Peptic Ulcer Disease Patients Research Articles

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.

Geographic distribution of the cagA, vacA, iceA, oipA and dupA genes of Helicobacter pylori strains isolated in China

BackgroundThere are geographic variations in the genotypes of Helicobacter pylori (H. pylori) cagA, vacA, iceA, oipA and dupA. The aim of the study was to investigate the distribution of these genotypes among H. pylori strains from five regions of China and their association with clinical outcomes.Materials and methodsGastric biopsy specimens were obtained from 348 patients with different gastrointestinal diseases in the five regions of China. The regional distribution was 89 patients from Shandong, 91 from Guangxi, 57 from Hunan, 58 from Qinghai and 53 from Heilongjiang. The presence of cagA, vacA, iceA, oipA and dupA genotypes was determined by polymerase chain reaction (PCR) from H. pylori DNA.ResultsA total of 269 H. pylori isolates were obtained, of which 74 isolates were from Shandong, 78 from Guangxi, 46 from Hunan, 33 from Qinghai and 38 from Heilongjiang. The cagA-positive status was predominant in the five regions. The predominant vacA genotypes were s1c (73.4%), m2 (70.6%) and i1 (92.9%). In strains from Shandong, s1a and m1 were dominant. By contrast, s1c was dominant in Guangxi and i1 was dominant in Hunan and Heilongjiang. The prevalence of m2 subtype in Qinghai (78.8%) was significantly higher than that in other regions (P < 0.05). The predominant iceA genotype was iceA1 and the frequency of iceA1 was significantly more prevalent in Hunan than in other regions (P < 0.05). The oipA status “on” gene was more frequent in Shandong (91.9%) and Guangxi (91%) than in Heilongjiang (71.7%) (P < 0.05). Conversely, the dupA-positive status was less than half in Shandong (31.1%) and Guangxi (15.4%), whereas it was 73.9% in Hunan and 81.8% in Qinghai (P < 0.001). There were no significant associations between the cagA, vacA, iceA, oipA genotypes and clinical outcomes. The dupA-positive strains were more common in peptic ulcer disease (PUD) patients than in non-ulcer dyspepsia (NUD) patients in Shandong and Guangxi (P < 0.05), but the association was not observed in other geographic regions.ConclusionsThere was significant geographic diversity of H. pylori genotypes in different regions of China and the presence of dupA gene can be considered as a marker for the development of gastroduodenal diseases. However, the cagA, iceA, vacA and oipA genes cannot be regarded for prediction of the clinical presentation of H. pylori infection in China.

Cannabis Use Disorders Lead to Hospitalizations for Peptic Ulcer Disease: Insights From a Nationwide Inpatient Sample Analysis.

ObjectivesIn this study, we aimed to explore the independent association between cannabis use disorders (CUD) and peptic ulcer disease (PUD)-related hospitalization, and then to delineate the demographic differences among PUD inpatients with versus without CUD.MethodologyWe conducted a cross-sectional study using the Nationwide Inpatient Sample of 50,444,133 patients. We then subgrouped them into PUD and non-PUD cohorts. We compared non-PUD and PUD cohorts using bivariate analysis to delineate the differences in demographics and comorbid risk factors (chronic lung disease, chronic kidney disease, liver disease, diabetes, chronic nonsteroidal anti-inflammatory drug use, tobacco abuse, and alcohol abuse). We used logistic regression analysis to measure the odds ratio (OR) of the association between CUD and PUD-related hospitalization.ResultsThe prevalence of PUD was 0.14% (N = 70,898) among the total inpatient population. It was more prevalent in whites (65%) and males were at higher odds (OR: 1.11; P < 0.001) of being hospitalized for PUD. After controlling for potential comorbid risk factors and demographic confounders, the odds of association between CUD and PUD-related hospitalization were statistically significant (OR: 1.18; P < 0.001).ConclusionsCUD was associated with a modest but significant increase of 18% in the likelihood of hospitalization for PUD. With the legalization of cannabis use and its increasing and problematic consumption, it is imperative to understand the impact of cannabis use on the physical health of patients and the related gastrointestinal problems.

“PREVALENCE OF H.PYLORI INFECTION IN PEPTIC ULCER DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL, KURNOOL, ANDHRA PRADESH.”

