Peptic Ulcer Disease Patients Research Articles

Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding: Meta-analysis of randomized controlled trials.

Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness. To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions. A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models. A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; P = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; P = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; P = 0.91. In SLE vs non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; P = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; P = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; P = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; P = 0.70. SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Comparison of Risk and Severity of Helicobacter Pylori Infection in Non-Native Versus US Native Pediatric Patients.

Helicobacter pylori (HP) infection is associated with gastritis, peptic ulcer disease (PUD) in the stomach and duodenum, and an increased risk of gastric cancer. The risk of infection, secondary symptoms, and negative outcomes is known to be increased in low- and middle-income countries and vastly less substantial in the United States and Europe. Current North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines recommend endoscopic diagnosis and susceptibility-guided therapy, which is not reflected by current adult guidelines for therapy. In this study, we complete a single-center retrospective review of HP risk by nativity status, as well as the results of the use of standard empiric therapy in HP and PUD patients. We retrospectively reviewed all endoscopies with patients aged 1-21 years with a known nativity status and identified all HP diagnoses. We also completed the classification of Kyoto scores and classified patients as gastritis versus PUD. Treatment records were obtained, as well as downstream documentation of the impact of empiric therapy. HP prevalence and severity were compared between non-native and native US populations. In total 332 patients were identified, with 59 HP diagnoses. However, 64 patients were immigrants, and 268 were US natives. Totally 39.1% of all immigrant patients had an endoscopically identified HP infection, compared to only 12.7% of US native patients (P < 0.01, relative risk 3.07). HP severity was worse in immigrant patients (Kyoto score 1.5 versus 0.89; P = 0.008). Empiric high-dose amoxicillin triple therapy was equally effective in reducing symptoms in gastritis versus PUD patients. Immigrant patients have a substantially higher risk and severity of HP infection than US natives. Empiric therapy remains highly effective at relieving symptoms. These findings in aggregate suggest that North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines may not adequately serve non-native pediatric patients, with an additional prospective multicenter study needed to confirm. In addition, a prospective study of treatment based on stool antigen tests, as well as a larger prospective study of empiric therapy, may suggest alterations to our approach in line with recent changes to adult Gastroenterology practice.

Elevated expression of the AIM2 gene in response to Helicobacter pylori along with the decrease of NLRC4 inflammasome is associated with peptic ulcer development.

Helicobacter Pylori (H. Pylori) cause peptic ulcer disease (PUD), but the inflammasome's role in PUD is not well understood. Therefore this study has investigated inflammasome compartment expression and IL-1β production in gastritis (G) and peptic ulcer disease. This study was based on gene expression of inflammasome compartments on stomach biopsies of 50 patients with PUD as cases and 50 individuals with gastritis as controls. The expression of NLRC4, ASC, IL-18, and serum IL-1β decreased in the PUD group compared to the control group. AIM2 gene expression increased, and NLRP12 gene expression decreased in H. pylori-seropositive positive (HP+ ) individuals compared to H. pylori-seronegative (HP- ) individuals. The G-HP+ subjects had higher serum IL-1β and AIM2 gene expression than G-HP- subjects but lower NLRP3 and NLRP12 gene expression. The PUD-HP+ had lower serum IL-1β, but higher AIM2 and IL-18 expression than PUD-HP- . The PUD-HP- patients had decreased IL-18 expression than G-HP- group. The PUD-HP+ had lower serum IL-1β and NLRC4 expression than G-HP+, while NLRP1 and NLRP3 were higher in expression in PUD-HP+ . The expression of caspase-1, NLRP3 and NAIP were correlated with IL-1β and IL-18. In conclusion, a decrease in NLRC4, IL-18, ASC genes, and IL-1β levels in PUD patients compared to gastritis may act in the development of PUD. H. pylori caused AIM2 induction and reduced NLRP12, indicating their contribution to bacterial responses. Decreased NLRC4 expression and IL-1β protein, together with enhanced NLRP1, and NLRP3 expression, promotes H. pylori to develop peptic ulcers.

OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS

Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD.

