Prevalence Of Peptic Ulcer Disease Research Articles

The Association of Obesity With Peptic Ulcer Disease Among U.S.-Born Versus Foreign-Born Urban Minorities

Introduction: Although obesity is associated with Barrett’s esophagus and adenocarcinoma as late sequelae of gastroesophageal reflux disease among whites, it is unclear if obesity affects the prevalence of acid peptic diseases among minorities. Aim: To compare the prevalence of peptic ulcer disease by body mass index among urban black and Hispanic adults. Methods: We reviewed the medical records of patients who had upper endoscopies at Howard University Hospital, Washington DC, from January 2009 to September 2010. We identified 687 patients who gave information about their places of birth, race-ethnicities, heights, and weights. We compared the presence of peptic ulcer disease by body mass index and place of birth. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The mean age of the study population was 52.2 years, 65.4% female, and 85.6% blacks. One hundred eighty-one (26.4%) were foreign-born, whereas 506 (73.6%) patients were born in the United States. There were 201 (29.3%) patients with normal BMI (<25 kg/m2),198 (28.8%) overweight (BMI=25-29 kg/m2), and 288 (41.9%) obese (BMI≥30 kg/m2). Overall, when compared to patients with normal BMI, there was no association between the presence of peptic ulcer disease and being overweight (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.49-1.76) or obese (OR 0.74; 0.39-1.41), and this was not affected by place of birth (Table). Conclusion: Obesity was not associated with the prevalence of peptic ulcer disease among urban black and Hispanic minorities.Table 1: Prevalence of Peptic Ulcer Disease by BMI and Place of Birth

Evaluating the effectiveness of endoscopic treatment of gastroduodenal bleeding in children

Introduction: One of the current problems of emergency abdominal child surgery are gastric (GU) and duodenal ulcer (DU). Thus, domestic and foreign researchers have noted that the prevalence of peptic ulcer disease in the pediatric population in recent years has nearly doubled. GU and duodenal ulcer occurs with frequency 1,6-2,7 cases per 1000 children and is 7-12 % of diseases of the gastrointestinal tract in children. Along with the growing incidence of this disease, there is a tendency of the number of complications increase.One of the major complications that pose a threat to a child's life is gastroduodenal bleeding. InUkraine, the rate for the last five years has increased by 14% and in the structure of hemorrhagic complications of diseases of the gastrointestinal tract up to 60 % .Despite the fact that endoscopic hemostasis is considered the "gold standard" treatment of gastroduodenal ulcer bleeding, their effectiveness in the primary use and application in cases of relapse in childhood actively discussed.Insufficient number of pediatric surgeons work on the effectiveness of the treatment of these complications with the use of modern minimally invasive technologies is largely determined by the relevance and purpose of the present study.Research objective. To analyze the efficacy of endoscopic treatment of bleeding and recurrence of gastric and duodenal ulcers in children.Material and research methods. Results of the treatment of 57children with acute bleeding from gastric and duodenal ulcers in age from 2 to 16 years who were treated in the surgical departments of pediatric surgery clinics Dnepropetrovsk State Medical Academy and Zaporozhye State Medical University were presented. 38 (67 %) were girls, 19 (33 %) - boys.All patients were admitted to the intensive care unit and undergone clinical, laboratory examinations, complex etiopathogenetic treatment (infusion, hemostatic, substitution, antisecretory therapy) and fibrogastroduodenoscopy (EGD) for diagnostic and therapeutic purposes. Activity of the bleeding was defined with scale by Forrest (Forrest-Rosch W., 1986) during endoscopy exam. Endoscopic electrocoagulation monoelektrod using fiberoptic gastroduodenoscopy «Olympus» UES 10 was done. Injection of 0.18% solution of adrenaline with endoscopic injection needle 5Ch in different volumes through the working channel of the endoscope and therapy in combination with electrocautery was done. Treatment effectiveness monitoring was based on clinical, laboratory data and endoscopic studies.Results of research. The study found that duodenal ulcer bleeding substantially prevailed and was found in 44 children, whereas bleeding from gastric ulcer were found in 13 patients. Thus at 52 (91 %) there was no history information of the diagnosed ulcer. Chronic abdominal pain with PUD previously was recorded only in 9% of cases.Bleeding duration up to 6 hours before admission was detected in 39% of children, between 6 and 24 hours – in 45% and more than 24 hours – in 16% of patients. During EGD macroscopic acute ulcers appearance was detected in the majority (86 %) of children, 32% of them in the last month had mentioned nonsteroidal anti-inflammatory drugs intake and 41% of patients noted aggressive and soft products intake. Ulcers size ranged approximately 5-7 mm. Contamination of Helicobacter pylori serological test according to the level of IgG antibodies was detected in 89.8% of children. Variations in the levels of pepsinogen and serum gastrin in 98 % of children do not cross the boundaries of age-reference values. The clinical picture was characterized by vomiting blood 15% of patients, vomiting "coffee grounds" was detected in 72 % of children, melena was observed in 61% of cases.Primary hemostasis using endoscopic electrocautery combinations and epinephrine injection solution was effective in 48 (84 %) children. 9 patients that undergone only electrocoagulation treatment on the 2nd day were diagnosed rebleeding, which required re-EGD using a combined endoscopic hemostasis. According to the results of clinical laboratory and endoscopic control full bleeding stop was observed during the first 2 days of children stay in hospital.Conclusions .1. Study improved predominance of duodenal ulcer bleeding in children.2. History of alcohol and/or nonsteroidal anti-inflammatory drugs intake increases the risk of acute gastric or duodenum ulcers complicated by bleeding.3. Use of surgery endoscopic hemostasis using combined coagulation- injection method on the background of the hemostatic and parenteral antisecretory therapy for primary and preventive stop ulcer bleeding ensures maximum efficiency of complex treatment in the practice.

