Recurrent Peptic Ulcer Disease Research Articles

PREVALENCE AND CAUSES OF RECURRENT PEPTIC ULCER

Background:Peptic ulcer disease (PUD) is a common disease of the gastrointestinal tract characterized by mucosal damage due to the secretion of pepsin and gastric acid. The current study aimed to determine the prevalence and causes of recurrent peptic ulcer. Methods:The current study adopted an exploratory study design in order to determine the prevalence and causes for recurrent peptic ulcer disease in individuals and predict an outcome. The participants for the current study were individuals belonging to the age group 18-75. This age group is chosen as the major influence of peptic ulcer disease is observed within this group.For the current study, questionnaire was adopted for data collection, which was also categorized as a study tool. Results:Study included 589 participants. It is noticed that most of participants (n= 530, 90.1%) strongly agree that they visit the doctor periodically to check on their health. Previous item has the highest rank followed by participants follow smoking lifestyle (n= 526, 89.4%). On the other hand, the least rank item on which participants strongly disagreed was participants suffered from soreness or bleeding from their stomach (n= 249, 42.4%). This gives a prevalence of 42.4% of peptic ulcer disease among study participants. Conclusion:Peptic ulcer illness burdens health care systems, which urge for adequate treatment to limit recurrence and effects. H. pylori, smoking, and aspirin usage are risk factors for 5-year peptic ulcer recurrence. Long-term PUD hazards include smoking and aspirin. Avoiding risk factors reduced the recurrence rate of H. pylori eradication, acid suppression medication, and surgery. This shows how eliminating risk factors may enhance long-term performance. Proper PUD treatment requires multicenter research to prevent recurrence and repercussions.

The Occurrence of a Thyroid Storm in a Patient with Recurrent Refractory Peptic Ulcer: A Case Report

A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.

Risk Factors for Recurrence of Peptic Ulcer Disease: A Retrospective Study in Tertiary Care Referral Center

BackgroundsPeptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. This study evaluated the five-year recurrence rate for patients with PUD and risk factors contributing to PUD relapses.MethodsFrom 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroids were analyzed by multivariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.ResultsAmong 223 patients, there were 187 (83.8%) diagnosed with endoscopy-proved PUD and 36 (16.2%) diagnosed with clinical PUD. Among them, 126 (56.5%) patients were males, and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroids and NSAID and Helicobacter pylori (H. pylori) infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05).ConclusionOur findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroids and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

Особливості проведення фізичної реабілітації при часто рецидивуючому типу перебігу виразкової хвороби

The article deals with the results of single-stage and multi-stage rehabilitation treatment of patients with often recurrent peptic ulcer disease. The aim of the investigation: to study and improve a comprehensive physical rehabilitation program for people who are actively involved in sports with recurrent peptic ulcer disease of the stomach and duodenum. Material and methods. The study involved 42 patients with peptic ulcer of the stomach and duodenum with often recurrent type (age 18–28). The results of the study: The first experimental group was recommended treatment at all stages of rehabilitation (inpatient, outpatient and sanatorium). During 9 months, each patient received treatment in a hospital (day hospital), clinic and sanatorium. The second control group underwent rehabilitation measures only at the inpatient or outpatient stage. Diet therapy, phytotherapy, medical physical training, physiotherapy were used at all stages of rehabilitation treatment.The effectiveness of treatment and rehabilitation was assessed by the following indicators: the dynamics of subjective and objective manifestations of the disease, the condition of the mucous membrane of the stomach and duodenum and the frequency of recurrences during the year. In the period between treatments, treatment methods were recommended to perform them at home (diet therapy, kinesitherapy, etc.). After rehabilitation and staged treatment, observation of patients lasted 12 months. Analysis of the disease course indicates that the prolonged treatment of peptic ulcer disease with the use of various rehabilitation measures in the inpatient, outpatient and sanatorium, reduced the number of exacerbations during the year and the number of hospitalizations compared to cases where patients underwent only one stage of rehabilitation.The greater efficiency of multi-stage treatment indicates the data obtained during the examination of the state of acid formation in the stomach. Conclusion: Rehabilitation should be carried out continuously, including all stages of rehabilitation and continue until maximum recovery is achieved.

