High Gastric Ulcer Research Articles

The global gastric cancer consortium: an update from the Stomach cancer Pooling (StoP) project.

We updated to December 2023 the main findings of the stomach cancer pooling (StoP) project including about 13 000 cases and 31 000 controls from 29 case-control and 5 nested studies. The StoP project quantified more precisely than previously available the positive associations of tobacco smoking, high alcohol consumption, meat intake, selected occupations (e.g. agricultural and miners), gastric ulcer and family history with gastric cancer and the inverse associations with socioeconomic status and selected aspects of diet (fruits, including citrus fruits, vegetables, including allium and mushrooms, and polyphenols). No consistent associations were found with coffee, yoghurt and leisure-time physical activity, metformin or proton pump inhibitors use.

Application of endoscopic purse-string sutures in high-risk peptic ulcer hemorrhage: preliminary experience of 38 cases

Objective This study is a prospective study to explore the therapeutic effect of endoscopic purse-string sutures in high-risk peptic ulcer hemorrhage. Patients and methods We prospectively collected and analyzed data from July 2018 to December 2020 from patients in Jinshan hospital, Fudan University, who underwent emergency endoscopy for acute severe high-risk non-variceal upper gastrointestinal hemorrhage (NVUGIB) and were treated with endoscopic purse-string sutures. Results We included 38 patients whose median age was 64 years (interquartile range: 57.2 − 71.2 years). All patients were high risk gastric ulcer larger than 1 cm, including Forrest Ia (n = 4, 10.5%), Forrest Ib (n = 13, 34.2%) and Forrest IIa (n = 21, 55.3%). All patients were treated with endoscopic purse-string sutures. The clinical success rate reached 89.5%. Three patients suffered from rebleeding within seven days, and were treated with surgery or arterial embolization, respectively, all of which successfully stopped bleeding. One patient died of myocardial infarction. All other patients were followed up for 30 days without bleeding. Conclusions We conclude that endoscopic purse-string sutures seem to be safe and effective in the treatment of patients at high risk of ulcer bleeding.

Factors Associated with Colorectal Polyps in Middle-Aged and Elderly Populations.

Colorectal polyps are the precursor lesions of most colorectal cancers. This study aimed to evaluate associations between bone mineral density (BMD), metabolic syndrome (MetS), and gastrointestinal diseases with colorectal polyps in middle-aged and elderly populations. A retrospective cross-sectional study was performed using data from the health examination database of a tertiary medical center in southern Taiwan in 2015. Subjects aged 50 years and older who had been assessed for metabolic factors and had undergone colonoscopy, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scan (DEXA) were included. Factors associated with colorectal polyps were evaluated using univariate and multivariate logistic regression. In total, 1515 subjects were included, with mean age 60.1 years. Among them, 710 (46.9%) had colorectal polyps. Multivariate logistic regression analysis showed that high fasting glucose (OR = 1.08, p = 0.001), high triglycerides (OR = 1.02, p = 0.008), high total cholesterol (OR = 1.004, p = 0.009), reflux esophagitis (OR = 1.44, p = 0.002), duodenal polyps (OR = 1.75, p = 0.026), gastric ulcer (OR = 1.38, p = 0.024), duodenal ulcers (OR = 1.45, p = 0.028), osteopenia (OR = 1.48, p = 0.001), and MetS (OR = 1.46, p < 0.001) were independently associated with colorectal polyps. In conclusion, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, MetS, duodenal polyps, gastric and duodenal ulcers, reflux esophagitis, and low BMD are independent risk factors associated with colorectal polyps in the middle-aged and elderly Taiwanese population.

Ginger–a potential source of therapeutic and pharmaceutical compounds

Ginger is traditionally known for its therapeutic and pharmaceutical properties. It has been used widely to treat various health problems such as high blood pressure, coughs, colds, swelling, nausea, rheumatic disorders, vomiting, bronchitis, indigestion, gastric ulcers, and behavioral problems. Shogaol and Gingerol are anti-inflammatory, anti-fever, anti-pain, and anti-cough compounds that may help treat a cold. This review provides an up-to-date understanding of the impact of ginger and its active compounds on human health. Various ginger compounds such as gingerol, shogaols, zingiberene, zingerone, paradols and zingerone are receiving attention for their clinical applications and pharmaceutical properties. Studies indicate that ginger is anti-inflammatory, anti-tumor, antimicrobial, antiemetic, hepatoprotective, and neuroprotective. During the inflammatory response, ginger inhibits (NF-κB) and immune system activation in addition to many other cellular processes. Ginger has shown benefits in preclinical and clinical studies for neurology, cardiovascular disease, and cancer. These findings indicate the necessity for further in vivo and clinical studies.

