Bleeding Gastric Ulcer Research Articles

Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

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.

The Prevalence of Helicobacter pylori Infection in Bleeding and Non -Bleeding Gastric Ulcers: A Cross-Sectional Case-Control Study

Introduction: Helicobacter pylori is a known and important cause of peptic ulcer disease, and can result in many different complications, both gastrointestinal and systemic. The gastric complications include upper gastrointestinal bleeding. The costs associated with testing and treatment of complications of H. pylori infection is also high, both in private and public setting. Studies in Iran showed high prevalence of H. pylori infection, with figures as high as 89.2% in the adult population. In South Africa, patients with bleeding gastric ulcers receive empirical eradication therapy, an expensive practice in a resource limited country like South Africa. It is for this reason that we conducted a case-control study to determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Aim: To determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Methods: In this prospective cross-sectional case-control study, a total of 173 patients who underwent upper endoscopy at Steve Biko Academic Hospital were recruited. All patients with gastric ulcer on upper endoscopy had antral mucosal biopsy taken and CLO test done on this specimen, in addition to the CLO test, the 42 with a history of upper gastrointestinal bleeding had additional biopsies send for histology for detection of H. pylori. The CLO tests were evaluated 24 h later and results documented as either positive or negative. Results: From the 173 patients enrolled, 131 patients were found to have no history of upper gastrointestinal bleeding, while 42 patients were found to be bleeding on upper endoscopy or had a recent history of bleeding. Of the total of 173, 134(77.5%) tested negative for H. pylori infection on CLO test and 39(22.5%) tested positive. Of the bleeding group, 7(16.7%) were CLO test positive and 35(83.3%) were negative. In the non-bleeding group of patients, 99(75.6%) were CLO test negative and 32(24.4%) tested positive. There was a 100% correlation between CLO test and histology. Of the bleeding group 35(83%) tested negative on both CLO test and histology and 7(16.7%) tested positive. Conclusion: The prevalence of H. pylori infection in this South African population with bleeding gastric ulcer was found to be lower than in patients with gastric ulcers that were not bleeding. This was, however not statistically significant (p value 0.404). To our knowledge there is no South African data for comparison with our study group. The sensitivity of CLO test was as high as histology. This finding suggests that CLO test can be used reliably in bleeding peptic ulcer.

A bleeding gastric ulcer caused by anisakiasis.

A bleeding gastric ulcer caused by anisakiasis.

Optimal Operational Definition of Patient with Peptic Ulcer Bleeding for Big Data Analysis Using Combination of Clinical Characteristics in a Secondary General Hospital

Peptic ulcer bleeding (PUB) is the most common cause of upper gastrointestinal bleeding in Korea but there has been no research done using big data. This study evaluates the optimal operational definition (OD) for big data research by analyzing clinical characteristics of PUB. We reviewed the clinical characteristics of 92 patients with PUB confirmed on endoscopy in Wonkwang University Sanbon Hospital (January 2013 to December 2014). We calculated sensitivity and positive predictive value (PPV) to detect confirmed PUB patients using ODs developed by combining clinical features of patients with PUB. The mean patient age was 63 years. Men had higher prevalence of PUB than women. Bleeding gastric ulcer was proportionately common in the age range of 40s to 60s in men, while a significantly higher rate of bleeding occurred in women older than 70s. The rate of drug-induced ulcer was 28.2%, whereas the prevalence of Helicobacter pylori was 47.8%. Among the hospitalized patients with diagnostic code of PUB, we ruled out patients with endoscopic removal of gastric adenoma or peritonitis, and selected patients who had been administered intravenous proton pump inhibitor. The sensitivity in this setting was 82.6%, and PPV was 88.4%. PUB was more common in older patients, and there was a clear gender difference in gastric ulcer bleeding by age. With a proper OD using PUB diagnostic codes, we can identify true patients with sufficiently high sensitivity and PPV.

