Risk Of Peptic Ulcer Disease Research Articles

Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials

SummaryBackgroundGastroprotectant drugs are used for the prevention and treatment of peptic ulcer disease and might reduce its associated complications, but reliable estimates of the effects of gastroprotectants in different clinical settings are scarce. We aimed to examine the effects of proton-pump inhibitors (PPIs), prostaglandin analogues, and histamine-2 receptor antagonists (H2RAs) in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs.MethodsWe searched MEDLINE and Embase from Jan 1, 1950, to Dec 31, 2015, to identify unconfounded, randomised trials of a gastroprotectant drug (defined as a PPI, prostaglandin analogue, or H2RA) versus control, or versus another gastroprotectant. Two independent researchers reviewed the search results and extracted the prespecified outcomes and key characteristics for each trial. We did meta-analyses of the effects of gastroprotectant drugs on ulcer development, bleeding, and mortality overall, according to the class of gastroprotectant, and according to the individual drug within a gastroprotectant class.FindingsWe identified comparisons of gastroprotectant versus control in 849 trials (142 485 participants): 580 prevention trials (110 626 participants), 233 healing trials (24 033 participants), and 36 trials for the treatment of acute upper gastrointestinal bleeding (7826 participants). Comparisons of one gastroprotectant drug versus another were available in 345 trials (64 905 participants), comprising 160 prevention trials (32 959 participants), 167 healing trials (28 306 participants), and 18 trials for treatment of acute upper gastrointestinal bleeding (3640 participants). The median number of patients in each trial was 78 (IQR 44·0–210·5) and the median duration was 1·4 months (0·9–2·8). In prevention trials, gastroprotectant drugs reduced development of endoscopic ulcers (odds ratio [OR] 0·27, 95% CI 0·25–0·29; p<0·0001), symptomatic ulcers (0·25, 0·22–0·29; p<0·0001), and upper gastrointestinal bleeding (0·40, 0·32–0·50; p<0·0001), but did not significantly reduce mortality (0·85, 0·69–1·04; p=0·11). Larger proportional reductions in upper gastrointestinal bleeding were observed for PPIs than for other gastroprotectant drugs (PPIs 0·21, 99% CI 0·12–0·36; prostaglandin analogues 0·63, 0·35–1·12; H2RAs 0·49, 0·30–0·80; phet=0·0005). Gastroprotectant drugs were effective in preventing bleeding irrespective of the use of non-steroidal anti-inflammatory drugs (phet=0·56). In healing trials, gastroprotectants increased endoscopic ulcer healing (3·49, 95% CI 3·28–3·72; p<0·0001), with PPIs more effective (5·22, 99% CI 4·00–6·80) than prostaglandin analogues (2·27, 1·91–2·70) and H2RAs (3·80, 3·44–4·20; phet<0·0001). In trials among patients with acute bleeding, gastroprotectants reduced further bleeding (OR 0·68, 95% CI 0·60–0·78; p<0·0001), blood transfusion (0·75, 0·65–0·88; p=0·0003), further endoscopic intervention (0·56, 0·45–0·70; p<0·0001), and surgery (0·72, 0·61–0·84; p<0·0001), but did not significantly reduce mortality (OR 0·90, 0·72–1·11; p=0·31). PPIs had larger protective effects than did H2RAs for further bleeding (phet=0·0107) and blood transfusion (phet=0·0130).InterpretationGastroprotectants, in particular PPIs, reduce the risk of peptic ulcer disease and its complications and promote healing of peptic ulcers in a wide range of clinical circumstances. However, this meta-analysis might have overestimated the benefits owing to small study bias.FundingUK Medical Research Council and the British Heart Foundation.