Epidemiological Aspects of Peptic Ulcer Disease in Mopti (Mali)

Introduction: Peptic ulcer disease is a benign condition, but its severity is linked to the risk of complications, hemorrhage, perforation, stenosis and gastric cancer. The objective of this work was to describe the epidemiological aspects of peptic ulcer disease in Mopti (Mali). Methods and patients: From 1st January 2019 to December 2021, we carried out a descriptive cross-sectional study on cases of peptic ulcer disease in patients seen in upper digestive endoscopy in the medical department of the Sominé Dolo hospital in Mopti and the BRICO II medical center in Sévaré. Were included in this study, all patients with a peptic ulcer objectified by upper digestive endoscopy with biopsy for histological examination. Were not included, cases of gastric ulceration related to cancer, lymphoma, granuloma. Result: During the study period, 1894 upper digestive endoscopies were performed and 107 gastroduodenal ulcers were diagnosed, representing a frequency of 5.64%. The patients were divided into 65 men (60.75%) and 42 women (39.25%), i.e. a sex ratio of 1.54. Housewives and farmers were respectively represented (36.4%) and (19.6%). The lesions were located on: the antrum (70.10%), the bulb (25.20%), the antrum and bulb (4.70%). The other gastroduodenal affections found were: erosive duodenitis (2.8%), gastropathy erythematous antral (7.8%), gastropathy corporeal - antral erythematous (15.8%), mosaic PH gastropathy (5.6%). Helicobacter _ pylori was found in 96% of patients and all patients had chronic, active gastritis more or less atrophic according to the Sydney classification. Conclusion: Our study revealed a high frequency of Helicobacter pylori. The proliferation of digestive endoscopy centers makes it possible to better improve diagnosis and management at the regional level.

Proteome analysis reveals novel serum biomarkers for Henoch-Schönlein purpura in Chinese children

PurposeHenoch-Schönlein purpura (HSP) is diagnosed based on characteristic skin changes. This study aimed to identify the serum biomarkers of HSP in children. Experimental designWe performed proteomic analysis of serum samples from 38 paired pre- and posttherapy HSP patients and 22 healthy controls using a combination of magnetic bead-based weak cation exchange and MALDI-TOF MS. ClinProTools was used to screen the differential peaks. Then, LC–ESI–MS/MS was performed to identify the proteins. ELISA was used to verify the expression of whole protein in the serum of 92 HSP patients, 14 peptic ulcer disease (PUD) patients and 38 healthy controls, which were prospectively collected. Finally, logistic regression analysis was performed to analyze the diagnostic value of the above predictors and existing clinical indicators. ResultsSeven potential HSP serum biomarker peaks (m/z:1228.95, m/z:1781.22, m/z:1468.43, m/z:1619.53, m/z:1868.41, m/z:1694.05, m/z:1743.25) with higher expression in the pretherapy group and one peak (m/z:1947.41) with lower expression in the pretherapy group were all identified as peptide regions of albumin (ALB), complement C4-A precursor (C4A), tubulin beta chain (TUBB), isoform 1 of fibrinogen alpha chain (FGA), and ezrin (EZR). The expression of identified proteins was validated by ELISA. Multivariate logistic regression analysis showed that serum C4A EZR and ALB were independent risk factors for HSP, serum C4A and lgA were independent risk factors for HSPN, and serum D-dimer was an independent risk factor for abdominal HSP. Conclusions and clinical relevanceThese findings revealed the specific etiology of HSP from the perspective of serum proteomics. The identified proteins might serve as potential biomarkers for HSP and HSPN diagnoses. SignificanceHenoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, and its diagnosis depends primarily on characteristic skin changes. Early diagnosis of non-rash patients is difficult, especially for abdominal and renal types (Henoch-Schönlein purpura nephritis, HSPN). HSPN has poor outcomes, is diagnosed based on urinary protein and/or haematuria, and cannot be detected early in HSP. Patients with an earlier diagnosis of HSPN appear to have better renal outcomes. Our plasma proteomic analysis of HSP in children revealed that HSP patients could be distinguished from healthy controls and peptic ulcer disease patients using complement C4-A precursor (C4A), ezrin, and albumin. C4A and IgA could distinguish HSPN from HSP in the early stages, and D-dimer was a sensitive index used to distinguish abdominal HSP; identifying these biomarkers could promote the early diagnosis of HSP, especially pediatric HSPN and abdominal HSP, thereby improving precision therapy.

OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS

Abstract INTRODUCTION Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &amp;/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p &amp;lt; 0.05 for statistical significance. RESULTS A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population. DISCUSSION The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .

THE ASSESSMENT OF ACUPRESSURE EFFECTIVENESS AND SAFETY IN THE COMPREHENSIVE TREATMENT AND REHABILITATION OF PATIENTS WITH PEPTIC ULCERS

