Prevalence Of Peptic Ulcer Disease Research Articles

A Study of Peptic Ulcer and Associated Risk Factors Among Patients Undergoing Upper GIT Endoscopy in Duhok, Kurdistan, Iraq

Background: Peptic ulcer disease (PUD) is a multifactorial disease whose global prevalence has reduced over the past years. Objectives: This study aimed to determine PUD's prevalence and risk factors and the associated risk factors behind this disease. Methods: A cross-sectional study was conducted in Duhok, Kurdistan, Iraq, between August 11 and December 17, 2022. A total of 218 patients (116 males and 102 females) who underwent upper gastrointestinal endoscopy by specialists at Azadi Teaching Hospital were interviewed face-to-face. The participants' ages ranged between 18 and 81. The upper GIT endoscopy was performed using a PENTAXI-scan 5000-type endoscopy. Results: The prevalence of peptic ulcers among the participants was 30 (13.8%), 27 (12.4%) duodenal ulcers and 3 (1.4%) gastric ulcers. Abdominal pain was the primary complaint, reported by (39%) of the participants, followed by heartburn (28.4%) and vomiting (6.9%). Regarding the risk factors for developing peptic ulcer among the studied cases, NSAID use was the highest risk factor (25.7%), followed by spicy food (21.6%), smoking (20.6%), family history (17%), and Helicobacter pylori infection (12.4%). A significant association was observed between H. pylori (P = 0.001) and gender (P = 0.001) with peptic ulcer. Additionally, (5%) of the participants reported melena as a complication, while only (2.3%) reported hematemesis. Conclusions: This study found that 13.8% of individuals undergoing upper gastrointestinal endoscopy exhibit peptic ulcers, with 12.4% manifesting duodenal ulcers and 1.4% exhibiting gastric ulcers. Identified risk factors for peptic ulcer disease include sex and H. pylori infection. Further research is crucial to thoroughly explore the impact of various factors on the development of PUD.

Investigating the prevalence burden of peptic ulcer disease in older adults aged 70+ from 1990 to 2019: an analysis of Global Disease Burden Studies

Background Peptic ulcer disease (PUD) affects individuals aged ≥70 years globally, exerting a significant impact on their health and well-being. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management. Methods This study utilized Global Burden of Disease Study data to examine the prevalence and temporal changes of PUD in individuals aged 70 years and older between 1990 and 2019. The analysis included assessing estimated annual percentage changes (EAPCs) to investigate temporal trends and regional variations. Results Over the past 30 years, the number of individuals aged 70 years and above suffering from PUD globally has increased from 1 065 730 cases in 1990 to 1 608 463 cases in 2019. Despite an increasing number of cases, the prevalence of PUD among the elderly has exhibited a steady decline, with an EAPC of −1.47 (95% confidence interval: −1.57 to −1.37) over this timeframe. In 2019, the prevalence rates of PUD among individuals aged 70–74, 75–79, 80–84, and 85 years and older were 313.36, 365.77, 388.45, and 352.51 per 100 000 population, respectively. South Asia, high-income North America, and Central Sub-Saharan Africa were the regions with the highest prevalence rates of PUD in 2019, with rates of 624.90, 575.48, and 474.80 per 100 000 population, respectively. At the national level, Ireland, Australia, Brazil, Brunei Darussalam, and Bangladesh have effectively managed the burden of PUD among the elderly, achieving the greatest reduction. Additionally, regions with higher levels of socioeconomic development tended to have relatively lower burdens of PUD among the elderly, and prevalence rates varied across different regions and age groups. Conclusion Our study highlights the enduring burden of PUD among the global elderly population, emphasizing the significance of tailored interventions to address this pressing issue. This research underscores the critical need for targeted public health strategies aimed at improving outcomes specifically for older adults affected by PUD.

