Gastroduodenal Ulcer Patients Research Articles

Risk factors for rebleeding in gastroduodenal ulcers.

Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870). Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.

Analysis on the effect of comprehensive nursing intervention on nutritional status and quality of life after perforation of gastroduodenal ulcer

Objective To analyze the effect of comprehensive nursing intervention on the nutritional status and quality of life after perforation of gastroduodenal ulcer. Methods A total of 97 patients with gastroduodenal ulcer treated in this hospital from December 2015 to December 2016 were selected as research subjects.According to the random number table method, they were divided into the intervention group with 49 cases and control group with 48 cases.The patients of the control group was given routine care.On the basis of routine nursing, the intervention group was given comprehensive nursing intervention.The nutritional status and quality of life of the two groups were analyzed and compared. Results After nursing intervention, the contents of transferrin and serum albumin in the intervention group were significantly higher than those in the control group, and the differences were statistically significant(P 0.05). After nursing intervention, the score of quality of life in the intervention group was significantly better than that of the control group, and the difference was statistically significant(P<0.05). After the intervention, the complication rate of the intervention group was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). The 1-year recovery rate of the intervention group was significantly higher than that of the control group(P<0.05). The length of stay in the intervention group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.05). The satisfaction degree of patients in the intervention group was significantly higher than that of the control group, and the difference was statistically significant(P<0.05). Conclusions Comprehensive nursing intervention after perforation of ulcer in gastroduodenal ulcer patients can improve the nutritional status, improve the quality of life and reduce the occurrence of postoperative complications.Comprehensive nursing intervention can promote the early recovery of patients, and the postoperative recovery rate is high, thus improving the patients' satisfaction with the nursing service.It is worthy of clinic application. Key words: Gastroduodenal ulcer; Perforation of ulcer; Comprehensive nursing intervention; Nutritional status; Quality of life

Association of TLR-9 polymorphisms with the development of gastroduodenal ulcer: A hospital-based study in a Chinese cohort

Helicobacter pylori infections have been one of the major factors associated with gastroduodenal ulcer. Toll-like receptors (TLRs) of human recognize mycobacterium-induced immune response and protect subjects from disease pathogenesis. Variants in TLR genes are believed to influence immune responses to H. pylori and clinical severity. TLR-9 polymorphisms have been associated with susceptibility to gastroduodenal ulcer in different populations. In this study, we investigate the role of common TLR-9 variants in susceptibility/resistance to the development of gastroduodenal ulcer in a Chinese cohort. The present hospital-based case–control study enrolled 580 patients with abdominal discomfort, and based on endoscopic investigation, the patients were categorized into (1) gastric ulcer (n = 154), (2) duodenal ulcer (n = 70), (3) gastric and duodenal ulcers (n = 25), (4) gastritis (n = 195), and (5) healthy stomach (n = 136). A total of 520 healthy controls from similar geographical areas were enrolled as controls. TLR-9 (C-1237T, C-1486T, and G+2848A) polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β in both healthy controls and patients were quantified by enzyme-linked immunosorbent assay (ELISA). Furthermore, messenger RNA (mRNA) expressions of TNF-α, IL-6, and IL-1β in biopsy tissues were quantified by real-time polymerase chain reaction (RT-PCR). The prevalence of TLR-9+2848 heterozygotes (CT) was significantly higher in gastroduodenal ulcer patients compared to healthy controls. Sub-categorization of patients revealed higher prevalence of heterozygotes of TLR-9 C+2848T and C-1486T polymorphisms in patients with gastric ulcer (GU), duodenal ulcer (DU), and those with both gastric and duodenal ulcers (GDU) when compared to controls. Patients displayed higher plasma cytokine levels than healthy controls. TLR-9 polymorphisms (C+2848T and C-1486T) correlated with altered cytokine expression in biopsy tissues and their plasma levels. In conclusion, TLR-9 (C+2848T and C-1486T) polymorphisms are associated with gastroduodenal ulcer and correlated with altered cytokine levels.

Gastrointestinal bleeding associated with antithrombotic therapy in the elderly in Japan.

We summarize data of patients with gastrointestinal bleeding (GIB) and discuss the relationship between antithrombotic drug use and age in patients with GIB. One-hundred and twenty patients with GIB were divided into two groups according to age (=75 years old and <75 years old). The causes and clinical outcome of each group were compared. Forty-two patients received antithrombotic therapy. The main antithrombotic drugs were low dose aspirin (38 patients), ticlopidine (5 patients) and warfarin (3 patients). Compared with younger GIB patients, elderly patients had more coexisting illness and antithrombotic drugs. In patients taking antithrombotic drugs, upper GIB is more frequent than those not taking antithrombotic drugs (p<0.05) and antithrombotic drugs were the risk for GIB from erosive lesions of the esophagus or stomach. In the lower gastrointestinal tract, there was no difference of incidence related to antithrombotic use. The initial endoscopic hemostasis was performed in 14 patients. Eight varices patients received endoscopic vanding and 6 of 43 gastroduodenal ulcer patients had mechanical clip hemostasis. From our findings, antithrombotic drugs were considered to be a risk for GIB. It might be important to prevent or minimize GIB in elderly patients prescribed antithrombotic drugs.

Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro‐duodenal ulcer diseases in Taiwan

The prevalence of Helicobacter pylori-negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro-duodenal ulcer (GDU) diseases in Taiwan. All patients with an endoscopic diagnosis of DU or GDU from September 2003 to May 2004 at Taipei Veterans General Hospital were included. Rapid urease test was done for all patients, while urea breath test was carried out on those with negative rapid urease tests. A patient was considered infected if either test was positive. The prevalence of H. pylori was 88.7% (555/626) in DU and 90.5% (95/105) in GDU patients. There was no difference in sex and prevalence of H. pylori between the two groups but age was higher in the GDU patients (60.1 +/- 15.5 vs. 55.4 +/- 15.5, P = 0.005). Of H. pylori-negative DU patients, 28.2% (20/71) reported using non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin, which were used by all 10 H. pylori-negative GDU patients (100%) (P < 0.001). There was no difference in sex and age between H. pylori-positive and negative DU patients. The prevalence rate of H. pylori in DU was not statistically different among outpatients, inpatients, and physical check-up subjects (86.8% vs. 93.3% vs. 90.7%, P = 0.163). The prevalence of H. pylori infection in DU appears to be decreasing in Taiwan. Thus, eradication therapy without confirming the presence of H. pylori in DU patients cannot be recommended. NSAIDs/aspirin is the major risk factor for H. pylori-negative DU patients, especially those with co-morbid gastric ulcer.

Clinical Features of Gastroduodenal Ulcer in Japanese Patients Taking Low-Dose Aspirin

The risks of peptic ulcer complications increase in association with low-dose aspirin (LDA) use. The endoscopic findings and clinical features of gastroduodenal ulcer have not been thoroughly investigated in patients taking LDA. We classified 1,041 gastroduodenal ulcer patients into three groups [patients taking LDA (group A), patients taking nonaspirin nonsteroidal anti-inflammatory drug (NSAID) (group N), and patients taking neither aspirin nor nonaspirin NSAID (group C)] and 241 bleeding gastroduodenal ulcer patients into three corresponding groups (groups a, n, and c). We investigated the clinical features, endoscopic characteristics, and endoscopic treatment of the hemorrhagic lesion in the gastroduodenal ulcer patients taking LDA and compared them with those of the other groups. The frequency of bleeding events such as hematemesis, melena, and anemia was significantly higher in group A and N than in group C. The percentage of ulcers located in the antrum was higher in group A and N than in group C, and also higher in group a and n than in group c. The percentage of ulcers located in the body, fundus, and cardia was significantly higher in the bleeding patients than in all gastroduodenal ulcer patients. The percentage of cases that required additional endoscopic treatment in group a was higher than in group c. Duration of hospitalization of group a was significantly longer than that of group c. These results indicate that it is very important to prevent LDA-induced gastroduodenal ulcer complications, including bleeding.

Helicobacter pylori , Non-steroidal Anti-inflammatory Drugs and Smoking in Risk Pattern of Gastroduodenal Ulcers

Background: Helicobacter pylori , NSAID and cigarette smoking are major risk factors for gastroduodenal ulcers. However, the results of studies on the interaction between these factors on ulcerogenesis are controversial. This study was designed to examine the association between gastroduodenal ulcers and H. pylori infection, NSAID use, smoking and age. Methods: 5967 dyspeptic patients underwent 13 C-urea breath test (UBT) and upper endoscopy, while age and dyspeptic symptoms were reported. Results: Out of 5967 patients, 31.8% were ulcerated; 9.2% had gastric, 17.2% duodenal and 5.4% both gastric and duodenal ulcers. H. pylori was found in 72.5% of gastric ulcer patients, in 83.6% of duodenal ulcer patients, in 76.9% of gastroduodenal ulcer patients and in 64.8% of dyspeptic patients. The gastric, duodenal and gastroduodenal ulcers were related to H. pylori significantly and the respective ORs were: 1.44, 2.77 and 1.81. NSAID alone was used by 6.2%-12.7% of ulcer patients, tending to raise only the risk of gastric ulcer but reducing that of duodenal and gastroduodenal ulcers. The H. pylori prevalence was significantly higher in smokers (76%) than in non-smokers (67%) and the ulcer risk was also significantly higher in smokers than in non-smokers. About 20% of ulcers were 'idiopathic', i.e. without NSAID and H. pylori and the ratio of these ulcers to all ulcers significantly increased during the 5 years of the study. Conclusions: Based on multivariable logistic regression analysis we conclude that: 1) H. pylori infection, NSAID use, smoking and age play major roles in the pathogenesis of peptic ulcerations; 2) there is a negative interaction between H. pylori and NSAID on duodenal ulcers, suggesting that H. pylori reduces the development of these ulcers in NSAID users, and 3) about 20% of peptic ulcers in the Polish population are unrelated to H. pylori and NSAID use (idiopathic ulcers).

