Chronic Duodenal Ulcer Research Articles

New Study: Helicobacter Species as a Potential Zoonotic Infectious Carcinogen : A Review

In 1983 two Australian doctors discovered a spiral bacterium in the human stomach which was called Campylobacter pylori (or pyloridis) to be re-named (Helicobacter pylori) in 1990. Carried by half the global population it was first believed exclusive to Human causing chronic gastritis, peptic and duodenal ulcer, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This discovery revolutionized peptic ulcer treatment with antibiotics instead of surgery. H.pylori is the only bacterial agent classified as Class 1 carcinogen. In 1997 genetic advances allowed genome sequencing and detailed research particularly on genomic pathogenesis. Genome printing methods revealed that H.pylori was transmitted from domesticated animals to pre-stone-age man probably of African ancestry. New non-pylori Helicobacter species were found in farm, small, wild, and non-human primate animals. Some cause chronic gastritis and vomiting, occasionally lymphocytic gastric tissue proliferation and cancer. Some animal and avian species are contagious to human, sometimes sharing genomic similarities with H.pylori. There are currently about 35 Helicobacter species. In pathogenic strains, certain genes function as virulence factors making proteins responsible for chronic inflammatory reactions and carcinogenesis in variable degrees. This is called (genomic polymorphism), it create diverse species and strains with variable degrees of pathogenicity. Genomic heterogeneity is the result of Helicobacter adaptation in various environmental, geographic, and host circumstances. Helicobacter strains with diverse virulence may exist in different ethnic and geographic groups. Both H.pylori in human and non-pylori species in animal may co-exist mixed in one host. Sheep is believed the reservoir for H.pylori and H.canis.

A rare cause of gastric outlet obstruction

Gastric outlet obstruction is the clinical and pathophysiological consequence of any disease process that produces mechanical impediment to gastric emptying. It may be acute from inflammatory swelling and peristaltic dysfunction or chronic from cicatrix. Chronic inflammation of the duodenum may lead to recurrent episodes of healing followed by repair and scarring ultimately leading to fibrosis and stenosis of the duodenal lumen. We would like to present a unique case of an elderly lady presenting with intractable vomiting over 3 months, gradually progressive which aggravated on consuming solids initially to consuming liquids later. After thorough investigations a provisional diagnosis of chronic duodenal ulcer with gastric outlet obstruction probably due to cicatrix was made. On laparotomy there was a chronic scarred duodenal ulcer following a previously contained perforation which was causing the gastric outlet obstruction. Cholecystectomy, duodenoplasty and loop gastrojejunostomy was performed with no complications post-operatively. This is a rare case of previous contained duodenal perforation causing gastric outlet obstruction.

Povezanost rekurentnog abdominalnog bola i infekcije sa Helicobacter pylori u korelaciji sa nalazom ezofagogastroduodenoskopije

Abstract: Aim: The aim of this research was to determine the association of recurrent abdominal pain and Helicobacter pylori (H. pylori) infection in childhood, in correlation with the finding of an upper endoscopy. Introduction: Recurrent abdominal pain (RAP) was defined according to Apley and Naish's criteria from the year 1959 as at least three or more episodes of abdominal pain lasting longer than three months in children older than 3 years, and severe enough to prevent normal activities in child. The association of RAP and H. pylori has been analyzed in several different researches, and there are conflicting results about their interconnection. However, the etiological association of the presence of H. pylori with the onset and development of acute and chronic active gastritis and duodenal ulcer is known. Material and method: The research protocol included a total of 77/183 (42.07%) children divided by age into three subgroups: preschool age (3 to 6.9 years), school-age (7 to 10.9 years) and adolescent age (11 to 15 years) in whom the diagnosis of RAB was determined by meeting the criteria according to Apley and Naish (1959), and the American Academy of Pediatrics (2005). H. pylori infection was confirmed by enzyme-linked immunosorbent assay (ELISA), while esophagogastroduodenoscopy was performed by the device for upper endoscopy type Olimpus GIF Type Q156, in the endoscopic cabinet of the Clinic for Internal Medicine, University Clinical Center Tuzla. Results: Of the total number of examined children (77), the analyse of Helicobacter pylori infection presence showed the biggest number of positive findings in school age 91.3%, in adolescent age 78.0%, while the smallest number was in preschool age (25.0%). The most common findings of upper endoscopy and microscopic findings were described as: antritis acuta in 16%, gastritis chronica activa et erosiva in 32%, and duodenitis acuta (12%). Conclusion: A significant association of H. pylori infection and RAP are confirmed by positive finding of esophagogastroduodenoscopy, leading to conclusion that immunological testing for the presence of this bacteria is justified. After obtaining a positive finding with confirmed infecion, it is necessary to start with the treatment.

