Gastroduodenal Ulcers Research Articles

Risk models for VTE and bleeding in medical inpatients: systematic identification and expert assessment

AbstractRisk assessment models (RAMs) for venous thromboembolism (VTE) and bleeding in hospitalized medical patients inform appropriate use of thromboprophylaxis. Our aim was to use a novel approach for selecting risk factors for VTE and bleeding to be included in RAMs. First, we used the results of a systematic review of all candidate factors. Second, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence for the identified factors. Third, we using a structured approach to select factors to develop the RAMs, by building on clinical and methodological expertise. The expert panel made judgments on whether to include, potentially include, or exclude risk factors, according to domains of the GRADE approach and the Delphi method. The VTE RAM included age >60 years, previous VTE, acute infections, immobility, acute paresis, active malignancy, critical illness, and known thrombophilia. The bleeding RAM included age ≥65 years, renal failure, thrombocytopenia, active gastroduodenal ulcers, hepatic disease, recent bleeding, and critical illness. We identified acute infection as a factor that was not considered in widely used RAMs. Also, we identified factors that require further research to confirm or refute their importance in a VTE RAM (eg, D-dimer). We excluded autoimmune disease which is included in the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding RAM. Our results also suggest that sex, malignancy, and use of central venous catheters (factors in the IMPROVE bleeding RAM) require further research. In conclusion, our study presents a novel approach to systematically identifying and assessing risk factors to be included or further explored during RAM development.

Combined Use of Biologically Active Hemostatic and Granulated Sorbent in Endoscopic Cytoprotective Hemostasis in Patients with Bleeding Gastroduodenal Ulcers

Combined Use of Biologically Active Hemostatic and Granulated Sorbent in Endoscopic Cytoprotective Hemostasis in Patients with Bleeding Gastroduodenal Ulcers

Is intra-arterial hepatic chemotherapy painful?

Liver metastases are mainly supplied by the hepatic artery, allowing the administration of intra-arterial hepatic chemotherapy (IAHC) while preserving normal parenchyma. The progression-free survival and response rate are prolonged by IAHC which can improve the rate of secondary resectability. Severe abdominal pain requiring high-dose opioids can appear during HIAC administration. This pain is related to extrahepatic infusion and gastroduodenal ulceration. However, intense abdominal pain was observed under oxaliplatin IAHC specifically without any extrahepatic infusion. We retrospectively reviewed the charts of 68 patients who received IAHC in our center between 2011 and 2015. Patient's demographics and disease characteristics were collected. Other variables such as the type, duration, and dosage of the chemotherapy administered, as well as the usage of painkillers before, during, or after intra-arterial administration, were also registered. The mean age of the patients was 59years. 61.7% were male (n = 42). The mean dose of oxaliplatin administered was 162mg per cure over 6.7-h course. Fifty percent were diagnosed with a left colon cancer, and 85.2% had synchronous liver metastasis. While 47% of patients received IAHC as a third-line therapy, the main chemotherapeutic drug was oxaliplatin (85.2% of cases; n = 58), then OPTILIV protocol (5FU, irinotecan, oxaliplatin) (13.3%; n = 9), and mitomycin C (1.5%; n = 1). A dose reduction of 23.6% had been noted in 58.8% (n = 40) cases due to adverse effects. Among patients who received opioids during IAHC (n = 40), 20% required opioids in intercure. Before, during, and after IAHC administration, patients complained of abdominal pain in 8.8%, 58.8%, and 19.1%, and opioids were used in 10.2%, 57.3%, and 19.1%, respectively. The main onset of pain occurs during the third cycle of chemotherapy. Among our patients, 11.7% and 22% had ulcer and extrahepatic perfusion, respectively, while 7.3% of them were asymptomatic. The mean occurrence of these signs was during the fourth cycle of IAHC. 33.8% and 52.9% of patients had abdominal pain while an extended and short infusion time, respectively. Lengthening of the infusion time did not prevent the occurrence of abdominal pain significantly but was nonetheless decreased compared with patients undergoing short infusion durations. Pain was more common in patients who did not have a dose reduction and who presented with ulcer and extrahepatic perfusion. Abdominal pain occurred on average one cycle before ulcer or extrahepatic perfusion diagnosis. In current practice, pain should be an alarming indicator in patients receiving IAHC, as it may be associated with ulcer or extrahepatic perfusion and thus requiring opioids.