MDCT diagnosis of gastroduodenal ulcers: key imaging features with endoscopic correlation.

Although the overall prevalence of peptic ulcer disease (PUD) and related hospitalizations are decreasing, the initial presentation of complicated PUD on CT remains common. It, therefore, remains critical for radiologists to recognize the findings of PUD at CT for initial diagnosis. While the CT findings of complicated PUD have been previously described in the literature, the CT findings of uncomplicated PUD have not been well documented. Furthermore, although CT is certainly not the diagnostic evaluation of choice for patients with suspected uncomplicated PUD, many patients with PUD will nonetheless present to the emergency department with unexplained abdominal pain and undergo MDCT evaluation as the initial diagnostic test. Therefore, recognizing the MDCT findings of uncomplicated PUD can help appropriately direct patient management, and help prevent the development of complications. To facilitate improved recognition of PUD on abdominal CT, we present an overview of the CT findings of both uncomplicated and complicated PUD, as well as several diagnostic pitfalls which can result in misdiagnosis from peptic ulcer mimics.

Peptic ulcer complications requiring surgery: what has changed in the last 50 years in Turkey.

The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.

Prevalence of Peptic Ulcer Disease in Asymptomatic Subjects Referring to the Check- Up Clinic of Razavi Hospital from 2006 - 2011

Background: Life style change is considered as a factor affecting on the increasing number of subjects with peptic ulcer disease (PUD). Helicobacter pylori (H. pylori) infection is regarded as a risk factor for the mentioned disease. Objectives: This study aims to analyze the prevalence of PUD in asymptomatic subjects referring to the check-up clinic of Razavi Hospital and the relation between PUD and H. pylori. Materials and Methods: 499 asymptomatic subjects who had referred to the Check-Up Clinic of Razavi Hospital from 2006 till 2011 included in this study. Their data including: age, sex, endoscopy report and rapid urease test (RUT) were evaluated and the results of 260 Biopsy were analyzed by SPSS. Results: The mean age of the subjects was 52 which included 73.1% males and 26.9% females. Positive H. Pylori were reported in 75.2% of males and 24.8% of females. Endoscopy results revealed 57.2% subjects with PUD from which 23% were seen with erosion, 11.6% with gastritis, 11.4% with ulcer, 8% with erythema, 1.6% with sub epithelial hemorrhage, 0.8% with deodenitis and 0.8% with gastroduodenitis. In 72% of subjects that their endoscopy showed PUD and in 38% of the subjects with normal endoscopy, positive RUT was reported. There was a significant relation between PUD observed in endoscopy and RUT (P = 0.001). In 89.6% of subjects who had PUD in biopsy, 57.7% subjects had gastritis with positive H. pylori and 13.8% subjects had gastritis without H. Pylori. There was a significant relation between gastritis incidence based on biopsy and RUT (P = 0.001). Conclusions: The prevalence of PUD is more common in asymptomatic males than females. Regarding the high prevalence of PUD and H. pylori in the population under study and according to other studies, life style change and healthy nutrition are considered as effective factors in PUD prevention. According to the results of this study, the patients with upper GI symptoms should be suspect to PUD and positive H. pylori infection.

Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain Attending the Department Of Medicine in Dhaka Medical College Hospital, Bangladesh

Peptic Ulcer Disease or PUD, one of the most common ulcers, refers to ulcer of the gastrointestinal tract in the region of the stomach. This is an important cause of morbidity and mortality throughout the world affecting the lives of millions of people in their everyday life. However, sufficient and up-to-date data regarding the disease in Bangladesh are largely lacking. Therefore this descriptive study was conducted from June to December 2013 to explore the prevalence of peptic ulcer disease among the patients attending the department of medicine in Dhaka Medical College Hospital, Bangladesh. Detailed information was collected from the patients (respondents) and hospital files of 196 patients with peptic ulcer on a predesigned pro-forma and analyzed using SPSS 17 for frequencies and distributions. The study shows that 16.3%, 24%, 7.7%, 25.5% and 26.5% of the respondents belongs to age group of 15-20 years, 21-25 years, 26-30 years, 31-35 years and 36-45 years with the mean age Mean ± SD=3.22  1.474. The study reveals that most of the respondents (62.8%) are Male and rests of them were Female (37.2%). Majority of the respondents (60.2%) had a family history of the disease and only 39.8% did not. The study shows that most of the respondents (33.7%) were higher secondary, 16.8% were undergraduate, 15.3% were postgraduate, 13.3% were secondary, 10.7% were illiterate and only 10.2% were primary. Most of the respondents (35.2%) are professional followed by 26% were technical, 19.9% were day labour and only 18.9% were farmer. Majority of the respondents' monthly family income about 53.6% was less than 10000 Tk, 36.2% of the respondents had 10001 to 20000 Tk, 3.1% had 20001 to 30000 Tk, 2.6% had 30001 to 40000 Tk, 1.5% had 40001 to 50000 Tk and 3.1% had an income above 50001 Tk.The problems of the disease can be tackled through prevention and treatment which includes education, increasing awareness, reducing stress, smoking and decreased intake of NSAIDs.

A comparison between standard triple therapy and sequential therapy on eradication of Helicobacter pylori in uremic patients: A randomized clinical trial.

Background:The prevalence of peptic ulcer disease in hemodialysis dependent patients is higher than the general population. These patients are also more prone to upper gastrointestinal bleeding. The aim of this study was to compare the effects of a standard triple therapy with a sequential therapy on Helicobacter pylori eradication in azotemic and hemodialysis patients.Materials and Methods:Forty nine hemodialysis and azotemic patients, naïve to H. pylori treatment, were randomized into two groups to receive either standard triple therapy (pantoprazole 40 mg, amoxicillin 500 mg and clarithromycin 250 mg twice a day for 14 days) or a sequential therapy (pantoprazole 40 mg for 10 days, amoxicillin 500 mg twice a day for the first 5 days and clarithromycin 250 mg + tinidazole 500 mg twice a day just during the second 5 days). H. pylori eradication was evaluated by fecal H. pylori antigen assessment 8 weeks after the treatment.Results:Of 49 patients, 45 patients (21 in triple therapy group and 24 in the sequential group) completed the study. Based on intention to treat analysis, H. pylori eradication rates were 66.7% (95% confidence interval [CI]: 47.8-85.5%) in standard triple therapy group and 84% (95% CI: 69.6-98.3%) in sequential therapy group (P = 0.34). Per-protocol (PP) eradication rates were (95% CI: 76.2%. 6-89.3%) 54 and 87.5% (95% CI: 68.8-95.5%), respectively (P = 0.32).Conclusion:According to Maastricht III consensus report, the results of our study showed that sequential therapy might be a better choice compared with the standard triple therapy in azotemic and hemodialysis patients Iran. We propose to assess the effects of shorter-duration sequential therapy (less than 10 days) for H. pylori eradication.

Difficult establishment of a chronic nonsteroidal anti-inflammatory drugs induced gastric inflammation rat model due to gastric adaptation and small bowel damage.

