Peptic Ulcer Research Articles

Incidence and predictors of major gastrointestinal bleeding in patients on aspirin, low-dose rivaroxaban, or the combination: Secondary analysis of the COMPASS randomised controlled trial.

The incidence of major gastrointestinal bleeding (GIB) in patients on low-dose direct-acting oral anticoagulants (DOACs) is relatively unknown. Estimates from randomised controlled trials (RCTs) are lacking. To assess GIB incidence and predictors from RCT data of patients on aspirin, low-dose rivaroxaban, or both. This was a secondary analysis of RCT data wherein patients received aspirin 100 mg daily and rivaroxaban 2.5 mg b.d., aspirin alone, or rivaroxaban 5 mg b.d. Patients were followed from 2013 to 2016 at 602 centres. Outcomes included overall, upper, and lower GIB. We employed multivariable logistic regression to yield odds ratios (ORs) and 95% confidence intervals for potential exposures. Among 27,395 patients, the annual incidence of GIB on rivaroxaban 2.5 mg b.d. with aspirin was 801.7 per 100,000 compared with 372.3 in 100,000 for aspirin. Age (OR 4.16, 2.53-6.82 for ≥75 vs. 55-64), peptic ulcer disease (PUD, OR 1.57, 1.01-2.44), liver disease (OR 2.09, 1.01-4.33), hypertension (OR 1.42, 1.04-1.94), and smoking (OR 1.85, 1.26-2.73) were associated with overall GIB. Kidney disease (OR 1.68, 1.12-2.51) was significantly associated with upper GIB, whereas diverticular disease (OR 3.75, 1.88-7.49) was associated with lower GIB. Addition of rivaroxaban to aspirin was associated more with lower GIB (OR 2.82, 1.64-4.84) than upper GIB (OR 1.86, 1.18-2.92). We established incidences and identified risk factors for GIB in users of low-dose DOACs. Novel risk factors included current or former smoking and diverticulosis. Future studies should aim to validate these risk factors.

Transcatheter Arterial Radioembolization–Induced Gastric Ulcer in an Excluded Stomach After Roux-en-Y Gastric Bypass

ABSTRACT Transcatheter arterial radioembolization (TARE) is a common locoregional treatment for hepatocellular carcinoma. It is associated with peptic ulcer disease in up to 5% of patients. A 70-year-old man with Roux-en-Y gastric bypass and liver cirrhosis with hepatocellular carcinoma treated with TARE 6 months earlier was evaluated for continued melena and was found to have an ulcer in the excluded stomach. This was successfully treated with liquid proton pump inhibitor through gastrostomy tube to the excluded stomach. This represents a unique case of successful management of TARE-induced peptic ulcer disease in the excluded stomach of a Roux-en-Y gastric bypass patient.

Prognostic impact of deprivation on esophagogastroduodenoscopy outcome.

Background and study aims Socioeconomic deprivation has long been associated with many gastrointestinal diseases, yet its influence on esophagogastroduodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Patients and methods Two thousand consecutive patients presenting to four Health Boards in Wales beginning in June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into quintiles for analysis (Q1 most, Q5 least deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with peptic ulcer (Q1 7.9%, Q5 4.7%; odds ratio [OR] 0.498, P =0.018), severe esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, P 0.002), Helicobacter pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, P =0.002), but less likely to be diagnosed with Barrett's esophagus (Q1 6.3% v Q5 12.3%, OR 2.146, P =0.004) than those from the least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after presentation for urgent suspected cancer (USC, n=35, 4.6%) than for routine referrals (n=3, 0.6%, P < 0.001). Deprivation was associated with more advanced stage cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, P =0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, P =0.049). Conclusions Deprivation was associated with two-fold more peptic ulcer disease, three-fold more H. pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.

Relation between Helicobacter Pylori Infection and Blood Group in Patients with Peptic Ulcer

Relation between Helicobacter Pylori Infection and Blood Group in Patients with Peptic Ulcer

Implementing pharmacogenetic testing to optimize proton-pump inhibitors use among Indian population based on CPIC-CYP2C19-PPI dosing guidelines: The need of the hour.

