Peptic Research Articles

Intervention Options for Uncontrolled Peptic Ulcer Bleeding After Endoscopic Therapy

When mainstay endoscopic therapy fails to treat bleeding peptic ulcers or rebleeding occurs, surgery has been the traditional next-step therapy;

Not All Nonvariceal Upper GI Bleeding Is the Same

Most studies of nonvariceal upper gastrointestinal bleeding (NVUGIB) include peptic ulcers but exclude bleeding from Mallory-Weiss tears, vascular

Intimate partner violence among women attending a general practice clinic in Nigeria

Background: There has been an increasing concern about the magnitude of violence against women, especially pregnant women in Nigeria. The long-term health impact of violence on the victims as well as the difficulty in directly associating violence with the health outcome of the victims is understudied in Nigeria. This study aimed to determine associations between physical health outcomes and intimate partner violence (IPV) in adult females attending a general practice clinic. Methodology: This was a cross-sectional descriptive study of 360 participants recruited using systematic sampling methods. A modified Abuse Assessment Screen tool was used to screen for IPV and the data were analyzed using version 21 of the Statistical Package for the Social Sciences (SPSS). Results: The prevalence of IPV in this study was 80%. Sexual abuse had the highest prevalence (56.4%), followed by physical and psychological abuse which had the prevalence of 46.7% and 31.9%, respectively. The common risk factors for IPV observed in this study included younger age of respondents, having a large family size, being employed, and partner's educational status. The common comorbidities found among the respondents experiencing IPV included hypertension, pelvic inflammatory disease, peptic acid disorders, osteoarthritis, and depressive illnesses. Alcohol use by partners was the most common perceived reason given by the respondents for their partners' perpetration of IPV. Conclusion: IPV as a part of violence against women remains very high and underreported in our society. The study showed a strong association between IPV and hypertension; this should be of interest to health-care practitioners and researchers.

Analysis of TCM nursing intervention on Helicobacter pylori peptic ulcer in children

目的 分析中医护理干预对小儿幽门螺杆菌(Hp)消化性溃疡的效果。 方法 回顾分析2015年5月至2017年5月在中国医科大学附属盛京医院治疗的Hp伴消化性溃疡患儿108例的临床资料，按护理方式不同分为两组，对照组54例行常规护理，观察组54例行中医护理，比较组间症状及生活质量、护理满意度。 结果 护理前，两组胃胀、嗳气、隐痛等各项症积分差异均无统计学意义(均P>0.05)；护理后，观察组胃胀、嗳气、隐痛等各项症积分均明显低于对照组(均P 0.05)；护理后，两组SF-36量表中的躯体功能、情感功能、精神状态及总体健康等评分均高于对照组(均P<0.05)。观察组近亲属对护理满意度为92.6%，明显高于对照组的64.8%(χ2＝7.684，P<0.05)。 结论 中医护理可有效改善Hp消化性溃疡患儿临床症状，改善患儿生活质量，提高近亲属满意度，干预效果显著。

Peptic ulcer rebleeding in patients with and without chronic kidney disease

Objetivo: Determinar si el resangrado de la enfermedad ulcerosa peptica (EUP) en pacientes con enfermedad renal cronica (ERC) es mayor que en los pacientes con EUP sin ERC en los pacientes hospitalizados en la Unidad de Hemorragia Digestiva del Hospital Nacional Edgardo Rebagliati Martins. Materiales y metodos: Se realizo un estudio de casos y controles, observacional, analitico y retrosprospectivo en pacientes mayores de 18 anos, con resangrado por ulcera peptica, ingresados a la Unidad de Hemorragia Digestiva del Hospital Nacional Edgardo Rebagliati Martins durante un periodo de 1 ano. Resultados: Total de 146 pacientes, 26 % son mujeres y 74 % varones. Media de edad: 65,47 ± 17,95 anos. Los casos (EUP con ERC) fueron 34 y los controles (EUP sin ERC) fueron 112. La causa del sangrado fue ulcera duodenal en 53 % y ulcera gastrica en 47 %. La razon entre la presencia de resangrado en pacientes con EUP con ERC es 6,43 veces mayor que en pacientes con EUP sin ERC. Resangrado en pacientes con ERC 41,1 % y en los pacientes sin ERC de 9,8 %. El tipo de ulcera con mayor resangrado fue el tipo IIa en ambos grupos. El 94 % de pacientes fueron dados de alta, 2,7 % referidos a cirugia. La tasa de mortalidad total fue de 2,7 %, y de 5,8 % en los pacientes con ERC. (p=0,2). Conclusiones: La razon de resangrado de la ulcera peptica en pacientes que padecen de enfermedad renal cronica es 6,43 veces mayor que en los pacientes sin enfermedad renal cronica, La tasa de resangrado de la enfermedad ulcerosa peptica en pacientes con enfermedad renal cronica, fue del 41,1 %, mientras que en los pacientes sin enfermedad renal cronica fue de 9,8 %.

