History Of Peptic Ulcer Disease Research Articles

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient: A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction (STEMI) and gastric ulcers poses a challenge to primary percutaneous coronary intervention (PPCI), particularly for young patients. The role of drug-coated balloons (DCBs) in the treatment of de novo coronary artery lesions in large vessels remains unclear, especially for patients with STEMI. Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion. CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24, 2019. Within the first 3 minutes of the initial assessment in the emergency room, the electrocardiogram (ECG) showed significant changes. There was atrial fibrillation with ST-segment elevation. Subsequently, atrial fibrillation terminated spontaneously and reverted to sinus rhythm. Soon after, the patient experienced syncope. The ECG revealed torsades de pointes ventricular tachycardia. A few seconds later, it returned to sinus rhythm. High-sensitivity tropon in I was normal. The diagnosis was acute STEMI. Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery. Considering the patient's age and history of peptic ulcer disease, after the intracoronary injection of prourokinase, percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning, and paclitaxel drug-eluting balloon angioplasty was performed without any stents, achieving favorable outcomes. CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI, and further research is warranted.

Evaluation of Aspirin Prescribing and Gastrointestinal Bleeding in Adults 60 Years of Age and Older in a Large, Academic Health System.

Background National guidelines no longer recommend adults 60 years of age and older to begin treatment with low-dose daily aspirin for primary prevention of atherosclerotic cardiovascular disease (CVD) due to a lack of proven net benefit and a higher risk of bleeding. Objective The objective of this cross-sectional retrospective analysis was to evaluate the appropriateness of low-dose aspirin prescribing and subsequent gastrointestinal bleeding in older persons receiving primary care in a large academic health system. Setting Large, academic health system within Colorado. Patients Patients with an active order for daily low-dose aspirin as of July 1, 2021, were assessed for appropriateness based on indication (primary vs secondary prevention) and use of a concomitant proton-pump inhibitor (PPI). Incident gastrointestinal bleeds (GIBs) in the subsequent 12 months and GIB risk factors were also evaluated. Results A total of 19,525 patients were included in the analysis. Eighty-nine percent of patients identified as White and 54% identified as male. Of the total cohort, 44% had CVD and 19% were co-prescribed a PPI. GIB occurred in 247 patients (1.27%) within the subsequent year. Risk factors significantly associated with a GIB within 1 year included: history of GIB, history of peptic ulcer disease, other esophageal issue (esophagitis, Barrett's esophagus, Mallory Weiss tears, etc.), 75 years of age or older, and history of gastroesophageal reflux disease. Conclusion This evaluation found that many older persons at this institution may be inappropriately prescribed aspirin, providing opportunities for pharmacists to improve medication safety by deprescribing aspirin among primary prevention patients or potentially co-prescribing a PPI in secondary prevention patients.

Unraveling the Mind-Gut Connection: Investigating Anxiety and Depression in Functional Dyspepsia

Psychological association with functional dyspepsia underscores the importance of a holistic approach to its management, addressing both physical and psychological aspects of the condition. Objective: To determine the relationship of anxiety and depression with severity of dyspepsia. Methods: A prospective cross sectional study was carried out in the Endoscopy Unit, Department of Gastroenterology, Baqai Medical Institute. All patients fulfilling the Rome III criteria for functional dyspepsia with normal endoscopy findings were included in the study, Pregnant females, patients with known diabetes, chronic kidney disease, chronic liver disease and known psychiatric illness, history of peptic ulcer disease and use of NSAIDs, steroids or alternative medicine were excluded. Severity of dyspepsia was assessed by Short Form Leeds Dyspepsia Questionnaire (SF-LDQ). Whereas hospital anxiety and depression scale (HADS) was used to assess the psychological factors. Results: A total of 223 participants were included in the study. Out of 223 participants, majority 55.6% (124) had moderate dyspepsia, followed by severe dyspepsia 26.9% (60), mild dyspepsia 12.6% (28) and very mild dyspepsia 4.9% (11). Using Hospital Anxiety And Depression Scale (HAD-S), we found that out of 223 participants, 56.5% (126) had moderate to severe anxiety and depression while 29.1% (65) had mild anxiety and depression. Conclusions: It was concluded that functional dyspepsia is clearly associated with common psychological disorders like depression and anxiety. Early recognition and timely linkage to care in such cases can considerably improve the health-related quality of life and hence decrease the global burden of this common disorder.

Landscape of esophageal cancer in Northern Kenya: experience from Garissa Regional Cancer Center.

