Cases Of Peptic Ulcer Research Articles

Clinical features of parathyroid space-occupying lesions

To investigate the clinical manifestation, diagnosis, treatment of parathyroid occupying lesions. The clinical data of 42 patients with parathyroid occupying lesions were retrospectively analyzed, including the clinical symptoms and signs, laboratory results, pathologic and imaging results and treatment. The number of males and females were 8 and 34, with females: males ratio being 1:5.25. The median age was 39 years. There were 2 cases of parathyroid cancer, 29 cases of parathyroid adenoma, 11 cases of parathyroid cysts in this study. The symptoms were as follows: 40 cases of neck lump, 34 cases of osteoporosis/osteitis fibrosa cystica, 29 cases of urinary symptom, 7 cases of voice hoarseness, 4 cases of peptic ulcer, 3 cases of dyspnoea and dysphagia, 3 cases of thoracic cavity lump, 2 cases of enhanced amylase activity. Serum calcium ion level and serum parathyroid hormone (PTH) level were examined qualitatively before operation. Ultrasonography, ECT-99mTc-MIBI, CT, MRI were used in diagnosing and locating parathyroid occupying lesions before operation. Twenty nine cases of parathyroid adenoma were treated with operation, 28 patients achieved complete remission, 1 suffered relapse after 23 months postoperative follow up. Eleven cases of parathyroid cysts were treated with operation and the outcome was no recurrence. Two cases of parathyroid cancer survived with out recurrence during follow up for 28 months and 50 months after operation. Examination of serum calcium and PTH level together with ultrasonography, ECT-99mTc-MIBI, CT, MRI is helpful to diagnose parathyroid occupying lesions. Surgery should be done as primary treatment. Tumor resection can be performed for parathyroid cysts, intraoperative exploration of bilateral neck is indicated for parathyroid adenoma, and a radical resection should be performed primarily for the parathyroid cancer.

Antibody Response to Helicobacter pylori Excretory Antigen and the Cross Reaction Study

Helicobacter pylori is recognized as a major case of gastritis and peptic ulcer and a key factor in the development of gastric cancer, gastric lymphoma, and non-ulcerative dyspepsia in man. The detection of antibodies specific for strains of H. pylori has demonstrated the value of serology for providing evidence of infection. The present study was conducted to detect the antigenic proteins of excretory antigen of H. pylori with Western blotting and examine whether anti-H. pylori IgG and IgA antibodies from H. pylori positive patients cross-react with antigens from other common bacterial pathogens. By using SDS-PAGE, 20 different proteins were found in the excretory antigen. By Western blotting and absorption studies, there were indications that anti-H. pylori IgA antibodies directed against 54 kDa, 50 kDa and 27 kDa cross-reacted with antigens from other bacteria, and that H. pylori proteins of 99 kDa, 88 kDa and 81 kDa possibly shared similar epitope with antigens of other pathogens not tested in the absorption studies. The cross-reactivity occurred in this study was not significantly affect the performance of the in-house ELISA.

Perforated peptic ulcer associated with abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation.

Gastroventricular fistula in a patient with Roux-en-Y gastric bypass (with video)

Gastric ulcers leading to fistulous communication between the gastric lumen and the left ventricle are rare and almost always fatal.1-3 There have been several cases of benign peptic ulcers eroding into the left ventricle under diverse circumstances.1-3 We report the first case of a gastroventricular fistula through the distal pouch of the stomach, in a patient who underwent Roux-en-Y gastric bypass for morbid obesity several years before presentation.