Application of refined care in patients with peptic ulcer bleeding

目的 探讨精细化护理在消化性溃疡出血治疗中的应用。 方法 选择温州医科大学附属第二医院2016年1月至2017年12月收治的消化性溃疡伴出血患者179例，采用随机数字表法分为对照组(80例)和干预组(99例)，对照组进行常规护理干预，干预组应用精细化护理。护理干预2周后观察两组止血时间、胃肠道症状消失时间和住院时间，评估患者健康知识评分、依从性、满意度、生活质量，应用Zung焦虑自评量表(SAS)评估患者焦虑状况。 结果 干预组止血时间、胃肠道症状消失时间和住院时间分别为(4.54±0.96)d、(7.15±1.01)d和(11.40±3.72)d，均短于对照组的(5.90±1.03)d、(9.82±0.94)d和(13.85±3.51)d，差异均有统计学意义(t＝8.96、9.57、10.38、12.45，均P<0.05)；干预组护理依从性、健康知识评分、护理满意度、胃肠道症状、全身症状、情感功能、社会功能评分分别为(96.51±7.64)分、(93.70±8.62)分、(98.61±10.14)分、(60.81±4.32)分、(31.50±2.07)分、(77.56±5.92)分，均高于对照组的(90.85±6.97)分、(81.39±9.30)分、(91.24±9.36)分、(54.60±4.51)分、(28.32±1.85)分、(73.18±5.59)分和(28.03±2.62)分，差异均有统计学意义(t＝11.06、11.89、11.76、10.81、9.67、10.05，均P<0.05)，干预组干预后SAS评分结果为(50.73±6.20)分，低于对照组的(55.26±6.42)分，差异有统计学意义(t＝11.24，P<0.05)。 结论 应用精细化护理对消化性溃疡出血患者进行护理干预，能够显著缩短患者止血时间、胃肠道症状消失时间和住院时间，改善患者负性情绪，提高患者依从性、满意度和生活质量，值得推广应用。

Monopolar Forceps with Soft Coagulation Effectively Treats Bleeding Peptic Ulcers

The standard endoscopic treatment of high-risk peptic ulcers is epinephrine injection followed by bipolar cautery or hemoclips. Despite the popularity

Helicobacter Pylori Infection and Lung Cancer: New Insights and Future Challenges.

Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and peptic ulcer diseases and is an important risk factor for the development functional dyspepsia, peptic ulceration, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. H. pylori has very high rates of infection in human populations, and it is estimated that over 50% of the world population is infected. Recently, certain extra-gastric manifestations, linked to H. pylori infection, have been widely investigated. Noteworthy, a growing body of evidences supports an association between H. pylori infection with lung cancer. The present review intend to highlight not only the most recent evidences supporting this association, but also some missed points, which must be considered to validate this emerging association.

A comparison of clinical characteristics between reflux esophagitis and non-erosive reflux disease