Gastric Adenocarcinoma in a Young Nigerian – A Case Report

Abstract Gastric adenocarcinoma is uncommon among young Nigerians. We present Mrs O.V. a 41year old Nigerian who presented with one year history of recurrent epigastric pain that was peppery/burning in nature, non-radiating, aggravated by eating and temporarily relieved with the use of antacids. There is associated progressive weight loss and secondary amenorrhea since the onset of her illness. She started vomiting two weeks prior to presentation which was non-projectile, containing both recently ingested meals and partially digested stale food substances, vomitus was non-bilous. Episodes of vomiting is usually preceded by abdominal bloating or feeling of indigestion. Clinical examination revealed a chronically ill-looking young woman with a positive succussion splash on abdominal examination. Examination of the other systems was normal. Provisional diagnosis was suspected Chronic Gastric Antral Ulcer complicated by Gastric Outlet Obstruction to rule out Gastric Antral Adenocarcinoma. Abdominal ultrasound and CT scans showed features consistent with Gastric Outlet Obstruction. Upper GI Endoscopy revealed Gastric Antral Adenocarcinoma with Duodenal extension and Chronic Duodenal Ulcer complicated by Gastric Outlet Obstruction. Histology showed well differentiated Gastric Antral Adenocarcinoma. She had a Bilroth II procedure(Partial Gastrectomy and Gastro-Jejunostomy)and was commenced on adjunct chemotherapy: FAM regimen(5-Fluorouracil, Adriamycin and Mitomycin). She was also placed on long term proton pump inhibitor therapy. She has sustained remarkable clinical improvement with resolution of all her initial symptoms and she is currently on regular clinic follow-up. More cases of Gastric Adenocarcinoma among young Nigerians are being reported. There is a need for more extensive studies on this and possibly an indication for commencing endoscopy screening at an earlier age among individuals presenting with recent onset dyspepsia. Key words: Gastric, Adenocarcinoma, Young, Nigerians.

