Recurrent Peptic Ulcer Research Articles

Ulcer Symptoms Concealing Primary Jejunal Follicular Lymphoma: A Case Report

<p>胃腸道淋巴瘤的臨床表現多樣且非特異，往往難以區分良性或惡性。內視鏡和放射學檢查的表現也不具特定性。在胃腸道，淋巴瘤是一種相對罕見的腫瘤，佔胃腸道惡性腫瘤的1%–8%，初發性胃、小腸和十二指腸淋巴瘤的比例約為10:3:1。濾泡性淋巴瘤主要發生在十二指腸，瀰漫性大B細胞淋巴瘤在胃和迴腸，黏膜相關淋巴組織淋巴瘤在胃，套細胞淋巴瘤在末端迴腸、空腸和結腸，而腸病相關T細胞淋巴瘤多在空腸。對於濾泡性淋巴瘤，觀察也是一種選擇，手術介入通常僅適於複雜的臨床狀況，如腸阻塞或穿孔。</p> <p>本篇病例報告一位74歲男性個案，十八年前出現反覆性上腹痛、腹部脹氣、打嗝、腹瀉，偶有便秘，多次上消化道內視鏡檢查診斷胃與十二指腸潰瘍，治療後症狀仍然存在。兩年後出現嘔吐，全套血液、生化、糞便檢驗皆無異常，上消化道內視鏡顯示多發性胃與十二指腸潰瘍，無幽門桿菌感染。腹部超音波顯示明顯胃擴張，電腦斷層檢查未發現腸阻塞或狹窄。小腸鏡顯示第三至第四部分十二指腸狹窄，組織切片為B細胞型態淋巴瘤。個案接受手術，術中發現在屈氏韌帶下方約5 cm處近端空腸有一4.8 cm × 3.0 cm × 1.3 cm環狀腫瘤併腸繫膜數顆腫大淋巴結，予以切除9.8 cm空腸與淋巴結並接受腸道吻合。病理診斷為第2級濾泡性淋巴瘤。術後接受化學治療及定期追蹤。至今已過十六年，病人情況良好。定期追蹤檢查並無復發。</p> <p>藉此病例報告提醒基層醫師面對反覆性消化性潰瘍時，必需將消化道淋巴瘤列入鑑別診斷。</p> <p> </p><p>It is challenging to distinguish benign gastrointestinal tumors from malignant ones due to their diverse and nonspecific symptoms, and endoscopic and radiological findings often lack specificity. Lymphoma is relatively uncommon in the gastrointestinal tract, constituting 1%-8% of malignant tumors with a primary tumor ratio of approximately 10:3:1 for the stomach, small intestine, and duodenum. Follicular lymphomas mainly occur in duodenum, diffuse large B-cell lymphomas in stomach and ileum, MALT lymphomas in stomach, mantle cell lymphomas in terminal ileum, jejunum, and colon, and enteropathy-associated T-cell lymphomas in jejunum. For the treatment of follicular lymphomas, observation remains a viable option, while surgical intervention is usually reserved for complicated clinical conditions, such as intestinal obstruction or perforation. </p> <p> This case report features a 74-year-old male with recurrent epigastric pain, abdominal distention, hiccups, diarrhea and occasional constipation since he was diagnosed with duodenal ulcers eighteen years ago. Repeated panendoscopic examinations showed gastric and duodenal ulcers. Symptoms persisted after treatment and were followed by vomiting two years later. Comprehensive blood, biochemical, and stool analyses revealed no abnormalities. Panendoscopic examination showed multiple ulcers in the stomach and duodenum without Helicobacter pylori infection. Abdominal ultrasound indicated significant gastric dilation, and computed tomography scan revealed neither intestinal obstruction nor stenosis. Small intestinal fiberscope found stenosis in the third to fourth portions of the duodenum, and tissue biopsy suggested B-cell lymphoma. Intraoperatively, a circumferential tumor measuring 4.8 cm × 3.0 cm × 1.3 cm was identified, located approximately 5 cm proximal to the Ligament of Treitz. It was accompanied by enlarged mesenteric lymph nodes. The excision of 9.8 cm of the jejunum, along with lymph node dissection, was followed by anastomosis. Surgical pathology confirmed grade II follicular lymphoma. Postoperatively, the patient receives chemotherapy and undergoes regular follow-up. The patient has remained in good medical condition over these sixteen years. Follow-up examinations did not show tumor recurrence. This case report aims to remind primary care physicians to consider gastrointestinal lymphoma early in the differential diagnosis of recurrent peptic ulcers.</p> <p> </p>

