Prevention Of Peptic Ulcer Disease Research Articles

PREVALENCE AND ASSOCIATED FACTORS OF PEPTIC ULCER DISEASE AMONG DYSPEPTIC PATIENTS AT ENDOSCOPY UNIT IN KABUL, AFGHANISTAN

Introduction: Dyspepsia is a medical term utilized to describe a cluster of symptoms related to the digestive system, particularly in the upper gastrointestinal tract. The most prevalent causes of dyspepsia encompass gastro esophageal reflux disease (GERD), peptic ulcer disease (PUD), and non-ulcer dyspepsia (NUD). A peptic ulcer is a sore or erosion that forms in the lining of the stomach, upper part of the small intestine, or lower part esophagus.
 Materials and Methods: The study incorporated 500 dyspeptic patients who underwent upper gastrointestinal endoscopic assessments. This hospital-based analytical cross-sectional study was conducted at the endoscopy unit of different hospitals, spanning from January 1, 2023, to September 30, 2023.
 Results: The findings revealed that out of 500 dyspeptic patients, 45 (9%) exhibited positive results for peptic ulcer, while 455 (91%) displayed non-peptic ulcer conditions. The correlation between dyspepsia and peptic ulcer was statistically significant (χ2= 73, P= 0.01). Gender-specific prevalence indicated that 17 (37.7%) males and 28 (62.2%) females exhibited peptic ulcers. When stratified by age, the prevalence was 20 (44.4%) for individuals aged 18-40, 10 (22.2%) for those aged 41-52, and 15 (33.3%) for those above 52 years. Notably, significant differences were observed among age groups (χ2= 85, P= 0.04). Peptic ulcer prevalence was 16 (35.55%) for urban residents and 29 (64.44%) for rural residents. In the context of smoking habits, 30 (66.6%) of smokers exhibited peptic ulcers, compared to 15 (33.3%) of non-smokers. The association between smoking and peptic ulcers was statistically significant (χ2= 101, P= 0.02). Additionally, 28 (62.2%) of individuals with H. pylori infections displayed peptic ulcers, in contrast to 17(37.7%) without the infection. The association between H. pylori infection and peptic ulcers was statistically significant (χ2= 85, P= 0.05). Regarding NSAID use, 29 (64.4%) of participants who used NSAIDs and 16 (35.5%) who did not use NSAIDs showed peptic ulcer prevalence. The highest prevalence was among individuals using NSAIDs for pain relief. The association between NSAID use and peptic ulcers was statistically significant (χ2= 100, P= 0.05).
 Discussion: These results highlight the significance of addressing these risk factors in the management and prevention of peptic ulcer disease.

PDE5 inhibitors and gastric mucosa: implications for the management of peptic ulcer disease.

Peptic ulcer disease (PUD) continues to be a cause of significant morbidity and mortality worldwide. Almost two-thirds of PUD cases are asymptomatic. In symptomatic patients, epigastric pain is the most common presenting symptom of PUD, which is manifested by nausea, abdominal fullness, bloating, and dyspepsia. Most PUD cases are associated with the use of COX inhibitors or Helicobacter pylori infection, or both. The traditional management of PUD includes the use of proton pump inhibitors to reduce the gastric acid secretion and antibacterial drugs to combat H. pylori. Timely diagnosis and treatment of PUD are vital to reduce the risk of associated morbidity and mortality, as is prevention of PUD among patients at high risk, including COX inhibitors users and those infected with H. pylori. PDE5 inhibitors have been used for the management of erectile dysfunction and pulmonary hypertension for decades. In recent years, studies have mentioned tremendous pleiotropic effects of PDE5 inhibitors on gastrointestinal, urogenital, musculoskeletal, reproductive, cutaneous, and neurologic disorders. Recent data shows that PDE5 inhibition augments gastric mucosa protection, and here, we review the most recent findings regarding the use of PDE5 inhibitors for the prevention and management of PUD.