BACKGROUND: With the outstanding &amp; revolutionary discovery of Helicobacter Pylori(H.Pylori) organism as a causative agent in Peptic Ulcer Disease (PUD), Gastric carcinoma and Malt Lymphoma, there has been a lot of interest generated about H.Pylori in modern times. The role of NonSteroidal Anti-Inammatory Drugs(NSAIDs) in the causation of Gastric Ulcer (GU) &amp; Duodenal Ulcer (DU) is also an important point of study now-a-days. AIM &amp; OBJECTIVES: To assess the prevalence of H.Pylori in patients of PUD diagnosed with Upper Gastro-Intestinal Endoscopic (UGIE) examination. MATERIALS &amp; METHODS: Total 100 patients of the study underwent UGIE examination. Rapid Urease Test of gastric biopsy specimens of all patientswas done forthepresenceofH.Pylori. RESULTS:Out of 100PUDpatients, 74weremales&amp;26were females.Out of 54H.Pylori associatedPUDpatients, 41(76%)weremales and 13(24%) were females. About 47% patients had GU, 43% had DU and 10% had both GU &amp; DU. About 34(79%) DU patients were associated with H.Pylori infection. Out of 47 GU patients, 11(23%) are associated with NSAID usage, 7(15%) are associated with H.Pylori &amp; other 53% had associated comorbidities like HTN, DM, CAD and CLD. Descriptive analysis in percentage was done by using MS Excel. CONCLUSION:Thendings ofthisstudy revealthatH.Pyloriinfection ismore common inmalesthan females.High prevalence ofH.Pyloriinfection isseeninDUpatients.NSAIDabusewas highinGUpatients.Thisstudyhighlightsthe signicanceofH.Pylori&amp;NSAIDusage inPUDpatients.

Feasibility of laparoscopic repair of peptic ulcer perforation

Background: Perforation is a common complication of peptic ulcer disease and presents as Perforation peritonitis. It has the highest number of mortality among all complications (≈15%). In spite of modern progress in the management, it is still a life-threatening catastrophe. Emergency surgery for complicated cases required in 7% of hospitalized peptic ulcer disease patients. Factors such as &gt;24 hours of history, concomitant disease, shock, post operated wound infections, all are associated with increase in mortality and morbidity.Methods: A Prospective, observational, single hospital base study done during the period from 2016 to 2020 in the Department of Surgery, Gandhi medical college Bhopal. Sample size was taken 63Results: 52 out 63 cases presented with perforation peritonitis included under study period, 11 cases were excluded due to death and absconding of cases. In rest 52 cases, 15 of them went through laparoscopic repair, 28.85% of the cases were shifted directly to ORG.Conclusions: Laparoscopic repair of peptic ulcer perforation is feasible if patient presents early to the hospital. All perforation peritonitis should give fair chance to repair laparoscopically if patient’s general condition and anesthetic permits. This is a good alternative for conventional open surgery with less post-operative pain, early return to normal activities, less hospital stays and few postoperative wound infections. Thus it can significantly decrease the economic burden.

Study on Socio-Demographic Profile of Peptic Ulcer Disease in A Tertiary Care Teaching Hospital, Dhaka, Bangladesh

Background: The prevalence and socio-demographic factors of peptic ulcer disease (PUD) have changed remarkably now a day. Currently, peptic ulcer disease has considered as a multifactorial health problem.&#x0D; Objective: To determine the socio-demographic factors of Peptic ulcer disease among patients attending Bangladesh Medical College, Dhanmondi, Dhaka, Bangladesh.&#x0D; Methods: This is a hospital-record based cross sectional descriptive study executed in a tertiary care teaching hospital, Dhanmondi, Dhaka. The study group comprises 200 PUD patients enrolled in our Bangladesh Medical College Hospital from July 2019 to December 2020. Analysis of data was done by using SPSS 15 software. Prevalence of PUD patients among study population was calculated by using percentage and the strength of association of socio- demographic factors were evaluated in our study.&#x0D; Results: Total prevalence of PUD among the studied group was 83.5%; gastric ulcer 54.5% and duodenal ulcer 29%. Majority 56% were female patients in the age group of 41-50 years. Most prevalent endoscopic finding was erosive antral gastritis (48.50%). PUD was diagnosed predominantly among unemployed population (48.50%) in the urban locality (62%). The cardinal features were pain precipitated by certain food (55.69%) and loss of appetite (52. 09%).Regarding risk factors spicy food (55.69%) has secured the first position in our study followed by smoking (34.13%) and stress (18.56%).&#x0D; Conclusion: Multifactorial variables were considered as risk factors for PUD. Population based endoscopic studies can detect PUD at its earliest possible stage and create awareness among population to prevent its further progression.