Proton-pump inhibitors (PPIs) are widely prescribed to decrease stomach acid and treat various acid-related Gastrointestinal tract (GIT) diseases. However, genetic variations, particularly in the CYP2C19 gene, affect PPIs metabolism and efficacy. Variants in CYP2C19 can result in different rates of PPI metabolism, influencing their effectiveness. Personalized medicine strategies, such as genotyping for CYP2C19, have the potential to enhance the effectiveness of PPI therapy and patient safety. This review aims to describe the relevance of CYP2C19 genetic profiling in the indian population, including normal function (e.g. CYP2C19*1, *11, *13, *15, *18, *28, and 38), decreased function (e.g., CYP2C19*9, *10, *16, *19, *25, and 26), loss of function (e.g., CYP2C19*2, *3, *4, *5, *6, *7, *8, *22, *24, *35, *36, and *37), and increased function (e.g., CYP2C19*17) variants. This review also examines the clinical pharmacogenomics implementation consortium (CPIC)-CYP2C19-PPI guidelines to highlight the importance of pharmacogenomics (PGx)-informed personalized PPI therapy for gastroesophageal reflux disease and peptic ulcer disease treatment. On average, each person in India possesses eight pharmacogenetic (PGx) variants that can be clinically significant, underscoring the need for preemptive testing. Implementing CYP2C19 genetic testing in India requires expanding laboratory capacity, increasing accessibility in primary care, increasing public awareness, collaboration between pharmacovigilance and PGx programs, investing in advanced sequencing technologies, data management systems, and integration with electronic health records and clinical decision support systems. Addressing challenges such as genetic diversity, socioeconomic factors, health-care access issues, and shortage of trained professionals is essential for implementation. Due to the lack of definitive country-specific policies and PGx guidelines from Indian drug regulatory agencies, guidelines from international consortia such as the Clinical Pharmacogenetics Implementation Consortium and drug labeling offer crucial foundational evidence. This evidence can be used to enhance patient outcomes and ensure the safe and effective use of PPIs in India.

New trends in the valuation of micro and nanocrystalline cellulose and their derivatives extracted from the wastes of palm frond for curing of peptic ulcers

The current study was directed to explore new natural products that alleviate inflammation with the least harming effects on the gastric mucosa. This study examined the anti-ulcerative properties of micro and nanocrystalline cellulose (MCC, NCC) palm frond and their chemically modified samples (sulfated (SMCC and SNCC), methylated (MMCC and MNCC) and phosphorylated (PMCC and PNCC)). The lowest prebiotic index (I) was recorded in case of the MMCC and MNCC extract with L. Reuteri (I = 1) while the higher prebiotic index was recorded in case of the PMCC against L. casei (I = 3.7). All treated groups showed significant improvements in the ulcer scores (P < 0.05) compared to the control (indomethacin) group. However, MMCC showed marked effects similar to ranitidine. A significant decrease was found in pro-inflammatory cytokines (IL-6 and TNF-α) and pro-apoptotic gene (Bax) in all treated groups compared to the ulcer-induced group. In conclusion, the histopathological evaluation of MNCC, PNCC and SNCC had superior ameliorating effect on gastric ulcer induced in rats when compared to Omeprazole 20 mg/kg and other treated groups (MMCC, PMCC, SMCC).

Gastroprotective Effect of Abelmoschus esculentus (Ex-Maradi Okra Fruit Variety) Against Ethanol-Induced Ulcers in Rats