A study on prevalence of smoking on peptic ulcer: a survey

Cigarette smoking appears to be a risk factor for the development, maintenance, and recurrence of peptic ulcer disease. Peptic ulcer is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in our digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Smoking has an inconsistent effect on gastric acid secretion, but it does have other effects on upper gastrointestinal function that could contribute to the pathogenesis of peptic ulcer disease. The purpose of the study was to assess the role of cigarette smoking in ulcer. An online prospective questionnaire based survey was carried out in 100 individuals who were selected in random and their responses were recorded and the results were analysed. The present study suggests that now, most ulcer perforations may arise among individuals (especially mens) aged above 25 are caused by smoking. We found a very strong association between current cigarette smoking and ulcer perforation from these survey

Calcium-phosphorus balance in comorbid peptic ulcer disease and arterial hypertension and its correction of calcium channel blockers

Recurrence of peptic ulcer disease, its comorbid with arterial hypertension is accompanied by calcium-phosphorus imbalance, contributing to the increase of acid-peptic factor, the changes of motor function of the stomach, regional microcirculation, activation of the ulcer process. The use of nifedipine in the therapy of comorbid peptic ulcer disease and arterial hypertension, contributes to the restoration of calcium-phosphorus balance, gastric functions and regional microcirculation, reduces the time and increases the frequency of scarring of ulcers.

The state and role of esophagus, stomach, intestinal microbiota in patients with ulcer disease, chronic gastritis, esophagitis.

The microflora of 64 biopsies taken during fibrogastroduodenoscopy of the mucous membrane of the esophagus, stomach and duodenum in healthy volunteers and 1120 samples obtained from the same parts of the digestive tract in patients with esophagitis, chronic gastritis and peptic ulcer disease were studied. The patients ranged in age from 18 to 62 years. Traditional bacteriological method was used to isolate and identify microorganisms. Staphylococcus spp., Streptococcus spp., Lactobacillus spp., Bacteroides spp., Stomatococcus spp., Enterobacteriaceae, Corynebacterium spp., Micrococcus spp., Neisseria spp., Veilonella spp. were isolated from biopsies of healthy respondents in an average amount from 3.2 to 4.68 lg CFU/g. H.pylori was found in 60% (5.66 lg CFU/g) in the esophagus, in 33.3% of cases (5.12 lg CFU/g) from the fundal part of the stomach, in 44.4% (5.25 lg CFU/g) from the antral part of the stomach, in 5.5% (4.2 lg CFU/g) in the duodenal mucosa. In samples obtained from the inflamed and eroded mucous membrane of the esophagus, stomach and duodenum, opportunistic bacteria of the genera Klebsiella, Enterobacter, Proteus, Pseudomonas, Peptococcus, Actinomyces, yeast fungi of the genus Candida etc. were detected in an amount exceeding 4 lg CFU/g. H. pylori isolated in 6.3-16.7% of patients (4.25-4.6 lg CFU/g) and did not dominate in relation to other microorganisms, and in most cases had a low frequency of its occurrence. In patients with the recurrence of peptic ulcer disease, exacerbation of chronic gastritis and esophagitis, dysbiosis was developed, characterized by an increase in the species and quantitative composition of opportunistic microflora, an increase in its enzymatic and cytotoxic activity, which can contribute to the maintenance of inflammatory and necrotic processes and inhibit the elimination of the pathological process.

Sleep duration, depression, and peptic ulcer recurrence in older patients with mild cognitive impairment.