Development and validation of the peptic ulcer scale under the system of quality of life instruments for chronic diseases based on classical test theory and generalizability theory

BackgroundQuality of life (QOL) for patients with Peptic ulcer disease (PUD) is of interest worldwide and disease-specific instruments are needed for clinical research and practice. This paper focus on the development and validation of the PUD scale under the system of quality of life instruments for chronic diseases (QLICD-PU) by the modular approach and both classical test theory and Generalizability Theory.MethodsThe QLICD-PU is developed based on programmatic decision-making procedures, including multiple nominal and focus group discussions, in-depth interviews, and quantitative statistical procedures. Based on the data of 153 PUD inpatients, correlation analysis, factor analysis, t-test, and Generalizability Theory analysis (including generalizability study and decision study, ie. G-study and D-study) were used to assess the validity, reliability, and responsiveness of the scale.ResultsWhen the popular scale health survey short form (SF-36) was used as the standard, correlation and factor analysis confirmed good construct validity and criterion-related validity of QLICD-PU. Except for the social domain (0.62), the internal consistency α of all domains is higher than 0.70. The overall score and the test–retest reliability coefficients (Pearson r and intra-class correlation ICC) in all domains are higher than 0.80 (0.77 in the social domain). After treatments, the overall score and scores of all domains have statistically significant changes (P < 0.01), except for social impact and sexual function scores. The SRM (Standardized response mean) of domain-level scores ranges from 0.34 to 1.03. The G coefficient and reliability index (Ф coefficient) further confirm the reliability of the scale through more accurate variance components and decision-making information about changes in the number of items.ConclusionsThe QLICD-PU can be used as a useful measurement to assess the quality of life of PUD patients with good psychometric characteristics and multiple advantages.

S3085 Incidence of Peptic Ulcer Disease in Patients Undergoing ERCP for Pancreato-Biliary Disorders: A Retrospective Study at a Tertiary Care Medical Center

INTRODUCTION: Peptic ulcer disease and biliary disease typically have overlapping symptoms of abdominal pain and frequently require endoscopic evaluation for diagnosis and management. Alteration in the normal biliary physiology due to obstruction effects bicarbonate and biliary secretion which are protective to the duodenal mucosa from the gastric acid secretion. We hypothesize that biliary stasis effects the normal biliary and bicarbonate secretion leading to prolonged exposure of duodenal mucosa to gastric acid resulting in duodenitis and ulcers. Our study aims to investigate any correlation between incidence of duodenitis and PUD in patients with biliary or pancreatic disease undergoing ERCP. METHODS: A retrospective chart review of patients who underwent ERCP between January to June, 2019 at our institute were included. Patients were grouped into six categories these included: (1) choledocholithiasis; (2) chronic pancreatitis; (3) pancreatic cancer; (4) bile leak; (5) cholangiocarcinoma (CCA); and (6) abnormal imaging. Extracted data included several lab values (e.g., AST, ALT) and PUD. Use of non-steroidal and corticosteroids were taken into account in the final data analysis. ANOVA with Bonferonni-corrected post hoc analyses were utilized for continuous measures, and Chi-square were utilized for categorical measures. All analyses were conducted in SPSS (v. 25). RESULTS: Out of the total 77 patients, 41 (53.2%) patients had evidence of duodenitis and 39 (50.6%) patients had evidence of PUD. Female patients accounted for the majority of the sample (62.3%; P = 0.030), though 70% of pancreatic cancer patients were male. For clinical measures, significant differences were found for PUD (X2 = 12.143, P = 0.033), with the greatest percentage for chronic pancreatitis (60%) and CCA (75%) and for duodenitis (X2 = 20.645, P = 0.001), with the greatest percentage for choledocholithiasis (63.4%), Pancreatic cancer (60%). (Figure 1,2). CONCLUSION: Our study represents the first comprehensive research demonstrating increased incidence of duodenitis and PUD in patients undergoing ERCP for Pancreatico - Biliary disorders. Potential limitation includes small sample size, use of side viewing duodenoscope, and lack of Helicobacter pylori testing. This study emphasizes the importance of a more careful mucosal examination during ERCP to diagnose duodenitis and duodenal erosions as these patients may benefit from proton pump inhibitors. Future prospective studies are required to further validate the results of our study.Figure 1.: Incidence of duodenal ulcers in patients with pancreato-biliary disorders.Figure 2.: Incidence of duodenal erosion in patients with pancreato-biliary disorders.