Prevalence of Peptic Ulcer Disease and its Associated Factors in Jeddah Saudi Arabia

Introduction: Peptic ulcer disease's (PUD) global significance, emphasizing its health burdens and associations with factors like Helicobacter pylori infection and lifestyle habits. The need for comprehensive approaches to prevention and management. Despite global research, there's a gap in understanding PUD in Jeddah, Saudi Arabia, necessitating this study to inform healthcare policies and interventions in the region. The study aims to investigate PUD prevalence, associated factors, healthcare-seeking behavior, and knowledge levels in Jeddah's population to provide insights for public health strategies and clinical practices. MethodologyThis cross-sectional study investigated the prevalence of peptic ulcer disease (PUD) and its associated factors in Jeddah, Saudi Arabia, using a validated questionnaire covered demographic details, knowledge, psychosocial aspects, symptoms, healthcare-seeking behavior, and medical history. It was translated into Arabic, culturally adapted, and validated through expert review and pilot testing. A sample size of 561 participants was determined using an online sample calculator, targeting a 95% confidence level. Ethical approval was obtained from the Institutional Research Review Board (IRRB-02-03092023). Data was collected through an online survey using convenience sampling and analyzed with SPSS and Excel, employing both descriptive and inferential statistical methods. ResultThe survey in Jeddah, Saudi Arabia, examined peptic ulcer disease (PUD) prevalence and associated factors. Demographic analysis showed 561 participants, almost evenly split by gender (269 males, 292 females), with varying ages and educational backgrounds. Symptoms like abdominal pain were prevalent (398 respondents), as were lifestyle factors such as spicy food consumption (456 respondents) and stress (496 respondents). The study revealed a high PUD prevalence, with 463 respondents (82.53%) reporting a history of the disease, primarily gastric ulcers (256 cases, 45.63%) and duodenal ulcers (207 cases, 36.89%). Treatment mainly involved outpatient antibiotic use (419 respondents, 74.68%), while 44 respondents (7.84%) required hospitalization. Reported well-being levels ranged from 1 to 10, with various satisfaction levels among respondents. ConclusionsThe study highlighted a substantial prevalence of PUD, primarily gastric ulcers, among participants. The findings advocate for tailored interventions, including education, screening, and treatment optimization, to alleviate the PUD burden and enhance healthcare outcomes. The study offers crucial insights into PUD epidemiology, guiding evidence-based prevention and management strategies.

Low prevalence of peptic ulcer disease in hospitalized patients with cystic fibrosis: A national database study

BackgroundAlthough cystic fibrosis (CF) is widely considered a lung disease, the prevalence of CF-specific gastrointestinal symptoms and diseases has continued to rise. Peptic ulcer disease (PUD) has not been well-studied among people with CF (PwCF) and may be a common cause of abdominal symptoms. In PwCF, impaired bicarbonate secretion and unbuffered gastric acid production have been attributed to the development of ulcers, although ulcers remain uncommon. The objective of this study was to evaluate the prevalence of PUD in PwCF and assess for possible contributing factors. MethodsThis study utilized the National Inpatient Sample (NIS) database. All patients 18 years or older with CF were identified from 2014 to 2019. Relevant patient characteristics and procedures were identified using ICD-9 and ICD-10 codes. Linear trend, bivariate analyses, and multiple regression analysis were performed. The outcomes of interest were peptic ulcer disease, pancreatic insufficiency, and nonalcoholic steatohepatitis or NASH. All analyses accounted for complex sampling scheme of the NIS. ResultsThe total prevalence of PwCF in the National Inpatient Sample (NIS) database was 0.08 %, and the number was stable year to year from 2014 to 2019. Hispanic patients were more likely to be diagnosed with PUD than other white (aOR 1.802 [1.311,2.476]). Multiple regression analysis indicated that PUD in PwCF was strongly associated with a diagnosis of NASH (aOR 2.421[1.197, 4.898]). PUD patients were less likely to have pancreatic insufficiency compared to the non-PUD group (aOR 0.583 [0.455, 0.745]). ConclusionAlthough cystic fibrosis has been historically known as a disease of childhood, advancements in therapy have led to prolonged life expectancy and higher prevalence for cystic fibrosis-related digestive diseases. This study revealed a low prevalence of PUD in PwCF. Hispanics and those with NASH are more likely to develop peptic ulcers.

Prevalence of gastritis and gastric and duodenal ulcers in Russian Guard servicemen