POST-VAGOTOMY GASTROPARESIS – A CASE REPORT

We present Mr M.A. a 27 year old Nigerian of the Yoruba tribe who has been having recurrent dyspeptic symptoms for 5 years but not previously endoscopically evaluated for peptic ulcer disease who now presented with six days history of abdominal pain which was initially epigastric but later became generalized associated with four episodes of vomiting and a day history of abdominal distension and fever. He was acutely ill-looking and dehydrated. The Abdomen was moderately distended, does not move with respiration, generalized tenderness with guarding and rebound tenderness, intra-abdominal organs were difficult to palpate due to the guarding. Bowel sound was absent. Examination of the other systems was not remarkable. A provisional diagnosis of Generalized peritonitis likely secondary to perforated peptic ulcer was made. He had an emergency exploratory laparotomy under general anaesthesia. He was commenced on intravenous fluids and parenteral proton pump inhibitor(PPI) and antibiotics. Intra-op findings include 2 liters of bilious peritoneal fluid, Multiple fibrous adhesions, a 2.5cm x 2cm gastric perforation at the anterior wall of the antrum and a grossly normal bowel. The surgical operation performed was a Graham Omental patch closure of the gastric defect with Bilateral Truncal Vagotomy and Peritoneal lavage. Post-operative state was satisfactory and he was later discharged. He presented at the gastroenterology out-patient clinic eight months later with complaints of early satiety, feeling of indigestion and episodes of vomiting. Vomitus is usually offensive / foul smelling and contains undigested or partially digested stale food substances. Abdominal examination revealed a positive succussion splash. Other clinical examination findings were not remarkable. A Provisional Diagnosis of suspected Gastric outlet obstruction probably secondary to a chronic duodenal ulcer was made. Endoscopy findings revealed copious fluid and food debris in the stomach cavity which had an offensive smell with remnants of partially digested stale food substances seen. There was poor peristaltic activity and the stomach was poorly distensible. There were multiple areas of mucosa erosions seen in the gastric cardia and corpus. No corporal or antral lesion seen. The pyloric ring was normal and the duodenum was normal. Diagnosis- (1) Endoscopic features of Gastroparesis likely secondary to previous Bilateral Truncal Vagotomy. No evidence of mechanical obstruction of the Gastric outlet. (2) Gastric Cardia and Corporal mucosa lesions likely secondary to Stasis Gastritis. Histology of biopsy specimens showed acute on chronic non-specific gastritis and acute duodenitis. He was commenced on empirical first line Helicobacter pylori eradication triple therapy (PPI, Amoxycillin and Clarithromycin) and a prokinetic drug (Domperidone). He had made significant clinical improvement with resolution of the symptoms by the time he was seen in the clinic three weeks later. He was tolerating oral food intake adequately and he had no new complaints. He was counselled on dietary modification and placed on long term prokinetic agent (Domperidone) and long-term PPI therapy with regular clinic follow-up. The initial management of post-vagotomy gastroparesis should be conservative as many symptoms resolve with time, this occurs possibly because the enteric nervous system is able to adapt to the loss of vagal input. Modification of dietary habits, such as regular intake of small meals, and use of prokinetic drugs bring about symptomatic relief in most patients.

Proinflammatory cytokines in the gastric juice in acid-related diseases before and after standart therapy.

The aim of research was to evaluate the effectiveness of the effect of eradication therapy on the cytokine status of gastric juice in patients with chronic non-atrophic gastritis (CNG) and duodenal ulcer (DU) associated with Helicobacter pylori. Clinical observations and laboratory-instrumental studies performed in 95 patients aged 20 to 55 years with CNG and duodenal ulcer with determination of cytokine content of IL-1β, IL-6 and TNF-α in the fasting portion of gastric juice. The most pronounced decrease in the content of proinflammatory cytokines in gastric juice on the background of treatment was found in patients of the 1st group who received combined therapy according to the scheme omeprazole + clarithromycin + amoxicillin. Analysis of the content of proinflammatory cytokines (IL-1β, IL-6 and TNF-α) in gastric juice in patients with acute exacerbation showed that their concentration in all 8 patients after the course of therapy exceeded the norm (P < 0.05) and was IL -1β - 30,30 + 1,15 pg/l, IL-6 - 10,4 + 0,83 pg / l and TNF-α - 32,5 + 1,13 pg / l. At the same time, the level of proinflammatory cytokines in gastric juice correlated with the degree of dissemination of H. pylori in the mucosa of the gastroduodenal zone. Helicobacter pylori infection in inflammation and ulceration in the mucous membrane of the stomach and duodenum, possibly in addition to other mechanisms, affects the activation of pro-inflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in gastric juice. Incomplete eradication of H. Pylori after treatment during clinical endoscopic remission in patients with duodenal ulcer in the vast majority of cases is accompanied by the preservation of an increased level of pro-inflammatory cytokines in gastric juice, which may be one of the reasons for the relapse of the disease.