Trends and outcomes of peptic ulcer disease in patients with cirrhosis

ABSTRACT Background Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. Methods We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002–2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes. Results Between the years 2002–2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63–1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 − 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis. Conclusion Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes.

Bell's Palsy in Elderly Taiwanese Patients with a History of Peptic Ulcer Disease: A Correlation Study

Background: This nationwide, retrospective cohort study was initiated to investigate the correlation between Bell's palsy (BP) and peptic ulcer disease (PUD). Methods: The Taiwan National Health Insurance statistics were used in this large case-control study to investigate the correlation of BP in patients with a history of PUD. We included 69,340 patients in whom PUD was newly diagnosed between January 2000 and December 2005. The PUD patients were tracked until 31 December 2011 or when BP was first diagnosed. For comparison, 208,020 patients without PUD were randomly selected using a 1:3 case-control matching of age, gender and the year of diagnosis of PUD. The correlation of BP in patients with and without PUD was computed using Cox's proportional hazards model. The cumulative incidence of BP in both cohorts was estimated using the Kaplan-Meier method. Results: Elderly patients aged 65 years or older with a history of PUD had a higher incidence rate of BP (at 1.21 per 1000 persons/year) compared to those without PUD (0.96 per 1000 persons/year). A significantly higher adjusted hazard ratio of 2.5 (95% CI 2.13-2.93; p ＜ 0.0001) was found in this group as compared to patients aged 40-65 years. Conclusions: A significant positive correlation between BP and a history of PUD was observed in elderly patients.

Hospitalizations for peptic ulcer disease in China: Current features and outcomes.

Rates and outcomes of hospitalizations for peptic ulcer disease (PUD) are unknown in mainland China. We aimed to describe characteristics and treatments of PUD inpatients in secondary and tertiary care hospitals registered in the national Health Statistics and Information Reporting System in 2015 and to explore factors related to inpatient outcomes. We retrieved and validated PUD hospitalization data from 4441 hospitals reporting to Health Statistics and Information Reporting System in 2015. Sensitivity analyses were performed to examine the robustness of findings considering different reporting rates across provinces. Current analyses focused on ulcer sites, complications, therapies, and rates of in-hospital death or unauthorized discharge. Total admissions for PUD were 443433 (mean age 55.14years), constituting 0.59% of all-cause hospitalizations of 2015 in 4441 hospitals. Duodenal ulcers were more common than gastric ulcers (44.69% vs 37.42%). About 61% of inpatients had complications (46.45% for bleeding and 14.66% for perforation). Over 96% of uncomplicated or bleeding inpatients were managed medically. Surgery was provided to 64.22% of perforated cases. Endoscopic hemostasis and transcatheter embolization were performed for 1.59% of the bleeding and 0.59% of the perforation cases. For all PUD cases, the average in-hospital mortality was 0.35%. Six percent of inpatients left hospitals without authorization. Multinomial logistic regressions showed that inpatient death and unauthorized discharge were associated with older age, gastric ulcer, bleeding, perforation, and comorbidity after controlling for gender, insurance status, hospital type, area, and region. Currently, pharmacologic management is dominant, and endoscopic hemostasis is notably underutilized for PUD hospitalizations in mainland China.