Esophageal cancer (EC) is the ninth most common cancer and the sixth leading cause of cancer deaths worldwide. More than 80% of cases and deaths from EC occur within developing countries. In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase as per the 2020 GLOBOCAN report showing 42,116 new cases annually with a mortality of 27,092 cases. EC is the leading cancer in men and the third most common in women in Kenya. The Garissa Regional Cancer Center (GRCC) is one of the three regional cancer centres in Kenya. Despite the rising EC incidence in the region, there is limited data about the clinicopathological features and treatment outcomes of EC, therefore, this is the first study to look at the landscape of EC in the northern Kenya region. This was a retrospective study involving patients' file review of confirmed EC cases diagnosed or treated at the GRCC from 2019 to 2023. Data collected from each patient's chart included age, sex, risk factors, family history of EC, histological type, stage at diagnosis, treatment type and survival outcomes. For patients who were no longer in contact with the staff through clinic visits, the patients or their next of kin were contacted through phone calls for patients' survival status. Data were collected and stored using the STATA software. Over the study period, 124 esophageal cases were identified, 64 (51.4%) were males and 60 (48.4%) were females with a mean age of 57.56 years. In terms of risk factors, hot beverage consumption was the highest (47 cases, 37.9%), followed by history of peptic ulcer disease (27 cases, 21.8%), smoking (8.9%) and gastresophageal reflux disease (2 cases, 1.6%). Stage of diagnosis at presentation was stage 1 (1 case, 0.8%), stage 2 (22 cases, 17.8%), stage 3 (25 cases, 20.2%), stage 4 (50 cases, 40.3%), not staged (26 cases, 21%). The majority had squamous cell carcinoma (SCC) (105 cases, 84.7%), followed by adenocarcinoma (5 cases, 4%), anaplastic (5 cases, 4%), SCC+ adenocarcinoma (1 case, 0.8%), unknown histology (8 cases, 3.2%). Nearly all patients had triple assessment (Endoscopy, histology and staging scans) accounting for 92 cases (74.2%), 24 cases (20%) had endoscopy+ histology only, and 8 cases (3.2%) had only imaging scans. In terms of family history of EC, 20 cases (16.1%) had a family history of EC.Most of the patients were of ethnic Kenyan-Somali background (108 cases, Kenyan Somali, 87.1%) and majority were from Garissa County 96 cases (77.4%), 12 cases (9.7%) Wajir County, 12 cases (9.7%) from Tana River County and 4 cases (3.2%) from other counties. Many patients lacked health insurance (27 cases, 25.8%), while the majority paid out of pocket (92 cases,74.1%). Only 21% (26 cases) received chemotherapy alone, 5 cases (4%) got radiotherapy alone, 12.9% (16 cases) got chemoradiotherapy and a significant number of patients (77 cases, 62.1%) did not receive hospital-based cancer treatment. This study is the first esophageal study at the GRCC and in northern Kenya in general. Our study confirmed the clinicopathological features of one of the most common cancers in Kenya and more so among Kenyan-Somalis.The study also validates the predominance of histological subtypes of esophageal SCC with the late presentation, short survival and significant loss of follow-up. We recommend future EC studies employing a large prospective design with a large sample size to determine the impact of the new GRCC on the outcomes of EC patients and the local community.

NSAID-induced gastropathy in a comorbid patient in a multidisciplinary hospital

The purpose of this case report is to demonstrate the importance of outpatient management of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients, especially those at risk (elderly patients, alcohol abusers, patients with a history of peptic ulcer disease, patients taking glucocorticoids or anticoagulants) to avoid life-threatening complications. The following clinical case shows the association between gastric and duodenal mucosal barrier disruption and the use of nonsteroidal anti-inflammatory drugs. Methods: a complete blood count, blood biochemistry test, ultrasound, and abdominal radiography. Results. The clinical case describes a patient with coronary heart disease, ischemic cardiomyopathy, hypertension, permanent atrial fibrillation, impaired glucose tolerance, obesity, and a long history of smoking who had been taking 1–2 tablets of Nimesulide per day for a long time without doctor’s prescription; the intake of NSAIDs was not controlled on an outpatient basis. The reason for hospitalization was sharp pain in the epigastrium; the plain abdominal radiography in the emergency room revealed free gas below both domes of the diaphragm, and ultrasound examination of the abdominal cavity showed a level of inhomogeneous free fluid detected in all sloping areas and pneumatosis intestinalis. In this regard, the patient was urgently hospitalized to the department of surgery, where surgical intervention was performed, including upper-middle laparotomy, abdominoscopy, suture repair of the perforated gastric ulcer, and sanitation and drainage of the abdominal cavity. Conclusion. This clinical case draws attention to the problem of NSAID gastropathy in clinical practice. The task of a clinician is to prevent the development of NSAID-induced gastropathy, identify patients with risk factors for NSAID gastropathy at the earliest possible time, and carry out preventive and therapeutic measures. Patient management at the outpatient stage according to the clinical recommendations could have prevented the development of gastrointestinal bleeding associated with NSAID gastropathy.