Risk Factors, Management and Other Correlates of Peptic Ulcer Disease in a University Community in South-South Nigeria

The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs).Treatment choices include standard triple therapy. This study evaluated the patterns of prevalence, life-style risk factors and correlates of management of PUD among Staff and Students of Delta State University, Abraka Campus, Nigeria. A descriptive cross sectional study was initiated among 450 willing staff and student respondents. A total of 126 respondents that had been diagnosed for PUD were further evaluated for prevalence and patterns, confounding life-style factors, drug therapy and other correlates of PUD management by using self-designed, pre-tested questionnaires that addressed the objectives of the study. Data was analyzed using Statistical Package for Social Sciences, version16.0 (SPSS Inc. Chicago Illinois). Duodenal Ulcer (DU) had a higher prevalence than Gastric Ulcer (GU) in a ratio of 1.5:1. The prevalence of GU was higher among Staff, Males and those older than 35 years; DU had a higher prevalence among the Students, Females and 16-35 yrs age group. The greatest life-style risk factors identified were consumption of NSAIDs, Tobacco and Alcohol. Regarding drug treatment, over 90% of drugs prescribed were antibiotics; nearly all respondents claimed to experience side-effects which included Diarrhea, Abdominal Pain and Headache; nearly all respondents often adhered to instructions to avoid Alcohol. In this population, PUD prevalence and pattern was structured along gender and age. There were issues with life-styles which could have contributed to the pathophysiology of PUD. Patients experienced some side-effects that affected adherence to instructions. Management seemed appropriate with the use of triple therapies. However, there is still a dire need for strategic health education on PUD risk factors and self-care practices.

Point-of-care Helicobacter pylori testing: primary care technology update.

#### Clinical Question In adults attending primary care with upper gastrointestinal symptoms, what is the accuracy and utility of point-of-care testing to detect Helicobacter pylori infection? Helicobacter pylori (HP) infection causes approximately 5% of uninvestigated dyspepsia and a 20% lifetime risk of peptic ulcer disease.1 HP is a grade 1 carcinogen: 5.2% of cancers globally are attributable to HP infection.2 HP eradication results in: reduced gastric cancer incidence; prevention of recurrent duodenal (number needed to treat [NNT] = 2) and stomach (NNT = 3) ulceration; and resolution of dyspepsia (NNT = 13).3 Non-invasive Helicobacter pylori diagnostic tests are available for point-of-care (POC) use in primary care and include IgG serology, 13C-urea breath test (UBT), and monoclonal stool antigen. Only UBT is sufficiently accurate to confirm current infection or eradication.4 HP IgG serology cannot differentiate current from past infection. Rapid qualitative stool antigen testing currently lacks diagnostic accuracy. Isotope ratio mass spectrometry (IRMS) is the most commonly used 13C-UBT method in the UK. However, the sampling procedure involves many opportunities for test incompletion: collection of the test from the pharmacy; returning for a subsequent extended appointment; sending the test to the laboratory; and awaiting results. In comparison, non-dispersive isotope selective infrared spectroscopy (NDIRS) has potential as a POC device: it can be used by non-specialist staff outside the laboratory setting, it …

Peptic ulcer risk with antidepressants and NSAIDs

Although the selective serotonin reuptake inhibitors (SSRIs) have a very good safety profile, they have been associated with spontaneous bleeding in some patients. The risk could be further increased if patients are taking concurrent nonsteroidal anti‐inflammatory drugs (NSAIDs). Investigators recently conducted a retrospective analysis to evaluate the risk of peptic ulcer disease associated with concomitant use of both classes of drugs, as compared with use of antidepressants alone, as well as to examine the differential risk among the various classes of antidepressants and individual antidepressants.

TLR2 Arg677Trp but not TLR2 -196 to -174 ins/del and Arg753Gln polymorphism alter the risk of peptic ulcer in north of Iran