Risks of Sulpiride-Induced Parkinsonism in Peptic Ulcer and Gastroesophageal Reflux Disease Patients in Taiwan: A Nationwide Population-Based Study

BackgroundSulpiride is a highly selective dopamine D2 receptor antagonist and is commonly used in psychiatric disorders, Tourette syndrome, peptic ulcer disease (PUD), and gastroesophageal reflux disease (GERD). However, sulpiride has been recognized as a potential cause of drug-induced parkinsonism (DIP) for a long time. In this study, we aimed to focus on analysis of sulpiride-induced parkinsonism (SIP) in PUD and GERD patients based on a nationwide population.MethodsData were obtained from the Taiwan’s National Health Insurance Research Database. The study enrolled 5,275 PUD or GERD patients, of whom were divided into two groups, based on their exposure (1,055 cases) or non-exposure (4,220 cases) to sulpiride.ResultsDuring the study period (2000–2012), the incidence rate of parkinsonism was 261.5 and 762.2 per 100,000 person-years in the control and sulpiride-treated groups, respectively. For patients with at least 14 days of prescription for sulpiride, the adjusted hazard ratio (aHR) was 2.89, 95% confidence interval (CI): 2.04-4.11. Patients with age more than 65 years (aHR = 4.99, 95% CI = 2.58-9.65), hypertension (aHR = 2.39, 95% CI = 1.49-3.82), depression (aHR = 2.00, 95% CI = 1.38-2.91), and anxiety (aHR = 1.45, 95% CI = 1.01-2.09) had significant higher risk of developing parkinsonism. An average annual cumulative sulpiride dose > 1,103 mg was accompanied by the greatest risk of SIP; sulpiride use for ≥ 9 days is a cut-off point for predicting future SIP.ConclusionAt the population level, sulpiride may be frequently prescribed and apparently effective for PUD and GERD. SIP is associated with older age, hypertension, depression or anxiety comorbidities. Physicians should be aware of the neurogenic adverse effects, even when the drug is only used in low-dose or a short duration.

Risk of Recurrent Peptic Ulcer Disease in Patients Receiving Cumulative Defined Daily Dose of Nonsteroidal Anti-Inflammatory Drugs.

The purpose of this population-based case–control study was to clarify the impact of cumulative dosage of nonsteroidal anti-inflammatory drugs (NSAIDs) on recurrent peptic ulcers among chronic users after Helicobacter pylori (H. pylori) eradication. We analyzed data of 203,407 adult peptic ulcer disease (PUD) patients from the National Health Insurance Research Database in Taiwan entered between 1997 and 2013. After matching for age/gender frequencies and the length of follow-up time in a ratio of 1:1, the matched case–control groups comprised 1150 patients with recurrent PUD and 1150 patients without recurrent PUD within 3 years of follow-up. More recurrent PUDs occurred in NSAID users than in the control group (75.30% versus 69.74%; p = 0.0028). Independent risk factors for recurrent PUD included patients using NSAIDs (adjusted OR (aOR): 1.34, p = 0.0040), H. pylori eradication (aOR: 2.73; p < 0.0001), concomitant H2 receptor antagonist (aOR: 1.85; p < 0.0001) and anti-coagulant (aOR: 4.21; p = 0.0242) use. Importantly, in the initial subgroup analysis, the risk ratio of recurrent PUD did not increase in NSAID users after H. pylori eradication compared with that in non-users (p = 0.8490) but a higher risk for recurrent PUD with the increased doses of NSAIDs without H. pylori eradication therapy (aOR: 1.24, p = 0.0424; aOR: 1.47, p = 0.0074; and aOR: 1.64, p = 0.0152 in the groups of ≤28, 29–83, and ≥84 cumulative defined daily doses, respectively). The current study suggested that H. pylori eradication therapy could decrease the risk of recurrent PUD among patients with high cumulative doses of NSAIDs.