Evaluating reporting of patient-reported outcomes in peptic ulcer disease: a meta-epidemiological study of randomized controlled trials

ABSTRACT Objectives Peptic ulcer disease (PUD) can significantly affect quality of life (QoL). These QoL outcomes are often patient-reported, and their inclusion in clinical trials supplements efficacy outcomes to provide the patients’ perspective. This assese existing literature for completeness of PRO reporting across randomized controlled trials (RCTs) evaluating PUD. Methods This meta-epidemiological, cross-sectional study that assessed completeness of reporting among RCTs addressing management of PUD. We conducted a comprehensive literature search] to identify RCTs with a PRO as a primary or secondary outcome. These RCTs were assessed for completion of reporting according to the PRO adaptation of CONSORT checklist. RCTs were also assessed for Risk of Bias (RoB) using the Cochrane RoB 2.0 tool. Results Masked, duplicate screening of 829 results = yielded a final sample of 35 RCTs. The average completeness of reporting was 32.9% according to the CONSORT-PRO adaptation. Twenty-one (of 35; 60%) of the RCTs were assessed as having ‘high’ risk of bias and nine (of 35; 25.71%) were assessed as having ‘some concerns’ for risk of bias. Bivariate regression found completeness of reporting to be positively associated with increased PRO follow-up duration, sample size, and studies with conflicts of interest. Conclusion RCTs examining the treatment and prevention of PUD with PROs as an outcome measure have deficient reporting and ‘high’ risk of bias according to the CONSORT-PRO and Cochrane RoB guidelines.

Proton pump inhibitors are still overprescribed for hospitalized children

ObjectiveThe use of proton pump inhibitors has increased exponentially over the past 20 years. Several side effects have been reported and concerns exist about the consequences of long-term proton pump inhibitors on health, leading to limitation of their use. The present study analyzed prescriptions of proton pump inhibitors at inpatient units and assessed their compliance with current recommendations. MethodsThis single-center, observational, retrospective study reviewed medical file of patients hospitalized at the pediatric medical departments of the Bordeaux University Hospital between April 1 and September 30, 2019. Patients younger than 18 years, hospitalized in the pediatric hospital units and treated with proton pump inhibitors were included. Prescriptions of proton pump inhibitors were compared with French and international guidelines. ResultsProton pump inhibitors were prescribed for 251 of 2237 children (11%), mainly for gastroesophageal reflux disease (47%) and prevention of peptic ulcer disease (32.7%). Proton pump inhibitor prescription complied to recommendations in 34.5% of cases, less often in children aged younger than 1 year (13.5%) than in older children. Compliance to recommendations was lower when proton pump inhibitors were indicated for the prevention of peptic disease (5%) than for gastroesophageal reflux disease (48%). ConclusionsProton pump inhibitors are frequently prescribed for hospitalized children, and indications comply with recommendations in only 35% of the cases. Efforts in spreading awareness of the recommendations on the use of proton pump inhibitors in children are mandatory among hospital pediatricians.

Awareness of the General Population about the Causes, Management and Prevention of Peptic Ulcer Disease in Arar City, Northern Saudi Arabia

Background: Gastro-dudenal ulcere is a global problem with a lifetime risk of development ranging from 5% to 10%.
 Objective: This study aims to determine the public awareness in Arar, Saudi Arabia, regarding the causes, management and prevention of gastro duodenal ulcer.
 Methods: A cross-sectional study was conducted in Arar city, Saudi Arabia in the period of 1 September to 30 October 2021 among the general population of Arar, Saudi Arabia.
 Conclusion: Almost half of the participants had knowledge about gastric or duodenal ulcers and most of them know the risk factors and possible complications. There is non-significant relationship between gastro-duodenal ulcers awareness and age, gender and educational level while a significant relationship was found between level of awareness and social status, functional status and the average monthly income of the participants.

Underutilization of Peptic Ulcer Disease Prophylaxis Among Elderly Users of Antiplatelets and Anticoagulants.