Management and prevention of adverse effects related to treatment of liver tumours with 90Y microspheres

Selective internal radiation therapy with 90Y microspheres (SIR spheres) is increasingly used in the treatment of extensive liver tumours. Careful selection and preparation of patients are necessary to avoid possible adverse effects. We aimed to evaluate the incidence and severity of adverse effects resulting from the administration of SIR spheres during therapy. Between June 2004 and August 2006, 21 patients (11 women and 10 men; age range 40-75 years; mean, 58 years) with a wide range of extensive liver tumours were treated with SIR spheres. The mean administered dose was 1.87 GBq (range 1.2-2.5 GBq). During the follow-up period of 26 months, all adverse effects were monitored and classified according to the National Cancer Institute criteria. Four patients had adverse effects: one case of cholecystitis followed by fibrosis and portal hypertension, one case of peptic ulceration and two cases of radiation hepatitis. All cases responded to appropriate therapy. Proper selection of patients and accurate interpretation of pre-treatment investigations are vital for minimizing adverse effects following therapy with SIR spheres. In our experience, all adverse effects were moderate with no life-threatening consequences.

Twelve years’ progress in surgery for perforated gastric and duodenal ulcers: a retrospective study of indications for laparoscopic surgery, post‐operative course and the influence of Candida infection

SummaryBackgroundTwelve years has passed since we introduced laparoscopic surgery for gastroduodenal perforation.AimTo list problems and to investigate the feasibility of our clinical protocol for treatment of gastroduodenal ulcer perforation.MethodsCase records of 62 patients and histology samples of 9 patients undergoing surgery for gastroduodenal perforation were retrospectively reviewed.ResultsLaparoscopic omental implantation is feasible for some cases of perforated peptic ulcer in patients who have either stenosis or massive perforations. In patients undergoing laparoscopic omental implantation, oral ingestion of water was started at 3.3 ± 0.5 post‐operative days. Helicobacter pylori was positive in 27 of 35 patients (77%). Of 22 cases in whom intraoperative ascitic culture was taken, Candida was positive in nine (41%), and in six of eight cases involving wound infection or intraperitoneal abscess. Histological examination of resected stomach revealed the fungi with hypha formation at the base of the ulcer in 44% of patients.ConclusionsLaparoscopic omental implantation was more feasible than in the past. The possibility of Candida infection and subsequent abscess formation must be considered in patients with gastroduodenal ulcer perforation.

Twelve years’ progress in surgery for perforated gastric and duodenal ulcers: a retrospective study of indications for laparoscopic surgery, post‐operative course and the influence of Candida infection

SummaryBackgroundTwelve years has passed since we introduced laparoscopic surgery for gastroduodenal perforation.AimTo list problems and to investigate the feasibility of our clinical protocol for treatment of gastroduodenal ulcer perforation.MethodsCase records of 62 patients and histology samples of 9 patients undergoing surgery for gastroduodenal perforation were retrospectively reviewed.ResultsLaparoscopic omental implantation is feasible for some cases of perforated peptic ulcer in patients who have either stenosis or massive perforations. In patients undergoing laparoscopic omental implantation, oral ingestion of water was started at 3.3 ± 0.5 post‐operative days. Helicobacter pylori was positive in 27 of 35 patients (77%). Of 22 cases in whom intraoperative ascitic culture was taken, Candida was positive in nine (41%), and in six of eight cases involving wound infection or intraperitoneal abscess. Histological examination of resected stomach revealed the fungi with hypha formation at the base of the ulcer in 44% of patients.ConclusionsLaparoscopic omental implantation was more feasible than in the past. The possibility of Candida infection and subsequent abscess formation must be considered in patients with gastroduodenal ulcer perforation.

Treatment of Peptic Ulcer with Combination of Chinese Traditional and Western Medicine

目的 探讨中西医结合治疗消化性溃疡的治疗经验.方法采用中西医结合治疗消化溃疡患者35例,不同的病例,采取相应的中西医结合治疗措施.结果35例患者经过合理的中西医结合治疗,全部病例症状缓解、治愈出院.结论在消化性溃疡的治疗中,采用克拉霉素、羟氨苄青霉素、洛赛克三联七天治疗,配合中医能获得满意效果。