Guillain – Barre syndrome associated with Helicobacter pylori isolates from rectal swabs of Four Patients: University of Benin Teaching Hospital Experience

Background: A Gram-negative bacteria known as Helicobacter pylori (H. pylori) is thought to be the cause of autoimmune gastrointestinal diseases. Additionally, this pathogen has been connected to peripheral neuropathies and extra-gastrointestinal illnesses with autoimmune sequelae. H. pylori may be involved in the 30% of GBS cases that Campylobacter jejuni is blamed for. Guillain-Barré syndrome (GBS) typically has a post-infectious aetiology. The Aim of the study is to show that rectal swabs to isolate Helicobacter pylori as a cause of Guillain - Barre syndrome should be a routine instead of gastric biopsy. Methods: The study was a Retrospective Cross Sectional Study. It involved a review of Case notes of Patients that were admitted in the Neurology Unit of UBTH from 2014-2019, been managed for Guillain-Barre syndrome associated with H. pylori infection and also a review of their Medical microbiology laboratory test records during management especially their rectal swab Microscopy, Culture and Sensitivity results. It has never been the practice of the Neurology unit to do rectal swabs for patients with Guillain - Barre syndrome, this was done by the medical microbiology unit that co-managed the patient. Patients with incomplete or missing medical data were excluded from the study. Results: Four case series of one male and three female patients, age ranged from 7 years to 23years with the mean age of 15 ± 8 years. The most common initial symptom was weakness in the extremities which was seen in all the patients. Motor deficit involved all four limbs in all the patients. The mode of onset was progressive in all the cases and ascending. History of peptic ulcer disease was present in all four patient and H. pylori was isolated from rectal swabs from all the patients. Three (75%) of the patient showed marked improvement on commencement of Omeprazole and erythromycin, while one (25%) ,did well on amoxicillin and Omeprazole. One (25%) had complications of bilateral patchy lower limb skin exfoliation and desquamation. A case of death was recorded. On discharge complete functional recovery was noted in two (50%), while one (33%) had partial recovery. Conclusion: This study of four case series highlights a relatively inexpensive and straightforward faecal specimen collection by rectal swab, and readily available faecal specimen compared with gastric biopsy specimen, in the laboratory diagnosis and isolation of Helicobacter pylori, a cause (among other causes) of Guillain-Barre Syndrome, which is a medical emergency in most cases.In addition Guillain-Barre Syndrome linked with H. pylori is not always a Post-infectious diseases because medications used to clear the gastrointestinal tract of Bacterial usually lead to recovery from the paralysis caused by Guillain-Barre Syndrome.

Profile of Peptic Ulcer Disease and its Risk Factors amongst Health Science Students at Umm Al-Qura University

Background: Peptic ulcer is a common disease that can lead to several complications, such as bleeding and perforation. Identifying the prevalence and risk factors will help in prevention and early treatment to avoid further issues. Consequently, in this study, we aim to estimate peptic ulcer prevalence and risk factors among health science students at Umm Al-Qura University (UQU). Methods: A cross-sectional study was administered by an online questionnaire in June 2022. The survey was distributed to all health science students who study at Umm Al-Qura University during the 2021-2022 academic year. Results: A total of 342 participants were included in the study. The majority were males, accounting for 72.2%. Our study showed that only 4.4% of respondents had a positive history of peptic ulcer disease. We found that spicy food and Helicobacter pylori were the main risk factors for peptic ulcer disease among participants with 46.7% and 26.7% respectively. Conclusion: Peptic ulcer disease is a worldwide health dilemma. Our study found that 4.4% of the participants have a positive history of peptic ulcers. The main risk factors reported among respondents were spicy food and Helicobacter infection with 46.7% and 26.7% respectively. Educational health efforts are recommended.

Chicken bone-induced ileal perforation peritonitis mimicking duodenal perforation peritonitis: a case report

Introduction: Foreign body ingestion can lead to bowel perforation and peritonitis. We present a case of a 54-year-old male who ingested a chicken bone, resulting in ileal perforation that mimicked duodenal perforation peritonitis. Case Presentation: The patient has a history of peptic ulcer disease and regularly used non-steroidal anti-inflammatory drugs over the counter, adding more evidence to the provisional diagnosis of duodenal perforation. Exploratory laparotomy revealed the ileal perforation and the chicken bone was successfully removed. Wedge resection of the perforated segment and ileo-ileal anastomosis were performed. Discussion: Although history, examination, and investigation were more in favor of duodenal ulcer, our patient had ileal perforation due to chicken bone. Prompt identification and early surgical intervention are crucial to prevent complications and reduce mortality rates. The patient had an uneventful recovery. Conclusion: Timely referral to a tertiary care center is essential for early surgical intervention and successful management of bowel perforation caused by a foreign body.