962 AN NON-INFERIORITY RANDOMIZED CONTROLLED TRIAL TO COMPARE HEMOSTATIC POWDER TC325 AND STANDARD THERAPY IN BLEEDING FROM NON-VARICEAL UPPER GASTROINTESTINAL CAUSES

Observational studies suggest that endoscopic application of TC-325, a hemostatic powder can control active bleeding from non-variceal upper gastrointestinal causes. TC-325, as a monotherapy, has not been compared to standard treatment in a randomized controlled trial with adequate sample size. In this multicenter non-inferiority randomized controlled trial, we assigned patients actively bleeding from a non-variceal cause during esophago-gastro-duodenoscopy to receive either spraying with TC-325 or standard treatment. They were followed up for 30 days for further bleeding. A total of 224 patients were randomized (TC-325 N=111, standard treatment N=113). These include 130 gastroduodenal ulcers (58%), 32 tumors (14.3%) and 62 other causes (27.7%). With intention-to-treat analysis, the re-bleeding free probability over 30 days was 89.8% in the TC-325 group and 81.1% in the standard treatment group (difference in proportions, 95%CI; 8.7%, -1.3%, 18,7%). There were fewer failures in the control of bleeding during index endoscopy with the use of TC-325 (3 vs. 11, OR, 95%CI, 3.88, 1.05-14.32). Recurrent bleeding was similar between groups (9 vs. 10). There were 14 deaths to each group (P=0.96). Further interventions were similar (endoscopic treatment; 8 vs. 13, angiography 1 vs. 3) In patients with bleeding gastroduodenal ulcers, further bleeds occurred in 8 of 65, 12.5% in the TC-325 group and 10 of 65, 15.4% in the standard treatment group. The hemostatic powder, TC-325, is not inferior to standard treatment in the control of bleeding from non-variceal upper gastrointestinal causes. [Funded by the University Grant Council, the Hong Kong SAR Government]

THE CLINICAL CHARACTERISTICS, ENDOSCOPIC FINDINGS AND THE EFFICACY OF THE BISMUTH-CONTAINING QUADRUPLE REGIMEN INTREATMENT OF PATIENTS WITH HELICOBACTER PYLORIGASTRODUODENAL INFLAMMATORY AND ULCER AT CAN THO HOSPITAL OF UNIVERSITY OF MEDICINE AND PHARMACY