Enhanced mucosal fibrinolytic activity in gastroduodenal ulcer haemorrhage and the beneficial effect of acid suppression.

The high mortality rate in patients with upper gastrointestinal bleeding appears to be particularly related to re-bleeding. The haemostatic mechanisms that may influence the re-bleeding of ulcers are largely unknown. We studied and analysed fibrinolytic activity in bleeding ulcer patients and the effect of acid suppression on this activity. Fibrinolytic activity was analysed in mucosal biopsies from 29 bleeding gastroduodenal ulcer patients and six controls. We analysed levels of D-Dimer, fibrin plate lysis area, plasminogen activator activity, plasminogen activator inhibitor activity, and plasmin antiplasmin complexes. Significantly more fibrinolytic activity was detected in biopsies from patients with bleeding ulcers compared to controls. Moreover, in patients with endoscopic stigmata of recent haemorrhage, mucosal fibrinolytic activity was higher compared to patients without stigmata of recent haemorrhage. In mucosal biopsies of patients that had used acid suppression before admission, a decreased fibrinolytic activity was found compared to patients without such therapy. This effect of acid suppression on fibrinolytic activity was confirmed in nine patients before and after a 24-h ranitidine infusion. Fibrinolytic activity is enhanced in patients with bleeding gastroduodenal ulcers. Acid suppressive therapy decreases this increased activity, which may be one of the mechanisms explaining the potential beneficial effect of this therapy.

Amino acid in gastric juice of peptic ulcer patients.

To clarify the protein metabolism in peptic ulcer disease, the amino acid content was determined in gastric juice of gastric ulcer patients (n = 30), duodenal ulcer patients (n = 16), gastroduodenal ulcer patients (n = 8), and hospital controls (n = 8). The amino acid output in the gastric ulcer group was greater than that of the hospital control both in basal and maximal secretion. In the duodenal ulcer group of patients who were high secretors of gastric juice, the amino acid concentration was low, so the amino acid output was also lower than that of the hospital control group. Tetragastrin did not increase the amino acid output in the gastric juice. The amino acid amount may be decided also by the architecture of the gastric mucosa and not only by the ulcer lesion itself. The protein loss from gastric mucosa may well result in hypoproteinemia in peptic ulcer disease of the stomach.

Experimental studies on the fatty acid metabolism in the host bearing tumor

Plasma fatty acid fraction and lipoprotein fraction of patients with stomach cancer were determined respectively by means of gaschromatography and paperelectrophoresis as compared with non cancer patient in order to investigatethe changes of fatty acid coposition in the host bearing tumor. The results obtained were as follows: Decreasing of the linoleic acid and increasing of the oleic acid were mostly observed as characteristic changes of fatty acid in the patient of stomach cancer group. These tendencies were not observed in the case of gastroduodenal ulcer patients. Low levels α-lipoprotein based on hypoproteinamia accompanied with decreasing of albumin were mostly observed in stomach cancer patients. No relations were found between variations of plasma fatty acid fraction and those of the removed specimens which were classified according to Borrmanns and histological classification.

Comparative Value of "Gastric Mucin" and "Alkalies" in Prevention of "Peptic" Ulcer in Biliary Fistula Dogs

Fogelson and Atkinson have observed clinically that the administration of “gastric mucin” to gastro-duodenal ulcer patients was followed by a relief of the ulcer symptoms and an increase of body weight. Kim and Ivy found that one ounce of “gastric mucin” a day prevented the occurrence of duodenal ulcer in biliary fistula dogs, in which the incidence of duodenal ulcer is from 40% to 60%, and that the animals on “gastric mucin” maintained their body weight much better than the control dogs not receiving mucin. It is well known that the administration of alkaline powders is of benefit in the management of patients with gastro-duodenal ulcer. We desired to ascertain if the administration of alkaline powders would have the same effect as “gastric mucin” in preventing the occurrence of duodenal ulcers and in maintaining body weight in biliary fistula dogs. Ten healthy dogs were used in each series. The biliary fistula was made according to the method of Rous and McMaster. All the animals were kept in single cages and were fed a stock diet of cooked yellow corn meal, bone soup and bread with mucin or alkali twice a day. The dose of “mucin” was 15 gm. with each meal. The dose of alkaline powder consisted of 1 gm. each of sodium bicarbonate and calcium carbonate with each meal. This dose of alkali was used because it has a slightly greater “buffering action” than 15 gm. of the “mucin” used in these experiments. All of the animals showed an absence of bile in the feces during life and in the stomach and duodenal contents immediately after being sacrificed. They secreted daily from 5 to 15 cc. of bile per kilo body weight, which is “normal” for biliary fistula dogs.