Gastroscopic analysis of 2298 cases of peptic ulcer in Monglian area

目的 探讨蒙古族聚集地区消化性溃疡(PU)的发病特点.方法对17年间15 826例内镜检查资料进行回顾分析,相关数据进行统计学处理.结果消化性溃疡检出2 298例,检出率14.52%,其中十二指肠溃疡(DU)1 376例(59.88%),胃溃疡(GU)739例(32.16%),复合性溃疡(CU)183例(7.96%).男、女检出率分别为18.53%和8.06%,蒙、汉族检出率分别为18.43%和13.15%.结论该地区消化性溃疡的检出率,男性多于女性(P＜0.01),DU高于GU,蒙古族高于汉族(P＜0.01),好发于秋冬和冬春之交。

Association of peptic ulcer with increased expression of Lewis antigens, but not vacuolating cytotoxin activity or babA2 gene status, in Helicobacter pylori strains from China

Controversies exist regarding the virulence factors, such as vacA, babA2 and Lewis blood group antigens, of Western and Asian strains of Helicobacter pylori. The aim of the present study was to determine the significance of these potential virulence factors in the Chinese population. Seventy-two strains of H. pylori isolated from patients in Zhengzhou, China, including 43 cases of peptic ulcer (PU) and 29 cases of chronic gastritis, were determined. Vacuolating cytotoxin assay was performed by HeLa cells. The expression of Le blood group antigens (Le(a), Le(b), Le(x) and Le(y)) was performed by enzyme-linked immunosorbent assay (ELISA). babA2 gene was identified by polymerase chain reaction. Frequencies were compared using two-tailed Fisher's exact test. Cytotoxin activities were compared using Spearman's rank correction test. Vacuolating cytotoxin activity was detected in 61 of the 72 strains (84.7%), but there was no significant difference in vacuolating cytotoxin activity (83.7% vs 86.2%, P = 0.821) or titer (4.4 +/- 3.8 vs 4.2 +/- 4.1, P = 0.876) between the PU and gastritis strains. Significantly more PU strains expressed two or more Lewis antigens (Le(x), Le(y), Le(a) or Le(b)) than strains from the chronic gastritis patients (90.7% vs 65.5%, P = 0.029). Of the 43 strains from PU patients, 17 (39.5%) were positive for babA2, compared with 11 (38.5%) of the 29 strains from gastritis patients (P = 0.924). There was no significant difference in the vacuolating cytotoxin activity or titer between strains expressing two or more Lewis antigens and less than two antigens (84.5% vs 85.7%, P = 1.000; 4.4 +/- 4.2 vs 4.3 +/- 3.2, P = 0.965). Of the 72 H. pylori strains, 28 were babA2 positive, of which 24 were cytotoxic, compared with 37 of 44 babA2-negative strains (P = 1.000). The present study suggests that PU is associated with increased Lewis antigen expression, but not vacuolating cytotoxin production or the presence of babA2, in the H. pylori strains in the Chinese population.

NSAID-Associated Adverse Effects and Acid Control Aids to Prevent Them

NSAIDs are central to the clinical management of a wide range of conditions. However, NSAIDs in combination with gastric acid, which has been shown to play a central role in upper gastrointestinal (GI) events, can damage the gastroduodenal mucosa and result in dyspeptic symptoms and peptic lesions such as ulceration.NSAID-associated GI mucosal injury is an important clinical problem. Gastroduodenal ulcers or ulcer complications occur in up to 25% of patients receiving NSAIDs. However, these toxicities are often not preceded by indicative symptoms. Data obtained from the Arthritis, Rheumatism, and Aging Medical Information System have shown that 50-60% of NSAID-associated peptic ulcer cases can remain clinically silent and do not present until complications occur. Therefore, prophylactic treatment to prevent GI complications may be necessary in a substantial proportion of NSAID users, especially those in groups associated with a high risk of developing these complications. Use of cyclo-oxygenase (COX)-2 selective NSAIDs, also known as 'coxibs', substantially reduces the incidence of upper GI toxicities seen with non-selective NSAIDs. However, there are concerns regarding the cardiovascular safety of coxibs. For this reason, the US FDA recommends minimal use of coxibs and only when strictly necessary. Additionally, rofecoxib has been removed from the US market and sales of valdecoxib have been suspended. Furthermore, upper GI toxicities still occur in patients receiving coxibs. Therefore, cotherapies are required to prevent and/or heal upper GI effects associated with NSAID use. Effective prophylactic and treatment strategies include misoprostol, histamine H(2) receptor antagonists and proton pump inhibitors (PPIs). The key role that gastric acid plays in upper GI adverse events among NSAID users suggests that it is important to choose the most effective agent for acid control to alleviate symptoms, heal mucosal erosions and improve the reduced quality of life in this patient population. PPIs provide effective acid suppression, which is essential to avoid GI mucosal injury, and they are, therefore, capable of dramatically decreasing the morbidity and mortality associated with this disorder. Since many serious GI complications are not heralded by any previous symptoms, physicians need to be aware of risk factor profiles that predispose patients to serious GI problems. Physicians also need to initiate the appropriate preventative acid suppressive therapy to minimise the burden of NSAID-associated GI adverse effects.