Study’s Novelty/Excerpt The study evaluates the gastroprotective properties of the Ex-Maradi variety of Abelmoschus esculentus (okra) against ethanol-induced gastric mucosal damage in Wister rats, specifically comparing fresh okra mucilage (FOM) and dried okra powder (DOP). The significant ulcer inhibition and antioxidant effects of DOP, particularly at a 500 mg/kg dosage, indicate its potential as a natural therapeutic agent for peptic ulcer disease. The research highlights the potential for developing green anti-ulcer formulations derived from okra, expanding the scope of nutraceutical applications for this commonly consumed vegetable. Full Abstract Peptic ulcer disease, a notable gastrointestinal disorder, results from an imbalance between gastric acid secretion and the factors maintaining gastric mucosal integrity. Abelmoschus esculentus, commonly known for its mucilaginous and nutraceutical properties, also exhibits an antacid effect. This research aimed to examine the antacid properties of fresh okra fruit mucilage (FOM) and dried okra fruit powder (DOP) of the Ex-Maradi okra fruit variety against ethanol-induced gastric mucosal damage in Wister rats. Rats were randomly assigned to seven groups consisting of six rats each. Rats in the FOM and that of the DOP group were pretreated orally with 250 and 500 mg/kg body weight of the FOM and DOP, respectively; the drug control (DC) group was pretreated orally with 20 mg/kg body weight of Cimetidine while the normal control (NC) group and the ulcer control (UC) group were pretreated orally with normal saline (2 mL/kg body weight). All the treatments were done for seven days before the induction of the ulcer. Ulcer index (UI), percentage inhibition (PI), gastric volume, gastric pH, total acidity, and total antioxidant power (TAP) were evaluated to assess the gastro-protective effect of the FOM and DOP in the rats. Both FOM and DOP groups demonstrated significant (P &lt; 0.05) protection with a low ulcer index (2.41 ± 0.12) and high ulcer inhibition (75.6 %) against the damaging effect of ethanol on the gastric mucosa of the animals. Additionally, DOP also exhibited a strong antioxidant effect with a good percentage inhibition value (56.53 ± 2.1%) compared to the ulcer control group. These results were further supported by the histopathological findings from the rats’ stomachs. In conclusion, the Ex-Maradi okra fruit, especially the DOP500, demonstrated significant (P &lt; 0.05) gastro-protective effects and maintained a relatively intact and continuous epithelial surface of the rats’ stomachs. Overall, its gastroprotective effects may be possibly mediated by its potential to modulate the antioxidant system and gastric acid levels. Hence, the dried okra fruit could be suitable for the development of green anti-ulcer formulations.

Non-Traumatic Full-Thickness Duodenal Perforation: A Case Report

Duodenal perforation is a life-threatening condition with high mortality and morbidity. In this study, we aim to present a case of spontaneous duodenal perforation that was detected and treated. The 66-year-old male patient, who applied to the emergency clinic with complaints of malaise, fever, weakness and shortness of breath, had no additional disease other than Chronic obstructive pulmonary disease and dementia. Pneumonia was diagnosed based on physical examination and imaging findings, and he was admitted to the pulmonology clinic and treated. During follow-ups, the patient developed sepsis and an acute abdominal pain. An emergency laparotomy revealed a non-traumatic spontaneous duodenal perforation, which caused near ruptured duodenum. The perforated duodenum part was resected and gastrojejunostomy was performed. The rupture of the duodenum and large duodenal perforation can occur in association with iatrogenic or trauma-related causes. In the patient who had no history of trauma, the most likely cause of perforation was thought to be peptic ulcer. It was thought that possible peptic ulcer perforation expanded with necrosis over time. In cases without a history of trauma, the possibility of large duodenal perforation or rupture should not be ruled out, and if there is suspicion of spontaneous duodenal perforation, laparotomy should not be avoided.

Analgesic and anti-inflammatory activities of NPK 500 capsules, a Cassia sieberiana DC. - Based herbal analgesic medicine used to treat dysmenorrhea and peptic ulcer, is mediated through the inhibition of PGE2 and iNOS

Ethnopharmacological relevancePain and inflammation are the most frequent reasons for which people seek medical care. Currently available analgesics against these conditions produce fatal adverse effects. NPK 500 capsules is an alternative herbal analgesic employed to treat dysmenorrhea, peptic ulcer and pain. NPK 500 is produced from Cassia sieberiana. A plant used in traditional medicine to treat pain and inflammation. Aim of the studyThis study reports the analysis, phytochemical characterization and mechanism of analgesic and anti-inflammatory activities of two NPK 500 capsules, called old and new NPK500 capsules (ONPK500 and NNPK500) respectively. Materials and methodsPhysicochemical, organoleptic, GC-MS and LC-MS methods were employed to analyze the NPK 500 capsules. Analgesic activity was evaluated using tail immersion, Randall-Selitto and acetic acid induced writing tests. Anti-inflammatory activity was evaluated using carrageenan-induced rat paw inflammation. Additionally, pro-inflammatory mediators such as prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS), cyclooxygenase 1 and 2 (COX-2 and COX-1) were quantified in the sera of the rats using Enzyme Linked Immunosorbent Assay (ELISA) kits. ResultsThirteen major compounds were characterized in the NNPK 500 capsules via the GC-MS and LC-MS spectroscopies. Kaempferol was the major compound characterized in addition to physcion, β-sitosterol 3-O-β-D-glucopyranoside, betulinic acid and nine others. Physicochemical and organoleptic indices of the capsules were also derived for its authentication and quality control. Furthermore, NNPK 500 0.5–1.5 mg/kg p.o. produce significant (P < 0.5) analgesic activity (160–197%) higher than that of ONPK500 (109.8%) and Morphine (101%) in the tail immersion test. The analgesic activity of NNPK 500 0.5–1.5 mg/kg p.o. (171.0–258.3%) and ONPK 500 (179.5%) were also significant (P < 0.01) and higher than that of Aspirin (103.00%) in the Randall-Selitto test. Both capsules also demonstrated significant (P < 0.5) analgesic and anti-inflammatory activities in the acetic acid-induced writhing and carrageenan-indued paw edema tests respectively. The two NPK500 capsules also, significantly (P < 0.5) inhibited PGE2 and iNOS but not COX-2 and COX-1 in the carrageenan-indued paw edema test. ConclusionThese results show that NNPK 500 and ONPK 500 capsules possessed potent analgesic and anti-inflammatory activities via inhibition of PGE2 and iNOS as a result of their chemical constituents. NPK500 capsules thus, relief acute pain and inflammation without causing gastrointestinal, renal or hepatic injuries, since they did not inhibit COX-1.