Correlation among fecal indicator bacteria and physicochemical parameters with the presence of Helicobacter pylori DNA in raw and drinking water from Bogotá, Colombia

The quality of raw and drinking water is a matter of considerable concern due to the possibility of fecal contamination. To assess the quality and public health risk of different types of water, the fecal indicator bacteria (FIB) are used. However, some pathogens, such as Helicobacter pylori, may be present in water when FIB cannot be found. Hpylori is recognized as the causative agent of chronic gastritis, peptic and duodenal ulcers, and gastric cancer. The aim of this study was to evaluate the relationships among physicochemical parameters, FIB concentrations, and the presence of Hpylori DNA in raw and drinking water from Bogotá, Colombia. A total of 310 water samples were collected 1day per week from July 2015 to August 2016, and physicochemical parameters (pH, turbidity, conductivity, and residual free chlorine) were measured. Presence of Hpylori DNA was determined and quantified by quantitative polymerase chain reaction (qPCR). Fecal indicator bacteria (total coliforms, Escherichia coli, and spores of sulfite-reducing Clostridia) were enumerated by using standard culture techniques. Thirty of 155 (31%) raw water samples and forty-eight of 155 (38.7%) drinking water samples were positive for the presence of Hpylori. No statistically significant relationships were found between physicochemical parameters or FIB with the presence or absence of Hpylori in any sample (P<0.05). This study provides evidence of the presence of Hpylori DNA in raw and drinking water in Bogotá, and shows that the detection and enumeration of FIB and physicochemical parameters in water do not correlate with the risk of contamination with Hpylori.

The results of multicenter study of efficacy of Helicobacter pylori eradication therapy, conducted according to the recommendations of Maastricht V Consensus Report

Objective — to study efficacy and safety of two weeks quadruple therapy with high doses of pantoprazole, bismuth subcitrate, clarithromycin, amoxicillin with concomitant adjuvant symbiotic therapy (Saccharomyces boulardii, Lactobacillus rhamnosus, prebiotic inulin) in the eradication therapy for Helicobacter pylori.Materials and methods. In five centers, thirty patients aged 18 — 65 years with Helicobacter pylori-associated diseases (functional dyspepsia, chronic antral gastritis and peptic duodenal ulcers) were diagnosed and treated. The Helicobacter pylori status was confirmed by rapid urease test, 13С-Urea breath test, enzyme immunoassay with detection of IgG antibodies for Helicobacter pylori. Efficacy of eradication evaluated after four weeks of treatment’s termination with 13С-Urea breath test of Stool Antigen Helicobacter pylori test.Results. Twenty-nine patients completed the treatment protocol in full. H.pylori infection eradication was confirmed in 96.5 % of patients, compliant with the protocol. The mild transitory side effects of therapy were reported in 11 patients (36.6 %), mostly often diarrhea, nausea and black coloring of the feces. Four patients (13 %) reported about appearance of two side effects. The treatment was preliminary terminated in one case because of side effect due to severe nausea on the tenth day of treatment.Conclusions. The studied regimen of quadruple eradication therapy for Helicobacter pylori infection with high doses of pantoprazole, bismuth subcitrate, clarithromycin and amoxicillin with adjuvant treatment by symbiotic Opephera provided eradication of Helicobacter pylori infection in 96.5 % of patients.

Helicobacter pylori infection in pregnant women and it’s correlation with the alterations of some trace elements levels in the serum at Maternity Teaching Hospital in Erbil City

Helicobacter pylori (H. pylori) is a spiral-shaped pathogenic bacterium found on the human gastric mucosa, Warren and Marshall isolated H pylori for the first time in 1982. It is one of the most common worldwide human infections [1].H. pylori play a vital role in the development of chronic gastritis, gastric ulcer, duodenal ulcer, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma [2]. The current study included (120) pregnant women, (50) positive anti -H. Pylori Ig and (70) negative anti- H. Pylori Ig with pregnancy for first, second and third semester at mean age/ years 28.36 for the positive anti-H. Pylori and 26.17 for the negative anti-H. Pylori appeared that an alteration of zinc level in serum of positive anti- H. Pylori Ig groups was (48.904 ± 18.3486) (μg/dl) comparing with the negative groups (90.757 ± 9.2727) with the highly significant difference (P &lt; 0.01). While serum copper levels of positive anti-H. Pylori Ig group was (μg/dl), (100.412 ± 23.8234), documented as normal highly significant (P &lt; 0.01) compared to the negative anti- H. Pylori Ig group (114.971 ± 20.4995).In this study, the GIT disorder with anti-H. Pylori Ig positive groups were (32, 64%) and anti-H. Pylori Ig negative groups were (32, 45.7%), with significant difference (P &lt; 0.05).