Based on the annual statistical reports for 2018–2023 and the cumulative median prevalence of various studies in 2009–2020 in Russia, the prevalence of peptic ulcer with uncomplicated and complicated course and various forms of gastritis in servicemen of the Regardie of the North Caucasian District was estimated, and the current trends are explained. The incidence of peptic ulcer with uncomplicated and complicated course and various forms of gastritis among the servicemen of the Regardie of the North Caucasian District for the specified period ranged from 11.521% to 16.351% (confidence interval: 10.515–12.588 and 15.233–17.517, respectively) and from 27.212% to 51.889% (confidence interval: 25.791–28.669 and 50.316–53.460, respectively). Random effects analysis has demonstrated different true effect sizes relative to the overall average. The revealed statistical patterns are only the first stage in an ongoing study on the prevalence of upper gastrointestinal diseases among the servicemen of the Regardie of the North Caucasian District. In general, the prevalence of peptic ulcer disease, including with a complicated course, and various forms of gastritis among military personnel was 13.270% and 37.679%, respectively (confidence interval: 10.617–16.170 and 24.292–52.102, respectively), showing an upward trend. The expected prevalence of peptic ulcer and gastritis in 2023 was 16,351 and 51,889%, respectively, which is not accidental and depends on the impact of specific risk factors. The identification of risk factors enables the development of measures to prevent delayed complications of the pathology under study and improvement of health in servicemen of the Regardie of the North Caucasian District. Thus, the study of the health status of the general population and military personnel, in particular, and the effect of various environmental factors determines their social significance both in military medicine and the structure of the healthcare system.

Outcomes and risk factors for mortality in clostridioides difficile infection in patients with NAFLD and NASH

Introduction and ObjectivesNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and can progress to non-alcoholic steatohepatitis (NASH) and, ultimately, cirrhosis. Clostridioides difficile is the most common nosocomial cause of diarrhea and is associated with worse clinical outcomes in other liver diseases, including cirrhosis, but has not been extensively evaluated in concomitant NAFLD/NASH. Materials and MethodsWe conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2017. Patients with a diagnosis of CDI, NAFLD, and NASH were identified using International Classification of Diseases (Tenth Revision) codes. The outcomes of our study include length of stay, hospitalization cost, mortality, and predictors of mortality. ResultsThe CDI and NASH cohort had a higher degree of comorbidity burden and prevalence of peptic ulcer disease, congestive heart failure, diabetes mellitus, and cirrhosis. Patients with NASH and CDI had a significantly higher mortality rate compared to the CDI only cohort (mortality, 7.11 % vs. 6.36 %; P = 0.042). Patients with CDI and NASH were at increased risk for liver-related complications, acute kidney injury, and septic shock (P < 0.001) compared to patients with CDI only. Older age, intestinal complications, pneumonia, sepsis and septic shock, and liver failure conferred an increased risk of mortality among the CDI and NASH cohort. ConclusionsPatients with NASH had a higher rate of liver-related complications, progression to septic shock, and mortality rate following CDI infection compared to the CDI only cohort.

Peptic Ulcer Disease among Patients Undergoing Upper Gastrointestinal Endoscopy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Peptic ulcer is a common disease of gastrointestinal tract usually present with epigastric pain and discomfort. Upper gastrointestinal endoscopy is its gold standard investigation. There has been limited study on the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy especially in Nepal. Our study aimed to find the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy at our centre. A descriptive cross-sectional study was conducted among patients undergoing upper gastrointestinal endoscopy at a tertiary care centre from October 1, 2022 to March 31, 2023. Data was retrieved from hospital records using a preformed proforma and sample size of 219 was calculated and data of 273 cases was collected using the convenience method of sampling. Among 273 patients, peptic ulcer disease was found in 29 (10.62%) of patients among which 28 (10.25%) had antral ulcer and only 1 (0.36%) had duodenal ulcer. The prevalence of peptic ulcer disease is lower in our study centre compared to other studies and further studies can be conducted on the associated risk factors and socio-demographic distribution of peptic ulcer disease.