Incidence of Acute Upper Gastrointestinal Bleeding and Related Risk Factors among Elderly Patients Undergoing Surgery for Major Limb Fractures: An Analytical Cohort Study

(1) Background: Upper gastrointestinal bleeding (UGIB), a major postoperative complication after surgical fixation of major limb fractures, can be fatal but is often neglected. This study determined the incidence rates of and related risk factors for perioperative UGIB among older patients with major upper limb fractures but without a history of peptic ulcer disease (PUD). (2) Methods: We collected the data of patients aged more than 65 years who underwent surgery for major limb fracture between 1 January 2001 and 31 December 2017, from Taiwan’s National Health Insurance Research Database and excluded those with a history of UGIB and PUD before the date of surgery. The primary outcome was the incidence of UGIB requiring panendoscopy during hospitalization. A multiple logistic regression model was used to identify the independent predictors of UGIB, with adjustment for confounding factors. The final model included variables that were either statistically significant in univariate analyses or deemed clinically important. (3) Results: The incidence of UGIB was 2.8% among patients with major limb fractures. Male sex, older age, major lower limb fracture, and a history of chronic renal disease were significant risk factors for the increased incidence of perioperative UGIB. (4) Conclusions: Patients with major limb fractures who underwent surgery exhibited a higher rate of stress ulceration with UGIB, even when they had no history of PUD. Perioperative preventive protocols (e.g., protocols for the administration of proton-pump inhibitors) may be necessary for patients with these major risk factors.

Antiplatelet Therapy for Secondary Prevention of Stroke in Hypertensive Elderly Patients with History of Peptic Ulcer Disease: A Multicenter Cohort Study

<p>背景/目的：阿斯匹林(Aspirin)被用來當作心血管疾病的次級預防治療，但目前特別針對老人族群的阿斯匹林使用實證和指引並未完全建立。若產生消化性潰瘍之高血壓長者，尚未有研究去探討出血後繼續使用阿斯匹林之適切性，本研究將探討上消化道出血後，高血壓長者若持續使用阿斯匹林後續產生主要心腦血管事件及上消化道出血住院的相關性。</p> <p>方法：本研究設計擬以回溯性世代研究的方式，於台大醫院及其分院資料庫作為研究資料來源。申請臺大醫療體系醫療整合資料庫，日期自2014年1月1日至2018年12月31日，當中有使用阿斯匹林且做胃鏡之65歲以上高血壓病人。分三組進行前瞻性追蹤（病歷回溯日期範圍自2014年1月1日至2020年12月31日），分別為停止使用阿斯匹林組、續用阿斯匹林組、轉換成Clopidogrel組，主要預後為主要腦心血管事件、上消化道出血住院。分析方式包括Cox比例風險模型、治療權重倒數機率。</p> <p>結果：共735位病人納入分析，平均追蹤時間為39.7個月，共140人發生腦心血管事件。轉換成Clopidogrel組(n=88)並未發現減少主要腦心血管事件(adjusted HR 1.09, 95% CI 0.63-1.87)，且續用阿斯匹林組(n=210)增加主要腦心血管事件發生(adjusted HR 1.58, 95% CI 1.04-2.38)，相對於停止使用阿斯匹林組(n=172)。在後續上消化道出血住院的風險，轉換成Clopidogrel組(adjusted HR 1.07, 95% CI 0.48-2.37)和續用阿斯匹林組(adjusted HR 1.14, 95% CI 0.61-2.10)都沒有增加，但在次族群分析當中，慢性腎病病人有較高風險產生後續上消化道出血住院(adjusted HR 2.41, 95% CI 1.30-4.47)。</p> <p>結論：此研究發現使用阿斯匹林之老年高血壓病人若因消化道潰瘍出血，後續續用阿斯匹林作為次級預防，並未減少心血管事件發生。抗血小板藥物作為老年高血壓病人之次級預防的適切性在消化道潰瘍發生後更應小心評估，尤其是在慢性腎病的共病下，可能會增加後續產生上消化道出血住院之風險。</p> <p> </p><p>Objectives: The cardiovascular and bleeding outcomes of antiplatelet therapy continuation in older hypertensive adults with peptic ulcer disease (PUD) are uncertain. We aimed to investigate the appropriateness of maintaining antiplatelet therapy in older hypertensive aspirin users with PUD by determining the risks of major adverse cardiac events (MACEs) and hospitalizations for upper gastrointestinal bleeding (hUGIBs). </p> <p> Methods: This multicenter cohort study screened patients with panendoscopy-proven PUD and hypertension aged 65 years or older between 2014 and 2018. Subsequent antiplatelet strategies were categorized as aspirin discontinuation (AD), aspirin continuation (AC), and switch to clopidogrel (SC) groups. Inverse probability of treatment weighting was applied. The main outcomes were incident MACEs and hUGIBs, followed through 31 December 2020. </p> <p> Results: 735 eligible patients were analyzed. During a median follow-up of 39.7 months, 140 MACEs occurred. Compared with AD, AC increased the risk of incident MACEs (adjusted HR 1.58, 95% CI 1.04-2.38) in secondary prevention patients. On the other hand, 102 hUGIBs occurred during a median follow-up of 43.4 months. Compared with AD, neither AC nor SC affected the risk of hUGIBs in secondary prevention patients. However, secondary prevention patients with chronic kidney disease were at increased risk of hUGIBs (adjusted HR 2.41, 95% CI 1.30-4.47). </p> <p> Conclusions: AC did not reduce MACEs in older hypertensive adults with PUD previously taking aspirin for secondary prevention. We do not advocate continuing antiplatelet therapy in older hypertensive adults once with PUD, despite its neutral association with hUGIBs.</p> <p> </p>

Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view.

Aspirin, other antiplatelet agents, and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases. A concomitant proton pump inhibitor (PPI) treatment is often prescribed in these patients, as gastrointestinal complications are relatively frequent. On the other hand, a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs; in particular, it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel, due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism. Previously, the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged. In contrast, it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel, new P2Y12 receptor antagonists. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids, or non-steroidal anti-inflammatory drugs, and Helicobacter pylori (H. pylori) infection. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could be recommended, even if their usefulness deserves further data. H. pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease (with or without complication) treated with antithrombotic drugs. The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors, anticoagulants, and PPIs, discussing consequent clinical implications.

Principles for the use of non-steroidal anti-inflammatory drugs with proton pump inhibitors

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in numerous areas of medicine. By inhibiting the prostaglandin synthesis pathway, they contribute to the development of injuries to the mucous membranes within the gastrointestinal tract, possibly leading to gastrointestinal bleeding. Proton pump inhibitors (PPIs) are used to prevent such events in high-risk groups. The bleeding risk is highest in patients above the age of 65, patients with a history of gastrointestinal bleeding, and patients with a history of peptic ulcer disease. The efficacy of bleeding prevention could not be proven in other groups. Notably, PPIs are associated with serious side effects, including acute kidney injury, malabsorption syndrome, and osteoporosis. Therefore, recommending the use of PPIs within the framework of prevention should be approached with caution. The widespread belief that IPP should be automatically prescribed together with NSAIDs is false and harmful to patients.

Features of the blood cytokine profile in gastroesophageal reflux disease in schoolchildren with gastritis and family history of peptic ulcer

Gastroesophageal reflux disease (GERD) is a common acid-dependent disease among the population, including children, with multifactorial genesis. It, like many other acid-dependent diseases (peptic ulcer, etc.) is associated with a family predisposition to the disease. Of interest is the study of the role of cytokines in the regulation of pathology in childhood, depending on the severity of a family history of peptic ulcer disease. Aim: to evaluate the levels of cytokines in the blood serum in case of family history of ulcerative diseases in schoolchildren with gastritis associated with GERD. In the course of a scientific study, 142 children with gastroenterological complaints aged 7-17 years were examined. The diagnosis of GERD was made in the presence of weekly heartburn in accordance with the global consensus on pathology in children. All subjects underwent gastroscopy with taking biopsy material from the gastric mucosa and morphological confirmation of their diagnosis of gastritis in accordance with the Sydney classification. The concentration of cytokines in blood serum (IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, IL-1β, IFNα, TNFα) was obtained by enzyme immunoassay. During statistical processing, the χ2 and Mann–Whitney tests were used. The studies were approved by the ethics committee and informed consents of patients and their parents were obtained prior to the start of the study. The results of the study did not show significant differences in the concentration of cytokines in schoolchildren depending on the presence of GERD. In children with a family burden of peptic ulcer, GERD was detected more often (p = 0.054), which is probably a consequence of their increased acid formation. Changes in the cytokine profile of the blood were noted. During GERD, with aggravation of peptic ulcer, there was an increase in the replication of IL-4 (p = 0.027) and IFNα (p = 0.001). The increase in blood IFNα in children with GERD with family burden is obviously aimed at enhancing immune responses involving the whole body to damage. This is due to its functional role – participation in the immune response. Increased replication of IL-4, obviously, provides an increase in metabolic, immune processes in the body aimed at optimizing the course of proliferative processes in the esophageal mucosa under conditions of increased secretion of hydrochloric acid in the stomach. Thus, when a family history of peptic ulcer is aggravated in schoolchildren with gastritis associated with GERD, a number of links in the cytokine network (IL-4, IFNα) move to the systemic level of regulation.

