Gastric Ulcer Disease Research Articles

Phenyl lactic acid alleviates Helicobacter pylori infection in C57BL/6 mice.

Helicobacter pylori is a gastric pathogen that colonizes approximately 50% of the world's population. Infection with H. pylori causes chronic inflammation and significantly increases the risk of developing duodenal and gastric ulcer disease and gastric cancer. In the present study, we found that phenyl lactic acid (PLA) derived from Lactobacillus plantarum ZJ316 (L. plantarum ZJ316) can directly inhibit the growth and urease activity of H. pylori in vitro with a minimum inhibitory concentration (MIC) of 2.5 mg mL-1. Moreover, PLA also caused a dramatic morphological transformation from a spiral to a coccoid form in H. pylori. In this work, we also analyzed the beneficial effects of PLA in mice. The results showed that PLA administration ameliorated H. pylori-induced gastric mucosal damage and significantly decreased lymphocyte infiltration and inflammatory cytokines, including interleukin-1β (IL-1β), interleukin 6 (IL-6), and interferon-γ (IFN-γ) by 59.93%, 63.95%, and 48.05%, respectively, but elevated the interleukin-10 (IL-10) and glutathione (GSH) levels. Furthermore, PLA administration improved microbiota diversity with increased Bacteroidetes abundance and decreased Proteobacteria abundance by 46.39% and 24.05%, respectively. PLA also significantly reduced the abundance of H. pylori but increased the relative abundances of potential beneficial bacteria, such as Faecalibacterium, Bifidobacterium, and Lactobacillus. These results demonstrated that PLA can ameliorate H. pylori-induced inflammation and support beneficial gut bacteria, providing a new perspective against H. pylori infection.

Efficacy of emotion regulation training on pain intensity and life quality in patients with peptic ulcer disease (PUD).

Because gastric ulcer is a psychosomatic disease involving many psychological factors like assertiveness and cognitive beliefs, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease. Gastric ulcer, a recurrent and common disease worldwide, is associated with gastrointestinal symptoms and lower health-related quality of life. Psychological factors and stress have been recognized as important contributors to the onset and duration of gastric ulcer, highlighting the need for effective psychological interventions to improve pain intensity and quality of life in patients. The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants selected by a Purposive Sampling method and placed randomly in the experimental and control groups. At first, simultaneously, and under the same conditions, all the participants responded to the Chronic Pain Grade Questionnaire (CPG) and Quality of Life Questionnaire (SF-12). The emotion regulation training was performed on the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after three months. To analyze data, the ANCOVA test was applied through SPSS 22. Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01), but after three months interval, no significant changes were found in the results. Due to the results about emotion regulation training protocol that has successfully reduced pain intensity symptoms in PUD patients and increased life quality, it is suggested that this protocol can be added to other treatments for PUD patients.

Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores.

Nonvariceal upper gastrointestinal bleeding (UGB) has important morbidity and mortality. Predicting high-risk patients for mortality and rebleeding is necessary for a treatment plan. In the present study, we aimed to define the epidemiological and etiological characteristics of patients presenting with nonvariceal UGB and to observe mortality and morbidity rates. We also aimed to compare Rockall and Glasgow-Blatchford scoring systems in predicting rebleeding and mortality. Subjects presenting with nonvariceal UGB over a 3-year period were included. Demographic characteristics, symptoms, and signs on physical examination, laboratory data, endoscopic signs and diagnosis, interventions during hospitalization and follow-up period were recorded. Glasgow-Blatchford and Rockall scores were calculated for every participant at the first day of the admission. A total of 709 patients were enrolled in the study. A total of 490 of them (69.1%) were men. The mean age of the women and men was 60.7±1.2 and 58.6± 0.7 years, respectively. Melena was the most common presenting symptom. Duodenal ulcer (31%), gastric ulcer (20.7%), and erosive disease (17.6%) were the most common causes of bleeding. History of use of aspirin and/or nonsteroidal anti-inflammatory drug use were present in 63.7% of the subjects. All patients were followed up for 30th-day mortality. Overall, rebleeding and mortality rates were 11% and 7%, respectively. A Rockall score greater than 6 was the most important predictor of mortality (odds ratio:39.1) and rebleeding (odds ratio:4.7). Nonvariceal UGB patients with a Rockall score greater than 6 should undergo aggressive endoscopic treatment and inpatient care.