The gastroprotective effect of Yucca filamentosa standardized crude leaves extract versus its nano-cubosomal formulation in ethanol-induced gastric injury

Yucca filamentosa (YF) is widely used in folk medicine for its anti-inflammatory effects. Our study aimed to evaluate the chemical profile of YF extracts. Additionally, the gastroprotective efficacy of its crude leaf extract and nano-cubosomal formulation was assessed in a rat model of ethanol-induced gastric injury by altering the HMGB-1/RAGE/TLR4/NF-κB pathway.The phytochemical composition of YF was investigated using FTIR spectroscopy and LC-MS/MS techniques. Standardization was further accomplished using HPLC. Rats were treated orally with yucca crude extract or its nano-cubosomal formulation at doses of 25, 50, and 100 mg/kg. Famotidine (50 mg/kg, IP) was used as a reference drug. After 1 h, rats were administered ethanol (1 ml, 95 %, orally). One hour later, the rats were sacrificed, and the serum was separated to determine TNF-α and IL-6 levels. Stomachs were excised for the calculation of the ulcer index and histopathological examinations. Stomach tissue homogenate was used to determine MDA and catalase levels. Additionally, the expression levels of HMGB-1/RAGE/TLR4/NF-κB were assessed.Phytochemical analysis confirmed the predominance of steroidal saponins, sucrose, organic and phenolic acids, and kaempferol. The nano-cubosomal formulation demonstrated enhanced gastroprotective, anti-oxidant, and anti-inflammatory efficacy compared to the crude extract at all tested doses. The most prominent effect was observed in rats pretreated with the YF nano-cubosomal formulation at a dose of 100 mg/kg, which was similar to normal control and famotidine-treated rats.Our results highlighted the enhanced gastroprotective impact of the yucca nano-cubosomal formulation in a dose-dependent manner. This suggests its potential use in preventing peptic ulcer recurrence.

Efficacy and safety of seven Chinese patent medicines combined with conventional triple/quadruple therapy for Helicobacter pylori-positive peptic ulcers: a systematic review and network meta-analysis

ObjectivesTo compare the efficacy and safety of seven Chinese patent medicines (CPMs) combined with conventional triple/quadruple therapy (T/Q) for Helicobacter pylori-positive peptic ulcers.DesignA systematic review and network meta-analysis.Data sourcesChina National...

Sporadic gastrinoma with refractory benign esophageal stricture: A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin, leading to hypersecretion of gastric acid, subsequently resulting in recurrent peptic ulcers, chronic diarrhea, and even esophageal strictures. This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture (RBES). Additionally, it highlights the persistent challenges that gastroenterologists encounter in managing RBES. CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy, multiple endoscopic bougie dilations and endoscopic incisional therapy (EIT). CONCLUSION It is essential to diagnose gastrinoma as early as possible, as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures. In patients with esophageal strictures causing complete luminal obstruction, blind reopening EIT presents challenges and carries a high risk of perforation.

