Prevalence Of Peptic Ulcer Research Articles

An elderly woman with progressive odynophagia, epigastralgia and nausea

An 84-year-old woman presented to the author's hospital with a 5-day history of progressive odynophagia, epigastralgia and nausea. These symptoms developed 3 days after taking an alendronate oral tablet (35 mg once-weekly) for the treatment of postmenopausal osteoporosis. The patient's other medication consisted of 10 mg/day of rivaroxaban for atrial fibrillation; 200 mg/day of cilostazol for lacunar infarction; 20 mg/day of esomeprazole and 300 mg/day of rebamipide for the prevention of peptic ulcer. Esophagogastroduodenoscopy (EGD) revealed severe erosion and ulceration with sloughing mucosal casts in the mid and lower esophagus (Fig. 1, Panels A and B). What is the diagnosis? The abovementioned endoscopic findings are compatible with drug-induced esophagitis. Alendronate can cause chemical esophagitis including severe ulcerations [[1]de Groen P.C. Lubbe D.F. Hirsch L.J. et al.Esophagitis associated with the use of alendronate.N Engl J Med. 1996; 335: 1016-1021Crossref PubMed Scopus (700) Google Scholar]; therefore, alendronate-induced esophagitis was diagnosed. Alendronate therapy was discontinued, and the patient was hospitalized; thus, parenteral nutrition and intravenous administration of a proton pump inhibitor (PPI) (lansoprazole 30 mg twice-daily) were performed. The symptoms were disappeared within a few days, and 6 days later, EGD confirmed remarkable improvement of the esophagitis (Fig. 1, Panel C). The patient was discharged on the 8th day after admission, and monthly intravenous ibandronate 1 mg was prescribed as an alternative to weekly oral alendronate 35 mg. Alendronate, an aminobisphosphonate, is a selective inhibitor of osteoclast-mediated bone resorption and has been widely used to treat osteoporosis. A large review of worldwide post-marketing surveillance data for alendronate in 1996 showed that 0.04% (199/475,000) of patients had adverse effects related to the esophagus [[1]de Groen P.C. Lubbe D.F. Hirsch L.J. et al.Esophagitis associated with the use of alendronate.N Engl J Med. 1996; 335: 1016-1021Crossref PubMed Scopus (700) Google Scholar]. Recovery of the esophagitis can be solved by stopping alendronate, with additional treatment such as acid-suppressing agent and parenteral nutrition when necessary. Furthermore, drug-induced acid suppression is not a substitute for the discontinuation of alendronate [[1]de Groen P.C. Lubbe D.F. Hirsch L.J. et al.Esophagitis associated with the use of alendronate.N Engl J Med. 1996; 335: 1016-1021Crossref PubMed Scopus (700) Google Scholar]. Physicians need to be cautious of esophagitis induced by alendronate, even though the patient has taken an oral PPI. None declared.

Роль препаратов висмута в повышении эффективности эрадикации инфекции Helicobacter pylori

Aim of review. To demonstrate modern potential of bismuth agents administration for increasing of Helicobacter pylori (H. pylori) eradication efficacy. Summary. Prevention of peptic ulcer and stomach cancer makes eradication of H. pylori infection more and more important. At the same time efficacy of some eradication modes, first of all - that of standard triple therapy, steadily decreases because of growing antibiotic resistance of H. pylori strains, first of all - clarithromycin resistance. The concept that empirical prescription of standard triple therapy should be abandoned in favor of initial H. pylori clarithromycin-resistance testing by culture or real-time polymerase chain reaction became widely accepted. Bismuth-based quadrotherapy mainly - with bismuth tripotassium dicitrate (BTD) is alternative to standard triple mode therapy nowadays. Potential of BTD combination not only to tetracycline but to other antibiotics as well was demonstrated. Addition of BTD to triple therapy containing clarithromycin, levofloxacin, metronidazole allows to increase eradication efficacy for 30-40% at H. pylori-resistant strains. Absence of H. pylori resistance development to BTD, combined antibacterial and cytoprotective effects as well as good tolerance are important advantages of the drug. Conclusion. Addition of BTD to triple H. pylori eradication modes, that include different antibiotics (clarithromycin, levofloxacin and metronidazole) provide significant increase in efficacy of eradication at antibioticresistant Helicobacter pylori strains.

Benign and malignant gastroduodenal diseases associated with Helicobacter pylori: a narrative review and personal remarks in 2018.