To examine the longitudinal association between objective measure of sleep duration and subsequent recurrence of peptic ulcer disease (PUD) in older patients with mild cognitive impairment (MCI) and the potential influence of change in the severity of depression on this association. Older Chinese patients with MCI and Helicobacter pylori (H. pylori)-infected PUD (N = 2,208) were recruited from hospitals in the People's Republic of China between 2010 and 2014. H. pylori was eradicated and PUD cleared in 2,015 patients by the end of 2014; 1,866 of these were followed for up to 48 months. Sleep duration was measured using an accelerometer. The Kaplan-Meier method was used to assess how PUD recurrence in older patients, as confirmed with esophagogastroduodenoscopy, varied with the levels of sleep duration and change in depression. Multivariate Cox-proportional hazards models were calculated to examine the associations between sleep duration, depression, and PUD recurrence. The present results are based on no change, a decrease, or an increase in caregiver-assessed depressive symptoms. Multivariate analyses showed that short sleep duration was associated with PUD recurrence during the 48-month follow-up period (hazard ration [HR] = 2.685; 95% confidence interval [CI: 1.622, 4.538]). Sleep duration did not affect recurrence in patients without depression (HR = 1.325; 95% CI [.878, 1.998]) or with reduced depression (HR = 1.048; 95% CI [.695, 1.581]). However in patients with unchanged or increased depression, a higher risk of PUD recurrence was found in short sleepers (HR = 1.598; 95% CI [1.042, 2.451]; HR:HR = 2.668; 95% CI [1.720, 4.083], respectively) than in medium and long sleepers. Short sleep duration is associated with a greater risk of PUD recurrence, but decrease in depression or absence of depression may alter this relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of Social Isolation on Subsequent Peptic Ulcer Recurrence in Older Adults With Mild Cognitive Impairment: The Role of Change in Severity of Depression.

This study aimed to examine the association between social isolation, change in severity of depression, and subsequent recurrence of peptic ulcer disease (PUD) in older adults with mild cognitive impairment. Older adults (≥55 years) with mild cognitive impairment and Helicobacter pylori-infected PUD (N = 2208) were recruited between 2010 and 2014 from 12 hospitals in the People's Republic of China. H. pylori was eradicated and PUD was cleared in 2015 participants by the end of 2014; 1900 of these were followed up for up to 36 months. The Kaplan-Meier method was used to assess how PUD recurrence varied with social engagement levels and changes in depression severity. Multivariate Cox proportional hazard models were used to examine associations between social isolation, changes in depression severity, and PUD recurrence. PUD recurrence was more prevalent in socially isolated (10.8%) than in socially engaged participants (5.5%). However, the rates of PUD were lower in socially isolated individuals without (absence of) depression (7.2%) and those with decreased depression (8.2%), whereas socially isolated individuals with unchanged and increased depression had substantially higher rates of PUD (16.3% and 17.8%, respectively; the social isolation by depression group for PUD recurrence was significant (p < .001). Specifically, although social isolation was associated with PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 2.665 [1.602-4.518]), it did not increase PUD recurrence risk in participants without depression or with reduced depression. However, in participants with unchanged or increased depression, PUD recurrence was more likely to occur in socially isolated (HR = 1.587 [1.125-2.588]; HR = 1.886 [1.012, 3.522] respectively) than in socially engaged participants. Social isolation is associated with a greater risk of PUD recurrence; however, the absence of or decreased severity of depression may alter this relationship.

Risk of Recurrent Peptic Ulcer Disease in Patients Receiving Cumulative Defined Daily Dose of Nonsteroidal Anti-Inflammatory Drugs.