Availability of Mean Platelet Volume and Neutrophil/Lymphocyte Ratio in Control of Helicobacter Pylori Eradication

Aim: The most common chronic bacterial infection in humans is Helicobacter pylori (HP) and has been proven to cause gastritis, recurrent peptic ulcers, duodenal ulcers, and gastric cancer. We investigated the neutrophil-lymphocyte ratio (NLR) and the mean platelet volume (MPV) in the control of HP infection eradication success.
 Material and Method: Patients with HP infection in endoscopic biopsy performed due to dyspeptic complaints were included in this retrospective analysis. Quadruple antibiotic eradication therapy was given to the patients for 14 days. Pre- and post-treatment complete blood count parameters of 217 patients whose eradication treatment was successful were evaluated.
 Results: There was a statistically significant decrease in the neutrophil count after treatment compared to before treatment (p

Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature.

Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.

SAT205 99Technitiumm Sestamibi Negative Sporadic Metastatic Parathyroid Carcinoma In A Young Female-A Diagnostic Conundrum

Abstract Disclosure: D.V. Reddy: None. S. Paidipally: None. V. kyatham: None. S. Palle: None. C. Bhandiwad: None. Background: Parathyroid carcinoma (PC) is a very rare and indolent endocrine malignancy occurring a decade earlier than parathyroid adenoma. It can present as recurrent pancreatitis, anemia, and peptic ulcers. Serum calcium >14mg/dl, 3-10 times ULN of PTH, and concomitant renal and bone involvement should arise suspicion for PC. PC is diagnosed only through histopathology in the majority. It can also present during a prolonged follow-up, either by local recurrences or distant metastases. Clinical Case: A 27 year old female presented with hypercalcemic crises (as pancreatitis). At admission serum calcium and PTH were grossly elevated; 15.1 mg/dl (8.5-10 mg/dl) and 363 pg/ml (10-55 pg/ml) respectively. Abdominal CT revealed acute pancreatitis with medullary nephrocalcinosis. Ultrasonography of the neck revealed a colloid cyst in the right lobe of thyroid.99Tc m-sestamibi /SPECT-CT revealed no uptake. CT neck and chest showed a 13 mm X 13 mm well-defined round nodular lesion in the left apico-posterior segments of the lung. 18F-FDG PET/CT revealed uptake in the lesion with an SUV max of 10, suggestive of a metabolically active solitary pulmonary nodule. She had a similar presentation 8 years back and was diagnosed to have parathyroid adenoma for which she underwent resection. Serum PTH and calcium levels normalized postoperatively and also on follow-up till 3 years. Differentials include-recurrent ectopic parathyroid adenoma, parathyromatosis, and metastatic parathyroid carcinoma. After managing hypercalcemia medically, the patient underwent video-assisted thoracoscopic surgery with left lung wedge resection. Postoperatively serum calcium and PTH normalized. Histopathology revealed a grey-white nodule of 1.4X1.5X1.2 cm with sections, showing a well-defined lesion composed of lobules and nests of tumor cells separated by thin-walled vascular sinusoids. Tumor cells were polygonal with well-defined margins, moderate granular cytoplasm, and vesicular nuclei showing prominent nucleoli with a mitotic activity of 9/hpf. Immunohistochemistry revealed staining with PanCK, GATA3, and S100 with focal PAX 8 activity in the periphery. MIB index was 18%.IHC was suggestive of a neuroendocrine tumor consistent with metastatic parathyroid carcinoma. Whole exome sequencing did not reveal any pathogenic variants. Conclusion: Though 99Tc MIBI is useful in localizing PC, there are reports of false negative MIBI in documented cases of PC, which has been ascribed to the defective transport to the interior of the malignant cells. This demonstrates the importance of a multimodality imaging approach in such cases. 99Tc MIBI may miss certain cases of PC substantiating the importance of 18F-FDG PET/CT in diagnosis as well as follow-up. Reference: Evangelista L et al. FDG-PET/CT and parathyroid carcinoma: Review of literature and illustrative case series. World J Clin Oncol 2011; 2(10): 348-354. Presentation: Saturday, June 17, 2023