What has happened to perforated peptic ulcer?

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965-82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965-70 to 59.0 years in 1977-82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.

X-ray diagnosis and follow-up of children with peptic ulcer

目的 探讨小儿消化性溃疡的X线诊断价值.方法对128例小儿消化性溃疡进行胃肠钡餐检查及摄片,采用多体位及充盈后适当加压,分析其X线表现.其中76例进行随访.结果128例中,胃溃疡20例(16%),十二指肠溃疡105例(82%),胃、十二指肠复合性溃疡3例(2%).胃溃疡龛影切线位呈小锥形,十二指肠溃疡星小圆形或卵圆形,幽门管多痉挛.结论钡餐检查是小儿消化性溃疡的主要检查手段.早期发现,及时诊治有利于龛影的愈合及胃、十二指肠外形的恢复,对降低溃疡病发病率具有重要意义。

The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting

BackgroundGuidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting.MethodsAltogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed.ResultsSeventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting.ConclusionsIn a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases.

Cap assisted endoclipping of refractory bleeding from peptic ulcer

Bleeding that recurs despite repeated endoscopic hemostatic therapeis requires surgery. We describe a case of bleeding peptic ulcer that was refractory to conventional hemostasis, where cap assisted endoscopy combined with hemoclipping achieved successful hemostasis.

顎口腔領域癌患者における上部消化管内視鏡検査（ＧＩＦ）の検討

We investigated the relation of oral and maxillofacial cancer to upper gastrointestinal fiberscopic findings and evaluated the value and reliability of gastrointestinal fiberscopy (GIF). Sixty-two patients with oral and maxillofacial squamous cell carcinoma were examined by GIF in consultation with an internist.The results were as follows:1. The incidence of upper gastrointestinal lesions in patients with oral and maxillofacial cancer was higher than that in the general population.2. There was no relation between the region or the stage of squamous cell carcinoma and the incidence of upper gastrointestinal lesions.3. There were 6 cases (9.7%) of double cancer. There were also many precancerous lesions, such as esophageal dysplasia (3 cases, 4.8%), Barret's mucosa (3 cases, 4.8%), atrophic gastritis (26 cases, 41.9%), and intestinal metaplasia (9 cases, 14.5%). Four cases of active peptic ulcer (6.5%) were also found.4. The incidence of esophageal lesions in patients with smoking and drinking habits was significantly higher than that in patients without smoking habits, drinking habits, or both.In conclusion, it is important to examine the upper gastrointestinal tract of patients with oral and maxillofacial cancer by GIF not only to screen for double cancers but also to detect precancerous lesions and active peptic ulcers.

Publications on peptic ulcer in Britain, France, Germany and the US.