Aim: The paper evaluates effectiveness and safety of acupressure (AP) in the comprehensive treatment and rehabilitation of patients with uncomplicated peptic ulcer disease (PUD). Materials and Methods: The study retrospectively assessed the effectiveness of treating 24 PUD patients, who received AP session following the author’s protocol based on Houston F.M. recommendations. The statistical analysis of the results employed the algorithm for qualitative data analysis applying the MedCalc 2023 software package. We analyzed the frequency of clinical syndrome manifestations before and after treatment, calculating the interval estimate of this measure (95% confidence interval (CI)). The study formulated null and alternative statistical hypotheses applying the McNemar test to check the null hypothesis for paired samples. When evaluating the risk of AP side effects, we determined 95% CI for proportion, considering binomial distribution of the feature (“presence-absence of complications”). Results: After completing the treatment course and observing the absence of endoscopic signs of peptic gastropathy, we detected statistically significant changes in the frequency of all clinical syndrome manifestations (p-value &lt; 0.0001, based on the McNemar test). AP rapidly and effectively alleviated the main clinical manifestations in patients with PUD. The tolerability of acupressure was good, without side effects. The study determined with 95% probability, that the risk of adverse effects did not exceed 15%. Conclusions: AP is easy to use, non-invasive adjunctive therapy and alternative medical practice during the rehabilitation stage for PUD patients. It proves to be effective, safe, and inexpensive non-pharmacological method of treatment and rehabilitation, aligning with the alternative statistical hypothesis.

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

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

Prospective study on surgical complication of peptic ulcer disease in tertiary care hospital

Introduction: Peptic ulcer disease indicates both gastric and duodenal ulcers. This ulcer is a major threat worldwide over the past two centuries with a high morbidity and mortality. Some epidemiological studies concluded that there is strongly association between H. Pylori infection and peptic ulcer. There is also some studies suggested that there is a complications that is seen after post operative peptic ulcer. Objective: To study the postoperative complication in peptic ulcer disease patients in tertiary care hospital. Material: A prospective study conducted on 180 post operative peptic ulcer patients. This study was conducted in Department of Surgery, ASJSATDS Medical College, Fatehpur. This study was carried out after taking approval from Institute Ethics Committee and informed consent from patient. Results: The present study was carried out on 180 post operative peptic ulcer patients, among them majority of the patients were males 116 (64.44%), age group under 41 to 50 years. As per the occupation, majority of the patients were employed 112 (62.22%) followed by studying 48 (26.66%) Total of 54 patients having ulcers in stomach as such 32 (59.25%) having multiple ulceration.

S1584 Prevalence of Non-Helicobacter pyloriPeptic Ulcers in Patients With Chronic Pancreatitis: A Population-Based National Study

Introduction: Acute and chronic pancreatitis are recognized as a continuum of the same disease, with a significant overlap in clinical manifestations. The association between peptic ulcer disease (PUD) and acute pancreatitis (AP) has been described in the literature. However, there is no available data on the prevalence of PUD in patients with chronic pancreatitis (CP). Methods: The aim of this study was to investigate if CP is associated with increased overall risk of PUD, gastric ulcers, and duodenal ulcers. Data was collected from a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the US between 12/2016-12/2021. We identified patients with CP based on Systemized Nomenclature of Medicine – Clinical Terms and excluded patients with Helicobacter pylori infection of the gastrointestinal tract. We compared the prevalence of peptic ulcer, gastric ulcer, and duodenal ulcer after at least 30 days following a diagnosis of CP to a cohort without CP. Results: Of the 33,660,510 patients in the database without H. pylori, we identified 66,550 cases of CP. We identified 2,480 cases of peptic ulcer, 2,680 cases of gastric ulcer and 1,420 cases of duodenal ulcer in patients with CP. In comparison, we identified 160,270 cases of peptic ulcer, 201,600 cases of gastric ulcer and 81,920 cases of duodenal ulcer in patients without CP. Overall prevalence for peptic ulcer, gastric ulcer, and duodenal ulcer in patients with CP was 3727/100000, 4027/100000 and 2134/100000 people, respectively. In comparison, overall prevalence for peptic ulcer, gastric ulcer, and duodenal ulcer in patients without CP was 477/100000, 600/100000 and 244/100000 people, respectively. The prevalence ratios (PR) for developing each diagnosis after at least 30 days of a CP diagnosis were 7.81 (95% CI 7.51-8.12, P< 0.001), 6.71 (95% CI 6.47-6.97, P< 0.001), and 8.75 (95% CI 8.31-9.22, P< 0.001), respectively. Table 1 describes the prevalence of PUD among various demographics. Conclusion: In this large population-based study, peptic ulcer, gastric ulcer, and duodenal ulcer were all significantly more prevalent among patients with a diagnosis of CP. Future investigation will be useful in understanding the pathophysiology of this association. Table 1. - Prevalence of peptic ulcer, gastric ulcer and duodenal ulcer in patients with and without chronic pancreatitis Chronic Pancreatitis (CP) No CP Prevalence in CP /100,000 Prevalence in No CP /100,000 Prevalence Ratio 95% CI P-value Peptic Ulcer 2480 160270 3726.52 477.08 7.81 7.51-8.12 < 0.001 Adults (18-65) 1640 74130 3964.23 374.11 10.60 10.1-11.1 < 0.001 65)"}" > Elderly ( >65) 840 85440 3362.69 1088.74 3.09 2.89-3.30 < 0.001 Caucasian 1700 119480 3739.55 657.53 5.69 5.43-5.96 < 0.001 African American 670 24730 5153.85 648.38 7.95 7.38-8.57 < 0.001 Asian 20 2860 2985.07 536.31 5.57 3.61-8.58 < 0.001 Male 1210 64750 3587.31 434.60 8.25 7.81-8.73 < 0.001 Female 1270 95450 3861.36 516.79 7.47 7.08-7.89 < 0.001 Gastric Ulcer 2680 201600 4027.05 600.11 6.71 6.47-6.97 < 0.001 Adults (18-65) 1730 88420 4181.77 446.23 9.37 8.95-9.82 < 0.001 65)"}" > Elderly ( >65) 940 112280 3763.01 1430.75 2.63 2.47-2.80 < 0.001 Caucasian 1830 149090 4025.52 820.48 4.91 4.69-5.13 < 0.001 African American 740 28950 5692.31 759.02 7.50 6.99-8.05 < 0.001 Asian 30 3690 4477.61 691.96 6.47 4.56-9.19 < 0.001 Male 1260 77990 3735.55 523.46 7.14 6.76-7.54 < 0.001 Female 1420 123300 4317.42 667.58 6.47 6.15-6.81 < 0.001 Duodenal Ulcer 1420 81920 2133.73 243.85 8.75 8.31-9.22 < 0.001 Adults (18-65) 860 31370 2078.80 158.31 13.10 12.3-14.0 < 0.001 65)"}" > Elderly ( >65) 560 49880 2241.79 635.61 3.53 3.25-3.83 < 0.001 Caucasian 960 60480 2111.75 332.84 6.35 5.96-6.76 < 0.001 African American 400 11250 3076.92 294.96 10.40 9.46-11.5 < 0.001 Asian 20 1720 2985.07 322.54 9.26 6.00-14.3 < 0.001 Male 850 45120 2520.01 302.84 8.32 7.78-8.90 < 0.001 Female 570 36660 1733.05 198.49 8.73 8.04-9.48 < 0.001