Long-term safety and effectiveness of vonoprazan for prevention of gastric and duodenal ulcer recurrence in patients on nonsteroidal anti-inflammatory drugs in Japan: a 12-month post-marketing surveillance study

ABSTRACT Background This study assessed the safety and effectiveness of vonoprazan for prevention of duodenal and gastric ulcer recurrence in patients on long-term nonsteroidal anti-inflammatory drugs (NSAIDs) in routine clinical practice. Research design and methods This 12-month, prospective, observational study (145 sites, Japan, September 2016–April 2020) analyzed patients with a history of gastric or duodenal ulcer who started once-daily vonoprazan and were receiving NSAIDs for pain. The primary outcome was the incidence of adverse drug reactions (ADRs). Results Most patients (86.7% [1099/1268]) received vonoprazan for at least 6 months. Most patients (98.6% [1250/1268]) received the 10-mg dose of vonoprazan, 38.3% (486/1268) received cyclooxygenase-2 inhibitors, and 61.7% (782/1268) received other NSAIDs. The overall incidence of ADRs was 0.71% (9/1268). Most commonly reported ADRs were gastrointestinal (0.32%), nervous system (0.16%), and hepatobiliary system (0.16%) disorders. The overall incidence of gastric or duodenal ulcer recurrence was 1.04% (95% CI 0.56–1.78). Conclusions No new safety concerns were reported for vonoprazan for prevention of secondary ulcer or bleeding in patients receiving long-term NSAIDs. Vonoprazan was effective for preventing NSAID-related peptic ulcer recurrence in this real-world study. Trial registration ClinicalTrials.gov: NCT03214198; Japan Pharmaceutical Information Center Clinical Trials Information: JapicCTI-163436.

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.

Gastroprotective and anti-Helicobacter pylori potentials of essential oils from the oleoresins of Araucaria bidwillii and Araucaria heterophylla

Plant resins or oleoresins comprise a chemically complex mixture of different classes of compounds. Oleoresin of the genus Araucaria combines essential oil (EO) and resin. It possesses gastroprotective, cytotoxic, and timicrobial, antipyretic, and anti-inflammatory activities. The study aimed to investigate the EOs from the oleoresins of two Araucaria species, A. bidwillii and A. heterophylla, chemically and biologically for their gastroprotective, anti-inflammatory, antioxidant, and anti-Helicobacter pylori potentials. The chemical composition of both species cultivated in Egypt was analyzed with GC-MS and compared with those cultivated abroad using principal component analysis (PCA). There were 37 and 17 secondary metabolites identified in A. heterophylla and A. bidwillii, respectively. The EOs of both species showed a pronounced inhibitory effect on Helicobacter pylori activity in vitro. The gastroprotective effect was assessed in vivo using ethanol-induced gastric ulcer model in rats. Inflammatory cytokines, oxidative stress, and the nuclear factor-kappa B (NF-κB) biomarkers were assessed in the stomach tissues. The ulcer index and percentage of ulcer protection were determined. Stomach sections were examined histopathologically by staining with (H/E) and periodic acid Schiff (PAS). Moreover, the proliferative index was determined using the Ki-67 immunostaining. The treatment of rats with EOs (50, 100, and 200 mg/kg, orally) 1 hour prior to ethanol administration showed promising gastroprotective, anti-inflammatory, and antioxidant potentials. These findings declared the gastroprotective role played by both EOs with the superiority of A. bidwillii over A. heterophylla via modulation of oxidative stress/NF-κB/inflammatory cytokines. Their use can be recommended to protect against the recurrence of peptic ulcers.