Background: Helicobacter pylori causes inflammation of the gastric mucosa and is associated with many upper gastrointestinal diseases, including chronic gastritis, peptic ulcer disease and gastric cancer. The treatment of Helicobacter pylori still remains many challenges, because many factors such as the resistance of antibiotics, adverse efects or cost of drugs can affect the treatment’s efficacy. Bismuth-containing quadruple regimen is recommended as a first-line therapy in areas with high clarithromycin and metronidazole resistance as well as an option for patients who have previously failed to respond to Helicobacter pylori eradication therapy. Nowadays there have been very few researches on the effectiveness of this regimen including the replacement of Metronidazole by Tinidazole on Helicobacter pylori infection treatment in our country, especially in Can Tho city. Objective: 1. To describe the clinical characteristics and endoscopic findings of patients with Helicobacter pylori gastroduodenal inflammatory and ulcer. 2. To evaluate the efficacy of Bismuth-based therapy for the treatment of Helicobacter pylori infection. Patients and methods: From November 2019 to May 2020 we carried out our study on 40 patients with Helicobacter pylori infection. All of patients received a quadruple therapy consisted of Rapeprazole 20 mg bid, Colloidal bismuth subcitrate 120mg qid, Tetracycline 500mg qid and Tinidazol 500mg tid for 14 days. The diagnosis of Helicobacter pylori infection was performed by Clotest. Four to eight weeks after completion of therapy, Helicobacter pylori status was rechecked by Clotest or C13 urea-breath test. Results: A total of 40 patients with Helicobacter pylori infection were recruited. The most common clinical characteristics was epigastric pain (75%), the most popularly identified endoscopic findings were erythematous gastritis (57.5%) and ulcer (12.5%). The eradication rates of the Bismuth-containing quadruple regimen on intention to treat (ITT) and per-protocol (PP) analysis were 95% and 97.2%, respectively. Adverse effects occurred in 75% of subjects. The common side effects were fatigue, anorexia and nausea. The compliance rate was 97.5%. Conclusion: Bismuth-containing quadruple regimen achieved very high eradication rates. Side effects were common but not serious. The medication adherence rate was high. Key words: Bismuth-containing quadruple regimen, eradication, Helicobacter pylori infection

Diagnosis of perforation from the penetrating ulcer of the posterior wall of the duodenum

The article is devoted to the problem of emergency surgery for abdominal organs – perforated ulcer of the posterior duodenal wall (duodenum). 140 patients with perforated duodenal ulcer were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2016 and 2019. Eight patients had perforation from the penetrating ulcer of the posterior duodenal wall. The average age of patients with perforation from the penetrating ulcers in the posterior duodenal wall was 62.25 years (27 to 78 years). Most of the cases were found in men – 87.5%. 7 patients had surgery at the Institute, one was transferred from another medical institution where he underwent surgery. Four patients were discharged with a favorable outcome, and four died. Two of the deceased patients had perforation associated with penetrating duodenal ulcer that was diagnosed during laparotomy; in two other cases, perforation associated with the penetrating ulcer was detected only during autopsy. A feature of perforated gastroduodenal ulcers when they are localized on the posterior wall of the duodenum is poor clinical manifestation, which is associated with the entry of duodenal contents into a limited retroperitoneal space, leading to a significant inflammatory process of retroperitoneal tissue. Complex use of X-ray examination, oesophagogastroduodenoscopy, and CT allows to correctly assess and timely diagnose perforation associated with the penetrating ulcer of the posterior wall of the duodenum into the retroperitoneal space.

Association of Helicobacter pylori infection with colorectal polyps and malignancy in China

BACKGROUNDGastric Helicobacter pylori (H. pylori) infection is related to chronic gastritis, gastroduodenal ulcer, and gastric malignancies; whether this infection is related to colorectal polyps and colorectal cancer (CRC), remains debatable.AIMTo investigate the relationship between gastric H. pylori infection and the risk of colorectal polyps and CRC.METHODSWe retrospectively analyzed 3872 patients with colorectal polyps who underwent colonoscopy and pathological diagnosis. We also analyzed 304 patients with primary CRC. The characteristics of these patients were compared with those of the control group, which included 2362 patients with the normal intestinal mucosa. All subjects completed a 14C-urea breath test, bidirectional gastrointestinal endoscopy, and a biopsy on the same day. Data on the number, size, location, and pathology of the polyps, the location, and pathology of the CRC, the detection of H. pylori, and the incidence of H. pylori-associated atrophic gastritis or intestinal metaplasia were obtained. A logistic regression model was used to analyze the relationship between gastric infection due to H. pylori, and the incidence of colorectal polyps and CRC.RESULTSThe prevalence of H. pylori infection was higher in the multiple polyps group than in the solitary polyp group and the control group [95% confidence interval (CI) = 1.02-1.31, P = 0.03; 95%CI: 2.12-2.74, P < 0.001]. The patients with adenomatous polyps had a higher incidence of H. pylori infection than patients with non-adenomatous polyps [59.95% vs 51.75%, adjusted odds ratio (OR) = 1.41, 95%CI: 1.24-1.60, P < 0.01]. Patients with H. pylori-associated atrophic gastritis or intestinal metaplasia were at high risk of CRC (adjusted OR = 3.46, 95%CI: 2.63-4.55, P < 0.01; adjusted OR = 4.86, 95%CI: 3.22-7.34, P < 0.01, respectively). The size and location of the polyps, the histopathological characteristics and the location of CRC were not related to H. pylori infection.CONCLUSIONOur study demonstrates that the incidence of gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia elevates the risk of colorectal polyps and CRC.

Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis

AbstractThere may be many predictors of venous thromboembolism (VTE) and bleeding in hospitalized medical patients, but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify prognostic factors for VTE and bleeding in hospitalized medical patients and searched Medline and EMBASE from inception through May 2018. We considered studies that identified potential prognostic factors for VTE and bleeding in hospitalized adult medical patients. Reviewers extracted data in duplicate and independently and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 69 410 citations, we included 17 studies in our analysis: 14 that reported on VTE, and 3 that reported on bleeding. For VTE, moderate-certainty evidence showed a probable association with older age; elevated C-reactive protein (CRP), D-dimer, and fibrinogen levels; tachycardia; thrombocytosis; leukocytosis; fever; leg edema; lower Barthel Index (BI) score; immobility; paresis; previous history of VTE; thrombophilia; malignancy; critical illness; and infections. For bleeding, moderate-certainty evidence showed a probable association with older age, sex, anemia, obesity, low hemoglobin, gastroduodenal ulcers, rehospitalization, critical illness, thrombocytopenia, blood dyscrasias, hepatic disease, renal failure, antithrombotic medication, and presence of a central venous catheter. Elevated CRP, a lower BI, a history of malignancy, and elevated heart rate are not included in most VTE risk assessment models. This study informs risk prediction in the management of hospitalized medical patients for VTE and bleeding; it also informs guidelines for VTE prevention and future research.

Determination of ureid content in shoots of russian pea shrub and siberian pea tree

Among natural ureides, allantoin (5-ureidohydantoin or 2,5-dioxoimidazolidin-4-yl urea) is the most famous compound which have been found in various organisms: bacteria, plants, and animals. Allantoin is a product of purine catabolism in mammals (except for primates and humans) and insect larvae. It is found in many plants: comfrey (Symphytum officinale L.), soybean (Glycine hispida (Moench) Maxim), alfalfa (Medicago sativa L.), purslane (Portulaca oleracea L.).&#x0D; Allantoin has a reparative, antimicrobial, and anti-inflammatory effect, that substantiate it use in the composition of numerous cosmetic and therapeutic dermatological agents. It can be used also used for the treatment of gastroduodenal ulcers and chronic gastritis. In most species of the legume family allantoin is a transport form of nitrogen, besides, its role in the adaptation of plants to stress factors is known.&#x0D; The plants of the genus Caragana (Caragana) of the legume family (Fabaceae), due to nitrogen-fixing bacteria, receive nitrogen from the soil and convert it into transport forms, namely allantoin and allantoic acid. These substances were previously isolated from the shoots of russian pea shrub (Caragana frutex (L.) C. Koch) and siberian pea tree (Caragana arborescens Lam.) and identified, but the quantitative content of ureids in these raw materials has not been studied.&#x0D; The aim of the work was to determine the content of ureides in the shoots of russian pea shrub tree and siberian pea tree.&#x0D; The objects of study were shoots of russian pea shrub tree and siberian pea tree harvested in Kharkov in May 2019 (during flowering period). The total ureide content was determined by spectrophotometric method based on the reaction of chemical decomposition of allantoin to glyoxylic acid with subsequent formation of coloured phenylhydrazone, which had absorption maximum at 530 nm.&#x0D; The study results have shown that the content of ureides (expressed as allantoin) is slightly lower in the shoots of russian pea shrub than in the shoots of siberian pea tree and equals 0.34 ± 0.03% and 0.41 ± 0.02% respectively.&#x0D; The content of total ureids in the shoots of russian pea shrub and siberian pea tree was determined. The flowering shoots of these plants can be used as herbal raw material for the development of therapeutic and prophylactic dermatological and antiulcer drugs possessing reparative, anti-inflammatory, and astringent effects.