The subject of Helicobacter pylori continues to elicit worldwide interest in many research fields. Epidemiological data suggest that the prevalence of the infection is decreasing in Western/developed countries and even in some developing regions, but this is masked by the high prevalence in the most populous regions. Chronic gastritis, caused invariably by the bacterium, was again classified in Kyoto and Helicobacter pylori-associated gastritis was included as a distinct entity. The prevalence of peptic ulcers is decreasing, but bleeding ulcers are a challenging problem, with stable mortality levels even in the endoscopic era. With the extended use of endoscopy, gastric polyps (GP) have become more prevalent: some are associated with the infection, some are not. Autoimmune and Helicobacter-induced gastritis can share common pathogenetic mechanisms. Gastric cancer (GC) is ranked highly on mortality lists worldwide. Its surgical treatment has registered some progress though. Little, if any improvement has been achieved in the medical treatment of advanced GC. With proper organization, GC seems a preventable disease. In spite of many guidelines, the Pan-European registry of Helicobacter pylori management shows that eradication rates obtained in many places are suboptimal. A new therapeutic regimen was compiled with promising pilot results. The results obtained with vonaprazan are limited to Asia. New avenues of both antibiotic and non-antibiotic treatments are expected to accelerate the eradication of this ulcerogenic and carcinogenic bacterium.

Prevention of peptic ulcer by aqueous extract of Aegle marmelos leaf in rats

Background and objectives: Aegle marmelos (Bael), a medicinal plant, has been widely used indigenously to treat many diseases in Bangladesh and other countries. The present study was carried out to evaluate the efficacy of A. marmelos leaf to prevent ethanol induced gastric ulcer in a rat model.Methods: Thirty two Wister albino rats of either sex, weighing between 100-150g, were fed 200 mg/kg or 400 mg/kg aqueous extract of A. marmelos leaves one hour prior to oral administration of 90% ethanol (1 ml/200 gm body weight) to induce gastric ulcer. The animals were sacrificed after one hour and ulcer scores and index were determined. The protective efficacy of A. marmelos aqueous extract was expressed as percentage protection of ulcer.Results: Aqueous extract exhibited significant (p<0.05) dose dependent protection against gastric ulcer formation by ethanol in rat stomach. Percentage protection of ulcer with 200 mg/kg and 400 mg/kg of aqueous extract of A. marmelos leave were 19.3% and 37.2% respectively compared to standard anti-peptic ulcer drug omeprazole (50.4%).Conclusion: Thus, crude extracts of A. marmelos leave have been shown to have potential ability to prevent experimentally induced peptic ulcer formation in animal model.IMC J Med Sci 2018; 12(1): 11-14

Prevalence of peptic ulcer in Iran: Systematic review and meta-analysis methods.

Background:Peptic ulcer is a prevalent problem and symptoms include epigastria pain and heartburn. This study aimed at investigating the prevalence and causes of peptic ulcers in Iran using systematic review and meta-analysis.Materials and Methods:Eleven Iranian papers published from 2002 to 2016 are selected using valid keywords in the SID, Goggle scholar, PubMed and Elsevier databases. Results of studies pooled using random effects model in meta-analysis. The heterogeneity of the sample was checked using Q test and I2 index.Results:Total sample size in this study consist of 1335 individuals with peptic ulcer (121 samples per article). The prevalence of peptic ulcers was estimated 34% (95% CI= 0.25 – 0.43). The prevalence of peptic ulcers was 30% and 60% in woman and man respectively. The highest environmental factor (cigarette) has been addressed in 30% (95% CI= 0.23-0.37) of patients. The prevalence of Helicobacter pylori was estimated in 62% (95% CI= 0.49-0.75) of patients.Conclusion:The results of this study show that prevalence of peptic ulcers in Iran (34%) is higher that worldwide rate (6% to 15%). There was an increasing trend in the prevalence of peptic ulcer over a decade from 2002 to 2016.