S1657 Peptic Ulcer Disease in Non-Alcoholic Fatty Liver Disease (NAFLD) Hospitalizations: Identifying National Trends in the United States

Introduction: Nonalcoholic fatty liver disease (NAFLD) is rapidly emerging as one of the most common causes of chronic liver disease worldwide and in the United States (US), primarily secondary to the obesity epidemic, rising prevalence of diabetes mellitus, and an aging population. Although peptic ulcer disease (PUD) is commonly seen in patients with liver cirrhosis, there is a lack of data on PUD in patients with NAFLD. In this study, we aimed to identify trends of PUD in NAFLD hospitalizations in the US. Methods: This retrospective study utilized the National Inpatient Sample to identify all NAFLD hospitalizations with PUD in the US from 2009 to 2019. Trends of hospitalization characteristics and clinical outcomes were highlighted. P-values ≤0.05 were considered statistically significant. Results: Overall, the total number of NAFLD hospitalizations with PUD increased from 3,745 in 2009 to 3,805 in 2019, after an initial peak from 2009 to 2014 and a decline until 2016 (Table). NAFLD hospitalizations with PUD were primarily at large urban teaching hospitals. The mean age of the study cohort increased from 56 years in 2009 to 63 years in 2019 (P-trend< 0.001). Additionally, only the 65–79 age group with NAFLD had a rising trend of PUD from 26% in 2009 to 46% in 2019 (P-trend< 0.001) (Figure). Racial differences were also prevalent as we noted a rising trend of White and Hispanic NAFLD hospitalizations with PUD; however, a decline was observed for Blacks and Asians (Table). Trends of H. pylori infection and upper endoscopy decreased from 5% in 2009 to 1% in 2019 (P-trend< 0.001) and 60% in 2009 to 19% in 2019 (P-trend< 0.001), respectively. Furthermore, we noted an increase in inpatient mortality from 2% in 2009 to 5% in 2019 (P-trend< 0.001). The mean length of stay increased from 5.5 days in 2009 to 7.2 days in 2019 (P-trend< 0.001), and the mean inpatient charge from $41,474 in 2009 to $92,354 in 2019 (P-trend< 0.001). Conclusion: Literature reports a decrease in the incidence, prevalence, and hospitalization rates of PUD in the US. This study noted an overall increase in PUD in NAFLD hospitalizations. Furthermore, inpatient mortality also increased to 5% in 2019, the exact reason for which is currently unknown. However, we noted a decrease in the trends of H. Pylori infection and upper endoscopy for NAFLD hospitalizations with PUD. Additional prospective studies are needed to fully understand PUD trends in NAFLD populations.Figure 1.: Trends of age for peptic ulcer disease in non-alcoholic fatty liver disease (NAFLD) hospitalizations in the United States from 2009-2019. Table 1. - Trends of peptic ulcer disease in non-alcoholic fatty liver disease (NAFLD) hospitalizations in the United States from 2009–2019 Variable YEAR P-trend 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total Hospitalizations 3,745 4,563 5,230 5,655 5,759 6,885 5,745 2,880 3,070 3,430 3,805 Female 55% 48% 57% 58% 56% 56% 55% 64% 60% 50% 61% P=0.01 Mean Age (years) 56.0 57.1 56.7 57.1 57.1 57.4 57.5 62.4 62.8 63.7 63.0 P< 0.001 Age Groups (years) P< 0.001 18 - 34 9% 8% 8% 8% 7% 8% 8% 3% 4% 2% 3% 34 - 49 25% 24% 25% 25% 23% 22% 21% 12% 11% 15% 12% 50 - 64 39% 42% 41% 39% 42% 42% 39% 44% 40% 36% 38% 65 - 79 26% 25% 26% 27% 28% 28% 32% 42% 44% 47% 46% Race P=0.01 White 72% 73% 70% 71% 72% 71% 70% 74% 76% 76% 75% Black 10% 8% 9% 10% 9% 11% 10% 6% 5% 5% 5% Hispanic 11% 13% 14% 13% 12% 11% 13% 14% 15% 15% 15% Native American 1% < 1% 1% 1% 1% 1% 1% 2% 1% 1% 2% CCI ≥ 3 39% 44% 43% 47% 46% 47% 44% 86% 86% 86% 86% P< 0.001 Hospital Status P< 0.001 Large Hospital 67% 64% 67% 59% 63% 52% 55% 61% 59% 56% 56% Urban Teaching Hospital 46% 40% 44% 49% 53% 67% 66% 73% 75% 81% 80% Upper Endoscopy 60% 59% 62% 58% 59% 59% 62% 20% 22% 18% 19% P< 0.001 H. Pylori 5% 4% 4% 3% 5% 4% 3% 3% 2% 1% 1% P< 0.001 Mean Length of Stay (days) 5.5 5.7 5.7 5.5 5.5 5.5 5.9 6.1 6.8 6.5 7.2 P< 0.001 Mean Inpatient Charge (USD) 41,474 45,135 47,816 50,169 51,775 52,679 63,746 64,523 83,963 78,156 92,354 P< 0.001 Inpatient Mortality 2% 1% 2% 2% 2% 2% 1% 4% 4% 5% 5% P< 0.001