Peptic ulcer disease (PUD) develops in approximately 25% of chronic users of non-steroidal anti-inflammatory drugs (NSAIDs). The incidence of uncomplicated PUD has been declining over the past 3 decades unlike that of complicated PUD in the elderly. An expert consensus document published jointly in 2008 by the American College of Gastroenterology (ACG), the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA) provided recommendations on prevention of PUD among users of antiplatelets and anticoagulants. This work aimed to evaluate physicians' compliance with these guidelines in a tertiary academic setting. We examined our medical record database for the 9month period extending from April 2018 until December 2018. Using this database, we identified elderly patients (> 64years old) who were chronic (> 3months) users of low dose aspirin (81mg once daily) and had an indication for PUD prophylaxis as per the ACG-ACCF-AHA guideline document. We performed a retrospective chart review of patients included in this study. Descriptive statistics were compared using χ2 and independent sample t tests. A total of 852 patients were included in this study. The mean age was 75years old, and 43% of patients were females. In addition to aspirin, patients were prescribed P2Y12 inhibitors (45.5%), direct oral anticoagulants (DOACs) (23%), warfarin (12%), steroids (9%) or enoxaparin (1%). Users of DOACs were most commonly prescribed apixaban (16%), followed by rivaroxaban (6%) and dabigatran (1%). Overall, only 40% of patients with an indication for PUD prophylaxis received a proton pump inhibitor. PUD prophylaxis may be underutilized in elderly patients. This finding, along with increasing rates of NSAID use and an aging population, may help explain the increased incidence of complicated PUD in the elderly. Efforts are needed to raise physician awareness of PUD prophylaxis guidelines.

Influence of proton pump inhibitor or rebamipide use on gut microbiota of rheumatoid arthritis patients

Abstract Objective Patients with rheumatoid arthritis (RA) commonly use gastrointestinal (GI) protective drugs for treatment and prevention of peptic ulcer disease. However, how these drugs affect gut microbiota is unknown in RA patients. The objective of this study was to examine the gut microbiota of RA patients according to their use of GI protective drugs, such as proton pump inhibitors (PPIs), H2-receptor antagonists, and rebamipide. Methods Fecal samples were obtained from 15 healthy controls (HCs) and 32 RA patients who were receiving PPI, H2-receptor antagonist, or rebamipide. Bacterial DNA was extracted from the fecal samples and 16S rRNA sequencing was performed. Microbial composition and function were analyzed using QIIME and PICRUSt. Results RA patients showed reduced diversity and altered composition of the gut microbiota compared with HCs. Gut microbiota of RA patients receiving acid-suppressing drugs, particularly PPI, was distinct from that of RA patients receiving rebamipide (PPI versus rebamipide, p=0.005). Streptococcus was enriched in RA patients receiving PPI, whereas Clostridium bolteae was enriched in RA patients receiving rebamipide. Gut microbiota of PPI-users was highly expressing the microbial functional pathway involved in virulence factors production. This featured microbial function was positively correlated with the relative abundance of Streptococcus, the differentially abundant taxa of PPI-users. Conclusions Gut microbiota of RA patients receiving PPI was distinguished from those receiving rebamipide. Enriched virulent function in gut microbiota of PPI-users suggests that PPIs should not be overprescribed in RA patients.

Prevalence, indication and duration of proton pump inhibitor use in patients from unselected admissions

Proton pump inhibitors (PPIs) are inhibitors of gastric acid secretion and are among the most commonly prescribed drugs worldwide. Although they are effective for treatment and prevention of peptic ulcer disease and eradication of Helicobacter pylori , there is growing evidence of adverse effects

Prescription of prophylactic proton pump inhibitors at hospital discharge

BackgroundProton pump inhibitors (PPIs) are used in the treatment of conditions such as dyspepsia, gastro-oesophageal reflux disease and Zollinger-Ellison syndrome. They are also used in the prevention of peptic ulcer...