Upper and Lower Gastrointestinal Endoscopic Findings in HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy

BackgroundEndoscopic evaluation with biopsies are instrumental in the diagnosis and management of gastrointestinal (GI) disorders in the setting of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), especially in the era of highly active antiretroviral therapy (HAART).MethodsA retrospective chart review of 304 HIV-positive and 199 HIV-negative patients who had undergone upper and/or lower endoscopy in an urban community hospital from the years 2012 - 2017 was performed. Inclusion criteria included men and women between the ages of 45 to 75 years, which had undergone colonoscopies between within 2012 - 2017 and had tested positive for HIV. They were selected from that population if they had complete charts that included information regarding symptoms, viral load, cluster of differentiation 4 (CD4) count, prescribed HAART medication, findings from the upper and lower colonoscopy both from the gastroenterologist’s report and pathologist’s report. Only then would they be added to the pool of final selection that we could compute data from and draw conclusions.ResultsAmong HIV patients, those with less than 200 CD4 cells/µL counts had lower rates of diverticulosis and hemorrhoids, as compared with those with greater than 200 cells/µL counts. Other gross and histological findings (from either upper or lower endoscopy) were not statistically different between these two groups. In HIV-positive patients, gastritis, Helicobacter pylori (HP) infection, and esophagitis were significantly less common, while Candida esophagitis was more common. Among HIV patients taking different HAART regimens, the prevalence of peptic ulcers was significantly higher in those taking IIs than that in those who were not.ConclusionsPhysicians should consider the possibility that the GI symptoms in HIV-infected patients on HAART may be due to an opportunistic infection, even when the CD4 count is more than 200 cells/µL and the viral load is low.

Profile of peptic ulcer disease and its risk factors in Arar, Northern Saudi Arabia.

BackgroundPeptic ulcer disease is a multifactorial health problem, and its prevalence and risk factors have changed considerably within the past century.ObjectiveTo determine the prevalence of peptic ulcer among the population of Arar city and to identify risk factors for peptic ulcer and to estimate their relative impact on ulcer incidence.MethodsA cross-sectional study was carried out on the population of Arar city, Northern Saudi Arabia from November 01, 2016 to April 30, 2017. Data were analyzed by SPSS version 16, using descriptive statistics, prevalence, and Chi-square test.ResultsTotal prevalence of peptic ulcer among the studied respondents was thus: 21.9% had peptic ulcer; 16.2% gastric ulcer and 5.6% duodenal ulcer. In 19.7% of the cases, the pain was severe, 92.4% reported that pain was precipitated by certain food. In addition to heartburn, 78.8% reported loss of appetite, 71.2% indigestion, 66.7% regurgitation, 59.1% nausea and vomiting and 42.4% with chest pain. Regarding the risk factors, coffee drinking came in first place (81.8%) followed by physical stress in 77.3%, spicy food in 57.6%, prolonged use of Non-steroidal anti-inflammatory drugs (NSAIDs) in 33.3% and Helicobacter pylori (H. pylori) infection in 24.2%. A further 22.7% reported melena as a complication while only 10.6% reported hematemesis.ConclusionThis is the first population-based study in Arar, Northern Saudi Arabia reporting point prevalence of peptic ulcer disease. The rate of 16.2% for gastric ulcer and 5.6% for duodenal ulcers are substantially high. Coffee drinking, physical stress, spicy food, prolonged use of NSAID and H. pylori infection were the reported risk factors. Population-based endoscopic studies are recommended.

Prevalence of upper gastrointestinal endoscopic findings in the community: A systematic review of studies in unselected samples of subjects.

Upper gastrointestinal endoscopic findings, such as esophagitis, Barrett's esophagus, peptic ulcer, and malignancy, represent a public health problem. This systematic review aimed to evaluate the prevalence of upper gastrointestinal endoscopic findings in the community. A systematic search was conducted in PUBMED and EMBASE to May 2015. Studies were eligible if they reported the prevalence of upper gastrointestinal endoscopic findings in unselected samples of the community. Twelve articles were eligible, nine reported data from three endoscopic surveys (n = 3063 subjects), and three from national screening programs (n = 84 153). The overall prevalence of upper gastrointestinal endoscopic findings in the community was 30% in the Kalixanda study (Sweden), 24.9% in the Loiano-Monghidoro study (Italy), and 68.9% in the Systematic Investigation of Gastrointestinal Diseases study (China). The pooled prevalence of esophagitis, endoscopically suspected esophageal metaplasia (ESEM), peptic ulcer, and gastric cancer in all studies was 11.2, 5.1, 6.8, and 0.33%, respectively. The most frequent finding was esophagitis in Europe, with a prevalence of 15.5% in Sweden and 11.8% in Italy, and peptic ulcer in China (17.1%), both in asymptomatic and symptomatic individuals. The prevalence of Helicobacter pylori was positively associated with the prevalence of peptic ulcer (r = 0.91) but negatively associated with the prevalence of both esophagitis (r = -0.99) and ESEM (r = -0.95). Upper gastrointestinal endoscopic findings are present in at least a quarter of subjects in the community with different patterns in Western and Eastern countries, both in asymptomatic and symptomatic subjects. H. pylori prevalence negatively impacts on the prevalence of reflux-related esophageal findings.