Objective To analyze and compare the demographic characteristics and clinical features of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD), so as to appraise their different pathogenesis and effective treatment. Methods 127 patients with RE and 80 patients with NERD were enrolled and asked to complete the questionnaires. The general situation, living habits, typical esophageal symptoms, extra esophageal symptoms and the comorbidities were recorded in the two groups. Results There were more male patients in RE group, and more female patients in NERD group (P<0.05). There were more patients engaged in mental work in RE group , and NERD group had more physical workers (P<0.05). Compared with NERD, patients with RE were fatter and had more alcohol consumption (P<0.05). The proportion of patients with abnormal mental disorders in NERD group was significantly higher than that in RE group (P<0.05). NERD patients were more likely to incorporate irritable bowel syndrome (IBS) (P<0.05). RE patients were more likely to suffer from hiatal hernia (P<0.05). The incidence of anti-acid, chest pain, pharyngeal foreign body symptoms was higher in the NERD group (P<0.05). Conclusions The demographic characteristics, living habits, mental and psychological factors, esophageal symptoms, extra esophageal symptoms and comorbidities in patients with NERD or RE are different.These results suggest that there are different pathogenesis between RE and NERD . Key words: Esophagitis, peptic; Gastroesophageal reflux; Disease attributes

Risk factor analysis for early rebleeding in patients with peptic ulcer bleeding

Objective To explore the risk factors for early rebleeding in patients with peptic ulcer bleeding (PUB). Methods From June 2006 to May 2017, a total of 1 210 hospitalized patients with PUB from The General Hospital of Ningxia Medical University were enrolled. Totally 1 040 patients with bleeding stopped after the treatment were taken as the control group. And 170 patients with early rebleeding were as the rebleeding group. The clinical data of the patients in two groups were analyzed. Chi-square test, t-test and multivariate factors analysis were performed for statistical analysis. Results Between control group and rebleeding group, there were statistical significances in gender, age, place of residence, hematemesis, shock, volume of blood transfusion, anticoagulant use, combined diseases, hemoglobin level, albumin level, urea nitrogen, neutrophil ratio, platelet count, ulcer location, maximum ulcer diameter, Forrest classification and endoscopic treatment (all P<0.05). The rate of endoscopic hemostasis of rebleeding group (92.56%, 112/121) was lower than that of control group (98.70%, 228/231), and the difference was statistically significant (χ2=13.609, P=0.001). The result of multivariate logistic regression analysis showed that Forrest classification (odds ratio(OR)=7.735, P<0.01), hemoglobin (OR=7.332, P=0.040), shock (OR=5.245, P<0.01) and ulcer size (OR=2.360, P=0.029) were independent risk factors for rebleeding in patients with PUB. The effect of Forrest classification better than hemoglobin, hemoglobin better than shock and shock better than ulcer size in assessing the risk of rebleeding. Conclusions Forrest classification, hemoglobin, shock, ulcer size are the risk factors for rebleeding in patients with PUB. Endoscopic hemostasis can reduce the risk of rebleeding. Key words: Peptic ulcer hemorrhage; Rebleeding; Risk factors

Prevalence and Risk Factors for Helicobacter Pylori Infection inGastroduodenal Diseases in Kano, Nigeria

Background: Helicobacter pylori (H. pylori) has been well noted as a causative agent of many diseases in the gastrointestinal (GI) tract notably, gastritis, peptic ulcer disease, and gastric adenocarcinoma. Determining the burden and the risk factors for acquiring this infection may be crucial to containing it and its sequelae in Kano, Nigeria. Methodology: The study was cross‑sectional in design. Questionnaires were administered in dyspeptic patients to obtain the relevant clinical, and sociodemographic data. Upper GI endoscopy was performed in the patients, and gastric biopsy specimens were taken and sent to the histopathology laboratory for assessment and H. pylori identification. Results: Of the 306 participants, 136 (44.4%) were males, while 170 (55.6%) were females, with male: female ratio of 1:1.3. The ages of the participants ranged from 18 to 84 years with a mean of 41.2 ± 15.3 years. Of the 306 samples, 250 (81.7%) were positive for H. pylori. This gives H. pylori prevalence of 81.7%. Only 4 (1.3%) of the participants belonged to the higher social class, out of which 25% had positive H. pylori, while 230 (75.2%) participants belonged to the lower socioeconomic class with 87.8% H. pylori prevalence. The lower social class had a significant association (P < 0.0001) with increased H. pylori infection. A total of 290 subjects (94.8%) shared a room with three or more other siblings in childhood, out of which 233 (80.3%) had H. pylori. Only 80 subjects (26.1%) used pipe‑borne water in childhood, while 226 (73.9%) sourced their water from either well, pond or stream during childhood. Conclusion: This study showed a high prevalence of H. pylori in Kano, and low socioeconomic status, unclean water source, overcrowding, and cigarette smoking were significant risk factors for H. pylori infection. Keywords: Histology, prevalence of Helicobacter pylori in Kano, risk factors, water source.