The influence of risk factors in recurrent peptic ulcer hemorrhage

Gastrointestinal hemorrhage is one of the most frequent complications that occurs in 15 20% patients with peptic ulcer disease. Recurrent ulcer haemorrhage presents in the first 72 hours after initial bleeding: they are the most im portant cause of death. The aim of our study was to show the possibility of ulcer recurrent haemorrhage combined with risk factors: age 60, high risk lesion (active arterial bleeding, visible blood vessel, adherent coagulum), the size, ulcer base and localization (posterior duodenal wall. lesser curvature or high gastric ulcer), commorbidities ( cardiovascular and liver diseases) and haemodynamic instabilities. The combination of these risk-factor, unproportionally increases the risk: presence of two risk factors gives the possibility of recurrent bleeding of 16.67%, three risk factors 58.82%, four 93.33%, while the presence of five risk factors shows 100% posibility. Probability of death is 8.27 times greater if ulcer haemorrhage occurs.

Hypotensive Activity of Tacca chantrieri. and Its Hypotensive Principles

The rhizomes of Tacca chantrieri. Andre (Taccaceae) have been used in Chinese medicines for the treatment of various diseases including high blood pressure, burns, gastric ulcers, enteritis, and hepatitis. The rhizomes of this plant have been found to contain a wide array of saponins and other compounds. The aims of the current study were to investigate the hypotensive activity of the ethanol extract (TCE) and both the crude (TCS) and purified saponin extract of T. chantrieri., and thus to characterize the hypotensive principles. TCE and TCS at the dose of 5 mg/kg caused hypotension and bradycardia in normotensive rats under pentobarbital anesthesia. Both TCE and TCS caused a decrease in the force and rate of contractions in isolated rat atria. The vasorelaxant activity of TCE and TCS could be demonstrated when tested on the aortic ring with endothelium intact. It is therefore implied that TCE and TCS exert both their hypotensive effect and bradycardia by affecting the heart as well as blood vessels. Separation of the crude saponin extract of T. chantrieri. yielded four fractions with hypotensive activity. Fraction 1 contained diarylheptanoid glucosides, fraction 2 was a mixture of the glucosides and saponins, and fractions 3 and 4 contained spirostanol saponins. It is likely that in addition to the saponins, other constituents (diarylheptanoid glucosides) are involved in the hypotensive activity of T. chantrieri..

Maximal gastric secretion and duodenogastric reflux in patients with gastric or duodenal ulcer and in control subjects.

Maximal gastric secretion was studied in 41 unoperated patients with gastric ulcer, 201 patients with duodenal ulcer, and 122 control subjects. The patients with a gastric ulcer were divided into high, body and prepyloric, according to the site of the ulcer. Both high and body gastric ulcers secreted significantly less than the controls, and the duodenal ulcer patients secreted significantly more. However, the patients with gastric ulcer were older and lighter than the controls and, since these factors are known to influence maximal gastric secretion, the controls and patients with duodenal ulcer were standardized to the mean weight (and age, for the controls) of the gastric ulcer group. After this standardization, there was no significant difference in secretion between the patients with body ulcers and normal controls. Pyloric loss was a similar percentage of maximal gastric secretion in all groups, but duodenogastric reflux was higher in the gastric ulcer group compared to the controls. The mean volume of duodenogastric reflux was greatest in the patients with a prepyloric gastric ulcer. It is commonly accepted that hyposecretion in patients with a gastric ulcer is due to gastritis consequent upon increased duodenogastric reflux. However, in this study, no gastric hyposecretion was evident in the body and prepyloric gastric ulcer groups, both of whom had greater than normal levels of duodenogastric reflux.

Operative treatment of high gastric ulcer with special reference to Pauchet's method.

Abstract A high gastric ulcer may be treated by excision, or the ulcer may be retained and healing encouraged by other means. If the ulcer is retained there is a small but definite risk of malignancy. Neither gastric drainage, nor the Kelling–Madlener operation, nor vagotomy and pyloroplasty ensures healing in a high gastric ulcer. Local wedge resection of the ulcer is attended by very poor results, and a high mortality and morbidity preclude the use of subtotal or total gastrectomy. Pauchet's procedure combines the advantages of limited gastrectomy and gastroduodenal anastomosis with complete removal of the ulcer. It is the recommended operation for high gastric ulcers.