BackgroundMost polymorphisms that occur in TLR-2 are associated with gastrointestinal disorders such as peptic ulcer disease (PUD). Hence, in current study, association between TLR2-196 to -174 ins/del, Arg753Gln and Arg677Trp polymorphisms and risk of PUD development in north of Iran was evaluated. MethodsThis case-control study included 50 patients with PUD as cases and 50 people without peptic ulcer as control group. Blood and endoscopic biopsies were collected. Helicobacter pylori infection was screened by rapid urease test, specific IgG measurement and specific PCR for glmM gene. Then, TLR2-196 to -174 ins/del polymorphism was assessed by using allele-specific PCR. The Arg753Gln and Arg677Trp polymorphism in TLR2 gene were analyzed by the PCR-restriction fragment length polymorphism (RFLP). ResultsThere was no significant difference in the allele and genotype frequencies of polymorphisms in the TLR2-196 to -174 ins/ins and Arg753Gln genes between controls and patients, respectively. However, an association with increased risk for PUD was observed for polymorphism TLR-2 Arg677Trp (odds ratio [OR] = 7.9; 95% confidence interval [CI] = 0.94–67.5). Further analysis showed that H. pylori infection was associated with a significant difference in genotype and allele frequencies of TLR2-196 to -174 ins/ins and Arg753Gln polymorphism, respectively. Furthermore, there was no association between variant haplotypes and PUD development in H. pylori infected subjects. However, no association was detected between gender and genotypic frequencies of all polymorphisms in TLR2. ConclusionOur findings showed that TLR2 Arg677Trp polymorphism and H. pylori infection may play crucial roles in peptic ulcer development respectively in north of Iran.

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding.

Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.Learning points:Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.The treatment of brown tumor varies from case to case.

Statin Therapy Is Associated with Reduced Risk of Peptic Ulcer Disease in the Taiwanese Population.

Although statin use may affect the severity of chronic gastritis and gastric cancer, no data exists about the relationship between statin therapy and risk of peptic ulcer disease (PUD) in patients. We investigated the effect of statin use and the incidence of PUD from the Taiwan National Health Insurance Research Database (NHIRD). A total of 35,194 patients records for medical claims were enrolled. We performed a population-based case-control analysis to compare the incidence of PUD in patients who were prescribed statins and that in patients who were not. In the univariate logistic analysis, we found that statin was not significant risk of PUD. However, a multivariate model indicates that satin use was significantly associated with a reduced risk of PUD (adjusted odds ratio [aOR] = 0.87, 95% CI = 0.82–0.93, P < 0.001). The cumulative defined daily dose (DDD) was analyzed. Patients who prescribed fluvastatin ≥280 DDD, atorvastatin ≥200 DDD, and pravastatin ≥130 DDD dramatically decreased risk for PUD (aOR = 0.58, 0.67, and 0.71; 95% CI = 0.46–0.74, 0.57–0.78, and 0.56–0.91, respectively). Our results showed that statin therapy reduced the risk of PUD and this was associated with the high cumulative DDD of prescribed statins. This study reveals that active use of statins to be associated with decreased risk for PUD.

Association between fibromyalgia syndrome and peptic ulcer disease development

PurposeThe correlation of fibromyalgia syndrome (FMS) with peptic ulcer disease (PUD) is unclear. We therefore conducted a cohort study to investigate whether FMS is correlated with an increased risk of PUD.MethodsIn this study, we established an FMS cohort comprising 26068 patients aged more than 20 years who were diagnosed with FMS from 2000 to 2011. Furthermore, we established a control cohort by randomly choosing 104269 people without FMS who were matched to the FMS patients by gender, age, and index year. All patients were free of PUD at the baseline. Cox proportional hazard regressions were performed to compute the hazard ratio of PUD after adjustment for demographic characteristics and comorbidities.ResultsThe prevalence of comorbidities was significantly higher in the FMS patients than in the controls. The incidence of PUD was 29.8 and 19.4 per 1000 person-years in the FMS and control cohorts, respectively. In addition, the FMS cohort exhibited a 1.40-fold higher risk of PUD (95% confidence interval = 1.35–1.45) compared with the control cohort. After control for confounding factors, the medications (selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, and antidepressants) taken by the FMS patients did not increase the risk of PUD.ConclusionFMS patients exhibit a higher risk of PUD than that of patients without FMS.

Identification of Gastric Cancer-Related Strains of Helicobacter pylori: Findings from Single Biopsy Specimens for PCR and Campylobacter-Like Organism Test