Over-the-Scope Clips Effectively Treat Recurrent Peptic Ulcer Bleeding

Patients with recurrent bleeding from peptic ulcers after initial endoscopic therapy have high rates of further bleeding (>25%) after a second

Hiatus Hernia and Body Mass Index (BMI): A Possible Correlation?

INTRODUCTION: Hiatus hernia is the protrusion of the stomach or part of it through the oesophagus or a defect in the diaphragm into the thoracic cavity. Hiatus hernia is associated mainly with obesity and is sometimes encountered in patients with dyspepsia. Hiatus hernia can make worse the symptoms of dyspepsia especially in patients with reflux disease where it can cause non- cardiac chest pain or interferes with the acid pocket where there is a postprandial reflux of acid into the esophagus from the fundic area of the stomach. AIM: The aim of this study was to enroll patients coming for upper GIT endoscopy because of dyspepsia or peptic ulcer disease and were found to have hiatus hernia accidentally or as part of the reasons for referral to the endoscopy clinic. OBJECTIVE: The objective of this survey was to determine solely the relationship between hiatus hernia and body mass index of patients who were sent to the endoscopy clinic for upper gastrointestinal endoscopy for the suspected diagnosis of peptic ulcer disease or gastroesophageal reflux disease. METHOD: This was a prospective study between June 2010 and June 2016, the survey was conducted in two different centres in the north central part of Nigeria. Two consultant Gastroenterologists who also performed endoscopy on regular basis participated in the study. Consecutive patients who presented to the endoscopy clinic for the diagnostic upper GIT endoscopy were enrolled in the study. Patients who were found to have hiatus hernia by Hills classification had their weight and height recorded and their body mass index calculated. RESULT: Hiatus Hernia was found to be commoner in women but it was not found to be associated with obesity. Patient with the BMI indicating overweight had the highest rate of herniation while the obese individuals had the lowest. CONCLUSION: Obesity was not found to be associated with hiatus hernia and it may be possible that the rate of hiatus hernia may have a negative correlation with increasing BMI above 30Kg/M2.

Risk factors of depressive and anxiety symptoms in patients with digestive organic disease

Objective To explore the prevalence and possible risk factors of depressive/anxious symptoms of patients with digestive disease. Methods Totally 245 patients with digestive diseases were recruited consecutively.Face-to-face interview and the hospital anxiety and depression scale(HADS), self-rating anxiety scale(SAS) and self-rating depression scale(SDS) were employed to collect the clinical data.The non-condition logistic regression was performed to analyze the data. Results The prevalence of depression and anxiety in patients with organic diseases in digestive system was 36.3%.Among them, the higher incidence of depression and anxiety symptoms were digestive system tumors, peptic ulcer, acute pancreatitis and cirrhosis.The educational degree was correlated with simple depression, pure anxiety, depression complicated with anxiety (χ2=8.781, P=0.013; χ2=7.976, P=0.018; χ2=15.807, P=0.003), the degree of high school or above was a protective factor, the OR values were 0.347, 0.373, 0.301.The gender was also correlated with depression, anxiety, depression complicated with anxiety (χ2=4.343, P=0.031; χ2=1.056, P=0.017; χ2=2.382, P=0.03), female was the risk factor of mental illness, the OR values were 2.72, 2.438, 2.671.The age was correlated with depression, depression complicated with anxiety (χ2=9.872, P=0.002; χ2=15.710, P=0.031), the age of over 40 years old was the risk factor of mental illness, the OR values were 5.137, 5.731.The occupation was correlated with depression(χ2=6.017, P=0.017), the non-physical labor was the risk factors of depression, the OR value was 2.752. Conclusion There is a higher prevalence of depression and anxious symptoms in patients with digestive organic diseases.Female, senior high school or lower, older than 40 years, and non-manual work are the risk factors of these symptoms. Key words: Anxiety; Depression; Digestive system diseases; Factor analysis, statistical