S695 Factors Affecting Likelihood of Peptic Ulcer Disease as the Etiology of Suspected Upper Gastrointestinal Bleeding

Introduction: Patients presenting with suspected upper gastrointestinal bleeding (UGIB) have a broad differential diagnosis. Any process which affects mucosal integrity must be considered when developing a management plan. When treating UGIB a patient’s medical history may provide clues that prioritize consideration of certain diagnoses. This study aims to assess components of the medical history that affect the likelihood of finding a peptic ulcer during endoscopic evaluation. Methods: An IRB-approved retrospective study was performed to evaluate all adult patients who underwent endoscopy for suspected UGIB within five days of presentation, at two affiliated academic hospitals, between 2018 and 2022. Patients were excluded if they had prior endoscopy within 90 days of presentation. Demographic, procedural, and clinical data were obtained via electronic record. Descriptive statistics included t-tests and Chi-square tests. Multivariate analysis was conducted using logistic regression. (Table) Results: A total of 1392 charts were reviewed and 874 patients were included in the analysis. Average age was 64 years, and 525 (60%) were male. The most common symptoms were melena (68%), abdominal pain (32%) and hematemesis (28%). Peptic ulcer disease (PUD) was diagnosed in 397 patients (45%), with 97 patients (11%) classified as high-risk Forrest class 1a/1b/2a/2b lesions where endoscopic intervention is indicated. Another 300 patients (34%) had low risk PUD with Forrest class 2c/3 lesions, and 477 patients (55%) had no PUD. PPI-naïve patients were found to have PUD in 47% of endoscopies, compared to 36% in active PPI users. Multivariate analysis revealed PPI users were 37% less likely to have any ulcer (p< 0.0001). The risk of finding an ulcer increased by 2.0% for every year of age (p< 0.0001). High risk ulcers were more likely to be seen in males (OR 1.73, 95% CI 1.05-2.82), and a history of hepatic disease decreased the likelihood of finding these lesions (OR 0.56, 95% CI 0.37-0.85). Conclusion: Active outpatient PPI use leads to a significant decrease in the likelihood of finding PUD in patients with suspected UGIB. This result underscores the importance of considering other etiologies of bleeding in order to prevent a missed diagnosis and delay in care. The “protective” effect of hepatic disease likely stems from liver-related sources of UGIB present in this population. Even when PUD is suspected in these patients, the data suggest timely empiric treatment with antibiotics and vasoactive agents is warranted. Table 1. - Univariate & Multivariate Analysis of Factors Associated with Upper Gastrointestinal Bleed Presentations Any Ulcer High Risk Ulcer (Forrest 1a/1b/2a/2b) Low Risk Ulcer (Forrest 2c/3) No Ulcer Subjects (N=874) PPI Naïve (N=732) 346 (47%) 84 (11%) 262 (36%) 386 (53%) PPI Use (N=142) 51 (36%) 13 (9%) 38 (27%) 91 (64%) Active PPI Use OR 0.63 0.64 0.65 N/A (95% CI) (0.43-0.93) (0.33-1.23) (0.43-0.99) Age OR 1.02 1.04 1.01 N/A (95% CI) (1.01-1.03) (1.02-1.05) (1.01-1.02) Male Gender OR 1.29 1.73 1.21 N/A (95% CI) (0.97-1.72) (1.05-2.82) (0.88-1.64) Hepatic Disease History OR 0.56 0.86 0.46 N/A (95% CI) (0.37-0.85) (0.46-1.60) (0.28-0.73)