The role of cell adhesion molecules in the inflammatory process and development of gastric and duodenal peptic ulcer disease, their molecular genetic determinants

With gastric and duodenal peptic ulcer disease, a chronic inflammatory process develops, in which cell adhesion molecules are actively involved. Currently, as a result of genome-wide association studies (GWAS), more than 20 polymorphic variants involved in determining their level have been identified, including rs505922 of the ABO gene. At the same time, this polymorphic variant, according to GWAS, is associated with an increased risk of developing peptic ulcer disease (PUD). It should also be noted that the association of the O(I) blood group according to the ABO system with an increased risk of developing PUD has long been known. Therefore, the genetic determinants of cell adhesion molecules are of interest for studying as candidate genes for peptic ulcer disease.

Assessment of Gastric Acid Anti-Secretory Effects of Fraction Extracts of Piper guineense Leaf on Histamine-Induced Gastric Ulcer in Wistar Rats

Despite many etiological factors, gastric acid secretion is assumed to play a central role in the development of gastric ulcer. Blockade of gastric acid secretion therefore, seems to be the key therapeutic objective of gastric ulcer disease. Available acid-blocking/anti-secretory drugs used in the management of gastric ulcer are associated with high cost, unwanted side effects and treatment relapse. Extracts from plants can be useful and may serve as an alternative to conventional drugs in gastric ulcer management. This work was aimed at assessing the gastric acid anti-secretory effects of fractionated ethanol extract of Piper guineense leaf on histamine-induced ulcer in Wistar rats. This was conducted by administering orally, 400mg/kg of fraction extracts obtained by fractionation of ethanol-extracted residue, to fifty six adult Wistar rats randomized into eight groups (n=7) of animals followed by induction of ulcer with 40mg/kg histamine, orally. The effects of the plant extracts on histamine-induced ulcer, gastric pH and gastric volume were ascertained. From the results, all the extracts significantly (p&lt;0.05) produced ulcer inhibition, increased gastric pH and reduced gastric volume. This study concludes that extracts of Piper guineense leaf possess antiulcer effects, which may occur via histamine-2-receptor blockade and/or anti-secretory mediated activities. Keywords: Gastric acid, Fraction extracts, Histamine, Anti­secretory, Piper guineense

Strongly increased risk of gastric and duodenal ulcers among new users of low-dose aspirin: results from two large cohorts with new-user design.

Low-dose aspirin is a risk factor for peptic ulcer disease but previous, population-based cohort studies may have underestimated the low-dose aspirin risk because they did not use a new-user design. Gastrointestinal bleeding occurs more frequently early after initiation of low-dose aspirin therapy than in later years. To assess the associations of low-dose aspirin with gastric and duodenal ulcer incidence in prevalent- and new-user design. Multivariate Cox regression models in the German ESTHER study (N=7737) and the UK Biobank (N=213,598) with more than 10 years of follow-up. In the prevalent-user design, there was no significant association between low-dose aspirin and gastric ulcer observed in both cohorts. Furthermore, low-dose aspirin was weakly, statistically significantly associated with prevalent duodenal ulcer in the UK Biobank (hazard ratio [95% confidence interval]: 1.27 [1.07-1.51]) but not in the ESTHER study (1.33 [0.54-3.29]). When restricting the exposure to only new users, the hazard ratios for incident gastric and duodenal ulcer disease were 1.82 [1.58-2.11] and 1.66 [1.36-2.04] in the UK Biobank, respectively, and 2.83 [1.40-5.71] and 3.89 [1.46-10.42] in the ESTHER study, respectively. This study shows that low-dose aspirin is an independent risk factor for both gastric and duodenal ulcers. The associations were not significant or weak in the prevalent-user design and strong and statistically significant in the new-user design in both cohorts. Thus, it is important to weigh risks against benefits when low-dose aspirin treatment shall be initiated and to monitor adverse gastrointestinal symptoms after the start of low-dose aspirin therapy.