The prevalence of peptic ulcer disease has not decreased mainly due to an increase in the use of NSAIDs. This study was conducted in order to determine whether a chronic NSAID-induced gastric inflammation model could be established by repeated administration of NSAID. Indomethacin (10 mg/kg) was administered once per week for six weeks in 8- and 26-week rats and animals were sacrificed every week after administration. Gross ulcer index, histologic damage index, myeloperoxidase (MPO) activity, and mucus (glucosamine) levels were measured. Small bowel damage was also evaluated. Gross gastric damage index showed a peak level at three weeks and then decreased slowly in the 26-week indomethacin group. Gastric mucosal glucosamine level increased in both the 8-week (p=0.038) and 26-week groups (p=0.007). In addition, gastric mucosal MPO level decreased in the 8-week group (p=0.018) but did not show a decrease in the 26-week group. Small bowel damage began to occur at three weeks during the schedule and eight of 36 rats (22.2%) died due to perforation or peritonitis of the small bowel in the 8- and 26-week indomethacin groups, respectively. Due to gastric adaptation and small bowel damage, repeated administration of NSAID to experimental animals may not be an adequate method for establishment of the chronic gastric inflammation model.

Peptic ulceration, Helicobacter pylori seropositivity and chronic obstructive pulmonary disease

We have suggested that chronic inflammation of other foregut derivatives might be associated with airway inflammation and amplification of the response to inhaled stimuli such as cigarette smoke leading to chronic obstructive pulmonary disease (COPD). One of the commonest causes of chronic foregut inflammation is gastritis secondary to Helicobacter Pylori infection. We tested the hypothesis that peptic ulceration and H. Pylori seropositivity are associated with COPD independently of other shared risk factors. We reviewed primary care medical records and performed full lung function tests on 329 miners seen over 2 years as part of a compensation scheme. We also performed H. Pylori serology in patients with varying degrees of severity of COPD compared with a matched control population. The prevalence of peptic ulcer disease in the groups classed as normal, chronic bronchitis, mild, moderate and severe COPD was 3.2%, 16.2%, 21.4%, 42.4% and 56.2%, respectively. There was a strong and independent relationship between the presence of peptic ulcer disease and percent of predicted forced expiratory volume in 1 s (-13.3%; 95% confidence interval: 6.7-19.9; P < 0.001) and forced expiratory volume in 1 s/forced vital capacity ratio (-5.06%; 95% confidence interval: 1.8-8.2; P < 0.001). Positive H. pylori serology was present in 54.7% of 58 patients with COPD and 23.5% of 17 controls (P = 0.026). Our findings suggest a relationship between peptic ulcer disease and COPD that is more that just a shared susceptibility to different environmental stimuli.

Relationship between continuous use of low-dose enteric-coated aspirin and gastrointestinal injuries in patients with gastrointestinal hemorrhage

Gastrointestinal disorders are important side effects of aspirin therapy, even if the low-dose enteric-coated form is administered. The aim of the current study was to present the upper and lower endoscopic features of patients with gastrointestinal hemorrhage using low-dose enteric-coated aspirin. This prospective study was conducted among 633 consecutive patients with gastrointestinal hemorrhage who admitted to our tertiary referral hospital for endoscopy assessment. Patients were divided into two groups as low-dose aspirin users (n=168) and non-aspirin users (n=495). Aspirin users included those who were taking 80-100 mg of enteric-coated aspirin per day. Ulcer lesions were found in 78 patients in the aspirin user group and in 113 patients in the control group. Prevalence of duodenal ulcer was statistically similar between the two groups; however, gastric ulcer was seen more in the aspirin-user group. The use of low-dose aspirin could strongly predict gastric ulcers in the patients examined by endoscopy (p<0.001). Overall prevalence of peptic ulcer disease in those with confirmed Helicobacter pylori infection was significantly higher than in non-infected ones (p<0.001). The presence of this infection was strongly associated with peptic ulcer disease in the aspirin-user group (p<0.001). Multivariable analysis also demonstrated that the use of aspirin had a main triggering effect on short-term mortality following gastrointestinal endoscopy (p=0.003). Low-dose enteric-coated aspirin causes significant gastric endoscopic lesions and even predicts mortality due to progression of gastrointestinal disorders.