World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease.

PROBIOTICS—THE CONCEPTHistory and DefinitionsA century ago, Elie Metchnikoff (a Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) postulated that lactic acid bacteria (LAB) offered health benefits capable of promoting longevity. He suggested that “intestinal autoint

Antiulcer activity of aqueous and ethanolic extracts of Ocimum sanctum leaves in albino rats

Background: Peptic ulcer is one of the most common gastrointestinal disorders and a major cause of morbidity. The incidence and prevalence of peptic ulcer has been increasing worldwide. Persisting peptic ulcer leads to complications like gastrointestinal bleeding, gastric perforation and pyloric obstruction. The complications further increase the morbidity and mortality. The objectives of this study were to evaluate the antiulcer activity of aqueous and ethanolic extracts of Ocimum sanctum leaves in albino rats. Methods: 48 apparently healthy wistar albino rats of either sex weighing about 150-200 grams were divided randomly into 12 groups (n=4). All the drugs were given as pre-treatment, per oral daily for 3 days. Test drugs, aqueous leaf extract (100 mg/kg, 200 mg/kg) and ethanolic leaf extract (50 mg/kg, 100 mg/kg) in 1% carboxymethylcellulose (CMC) were administered. Pyloric ligation and cold restrain stress were used as experimental models in the study. Parameters like free acid, gastric volume and ulcer index were observed. Results: All the test drugs significantly reduced the free acid, gastric volume and ulcer index in pyloric ligation model. 100 mg/kg of aqueous leaf extract failed to decrease the ulcer index in cold restrain stress, but other doses of test drugs reduced the ulcer index. Conclusions: Both the doses of aqueous and ethanolic extracts of Ocimum sanctum leaves exhibited significant antiulcer activity in pyloric ligation model, whereas only 200 mg/kg of aqueous leaf extract was effective in cold restrain stress model.

Risk factors associated with gastroduodenal lesions in a Douala referral hospital (Cameroon)

The causes of gastroduodenal lesions are multifactorial, and few studies have assessed the impact of each of these factors in Africa. The aim of this study was to identify factors associated with the occurrence of gastroduodenal lesions in Cameroon. This prospective, analytical study took place over a 5-month period in the endoscopy unit of the Douala General Hospital. Lifestyle, medical history, demographic, and clinical variables were collected. Infection with Helicobacter pylori was determined with a rapid urease (CLO) test. Multivariate regression was used to determine risk factors. The study included 234 of 265 patients seen in the department over the study period. Gastroscopy was normal for 54.2% of the subjects. The prevalence of peptic ulcers was 17.1% and of inflammatory lesions 26.4%. Risk factors associated with a gastroduodenal lesion were: age greater than 60 years [OR age = 2.953; 95% CI: 1.399 to 6.231; p = 0.004], H. pylori infection [OR = 2.953; 95% CI: 1.399 to 6.231; p = 0.003] and regular NSAID use [OR = 0.912; 95% CI: 0.112 to 2.733; p = 0.044] either a month before the examination or over the long term. Age greater than 60 years, NSAID consumption, and H. pylori infection are associated with the occurrence of gastroduodenal lesions.

Changing prevalence of Helicobacter pylori infection and peptic ulcer among dyspeptic patients.