Rational Drug Therapy of Peptic Ulcer Disease In Patients Admitted To Gastroenterology Ward of LRH Peshawar, Khyber Pakhtunkhwa, Pakistan

The present study was conducted from 12 Sep.2019 to 10 Nov. 2019 at the Gastroenterology ward, Lady Reading Hospital Peshawar Pakistan, aiming to accurately investigate the Peptic Ulcer Disease state, signs and symptoms, to ensure complete information about drug therapy and patients response. Peptic ulcer disease is defined as an upper gastric mucosal rupture due to acid hat results in the formation of ulcers that extend beyond the muscular mucosa to the submucosa. Peptic ulcer is characterized by abdominal pain, change in appetite, unexplained weight loss, nausea, vomiting, heart burn and dark, tarry stools. Spicy and acidic foods, Stress and restless lifestyle were considered to be the leading causes of peptic ulcer. However the Helicobacter pyloribacterium is responsible for up to 60% stomach ulcers. Frequent use of painkillers, old age, obesity Smoking, excessive alcohol use, too little sleep, type O blood and chronic stress, are the risk factors of peptic ulcers. Acute peptic ulcers results from taking aspirin or anti-inflammatory drugs. Chronic peptic ulcer represents a profound loss of substance. Data from a total of10 patients (6 female and 4 male)of all age, having various peptic ulcer diseases were involved in this study. It was concluded that most of the female patients (60%) were having peptic ulcers as compared to male patient (40%). It was found that 30-40 years old peptic ulcer patient percentage was 20%.Moreover it was observed that frequent use of Nonsteroidal Anti-inflammatory Drugs has been found to be the main causes of peptic ulcers

Detection Capacity of Helicobacter pylori Infection by Stool Antigen Test Comparing with Rapid Urease Test among Peptic Ulcer Disease Patients

Background: Rapid urease test and stool antigen test are both important diagnostic tools for the detection of Helicobacter pylori infection among peptic ulcer disease patients.&#x0D; Objective: The purpose of the present study was to compare the detection capacity of Helicobacter pylori infection with stool antigen test by comparing with rapid urease test among peptic ulcer disease patients.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Clinical Pathology with the collaboration of Department of Gastroenterology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2011 to September 2012 for a period of one year. All the clinically suspected Helicobactor pylori infected peptic ulcer patients attending in the Department of Gastroenterology at Bangabandhu Sheikh Mujib Medical University (BSMMU) for upper GI endoscopy were selected as study population. Stool antigen test for Helicobactor pylori specific antigen from stool sample was done with “ABON-One Step Helicobactor pylori antigen test device”. Endoscopy of upper GIT was performed in the Department of Gastroenterology. Biopsy taken during endoscopy for RUT. Rapid urease test (RUT) of endoscopic biopsy was performed.&#x0D; Result: A total 86 patients were recruited for this study. The mean (±SD) age was found 38.53(±10.40) years. Out of 86 patients 76 cases were SAT positive and 10 cases were negative. The sensitivity, specificity, positive predictive values and negative predictive values and accuracy of SAT with RUT are 85.53%, 90.0%, 98.48%, 45.0%, 86.05% respectively. The area under the curve was 0.283 with the lower and upper limits of 95% confidence interval of 0.133 and 0.432. This was statistically significant (p=0.003).&#x0D; Conclusion: In conclusion the stool antigen test is an effective method for the diagnosis of Helicobacter pylori infection.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 161-164