Assessment of gastric caused by Helicobacter pylori and pathologic elements correlation with -511 IL1-β and -308 TNF-α polymorphisms in gastritis patients

Helicobacter pylori (H.pylori) is the main reason for gastric disorders including gastric lymphoma, ulcer disease, gastric carcinoma (GC), and chronic atrophic gastritis. H.pylori has two more significant virulence factors named cagA and vacA. Some host cytokines polymorphisms (Interleukin (IL-1) and tumor necrosis factor (TNF-α)) may contribute to H. pylori-related diseases. In the present study, we investigated the association of H. pylori gastritis and its pathogenic genes as well as the association of IL-1β and TNF-α polymorphisms in patients with gastritis. We collected gastric biopsy samples from patients with gastritis. After extracting DNA from biopsy specimens infected with H. pylori, cagA + and vacA + were detected by the polymerase chain reaction (PCR). To genotyping TNF-α polymorphism at position −308 and IL-1β polymorphism at position −511, PCR-based restriction fragment length polymorphism analysis was performed. Our study indicated that IL-1β-511 polymorphism, unlike TNF-α-308 polymorphism (P = 0.030), did not show a significant relationship between patients infected with H. pylori (p = 0.219). Also, our results indicated that alleles C and T of polymorphism of IL-1β-511 and alleles G of TNFα-308 were not significantly correlated with cagA status among patients infected with H. pylori (p = 0.793, p = 0.674, p = 0.179, respectively) unlike allele A of TNFα −308 (p = 0.016).

In Silico Investigation of Gastroprotective Compounds from n‐Butanol Fraction of Costus igneus on Antiulcer Druggable Targets

Gastric ulcer is a common gastrointestinal tract disorder characterized by discontinuation in the stomach mucosal lining and forming a painful lesion. Costus igneus is an ethnobotanical plant used in the management of gastrointestinal disturbances. This study characterized the gastroprotective bioactive compounds from n‐butanol fraction of C. igneus leaf (CIBF) and investigated their druggability effects on selected antiulcer targets using in silico approach.CIBF compounds were identified and characterized using gas chromatography‐mass spectrometry (GC‐MS) method. The 3D structures of CIBF compounds were downloaded in SDF format from Pubchem National Library of Medicine compound database and used as ligands to dock H+K+ATPase receptor (PDB ID: 5YLV), muscarinic receptor (PDB ID: 5ZHP), urease (PDB ID: 6ZJA) and histamine receptor (using Beta‐1‐adrenergic receptor [PDB ID: 2YCW] as a template). The 3D structures of the proteins were downloaded from the Protein Data Bank. Omeprazole, cimetidine and vonoprazan were used as reference drugs. The ligands and target proteins were processed and prepared for docking in pdb formats by using Chimera 1.14 and OpenBabel GUI version 2.3.2a, respectively. Multi‐targeted molecular docking was done using PyRx – Python Prescription 0.8. Physicochemical and pharmacokinetic properties were analyzed using Osiris DataWarrior version 5.5.0. Bioavailability and drug‐likeness analyses were done using the SwissADME web tool.GC‐MS analysis detected 15 suspected bioactive compounds in CIBF. Molecular docking study showed that 10‐11, (6ʹ,7ʹ) naphthoquinono [3.2] paracyclophane (NQP) had the highest ligand binding affinity for H+K+ATPase, muscarinic receptor, urease and histamine receptor when compared with the others 14 compounds, omeprazole, cimetidine and vonoprazan. Physicochemical properties of NQP did not violate the Lipinski, verber and lead likeness rules. Pharmacokinetic predictive analysis indicated that NQP possesses good oral bioavailability, high gastrointestinal absorption, blood‐brain barrier permeability and no inhibitory effect on cytochrome P450s.Findings from this study showed that NQP exhibited substantial inhibitory effects on proton pump, urease activity, muscarinic and histamine receptors. It also showed good physicochemical and pharmacokinetic properties. It is recommended that n‐butanol fraction of C. igneusleaves should be further explored as a potential source of drug lead candidate for the management of gastric ulcer disease.