Helicobacter pylori infection in pregnant women and it’s correlation with the alterations of some trace elements levels in the serum at Maternity Teaching Hospital in Erbil City

Helicobacter pylori (H. pylori) is a spiral-shaped pathogenic bacterium found on the human gastric mucosa, Warren and Marshall isolated H pylori for the first time in 1982. It is one of the most common worldwide human infections [1]. H. pylori play a vital role in the development of chronic gastritis, gastric ulcer, duodenal ulcer, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma [2]. The current study included (120) pregnant women, (50) positive anti -H. Pylori Ig and (70) negative anti- H. Pylori Ig with pregnancy for first, second and third semester at mean age/ years 28.36 for the positive anti-H. Pylori and 26.17 for the negative anti-H. Pylori appeared that an alteration of zinc level in serum of positive anti- H. Pylori Ig groups was (48.904 ± 18.3486) (μg/dl) comparing with the negative groups (90.757 ± 9.2727) with the highly significant difference (P &lt; 0.01). While serum copper levels of positive anti-H. Pylori Ig group was (μg/dl), (100.412 ± 23.8234), documented as normal highly significant (P &lt; 0.01) compared to the negative anti- H. Pylori Ig group (114.971 ± 20.4995).In this study, the GIT disorder with anti-H. Pylori Ig positive groups were (32, 64%) and anti-H. Pylori Ig negative groups were (32, 45.7%), with significant difference (P &lt; 0.05).

Helicobacter pylori infection in pregnant women and it’s correlation with the alterations of some trace elements levels in the serum at Maternity Teaching Hospital in Erbil City

Helicobacter pylori (H. pylori) is a spiral-shaped pathogenic bacterium found on the human gastric mucosa, Warren and Marshall isolated H pylori for the first time in 1982. It is one of the most common worldwide human infections [1]. H. pylori play a vital role in the development of chronic gastritis, gastric ulcer, duodenal ulcer, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma [2]. The current study included (120) pregnant women, (50) positive anti -H. Pylori Ig and (70) negative anti- H. Pylori Ig with pregnancy for first, second and third semester at mean age/ years 28.36 for the positive anti-H. Pylori and 26.17 for the negative anti-H. Pylori appeared that an alteration of zinc level in serum of positive anti- H. Pylori Ig groups was (48.904 ± 18.3486) (μg/dl) comparing with the negative groups (90.757 ± 9.2727) with the highly significant difference (P &lt; 0.01). While serum copper levels of positive anti-H. Pylori Ig group was (μg/dl), (100.412 ± 23.8234), documented as normal highly significant (P &lt; 0.01) compared to the negative anti- H. Pylori Ig group (114.971 ± 20.4995).In this study, the GIT disorder with anti-H. Pylori Ig positive groups were (32, 64%) and anti-H. Pylori Ig negative groups were (32, 45.7%), with significant difference (P &lt; 0.05).

MECHANISMS OF INTERRACTION OF HELICOBACTER PYLORI WITH EPITHELIUM OF GASTRIC MUCOSA. I. PATHOGENIC FACTORS PROMOTING SUCCESSFUL COLONIZATION