The risk factors for the recurrent upper gastrointestinal hemorrhage among acute peptic ulcer disease patients in Syria: A prospective cohort study

BackgroundUpper gastrointestinal bleeding (UGIB) is a life-threatening medical emergency characterized by bleeding from the esophagus, stomach, or duodenum. This study aims to analyze the risk factors for upper gastrointestinal tract rebleeding among acute peptic ulcer patients. MethodsThis is a cohort clinical study conducted between July 2018 and June 2020. Patients admitted or hospitalized because of UGIB or developed it during their hospital stay were included.s The patients were divided into two groups for the statistical analysis using Forrest's ulcer rebleeding risk classification. Group 1: Forrest 1a+1b+2a+2b, and group 2: Forrest 2c+3. The fasting time before the endoscopic procedure was from 12 to 24 hours. Follow-ups were conducted for 30 days after the treatment. ResultsThe total number of included subjects was 152, out of which 57.89% (n = 88) were male patients. The mean SD for patients’ age was 52.63 16.89±; more than 40% (n = 62) of subjects were using antiplatelet medications, while only 13.15% (n = 20) used NSAIDs, and the mean SD for the transferred units was 2.32 ± 1.88, 7.24% (n = 11) of patients died. After 30 days of the treatment, 6.57% (n = 10) of patients suffered from recurrent bleeding. The most common presentation was melena 67.95% (n = 103), 53% (n = 81) of patients had hematemesis, 69.73% (n = 106) patients had gastric ulcer and 30.26% (n = 46) had duodenal ulcers. ConclusionAge, NSAIDs, altered mental capacity, Forrest classification (Ia,Ib, and IIa), and blood transfusion were associated with a higher risk of rebleeding. Furthermore, patients who needed 3.83 blood units were at higher risk of recurrent bleeding.

Genome-Wide association between EYA1 and Aspirin-induced peptic ulceration.

BackgroundLow-dose aspirin can cause gastric and duodenal ulceration, hereafter called peptic ulcer disease (PUD). Predisposition is thought to be related to clinical and genetic factors; our aim was to identify genetic risk factors associated with aspirin-induced PUD.MethodsPatients (n=1478) were recruited from 15 UK hospitals. Cases (n=505) were defined as patients with endoscopically confirmed PUD within 2 weeks of using aspirin and non-aspirin Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). They were compared to two control groups: patients with endoscopically confirmed PUD without any history of NSAID use within 3 months of diagnosis (n=495), and patients with no PUD on endoscopy (n=478). A genome-wide association study (GWAS) of aspirin-induced cases (n=247) was compared to 476 controls. The results were validated by replication in another 84 cases and 162 controls.FindingsThe GWAS identified one variant, rs12678747 (p=1·65×10−7) located in the last intron of EYA1 on chromosome 8. The association was replicated in another sample of 84 PUD patients receiving aspirin (p=0·002). Meta-analysis of discovery and replication cohort data for rs12678747, yielded a genome-wide significant association (p=3·12×10−11; OR=2·03; 95% CI 1·65-2·50). Expression of EYA1 was lower at the gastric ulcer edge when compared with the antrum.InterpretationGenetic variation in an intron of the EYA1 gene increases the risk of endoscopically confirmed aspirin-induced PUD. Reduced EYA1 expression in the upper gastrointestinal epithelium may modulate risk, but the functional basis of this association will need mechanistic evaluation.FundingDepartment of Health Chair in Pharmacogenetics, MRC Centre for Drug Safety Science and the Barts Cardiovascular NIHR Biomedical Research Centre, British Heart Foundation (BHF)

S669 The Effect of Outpatient Proton Pump Inhibitor Use on Peptic Ulcer Disease in Patients Presenting With Suspected Upper Gastrointestinal Bleeding