Behavioural characteristics of rats differing in the sensitivity to stressors

Two lines of laboratory rats were genetically selected that differ in their sensitivity to stressors. While one line suffers from gastric ulcers and exhibits low heart lesions (measured by an incorporation of Hg) after the water immobilization stress (4 h), the other line exhibits high heart lesions and few gastric ulcers. The lines differ in their sensitivity to isoprenaline. The goal of this study was to determine the behavioural characteristics of these lines. Significant differences were detected in the exploratory/locomotory behaviour in an open-field as well as in the social aggression. The distinguished behavioural differences might possibly facilitate the prediction of the type of physiological reaction after stress. Housing systems for breeding rabbits with respect to animal welfare B. Drescher Universitiit Hohenheim, Institut fur Tierund Umwelthygiene und Tiermedizin mit Tierklinik, Postfach 700562, 70599 Stuttgart, Germany Abstract The German law on animal welfare requires housing suitable to the animals' behaviour as well as the possibility of species suitable movement. For rabbits this means group hous-The German law on animal welfare requires housing suitable to the animals' behaviour as well as the possibility of species suitable movement. For rabbits this means group hous-

Grade ofHelicobacter pyloriColonisation, Chronic Gastritis and Relative Risks of Contracting High Gastric Ulcers: A Seven-Year Follow-Up

A series of 38 patients with high gastric ulcer (GU) was examined twice a seven-year interval. One-third of the patients had an active ulcer at the second examination. Chronic gastritis was evaluated, and the level of Helicobacter pylori (HP) colonisation assessed semiquantitatively. The results were compared with age and sex matched non-ulcer controls. The GU series differed from the controls in having a higher degree of HP colonisation in gastric mucosa. The relative risks (RR) in predicting high GU connected with high HP colonisation were significantly elevated, both in the antrum (RR = 6.0-4.8) and in the corpus (RR 5.0-4.4), and still higher when combined HP colonisation values were used (RR 9.5-7.1). The persistence of active ulcer (GU+) was associated with a very high level of HP colonisation, with absence of corpus atrophic gastritis at the first examination and with young patients. Half of the GU+ patients had the maximum grade of combined HP colonisation in both examinations. The study indicates that the presence of HP infection as well as the level of HP colonisation are of importance in both the development and chronicity of peptic GU disease.

High gastric ulcer.

AbstractFifty‐six patients with high gastric ulcers were studied retrospectively. There were 38 women and 18 men. The mean age was 66 years. Findings were: 25% had ulcer histories of more than 5 years; 45% had illnesses in other systems making them poor operative risks; 34% were taking ulcerogenic drugs, and 36% were on antiulcer treatment prior to surgery; 43% presented with severe bleeding, 16% with perforation, and 2 patients had simultaneous bleeding and perforation; 38% had deeply penetrating ulcers and many ulcers were very large; 7 patients had ulcers in hiatus hernias. Sixty‐three percent of the procedures were emergencies. Half of the operations were nonresective, with or without vagotomy. The other half were gastric resections of various types. The overall mortality rate was 18%, but the mortality rate was 24% for emergency procedures and 9% for elective ones. The highest mortality rate, 45%, occurred after emergency resective procedures. Vagotomy did not increase postoperative mortality when added to a nonresective procedure. Beside the 10 patients who died, 6 others developed severe postoperative complications, usually respiratory failure or suture line leakage. Follow‐up of between 6 months and 12 years (average 3 years) was possible in 55% of the patients. Two developed recurrent ulcers and 2 had overlooked gastric carcinomas. An approach of management for high gastric ulcer is outlined recommending a Pauchet operation for good‐risk patients, and vagotomy and drainage for old and frail patients. Medical treatment should be pursued as long as possible to avoid an often hazardous operation.

Legal Regulation of Noise Control [Excerpts

Noise, known as "slow poison," takes many forms. Working in conditions of strong noise (exceeding 90 decibels), a person will feel a harsh grating in the ear and after a long period will become hard of hearing and even deaf from the noise. Investigations show that in workshops where there is a great deal of noise, the incidence of workers suffering from deafness caused by noise reaches more than 50 percent and is sometimes even as high as 90 percent. Tremendous noise will cause headaches, tinnitus, insomnia, blood vessel spasms, abnormal secretion of digestive fluids, the weakening of digestive functions, and weariness of the whole body. This often leads to heart disease, high blood pressure, gastric ulcers, and neurosis. Noise exceeding 150 decibels may cause serious damage to the human body, leading to bleeding in the eardrums, deafness in both ears, delirium, insanity, shock, and even death.