SIMI 2015 Dyspeptic syndrome defines a series of symptoms involving the upper GI tract. The syndrome affects about 25 % of the adult population, and is one of the most common GI problems in primary care or in gastroenterology practice [1]. In approximately 75 % of patients, dyspeptic symptoms are functional, meaning without an underlying cause on diagnostic evaluation. Authorities in the field stratify functional dyspepsia into three subgroups on the basis of the symptoms pattern: dyspepsia motility like, including symptoms such as bloating, predominant nausea, epigastric fullness, early satiety and anorexia; dyspepsia ulcer like, characterized by burning, epigastric hunger pain mitigated by antacid, antisecretory drugs and by food; finally unspecified dyspepsia [1]. The approach to and management of a patient with dyspepsia is based on the presence or absence of alarm features such as age older than 55 years, family history of upper GI cancer, weight loss with a regular diet, GI bleeding, dysphagia, jaundice, anemia, persistent vomiting and palpable mass or lymphadenopathy [1]. Because several disorders can be responsible for these symptoms including esophageal, gastroduodenal, pancreatic, and hepatobiliary diseases, for these patients, the goal will be to avoid invasive and expensive diagnostic procedures to arrive at a definitive diagnosis [1, 2]. Upper endoscopy is the gold standard for establishing a specific cause in patients with epigastric pain; however, it should be reserved only for patients with alarm features. For this reason, a detailed anamnesis and physical examination are fundamental to identify patients with gastroesophageal reflux disease, nonsteroidal anti-inflammatory drug (NSAID)-induced dyspepsia, as well as alarm features. The age cut-off also may be different among countries, depending upon the prevalence of gastroesophageal malignancy. In Europe, endoscopy is recommended in adults older than 45 years old [3]. The majority of investigated dyspeptic patients with a defined diagnosis of peptic ulcers have complained of epigastric pain, and we know that the most common causes of gastric and duodenal ulcers include Helicobacter pylori infection and NSAIDs use. Less common causes are: Zollinger‐Ellison tumors, Crohn’s disease, Curling ulcers (from stress due to serious

Peptic Ulcer Diseases

The etiology of peptic ulcers is generally related to impaired mucosal defenses in the presence of aggressive factors (e.g., gastric acid and pepsin). Major risk factors include infection with Helicobacter pylori and the use of nonsteroidal antiinflammatory drugs; high rates of acid secretion can also predispose to ulcer formation. The prevalence of peptic ulcers in Western countries has declined since the 1950s, a phenomenon that is likely due to a corresponding decrease in H. pylori infections among the general population. This review summarizes the epidemiology, etiology, diagnosis, and treatment of peptic ulcers. Figures show the etiopathogenesis of peptic ulcers, the approach to a patient who has new and undiagnosed ulcerlike symptoms, and images of a gastrointestinal series in which double contrast (barium and air) was used, as well as an upright chest x-ray of a patient with an acute abdomen caused by a perforated duodenal ulcer. Tables list the differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate H. pylori. This review contains 3 highly rendered figures, 2 tables, and 35 references.

Prevalence of cagA and vacA among Helicobacter pylori-infected patients in Iran: a systematic review and meta-analysis.

The varieties of infections caused by Helicobacter pylori may be due to differences in bacterial genotypes and virulence factors as well as environmental and host-related factors. This study aimed to investigate the prevalence of cagA and vacA genes among H. pylori-infected patients in Iran and analyze their relevance to the disease status between two clinical groups via a meta-analysis method. Different databases including PubMed, ISI, Scopus, SID, Magiran, Science Direct, and Medlib were investigated, and 23 relevant articles from the period between 2001 and 2012 were finally analyzed. The relevant data obtained from these papers were analyzed by a random-effects model. Data were analyzed using R software and STATA. The prevalence of cagA and vacA genes among H. pylori-infected patients was 70% (95% CI, 64-75) and 41% (95% CI, 24.3-57.7), respectively. The prevalence of duodenal ulcers, peptic ulcers, and gastritis among cagA+ individuals was 53% (95% CI, 20-86), 65% (95% CI, 34-97), and 71% (95% CI, 59-84), respectively. Odds ratio (OR) between cagA-positive compared with cagA-negative patients showed a 1.89 (95% CI, 1.38-2.57) risk of ulcers. In conclusion, the frequency of cagA gene among H. pylori strains is elevated in Iran and it seems to be more frequently associated with gastritis. Therefore, any information about cagA and vacA prevalence among different H. pylori-infected clinical groups in the country can help public health authorities to plan preventive policies to reduce the prevalence of diseases associated with H. pylori infection.