An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding

BackgroundPatients with Rockall scores ≥6 have an increased risk of long-term peptic ulcer rebleeding. This study was aimed toward investigating whether an extended course of oral esomeprazole up to 1 year decreased ulcer rebleeding in such patients.MethodsWe prospectively enrolled 120 patients with peptic ulcer bleeding and Rockall scores ≥6. After an initial 16-week oral proton pump inhibitor (PPI) treatment, patients were randomized to receive a 36-week course of oral twice-daily esomeprazole 20 mg (Group D, n = 60) or once-daily (Group S, n = 60). Thereafter, they were divided into the PPI-on-demand (n = 32) and PPI-discontinued (n = 77) subgroups. Our previous cohort with Rockall scores ≥6 served as the controls (Group C, n = 135); they received only an initial 8- to 16-week oral PPI. The primary and secondary outcomes were peptic ulcer rebleeding during the first year and the second year-and-thereafter, respectively.ResultsFor the primary outcome, groups D and S comprised a higher proportion of rebleeding-free than Group C (P = 0.008 and 0.03, log-rank test). The competing-risks regression analysis confirmed that extended PPI use and American Society of Anesthesiologists classification were independent factors contributing to the primary outcome. For the secondary outcome, PPI-on-demand had a borderline higher proportion of rebleeding-free than Group C (P = 0.07, log-rank test); however, only the Rockall score was the independent factor.ConclusionsAn extended 36-week course of oral esomeprazole 20 mg, twice- or once-daily for patients with Rockall scores ≥6 reduced ulcer rebleeding during the first year, but the effect needed to be further validated when PPIs were shifted to on-demand or discontinued thereafter (NCT02456012, 28/05/2015).

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.

Amyloidosis with recurrent oral and peptic ulcers mimicking Behcet's syndrome: A case report

AbstractIntroductionAmyloidosis and Behcet's syndrome (BS) are systemic diseases that affect multiple systems. Similar mucocutaneous damage occurs in amyloidosis and BS, thus causing a delayed or incorrect diagnosis. The prognosis of patients with amyloidosis is poor. Therefore, exclusion of other diagnoses is important before confirming the presence of BS.Case ReportWe report a case of a 43‐year‐old woman who initially presented with peptic ulcers, recurrent oral ulcers, and suspicious genital ulcers resembling BS. She was treated with systemic steroids at the local hospital for approximately 2 years. However, her symptoms were not relieved, and the gradual presence of macroglossia, hoarseness, periorbital purpura, proteinuria, and cardiac involvement strongly suggested amyloidosis. She was diagnosed with immunoglobulin light chain amyloidosis (lambda type) after extensive examinations, including an elevated monoclonal protein concentration, Congo red staining, and immunohistochemical staining of abdominal fat. She was then treated with a chemotherapy regimen (melphalan and dexamethasone).ConclusionRecurrent oral ulcers can be the first manifestation of amyloidosis. The diagnosis of BS requires the exclusion of other diseases, and amyloidosis should be considered as a differential diagnosis.

Improved PCR-based Methods for Detecting Helical Forms of Helicobacter Pylori

The paper would address Helicobacter pylori which is a starting of bacteria in the gastrointestinal tract's human epithelial cells. His disorder is linked with many common illnesses, including recurrent gastritis, peptic ulcers, gastrointestinal lymphoma, and adenocarcinoma. More than 50 percent of the world is found to be infected with Helicobacter pylori. It is found deep inside the stomach of humans, where neutral HP predominates, in epithelial cells that are secreting mucus. This bacteria has been identified as the primary cause of a variety of lymphoma-related gastrointestinal illnesses, including chronic gastritis, excretory ulcer, abdominal cancer, and lymphoma of the gastric mucosa, among others (MALT). In this study, two PCR-based techniques for the detection of Helical types of Helicobacter pylori were improved. Molecular treatment of a strain of Helicobacter Pylori using amplification and direct analysis of 16S rDNA PCR.