COMPARATIVE STUDIES ON SEGMENTAL GASTRECTOMY WITH OR WITHOUT VAGOTOMY FOR HIGH GASTRIC ULCER IN VIEW OF LATE POSTOPERATIVE COMPLICATIONS

A comparison was made of the long-term postoperative results of segmental gastrectomy with or without vagotomy in regard to high gastric ulcer. Forty four patients with high gastric ulcer, or 17.9% of the total number of patients, underwent digestive ulcer operations. Twenty eight patients, or 63.6%, had intractable ulcer and seven patients, or 15.9%, experienced bleeding. As chief complaints, 29, or 66.0%, suffered from precordia pain and two patients, or 4.5%, experienced left hypochondralgia. Thus, thirty one patients, or a majority of 70.5%, experienced pain of some kind. The acidity reduction rate was 50% for those patients who underwent segmental gastrectomy and 60% for those patients who underwent segmental gastrectomy with vagotomy. In both cases, five years after the operation the patients have far fewer complaints and are in satisfactory condition according to Vsick's index. The addition of the pyloroplastic operation has consequently increased the chance of dumping symptoms occurring. Three out of twenty four patients who underwent segmental gastrectomy with vagotomy experienced a recurrence of the disease, while no recurrence was observed in the patients who underwent segmental gastrectomy alone.

Surgical treatment of high gastric ulcer

The purpose of this study has been to review the late results of surgical treatment of 244 patients with endoscopically proved benign chronic gastric ulcer located 5 cm or less from the cardia. In five patients, a total gastrectomy with esophagojejunostomy was performed. Proximal gastrectomy was used in 3 patients, mesogastrectomy in 5 patients, a partial Schoemaker's procedure in 73 patients, Pauchet's procedure in 70 patients, and Csendes' procedure in 23 patients. Nonresective procedures were employed in 67 patients and included the Kelling-Madlener procedure in 23 patients, pyloroplasty alone in 10 patients, gastrojejunostomy alone in 4 patients, local or wedge excision of the ulcer in 9 patients, and vagotomy and pyloroplasty in 21 patients. The follow-up evaluation was performed in 91 percent of the patients (mean 9 years postoperatively, range 5 to 15 years), with emptying endoscopy in all nonresected patients. A high mortality was observed after total or proximal gastrectomy, as well as after nonresective procedures. After the other resective techniques, low postoperative morbidity and mortality were observed. No recurrent ulcer was seen after the resective procedures. Based on these results, we propose that when the ulcer is located 5 cm below the cardia, Schoemaker's or Pauchet's procedure should be performed; if the ulcer is located 2 cm or less from the cardia, Csendes' procedure or the Kelling-Madlener procedure should be employed.

COMPARATIVE STUDIES ON THE HEALING OF EXPERIMENTAL GASTRIC ULCERS MADE AT THE ANGULAR INCISURE AND SUBCARDIA

Experimental gastric ulcers were prepared in dogs after the method by Hatafuku and Thal, one at the subcardia and the other at the angular incisure, and healing of these two ulcers were compared. After the operation, endoscopy was carried out at weekly intervals and the sites of ulcers were subjected to macroscopic and microscopic examinations for measuring the ratio of epithelization. The healing of experimental ulcers was also examined under the conditions either with ligation or embolization of the left and right gastric arteries. The results obtained are summarized as follows. 1) Ten dogs with ulcer preparation only showed 3 persistent and 7 perforated ulcers at the subcardia and 4 healed, 4 persistent and 2 perforated ulcers at the angular incisure. 2) Four dogs with vessel ligation showed 2 persistent and 2 perforated ulcers at the subcardia and 1 healed, 2 persistent and 1 perforated ulcers at the angular incisure. 3) In 6 dogs with vessel embolization, 3 showed regional erosions. 4) The ratio of epithelization were 23.3% for the high and 68.2% for the low ulcers in the dogs with ulcer preparation only, while these were 11.3% and 54.5% respectively for the dogs with vessel ligation. In conclusion, the healing of high gastric ulcers were consistently inferior to the one of low gastric ulcers in every preparation. The cause of poor healing of the high gastric ulcers may be elucidated both by the circulatory disturbance and hypermotility of the ulcer region.

A surgical technic for high (cardial or juxtacardial) benign chronic gastric ulcer

A surgical technic for cardial or juxtacardial ulcers is presented. The surgical principle consists of resection of the distal stomach including the ulcer in a way that the esophageal mucosa remains intact. Reconstruction of the transit is accomplished by a Roux-en-Y esophagogastrojejunostomy in one layer. A variable portion of gastric reservoir is preserved, and alkaline reflux is highly improbable due to the long intestinal loop. This technic has been performed in six patients with excellent postoperative results. Clinical and radiologic follow-up to three years has shown no esophagitis or strictures or afferent loop syndrome.