Diagnostic upper Gastrointestinal Endoscopy in Kaduna, Northwest Nigeria

Context: An upper gastrointestinal endoscopy (UGIE) is now a routine procedure and is a guide to the prevalence and nature of gastrointestinal tract diseases in an area. Aim: To report indications and findings for UGIE in a tertiary hospital in Kaduna, Nigeria, and compare with past reports in the region and from the rest of Nigeria and Africa. Settings and Design: A retrospective review of endoscopy records (2014–2021) of consecutive patients referred to the endoscopy unit of Barau Dikko Teaching Hospital, Kaduna, Nigeria. Statistical Analysis: The data were analyzed using IBM SPSS version 22. Results: Over seven years, 1,525 patients had diagnostic UGIE: mean age = 44.8 years (range 8–100), 61% ≥ 40 years, and 55.7% females. Dyspepsia (70%) and hematemesis/melena (14%) were the most common indications. Superficial gastritis (60%) was the most common endoscopic finding. Peptic ulcer disease (PUD) was diagnosed in 9.6% of patients: Gastric ulcer (6.6%) was more common than duodenal ulcer (3.6%) and more frequent in males than females (9.5% vs. 4.3%, P = 0.000) and in those ≥ 40 years compared with &lt; 40 years (7.8% vs 5%, P = 0.032). Duodenal ulcer was also more common in males (6% vs 1.8%, P = 0.000). Erosive gastritis (20.5%), hiatus hernia (14.4%), esophagitis (13.7%), atrophic gastritis (8.3%), nodular gastritis (6.6%), esophageal varices (6.1%), and gastric carcinoma (1.2%) were other findings. There was no abnormality detected in 6% of patients. Conclusion: We reported a marked change in the pattern of some gastroduodenal diseases in our region. The patients are older and predominantly female. The prevalence of PUD has markedly declined with gastric ulcer now almost twice as common as duodenal ulcer.

Nursing care of patients with duodenal ulcer

Nursing care of patients with duodenal ulcer

The bacteriostatic property of melatonin targets peptic ulcer disease and cholangiocarcinoma

The marked drop in the frequency of Helicobacter pylori infection resulting from the use of antibiotics and potent anti-acid medications has substantially lowered the prevalence of peptic ulcer disease in recent decades. Management of this condition, however, is challenging because of the escalating perils of antibiotic resistance and the abuse of anti-inflammatory drugs. For example, the increased prevalence of cholangiocarcinomas may associate with this peptic ulcer disease management including the prolonged use of proton pump inhibitors. Cholangiocarcinoma is one of the most lethal cancers and accounts for almost 15% of all hepatic malignancies. This review provides a concise summary of the latest findings in the pathogenetic mechanisms of cholangiocarcinoma, essentially focusing on peptic ulcer disease and its associated therapies. We also suggest interventions that may reduce Helicobacter pylori infection and peptic ulcers with the bacteriostatic agent, melatonin. Melatonin treatment may reduce the incidence of this devastating cancer or improve the outcome of individuals that develop this disease.

Evaluation of Boey scoring in predicting morbidity and mortality in peptic ulcer perforation peritonitis

Among abdominal emergencies, perforations of peptic ulcer are third most common in frequency, after acute appendicitis and acute intestinal obstruction. The prevalence of peptic ulcer disease ranges from 5 to 15% in the western population. Perforation being the most dreaded complication, occurring in about 2–10% of peptic ulcer cases. Inspite of better understanding of the disease, effective resuscitation and prompt surgery under modern anaesthesia techniques, there is still high mortality and morbidity in perforated peptic ulcer with mortality rate ranging from 5% to 15%. Prompt recognition of the condition and early surgery are very important to reduce the mortality. In our study, we stratified the patients with perforated peptic ulcer peritonitis according to Boey score and found a significant relationship between increasing Boey score with higher rates of post-operative morbidity and mortality. The study also demonstrated that using a simple clinical scoring system in surgical emergency room proves critical to reduce the chances of morbidity and mortality among patients with perforated peptic ulcer peritonitis.

Obstructive jaundice secondary to duodenal ulcer: A case report

Peptic ulcers are acid-induced lesions found in the stomach and duodenum. The prevalence of peptic ulcer disease in the United States is estimated to be 8.4%. Describe an atypical presentation of complicated duodenal ulcer that causes jaundice and review the literature. A 42-year-old male patient, who consulted for generalized jaundice and coluria, associated with low back pain treated with non-steroidal anti-inflammatory drugs. In the laboratory, total bilirubin increased to direct prevalence. A magnetic resonance cholangiography was performed that revealed duodenal thickening, with a decrease in its lumen; and a double contrast computed tomography, where thickening of the duodenal walls was observed, without oral contrast leakage. Subsequently, an upper digestive video-endoscopy was performed where a 30 mm duodenal bulb ulcer was observed. The patient presented good evolution with medical treatment, being discharged on the fifth day of hospitalization. Jaundice can be caused by a duodenal ulcer that causes obstruction of the common bile duct. Medical treatment may specify in selected patients. In the present case, it was established to opt for medical treatment since the patient presented hemodynamic stability, without signs of generalized peritonitis, with complementary studies in favor of a contained duodenal ulcer without free air. We are dealing with a case of duodenal ulcer complicated with jaundice that presented good evolution with medical treatment.

External validation of the Madrid Acute Kidney Injury Prediction Score.