STRUCTURE AND METHODS OF TREATMENT BLEEDING FROM THE UPPER DEPARTMENTS OF THE GASTROINTESTINAL TRACT

Summary. The aim of our work was to optimize endoscopic care for patients with upper gastrointestinal bleeding and to identify optimal methods of endoscopic hemostasis.&#x0D; Materials and Methods. We analysed the outcome of the treatment of 297 patients with endoscopic hemostasis, which included infiltration of the parasasal area with colloidal solution and electrocoagulation.&#x0D; Results and Discussion. The study showed that the most common source of bleeding were duodenal ulcers — 45.8 % of observations. Endoscopic methods of stopping and preventing bleeding were effective in 75.5 % of cases.&#x0D; Conclusions. The effectiveness of endoscopic hemostasis in patients with bleeding from the upper gastrointestinal tract is determined by a differentiated approach. In the structure of gastrointestinal bleeding in the multidisciplinary emergency hospital, gastroduodenal ulcers predominate — 76.8 %. In ulcerative bleeding, the efficacy of endoscopic combined hemostasis is 97.0 %.

English

English

DIAGNOSIS OF HELICOBACTER PYLORI IN GASTRIC BIOPSY SPECIMENS OF PATIENTS WITH GASTRODUODENAL DISEASES BY POLYMERASE CHAIN REACTION USING UREA GENE-SPECIFIC PRIMERS

Objectives: (1) To compare PCR method using ureA gene-specific primers and rapid urease test (RUT) for the diagnosis of H. pylori infection in gastric biopsy specimens; and (2) to determine the prevalence of H. pylori infection among patients with gastroduodenal diseases by the combination of both methods. Materials and method: Gastric biopsy specimens were collected from by endoscopy from 106 patients with gastroduodenal diseases. H. pylori infection was determined by the rapid urease test (RUT), followed by the PCR using ureA gene-specific primers. Results: This study reveals a high-level concordance (κ = 0.885; 95%CI: 0.796 – 0.974) between PCR and RUT for the diagnosis of H. pylori infection. However, PCR detected H. pylori in 5 (10.4%) of RUT-negative patients; and only 1 (1.7%) of RUT-positive cases were PCR-negative. The prevalence of H. pylori infection diagnosed by both PCR and RUT methods was 53.7%. The H. pylori infection was prevalent in gastroduodenal ulcers and patients with unknown medical history, 75% (p = 0.015) and 63.5% (p = 0.029), respectively. Conclusion: PCR using ureA gene-specific primers can detect several cases with H. pylori infection overlooked by RUT. The prevalence of H. pylori infection was still high, particularly in gastroduodenal ulcers and patients with an unknown medical history. Key words: rapid urease test (RUT), H. pylori, ureA gene-specific primers

Glucagon mechanisms of therapeutic and prophylactic action of drinking mineral waters

Glucagon is one of the main hormones that regulate energy production, but its role in the implementation of the therapeutic and preventive potential of drinking mineral waters has not been sufficiently studied. Many of the effects of glucagon are related to the insulin supply of carbohydrate and lipid metabolism, and insulin takes an active part in the mechanism of action of mineral waters on various functional systems of the body. In an experiment in healthy animals, the stimulating effect of medium-mineralized water on the secretion of glucagon and the concentration of lipid precursors of enegretic metabolism was proved. It was found that activation of reparative processes and inhibition of acidic gastric secretion in rats with experimental gastroduodenal ulcer are associated with an increase in glucagon secretion under the influence of course intake of mineral water. It was found that in the case of metabolic syndrome, rats develop circadian rhythm disorders in the system of glucagon regulation of energy-homeostasis, which can be compensated by internal intake of mineral water. The hypothesis about the stimulating effect of drinking mineral waters on the interconnected insulin-glucagon regulation of the energy supply of sanogenetic reactions is analyzed.