H. pylori is a Gram-negative, crimp and motile bacterium that colonizes the hostile microniche of the human stomach roughly one half of the human population. Then persists for the host’s entire life, but only causes overt gastric disease in a subset of infected hosts. To the reasons contributing to the development of diseases, usually include: concomitant infections of the gastrointestinal tract, improper sterilization of medical instruments, usually endoscopes, nonobservance of personal hygiene rules, prolonged contact with infected or carriers, including family members and a number of other factors. Clinically, H. pylori plays a causative role in the development of a wide spectrum of diseases including chronic active gastritis, peptic and duodenal ulceration, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Due to the global distribution of H. pylori, we are able to conclude that smart strategies are contributing to adaptation of the bacterium in an aggressive environment of a stomach and lifelong permanent circulation in its host. Thirty-four years after the discovery of this bacterium, there are still many unanswered questions. For example, which strategies help the bacterium to survive in this inhospitable conditions? Understanding the mechanisms governing H. pylori persistence will improve identification of the increased risk of different gastric diseases in persons infected with this bacterium. A well-defined and long-term equilibrium between the human host and H. pylori allows bacterial persistence in the gastric microniche; although this coexistence leads to a high risk of severe diseases the diseases which are listed above. In this review, we discuss the pathogenesis of this bacterium and the mechanisms it uses to promote persistent colonization of the gastric mucosa, with a focus on recent insights into the role of some virulence factors like urease, LPS, outer membrane proteins, cytotoxins, factors, promoting invasion. Information on the mechanisms related to H. pylori persistence can also provide the direction for future research concerning effective therapy and management of gastroduodenal disorders. The topics presented in the current review are important for elucidating the strategies used by H. pylori to help the bacterium persist in relation to the many unfavorable features of living in the gastric microniche.

The ways of antihelicobacter therapy in Ukraine (based on the data of analysis of the Ukrainian Registry Hp-EuReg — UKRAINE)

Objective — to assess the state of affairs in the diagnosis and treatment of Helicobacter pylori infection in Ukraine and their conformity with the modern international recommendations. Materials and methods. The performed analysis included data of 500 patients with H. pylori-associated gastrointestinal diseases, registered in the period of the year 2013 to 26.10.2018 in the Ukrainian Registry «gfadeenko» within the frameworks of the multicentre prospective trial Hp-EuReg — UKRAINE, initiated by the European Group on the investigation H. pylori infection and microbiota (EHMSG). All patients were administered antihelicobacter therapy (AHBT). Results. The predominated nosological units, for which AHBT was prescribed, were chronic gastritis (73.7 %) and duodenal ulcer 23.3 %. The mostly prevailed methods of primary H. pylori diagnosis were histological (50.8 %), serologic (26.7 %) and fast urease test (19.5 %). The AHBT duration was 7 days in 15.4 % of cases, 10 days in 37.6 %, and 14 days in 47.0 % of cases. The proton pump inhibitor pantoprazole was administered in the AHBT schemes most frequently (80.5 %). For the eradication control, stool test with H. pylori antigen identification in feces was actively used (90.5 %), and not actively the histological method (5.7 %) and urease breast test (1.9 %). Serological test was used in 2.9 % cases, and this was a significant diagnostic error. The eradication efficacy at the administration of the standard triple therapy was 53.5 % at 7-days course, 68.2 %, at 10-days course and 75.0 % at 14-days treatment. The use of triple therapy with addition of bismuth tripotassium dicitrate (VTD), the eradication level at 7-days course reached 71.4 %, at 10-days 92.6 %, and at 14-days 94.1 %. Conclusions. The non-compliance of the Maastricht-V recommendations regarding the duration of AHBT and eradication control has been revealed. Pantoprazole was administered in the AHBT schemes most frequently, that was stipulated by the comorbidity presence in the most of patients and risk of the inter-medication interactions. The insufficient efficacy of 7-days triple therapy has been established, as well as sub-optimal efficacy of 10- and 14-days schemes of triple AHBT and 7-days of triple AHBT with VTD addition. The VTD addition in 10- and 14-days schemes of triple therapy promoted the increase of eradication efficacy (more than 90 %), thus making this method of AHBT optimization actual for Ukraine.