Background The Madrid Acute Kidney Injury Prediction Score (MAKIPS) is a recently described tool capable of performing automatic calculations of the risk of hospital-acquired acute kidney injury (HA-AKI) using data from from electronic clinical records that could be easily implemented in clinical practice. However, to date, it has not been externally validated. The aim of our study was to perform an external validation of the MAKIPS in a hospital with different characteristics and variable case mix.MethodsThis external validation cohort study of the MAKIPS was conducted in patients admitted to a single tertiary hospital between April 2018 and September 2019. Performance was assessed by discrimination using the area under the receiver operating characteristics curve and calibration plots.ResultsA total of 5.3% of the external validation cohort had HA-AKI. When compared with the MAKIPS cohort, the validation cohort showed a higher percentage of men as well as a higher prevalence of diabetes, hypertension, cardiovascular disease, cerebrovascular disease, anaemia, congestive heart failure, chronic pulmonary disease, connective tissue diseases and renal disease, whereas the prevalence of peptic ulcer disease, liver disease, malignancy, metastatic solid tumours and acquired immune deficiency syndrome was significantly lower. In the validation cohort, the MAKIPS showed an area under the curve of 0.798 (95% confidence interval 0.788–0.809). Calibration plots showed that there was a tendency for the MAKIPS to overestimate the risk of HA-AKI at probability rates ˂0.19 and to underestimate at probability rates between 0.22 and 0.67.ConclusionsThe MAKIPS can be a useful tool, using data that are easily obtainable from electronic records, to predict the risk of HA-AKI in hospitals with different case mix characteristics.

Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain at Tertiary Care Institute of Gujarat

Background: To establish the occurrence of peptic ulcer disease amid the Subjects with abdominal pain at tertiary care institute of Gujarat. Subjects and Methods: present research was performed at the Department of Surgery, tertiary care institute of Gujarat, for the period of one year in 200 patients with abdominal pain and diagnosed with peptic ulcer disease. Information was composed utilizing pre-designed questionnaire. Results:The majorities of participants was females, most were aged between 18 to 25 years. Around 97% had pain in the epigastric region. Gastric ulcers preponderate for 65% patients in current research, except refused during the later existence of the epoch, as the occurrence of duodenal ulcers stayed stable, however amplified rather the later phase. Conclusion: An extensive diversity of subjects with abdominal pain was documented amid the subjects. On the other hand, the socio-economic situation and educational levels of the Subjects with the illness were below par.

Abstract A11: How to adjust comorbidity in mortality outcome in Korean cancer patients using claim-based health care big data

Abstract Background and Objective: Cancer prognosis is frequently complicated by the presence of comorbid conditions. Prognostic prediction model with less-precise comorbidity risk adjustment would result in biased estimates. This study aimed to illustrate the impact of comorbidity measurements and algorithms for cancer patients using claim-based health care big data. Method: Data from population-based health claims data, national health insurance database in Korea were used to capture comorbidities in cancer patients. Quan’s ICD-10 was used to identify Charlson and Elixhauser comorbidity. The prevalence of comorbid condition and its impact on mortality were compared according to different claim types (inpatient and outpatient) and ascertainment periods (look-back and window). To improve diagnostic accuracy, Klabunde rule-out algorithm and drug prescriptions were considered, and we assessed how they affect our results. Impact of comorbidity on mortality was assessed by using Cox proportional hazards model adjusting for sex. Prognostic performance to predict short- and long- erm morality was compared using Harrel’s c-statistic. Result: The most common comorbid conditions were “peptic ulcer disease (PUD),” “chronic pulmonary disease (COPD),” and “mild liver disease (MLD)” in Korean cancer patients. Elixhauser additionally captured 30% of patients with “hypertension” and 3.6% with “depression”; these conditions are not included in Charlson. 90-day versus no window period decreased prevalence of PUD from 27.4 to 19.1 (COPD, 20.2 to 16.3; MLD, 16.4 to 9.5). By shortening the look-back from 3 years to 1 year, prevalence of PUD decreased from 22.9 to 12.9 (COPD, 19.7 to 10.3; MLD, 12.0 to 6.6). In the absence of rule-out algorithm, the prevalence was at most 1.8 times greater in COPD. Within inpatient claim, use of window period had increased HR of MLD (1.9 to 3.7), whereas HR of “myocardial infarction” turned out to be statistically nonsignificant. The C-statistic was 0.71 in 1-year mortality prediction with only inpatient claim. However, better performance was shown with both in- and outpatient claim in predicting 5-year mortality. Conclusion: Prevalence of comorbidity and its impact on the prognosis prediction vary considerably by comorbidity measurement and algorithm. The higher estimated risk of death in inpatient claim would reflect disease severity. Researchers need to check how patients’ comorbidities are captured by various factors associated with claim-based data, then choose the most adequate algorithm according to patients’ characteristics and study purpose. Citation Format: Sanghee Lee, Hyunsoon Cho. How to adjust comorbidity in mortality outcome in Korean cancer patients using claim-based health care big data [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A11.