Acid formation in gastroenterological patients with colonization of the stomach with virulent and non-virulent strains of helicobacter

Objective. To prove that increased acid production in patients with gastric ulcer and duodenal ulcer is associated with the impact of the virulent strains of Helicobacter pylori but due not to the persistence of non-virulent strains.Materials and methods. Patients with active gastroduodenal ulcer and patients with active chronic pancreatitis accompanied by the gastritis were compared in the respect of the level of pH in the antrum and corpus gastricum, as well as Helicobacter pylori virulence according to the presence cagA gene, especially in combination with vacA allele s1 / m1 (if any of the strains were found in gastric biopsy specimen).Results. In patients with gastric ulcer the average values of pH were significantly lower, both in the antrum and corpus gastricum, than in patients with chronic pancreatitis accompanied by gastritis. Helicobacter pylori strains were found only in half of the patients, either in the gastric ulcer group or in the group of chronic pancreatitis accompanied by the gastritis. Significant difference was revealed after virulent genes identification: virulent strains prevailed in patients with gastric ulcer and in contrast to the prevalence of non-virulent strains in patients with chronic pancreatitis accompanied by the gastritis (Mann-Whitney test, p = 0.001). Since there is no available data that Helicobacter has an affinity for a highly acidic medium in comparison with moderately acidic medium, it is concluded that just primary colonization of the stomach with virulent strains results in hyperacidity (as the consequence of cytotoxicity) and that persistence of non-virulent strains hardly effects hyperacidity.

SERUM LEVELS OF IL-8 IN PATIENTS WITH CHRONIC ACTIVE GASTRITIS AND PEPTIC ULCER DISEASE

The majority of researchers discover associations between H. pylori (Hp) and serum IL-8 production with the stage of chronic inflammation. Data on IL-8 levels in chronic gastritis (CG) and a gastroduodenal ulcer (GDU) are insufficient, and often controversial. All patients with chronic active gastritis (CAG) and GDU were divided into 4 subgroups: patients with GDU and found Hp infection according to common methods (GDU+Hp), patients with GDU and no documented Hp infection (GDU), patients with CAG and found Hp infection according to common methods (CAG+Hp), and patients with CAG with no documented Hp infection (CAG). The highest serum IL-8 levels were seen in patients with GDU+Hp, whereas the lowest ones were observed in patients with CAG. Men have the lowest IL-8 levels in the CAG+Hp subgroup as compared with other subgroups. The IL-8 values were significantly different from higher values in women. The rate of fecal Oantigen of H. pylori LPS found using the coagglutination test is 86%. The highest levels of O-antigen of H. pylori LPS were detected in the CAG subgroup. In patients with GDU+Hp, the levels of O-antigen of H. pylori LPS were significantly higher as compared with the GDU subgroup. So patients with GDU, especially those with GDU+Hp, and with CAG, have active IL-8 production. Coagglutination to detect O-antigen of H. pylori LPS in feces used along with common methods increases the probability to confirm that the patients (especially those with chronic gastritis) are infected with this microbe.

Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study.

Background Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding. Results Dialysis CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both Conclusion Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.