Should Empiric Anti-Fungals Be Administered Routinely for All Patients with Perforated Peptic Ulcers? A Critical Review of the Existing Literature.

A perforated peptic ulcer (PPU) is a surgical emergency with a high mortality rate. PPUs cause secondary peritonitis due to bacterial and fungal peritoneal contamination. Surgery is the main treatment modality and patient's comorbidites impacts perioperative morbidity and surgical outcomes. Even after surgery, resuscitation efforts should continue. While empiric antibiotics are recommended, the role of empiric anti-fungal treatment is unclear due to a lack of scientific evidence. This literature review demonstrated a paucity of studies evaluating the role of empiric anti-fungals in PPUs, and with conflicting results. Studies were heterogeneous in terms of patient demographics and underlying surgical pathology (PPUs vs. any gastrointestinal perforation), type of anti-fungal agent, timing of administration and duration of use. Other considerations include the need to differentiate between fungal colonization vs. invasive fungal infection. Despite positive fungal isolates from fluid culture, it is important for clinical judgement to identify the right group of patients for anti-fungal administration. Biochemistry investigations including new fungal biomarkers may help to guide management. Multidisciplinary discussions may help in decision making for this conundrum. Moving forward, further research may be conducted to select the right group of patients who may benefit from empiric anti-fungal use.

High comorbidity burden and low incidence of adverse events in primary shoulder arthroplasty in tertiary care at a university hospital

BackgroundReducing perioperative risk is in the focus of primary arthroplasty caregivers. Primary shoulder arthroplasty patients are considered among those with the lowest perioperative risk. Nonetheless, in tertiary care centres and university settings patients with significant comorbidities are being treated. It remains unclear whether the overall comorbidity burden is truly higher and if this results in an increased frequency of adverse events (AE). As a result, we conducted a study to assess the comorbidity burden and the frequency of major perioperative adverse events and predictive factors following primary shoulder arthroplasty in the university setting. MethodsA retrospective cohort analysis was conducted on patients undergoing primary shoulder arthroplasty for a non-trauma, non-tumour indication from January 1st, 2014 through December 31st, 2018. Administrative data were recorded to assess comorbidity burden and revision surgery within the first postoperative year. Major adverse events were routinely recorded on a weekly basis by the treating physicians. Descriptive and comparative statistical analyses were performed. The cohort was compared against a large North American sample. ResultsOf 386 patients who underwent 400 primary shoulder arthroplasties 14 (3.5 %) experienced adverse events. While AE were distributed equally among anatomical and reverse shoulder arthroplasties, no adverse event was recorded in the 34 hemiarthroplasty patients. The cohort showed an increased comorbidity burden in international comparison. Peptic ulcer disease was significantly associated with AE, while mild liver disease experienced a trend towards AE. ConclusionWe found an increased comorbidity burden and a low rate of AE for primary shoulder arthroplasty in a tertiary care and university setting. The distinct role of peptic ulcer disease in this cohort and the trend in mild liver disease merit further investigation in larger samples. The findings underscore the importance of perioperative risk assessment and management. Level of evidenceIII, retrospective cohort study.