Self-care ability and its influencing factors in patients with peptic ulcer

Objective To explore the status and influencing factors of self-care ability in patients with peptic ulcer (PU) , and provide evidences for the establishment of targeted interventions. Methods A total of 200 patients with peptic ulcer hospitalized in the Department of Gastroenterology of Ningbo Lihuili Eastern Hospital from June 2016 to May 2017 were enrolled in the study using objective sampling method. The general situation questionnaire and the Exercise of Self-Care Agency (ESCA) were used to assess the self-care ability and its influencing factors of PU patients. Results A total of 195 questionnaires were retrieved. The total ESCA score of PU patients was (107.45±18.43) . Patients with different inhabiting conditions, educational backgrounds, economic incomes, understanding of PU and cost payment method had significantly differences in the ESCA scores (t=-3.78, 11.48, 13.35, 27.32, 7.02; P<0.05) . Multiple linear regression analysis showed that educational background, economic income, understanding of PU and cost payment method were influencing factors of self-care ability of PU patients. Conclusions The overall self-care ability of patients with peptic ulcer is at a high level and affected by multiple factors. Nurses should take more targeted interventions to improve the self-care ability of patients. Key words: Peptic ulcer; Self-care ability; Influencing factor

The efficacy of single channel endoscopic purse-string sutures with hemostatic dips and endoloops for the peptic ulcer bleeding

Objective To investigate the efficacy and safety of single-channel endoscopic nylon rope combined with hemostatic clip suture in the treatment of peptic ulcer and bleeding. Methods Patients in our hospital due to peptic ulcer bleeding and hospitalization emergency electronic endoscopy from January 1st, 2001 to July 1st, 2017 were enrolled in the study. They were treated the single-channel endoscopic nylon rope combined with hemostatic clip suture. The basic information, clinical data, surgical records combined and retrospective analysed. Results 16 patients were included in the study. Among all the patients, peptic ulcer was located in 6 cases of gastric angle, 3 cases of gastric antrum, 3 cases of gastric body, 2 cases of duodenal bulb and stomach. Ulcer maximum 40 mm×25 mm, an average of (23.0±6.0)mm. All ulcer wounds in patients underwent single-channel endoscopic nylon rope combined with hemostatic clip pouch suture were completely closed, including 1 case of duodenal ulcer patients after bleeding, achieved hemostasis successfully when turned into our hospital intervention. The remaining 15 cases were no longer bleeding. 1 cases of gastric antral and 1 cases of stomach were diagnosed as moderately differentiated adenocarcinoma and they received endoscopic resuscitation after successful elective surgery gastric antral cancer radical surgery. Conclusions Single channel endoscopic nylon rope combined with hemostatic clip sacking is a safe and effective method for the treatment of giant peptic ulcer and bleeding. It is worthy of clinical manifestation, especially for those with deep and perforated ulcer. Key words: Peptic ulcer hemorrhage/SU; Endoscopy; Surgical stapling

Association of H.pylori cagA Gene with Duodenal Ulcer & Gastric Carcinoma in Bangladeshi Patients

Background: Prolong infection with Helicobacter pylori may lead to chronic inflammation of gastroduodenal mucosa which in turns develops into severe diseases like peptic ulcer and gastric carcinoma. Bacterial virulence factor Cytotoxin Associated gene (cagA) is found to be responsible for developing such severe diseases in different countries. So this study was conducted to assess the relationship between occurrence of several gastroduodenal diseases and the presence of H. pylori cagA gene in Bangladeshi patients. Methods: Endoscopic gastroduodenal biopsy sample of 113 dyspeptic patients from different districts of Bangladesh were studied. H. pylori infection was detected by Rapid urease test, PCR of ureC gene and histological staining (Geimsa). Gastroduodenal disease was diagnosed by histopathological examination and cagA gene was detected by PCR. Result: H. pylori infection was identified among 48% (54/113) patients. Fifty seven percent of H. pylori infected patients were found to be cagA gene positive. cagA gene is significantly associated with Duodenal ulcer (p= .024) and Gastric carcimoma (p < .001). However, a further larger study is required to confirm this finding.