Chronic Helicobacter pylori induced gastritis with erosive lesions of the gastric mucosa in the elderly

Аim. To study the clinical course of chronic gastritis with erosions in the elderly, depending on the presence of Helicobacter pylori in the gastric mucosa.Materials and methods. 75 patients (50 women and 25 men) aged 60 to 82 years with chronic erosive gastritis were examined. Тhey complained of pain in the epigastric region, pain of other localization, heaviness in the epigastric region, nausea, heartburn, constipation, having comorbidities. Patients were divided into 4 groups depending on the degree of contamination of the gastric mucosa with Helicobacter pylori: 1 group consisted of 20 people, which on the background of erosive lesions of the coolant, HP was not detected; in group 2 (25 man), it was observed a light contamination with coolant; in group 3 (20 patients) and in group 4 (10 patients) — high — were detected in more than 50 microbial cells in field of view.Result. The clinical picture of chronic erosive gastritis varies depending on the degree of contamination of the gastric mucosa Helicobacter pylori.Conclusion. This microorganism aggravates the course of the disease. The course of chronic erosive gastritis is influenced by concomitant pathology.

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study.

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Ibuzole: A Thwart for NSAID's Causing Gastro-Duodenal Endoscopic Ulcer

The oral route of Drug delivery is considered most perfect and patient complied of drug administration. Non-Steroidal anti-inflammatory Drugs (NSAID) are most widely and frequently prescribed for their anti- inflammatory, anti-thrombotic, anti-pyretic and analgesic activity. NSAID’s are given through oral route, but also at same time NSAID’s are most common factor causing Gastro-duodenal Endoscopic Ulcer. Ibuprofen is used mainly for treatment of orthopaedic disease. It has well known potential to generate gastritis and peptic ulcer by both local and systemic action. Omeprazole is proton pump inhibitor use for treatment of peptic ulcer. Aim of our study is to combine NSAID (Ibuprofen) with side effect reducing agent (Omeprazole) and to develop multi component Drug delivery system to increase patient compliance and duration of action and also the cost-effective formulation. This will give effects of NSAID and counteract peptic or duodenal ulcer. Ibuprofen and omeprazole are formulated as a Bilayer tablet for their respective effects. Bilayer tablets have some advantages over the conventional monolayer tablets. hence increasing the patient compliance as well as increasing drugs acceptance by avoiding the side effect. Bilayer tablets have enabled the development of controlled delivery of active pharmaceutical ingredients with predetermined release profiles by combining layers with various release patterns, or by combining slow release with immediate-release layers, hence increasing the patient compliance as well as increasing drugs acceptance by avoiding the side effect.

Comparative analysis of the effect of IV administered acid suppressants on gastric pH in dogs.

BackgroundUpper gastrointestinal (GI) ulceration and bleeding in critically ill dogs can cause severe anemia and increase morbidity. Acid suppressants using proton pump inhibitors or histamine‐2 receptor blockers administered IV is commonly recommended.Hypothesis/ObjectivesTo evaluate the efficacy of IV administered esomeprazole, pantoprazole, and famotidine constant rate infusion (CRI) on increasing the intragastric pH of dogs. We hypothesized that esomeprazole and famotidine CRI would provide superior acid suppression compared to pantoprazole and reach pH goals for the treatment of GI bleeding.AnimalsNine healthy research Beagles.MethodsRandomized, 3‐way crossover. Dogs received pantoprazole or esomeprazole at 1 mg/kg IV q12h and famotidine with a loading dose of 1 mg/kg followed by 8 mg/kg IV CRI daily for 3 consecutive days. The intragastric pH was recorded at baseline and for 72 hours of treatment. The mean pH and the mean percentage time (MPT) the intragastric pH was ≥3 or ≥4 were compared among and within treatment groups.ResultsSignificant increases in mean pH (P < 0.0001), MPT ≥3 (P < 0.001), and MPT ≥4 (P = 0.0006) were noted over time with all 3 treatments. The time effect did not differ by treatment for mean pH, MPT ≥3, and MPT ≥4 (P = .29, .56, and .37, respectively); however, only esomeprazole and famotidine CRI achieved the goals established for the treatment of gastroduodenal ulceration in people.Conclusions and Clinical ImportanceFamotidine CRI and esomeprazole might be superior acid suppressants compared to standard doses of pantoprazole for the first 72 hours of treatment.