H. Pylori Gastritis and Gastric Carcinoma: Uncovering Histological Links and Risk Factors

Objective: Aim was to determine the risk of gastric carcinoma among patients of Helicobacter pylori gastritics and its risk factors. Study Design: Retrospective study Place and Duration: Department of gastroenterology, DHQ Teaching Hospital and Ghazi Khan Medical College DG Khan, Punjab in the duration from November, 2022 to April, 2023. Methods: Total 131 patients who had gastric carcinoma were included. Stored serum samples collected, were tested for IgG antibodies to H. pylori by enzyme-linked immunosorbent assay. Data on cigarette use, blood group, ulcer disease, and gastric surgery were obtained from questionnaires administered at enrollment. Tissue sections and pathology reports were reviewed to confirm the histologic results. SPSS 23.0 was used to analyze data. Results: In our study, male patients were higher in numbers 86 (65.6%) as compared to females 45 (34.4%). The patients mean age was 51.17±6.20 years and had mean BMI 24.16 ±7.46 kg/m2. 73 (55.7%) patients had smoking history. 97 (74.04%) patients had gastric ulcer. Average time from serum collection to stomach gastric carcinoma was 12.7±3.26 years. Among all, 74 (56.5%) patients had adenocarcinoma, gastroesophageal junction was found in 20 (15.3) cases, gastric lymphoma in 11 (8.4%) cases and 26 (19.4%) cases had undetermined or other cancers. We found that 83 (63.4%) patients had history of H.pylori infection. There was a significant negative association between a history of peptic ulcer disease and eventual gastric carcinoma (P = 0.003) and an independent association between a history of gastric surgery and the development of cancer (p = 0.004). Conclusion: The results of this research led us to the conclusion that an infection with H. pylori is linked to an elevated risk of gastric adenocarcinoma and may play a role as a cofactor in the process that leads to the development of this malignant condition. Keywords: H.pylori infection, Gastric Carcinoma, Risk Factors

Frequency of Helicobacter Pylori (H. Pylori) among Patients presenting with Duodenal Perforation

Aim: To determine the frequency of helicobacter pylori among patients presenting with duodenal perforation. Study design: Descriptive cross-sectional study. Place and duration of study: General Surgery Department Hayatabad Medical Complex Peshawar from 1st March 2021 to 30th September 2021 Methodology: One hundred and seventy five patients who had a first-time duodenal perforation, were between the ages of 20 and 60, and had a prior history of peptic ulcer disease lasting at least six months were included. Results: Thirty three (18.8%) patients had H pylori in body mass index of 18.5-24.9kg/m2, 39(22.3%) in BMI 24.9-29.9kg/m2 and 19(10.8%) in BMI 30-32.2 kg/m2. Fifty nine (33.7%) patients had H. Pylori who had peptic ulcer disease (PUC) since 7-11 years and 32(18.36%) had the condition with PUC 11-15 years. 69(39.4%) belongs to Urban areas, while 22(12.6%) belongs to rural areas. 18(10.3%) patients found to be chain smoker, while diabetes mellitus and hypertension was noted in 15(8.6%) Conclusion: Our population frequently develops duodenal perforation from H. Pylori owing to peptic ulcer disease. It is a serious problem and we advise more study to identify risk factors linked to this high H. Pylori burden and preventive measures to stop its spread and the morbidity linked to it. Key Words: Helicobacter pylori, Duodenal ulcer, Gastric ulcer, Peptic ulcer, Perforated peptic ulcer, ELISA

Overuse of Intravenous Proton Pump Inhibitors in General Medicine and Surgery Wards.