Review on Exploration of Phytomolecules in the Treatment of Peptic Ulcer

Peptic ulcers are defined as the presence of destructions on the mucosa of the gastrointestinal system, which might extend to the muscular layer. Their origin is complex and arises when there is a disruption in the equilibrium between the elements that cause harm and those that protect the mucosa. Peptic ulcers are a significant international health issue, impacting millions of individuals and exhibitingelevated recurrence rates. The enormous range of structural diversity and unique biological activity exhibited by natural products has significantly contributed to the creation and discovery of novel medications. An exhaustive analysis on the investigation of phytomolecules in the management of gastricabscess might offer important considerate of the existing data regarding the utilization of these compounds. This review may analyze and combine the results of several research to discover potential of phytomolecules, explain how they work, and evaluate their safety and effectiveness. This data can contribute to the advancement of efficacious and secure therapeutic alternatives for peptic ulcer. By advocating for the utilization of natural therapies and plant-based medications, the aim is to enhance the health results of individuals suffering from peptic ulcer.

Vonoprazan: a promising advancement in proton pump inhibitor therapy

Vonoprazan, a potent potassium-competitive acid blocker (P-CAB), has emerged as a potential therapeutic option for acid-related disorders, particularly gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). This comprehensive review aims to provide an overview of the efficacy, safety profile, and clinical implications of vonoprazan based on current literature. Efficacy studies have demonstrated vonoprazan's superiority over proton pump inhibitors (PPIs) in achieving effective acid suppression, rapid symptom relief, and promoting mucosal healing in patients with GERD and PUD. Moreover, its long-lasting acid suppression properties offer protection against Helicobacter pylori (H. pylori) infection, presenting it as a potential alternative to traditional triple H. pylori eradication regimens. Safety evaluations reveal a favourable tolerability profile with minimal adverse effects and a lower risk of drug interactions compared to PPIs. However, concerns regarding long-term safety, such as hypomagnesemia and the potential for rebound acid hypersecretion, necessitate further investigation. Additionally, the role of vonoprazan in special populations, such as the elderly and those with renal impairment, warrants exploration. Overall, vonoprazan represents a promising advancement in acid suppression therapy, offering efficacy, safety, and potential advantages over traditional agents.

Peptic ulcer disease.

Peptic ulcer disease.

Zastaprazan: First Approval.

Zastaprazan (JAQBO®) is a next-generation potassium-competitive acid blocker being developed by Onconic Therapeutics, a subsidiary of Jeil Pharmaceutical, for the treatment of acid-related diseases. Zastaprazan binds directly to proton pumps in a competitive manner to reduce gastric acid secretion, allowing for a quick onset of action. On 24 April 2024, zastaprazan received approval in South Korea for the treatment of erosive gastroesophageal reflux disease (GERD). Zastaprazan is also undergoing phaseIII development for the treatment of gastric ulcer and for the prevention of non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulcer. This article summarizes the milestones in the development of zastaprazan leading to this first approval for erosive GERD.

Malnutrition in Acute Stroke: An Article Review

The prevalence of malnutrition after stroke varies widely. It is estimated about one-fifth of patients with acute stroke are malnourished on initial hospital admission, while the prevalence of malnutrition ranges from 6.1 to 62%. Energy requirements increase due to stress caused by stroke, while food intake decreases due to impaired ability to eat, so the body will use its fat and protein stores as fuel to produce glucose. Muscle and fat tissue undergo degradation due to the breakdown of amino acids to form energy. Systemic consequences occur after stroke, peripheral immunodepression in association with overstimulation of the autonomic and neuroendocrine systems. Damage to cerebral tissue can activates the hypothalamus-pituitary-adrenal axis, resulting in increased levels of glucocorticoid hormones, catecholamines, and glucagon, leading to hypermetabolism (increased energy use), hypercatabolism (increased protein breakdown), and persistent hyperglycemia. The prevalence of malnutrition increases with the length of stay and decreased functional improvement during rehabilitation. Malnourished patients with stroke experience a higher stress reaction, which increases the occurrence of peptic ulcers, and infections of the respiratory and urinary tracts, thus extending the length of stay and increasing mortality.