The purpose of this population-based case–control study was to clarify the impact of cumulative dosage of nonsteroidal anti-inflammatory drugs (NSAIDs) on recurrent peptic ulcers among chronic users after Helicobacter pylori (H. pylori) eradication. We analyzed data of 203,407 adult peptic ulcer disease (PUD) patients from the National Health Insurance Research Database in Taiwan entered between 1997 and 2013. After matching for age/gender frequencies and the length of follow-up time in a ratio of 1:1, the matched case–control groups comprised 1150 patients with recurrent PUD and 1150 patients without recurrent PUD within 3 years of follow-up. More recurrent PUDs occurred in NSAID users than in the control group (75.30% versus 69.74%; p = 0.0028). Independent risk factors for recurrent PUD included patients using NSAIDs (adjusted OR (aOR): 1.34, p = 0.0040), H. pylori eradication (aOR: 2.73; p < 0.0001), concomitant H2 receptor antagonist (aOR: 1.85; p < 0.0001) and anti-coagulant (aOR: 4.21; p = 0.0242) use. Importantly, in the initial subgroup analysis, the risk ratio of recurrent PUD did not increase in NSAID users after H. pylori eradication compared with that in non-users (p = 0.8490) but a higher risk for recurrent PUD with the increased doses of NSAIDs without H. pylori eradication therapy (aOR: 1.24, p = 0.0424; aOR: 1.47, p = 0.0074; and aOR: 1.64, p = 0.0152 in the groups of ≤28, 29–83, and ≥84 cumulative defined daily doses, respectively). The current study suggested that H. pylori eradication therapy could decrease the risk of recurrent PUD among patients with high cumulative doses of NSAIDs.

Association Between Depression and Recurrence of Peptic Ulcer Disease in Older Chinese Patients after Helicobacter Pylori Eradication: A Three-Year Study

Association Between Depression and Recurrence of Peptic Ulcer Disease in Older Chinese Patients after Helicobacter Pylori Eradication: A Three-Year Study

SUN-325 A Neuroendocrine Tumor with Liver Metastases in a patient with Acid Peptic Disease

Introduction: Gastrinomas are neoplasms that occur in 0.1% of patients with peptic ulcer disease (PUD). We present the case of a neuroendocrine tumor with liver metastasis in a woman with acid peptic disease. Clinical case: 46 yo F with 2 year diagnosis of gastroesophageal reflux disease (GERD) presents with epigastric pain and pyrosis, in addition to colicky right upper quadrant (RUQ) abdominal pain. Upper gastrointestinal endoscopy showed gastritis, multiple antral ulcers and erosive duodenitis. Positive rapid urease test prompted the start of a Helicobacter pylori eradication regimen. Due to continuing RUQ pain, an abdominal ultrasound (US) was ordered. It showed a lesion in the right lobe of the liver measuring 6.4 x 8.3 cm. The patient was referred for admission for further studies. At admission, the patient continued with symptoms of GERD. Laboratory testing showed: glucose: 87 mg/dl (n <100 mg/mL), creatinine: 0.5 mg/dl (n 0.4 - 1.1 mg/mL), total leucocytes: 7.3 x 109/L (n 4.0 -11.0 x 109/L), hemoglobin: 13.2 g/dL (n 12.3-15.3 g/dL), and no alterations on coagulation tests. Gastroscopy showed erythematous mucosa and three duodenal ulcers in scarring stage. A hormone evaluation showed: gastrin: 19,500 pg/ml (n 0-100 pg/mL), ACTH: 17pg/mL (n 5-27 pg/mL), cortisol: 21 µg/dL (n 7-28 µ/dL), GH: 0.3 ng/mL (n <10 ng/mL) , prolactin: 23 ng/mL (n 2-29 ng/mL), PTH: 64 pg/ml (n 10-65 pg/mL), calcium: 8.8 mg/dl (8.9-10.2 mg/dL), and phosphorus: 3.6 mg/dl (n 2.5-4.5 mg/dL). Liver biopsy revealed a neuroendocrine tumor (NET). Octreoscan corroborated the liver lesion, in addition to a lesion in the tail of the pancreas. The patient underwent extended right hepatectomy, distal pancreatectomy and splenectomy. Two lesions were identified in the pancreas, one of 2.4 x 1.6 cm and another one of 1.1 x 0.5 cm. A lesion measuring 13.2 x 8.7 cm and another one of 2.4 x 2 cm was found on the liver surgical sample. Immunohistochemical staining for gastrin and glucagon for the neuroendocrine metastatic tumor was positive. Conclusion: Approximately 25% of gastrinomas are associated with multiple endocrine neoplasia type 1; in this case, the gastrinoma appears to be sporadic. Gastrinomas occur more frequently in men (3:1), and it is diagnosed most frequently between the ages of 20 and 50. Zollinger-Ellison syndrome presents with recurrent PUD in over 90% of cases. The diagnosis is suspected because of clinical presentation, and gastrin levels, which are generally above 1000 pg/ml. Octreoscan is preferred due to its superior sensibility in comparison to other tests for tumor detection. Alternatively, MRI, spiral CT scan, and endoscopic US can be used. Metastases resection, when anatomically possible, is recommended for the treatment of liver metastasis, in addition to somatostatin analogs for symptoms management. Other treatment modalities are chemoembolization and systemic chemotherapy.