Background: Transmission of Helicobacter pylori occurs within families. It is known that elimination of H. pylori may reduce the risk of peptic ulcer disease (PUD) and gastric cancer (GC) and increase the risk of gastro-esophageal reflux (GERD), Barrett’s esophagus, and esophageal adenocarcinoma. Objectives: The present study aimed to determine gastric cancer-related strains of H. Pylori by precise diagnostic methods in patients with gastritis and PUD in East Azerbaijan, Iran, where the incidence of GC and esophageal cancer is high. Methods: The PCR assay was performed on the same biopsy samples used for Campylobacte-like organism test (CLO test), using the vacA d region (a gene predictor of gastric adenocarcinoma and peptic ulcer disease) and 16S rDNA gene in patients referring to the department of endoscopy at Imam Reza hospital in Tabriz, Iran. This study was conducted on individuals who had not received non-steroidal anti-inflammatory drugs or any anti-Helicobacter therapy at least for 3 months prior to endoscopy. The collected data were analyzed using SPSS version 19. Results: The rate of false negative results by CLO test was 8.3%. However, no false-positive results were found by CLO test. Among those patients infected with H. pylori, vacA d1 -positive strains, one case had a history of gastric cancer and another one had a history of gastric ulcer in first-degree relatives. However, no family history of gastric cancer or gastric ulcer was found in the patients with strains carrying the vacA d2 genotype. Conclusions: This study suggests that the vacA PCR can be very useful in diagnosis, treatment, and follow-up of patients with gastritis and PUD. The PCR assay and CLO test can complement and confirm each other in identification and eradication of cancer-related strains of H. pylori. The exclusion of patients with suspected achlorhydria from the study is likely a reason for the lack of false positive results in CLO test.

Women Who Sleep More Have Reduced Risk of Peptic Ulcer Disease; Korean National Health and Nutrition Examination Survey (2008-2009).

Sleep is integral to life and sleep duration is important in sleep quality, physical, and psychological health. Disturbances in sleep duration have been associated with increased risk of metabolic disorders, hypertension, and overall mortality. Sleep disturbance has also been linked with various gastrointestinal disorders. However, the association between sleep and peptic ulcer disease (PUD) has not been evaluated. We investigated the association between sleep duration and PUD. Subjects were included from the fifth Korean National Health and Nutrition Examination Survey conducted from 2008–2009. Individuals with PUD were defined as those with a physician diagnosis of PUD. Daily sleep duration was established by asking participants the amount of time that they slept per day. Multiple logistic regression models were used to evaluate the association of PUD and sleep duration. This study included 14,290 participants (8,209 women). The prevalence of PUD was 5.7% and was higher in men (6.8%) than in women (4.9%). Women who slept ≥9 hours were significantly less likely to have PUD compared to women who slept 7 hours. In men, longer sleep duration (≥9 hours) had a tendency toward PUD prevention. Our results suggest that longer sleep duration may play a protective role for PUD development.

Relationship between the iceA gene of Helicobacter pylori and clinical outcomes.

BackgroundThe complex pathogenesis of Helicobacter pylori (H. pylori) and the features of the host influence the diverse clinical outcomes. A mass of studies about virulence genes have accelerated the exploration of pathogenesis of H. pylori infection. Induced by contact with epithelium gene A (iceA) is one of the biggest concerned virulence genes. In this study, we explored the relationship between iceA and the magnitude of the risk for clinical outcomes and the prevalence of iceA-positive H. pylori in People’s Republic of China and other countries.MethodsWe searched the electronic databases of PubMed, Embase, CNKI, VIP, and Wanfang by literature search strategy. The studies conforming to the inclusion criteria were assessed. With these data, we systematically analyzed the relationship between the iceA gene of H. pylori and clinical outcomes.ResultsNineteen articles with 22 studies, a total of 2,657 cases, were involved in the study. The iceA1 gene was significantly associated with peptic ulcer disease (odds ratio =1.28, 95% confidence interval =1.03–1.60; P=0.03), especially in People’s Republic of China (odds ratio =1.40, 95% confidence interval =1.07–1.83; P=0.01). Moreover, the prevalence of iceA1 was significantly higher than iceA2 in People’s Republic of China (P<0.0001). The prevalence of both iceA1 and iceA2 was significantly different (P<0.0001) in People’s Republic of China and in other countries.ConclusionThe system analysis showed that infection with the iceA1-positive H. pylori significantly increased the overall risk for peptic ulcer disease, especially in People’s Republic of China. The iceA2 gene status and clinical outcome of H. pylori infection have no significant correlation. H. pylori iceA1 genotype is the major epidemic strain in People’s Republic of China.