Overuse of stress ulcer prophylaxis is prevalent globally despite guidelines leading to the added cost, especially the intravenous proton pump inhibitor (IVPPI). This study aims to analyze the prevalence of such overuse and be aware of rational use which may help develop local guidelines. This study analyzed the prospectively collected data on IVPPI use in adult patients in general wards of medicine and surgery at Patan Hospital, Patan Academy of Health Sciences, Nepal, from April-Jun 2022. Ethical approval was obtained. Variables analyzed were the patient's age, gender, history of peptic ulcer disease, risk for stress ulcer and gastrointestinal bleeding, the status of nil per os (NPO ≥12 hours), appropriate use of IVPPI, and cost. Prevalence of IVPPI use was 36.24% (274/756 admissions), surgery 39.45(189/479), medicine ward 30.68% (85/277). The mean age was 43.1 ±18.6 years, males 113(41.2%), surgery 189 (69%). Inappropriate overuse in 253(92.3%, significantly more in surgery-182 than medicine-7, p=0.001. Appropriate use was in 21 (7.7%, i.e., NPO-15, NPO + gastrointestinal bleed, and NPO + non steroid anti-inflammatory drugs each 3). Prevalence of IVPPI use was 36.24%. Inappropriate overuse of IVPPI was high (92.2%, 253/274), more in surgery. The nil per os status was the main reason for appropriate use of IVPPI.

ВАРИАНТ АЛГОРИТМА ПРОГНОЗИРОВАНИЯ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК ПРИ ИНФАРКТЕ МИОКАРДА У МУЖЧИН МОЛОЖЕ 60 ЛЕТ

Relevance. Acute kidney injury (AKI) in myocardial infarction worsens the prognosis and increases the duration of treatment of patients. Aim. To evaluate the significance of the AKI development predictors during MI in males under 60 years old. To create a model for predicting the risk of developing this complication in the form of a diagnostic algorithm to improve prevention and outcomes. Material and methods. The study included men 32-59 years old (y.o.) with type I MI. Patients were divided into two age-comparable groups: I - study group, with AKI - 25 patients; II - control, without it - 166 patients. Pearson's Chi-square method was used to assess the absolute (AR) and relative (RR) risks of developing AKI under the influence of various factors. Mathematical modeling of the risk of developing this complication was performed using the classification tree method. Results. Among the features of predictors of AKI in myocardial infarction in the examined patients in comparison with the established risk factors for its development, the following were distinguished: stress (AR: 15.9%; p=0.01), winter season (AR: 21.8%; RR: 3.1; p=0.003), hypertriglyceridemia (≥1.8 mmol/l) (AR: 23.0%; p=0.007) and peptic ulcer (AR: 25.8; RR: 2.5; p=002). For the decision tree, the most significant of them were the winter period of the year and the value of the patient's systolic (sys) blood pressure (BP) in the first hours of MI. With the help of a decision tree, four risk classes are identified. The highest risk level (30.2%; group size = 53) was in patients with MI in the winter period and BPsyst≥130 mmHg. The lowest risk level (0.0%, group volume = 45) for the development of AKI was observed for MI in spring, summer and autumn periods and BPsyst˂135.0 mm Hg. With BPsyst≥135 mm Hg. during these periods, the risk of developing AKI increases to 11.6% (69 patients). In winter, with a decrease in BP˂130 mm Hg. the risk of developing AKI is reduced to 4.2% (24 people). The sensitivity of the model was 94.1%; specificity - 70.9%; efficiency - 82.5%. Conclusions. Additions to the known predictors of the development of AKI in MI in males under 60 y.o. were: the winter period, stress, hypertriglyceridemia in the first hours of MI (≥1.8 mmol/l) and a history of peptic ulcer disease. Based on a combination of BP and winter period indicators, a model for assessing the risk of development this complication was built. It allows identifying a risk group for development AKI among patients with MI for follow-up and timely preventive and therapeutic measures.

Abstract P059: A case of stage I esophageal adenocarcinoma diagnosed using a multi-cancer early detection test