The Relationship of MMP-3 Levels with the Degree of Helicobacter Pylori Gastritis

Gastritis is an inflammation in the stomach tissue that can occur either acutely or gradually as a chronic condition. Incidence of gastritis in Indonesia is high, which is 274,396 cases out of 238,452,952 inhabitants. One of the most common causes of gastritis is Helicobacter pylori (H. pylori). Matrix metalloproteinase (MMP) is a dependent proteinase that is able to break down almost all extracellular matrix proteins. It is known from several studies that MMP is closely related to gastric ulcer disease and cancer. At present, in vivo and in vitro studies have established the activation of several MMPs associated with H. Pylori infection. There were 80 samples obtained through consecutive sampling in March-June 2019. Gastritis was ensured by endoscopy (Olympus, Tokyo, Japan). H.pylori is established through a change in color from yellow to red, magenta, pink, or orange in the examination of Campylobacter Like Organism test (CLO). MMP-3 level examination using a serum MMP3 was measured using RayBio Human MMP-3 and MICA ELISA kits (Norcross, GA). Data were collected and analyzed using SPSS version 22. There was a significant relationship between MMP-3 levels and the severity of H. pylori gastritis, namely between the degree of neutrophil infiltration (p = 0.016), atrophy (p = 0.001), and intestinal metaplasia (p &lt;0.001). Keywords: Gastritis, Helicobacter Pylori, MMP-3.

Changes in Oxidative Status Biomarkers in Saliva and Serum in the Equine Gastric Ulcer Syndrome and Colic of Intestinal Aetiology: A Pilot Study.

Simple SummaryGastric ulcers and colic of intestinal aetiology (CIE) are highly prevalent diseases in domestic horses, with a negative impact on equine sport and breeding life. Therefore, the studies investigating possible biomarkers for their diagnosis or clarifying their pathophysiology are of high interest. Oxidative status changes have been reported in both diseases, but only in the blood. However, saliva may be a relevant source of oxidative status biomarkers not yet assessed in horses with interesting advantages, owing to its non-invasive collection. Hence, this study aimed to validate in both saliva and serum automated assays for the measurement of oxidative status biomarkers and assess them in horses suffering gastric ulcer diseases (squamous and/or glandular) and CIE, studying their possible relationship with their inflammatory and immunity status. It was found that horses with glandular mucosa ulcers showed higher levels of some antioxidant and oxidative biomarkers in saliva correlating with a marker of the immune system such as salivary adenosine deaminase. Horses suffering from CIE had increases in serum uric acid associated with their systemic inflammatory response and outcome of the disease. In conclusion, some oxidative status analytes can be automatically measured in horses’ saliva and serum and may potentially be assessed as biomarkers of gastric ulcers and CIE.Changes in the oxidative status of the blood of horses suffering from gastric ulcers and colic of intestinal aetiology (CIE) have been reported. However, saliva can also be a source of biomarkers of oxidative status. Therefore, this study aims to validate automated assays for the measurement of oxidative status biomarkers (ferric reducing ability of saliva/serum—FRAS/FRAP, cupric reducing antioxidant capacity—CUPRAC, the Trolox equivalent antioxidant capacity—TEAC, uric acid, and advanced oxidation protein products—AOPP) in the saliva and serum of horses, to assess their changes in the different ulcer gastric diseases (squamous—ESGD and glandular—EGGD) and CIE, and to evaluate their relationship with serum amyloid A (SAA), adenosine deaminase (ADA), and the systemic inflammatory response syndrome (SIRS) status. The assays showed a low imprecision and good linearity with enough sensitivity in both fluids. In EGGD, higher levels of FRAS, uric acid, and AOPP in saliva were observed compared to the healthy group, correlating with the salivary ADA levels. Horses with CIE showed increases in uric acid concentrations in serum associated with their SIRS status and outcome of the disease. In conclusion, analytes related to the oxidative status can be measured in the saliva and serum from horses by automated assays, and some of them can potentially be assessed as biomarkers in horses with gastric ulcers and CIE.