Introduction: Proton pump inhibitors (PPIs) are prescribed to both prevent and treat peptic ulcer disease (PUD). There is a paucity of data regarding how outpatient PPI use affects the likelihood of finding PUD in patients with concern for an upper gastrointestinal bleed (UGIB). The aim of this study was to assess how active PPI use impacts PUD prevalence and severity in this population. Methods: An IRB-approved retrospective study was performed on all adult patients who underwent upper endoscopy between 1/2018 and 2/2021 at 2 affiliated hospitals within 5 days of admission for a suspected UGIB. Patients were excluded if endoscopy was performed up to 90 days prior to admission. Active PPI use was defined as once or twice daily dosing for at least 30 days. Demographic, procedural and clinical data were obtained via electronic records. Descriptive statistics included ANOVA and Chi-square tests. Multivariate analysis was conducted using polytomous logistic regression. Results: A total of 1122 unique charts were reviewed, with 696 patients included in the analysis (Table 1). Average age was 64 years; 405 (58%) were male. The most common symptoms were melena (67%), hematemesis (26%) and hematochezia (15%). Active PPI use was noted in 133 patients (19%). PUD was diagnosed in 350 patients (50.2%), with 74 patients (10.6%) classified as high risk Forrest class 1a/1b/2a/2b PUD where endoscopic intervention is indicated. Another 276 patients (39.7%) had low risk PUD with Forrest class 2c/3 lesions, and 346 patients (49.7%) had no PUD. A slim majority (51.2%) of PPI-naïve patients were found to have PUD on endoscopy, compared to 45.9% of active PPI users. PPI-naïve patients also were more likely to have high risk PUD than active PPI users (11.5% vs 8.3%), though neither reached statistical significance. A smaller percentage (20.4%) of active PPI users with PUD required blood transfusion compared to PPI-naïve patients (79.7%). Conclusion: It is surprising that there is no statistical difference in the percentage of patients with suspected UGIB found to have PUD based on active PPI use prior to admission. However, while PPIs may not decrease the likelihood of finding PUD, they do seem to decrease the severity of blood loss. The transfusion rate for active PPI users found to have PUD was a quarter of that found in PPI-naïve patients. Therefore, this study suggests PPI use at home may not prevent a PUD-related UGIB, but it may lessen the undesired effects of such an event.Table 1.: Mortality in MDS patients with GI bleed (OR).

Pattern of Presentation, Management and Early Outcome in Patients with Perforated Peptic Ulcer Disease in a Semi-urban Tertiary Hospital.

Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation in peptic ulcer disease (PUD) patients. This study aimed to describe the pattern of presentation, management and early outcome in patients with perforated PUD. This was a prospective study of patients who had operation for perforated PUD at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Southwestern Nigeria from June 2015 to May 2020. Forty-six patients were studied with their ages ranging from 21-85 years. Their mean age was 49.9±16.3 years while the median was 54 years. Males outnumbered females by a ratio of 5.5:1. Majority (56.5%) of the patients were farmers and artisans. Duration of symptoms was 6 hours to 9 days (mean 2.7±1.9 days). Non-steroidal anti-inflammatory drugs use, herbal concoction, alcohol and smoking was found in 54.3%, 52.2%, 30.4% and 21.7% respectively. More duodenal perforations (63.0%) were recorded. Graham's patch closure was done for 27 (58.7%) while the remaining (41.3%) had primary closure with omentoplasty. Sixteen (34.8%) had postoperative complications with wound infection predominating. Overall postoperative mortality was 17.4%. Age ≥ 60 years (p=0.04), premorbid illness (p=0.01), delayed presentation ≥ 48 hours (p=0.01), shock (p=0.01) and intraperitoneal effluent ≥ 2000ml (p=0.03) were associated with mortalities. Perforated PUD accounts for high morbidities and mortalities in our setting. Abuse of NSAIDs and herbal concoction ranked highest among the risk factors. Efforts at curtailing indiscriminate sales of NSAIDs and herbal concoction will reduce the menace.

Correlation of Clinical, Endoscopic, and Pathological Findings among Suspected Peptic Ulcer Disease Patients in Abuja, Nigeria.

Background Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and has been linked to Helicobacter pylori (H. pylori) infection. This condition may be suspected on clinical grounds, but diagnosis is established using upper gastrointestinal endoscopy. Aims To determine the correlation between the endoscopic and pathological findings among suspected PUD patients who have been referred for diagnostic upper gastrointestinal endoscopy in National Hospital Abuja. Methods This is a hospital-based prospective study conducted among suspected PUD patients at National Hospital Abuja over a one-year period. Clinical, endoscopic, and histological findings were ascertained and documented. Data obtained were analyzed using SPSS version 21.0. Tests of significance were done using the chi-square test and Student t-test at 95% confidence intervals. Results One hundred and thirty-two patients were included in the study. The ages ranged from 15 to 87 years, mean age 43.30 ± 11.94 years. Seventy-seven (58.3%) patients had abnormal endoscopic findings, of whom 37 (28.0%) had PUD. Prevalence of H. pylori infection was 42.2% and was found in 81.1% of PUD patients. H. pylori was significantly associated with confirmed PUD (p < 0.001) and abnormal endoscopic findings (p < 0.001). No association was found between normal endoscopic findings and histological findings (p = 0.924). Conclusion There is a poor correlation between clinical and endoscopic diagnoses of PUD. H. pylori was found to be significantly associated with PUD and abnormal endoscopic findings. Endoscopic facilities should therefore be made available and accessible for proper PUD diagnosis. Empirical treatment of H. pylori in patients with diagnosed PUD is strongly recommended.