Abstract Introduction: There is no guideline-recommended screening test for esophageal cancer, a cancer that occurs in approximately 1 in 125 men and 1 in 417 women in the US. Risk factors for esophageal adenocarcinoma include gastroesophageal reflux disease, Barrett’s esophagus, obesity, and smoking. A multi-cancer early detection (MCED) test that analyzes methylation patterns of cell-free DNA in the blood using sequencing assays and machine-learning classifiers is available as a complement to existing single-cancer screening tests. The MCED test reports either (1) ‘cancer signal detected’ with 1 or 2 cancer signal origin (CSO) prediction(s) or (2) ‘cancer signal not detected’. A case of esophageal adenocarcinoma is presented here to demonstrate early detection using the MCED test and to review the diagnostic journey following a cancer signal detected (positive) test result. Case Description/Methods: An asymptomatic 63-year-old White male (BMI: 27 kg/m2) with history of peptic ulcer disease was screened using the MCED test. He reported moderate alcohol use (6/week) and no tobacco use. His last colonoscopy was 5 years prior to using the test. Nine days after a blood sample was collected for analysis by the MCED test, a positive test result (CSO prediction=Stomach/Esophagus) was reported and communicated to the patient (Day 1). Computed tomography (CT) of the chest, abdomen, and pelvis with contrast showed no significant findings (Day 13). A submucosal bulge just below the gastroesophageal junction (GEJ) was noted on upper endoscopy. The lesion, and area above the GEJ were extensively biopsied (Day 15). Pathologic evaluation confirmed diagnosis of Clinical Stage I esophageal adenocarcinoma with superficial focally invasive adenocarcinoma arising in a background of intestinal metaplasia with high grade dysplasia (Day 29). The patient underwent total gastrectomy without complications (Day 104). He will undergo appropriate follow-up 6 months post-op. Discussion: The MCED test detected a cancer signal and predicted a gastrointestinal CSO for an asymptomatic individual with Clinical Stage I esophageal cancer. Diagnostic resolution was achieved within 1 month and treatment was provided with curative intent. Given that there is no guideline-recommended screening test available for esophageal cancer, the use of this MCED test detected cancer early, directed diagnostic workup, and potentially improved outcomes for this asymptomatic patient. Citation Format: David DeAtkine Jr. A case of stage I esophageal adenocarcinoma diagnosed using a multi-cancer early detection test. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P059.

Gastric Candidiasis Leading to Gastric Perforation: A Case Report

Gastric candidiasis is commonly seen in immunocompromised patients with malignant conditions and patients who have undergone gastrectomy. It is also observed in patients who frequently use antacids. The most common presentation of gastric candidiasis is single or multiple ulcerations, with perforation being an infrequent occurrence. The present case report describes a 38- year-old male with a known history of peptic ulcer disease, who presented with abdominal pain and shortness of breath for the past two days. The patient had been using antacids and Proton Pump Inhibitors (PPIs) for two years. Chest and abdomen radiographs revealed an air shadow under the right diaphragm. Emergency surgery was performed, revealing two stomach perforations. The patient underwent primary repair and a Modified Graham’s patch repair. Histological examination of the perforation margin showed invasive candidal colonisation. The patient experienced a series of postoperative complications during their hospital stay, all of which were successfully managed. The patient was discharged on the 40th postoperative day. Therefore, it was concluded in this case that the chronic use of antacids and PPIs may have created an alkaline environment, facilitating candidal colonisation of the stomach, ultimately leading to ulceration and perforation.

The Association between Peptic Ulcer Disease and Gastric Cancer: Results from the Stomach Cancer Pooling (StoP) Project Consortium.

Simple SummaryGastric cancer (GC) is the fifth most common type of cancer and the fourth most common cause of cancer-related mortality. In this meta-analysis, we utilized SToP consortium data to investigate the association between gastric ulcer (GU) and duodenal ulcer (DU) and development of GC. Among 4106 GC cases and 6922 controls, we detected a positive association between GU and GC (OR = 3.04, 95% CI: 2.07–4.49). On the other hand, no significant association between DU and GC was detected (OR = 1.03, 95% CI: 0.77–1.39). In the pooled analysis, incorporating 11 case–control studies revealed positive association between the gastric ulcer and risk of gastric cancer. Background. Gastric cancer (GC) is the fifth most common type of cancer and the fourth most common cause of cancer-related mortality. Although the risk of GC and peptic ulcer disease (PUD) is known to be increased by H. pylori infection, evidence regarding the direct relationship between PUD and GC across ethnicities is inconclusive. Therefore, we investigated the association between PUD and GC in the Stomach cancer Pooling (StoP) consortium. Methods. History of peptic ulcer disease was collected using a structured questionnaire in 11 studies in the StoP consortium, including 4106 GC cases and 6922 controls. The two-stage individual-participant data meta-analysis approach was adopted to generate a priori. Unconditional logistic regression and Firth’s penalized maximum likelihood estimator were used to calculate study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between gastric ulcer (GU)/duodenal ulcer (DU) and risk of GC. Results. History of GU and DU was thoroughly reported and used in association analysis, respectively, by 487 cases (12.5%) and 276 controls (4.1%), and 253 cases (7.8%) and 318 controls (6.0%). We found that GU was associated with an increased risk of GC (OR = 3.04, 95% CI: 2.07–4.49). No association between DU and GC risk was observed (OR = 1.03, 95% CI: 0.77–1.39). Conclusions. In the pooled analysis of 11 case–control studies in a large consortium (i.e., the Stomach cancer Pooling (StoP) consortium), we found a positive association between GU and risk of GC and no association between DU and GC risk.