A Study of the Association between Helicobacter Pylori, on Steroidal Anti Inflammatory Drugs and Peptic Ulcer Disease

NASID induced gastro intestinal injury represent the most frequent adverse drug event worldwide. Despite the large number of drug used, the incidence of serious side effects due to NSAIDs is considerably low. The wide spectrum of side effects includes of those affecting renal, hepatic and haematological functions. The major gastrointestinal adverse effects include peptic ulcer disease, gastrointestinal bleeding and perforation. Peptic ulcer disease is a chronic inflammatory condition of the stomach and duodenum affecting approximately 15% of people the world over. The two causative factors are Helicobactor pylori and NSAID. Helicobacter pylori and NSAID are independent risk factors for the developments of gastroduodenopathy.The two factors together do not increase the risk of peptic ulcer disease. Asymptomatic individuals with normal endoscopy are associated with histological changes of gastritis. Antral ulcers are associated with low prevalence of HP. Predicting which patients taking chronic NSAID s are at risk of ulceration; bleeding or perforation needs further evaluation.

Peptic Ulcer Disease in Living Liver Donors: A Longitudinal Population-Based Study.

The objective of this nationwide cohort study was to investigate the risk of peptic ulcer disease (PUD) in living liver donors (LDs). A total of 1333 LDs and 5332 matched nondonors were identified during 2003-2011. Hospitalized patients identified as LDs were assigned to the LD cohort, and the non-LD comparison cohort comprised age- and sex-matched nondonors. Cumulative incidences and hazard ratios (HRs) were calculated. The overall incidence of PUD was 1.74-fold higher in the LD cohort than in the non-LD cohort (2.14 vs. 1.48 per 1000 person-years). After adjustment for age, sex, monthly income and comorbidities, we determined that the LD cohort exhibited a higher risk of PUD than did the non-LD cohort (adjusted HR 1.74, 95% confidence interval [CI] 1.45-2.09). The incidence of PUD increased with age; the risk of PUD was 2.53-fold higher in patients aged ≥35 years (95% CI 2.14-2.99) than in those aged ≤34 years. LDs with comorbidities of osteopathies, chondropathies and acquired musculoskeletal deformities exhibited a higher risk of PUD (adjusted HR 3.93, 95% CI 2.64-5.86) compared with those without these comorbidities. LDs are associated with an increased risk of PUD after hepatectomy.

Prednisolone, Indomethacin Similarly Effective for Acute Gout

Prednisolone, Indomethacin Similarly Effective for Acute Gout

Role of allelic genes of matrix metalloproteinases and their tissue inhibitors in the risk of peptic ulcer disease development

Peptic ulcer disease is a chronic disease of the gastrointestinal tract, mainly manifesting itself in the formation of the fairly persistent ulcer defect of the mucous membrane of the stomach and/or duodenum. Association analysis of common polymorphisms of matrix metalloproteinases genes MMP-1 (rs1799750, rs494379), MMP-2 (rs2285052), MMP-3 (rs3025058), MMP-9 (rs3918242, rs17576), and MMP-12 (rs2276109) and their tissue inhibitors TIMP-2 (rs8179090) and TIMP-3 (rs9619311) was carried out in 353 patients with a gastric ulcer or duodenal ulcer and in 325 unrelated healthy individuals from the Republic of Bashkortostan. Associations of polymorphic variants rs1799750 and rs494379 of gene MMP-1, rs3025058 of gene MMP-3, rs3918242 and rs17576 of gene MMP-9, and rs9619311 of gene TIMP-3 with the risk of peptic ulcer disease in Russians and Tatars were revealed.

Helicobacter pylori Activates Matrix Metalloproteinase 10 in Gastric Epithelial Cells via EGFR and ERK-mediated Pathways.