La prescription hors AMM en gynécologie-obstétrique : du pragmatisme médico-économique au potentiel risque médico-légal

The scandal of the Mediator® case led the legislature to take measures in order to regulate off-label drugs prescriptions. Indeed the law issued in December 29th, 2011 on strengthening the safety of drugs and all derivative health products came to pave the way for an “over-cautious” practice of medicine in line with the precautionary principle erected as a constitutional principle. The supervision of off-label prescribing has had a direct impact on the exercise of the medical profession and has resurrected the issues related to the freedom of prescription, the obligation to provide information to patients and in general their whole responsibility. It is important to mention that the prescribing act is part of the freedom and the strict prerogative of those skilled in the art: the physician in this case. The off-label prescription is commonly accepted in certain specialties, such as anesthesia and intensive care, oncology or pediatrics where it is even subject of a memorandum of use because of concerns regarding the availability of forms adapted to children. However, the physician must ensure that no appropriate therapeutic alternative is available and inform the patient, fundamental principle of the right to respect for the will of the person. Off-label use of the prostaglandin-E1 analogue misoprostol in obstetrics and gynecology is a good example. In fact, this drug obtained a marketing authorization for the treatment or prevention of peptic ulcers and other stomach disorders, is commonly used off-label when inducing labour or intrauterine device insertion. These are the issues that need to be clarify and carefully assessed in order to help physicians to understand the impact of the law and the state of the jurisprudence on the exercise of their profession.

A multicenter prospective study on the prevalence of Helicobacter pylori-negative and nonsteroidal anti-inflammatory drugs-negative idiopathic peptic ulcers in Japan.

The prevalence of Helicobacter pylori-negative and nonsteroidal anti-inflammatory drug-negative peptic ulcers, commonly known as idiopathic peptic ulcers (IPUs), has been reported to be very low (0.9-2.6%) in Japan based on data from the 1990s. However, recent trends have yet to be been reported. Herein, we present a multicenter prospective analysis between 2012 and 2013 investigating current trends in the prevalence and characteristics of IPUs in Japan. Clinical data of all peptic ulcer subjects detected via endoscopy at four participating hospitals were prospectively collected between April 2012 and March 2013. Enrolled subjects were classified according to H. pylori infection status and intake of nonsteroidal anti-inflammatory drugs. Multiple logistic regression analyses were used to determine the risk factors for IPUs. Of 382 enrolled patients with peptic ulcers, 46 (12%) were judged to have IPUs. Compared with those with simple H. pylori-positive ulcers, patients with IPUs were significantly older (P < 0.02) and more often had underlying comorbidities such as hypertension (P < 0.02) and hyperlipidemia (P < 0.05). Multivariate regression analysis indicated that the presence of multiple underlying diseases was the only significant risk factor for IPUs, with an odds ratio of 3.8 (95% confidence interval, 1.3-11.1). This study revealed that the prevalence of IPUs in patients with peptic ulcers in Japan is 12%, much higher than previously reported. Presence of multiple underlying comorbid diseases, rather than aging itself, is an important risk factor for IPUs.

Changing prevalence of Helicobacter pylori infection and peptic ulcer among dyspeptic Sardinian patients.

Over the past 50 years, the prevalence of Helicobacter pylori infection has fallen as standards of living improved. The changes in the prevalence of infection and its manifestations (peptic ulcer disease and gastric mucosal lesions) were investigated in a large cohort of Sardinians undergoing upper endoscopy for dyspepsia. A retrospective observational study was conducted involving patients undergoing endoscopy for dyspepsia from 1995 to 2013. H. pylori status was assessed by histology plus the rapid urease test or 13C-UBT. Gastric mucosal lesions were evaluated histologically. Data including non-steroidal anti-inflammatory drugs (NSAIDs) use and the presence of peptic ulcers were collected. The prevalence of H. pylori was calculated for each quartile and for each birth cohort from 1910 to 2000. 11,202 records were retrieved for the analysis (62.9% women). The overall prevalence of H. pylori infection was 43.8% (M: 46.6% vs. F: 42.0%; P = 0.0001). A dramatic decrease in the prevalence of infection occurred over the 19-year observation period. The birth cohort effect was evident in each category (quartile) reflecting the continuous decline in H. pylori acquisition. Over time, the prevalence of peptic ulcers also declined, resulting in an increase in the proportion of H. pylori negative/NSAID positive and H. pylori negative/NSAID negative peptic ulcers. The prevalence of gastric mucosal changes also declined despite aging. The decline in H. pylori prevalence over time likely reflects the improvement in socioeconomic conditions in Sardinia such that H. pylori infection and its clinical outcomes including peptic ulcer are becoming less frequent even among dyspeptic patients.