抗凝固療法で治癒した出血性胃潰瘍併存大動脈弁位血栓弁の1例

抗凝固療法で治癒した出血性胃潰瘍併存大動脈弁位血栓弁の1例

Severe Ischemic Colitis from Gastric Ulcer Bleeding-Induced Shock in Patient with End Stage Renal Disease Receiving Hemodialysis

Upper gastrointestinal bleeding is a common condition and has various clinical courses and prognosis. End stage renal disease (ESRD) patients receiving hemodialysis have a high risk of vascular complications and increased risk of ischemic colitis. A 59-year-old male patient with ESRD receiving hemodialysis visited due to hematemesis. After admission, he showed recurrent hematemesis and hypovolemic shock. Upper esophagogastroduodenoscopy revealed gastric ulcer bleeding and endoscopic hemostasis was successfully performed. Blood transfusion and norepinephrine was administered for hypovolemic shock during initial 3 days. Ten days later, he exhibited hematochezia. Sigmoidoscopy revealed necrotic ischemic colitis in sigmoid colon and segmental colectomy was performed. However, recurrent leakage and ischemia were developed in colon as well as small bowel, and he finally died after 55 hospital days in spite of additional operations. Here, we report a case of peptic ulcer bleeding in patient with ESRD who suffered a severe form of ischemic colitis with transmural necrosis. (Korean J Helicobacter Up Gastrointest Res 2016;16:165-168)

リツキシマブとその後のステロイド治療により寛解達成し得た出血性胃潰瘍合併後天性血友病Ａの１例

リツキシマブとその後のステロイド治療により寛解達成し得た出血性胃潰瘍合併後天性血友病Ａの１例

潰瘍性大腸炎非典型例と鑑別を要したDiverticular colitisの1例

We describ the case of a 73-year-old man with diverticular colitis, a newly established disorder of chronic segmental colitis associated with diverticulosis. At the age of 63 years, the patient was admitted to our hospital for a hemorrhagic gastric ulcer. At the age of 67 years, he was diagnosed with anemia. A colonoscopy revealed segmental inflammation of the ascending colon. Histopathological examination showed nonspecific colitis. At the age of 68 years, another colonoscopy revealed redness and vascular pattern loss of the ascending colon ; however the rectum was not involved. Histopathological examination showed inflammatory cell infiltration with crypt abscess. He was diagnosed with atypical ulcerative colitis. Mesalazine therapy was started at an initial dose of 4000mg/day and gradually tapered. At the age of 73 years, another colonoscopy revealed deterioration of mucosal inflammation. After further examination, he was diagnosed with diverticular colitis. Another course of mesalazine therapy was started, with a dose of 3600mg/day, which was gradually tapered. After a year of treatment, the latest colonoscopy revealed mucosal healing ; the patient is still being followed up regularly.

食道狭窄と胃潰瘍穿孔を合併したStevens-Johnson症候群の1例

We report the first case of biperiden (Tasmolin®) -induced Stevens-Johnson syndrome (SJS) with late complications of gastric ulcer perforation and esophageal stricture. A 53-year-old male with schizophrenia had a fever and skin erythema after biperiden had been administered for 8 weeks. He was admitted, and diagnosed as biperiden-induced SJS. The skin erythema was disappeared after steroid pulse and immunoglobulin combined therapy. On the 22th day, he had melena and anemia. Endoscopic findings revealed the hemorrhagic gastric ulcers and the peelings of esophageal mucosal membrane. He was treated with endoscopic hemostasis and proton pump inhibitor. On the 44th day, gastric ulcer was perforated and treated surgically. On the 126th day, he had dysphagia because of the esophageal stricture. The mucosal inflammation was disappeared and stricture was 1 cm in length. Dysphagia was improved after endoscopic balloon dilation therapy.

Endoscopic Suturing for Ulcer Exclusion in Patients With Massively Bleeding Large Gastric Ulcer

