Complication Of Gastric Ulcer Research Articles

The effect of the type of constitution on the course of gastric ulcer in children

The purpose of the study. The study of the constitutional features of the course of gastric ulcer in children. Materials and methods. 102 children aged 12-17 years with a diagnosis of “gastric ulcer” were examined. A clinical and instrumental verification of the diagnosis, its complications, and an assessment of the type of constitution using the Pinier index was carried out using endoscopic examination. Results and conclusion. The dominance of children with gastric ulcer, having an asthenic type of constitution in comparison with normal and hypersthenics, has been established. Complications of gastric ulcer in the form of perforation of the stomach wall with the development of peritonitis, gastric bleeding were significantly more common in normosthenic patients, one and a half to two times less common in asthenics, never noted in hypersthenics, in whom concomitant reflux esophagitis was often detected.

К ВОПРОСУ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ НЕДОСТАТОЧНОСТИ ПИЛОРИЧЕСКОГО СФИНКТЕРА И СИНДРОМА ШМИДЕНА

Methods of restoring the evacuation and barrier function of the pyloric sphincter in treating complications of gastric ulcer, duodenal ulcer, and postcholecystectomy syndrome, cholelithiasis, gastritis reflux and Schmieden`s syndrome play an important role in abdominal surgery. This article presents a clinical case of a patient with a duodenal ulcer with the development of decompensated pyloric stenosis due to pyloric sphincter insufficiency and the method of its surgical treatment

Gastric Ulcer Complications after the Introduction of Proton Pump Inhibitors into Clinical Routine: 20-Year Experience

Background: The aim of this study was to analyze the admissions and the management of peptic ulcer disease (PUD) in a tertiary care surgical center. Methods: We evaluated the medical records of all patients admitted to the University Hospital of Tübingen, Germany, for treatment of PUD during 1989-2008. Patients were included into the study if the diagnosis was verified endoscopically or surgically. Annual number of admissions, length of hospitalization, mortality rate, age, rate of non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitor (PPI) medication, rate of Helicobacter pylori infection, and complications of PUD and surgery performed were recorded. Data were analyzed by descriptive analyses, Pearson's chi-square test, and regression analysis. Results: This study included 614 admissions. The number of annual admissions (31 ± 12), the length of hospitalization (9 ± 3 days), and the mortality rate (5 ± 4% per year) remained constant, whereas the age increased (1989: 52 ± 14 years vs. 2008: 67 ± 16 years). The rates of patients with H. pylori infection (47 ± 28% per year), NSAIDs treatment (29 ± 15% per year), and PPI treatment (31 ± 27% per year) remained constant. The most frequent PUD complication was hemorrhage (42 ± 16% per year), followed by perforation (9 ± 8% per year). During 1999-2008, more hemorrhages (125 vs. 121; p < 0.05) and perforations (40 vs. 21; p < 0.05) were registered than during 1989-1998. The rate of emergency surgery increased from 70% during 1989-1998 to 87% during 1999-2008. In contrast, elective surgery decreased from 21% during 1989-1998 to 7% during 1999-2008. Ulcer excision and oversewing was the most frequent surgical procedure performed (59%), with decreasing rates of acid-reducing surgery. Conclusion: Despite recent advances in PUD management, ulcer hemorrhage and perforation remain a significant health burden and a surgical disease.

Неускладнена виразкова хвороба шлунка: прогнозування перебігуі лікувальна тактика

Сучасні тенденції розвитку практичної медицини світу та нашої держави вимагають розробки та впровадження чітких покрокових програм-алгоритмів, стандартизованих схем лікування, показань до операційного лікування та профілактики ускладнень. На основі результатів обстеження 185 пацієнтів з ускладненою і неускладненою виразковою хворобою шлунка (езофагогастродуоденоскопія з експрес-біопсією виразки і періульцерозної інфільтрації з наступним імуноморфологічним дослідженням біоптатів, визначенням ступеня диспластичних процесів епітелію слизової оболонки шлунка) розроблено критерії прогнозування ускладнень та чіткі показання до превентивного операційного втручання. Опираючись на результати наших досліджень, превентивне операційне втручання було проведено 23 пацієнтам із високим прогностичним ризиком гострих ускладнень та 14 – із передраковими змінами. Показаннями до органощадних операцій вважали тривалонезагойні виразки з наявністю прогностичних ознак високого ризику виникнення гострих ускладнень виразкової хвороби шлунка на тлі легкої дисплазії і передракових змін з помірною дисплазією, неускладнені виразки шлунка, що рецидивують 3–4 рази на рік, або щорічні рецидиви протягом 4–5 років, до резекційних – гігантські або тривалонезагойні виразки, з наявністю передракових змін із тяжкою дисплазією.