Effect of Subjective and Objective Sleep Quality on Subsequent Peptic Ulcer Recurrence in Older Adults.

To examine the effect of subjective and objective sleep quality on subsequent recurrence of peptic ulcer disease (PUD) among older patients after Helicobacter pylori eradication. Eight grade A hospitals in China. Of 1689 older Chinese with H. pylori-infected PUD recruited between January 2011 and October 2014, H. pylori were eradicated and PUD was cleared in 1538 patients by the end of 2014; 1420 of these patients were followed up for up to 36 months. Using multiple measures at 6-month intervals, PUD recurrence was determined with esophagogastroduodenoscopy. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and number of awakenings. This study documented a 36-month cumulative PUD recurrence of 8.3% (annual rate = 2.8%). Multivariate analyses showed that participants who reported poorer sleep quality were more likely to experience PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 1.895; 95% confidence interval [CI] = 1.008-3.327). Regarding objective sleep quality domains, longer sleep onset latency (HR = 1.558; 95% CI = 1.156-2.278) and more nighttime awakenings (HR = 1.697; 95% CI = 1.168-2.665) increased the risk of PUD recurrence. However, a longer total sleeping time protected against PUD recurrence (HR = 0.768; 95% CI = 0.699-0.885). Poor sleep quality predicts a greater risk of PUD recurrence. Accurate diagnosis and effective treatments should, therefore, be provided for older adults afflicted with poor sleep, particularly for those who previously had PUD. It is equally important to include sleep assessment as an integral part while dealing with these patients.

Refractory Peptic Ulcer Disease

The eradication of Helicobacter pylori and the widespread use of effective antisecretory therapies, including proton pump inhibitors, have improved the management of peptic ulcer disease. However, in some patients, peptic ulcer disease is refractory to 8 to 12 weeks of standard antisecretory drug treatment. For refractory peptic ulcer disease, further evaluation of the risk factors and causes of refractory peptic ulcer disease, including patient risk factors and noncompliance (smoking, nonsteroidal anti-inflammatory drug use, and noncompliance with medical treatment), persistent H. pylori infection, and non-H. pylori-related factors (giant ulcer, gastrinoma, infections other thanH. pylori, and malignancy), is essential. The treatment should focus on the cause of the refractory peptic ulcer disease, avoiding smoking and nonsteroidal anti-inflammatory drug, the treatment of persistent H. pylori, use of high-dose proton pump inhibitors, or surgical excision of gastrinomas. Surgery should be considered in patients who are at high risk for complications and recurrent peptic ulcer disease despite medical treatment. In this review, I describe the diagnosis and treatment of refractory peptic ulcer disease. Key words: Anti-inflammatory agents, non-steroidal; Helicobacter pylori; Peptic ulcer; Ulcer, refractory

Association between Poor Sleep Quality and Subsequent Peptic Ulcer Recurrence in Older Patients with Mild Cognitive Impairment: Examining the Role of Social Engagement