Clinical Approach on the Management for Patients with Noncardiac Chest Pain in Korea

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP). An empirical trial with a proton pump inhibitor (the PPI test) was introduced as a non-invasive, readily available alternative diagnostic tool for NCCP. So, PPI test is known to be the first diagnostic step for NCCP. In Korea, in contrast to Western countries, patients with NCCP but who are without alarming features have been recommended to undergo esophagogastroduodenoscopy (EGD) to exclude gastric cancer or peptic ulcers because of the higher prevalence of peptic ulcer disease and gastric cancers in the region. However, there are only a few small sized studies in Korea. The report of Pyo et al. showed that out of 349 NCCP patients, reflux esophagitis was diagnosed in 35 patients (10.0%), peptic ulcer in 48 patients (13.8%) and gastric cancer in 1 patient. This result suggests that in Korea, unlike the West, stomach/duodenal lesions other than GERD are common causes of NCCP. Therefore, in Korea, prior to PPI test or empirical therapy, performing EGD is necessary for evaluating NCCP to rule out gastroduodenal lesions. Furthermore, a large scaled prospective study is needed to assess the accurate relation of endoscopic findings and chest pain. (Korean J Med 2013;84:512-514)

Temporal Trends of Peptic Ulcer Disease in Kashmir, India

BACKGROUND: Since late 1960s, the prevalence of peptic ulcer disease and its complications has been steadily decreasing.&#x0D; OBJECTIVE: To ascertain the changing trends in the prevalence and complications of peptic ulcer in Kashmir.&#x0D; METHODS: A cohort of 10474 people aged 15-60 years in district Baramulla of Kashmir was interviewed about symptoms, complications, and surgery related to peptic ulcer. People were enquired about smoking, use of NSAIDs, H2 Receptor antagonists, proton pump inhibitors and endoscopies. All symptomatic and randomly selected group of asymptomatic people underwent esophago-gastro-cluodenoscopy.&#x0D; RESULTS: In symptomatic group, 286 (41.45%) people hod peptic ulcer and in asymptomatic group 24 (5.35%) had peptic ulcer. There were 71 already diagnosed cases of peptic ulcer; totaling 381. Thirty three people had surgery for peptic ulcer. The point prevalence of peptic ulcer was 3.54% and lifetime prevalence 8.96%. The highest prevalence was in 4th decade. Bleeding was seen in 23.63%, gastric outlet obstruction 4.20%, ulcer perforation 0.52%. 9.39% of peptic ulcer patients had undergone surgery. When compared to previous study in 1985 in Kashmir, there was decrease in point prevalence of 25%, in life-time prevalence of 20.14%, Gastric outlet obstruction by 51.7%, ulcer perforation by 87%, surgery rate by 60% and bleeding by a marginal 2%.&#x0D; CONCLUSION: Prevalence of peptic ulcerand its complications (except bleeding) are showing downward trend in Kashmir over the last 20 years. JMS 2012;15(2):136-40

Peptic ulcer disease in children: An uncommon disorder with subtle symptomatology

Data concerning peptic and infectious ulcers in children are limited. The aim of the study was to investigate the prevalence, presenting symptoms and significance of symptomatology in ulcer diagnosis in the pediatric age group. Between January 2000 and 2009, upper gastrointestinal endoscopy charts were examined retrospectively. All children in whom a diagnosis of ulcer was established were included in the study. Demographic, clinical, endoscopic, and histopathologic data were obtained from the patients' records. Peptic ulcer disease prevalence, presenting symptoms and symptomatology were evaluated. Ulcer disease was observed in 31 (3.4%) of 902 patients. The mean age was 10.85 ± 4.25 (range: 2-17 years), and the male to female ratio was 2:1. The most common symptom was chronic abdominal pain (68%), hematemesis and melena (55%) and vomiting (39%). Helicobacter pylori was identified in 19 patients (61%) with ulcer. In the Helicobacter pylori-positive group, upper intestinal bleeding and pain were the major symptoms. Symptom frequency was not different between Helicobacter pylori-positive and -negative patients (p>0.05). Ulcer disease is an uncommon disorder in children with nonspecific clinical symptoms. Unlike the adult population, symptoms fail to diagnose peptic ulcer disease before gastrointestinal bleeding occurs.