Spectrum and outcome of gastric outlet obstruction in a tertiary care hospital

Background: Gastric Outlet Obstruction is a disorder wherein there is an obstruction in the opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum. Gastric Outlet Obstruction is the one of the most common clinical scenarios encountered in general surgery. Pyloric obstruction occurs in 2-4% of patients with chronic duodenal ulcer and it is described by Sir James Walton as “the stomach you can hear, the stomach you can feel and the stomach you can see”. Predominant cause for Gastric Outlet Obstruction has changed substantially with identification of H. Pylori and the use of proton pump inhibitor. In this study the various aspects and management of Gastric Outlet Obstruction are analysed.Methods: This prospective cohort study of 18 months duration was conducted among 50 patients in the department of general surgery from August 2016 to February 2018. The study population included patients presenting with gastric outlet obstruction in the deparment of general surgery who are treated on in-patient basis. An elaborate study of these cases was done and data pertaining to history, clinical features, investigations, management and follow up collected in a structured proforma.Results: Of the 50 cases of gastric outlet obstruction, 30 patients were diagnosed carcinoma pylorus and 17 of them were found to have cicatrising ulcer. Remaining 3 patients had other causes attributed to the presentation. The age incidence of the patients in this study ranged from 20 to 70 years with a mean age of 45.2 years. Majority of patients were manual labourers. 70% of the study subjects were smokers and 60% consumes alcohol. Vomiting and abdominal pain were the predominant symptom with recorded loss of weight in 35 cases.Conclusions: Gastric outlet obstruction is a common presentation of malignancy and cicactrising duodenal ulcers. However there has been changing trends in the pattern of disease incidence in view of changing trends in management and investigation modalities.

The complex treatment of patients with perforated gastroduodenal ulcers

To improve the immediate results of surgical treatment of patients with perforated gastroduodenal ulcers using minimally invasive correction and an integrated treatment. The results of 253 patients with perforated gastroduodenal ulcers who were treated from 2013 to 2018 were analyzed. Chronic ulcers were found in 82 (32%) cases among all gastric ulcers, acute ones constituted 42 (16%) cases. Chronic duodenal ulcers reached 94 (37%), acute ones constituted 35 (14%). The diagnostic laparoscopy was performed in 13 (5%) patients, in 8 (3%) patients the perforated hole was sutured laparoscopically and in 5 (2%) patients the conversion was performed. Abdominocentesis with preoperative abdominal cavity drainage was carried out in 45(18%) patients. Through this drainage after exudate evacuation 200 ml of dekasan solution was injected. In 119 cultures of abdominal exudates with determinate pathogenic microflora Enterococcus faecalis dominated - 31 patients (26%). Among the postoperative complications the failure of intestinal sutures was observed in 4 (1.5%) patients. Postoperative mortality was 11.5%. Progression of multiple organ failure became the cause of mortality in 17 (59%) patients. Thus, the time from the moment of perforation till the moment of surgery must not be the sole criterion in the choice of method of operative intervention, and it is insufficient as an absolute indicator for the possibility of the radical surgical procedures (gastric resection). Undoubtedly laparoscopic suturing of the perforated gastroduodenal ulcer has advantages over laparotomy.

EFFECT OF ENTERIC OXYGEN THERAPY ON HELICOBACTERIOSIS IN THE REHABILITATION OF CHILDREN WITH CHRONIC GASTRODUODENAL PATHOLOGY

The purpose of the study was to investigate the effect of enteric oxygen therapy on helicobacteriosis in the rehabilitation of children with chronic gastroduodenal pathology. 286 children and adolescents aged from 6 to 15 years with chronic gastritis, duodenitis, gastroduodenitis, gastric ulcer and duodenal ulcer were examined. To study the effectiveness of the recommended rehabilitation program, all patients were also divided into two rehabilitation groups, identical in age and clinical forms of the underlying disease. Determination of Helicobacter pylori (Hp-carrier) was performed using the breath test.Studies have shown that after the conventional course of eradication therapy, helicobacteriosis reduced to an average of 23.6%, but was not completely cured, or reinfection was observed. After primary rehabilitation, enteric oxygen therapy in combination with a prophylactic course of eradication therapy, a decrease in the Hp-carrier ratio on average by 14.3% was observed.It was concluded that patients with chronic gastroduodenal pathology after a course of standard treatment need rehabilitation therapy. After a comprehensive rehabilitation program there was observed a significant reduction in Hp-carrier up to 5 times, on the background of an improvement of laboratory and endoscopic test results.