This study aims to examine whether perceived poor sleep quality predicts subsequent recurrence of peptic ulcer disease (PUD) in older patients with mild cognitive impairment following Helicobacter pylori eradication and to investigate whether social engagement status alters this association. Of 1,689 older patients with H. pylori-infected PUD recruited from eight Grade-A hospitals in the People’s Republic of China between 2011 and 2014, H. pylori was eradicated and PUD cleared in 1,538 patients by the end of 2014; 1,420 of these were followed for up to 36 months. The Kaplan–Meier method was used to compare the proportion of PUD recurrence, as confirmed with esophagogastroduodenoscopy, among older patients with different levels of sleep quality and social engagement statuses. Multivariate Cox-proportional hazards models were performed to examine the association between sleep quality and PUD recurrence, and the role of social engagement in altering this relationship. The results showed that PUD recurrence was more prevalent in poor (10.8%) compared with good sleepers (5.5%). However, increased and continued social engagement reduced the proportion to 7.2% and 8.2% among poor sleepers, respectively. Poor sleep quality was associated with subsequent PUD recurrence (hazard ratio [HR] 1.965 (1.002, 3.518)). However, no significant difference was observed between good and poor sleepers who reported increased (HR 1.428 (0.736, 2.380)) and continued (HR 1.273 (0.915, 2.492)) social engagement, suggesting that increased and continued social engagement prevented the effect of poor sleep quality on PUD recurrence. To conclude, poor sleep quality is associated with subsequent PUD recurrence. However, increased and continued social engagement may moderate this association.

Roar Strøm - the Norwegian surgeon who was three years ahead of Zollinger and Ellison.

In 1952, Norwegian surgeon Roar Strøm (1903-58) published the medical history of a 32-year-old man with recurrent peptic ulcer disease and a pancreatic tumour. Three years later, two American surgeons described a similar condition and, only the following year, the condition was named after them: Zollinger-Ellison syndrome. Strøm's contribution has gone remarkably unrecognised. This article aims to highlight his professional achievements. We searched archives and reference databases for information on Roar Strøm. Roar Strøm grew up in Oslo, where he graduated with a medical degree in 1926, at just 23 years of age. Strøm pursued a focused career in surgery: specialist in surgery in 1935, medical doctorate in 1942, and senior consultant in surgery at Rogaland Hospital in Stavanger over the period 1945-1956. While in Stavanger, he published the extensive case history in Acta Chirurgica Scandinavica. The patient had a multi-year medical history of peptic ulcers, for which he had undergone surgery twice previously before being operated on by Strøm in the spring of 1951. The man died two years after the last operation. Neither Strøm nor Zollinger and Ellison were the first to identify this clinical condition as a new disease entity. But Strøm's article was an important contribution to the early literature on the syndrome.

Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

BackgroundPresented here is a rare case of a gastroduodenal artery (GDA) replaced to the superior mesenteric artery with continuation into an accessory left hepatic artery. To the authors’ knowledge, this rare anomaly is not described previously. Replaced GDA is reported, however without continuation into an accessory LHA.Case presentationA 74-year-old male with recurrent peptic ulcer disease presented with acute onset melena. This anomaly was discovered during abdominal angiography performed for treatment of a hemorrhagic duodenal ulcer. Initial celiac and common hepatic artery (CHA) subselection and angiography demonstrated no branch vessels. Angiography via the superior mesenteric artery demonstrated free extravasation into the duodenum and distal perfusion of the left hepatic lobe.ConclusionsThis is a rare variant of hepatic arterial anatomy. Importantly, this variant challenges a previously described anatomical model that attempts to explain observed CHA variation.

Comorbid for gastroduodenal ulcers in the aspect of calcium imbalance and blockersof slow calcium channels in their treatment.