PREVALENCE OF HELICOBACTER PYLORI IN PATIENTS OF GASTRIC CARCINOMA

INTRODUCTION : H. pylori is a gastric pathogen that colonizes approximately 50%-60% of the world's population. Infection with H. pylori causes chronic inflammation and significantly increases the risk of developing duodenal, gastric ulcer disease and gastric carcinoma. This study is undertaken to determine the clinical and pathological profile of gastric carcinoma in our institute and to find out the prevalence of H. pylori infection in gastric carcinoma patients. MATERIALS AND METHODS :We conducted our study in the Department of Surgery, Dr. B. R. A. M. Hospital, Raipur, C.G. over a period of 18 months. It was a hospital based, cross-sectional observational study. During upper GI endoscopy, site of the lesion and macroscopic type of the lesions were identified and recorded. Multiple tissue biopsy samples (&gt;10) were collected from non-necrosed region of cancer. One piece of each paired specimen were immediately subjected to RapidUrease Test dry kit (RUT) for detection of Helicobacter pylori. Further these biopsy specimens were subjected to modified giemsa staining and culture. RESULTS : Out of the 70 cases of gastric carcinoma, the prevalence of H.pylori was 64.28% . The most common age group associated with gastric carcinoma with H.pylori infection was more than 60 years. There was male predominance seen for both gastric carcinoma and gastric carcinoma positive for H.pylori infection. The most common lesion for gastric carcinoma and those positive for H.pylori was ulceroproliferative type. The most common site of stomach involved in cases of Gastric carcinoma associated with H.pylori infection was antrum+pylorus of stomach. The most common histological type of gastric carcinoma associated with H.pylori infection was poorly differentiated adenocarcinoma CONCLUSION : On the basis of our study it is evident that H.pylori is an independent risk factor for gastric carcinoma. .Infection with H. pylori causes chronic inflammation and significantly increases the risk of developing duodenal, gastric ulcer disease and gastric carcinoma.

Molecular detection of Helicobacter spp. and Fusobacterium gastrosuis in pigs and wild boars and its association with gastric histopathological alterations

Besides Helicobacter pylori, a Gram-negative bacterium that may cause gastric disorders in humans, non-Helicobacter pylori helicobacters (NHPH) may also colonize the stomach of humans and animals. In pigs, H. suis can induce gastritis and may play a role in gastric ulcer disease, possibly in association with Fusobacterium gastrosuis. In the present study, gastric samples from 71 slaughtered pigs and 14 hunted free range wild boars were tested for the presence of DNA of F. gastrosuis and gastric Helicobacter species associated with pigs, dogs cats and humans, using species-specific PCR assays, followed by sequencing of the amplicon. These gastric samples were also histopathologically evaluated. Almost all the pigs presented gastritis (95.8%). Helicobacter spp. were detected in 78.9% and F. gastrosuis in 35.2% of the animals. H. suis was the most frequently identified Helicobacter species (57.7% of the animals), followed by a H. pylori-like species (50.7%) and less often H. salomonis and H. felis (each in 2.8% of the animals). H. suis was most often detected in the glandular (distal) part of the stomach (pars oesophagea 9.9%, oxyntic mucosa 35.2%, antral mucosa 40.8%), while the H. pylori-like species was mainly found in the non-glandular (proximal) part of the stomach (pars oesophagea 39.4%, oxyntic mucosa 14.1%, antral mucosa 4.2%). The great majority of wild boars were also affected with gastritis (71.4%) and Helicobacter spp. and F. gastrosuis were detected in 64.3% and 42.9% of the animals, respectively. H. bizzozeronii and H. salomonis were the most frequently detected Helicobacter species, while a H. pylori-like species and H. suis were only occasionally identified. These findings suggest that these microorganisms can colonize the stomach of both porcine species and may be associated with gastric pathology. This should, however, be confirmed through bacterial isolation. This is the first description of the presence of F. gastrosuis DNA in the stomach of wild boars and a H. pylori-like species in the pars oesophagea of the porcine stomach.