Bleeding peptic ulcer is one of the most important causes for hospitalization worldwide. Though endoscopic hemostasis is the current standard of treatment for bleeding peptic ulcers, ulcer rebleeding remained a chief cause of mortality.1Chiu P.W. et al.Clin Gastroenterol Hepatol. 2009; 3: 311-316Abstract Full Text Full Text PDF Scopus (88) Google Scholar One of the important strategies to improve outcomes for bleeding peptic ulcers is to prevent rebleeding. Indeed, endoscopic features for ulcers with high risk of rebleeding include ulcers larger than 2 cm, actively bleeding and those located at posterior duodenal bulb or high lesser curvature.2Johnston J.H. et al.Gastroenterology. 1987; 92: 1101-1108Abstract Full Text PDF PubMed Scopus (111) Google Scholar With the use of high-dose intravenous proton pump inhibitors (PPI), those who developed rebleeding after PPI infusion were patients with significant perioperative risks, high proportion of comorbidities, as well as older age which rendered them high-risk surgical candidates.3Elmunzer B.J. et al.Am J Gastroenterol. 2008; 103: 2625-2632Crossref PubMed Scopus (119) Google Scholar A prototype endoscopic suturing device had been investigated for the safety and efficacy in achieving hemostasis among massively bleeding gastric ulcers.4Chiu P.W. et al.Dig Surg. 2009; 26: 243-248Crossref PubMed Scopus (16) Google Scholar This is an initial report on the clinical application of surgical ulcer exclusion using endoscopic suturing for large bleeding gastric ulcer. The Apollo Overstitch is an endoscopic suturing system which consists of a cap-based suturing system with a curved suture arm extending from one of the dual channels and the anchor exchange system extending from the same channel. The handle to control the suture plication system was mounted onto the shaft of a double-channel endoscope (Olympus 2T100 scope, Olympus Co Ltd, Hong Kong). The Overstitch system attached to the double-channel endoscope was introduced into the stomach through an overtube. The bleeding ulcer was first located with an ordinary single-channel endoscope. Endoscopic suturing begins with the needle first driving through the distal edge of the bleeding ulcer. After closing the curved needle driver, the detachable needle should be grasped by the anchor exchange and detached from the needle driver. After opening the needle driver, the endoscope with Overstitch should be moved away from the distal ulcer edge. The needle should be placed back in the needle driver by the anchor exchange. The needle should then be driven over the proximal edge of the ulcer and the procedure repeated until the 2 edges of the ulcer can be pulled together. The needle anchor should be dropped, while the anchor exchange is replaced by the cinching device which passes along the 2 ‘O’ polypropylene suture. After passage of the cinch to ulcer edge, the polypropylene suture should be tightened against the end of the cinch. The cinch is then closed to cut the stitch and release the plug to tighten the suture, and the ulcer should be excluded from an intragastric high acidity environment to stop current bleeding and prevent rebleeding. Three patients received endoscopic ulcer exclusion for a massively bleeding gastric ulcer. This video shows endoscopic suturing for ulcer exclusion in an actively bleeding gastric ulcer. The patient was a 78-year-old man who presented with passage of tarry stool for 3 days; upper endoscopy showing a 2 cm large gastric ulcer at angular incisura with visible vessel. There was active bleeding from visible vessel (Figure 1). The Overstitch device was introduced through an overtube. The first suture plication was performed over the superior edge of the ulcer. After exchange of the anchor, the second suture plication was performed over the inferior ulcer edge. This process was continued until a figure of eight suture was formed over the ulcer. The anchor was then dropped and the suture was tightened with the cinching device. The ulcer was excluded with adequate hemostasis (Figure 2). The patient had no clinical evidence of rebleeding, and a repeated endoscopy in 72 hours confirmed secure closure of the ulcer.Figure 2Ulcer exclusion achieved after tightening of overstitch.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Surgical exclusion of bleeding ulcer is a conventional treatment for prevention of further bleeding through suture closure of the ulcer and excluding it from intragastric acidity. This is the first technological report on clinical application of endoscopic surgical suturing for ulcer exclusion. The success of endoscopic ulcer exclusion will lead to improvement in primary endoscopic hemostasis, and theoretically excluding the ulcer from acid to prevent further bleeding. The ulcer exclusion shall be a better method to prevent rebleeding compared with adjunctive high-dose proton pump inhibitor infusion or prophylactic angiographic embolization. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0NDRlMDkxM2NmMGRhNGUwNGJiZDFkODUyMjRjMjQxYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgxMzYwNDY3fQ.XXJzrp-6yqa5X_Fxu-t93ZJmJ4gGt5KEIICkg-xZWs2P9QUVTwPcWU5BIAoyY161WQqS9Xoq2xlMpMeFIa03TVHD9haMAQ-SBed6va3cMQtozXytNgaNMojGDSQwMA4hN2-dG7kGlLfGkDlU3dV9Oi0epZaZBfhQIxkNVWPYU76Fm68LSNLJ7_1G29qT5DlWZrSOHsW10o5dkts0yBD9W0Bc9PUUOiJX1P41J4-g2lAv77tNCIPyZNrVzhbQnAt1xIYBD1YAb1HHnXEHF1q2P_ISMMsqrfBJmW0OLGH8PblHrNNDwqnDn3pnyRIekdVxovny7vwoogxhrPzxLQT2mw Download .mp4 (43.03 MB) Help with .mp4 files Video 1

Delirium in fast-track colonic surgery.

Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously demonstrated to enhance recovery and reduce morbidity. Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. Total median length of hospital stay was 3 days. Seven patients (2.8%) developed clinical signs of PD most within the first 72 postoperative hours and only 1 patient with PD extending to 120 h postoperatively. Only 1 PD patient required treatment with serenase. PD patients were older (83 vs. 73 years) and had longer median stay (6 vs. 3 days). No difference in development of PD between open and laparoscopic operation could be demonstrated. Among the 7 patients with PD, 3 of these patients had later surgical complications. One patient had a subsequent strangulated small intestine, another an anastomotic leakage complicated by a bleeding gastric ulcer and death on day 12 and 1 with fever, abdominal pain and suspected but disproven anastomotic leakage (stay 21, 12 and 22 days, respectively). The remaining 4 PD patients stayed 4, 4, 5 and 6 days with an uncomplicated course. These data support that an enhanced postoperative recovery program may decrease the risk and duration of PD after colonic surgery.

A case of bleeding gasric fundic varices difficult to distinguish from bleeding gastric ulcer: a case report

A case of bleeding gasric fundic varices difficult to distinguish from bleeding gastric ulcer: a case report

出血性胃潰瘍を合併した胃アニサキス症の1例

出血性胃潰瘍を合併した胃アニサキス症の1例

内視鏡的止血術困難な出血性胃潰瘍を伴った直腸癌穿通によるFournier壊疽の1例

症例は61歳の男性で，臀部痛を主訴に前医を受診後，直腸腫瘍を認め精査加療目的に当院へ紹介受診した．会陰部は悪臭を伴う広範囲な腫脹・壊死を認め，直腸診では全周性腫瘍を触れた．血液検査では炎症反応高値，腫瘍マーカー高値を認めた．造影CTでは下部直腸に全周性壁肥厚と皮下軟部組織への空気像の波及，胃内への造影剤漏出を認め，上部消化管出血を伴う直腸癌穿通によるFournier壊疽が疑われた．内視鏡的止血術を試みるも，多量の血餅によって視野確保が困難であり，内視鏡的止血術は困難と判断し開腹手術へ移行した．広範胃切除術・横行結腸人工肛門造設術，debridementを施行した．第12病日に腹会陰式直腸切断術を施行し，術後経過良好にて薬物療法科へ転科となった．

A Case of Early Gastric Cancer Resected Completely by Diagnostic Endoscopic Mucosal Resection Presented as Large Gastric Ulcer Bleeding

A Case of Early Gastric Cancer Resected Completely by Diagnostic Endoscopic Mucosal Resection Presented as Large Gastric Ulcer Bleeding

A Case of Multiple Hemorrhagic Gastric Ulcers Developed via a Mechanism Similar to Water-Immersion Restraint Stress

In rats, water-immersion restraint stress is a model of experimental ulceration. We encountered a case in which multiple hemorrhagic gastric ulcers formed in the stomach in a setting similar to water-immersion restraint stress. The patient was a 54-year-old man who was found wet on a riverbank and transported by ambulance. Because of hypothermia and renal failure, hemodialysis was performed. Tarry stools were noted and endoscopy revealed the presence of multiple hemorrhagic gastric ulcers; thus, hemostasis was performed end oscopically. During the course, pseudo membranous colitis also developed and was ameliorated with vancomycin. Further, the renal failure and gastric ulcers improved, and the patient was discharged from hospital 25 days later. The reason why he survived more than 2 weeks was the hot summer season and he was not soaked in the river water throughout.

North vs south differences in acute peptic ulcer hemorrhage in Croatia: hospitalization incidence trends, clinical features, and 30-day case fatality.