Peculiarities of values of acetylcholine concentration and cholinesterase activity in serum of patients with alcoholic chronic pancreatitis and duodenal ulcer

Introduction. There are a lot of pathogenic factors involved in development of polyetiologic diseases. Acetylcholine (AC) is known as first-order mediator as it plays an important role in development and maintenance of pathological processes. In this article we provide data on AC concentration in blood serum of patients with duodenal ulcer, alcoholic chronic pancreatitis and control group as well as activity of cholinesterase.&#x0D; The aim of this study was to identify a role played by AC in pathological process during disease, which may complicate a course of the disease as a bad prognostic factor.&#x0D; Results and discussion. We divided AC concentration into three types in the control group: low — 0.46–1.0 mmol/l (60% of individuals), moderate — 1.02–1.5 mmol/l (30%) , and high — more than 1.5 mmol/l (10%).&#x0D; Conclusion. We suppose that cholinesterase activity and AC concentration depend on localization of pathological process.

Helicobacter pylori therapy and clinical perspective.

Helicobacter pylori induces chronic gastritis and duodenal ulcer in a small fraction of the colonised population. Three decades after the discovery of H. pylori and disclosure of an urgent need for eliminating the bacterium in patients, it seems that we are still in the first steps of dealing with this mysterious organism. Treatment of H. pylori is a complex dilemma for clinicians, a repeating sentence by many scientists who spend years on this research topic. Apart from many modifications in initial first-line treatment of H. pylori, gastroenterologists are unable to overcome the problem of therapeutic failure. Choosing the best regimen in any region depends on many factors, which have been the focus of many randomised clinical trials. A potential increase in efficacy of future therapies may be influenced by adding the novel potassium-competitive acid blocker vonoprazan. Undeniably, in-depth analysis is necessary to propose more effective therapeutic regimens. Meanwhile, we recommend the performance of antimicrobial susceptibility testing before any antimicrobial prescription.

Advances in Research Progress of H. pylori

Helicobacter pylori infection is a global public health problem. It can lead to chronic gastritis, stomach & duodenal ulcer, mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Globally a lot of research has been conducted on H. pylori. This review is focused on its biological characteristics, pathogenic mechanisms and epidemiological characteristics.

Regularities of the Oxidative Stress Processes in Case of Bleedings from Acute and Chronic Ulcers of the Stomach and Duodenum

The main aim of the study was to determine ways of improving the results of treating patients with ulcer bleeding of various nature and severity. It was provided by the system study of free radical processes and evaluation of the effectiveness of timely antioxidant therapy. Material and methods. The study included 153 patients aged 18-94 years with acute and chronic gastric and duodenal ulcers complicated by gastroduodenal bleeding. Patients were divided into two groups: group I (experimental group) included 62 patients who received antioxidative therapy with reamberin as a part of the basic therapy; and group II (control group) included 91 patients who received standard therapy. Various parameters of Free Radical Processes (FRP) were studied in dynamics in all patients. Results. We revealed the significance of oxidative stress on the first day of hospitalization in patients with gastrointestinal ulcerous bleeding of various character and severity. It was discovered mostly in severe patients with acute Gastroduodenal Ulcerous Bleeding (GDUB). In case of mild gastrointestinal ulcerous bleeding, oxidative stress disorders affected an oxygen stage of oxidative stress and represented themselves adaptive compensatory mechanisms. As the severity of the disease increased, intensification of an oxidant stress was manifested by a decrease in oxygen activity and an increase in lipid imbalance. Imbalance in free radical processes continued for a long time until discharge of patients from the hospital. The data obtained claimed to be the basis for recommendation to include antioxidant energy-conserving therapy in the complex of therapeutic measures in the earliest possible terms. We found out an efficacy of using succinic acid therapy with reamberin in patients with gastrointestinal bleeding. Positive effect of succinic acid on the markers of oxidative stress was confirmed by improvement in the disease pattern and success of the treatment.