Multi- Factor etiopathogenesis of gastric and duodenal peptic ulcer disease

Gastric and duodenal peptic ulcer disease is a multifactorial pathology, in the etiopathogenesis of which the general and local reactions of the body to external and internal risk factors play a role. Psychoemotional stress is the main cause of the pathology of nervous and humoral regulation (general reaction), and the local reaction is expressed in a violation of the ratio between the factors of aggression and protection factors in the mucous membrane of the stomach and / or duodenum. The combined action of these components leads to the formation of an ulcerative defect.

Propolis and Its Gastroprotective Effects on NSAID-Induced Gastric Ulcer Disease: A Systematic Review

Gastric ulcer disease induced by the consumption of NSAIDs is a major public health problem. The therapy used for its treatment causes adverse effects in the patient. Propolis is a natural product that has been used for the treatments of different diseases around the world. Nevertheless, there is little information about the activity of propolis in gastric ulcers caused by treatment with NSAIDs. Therefore, this review evaluates and compares the gastroprotective potential of propolis and its function against NSAID-induced gastric ulcers, for which a systematic search was carried out in the PubMed and ScienceDirect databases. The main criteria were articles that report the gastroprotective activity of propolis against the damage produced by NSAIDs in the gastric mucosa. Gastroprotection was related to the antioxidant, antisecretory, and cytoprotective effects, as well as the phenolic compounds present in the chemical composition of propolis. However, most of the studies used different doses of NSAIDs and propolis and evaluated different parameters. Propolis has proven to be a good alternative for the treatment of gastric ulcer disease. However, future studies should be carried out to identify the compounds responsible for these effects and to determine their potential use in people.

CORRELATION BETWEEN CANDIDIASIS AND MORTALITY IN GASTRIC ULCER PERFORATION PATIENTS

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Abstract OR-5: Helicobacter pylori Surface Structures

Background: Helicobacter pylori, which infects at least half of the human population, is an etiopathogenetic factor in the development of chronic gastritis (CG), gastric and duodenal ulcer disease (UD), and is also considered a risk factor in the occurrence of some forms of stomach cancer. Various surface structures of H. pylori are important pathogenic factors. Methods: Reference (NCTC 11637, NCTC 11639) and freshly isolated H. pylori strains as well as samples of the gastric mucosa were examined using transmission (TEM) and scanning electron microscopy (SEM) by means of “JEM-100 В” (JEOL, Japan) and “Quanta 200 3D” (FEI Company, USA) systems, respectively. Samples for SEM fixed with formalin and not subjected to dehydration were sprayed with an electrically conductive layer of gold. Samples for TEM were prepared using negative contrast (NC) with ammonium molybdate and ultrathin sections (US) contrasted by Reynolds; fixation by Ito-Karnovsky was used in both cases. Accelerating voltage at TEM and SEM was 80 and 10 kV, respectively. Results: Three types of H. pylori surface structures were found: flagella, fimbria, and vesicles. Flagella were found both in the material of cultures maintained in vitro and in each native sample of the gastric mucosa. SEM images suggest the involvement of flagella in biofilm formation. On longitudinal sections of the flagellum, the outer electron-dense layer and the inner content in the form of a filament were visualized; on cross sections, the flagellum looked like an annular structure with a centrally located point accumulation of electron-dense matter. Paradoxically, the H. pylori forms with a defective cell wall also possessed flagella. Freely located flagellar sheaths without central filament were often found in vitro only. Fimbriae were found exclusively in negatively contrasted pure bacterial cultures material. In addition, vesicles detaching from the surface of bacterial cells were found both in the material of aging H. pylori pure cultures and in native samples of the gastric mucosa under CG and UD. A small part of the vesicles retains their connection with the cell wall, while detached vesicles are present in excess in the surrounding space. Massive detachment of vesicles leads to the formation of spheroplasts, devoid of an outer membrane. Conclusion: H. pylori has a representative set of surface structures that play an important role in the onset and development of the infectious process in the gastroduodenal area.