AimTo assess the seven-year trends of hospitalization incidence due to acute peptic ulcer hemorrhage (APUH) and associated risk factors, and examine the differences in these trends between two regions in Croatia.MethodsThe study collected sociodemographic, clinical, and endoscopic data on 2204 patients with endoscopically confirmed APUH who were admitted to the Clinical Hospital Center “Sestre Milosrdnice,” Zagreb and Clinical Hospital Center Split between January 1, 2005 and December 31, 2011. We determined hospitalization incidence rates, 30-day case fatality rate, clinical outcomes, and incidence-associated factors.ResultsNo differences were observed in APUH hospitalization incidence rates between the regions. Age-standardized one-year cumulative APUH hospitalization incidence rate calculated using the European Standard Population was significantly higher in Zagreb than in Split region (43.2/100 000 vs 29.2/100,000). A significantly higher APUH hospitalization incidence rates were observed in the above 65 years age group. Overall 30-day case fatality rate was 4.9%.ConclusionThe hospitalization incidence of APUH in two populations did not change over the observational period and it was significantly higher in the Zagreb region. The incidence of acute duodenal ulcer hemorrhage also remained unchanged, whereas the incidence of acute gastric ulcer hemorrhage increased. The results of this study allow us to monitor epidemiological indicators of APUH and compare data with other countries.

Ulcer and bleeding complications and their relationship with dyspeptic symptoms in NSAIDs users: a transversal multicenter study

Objectives. To evaluate the prevalence of lesions and digestive complications secondary to the use of non-steroidal anti-inflammatory drugs (NSAIDs), the clinical profile seen for digestive complaints and the relation with the endoscopic findings. Methods. Prospective, multicentric, open study, evaluating consecutively 1231 patients, divided as follows: group I – NSAID and group II – non-NSAID. All patients answered questionnaire to evaluate the onset, the type of clinical complaint, the use of medication and possible complications associated to digestive bleeding. Results. A total of 1213 patients were evaluated. Among them, 65% were female and 13.1% were smokers; 15.6% mentioned they ingested alcoholic beverages. The main signs and symptoms reported were epigastralgy and pyrosis (67% and 62%, respectively). The upper gastrointestinal (UGI) endoscopy was normal in 3.9% in group I and in 10.7% in group II (p < 0.001). Patient who do not use NSAID will be 2.5 times more likely to have normal UGI endoscopy (p = 0.001). The presence of erosive or ulcer lesions in the stomach and duodenum was more frequent in group I. The incidence of lesions in the stomach when compared to the duodenum is observed (erosions: 49.12% vs. 13.60%, p = 0.001; ulcers: 14.04% vs. 11.84%, p = 0.05). The risk of digestive bleeding is 12 times higher (6.14% vs. 0.51%) in those who used NSAIDs, and the stomach is the site in which bleeding occurs more frequently. Conclusions. The frequency of gastric ulcer, duodenal ulcer and digestive bleeding was higher in patients who used NSAIDs. There was no connection found between endoscopic findings and dyspeptic symptoms.

Sa1477 Absolute Ethanol Is a Highly Effective Agent in Injection Therapy of Bleeding Gastric Ulcer: Ulcer Enlargement Is Not a Complication but Could Be Proof of Hemostasis

Sa1477 Absolute Ethanol Is a Highly Effective Agent in Injection Therapy of Bleeding Gastric Ulcer: Ulcer Enlargement Is Not a Complication but Could Be Proof of Hemostasis

Sa1635 Comparison of Continuous Infusion and Bolus Injection of Proton Pump Inhibitor (Pantoprazole) for the Prevention of Bleeding After Endoscopic Submucosal Dissection: a Prospective Randomized Controlled Trial

To prevent bleeding and healing the artificial ulcer after endoscopic submucosal dissection, elevated intra-gastric pH is important. Intravenous bolus loading followed by continuous infusion of proton pump inhibitor (PPI) is the standard treatment of choice for the prevention of gastric ulcer bleeding. The optimal dose of proton pump inhibitor (PPI) for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear. Our aim is to compare the effects of continuous infusion and bolus injection of PPI for the prevention of delayed bleeding after gastric ESD.