer relapse rates than those seen after initial healing with the H2-antagonists. It has been postulated that this effect may be partly due to the antibacterial properties of CBS against Campylobacter pylori, a bacterium found in the gastric mucosa and gastric metaplasia within the duodenum of most patients with peptic ulcer and closely associated with gastritis. However, the role of C. pylori in the aetiology of peptic disease is far from clear. The mechanism by which CBS heals ulcers has not been fully elucidated, but several actions may be involved. CBS and mucus form a glycoprotein-bismuth complex in vitro. This provides a diffusion barrier to HCl and may, therefore, provide a protective coating in the ulcer crater which allows healing of the lesion to occur. Prostaglandin E2 production is also stimulated by CBS with subsequent secretion of alkali into the mucus layer. In addition, CBS has a direct inhibitory effect on C. pylori. Administration of CBS results in low levels of bismuth absorption. Most of the ingested bismuth is excreted as bismuth sulphide, causing blackening of the faeces, and the small amount absorbed is excreted in the urine. Bismuth intoxication (encephalopathy) has been reported with prolonged administration of bismuth salts, and there has been 1 report of similar intoxication in a patient receiving unusually high doses of CBS for a prolonged period. However, no such intoxication has been reported with CBS used at its recommended dosage in the acute treatment of peptic ulcer disease, and no other serious adverse effects have been associated with CBS. Tissue accumulation during prolonged therapy seems likely, and the safety of CBS during long term maintenance therapy has not been established. The lack of effect on gastric acid secretion is seen as an added advantage for CBS, since prolonged drug-induced hypochlorhydria has been postulated to have potentially detrimental effects. Thus, while the role of C. pylori in peptic ulceration requires further clarification, CBS would appear to have an important place in the treatment of peptic ulcer disease with the advantage of relatively slow relapse rates after initial healing and treatment discontinuation.

Prescription patterns of traditional Chinese medicine for peptic ulcer disease in Taiwan: A nationwide population-based study

Background: Peptic ulcer results from an imbalance between ulcer promoting factors (gastric acid, pepsin secretion) and ulcer preventing factors (gastric mucosa, prostaglandins). Unripe plantain and cabbage when used individually were effective in the treatment of peptic ulcer in folkloric medium. This hereby paved way for this research that involved the co-administration of aqueous extracts of Musa paradisiaca (plantain) and Brassica oleracea (cabbage) in the treatment of peptic ulcer. Objectives: To evaluate the healing effect of the aqueous extracts of Musa paradisiaca (plantain) and Brassica oleracen (cabbage) on peptic ulcer in rats, and the possible effect of these materials as prophylaxis against peptic ulcer. This could pave way for the production of anti-peptic ulcer drugs for use in clinical medicine. Methodology: A total of 45 rats of both sexes weighing 200-250g were used for this study. In the prophylactic study, 15 adult albino wistar rats were used. The animals were grouped into 5 groups of 3 animals each and were starved for 24 hrs before the experiment. Group 1 received 0.3ml of distilled water, group 2 received 100mg/kg of cimetidine, group 3 received 100mg/kg of Brassica oleracae extract, group 4 received 100mg/kg of Musa parasidiaca extract and group 5 received a combination of Musa paradistaca and Brassica oleracea extracts at the dose of 50mg/kg+ 50 mg/kg. I hr post treatment, peptic ulcer was induced in all the animals by a single oral administration of 30mg/kg of Indomethacin. 8 hrs after ulcer induction, each animal was sacrificed and the number of lesions in the stomach was counted. In the curative study, a total number of 30 rats were used. They were grouped into 5 groups of 6 animals each. The animals were denied access to food and water for 24hrs. Ulcer was induced in all the groups by single oral administration of 30mg/kg indomethacin. 8 hrs post ulcer induction, 2 animals from each group were sacrificed and the number of ulcer counted. The remaining animals in each group received treatment as follows: group 1 received 0.3ml of distilled water, group 2 received 100mg/kg of cimetidine, group 3 received 100mg/kg of Brassica oleracea extract, group 4 received 100mg/kg of Musa paradisiaca extract and group 5 received 50mg/kg combination of Musa paradisiaca and Brassica extract. They received the treatment for three days, then another 2 animals from each group were sacrificed and their number of ulcers counted. The remaining animals contained to receive treatment for another three days before their ulcer index were determined. The LD 50 test was carried out using the Lorke’s method. The phytochemical analysis was conducted using the trease and Evans method. Results: It showed that the co-administration of aqueous extract of Musa paradisiaca and Brassica oleracea possessed peptic ulcer healing activity, and had more of prophylactic effect than curatve effect. It also showed that the separate dose of Musa paradisiaca extract and Brassica oleracea possesses more curative anti ulcer action when used individually than when co-administered. Conclusion: The extracts of Musa paradisiaca and Brassica oleracea has peptic ulcer healing activity. This could find some relevance in the treatment of peptic ulcer disease. Clinicians and pharmacologists will find this study highly relevant with a view to actually formulating a medicament from the extracts for use in the treatment of peptic ulcer disease in man.