Fungal Peptic Ulcer Disease in an Immunocompetent Patient.

The lifetime prevalence of peptic ulcer disease (PUD) is 5–10%. While PUD in immunocompetent patients is most commonly associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs), other common causes of PUD must also be considered in the differential diagnosis. We describe a case of endoscopic and histological resolution of PUD related to Candida infection in a healthy, immunocompetent woman.LEARNING POINTSPeptic ulcer disease (PUD) can be secondary to fungal infections, even in immunocompetent patients.A higher index of suspicion needs to be maintained for fungal causes of PUD, particularly if symptoms do not improve.Recognizing fungal causes of PUD may lead to faster diagnosis and treatment.

Effect of work-related factors on the prevalence of peptic ulcer disease among Korean workers: a nationwide population-based study.

Working environment such as psychosocial factors impacts the health of workers. However, few studies have assessed the association of work-related factors with the prevalence of peptic ulcer disease (PUD) in large population based study. After exclusion of military personnel, 16,099 wage workers (20 ≤ age ≤ 65years) from the Fourth Korea National Health and Nutrition Examination Survey (2008-2011) were included in this study. Job status was defined as the place of employment of longest duration. To evaluate the working environment, we used a comprehensive work-stressor measure. Univariate and multivariable regression analyses were performed to assess the effect of occupation type on the prevalence of PUD. Among the subjects, 5540, 3398, and 7161 were white-, pink-, and blue-collar workers, respectively. The prevalence of PUD was highest among blue-collar workers (n = 336, 7.1%), followed by pink-collar (n = 116, 5.1%) and white-collar (n = 180, 4.9%) workers. In the multivariable analysis, work type and uncomfortable gestures were independently associated with the risk of PUD. Compared with office workers, operators in industrial plants and machine operators had a significantly higher prevalence of PUD (odds ratio, 1.9; 95% confidence interval, 1.1-3.3) after adjusting for age, socioeconomic factors, sex, smoking, alcohol consumption, daily exercise, sleep duration, and working conditions. In conclusion, work-related factors, particularly blue-collar work and uncomfortable job gestures, are independently associated with the risk of PUD. Therefore, it is important to monitor the development of PUD in workers exposed to these factors.

Pregnancy outcomes among women with peptic ulcer disease.

Background Little is known about the impact of peptic ulcer disease (PUD) on pregnancy. Our objective was to evaluate the effect of PUD on pregnancy and newborn outcomes. Methods A retrospective cohort study was carried out using the Healthcare Cost and Utilization Project (HCUP)-National Inpatient Sample (NIS) from the United States. The cohort consisted of all births that took place from 1999 to 2015. PUD was classified on the basis of the International Classification of Diseases-Ninth Revision (ICD-9) coding. Multivariate logistic regression was used to evaluate the adjusted effect of PUD on maternal and neonatal outcomes. Results Of the 13,792,544 births in this cohort, 1005 were to women with PUD (7/100,000 births). Between 1999 and 2015, prevalence of PUD in pregnancy increased from 4/100,000 to 11/100,000, respectively. Women with PUD were more commonly older and more likely to have comorbid illnesses. Women with PUD were at greater risk of preeclampsia [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.67-2.66], preterm premature rupture of membranes (PPROM; OR 2.16, 95% CI 1.30-3.59), cesarean delivery (OR 1.60, 95% CI 1.40-1.82), venous thromboembolism (OR 3.77, 95% CI 2.08-6.85) and maternal death (OR 24.50, 95% CI 10.12-59.32). Births to women with PUD were at increased risk of intrauterine growth restriction (IUGR; OR 1.54, 95% CI 1.11-2.14), preterm birth (OR 1.84, 95% CI 1.54-2.21), intrauterine fetal death (OR 2.18, 95% CI 1.35-3.52) and congenital anomalies (OR 2.69, 95% CI 1.59-4.56). Conclusion The prevalence of PUD in pregnancy has risen over the last several years. PUD in pregnancy should be considered a high-risk condition associated with important adverse maternal and neonatal outcomes.