Find out the calcium content of the blood reflecting its balance and functional status the calcium regulatory system when it is comorbid for gastroduodenal ulcers (GDU), developed on the background of chronic erosive gastritis (CEG), chronic erosive duodenitis (CED), arterial hypertension (AH) and osteo-articular pathology with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and the impact of his changes on the activity ulzerogennogo process, the state of regional microcirculation and the functions of the stomach. To determine the pathogenetic justification for and effectiveness of blockers of slow calcium channels (BSCaC) in complex treatment. Examined 132 patients with GDU. All patients were divided into groups: the 1st (n=49) - patients with recurrent of peptic ulcer disease (PUD) and CEG/CED; the 2nd (n=23) - with recurrence of PUD and AH, the 3rd (n=14) - with GDU and osteoarticular pathology, taking NSAIDs. Patients of these three groups for the treatment of erosive ulcerous lesions of gastroduodenal zone (GDZ) has been appointed complex therapy with inclusion of nifedipine. The 4th (control) group consisted of 56 patients with recurrent BU without concomi- tant pathology, applying integrated therapy with nifedipine. The PU relapse, comorbid her over with erosive gastroduodenitis, hypertension, GDU with of osteoarticular pathology and taking NSAIDs is accompanied by a calcium imbalance with increased levels of calcium in the blood, contributing to increase of acid-peptic factor in the formation of hypermotor dyskinesia stomach, disruption of regional microcirculation and repair processes, activa- tion of ulcerogenesis in GDZ. Inclusion in the complex therapy of GDU of nifedipine leads to the recovery of calcium balance, functions of the stomach and regional mi- crocirculation, accelerates the timing and increases the percentage of scarring ulcers. GDU accompanied by dysfunction the calcium regulatory system with increasing levels of blood calcium, contributing to the for- mation of the major pathogenetic mechanisms of ulcerogenesis. BSCaC application in complex therapy of GDU is pathogenetically justified and clinically effective, reduces the excessive drug treatment in the treatment.

Is Oral Bacterial Flora with Dental Disease a Risk Factor for Recurrence of Peptic Ulcer Disease? A Retrospective Study on 644 Patients

Is Oral Bacterial Flora with Dental Disease a Risk Factor for Recurrence of Peptic Ulcer Disease? A Retrospective Study on 644 Patients

Pathogenetic bases and efficacy of slow calcium channel blockers in the therapy of recurrent peptic ulcer disease associated with hypertension

To clarify blood calcium concentrations (BCCs) as an indicator of the functional state of the calcium-regulating system in the concomitant course of recurrent peptic ulcer disease (PUD) and hypertension, by comparing with the severity of a ulcerous process, with changes in regional microcirculation, and with the functions of the stomach. To elucidate the pathogenetic justification for and clinical efficacy of slow calcium channel blockers (SCCBs) in the treatment of this comorbidity. In the case-control study, each patient with recurrent PUD and grade 1, Stage I hypertension (Group 1; n=23) corresponded to a recurrent PUD patient matched for sex, age, and ulcer site (Group 2, n=23). The complex of treatment for these patients included the SCCB nifedipine. A control group consisted of 56 recurrent PUD patients who received combination therapy without nifedipine. All the patients over time underwent clinical and endoscopic examinations and determinations of BCCs, indicators of gastric secretory and motor functions, and regional microcirculation in the gastroduodenal mucosal biopsy specimens. Recurrent PUD was present with a reliable BCC increase that was more substantial when it was associated with hypertension. Calcium imbalance was accompanied by changes in regional microcirculation and gastric secretory and motor functional indicators forming an acid peptic factor, as well as by hypermotor dyskinesia, which were more pronounced in patients with comorbidity. Incorporation of a SCCB into a complex of therapy for recurrent PUD to eliminate the pathogenic effect of blood calcium contributed to more rapid arrest of the clinical symptoms of a recurrence, to elimination of acute-phase microcirculatory disorders in the gastroduodenal zone, and to the recovery of gastric functional indicators. Elevated blood pressure was ruled out during the therapy of concomitant diseases. Incorporation of a SCCB into the combination therapy of recurrent PUD associated with hypertension is pathogenetically sound and clinically effective.