There are no reasonable explanations for the increases first of gastric, and then of duodenal, ulcers in the second half of the nineteenth century. Previous studies have analysed hospital admissions, necropsies and mortality data. This paper uses a novel method, a study of the rates of increases in publications on these peptic ulcers over the centuries in four countries, the US and three in Europe. Between 1700 and 1919 the Surgeon General's Catalogues listed 2958 publications on gastric ulcer in Britain, France, Germany and the US, and between 1700 and 1929 1132 publications on duodenal ulcer. The published US cases of proven peptic ulcer in the nineteenth century were further analysed; details of sex, year of proven diagnosis and year of birth were available for 184 (90 male) cases of gastric ulcer and 77 (63 male) cases of duodenal ulcer. There were exponential increases in the number of monographs and articles on both types of peptic ulcer in the nineteenth century, and the curves for the four countries are remarkably similar. The increases in publications on gastric ulcer began about 1800 and for duodenal ulcer decades later. The number of cases of gastric ulcer diagnosed definitively in the US rose slowly in the first half of the nineteenth century and then increased markedly, with the increases in proven duodenal ulcer 10-20 years later. The birth years of patients with gastric ulcer peaked for those born in the 1850s, and about 10-20 years later for patients with duodenal ulcer. Such exponential increases are compatible with current models of infection with Helicobacter pylori but do not explain either the difference in timing between gastric and duodenal ulcer or the simultaneity between the four countries.

Validation of diagnoses of peptic ulcers and bleeding from administrative databases: A multi-health maintenance organization study

The automated health plan data and data from medical chart abstractions from eight large health maintenance organizations were used to evaluate the positive predictive values (PPVs) of the International Classification of Diseases, 9 th revision (ICD-9) codes for cases of peptic ulcers and upper gastrointestinal bleeding. Overall, 207 of 884 cases of peptic ulcers and upper gastrointestinal bleeding (23%) were confirmed by surgery, endoscopy, X-ray, or autopsy. The PPVs were 66% for hospitalizations with codes for duodenal ulcer (ICD-9-CM 532), 61% for gastric/gastrojejunal ulcer (ICD-9-CM 531, 534), 1% for peptic ulcer (ICD-9-CM 533), and 9% for gastrointestinal hemorrhage (ICD-9-CM578). The overall and diagnostic category-specific PPVs were generally similar for the various HMOs. This study, using data from a large number of health plans located in different geographical regions, underscores the importance of evaluating the accuracy of the diagnoses from automated health plan databases.

The histopathology of non-steroidal anti-inflammatory drug induced gastroduodenal damage: correlation with Helicobacter pylori, ulcers, and haemorrhagic events

Aims—The spectrum of microscopic lesions resulting from the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), known as chemical gastritis, remains unclear, and the variable prevalence reported in different studies makes...

Altération de l’état général inexpliquée du sujet âgé : intérêt de la fibroscopie gastrique, étude d’une cohorte de 77 patients avec un suivi à 13 mois

Purpose. – In case of unexplained weight loss, chest X-ray, abdominal ultrasonography and gastroscopy are usually recommended. However, gastroscopy is not usually performed in elderly patients. Methods. – We evaluated 77 patients (mean age: 80 ± 8 years) hospitalized in our geriatric unit between January 1995 and May 1997 for unexplained weight loss. All patients underwent chest X-ray, abdominal ultrasonography and gastroscopy. Results. – These investigations led to diagnosis in respectively 17, 15 and 46 patients. The etiology of weight loss was unique in 47 patients, while in 30 other patients at least two or three causes could be described. Gastroscopy appeared to be the most useful test, as it allowed description of eight cases of cancer, 29 cases of peptic ulcer, two cases of candidosis, and one case of actinomycosis in patients who did not present any clinical sign. Conclusion. – Sixty-five patients were followed-up for a mean period of 13 ± 21 month; 33 patients died. The condition of 23 patients improved either slightly or definitely. Simple investigations led to diagnosis in 95% of the cases. However, 42% of the patients died within 3 months. Gastroscopy appears to be the most valuable test, leading to diagnosis in more than half of the cases. With adapted treatment, the condition of 75% of the patients with gastro-intestinal lesions improved.