Sarcopenia is Independently Associated with an Increased Risk of Peptic Ulcer Disease: A Nationwide Population-Based Study.

Background and objective: Although obesity is associated with an increased risk of peptic ulcer disease (PUD), no study has evaluated the association of PUD with sarcopenia. The aim of this study was to evaluate the association of sarcopenia and obesity with PUD. Material and Methods: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV and V for 2007–2012 were used. PUD history, dietary, alcohol consumption, smoking, physical activity patterns, and other socioeconomic factors were analyzed. Sarcopenia index (appendicular skeletal muscle mass (kg) ÷ body mass index (kg/m2)) and body fat mass were determined by dual-energy X-ray absorptiometry. Univariate and multivariate analyses were performed to evaluate the association of sarcopenia with the prevalence of PUD. Results: The 7092 patients were divided into the sarcopenic obesity (SO, n = 870), sarcopenic non-obesity (n = 2676), non-sarcopenic obesity (NSO, n = 2698), and non-sarcopenic non-obesity (NSNO, n = 848) groups. The prevalence of PUD in these groups was 70 (7.9%), 170 (7.4%), 169 (6.3%), and 47 (3.8%), respectively (p < 0.001). A crude analysis revealed that the prevalence of PUD was 2.2-fold higher in the SO group than in the NSNO group (odds ratio (OR), 2.2; 95% confidence interval (CI), 1.5–3.2), the significance of which remained after adjustment for age, sex, body mass index, and HOMA-IR (homeostatic model assessment insulin resistance) score (OR, 1.9; 95% CI, 1.3–2.7). Conclusion: In conclusion, in this nationally representative cohort, the combination of muscle and fat mass, as well as obesity, was associated with an increased risk of PUD.

1982 The Plight of the Peptic Ulcer: Seconds From Exsanguination

INTRODUCTION: Most peptic ulcer disease cases are often asymptomatic or present with dyspepsia. However, a small number present with complications such as bleeding, gastric outlet obstruction or perforation. Most of these complications can be treated with endoscopic interventions, while sometimes surgical intervention is required in cases with perforation or severe bleeding. Here we report a case of a man with a penetrating gastric body ulcer that led to massive bleeding requiring emergent surgery. CASE DESCRIPTION/METHODS: A 65-year old male with a history of hypertrophic obstructive cardiomyopathy presented with melena, dyspnea, and lightheadedness. Prior to the melena, he had abdominal pain and consumed ten tablets of Ibuprofen daily. On presentation, he was tachycardic, anemic with a Hb of 7.4 g/dL, BUN/Cr of 51 and was given a unit of blood. Electrolytes, creatinine and coagulation profile were unremarkable. A CT A/P showed a large, deep peptic ulcer (Figure 1). An EGD revealed a clean-based 5 cm non-bleeding, posterior wall gastric body ulcer with a biopsy positive for chronic active H.pylori gastritis. However, he continued to bleed and received several transfusions. A repeat EGD revealed the previous non-bleeding ulcer with a large, visible vessel (Forrest IIA) (Figure 1) with unsuccessful hemostasis and resultant active bleeding and hemodynamic instability. An emergent laparotomy and anterior gastrotomy revealed 2L of blood in the stomach. The ulcer had penetrated the retroperitoneal tissue and vessels and was resected carefully. He was started on quadruple therapy for H.pylori. DISCUSSION: The prevalence of peptic ulcer disease (PUD) has been declining since the 1990s and while H.pylori prevalence has reduced, more PUD cases are being attributed to the use of NSAIDs, aspirin and anticoagulants. Some cases precipitate into severe complications such as gastric outlet obstruction, perforation, bleeding or penetration. As in this case, posterior wall ulcers are associated with penetration and hemorrhage due to the close proximity to vessels such as the gastroduodenal artery and retroperitoneal vessels and pursuing endoscopic hemostasis must be considered a high-risk procedure in these patients. Caution must be applied in such cases where a large vessel is visualized, due to the risk of exsanguination. If imaging prior to endoscopic intervention shows close proximity to a large vessel, it may be prudent to defer endoscopic treatment and consider interventional radiology or surgical intervention instead.