Helicobacter pylori colonizes the human stomach and increases the risk for peptic ulcer disease and gastric carcinoma. H. pylori upregulates the expression and activity of several matrix metalloproteinases (MMPs) in cell lines and in the gastric mucosa. The aim of this study was to explore the mechanisms leading to upregulation of MMP10 in gastric epithelial cells induced by H. pylori Infection of gastric cells with H. pylori led to an increase in levels of MMP-10 messenger RNA, protein secretion, and activity. cagA knockout mutants or CagA phosphorylation-defective mutants failed to increase MMP10 expression. These results were confirmed in infection experiments with clinical isolates with known cagA status and in human gastric biopsy specimens. Treatment of cells with chemical inhibitors of the receptor tyrosine kinase EGFR and the kinase Src abrogated H. pylori-induced MMP10 expression. Inhibitors of ERK1/2 and JNK kinases abolished and significantly decreased H. pylori-induced MMP10 expression, respectively, whereas inhibition of the kinase p38 had no effect. Finally, inhibition of MMP10 expression by small interfering RNA led to a decrease in the gastric cell-invasive phenotype mediated by the infection. In conclusion, CagA-positive H. pylori strains stimulate MMP10 expression. MMP-10 modulation occurs via EGFR activation in a process that involves Src, ERK, and JNK pathways. MMP-10 may be implicated in H. pylori-mediated extracellular matrix remodeling.

Distinctive aspects of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss syndrome in patients with advanced alcoholic liver disease or cirrhosis.

To systematically review the data on distinctive aspects of peptic ulcer disease (PUD), Dieulafoy's lesion (DL), and Mallory-Weiss syndrome (MWS) in patients with advanced alcoholic liver disease (aALD), including alcoholic hepatitis or alcoholic cirrhosis. Computerized literature search performed via PubMed using the following medical subject heading terms and keywords: "alcoholic liver disease", "alcoholic hepatitis"," alcoholic cirrhosis", "cirrhosis", "liver disease", "upper gastrointestinal bleeding", "non-variceal upper gastrointestinal bleeding", "PUD", ''DL'', ''Mallory-Weiss tear", and "MWS''. While the majority of acute gastrointestinal (GI) bleeding with aALD is related to portal hypertension, about 30%-40% of acute GI bleeding in patients with aALD is unrelated to portal hypertension. Such bleeding constitutes an important complication of aALD because of its frequency, severity, and associated mortality. Patients with cirrhosis have a markedly increased risk of PUD, which further increases with the progression of cirrhosis. Patients with cirrhosis or aALD and peptic ulcer bleeding (PUB) have worse clinical outcomes than other patients with PUB, including uncontrolled bleeding, rebleeding, and mortality. Alcohol consumption, nonsteroidal anti-inflammatory drug use, and portal hypertension may have a pathogenic role in the development of PUD in patients with aALD. Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients. The frequency of bleeding from DL appears to be increased in patients with aALD. DL may be associated with an especially high mortality in these patients. MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism, and is associated with aALD. Patients with aALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics. Pre-endoscopic management of acute GI bleeding in patients with aALD unrelated to portal hypertension is similar to the management of aALD patients with GI bleeding from portal hypertension, because clinical distinction before endoscopy is difficult. Most patients require intensive care unit admission and attention to avoid over-transfusion, to correct electrolyte abnormalities and coagulopathies, and to administer antibiotic prophylaxis. Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal. Prompt endoscopy, after initial resuscitation, is essential to diagnose and appropriately treat these patients. Generally, the same endoscopic hemostatic techniques are used in patients bleeding from PUD, DL, or MWS in patients with aALD as in the general population. Nonvariceal upper GI bleeding in patients with aALD has clinically important differences from that in the general population without aALD, including: more frequent and more severe bleeding from PUD, DL, or MWS.

Depression and the Risk of Peptic Ulcer Disease: A Nationwide Population-Based Study.

The risk of peptic ulcer disease (PUD) among patients with depression has raised concern. This study determined the association between depression and the subsequent development of PUD using claims data.Patients newly diagnosed with depression in 2000 to 2010 were identified as depression cohort from the Taiwan National Health Insurance Research Database. The comparison cohort was randomly selected from subjects without depression, frequency matched by age and gender and diagnosis date, with a size 2-fold of the size of the depression cohort. The incidence of PUD was evaluated for both cohorts by the end of 2011. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of PUD using the Cox proportional hazards regression model.The depression cohort consisted of 23,536 subjects (129,751 person-years), and the comparison cohort consisted of 47,069 subjects (285,592 person-years). The incidence of PUD was 2-fold higher in the depression cohort than in the comparison cohort (33.2 vs 16.8 per 1000 person-years) with an age adjusted HR of 1.97 (95% CI = 1.89–2.06) or a multivariable adjusted HR of 1.35 (95% CI = 1.29–1.42).Depression might increase the risk of developing PUD. Prospective clinical studies of the relationship between depression and PUD are warranted.