PP31 - Changing of extracellular nucleic acids and histone like proteins in blood of patients with complications of peptic ulcer disease

Peptic ulcer disease - a chronic relapsing poly etiologic disease is widespread throughout the world. Among the patients who are hospitalized with gastrointestinal diseases, peptic ulcer disease is diagnosed in 35.8% of cases. Implementation of peptic ulcer disease is carried out by the interaction of exogenous and endogenous factors: genetic predisposition, such as the nervous and endocrine systems, psycho-emotional characteristics, the characteristics of metabolic, biochemical reactions. In modern conditions, there is a noticeable increase in the incidence of peptic ulcer caused by stressful situations, bad habits, use of drugs, resulting in impaired balance between “aggressive” factors and “protective” factors of gastroduodenal zone. Aim of research Investigating of extracellular nucleic acid contamination changing and histone like proteins in blood of patients with complications of peptic ulcer disease. Material and methods The object of the study was the blood of patients with ulcer complications, which were determined precursors of nucleic acids and histone like proteins. Results of study A significant increase in the fraction 1.9 times H1, H2A, and H3, H4 fraction in 3.5 times in comparison with the control values and a significant decrease H2B fraction 1.5. The quantity of ASF in the blood of patients with peptic ulcer disease significantly increased by 1.2 times compared with the control, with corresponding reduction of circulating extracellular nucleic acids. Conclusion Changing the content of histone like proteins extracellular nucleic acids, in patients with a complication of gastric ulcer, can be explained by “breakdown” compensatory mechanisms adapted by the action of unfavorable factors that lead to oxidative degradation of histone proteins and metabolic disorders predecessors nucleic acids.

Double pylorus: a complication of gastric ulcer

Double pylorus: a complication of gastric ulcer

A Case of Gastroduodenal Fistula Caused by Gastric Ulcer

Gastroduodenal fistula or double pylorus is a very rare condition. It is a fistulous communication between gastric antrum and duodenal bulb. It can be either congenital or acquired. In most cases it is thought to be a complication of gastric ulcer. We recently experienced a case of gastroduodenal fistula in 70 year-old man presenting as epigastric pain. He was diagnosed with non ST elevation myocardial infarction previously, and was taking aspirin. Gastroduodenal communication was revealed by endoscopy. We report a case of gastroduodenal fistula that developed in man who was taking aspirin, with review of the literature. (Korean J Helicobacter Up Gastrointest Res 2012; 12:195-197)

Misoprostol: pharmacoeconomics of its use as prophylaxis against gastroduodenal damage induced by nonsteroidal anti-inflammatory drugs.

Misoprostol effectively prevents nonsteroidal anti-inflammatory drugs (NSAID)-induced gastric ulcer and is the only agent currently indicated for this purpose. In addition, misoprostol is effective as prophylaxis against NSAID-induced duodenal ulcer. Because of the widespread use of NSAIDs, the cost of routine misoprostol prophylaxis would be high, and thus its pharmacoeconomic evaluation is an important factor in assessing the most appropriate role of misoprostol in this group of patients. Current cost-benefit analyses undertaken in major European centres and the US have generally indicated that, depending on initial assumptions, misoprostol prophylaxis over a 3-month period is cost-saving in patients with osteoarthritis taking NSAIDs. The net savings (costs) realised were dependent on several variables, including the acquisition cost of misoprostol, silent ulcer rate and patients' compliance. Importantly, misoprostol prophylaxis was consistently more cost-beneficial in elderly patients aged greater than 60 to 65 years than in their younger counterparts. In contrast, in one study misoprostol was found to reduce patients' quality of life and, although misoprostol therapy is potentially cost-saving to society, patients generally preferred no therapy. A single study assessing the cost-effectiveness of misoprostol prophylaxis in preventing ulcerative complications concluded that primary treatment was not an economically viable option for all NSAID users. Misoprostol was most cost-effective in the prevention of recurrent or secondary gastric ulcer complications in 'high-risk' patients, for example patients aged over 60 years and patients with rheumatoid arthritis. Thus, although there are areas of interest awaiting further pharmacoeconomic investigation, misoprostol prophylaxis appears to be cost-effective in elderly and high risk patients receiving NSAIDs. Additionally, misoprostol prophylaxis is cost-saving in elderly patients with osteoarthritis requiring NSAID therapy.

A CASE OF GASTRIC VOLVULUS COMPLICATED BY A HEMORRHAGIC ULCER WITH SUBSEQUENT LEFT DIAPHRAGM CHALASIA

We report a very rare condition that we treated surgically. The patient was a 38-year-old-male with a history of melena, which had occurred on five occasions. Following this, he was examined by a local physician, who had diagnosed gastric deformation of unknown etiology. After another episode of melena, the patient consulted our hospital. Careful inspection of thoracic X-ray films, together with endoscopy and contrast medium imaging resulted in a diagnosis of gastric volvulus with a hemorrhagic gastric ulcer.Gastrectomy (Billroth-I method) was performed. The presence of a gastric volvulus made diagnosis easier. However, chronic cases without the complication of gastric ulcer might be more difficult to diagnose and may not receive the necessary surgery. There is, therefore, no definitive surgical procedure for this condition.It is necessary to carefully consider age, complications, and their severity when examining patients with suspected gastric deformation.