The etiology of pneumoperitoneum in the 21st century

We sought to determine the origin of free intraperitoneal air in this era of diminishing prevalence of peptic ulcer disease and imaging studies. In addition, we attempted to stratify the origin of free air by the size of the air collection. We queried our hospital database for "pneumoperitoneum" from 2005 to 2007 and for proven gastrointestinal perforation from 2000 to 2007. Massive amount of free air was defined as any air pocket greater than 10.0 cm. Among patients with free air, the predominant causes were perforated viscus (41%) and postoperative (<8 days) residual air (37%). For patients with visceral perforation, only 45% had free air on imaging studies, and for these patients, the predominant cause was peptic ulcer (16%), diverticulitis (16%), trauma (14%), malignancy (14%), bowel ischemia (10%), appendicitis (6%), and endoscopy (4%). The likelihood that free air was identified on an imaging study by lesion was 72% for perforated peptic ulcer, 57% for perforated diverticulitis, but only 8% for perforated appendicitis. The origin of massive free air was equally likely to be gastroduodenal, small bowel, or colonic perforation. The cause of free air when surgical pathology is the source has substantially changed from previous reports. Epidemiologic study, level IV.

Significant decrease in prevalence of Helicobacter pylori and peptic ulcer disease over a 17-year period

Background: We and others have already suggested that the incidence of Helicobacter pylori (H. pylori) negative peptic ulcer disease (PUD) has increased in the latest years. Aims: to investigate in a retrospective study the prevalence of H. pylori and PUD and to compare etiology, gender and age distribution in PUD in 1995, 2000, 2005 and 2011. Methods: Medical and endoscopic records were retrospectively reviewed with similar data obtained over a 17-year period at the same endoscopic unit with regard to H. pylori status and prevalence of endoscopically proven PUD. Results: The rate of H. pylori positivity decreased significantly from 1995 to 2011 (42% and 19% of total endoscopies, respectively, p<0.05). The prevalence of PUD, compared to all endoscopic examinations decreased significantly over a 17-year period: 125 PUD were found in 1995, 141 in 2000, 99 in 2005 and 174 in 2011 (9%, 7%, 4% and 5% of total endoscopies, respectively, p<0.05). The rate of H. pylori negative PUD increased significantly from the year 1995 to 2011 (13% and 49%, respectively, p<0.01). No significant differences were observed with respect to age and gender distribution between H. pylori positive and negative PUD. Conclusion: Endoscopic H. pylori prevalence has decreased significantly over a 17-year period in our academic centre. Endoscopic PUD also has decreased significantly from 1995 to 2011. In accordance with the data in literature, we found a significant increase in the incidence of H. pylori negative PUD.

Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population‐based study

Peptic ulcer bleeding remains a major healthcare problem despite decreasing prevalence of peptic ulcer disease. The role of chronic obstructive pulmonary disease (COPD) in the risk of peptic ulcer bleeding has not yet been established. To determine if COPD patients have a higher risk of peptic ulcer bleeding than the general population and to identify the risk factors of peptic ulcer bleeding in COPD patients. From Taiwan's National Health Insurance research database, 62,876 patients, including 32,682 COPD and 30,194 age-gender-matched non-COPD controls, were recruited. Cox proportional hazard regression was performed to evaluate independent risk factors for ulcer bleeding in all patients and to identify risk factors in COPD patients. During the 8-year follow-up, COPD patients had a significant higher rate of peptic ulcer bleeding than the control group (P < 0.001, by log-rank test). By Cox proportional hazard regression analysis, COPD [hazard ratio (HR) 1.93, 95% CI 1.73-2.17] was an independent risk factor after adjusting for age, gender, underlying comorbidities and ulcerogenic medication. Age > 65 years, male, comorbidities of hypertension, diabetes, heart failure, history of peptic ulcer disease, and chronic renal disease and use of nonsteroidal anti-inflammatory drugs were risk factors of ulcer bleeding in COPD patients. Patients with chronic obstructive pulmonary disease have a higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like underlying comorbidities and ulcerogenic medication.

Recent Advances in Noncardiac Chest Pain in Korea

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and is present in up to 60% of patients with NCCP in Western countries. In Korea, after a reasonable cardiac evaluation, GERD is reported to underlie 41% of NCCP cases. Typical reflux symptoms are frequent in Korean patients suffering from NCCP. Therefore, a careful history of the predominant symptoms, including heartburn and acid regurgitation, is relatively indicative of the GERD diagnosis in Korea. In Korea, in contrast to Western countries, patients aged 40 years and over who have been diagnosed with NCCP but who are without alarming features should undergo endoscopy to exclude gastric cancer or peptic ulcers because of the higher prevalence of peptic ulcer disease and gastric cancers in the region. In a primary care setting, in the absence of any alarming symptoms, a symptomatic response to a trial of a proton pump inhibitor (PPI) is sufficient for the presumptive diagnosis of GERD. In addition, the optimal duration of a PPI test may be at least 2 weeks, as GERD symptoms tend to be less frequent or atypical in Korean patients than in patients from Western countries. In patients diagnosed with GERD-related NCCP, long-term therapy (more than 2 months) with double the standard dose of a PPI is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon, and pain modulators seem to offer significant improvement of chest pain control in non-GERD-related NCCP. Most traditionally available tricyclics or heterocyclics have many undesirable effects. Therefore, newer drugs with fewer side effects (for example, the serotonin - norepinephrine reuptake inhibitors) may be needed.