Stability study of famotidine effervescent tablets prepared by a separated granulation technique

Famotidine is a highly selective H2-​receptor antagonist widely used in the treatment and prevention of peptic ulcer disease. Famotidine effervescent tablets (ET) with acceptable taste and phys. properties and rapid disintegration time were prepd. by wet granulation using peppermint, tutti frutti or caramel as flavoring agents. Aiming for the prodn. of more stable ET; the formula contg. tutti frutti, which has the most acceptable taste, was chosen to prep. ET utilizing a modified wet granulation technique. This involves the prodn. of two sepd. granulations; one contg. the acidic ingredients with the drug, and the other contg. the basic ones. The stability of the two prepd. formulations, at room temp. (25°)​, were also studied by storing each formula inside three different packaging systems. The first inside a plastic bottle alone, the second were wrapped in aluminum foil while in the third one, the bottle included a desiccant. The decrease in the disintegration time values upon aging was detected as a parameter for the ET stability. The stability study revealed that; tablets prepd. by sepd. granulation showed a pronounced enhancement of stability without significant difference between each of the three packaging systems. Whereas, tablets stored in plastic bottles after wrapping in aluminum foil including a desiccant showed the best stability results for total granulation technique. This indicates fewer requirements of special packaging for tablets prepd. by the promising sepd. granulation method.

Clinical Pharmacokinetics of Famotidine

Famotidine is a potent histamine H2-receptor antagonist widely used in the treatment and prevention of peptic ulcer disease. After intravenous administration the plasma famotidine concentration-time profile exhibits a biexponential decay, with a distribution half-life of about 0.18 to 0.5h and an elimination half-life of about 2 to 4h. The volume of distribution of the drug at steady-state ranges from 1.0 to 1.3 L/kg; plasma protein binding is low (15 to 22%). Famotidine is 70% eliminated unchanged into urine after intravenous administration. The total body and renal clearances of famotidine correlate significantly with creatinine clearance. Because its renal clearance (15 L/h) far exceeds the glomerular filtration rate, famotidine is considered to be eliminated not only via glomerular filtration but also via renal tubular secretion. Since its clearance is reduced in patients with renal insufficiency and in elderly patients, the maintenance dosage should be reduced in these patient groups. Removal of famotidine by any of the currently employed blood purification procedures (haemodialysis, peritoneal dialysis and haemofiltration) does not occur to a clinically significant degree. Liver cirrhosis does not appear to affect the disposition of famotidine unless severe renal insufficiency coexists. After oral administration, peak plasma concentrations are attained within 2 to 4h; the oral bioavailability ranges from 40 to 50%, due mainly to incomplete absorption. The oral absorption of the drug is dose-independent within a range of 5 to 40 mg. There are 3 formulations available (tablet, capsule and suspension), which appear to be bioequivalent. Coadministration of potent antacids reduces the oral absorption of famotidine by 20 to 30%. On a weight-to-weight basis, the antisecretory effect of famotidine is about 20 and 7.5 times more potent than those of cimetidine and ranitidine, respectively. Plasma famotidine concentrations correlate with its antisecretory effect: values of about 13 and 20 micrograms/L produce a 50% reduction in the gastrin-stimulated gastric acid secretion and a fasting intragastric pH of greater than 4, respectively. Available data suggest that famotidine interacts neither with the hepatic oxidative drug metabolism nor with the tubular secretion of other commonly used therapeutic agents. However, further studies are required to evaluate a full spectrum of its drug interaction potential.

Medical treatment and prevention of peptic ulcer disease

Many agents seem to be equally effective for the treatment of peptic ulcer disease. This is true despite the drugs' varied mechanisms of action, and this observation has caused investigators to shift their focus from aggressive to defensive factors when studying ulcer pathogenesis. Patients with a healed ulcer are always at risk for recurrence, and guidelines are available for management of these patients. Ulcer prevention becomes a crucial issue in intensive care units where critically ill patients have many known risk factors. Maintaining a gastric pH above 4.0 appears to reduce the morbidity and mortality associated with such stress-induced ulcers. Use of nonsteroidal anti-inflammatory drugs increases ulcer risk and complications in the elderly, in women with rheumatoid arthritis, and in smokers and abusers of alcohol. Prophylaxis with the synthetic prostaglandin analogue misoprostol (Cytotec) appears to reduce this risk.