Study of Endoscopic Findings in First Episode of Upper Gastrointestinal Bleeding

Background and Aims: Upper gastrointestinal bleeding (UGIB) is one of the most common and grave emergencies encountered in Emergency department in Tertiary health care centre in our country. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding. The aim of this study is to assess the endoscopic findings in patients presenting with first episode of UGIB.&#x0D; Methods: This was a hospital based cross sectional study of patients with haematemesis, melena or both who underwent UGI endoscopy at Bir Hospital during January 2019 to January 2020. Patient demographics, site and nature of lesions and risk factors for bleeding were analyzed.&#x0D; Results: Among 72 enrolled patients 48 (66.67 %) were male and 24 (33.3 %) were female. Haematemesis 27% was the most common presenting complain followed by melena 25.5% and fainting/ dizziness 22.5%. Endoscopy was done in all cases and gastric ulcer disease 27.8% was the commonest cause of first episode of UGI bleeding followed by variceal bleeding, gastric erosion and duodenal ulcer, 25%, 16.7%, 12.5% respectively.&#x0D; Conclusions: Peptic ulcer disease was the most common cause of first episode of UGI bleeding in our context. Among peptic ulcer diseases gastric ulcer was more common than duodenal ulcer. Haematemesis and melena were the commonest clinical presentation of UGI bleeding.

Accelerated Progression of Prediabetes to Insulin-Dependent Diabetes After 9 Cycles of Nivolumab

Abstract Introduction: Diabetes mellitus have been reported in around 1% of patients receiving immune checkpoint inhibitors (ICI) resultingin immune checkpoint inhibitor induced diabetes mellitus (ICI-DM). 4 phenotypes of ICI-DM exist: acute autoimmuneinsulin-dependent diabetes, decompensation of prediabetes or type 2 diabetes, autoimmune pancreatitis, andautoimmune lipoatrophy. Clinical Case: A 52-year-old man was diagnosed with stage IIIb malignant melanoma. Two months following local excision, he wasstarted on nivolumab every 4 weeks planned for 1 year. His past medical history was significant for prediabetes,hypertension, obesity (BMI 33.27 kg/m²), primary hypogonadism, adult attention deficit disorder, obstructive sleepapnea, gastric ulcer, and gastroesophageal reflux disease. He denied tobacco use but reported semi-daily use ofmarijuana and alcohol. His baseline HbA1c was 6.0%. After the 8th cycle of nivolumab, he reported several bloodglucose readings in the 200 mg/dL range. He was thought to have progressed to type 2 diabetes and metformin wasstarted. Glipizide was added shortly thereafter due to persistent hyperglycemia. At the 9th cycle of nivolumab, hisHbA1c was 8.2%. In 1 week from this time, the patient developed abdominal pain, nausea, and persistent vomiting. Hewas found to be in DKA with blood glucose of 278 mg/dL, bicarbonate of 9.3 mmol/L, anion gap of 21, and arterial pHof 7.22. He was treated in the ICU per standard DKA care. His C-peptide was 0.5 ng/mL (reference 0.8–3.5) withconcomitant plasma glucose of 229 mg/dL. Autoantibody screening was negative including glutamic aciddecarboxylase antibody (anti-GAD), insulin antibody, insulin antigen-2 (IA-2) autoantibody, and zinc transporter 8antibody. The patient was discharged home on multiple daily injections of insulin but he struggled with diabetes carewhich proved to be of brittle nature requiring CGM use. Two months after completion of nivolumab treatment, thepatient reported epigastric abdominal pain with frequent nausea and occasional vomiting of few weeks duration. He wasdiagnosed with subacute pancreatitis based on symptoms and elevated lipase. There was no evidence of gallstones. Although immunotherapy-related pancreatitis was considered, we decided to try alcohol cessation first hoping to avoidthe need to use prednisone. Over several weeks, lipase normalized and his symptoms completely resolved. Conclusion: In this case, nivolumab resulted in progressive beta-cell failure and complete insulin dependence in a person with ahistory of prediabetes. Not all pancreatitis cases in the settings of immunotherapy use are immune-related adverseevents (irAE). Usual causes, e.g. alcohol, should still be considered. With cessation of alcohol, pancreatitis fullyresolved leading to avoidance of prednisone which would likely have worsened diabetes management in this patientwith brittle diabetes.