Unique EPIYT motif CagA gene Helicobacter pylori Bali 01 isolate as the cause of hematemesis in a male gastric ulcer patient in Wangaya General Teaching Hospital Denpasar Bali: a case report

Background: Helicobacter pylori (H. pylori) infection is related with a number of gastrointestinal disorders, including gastritis, peptic ulcer disease, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This case report aims to present an unique EPIYT motif CagA gene H. pylori Bali 01 isolate as the cause of hematemesis in a male gastric ulcer patient Case Presentation: A 70-year-old male Balinese patient came to the hospital due to hematemesis. Esophagogastroduodenoscopy was performed after stabilizing patient condition with prompt treatment and intravenous proton pump inhibitor. Esophagogastroduodenoscopy revealed a solitary giant ulcer in the gastric antrum. Gastric biopsy was performed and histopathology examination revealed a spherical-like organism, confirmed as H. pylori. Biopsy was sent to the Biomedical Laboratory at West Nusa Tenggara, Mataram, Lombok Island. Culture of biopsy and polymerase chain reaction revealed H. pylori, then named H. pylori Bali 01 isolate. Standard protocol of H. pylori eradication is conducted by administration of triple drug therapy consisting of omeprazole, amoxicillin, and clarithromycin for 14 days. Patient was discharged from hospital in stable condition. Helicobacter pylori was successfully eradicated and revealed completely normal gastric antrum in reperformance of esophagogastroduodenoscopy 3 months later. Conclusion: The EPIYA-ABD motif on this H. pylori Bali 01 isolate is distinctively unique from the EPIYT motif on the second EPIYA sequence.

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: is it suitable for all?

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: is it suitable for all?

Novel thiolated pluronic anchored gastro-retentive SEDDS of azithromycin against peptic ulcer

Peptic ulcer disease is a substantial health issue worldwide, owing to excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) and poor hygienic conditions. Numerous therapeutic approaches including antibiotics and PPIs are commonly used, but these therapies are rendered with multi-drug resistance, increased frequency of dosing, less retention time, deceased safety, efficacy, and non-patient compliance. Herein, azithromycin (AZM), an expansive-spectrum antibiotic with notable anti-ulcer efficiency was integrated into a thiolated pluronic self- emulsifying drug delivery system (SEDDS) to enhance its solubility, mucoadhesion, stability, gastro-retention, and targeted drug delivery. Pluronics are triblock copolymers with excellent biocompatibility and amphiphilic properties, widely used in drug delivery, disease diagnosis, and treatment, among other applications. In vitro and in vivo tests were performed to assess the drug-release kinetics, H-pylori clearance, and efficacy. The optimized formulation possessed a size of 357 nm, PDI ≤ 0.5 and a zeta potential of 30 mV. Drug release was 85 % in 72 h, following Korsmeyer-Peppas model. Thiolated SEDDS proved to be extremely potent in eradicating bacterial load (40-load) when compared to alternative formulations. Furthermore, the retention duration, biofilm elimination and nanoparticle uptake were maximized. This novel thiolated SEDDS composition is highly recommended as it holds promising potential to markedly enhance the therapeutic outcomes of AZM in peptic ulcer treatment and overcomes the restrictions of current methodologies. The study not only boosts scientific comprehension of more effective drug-delivery techniques but also recommends significant implications for the broader disciplines of gastroenterology and personalized medicine.

FREQUENCY OF HELCIOBACTER PYLORI AMONGST PATIENTS WITH GASTROINTESTINAL TRACT SYMPTOMS

Worldwide, H. pylori is recognised as a serious concern for public health that causes peptic ulcer disease, gastric cancer and chronic gastritis. The frequency of H. pylori infection ranges from 13% to 81%. Globally, H. pylori infection accounts for around 89% of stomach cancer. Objective: To determine the frequency of helicobacter pylori amongst patients with gastrointestinal tract symptoms. Methodology: The current cross-sectional study was carried out at the Department of Medicine General Hospital Peshawar from September 2023 to February 2024. The overall sample size of the current study was 150 patients. All the patients were assessed for the pylori SAT (Stool antigen test). All the information was gathered on a specialized proforma designed for our research. All the data was analysed using SPSS version 23.0. Results: In the current study, 150 patients were enrolled. Male patients were 100 (66.67%) while female patients were 50 (33.33%), with a ratio of males to females of 1:2. Among 150 patients, 129 (86%) individuals tested positive for H. pylori, whereas 21 (14%) patients tested negative. The enrolled patients' ages ranged from 15 to 85 years with a mean age (SD) of 50.3 (11.01). After analysing the endoscopic reports of patients, it was found that fifteen patients (25%) had chronic gastritis, thirty-five patients (58%) had duodenal ulcers, ten patients (16.6%) had stomach ulcers, and eight patients (13.3%) had non-ulcer dyspepsia. Conclusion: Our study concludes that Helicobacter pylori is the most prevalent problem among patients with gastrointestinal tract symptoms. Early diagnosis and timely treatment are fundamental to avoiding this severe problem.