2726 Dilemma of Hypercalcemia and Persistent Peptic Ulcer Disease: Case Report and Literature Review

INTRODUCTION: Hypercalcemia has been linked to peptic ulcer disease (PUD), but between the two is not well understood. We are presenting a case of PUD that did not respond to long term twice daily PPI but did improve when the hypercalcemia was corrected with parathyroidectomy. CASE DESCRIPTION/METHODS: A 48-year-old male patient underwent one yearlong evaluation for persistent abdominal pain. His evaluation included three CT scans, EGD as well as octreotide and parathyroid scans. Initially, it was believed that his symptoms were related to severe PUD that did not respond to prescribed medical treatment due to poor patient compliance. He presented to the ED complaining of epigastric pain. Abdominal imaging revealed inflammation and narrowing of the entire duodenum as well as non-obstructive nephrolithiasis. His Calcium level was 11 mg/dl. An EGD revealed many non-bleeding cratered duodenal ulcers in the entire duodenum. An acquired non-obstructing, benign-appearing, intrinsic stenosis was found in the third portion of the duodenum. Biopsies were negative for H. pylori infection. He denied NSAID use. He was discharged on oral PPI therapy twice daily. Two months later, he returned with recurrent abdominal pain after running out of his PPI. CT scan showed persistent inflammatory changes involving the entire duodenum to the jejunum. Serum gastrin level was 201 pg/ml. Calcium level was 10.4 mg/dL. He was treated symptomatically with plans for outpatient push enteroscopy. The patient’s clinical course was complicated by obstructive nephrolithiasis requiring bilateral ureteral stents. Almost one year later, he returned with abdominal pain. Another CT scan showed persistent duodenitis. His labs showed evidence of Hypercalcemia 12 mg/dl. Gastrin Level 382 pg/ml. Octreotide scan was performed and was negative for any active neuroendocrine tumor. Parathyroid scan revealed parathyroid adenoma. The patient underwent parathyroidectomy and did well. He was discharged home on PPI twice daily. He was seen in follow-up and denied any PUD symptoms. DISCUSSION: This patient with severe non-resolving peptic ulcers. Removal of the parathyroid adenoma resulted in complete resolution of his symptoms. The gastric secretory response to hypercalcemia may be responsible for the occurrence of peptic ulcer disease in patients with hyperparathyroidism. In conclusion, serum calcium level must be considered among the usual tests in patients with rare and/or non-specific abdominal symptoms and part of the workup for persistent PUD.

The association between ABO blood group distribution and peptic ulcer disease: a cross-sectional study from Ethiopia.

BackgroundStudies have shown that ABO blood group antigens are associated with peptic ulcer disease (PUD). There are limited sources regarding the association of blood groups with PUD patients in Ethiopia. The aim of this study was to assess the association between ABO blood group distribution, non-steroidal anti-inflammatory drugs (NSAIDs), smoking, alcohol, coffee, and PUD at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA cross-sectional study was undertaken, and a total of 63 endoscopically confirmed PUD patients and 63 healthy controls were screened for ABO blood grouping using the standard slide agglutination reaction. Stool antigens were checked to determine Helicobacter pylori status of PUD patients. Chi-square and logistic regression were used for statistical analysis.ResultsThe ABO blood group distribution of PUD patients was 19.04% (12/63), 19.04% (12/63), 11.11% (7/63), 50.79% (32/63) for blood group A, B, AB, and O, respectively, while among control groups it was 25.39% (16/63), 23.80% (15/63), 12.69% (8/63), and 38.09% (24/63) for blood group A, B, AB, and O, respectively. 34.1% (22/63) of PUD patients had gastric ulcer and 65.9% (41/63) had duodenal ulcer. There was statistically a significant association between sex (p=0.001), use of NSAIDs (p=0.001), smoking cigarette (p=0.014), alcohol consumption (p=0.028), and PUD.ConclusionAlthough PUD trended as more prevalent among patients with blood group O than other blood group types their association was not statistically significant.

Risk factors for peptic ulcer disease in patients with end-stage renal disease receiving dialysis.