The clinical course of 250 gastric ulcer patients.

Introduction In gastric ulcer disease, the practical problem which confronts the surgeon is that of management. The complications of gastric ulcer, such as acute perforation, hemorrhage, and obstruction, are usually treated surgically, and this aspect presents little controversy. In the absence of these complications, the inability to differentiate a benign gastric ulcer from a malignant one dominates the clinical picture, and this often becomes the indication for surgical intervention. In general, the policy at this institution has been to recommend resection for any gastric ulcer which is not resolved completely on an intensive hospital ulcer regimen lasting no longer than 3 weeks. At times, this rather popular policy has been considered somewhat radical. This latter opinion led us to a consideration of the mortality, morbidity, and the natural course of gastric ulcer disease, in addition to its malignant potential. The purpose of this report is to review our experience with

Complications of Gastric Ulcer

Complications of Gastric Ulcer

Malignant Degeneration of Gastric Ulcer

Malignant degeneration is the most serious complication of gastric ulcer. Its recognition is difficult both in the early stage and in advanced cases in which only the evidence of a previous ulcer-cavity, and the radiating folds of the mucous membrane indicate progressive development of carcinoma from an original ulcer.It is impossible to say how often gastric ulcer becomes malignant; one can only state the frequency of ulcer-carcinoma, found in gastric resections.One hundred and forty-one personal cases of ulcer-carcinoma are recorded, and are divided into three groups.GROUP I: 41 which were diagnosed clinically and at operation as cases of ulcer, but in which histological examination showed incipient cancer.GROUP II: 55 diagnosed clinically as cases of ulcer, but in which a diagnosis of ulcer-carcinoma was made during operation and afterwards histologically confirmed.GROUP III: 45 diagnosed both clinically and macroscopically (from the typical folding of the mucous membrane) as cases of ulcer-cancer, in which the cancer had entirely overgrown the ulcer.Therefore in the series of 532 resections for gastric ulcer the frequency of ulcer-carcinoma was 20.9%, or 15.2% if the third group is omitted.In a series of 718 resections for gastric cancer, the frequency of ulcer-carcinoma was 19.6% (or 14.2% if the third group is omitted).The mortality in simple two-third resection of the stomach is low (four deaths in 99 cases = 4%). When the pancreas, liver, colon, or oesophagus, is involved, the resection mortality is high (14 deaths in 42 cases = 33.3%), but even in these cases the operation is justifiable because permanent cures were achieved in a number of cases.The prognosis in cases of ulcer-cancer is very grave. In many cases, judging from the author's own experience, patients suffering from incipient ulcer-cancer-only histologically diagnosed as cancer-die from liver metastases, in spite of radical resection. It will thus be seen that the end-results of resection for ulcer-carcinoma are actually worse than those of resection for primary carcinoma.A. Ulcer-cancer: In Group I, 35 cases were operated on before 1933, and in 18 of these (51.4%) the patients have been free from symptoms for more than five years; in Group II, 27 cases were operated on before 1933, and in four of these (14.8%) the patients are still symptom-free. In Group III, out of 37 cases operated on, only two patients (5.4%) have been symptom-free for the same period.B. Primary cancer: Out of 260 cases of resection for primary cancer before 1933, 77 patients (29.6%) are permanently cured.If the ulcer-cancer is so far advanced that the diagnosis can be made clinically, or during operation, the prognosis is extremely bad (permanent cures having been only 9.3% in the series).In cases of gastric ulcer the best plan is to carry out resection before malignant degeneration begins. The result would then be that not merely 51% but at least 90% of the patients would be alive and well after five years.

Pseudo-Gastroduodenal Fistula

GASTRODUODENAL fistula as a complication of gastric ulcer is rare. Monroe (12), in 1927, in a summary of the literature on fistula as a complication of gastric ulcer, found ten cases and added one of his own. Of these only two, his own and that of Casellas (2), had been recognized by roentgenology. Low-Beer (8) refers to 12 cases, eight of which were on an ulcer basis, and adds one of his own. These 12 cases include six of those summarized by Monroe. Of the cases reviewed by Monroe and Low-Beer, five, those of Casellas, Monroe, Berg, Haudek, and Low-Beer, were recognized by roentgen examination. Melchart (10) reports two cases and points out that these, and some of those reported in the literature, although having a roentgen appearance of gastroduodenal fistula, are not true fistula, but are due to contraction of the lesser curvature drawing the pylorus upward and to the left. We have found reports of 11 cases, in addition to those mentioned by Monroe and Low-Beer, which have been recognized by roentgen e...

A Clinical Lecture on the Complications of Gastric Ulcer and their Treatment: Delivered at the Leeds General Infirmary

A Clinical Lecture on the Complications of Gastric Ulcer and their Treatment: Delivered at the Leeds General Infirmary