Propantheline

BackgroundPerforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients.MethodsThis was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pre-tested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.ResultsA total of 84 patients were studied. Males outnumbered females by a ratio of 1.3: 1. Their median age was 28 years and the modal age group was 21-30 years. The median duration of illness was 5.8 days. The majority of patients (69.0%) had no previous history of treatment for peptic ulcer disease. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking was reported in 10.7%, 85.7% and 64.3% respectively. Eight (9.5%) patients were HIV positive with a median CD4 count of 220 cells/μl. Most perforations were located on the duodenum {90.4%) with the duodenal to gastric ulcers ratio of 12.7: 1. Graham's omental patch (Graham's omentopexy) of the perforations was performed in 83.3% of cases. Complication and mortality rates were 29.8% and 10.7% respectively. The factors significantly related to complications were premorbid illness, HIV status, CD 4 count < 200 cells/μl, treatment delay and acute perforation (P < 0.001). Mortality rate was high in patients who had age ≥ 40 years, delayed presentation (>24 hrs), shock at admission (systolic BP < 90 mmHg), HIV positivity, low CD4 count (<200 cells/μl), gastric ulcers, concomitant diseases and presence of complications (P < 0.001). The median overall length of hospital stay was 14 days. Excellent results using Visick's grading system were obtained in 82.6% of surviving patients.ConclusionPerforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting young males not known to suffer from PUD. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of survivors despite patients' late presentation in our center.

Many agents seem to be equally effective for the treatment of peptic ulcer disease. This is true despite the drugs' varied mechanisms of action, and this observation has caused investigators to shift their focus from aggressive to defensive factors when studying ulcer pathogenesis. Patients with a healed ulcer are always at risk for recurrence, and guidelines are available for management of these patients. Ulcer prevention becomes a crucial issue in intensive care units where critically ill patients have many known risk factors. Maintaining a gastric pH above 4.0 appears to reduce the morbidity and mortality associated with such stress-induced ulcers. Use of nonsteroidal anti-inflammatory drugs increases ulcer risk and complications in the elderly, in women with rheumatoid arthritis, and in smokers and abusers of alcohol. Prophylaxis with the synthetic prostaglandin analogue misoprostol (Cytotec) appears to reduce this risk.

Diagnosis and Treatment of Peptic Ulcer Disease

Background: Peptic ulcer disease (PUD) is prevalent in almost all parts of the world. PUD complications are creating a major source of preventable health care expenses. The major factors responsible for the incidence of PUD and its complication have changed over the past few decades after the identification of non-steroidal inflammatory drugs (NSAIDs) and Helicobacter pylori bacterial infection along with a marked increase in the use of proton-pump inhibitors (PPIs) as drug therapy. The management of PUD has become more complex and challenging due to antimicrobial resistance. Objective: The objective of the study was to highlight current therapy and novel techniques used in the treatment of peptic ulcer diseases. Methods: An exhaustive literature search has been conducted across PubMed, Google, Scopus and Web of Science as an electronic database to add the crucial information from the relevant literature. Results: In the present review, we have discussed PUD and its pathophysiology. The recent trends in PUD and possible treatments with novel techniques have also been discussed. The type and presence of ulcers cannot be predicted accurately based on symptoms. The available treatment approaches for peptic ulcers based on their clinical presentation and etiology are anti-secretary therapy, endoscopy to reveal ulcers followed by drug therapy, and triple therapy for H pylori infection. Conclusion: Thus, the popular and effective methods are very beneficial in controlling PUD. The treatment based on diagnosis is the foremost requirement for ameliorating any disorder. In this article, the emerging techniques and development in the treatment and diagnosis of PUD have been reviewed.

The surgical treatment of peptic ulcer disease (PUD) has undergone a radical shift in the past 10 years. This is primarily because of the recognition that most gastric and duodenal ulcers are caused by Helicobacterpylori (H. pylori). The recognition that PUD is an infectious problem, rather than a problem with excess acid production, and can be definitely cured, has rendered most peptic ulcer operations obsolete. Eradication of the H. pylori eliminates recurrence of the ulcer disease, whereas healing an ulcer with antacid therapy alone results in a 70–80% recurrence rate. Thus, most surgical literature prior to the recognition of H. pylori was based on controlling acid production is no longer relevant to modern day ulcer surgery.KeywordsDuodenal UlcerTotal GastrectomyPeptic Ulcer DiseaseGastric Outlet ObstructionZollinger Ellison SyndromeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.