BackgroundCompared to the general population, patients with end-stage renal disease have more gastrointestinal symptoms and a higher prevalence of peptic ulcer. Risk factors for peptic ulcer disease in patients with end-stage renal disease, however, remain poorly defined. This study aims to better identify those risk factors.MethodsWe analyzed 577 patients with end-stage renal disease from 2004 to 2016. We excluded patients with life-threatening conditions. All patients underwent upper endoscopy. We analyzed patient medical records, medication history, and endoscopic findings. Independent sample t test, chi-square test, Fisher’s exact test, and multiple logistic regression analysis were used in statistical analyses.ResultsOf the 577 patients with end-stage renal disease, 174 had peptic ulcer disease (gastric or duodenal ulcer). Patients on hemodialysis had a higher prevalence of peptic ulcer disease than those on peritoneal dialysis. Patients with peptic ulcer disease had lower serum albumin level and higher blood urea nitrogen level than those without peptic ulcer disease. Positive scores on two or more nutritional indices (albumin, serum cholesterol, uric acid, and creatinine levels) were associated with peptic ulcer disease in end-stage renal disease.ConclusionHemodialysis, hypoalbuminemia, and multiple malnutrition indices were associated with the prevalence of peptic ulcer disease in patients with end-stage renal disease receiving dialysis.

Prevalence of Peptic Ulcer Disease in Patients with Chronic Obstructive Pulmonary Disease in a Teaching Hospital

Objective: Chronic obstructive pulmonary disease is major cause of chronic morbidity and mortality throughout the world. Peptic ulcer disease is not uncommon in patients with chronic medical condition like chronic obstructive pulmonary disease. Patients who smoke or have chronic obstructive pulmonary disease carry higher risk of developing peptic ulcer disease. The aim of this study was to saw the prevalence of peptic ulcer disease as well as prevalence variation in relation with severity of chronic obstructive pulmonary disease. Methods: This was cross sectional observational study from January, 2013 to January, 2014 in department of Medicine, Rajshahi Medical College Hospital, Rajshahi who fulfilled the inclusion &amp; exclusion criteria were selected in this study. Data was collected in a prefixed questionnaire form and data collection sheet after taking informed consent of the patient. All the patients were investigated with spirometry, chest X-ray, complete blood count, electrocardiogram, echocardiography and endoscopy upper gastrointestinal tract. Results: Among the study population 100% patient was male. Most of them were 51-60 years (42.4%) with mean aged was 56.48 ± 7.64 years. Endoscopic finding was normal (55, 85.94%), gastritis (02, 3.12%), gastric erosion (03, 4.69%), peptic ulcer (03, 4.69%) and peptic ulcer with active bleeding (01, 1.56%).Prevalence of peptic ulcer disease in this study was 14.06%.Conclusion: Prevalence of peptic ulcer was more in chronic obstructive pulmonary disease patient than normal population. The prevalence of peptic ulcer diseases also increases with the severity of the disease.TAJ 2017; 30(1): 30-35

Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors.

Nonsteroidal anti-inflammatory drugs, low-dose aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors and corticosteroids increase the risk of gastroduodenal bleeding. To determine in a retrospective cohort study the contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients taking these drugs. Among patients with peptic ulcer disease diagnosed by endoscopy from 01/2004 to 12/2014 (N=1719, 60% males, age 65.8±14.5), 56.9% had peptic ulcer bleeding (cases) and 43.1% uncomplicated peptic ulcer disease (controls). Demographics, intake of nonsteroidal anti-inflammatory drugs, aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors, proton pump inhibitors and corticosteroids were documented. H.pylori status was determined by histology, rapid urease test or serology. Adjusted odds ratios (OR) were estimated by logistic regression analysis. Helicobacter pylori infection increased the risk of peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users (OR=2.91, 95% CI=1.71-4.98 and OR=2.23, 95% CI=1.52-3.28, respectively), but not in patients on anticoagulants, selective serotonin reuptake inhibitor or corticosteroid therapy. H.pylori-positive status substantially increased the risk of peptic ulcer bleeding in patients on non-aspirin antiplatelet agents (OR=4.37, 95% CI=1.28-14.99), concomitant aspirin/nonsteroidal anti-inflammatory drug intake (OR=5.85, 95% CI=1.68-20.36) and combined antiplatelet therapy (OR=8.43, 95% CI=1.09-65.17). After further adjustment for proton pump inhibitor intake, H.pylori infection was still a risk factor for peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users. Helicobacter pylori infection increases the risk of peptic ulcer bleeding in peptic ulcer disease patients on nonsteroidal anti-inflammatory drugs, aspirin and non-aspirin antiplatelet agents. H.pylori-positive patients on combined antiplatelet therapy carry the highest risk for peptic ulcer bleeding.