Relevance of Helicobacter pylori vacA 3'-end Region Polymorphism to Gastric Cancer.

Helicobacter pylori vacA genotypes play an important role in the pathogenesis of severe gastrointestinal disease. We identified a novel polymorphic site in the 3'-end region of H. pylori vacA gene, denoted by c1/-c2 (c1: with deletion of 15 bp), and examined associations of this and the previous four sites as well as cagA status with gastroduodenal diseases, in a total of 217 Iranian H. pylori isolates. Histopathologic evaluations were performed and patients with gastric cancer (GC) were further classified based on the anatomic site of tumor, including cardia and noncardia GC, and the histopathologic type of tumor, including intestinal- and diffuse-type GC. The vacA m1, i1, d1, c1, and cagA genotypes were significantly associated with an increased risk of GC, the odds ratio (95% confidence interval) was 4.29 (2.03-9.08), 6.11 (2.63-14.19), 3.18 (1.49-6.76), 15.13 (5.86-39.01), and 2.59 (1.09-6.12), respectively. The vacA c1 genotype had an increased age- and sex-adjusted risk for GC by the multiple logistic regression analysis; the OR was 38.32 (95% CI, 6.60-222.29). This association was independent of and larger than the associations of the m-, i-, and d-type of vacA or cagA status with GC. No significant correlation was found between s1, whether independently or in combination, and the risk of GC or peptic ulcer disease (PUD). The vacA i1 and cagA genotypes were linked to an increased risk of PUD; the OR (95% CI) was 2.80 (1.45-5.40) and 2.62 (1.23-5.61), respectively. The presence of both the vacA i1 and cagA genotypes further increased the risk of PUD; the OR was 5.20 (95% CI, 1.92-14.03). The H. pylori vacA c1 genotype might therefore be one of the strongest risk predictors of GC in male patients aged ≥55 in Iran.

The distribution of jhp0940, jhp0945, jhp0947, jhp0949 and jhp0951 genes of Helicobacter pylori in China.

BackgroundThe plasticity region of Helicobacter pylori (H. pylori) is a large chromosomal segment containing strain-specific genes. The prevalence of the plasticity region genes of the H. pylori strains in China remains unknown. The aim of this study was to examine the status of these genes and to assess the relationship between the genes and the diseases caused by H. pylori infection.MethodsA total of 141 strains were isolated from patients with chronic active gastritis (CAG), peptic ulcer disease (PUD) and gastric carcinoma (GC). The prevalence of jhp0940, jhp0945, jhp0947, jhp0949 and jhp0951 was determined using PCR, and the results were analyzed using the chi-squared test.ResultsThe prevalence rates of jhp0940, jhp0945, jhp0947, jhp0949 and jhp0951 in the H. pylori strains were 42.55, 51.06, 20.57, 56.03 and 63.12 %, respectively. The prevalence rates of jhp0940 were similar in the isolates from the CAG, PUD and GC patients, and there was no association between the jhp0940 status and any of the diseases. In contrast, the prevalence rates of jhp0945, jhp0947, jhp0949 and jhp0951 were significantly higher in the PUD and GC isolates than in the CAG isolates (p < 0.01). A univariate analysis showed that jhp0945, jhp0947, jhp0949 and jhp0951 increased the risk of PUD, while only jhp0951 was significantly associated with PUD in the multivariate analysis (p = 0.0149). The jhp0945-positive isolates were significantly associated with an increased risk for GC (p = 0.0097).ConclusionThe plasticity region genes are widely distributed in Chinese patients, and a high prevalence of these genes occurs in more serious diseases. Therefore, jhp0951 status is an independent factor associated with the development of PUD, and jhp0945 may predict the future development of GC in patients with CAG and is considered to be the best candidate disease marker for H. pylori-related diseases.