The effects of zinc sulphate on vagal-induced mast cell changes and ulcers in the rat stomach

The effects of zinc sulphate pretreatment on the formation of gastric ulcers, changes in intragastric pressure and changes in the gastric mucosal mast cell count induced by electrical vagal stimulation were studied in anaesthetized rats. Vagal stimulation produced a high gastric glandular ulcer incidence and ulcer index, increased the intragastric pressure, and reduced the number of granulated mast cells in the gastric mucosa and submucosa. Pretreatment with zinc sulphate (22, 44 ot 88 mg/kg), injected i.p. 48 h beforehand, reversed the changes in these parameters in a dose-related manner. These observations suggest that the inhibitory effects of zinc sulphate on mucosal mast cell degranulation may account for its ability to antagonise vagal-induced gastric glandular ulceration. The mechanisms involved in the aetiology of this type of gastric ulcer are discussed in the light of these results.

Vagotomy and pyloroplasty for gastric ulcer.

In a series of 68 patients with gastric ulcer who were treated by vagotomy and pyloroplasty there were no operative deaths, though one patient who received massive transfusions died 14 weeks later from hepatic necrosis probably associated with serum hepatitis. Four patients developed recurrent peptic ulceration requiring further surgical treatment. The clinical condition of all but three of the remainder was satisfactory after an average follow-up period of three years and two months. Of the 14 patients who presented with an acutely bleeding gastric ulcer, one subsequently required gastrectomy for continued bleeding; in all the others the immediate and long-term results were satisfactory. Of 21 patients with a "high" ulcer and 29 with combined gastric and duodenal ulceration one (4.8%) and three (10%) respectively suffered recurrences. We conclude that vagotomy and pyloroplasty is a satisfactory form of treatment for a high or bleeding gastric ulcer, but that for all other gastric ulcers some form of gastric resection is preferable.

Selective surgery for chronic gastric and duodenal ulcers

At the University of Niigata Hospital, selection is attempted from several possible operative procedures for gastric and duodenal ulcers, the independent variables being the patients age, the acidity of gastric juice, the location of ulcer, the degree of gastric tonicity and the complicating lesions of stomach including gastritis. Each procedure and its indication are delineated as follows: 1) Usually, antrectomy or hemigastrectomy with vagotomy is performed for duodenal and gastric ulcers located distal to gastric angle, while a 75% gastrectomy is employed for the patients of old age or with a remarkable atony of the stomach. 2) For gastric ulcers located proximal to gastric angle, a 75% gastrectomy has been performed. 3) For high gastric ulcers, a segmental gastrectomy with pyloroplasty of the Heineke-Mikulicz type and vagotomy is employed. Upon performance of this procedure, the combined vagotomy is not carried out for the cases with the maximal free free acid of less than 30 to 40 cl.u., because the sufficient effective reduction of gastric acidity may be obtained by this procedure (less than 50% gastrectomy) alone. 4) For ulcers of cardiac region, a proximal gastrectomy, about 50% resection of the stomach, is performed. For the cases not associated with the conditions above mentioned, however, a 75% gastric resection is performed. These surgical procedures have been carried out in 659 cases with chronic peptic ulceration of the stomach and duodenum at the University of Niigata Hospital during the past 8 years. Conservative gastrectomies (antrectomy or hemigastrectomy with vagotomy, segmental gastrectomy and proximal gas t rectomy)have been performed in 189 cases or 29% of these 659 cases and gained satisfactory results. The present study has shown the procedures of selective surgery based on Prof. Sakai's new device at the University of Niigata Hospital. Detailed results of this policy may be reported in the future.

Procedure for lesions of proximal end of stomach and lower end of esophagus

1. 1. A procedure maintaining a gastric pouch is described for definitive therapy in high gastric lesions and for palliation in high malignant lesions not involving the lower end of stomach. The procedure can also be applied to lesions of the lower esophagus. 2. 2. The more physiologic continuity of the alimentary tract is maintained. 3. 3. The procedure could be considered as a primary form of surgical therapy for juxtaesophageal ulcer (after medical trial) or for high gastric ulcers in which malignancy is suspected and which, in the past, have been treated either medically or by resection of the distal part of stomach leaving the ulcer in place. 4. 4. In poor risk patients the procedure would be no more dangerous and time-consuming than total gastrectomy. 5. 5. Esophagitis is eliminated. 6. 6. Function of the antral portion of stomach is retained. 7. 7. The procedure could be considered for esophagogastric resection for gastric and esophageal varices secondary to portal hypertension and cirrhosis. (Extrahepatic block not amenable to shunt procedures.)