CYP2C19 Genetic Polymorphisms in Patients with Peptic Ulcer Disease and Nonulcer Dyspepsia in Thailand

Purpose: Recently, the CYP2C19 genotype has been found to be an important factor in peptic ulcer healing rate, H. pylori. eradication and has influences on the therapeutic efficacy of proton pump inhibitor. The aim of this study was to investigate CYP2C19 genotype status in patients with peptic ulcer disease and non-ulcer dyspepsia in Thailand. Methods: Clinical information, endoscopic findings and H. pylori infection of all patients were collected between January 2009 and April 2010 in Thammasat University Hospital, Thailand. The upper GI endoscopy was performed in all patients. Three antral biopsies were obtained, one for rapid urease test and culture, one for histopathology and another one for CYP2C19 study. Patients were regarded as H. pylori-positive if at least one of the examinations gave a positive result. The CYP2C19 genotype was determined by polymerase chain reaction and restriction fragment length polymorphism analysis and was classified as rapid metabolizer (RM), intermediate metabolizer (IM) or poor metabolizer (PM). Results: Total 121 patients were enrolled in this study including 61 males and 60 females with mean age of 51.3 years. There were 86 patients with non-ulcer dyspepsia and 36 patients with peptic ulcer disease. The prevalence of CYP2C19 genotype was 45/121 (37.2%) in RM, 65/121 (53.7%) in IM and 11/121 (9.1%) in PM. The prevalence of H. pylori infection was demonstrated in 77.8% in RM, 76.9% in IM and 63.7% in PM without statistical different between each group. However, the prevalence of peptic ulcer disease in CYP2C19 genotype RM and IM was significantly greater than those of genotype PM (29.5% vs 16.7%: P<0.05 and 29.2% vs 16.7%: P<0.05 respectively). Conclusion: CYP2C19 genotype IM was the most common genotype in Thailand followed by genotype RM and PM. Peptic ulcer disease has significant greater prevalence in CYP2C19 genotype RM and IM than those of genotype PM. CYP2C19 genotypes might play a role in the development of peptic ulcer disease and need further studies to clarify this relationship.

High prevalence of duodenal ulcer in a tertiary care hospital in the city of São Paulo, SP, Brazil

In spite of Helicobacter pylori infection being the etiological cause of peptic ulcer and its high prevalence in Brazil, the prevalence of peptic ulcer disease has been poorly studied. To verify the peptic ulcer disease prevalence in patients of a tertiary care hospital. Diagnostic findings from 1,478 consecutive endoscopies were correlated with the urease test results for H. pylori infection diagnosis and demographic data in a total of 3,779 endoscopies performed in 2005. The mean age of the patients was 51.14 ± 16.46, being 613 (41.5%) men. Peptic ulcer was diagnosed in 494 (33.4%) patients with a mean age of 54.86 ± 14.53, 205 (52%) were men, being 391 (26.5%) duodenal ulcer and 103 (7%) gastric ulcer. Normal endoscopy was found in 272 (18.4%) patients with a mean age of 38.4 ± 15.22, being 49 (18%) men. The comparison of peptic ulcer group with the patients that had normal endoscopy revealed that H. pylori infection [P = 0.005; OR = 1.70; 95% CI = 1.17-2.47], male gender [P<0.0001; OR = 5.53; 95%CI = 3.67-8.34] and older age [P<0.0001; OR = 1.08; 95%CI = 1.06-1.09] increased the risk of peptic ulcers. The overall H. pylori prevalence was 53% (786). Prevalence of duodenal ulcer is high in a Brazilian population that had H. pylori infection associated with older age and male gender as important determinants to gastrointestinal diseases outcome. Future prospective studies should confirm these findings.

NURSING CARE OF PATIENTS WITH DUODENAL ULCER

NURSING CARE OF PATIENTS WITH DUODENAL ULCER