The clinical value of the polymerase chain reaction technique in detection of pediatric helicobacter pylori infection

Objective To investigate the clinical value of the polymerase chain reaction (PCR) technique in detection of pediatric helicobacter pylori(HP) infection. Methods A total of 130 children with different digestive tract symptoms received esophagogastroduodenoscopy, and 120 children between 3 and 17 years old were enrolled.The gastric antrum mucosa was taken under the gastroscope for 2 blocks, and the gastric juice was absorbed as the specimen.One block of gastric antrum mucosa was examined histopathologically, and the other block of gastric antrum mucosa and gastric juice were examined by PCR.We used the primers UreC, HP-16s, CSTP to detect HP, and then used the primers Cag750 and Cag595 to detect CagA. Results A total of 28 cases (23.33%) of upper gastrointestinal ulcer were detected by gastroscopy, and HP was detected by histopathological method in 26 cases (21.67%), and 41 cases (34.17%) were detected by PCR method.The detection rate of HP by PCR was significantly higher than that of HP in pathological method (χ2=4.659, P=0.031). By pathological examination of HP, 14 cases (50%) and 12 cases (13.04%) with peptic ulcers and no peptic ulcers were detectd, and the difference in detection rate was statistically significant(χ2=17.275, P<0.001). Samples of children with peptic ulcers and no peptic ulcers were detected in 16 cases(57.14%) and 25 cases (27.17%) by PCR, and the difference in detection rate was statistically significant (χ2=8.572, P=0.003). The CagA were detected in 7 cases of peptic ulcers and 7 cases of non peptic ulcers by PCR, and the difference in detection rate was statistically significant (25.00% vs 7.61%, χ2=6.300, P=0.012). Conclusion The PCR method could quickly and sensitively detect the HP and its CagA gene, and the detection of gastric mucosa and gastric juice by PCR could improve the detection rate of HP.A combination of PCR and pathological method is suggested as the detection method for children′s HP infection. Key words: Children; Helicobacter pylori; Histopathology examination; Polymerase chain reaction; CagA,

Effect of stomach dampness decoction combed with quadruple therapy in the treatment of Hp related peptic ulcer

Objective To observe the effect of stomach dampness decoction combed with quadruple therapy in the treatment of Hp related peptic ulcer. Methods 80 patients with Hp related peptic ulcer were randomly divided into two groups according to randomized block design, with 40 cases in each group.The control group received the quadruple therapy, inculding orally pantoprazole enteric-coated tablets, bismuth potassium citrate granules, amoxicillin capsules, levofloxacin tablets.The study group was given Hewei Huashi decoction on the basis of the control group.The duration of treatment was 14 days and the effect was assessed after 1 month, the healing of ulcer and the improvement of clinical symptoms were observed. Results The ulcer healing rate in the study group(82.5%) was higher than that in the control group(62.5%), the difference was statistically significant(χ2=4.013, P=0.045). There was no statistically significant difference in total effective rate between the two groups(95.0% vs.87.5%, χ2=0.626, P=0.429). Before treatment, there were no statistically significant differences in the integral and the total integral of the imultaneous phenomenon between the two groups(all P>0.05). After treatment, the accompanying symptom scores and the total integral of the study group significantly reduced, and the fullness[(0.28±1.03)points vs.(0.62±0.87)points, Z=-2.022], ructus[(0.40±0.67)points vs.(0.88±1.04)points, Z=-2.054], noisy[(0.25±0.49)points vs.(0.60±0.78)points, Z=-2.135], diarrhea[(0.25±0.49)points vs.(0.62±0.71)points, Z=-2.642]and the total score[(2.52±1.71)points vs.(4.35±2.76)points, Z=-3.073]were better than those of the control group, and the differences were statistically significant(all P<0.05). The total effective rate of imultaneous phenomenon in the study group(97.5%) was higher than that of the control group(75.0%), and the difference was statistically significant(χ2=6.746, P=0.009). Conclusion The stomach dampness decoction combined with quadruple therapy in the treatment of Hp related peptic ulcer has better curative effect, and it can more effectively improve the quality of healing and clinical symptoms. Key words: Peptic ulcer; Helicobacter pylori; Drug therapy, combination; Stomach dampness decoction

High Worldwide Variation in Prevalence of

Helicobacter pylori infection is associated with multiple gastrointestinal disorders, including peptic ulcer disease, gastritis, and gastric cancer.