Antisecretory and antigastrin effects of rioprostil in gastric fistula dogs.

This investigation examined the effect of rioprostil, a primary alcohol prostaglandin E1 analog, on betazole-stimulated gastric acid secretion and on basal and food-stimulated (postprandial) serum gastrin levels in gastric fistula dogs. Rioprostil inhibited betazole-stimulated gastric acid secretion with an ED50 of 16 (10-24) micrograms/kg, intragastrically. A near-maximal gastric antisecretory dose (100 micrograms/kg, intragastrically) had no effect on basal serum gastrin levels but significantly attenuated the rapid rise in serum gastrin which follows feeding, a result different from that reported for other prostaglandin E1 analogs. A nonantisecretory dose of rioprostil (1.0 micrograms/kg, intragastrically) also attenuated the rise in postprandial serum gastrin. An antigastrin effect using a nonantisecretory dose of an antiulcer agent has not been reported previously and may indicate that rioprostil has a direct inhibitory effect on secretion of gastrin. The ability of rioprostil to inhibit gastric acid secretion and decrease postprandial peak serum gastrin levels, coupled with previously established cytoprotective efficacy, makes it an attractive clinical candidate for the treatment and prevention of peptic ulcer disease.

Milk-Alkali Syndrome in Patients Treated With Calcium Carbonate After Cardiac Transplantation

Heart and heart-lung transplant recipients at Stanford (Calif) University Medical Center were routinely prescribed long-term calcium carbonate antacid therapy to aid in the prevention of peptic ulcer disease and osteoporosis associated with glucocorticoid immunosuppressive therapy. Patients consumed 4 to more than 10 g/d of elemental calcium. Since calcium carbonate also provides the essential ingredients for the development of the milk-alkali syndrome, the laboratory flow sheets of 297 heart and heart-lung transplant recipients were reviewed to examine the incidence of hypercalcemia. Sixty-five patients developed significant hypercalcemia after transplantation. Thirty-one patients were alkalotic at the time of hypercalcemia; 37 had impairment in renal function. It is likely that most of these patients had the milk-alkali syndrome. While most patients became eucalcemic by discontinuing calcium carbonate therapy, intravenous hydration and forced diuresis were used to treat severe cases. It is possible that the incidence of the milk-alkali syndrome will increase with the current popularity of prescribing calcium carbonate for the prevention and treatment of osteoporosis.

Milk-alkali syndrome in patients treated with calcium carbonate after cardiac transplantation

• Heart and heart-lung transplant recipients at Stanford (Calif) University Medical Center were routinely prescribed long-term calcium carbonate antacid therapy to aid in the prevention of peptic ulcer disease and osteoporosis associated with glucocorticoid immunosuppressive therapy. Patients consumed 4 to more than 10 g/d of elemental calcium. Since calcium carbonate also provides the essential ingredients for the development of the milk-alkali syndrome, the laboratory flow sheets of 297 heart and heart-lung transplant recipients were reviewed to examine the incidence of hypercalcemia. Sixty-five patients developed significant hypercalcemia after transplantation. Thirty-one patients were alkalotic at the time of hypercalcemia; 37 had impairment in renal function. It is likely that most of these patients had the milk-alkali syndrome. While most patients became eucalcemic by discontinuing calcium carbonate therapy, intravenous hydration and forced diuresis were used to treat severe cases. It is possible that the incidence of the milk-alkali syndrome will increase with the current popularity of prescribing calcium carbonate for the prevention and treatment of osteoporosis. (<i>Arch Intern Med</i>1986;146:1965-1968)