Optimization of composition and technology for tablets containing aspen bark extract

Summary. Influence of quantitativefactorsof basic quality parameters has been investigated for tabletscontainingextractofaspenbark, receivedbydirect pressingmethodand mathematicalplanningof experiment.To set the optimal composition of tablets containingaspen bark extract the proportion ofProsolv 90, Ludiflash and Polyplasdone XL 10 has been studied. The relationship between the studied factors and parameters of tablets’ regression models has been described. As a result tablets containing aspen bark extractwith mentioned above formula match necessary pharmaco-technological parameters of State Pharmacopoeia of Ukraine.Introduction.Peptic and duodenal ulcer are serious problems in modern medicine. According to statistics this disease is found in 12,83 % of the adult population in Ukraine [1]. Among the remedies for treatment and prevention of peptic ulcers we can find herbal medicines that may be used in the treatment of pre-peptic conditions and during an acute period as a means of adjuvant therapy in combination with strong remedies [2]. An antacid, cytoprotective, anti-inflammatory and reparative actions of aspen bark extract were proved by the researches of domestic and foreign scientists [3, 4].Previously, we researched the mutual influence of excipients on the main indicators of quality of aspen bark extract tablets obtained by direct compression method. Due to these researches the best excipientshave been selected. It is necessary to establish the optimal quantitative proportion of excipients in order to obtain the tablets with suitable parameters that satisfy the requirements of the State Pharmacopoeia of Ukraine (SPU) [5, 6].Rational selection of excipients requires wide range of studies to obtain the optimal composition of the tablets containing aspen bark extract. Using mathematical planning of the experiment gives the possibility to reduce the number of experiments and to obtain the most detailed results of researches about effects of excipients on the basic parameters of tablet quality.The aim of investigation.In the previous stages of the experiment, we studied the effect of quantitative factors on pharmaco-technological parameters of tablets. To further study were selected Prosolv 90, Ludiflash and Polyplasdone XL 10.The aim of investigation was to set and study the proportion of excipients selected for developing optimal formula of tablets containing aspen bark extract.Materials and methods.The tablets based on aspen bark extract, obtained by direct compression method, have beenselected as research object. In the development of technology and tablet form,dry aspen bark extract, obtained by the Department of Pharmacognosyof the National University of Pharmacy,has been used [7]. The dry aspen bark extract is hygroscopic fine powder with particles of anizodiametric shape.Namely, from the group of samples of microcrystalline cellulose (MCC) – Prosolv 90 (Silicified MCC, manufactured by JRS Pharma GMBH &amp; Co KG., Germany), from the group structure-based substances sugars – Ludiflash (combination of mannitolCrospovidone, Povidone and polyvinyl acetate, manufactured by BASF Corp., USA) and from the group of disintegrants – Polyplasdone XL 10 (homopolymer of vinyl pyrrolidone, manufactured by manufactured by Ashland Inc., USA). At establishment of optimal composition of the tablets based on aspen bark extract three excipientsinfluence, and also their correlation in composition of tabletshas been studied [8].Results and discussion.The optimal formula of selected excipients has been set and their proportions in tablet dosage form at the shorter intervals have beendetermined. The study of each researched factor has been carried out according to 5 levels. As a result of studies we found the optimal number of excipients for tablet formula: Prosolv 90 – 0,054 g, Ludiflash – 0,03 g, Polyplasdone XL 10 – 0,025 g, MCC 102 – 0,0835 g, magnesium stearate – 0,0025 g in one unit of dose medication. As a result tablets of aspen bark extract with mentioned above formula have necessary pharmaco-technological parameters that meet the requirements of SPU: resistance to crushing – 130 H, abrasion – 0,04 % mass uniformity of tablets – ± 2,85%, disintegration – 6 min [9].ConclusionsDue to mathematical planning the quantitative impact of significant excipients on pharmaco-technological parameters of tablets based on aspen bark extract: Prosolv 90, LudiflashтаPolyplasdone XLhave been studied.Due to the regression analysis optimal composition of tablets based on aspen bark extract : dry aspen bark extract – 0,05 g, Prosolv 90 – 0,054 g, Ludiflash – 0,03 g, Polyplasdone XL 10 – 0,025 g, MCC 102 – 0,0835 g,Neusilin US 2 – 0,0025 g, talc –0,0025 g, magnesium stearate – 0,0025 ghas been determined. As a result tablets of aspen bark extract with mentioned above formula have necessary pharmaco-technological parameters that meet the requirements of SPU.

Peptic ulcer frequency differences related to h. Pylori or aines.

Peptic ulcer etiology has been changing because of H. pylori decline. To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer.

Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.