Calcium imbalance in comorbid gastroduodenal ulcers

Purpose of the study. To study the level of blood calcium, reflecting the functional state of the calcium-regulating system (CRS), in the comorbid course of gastroduodenal ulcers (GDU) with chronic erosive gastritis / chronic erosive duodenitis (CEG/CED), arterial hypertension (AH), their symptomatic nature when taking non-steroidal drugs (NSAIDs) and find out its effect on the activity of the ulcerous process, the state of regional microcirculation and the secretory function of the stomach.Materials and methods. 132 patients with GDU were examined. All patients were divided into groups: the first (39 people) – patients with recurrent peptic ulcer (PU) and CEG/CED, the second – 23 people with recurrent peptic ulcer and hypertension, the third – 20 patients with symptomatic gastroduodenal ulcers (SGDU) when taking NSAIDs. The fourth (control) group included 56 patients with PU without associated pathology.Results and discussion. Recurrence of PUr, comorbid to its course with CEG/CED, AH, SGDU, when taking NSAIDs, occurs with an increase in the level of calcium in the blood, which contributes to the activation of the acid-peptic factor, impaired microcirculation and repair processes in the mucous of the gastroduodenal zone, the development and maintaining the ulcerous process.Conclusion. Gastroduodenal ulcers are accompanied by dysfunction of the calcium regulatory system, which is characterized by an increase in blood calcium, which supports the formation of the main ulcerous mechanisms. In the treatment of comorbid and symptomatic gastroduodenal ulcers, it is necessary to include drugs for correcting the calcium-regulating system, which will increase the activity of sanogenic mechanisms.

Helicobacter pylori Eradication and Gastric Cancer Prevention

Since Warren and Marshall demonstrated Helicobacter pylori (H. pylori) as a cause of gastritis in the early 1980s, H. pylori has been associated with various gastric diseases, including gastric ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, gastric adenoma, gastric adenocarcinoma, and hyperplastic gastric polyps. H. pylori eradication therapy can treat some associated diseases, including low-grade gastric MALT lymphoma, and significantly reduce the risk of peptic ulcer recurrence or progression of atrophic gastritis and intestinal metaplasia. In East Asia, where H. pylori and gastric cancer are prevalent, several studies have been conducted to prove whether the risk of gastric cancer development is reduced through H. pylori eradication therapy. Early studies failed to show the benefits of H. pylori eradication therapy in gastric cancer prevention. However, recent studies with extended follow-up periods have reported reduced risks of gastric cancer after treatment of H. pylori infection. H. pylori eradication therapy effectively prevents gastric cancer even in patients who were treated for early gastric cancer, and can be used in treating hyperplastic gastric polyps. Herein, we reviewed current evidence supporting the benefits of H. pylori eradication therapy to help clinicians understand its impact on gastric cancer prevention and hyperplastic polyp treatment.

Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies.

Zollinger-Ellison syndrome (ZES) associated with pancreatic or duodenal gastrinoma is characterized by gastric acid hypersecretion, which typically leads to gastroesophageal reflux disease, recurrent peptic ulcers, and chronic diarrhea. As symptoms of ZES are nonspecific and overlap with other gastrointestinal disorders, the diagnosis is often delayed with an average time between the onset of symptoms and final diagnosis longer than 5 years. The critical step for the diagnosis of ZES is represented by the initial clinical suspicion. Hypergastrinemia is the hallmark of ZES; however, hypergastrinemia might recognize several causes, which should be ruled out in order to make a final diagnosis. Gastrin levels > 1000 pg/mL and a gastric pH below 2 are considered to be diagnostic for gastrinoma; some specific tests, including esophageal pH-recording and secretin test, might be useful in selected cases, although they are not widely available. Endoscopic ultrasound is very useful for the diagnosis and the local staging of the primary tumor in patients with ZES, particularly in the setting of multiple endocrine neoplasia type 1. Some controversies about the management of these tumors also exist. For the localized stage, the combination of proton pump inhibitory therapy, which usually resolves symptoms, and surgery, whenever feasible, with curative intent represents the hallmark of gastrinoma treatment. The high expression of somatostatin receptors in gastrinomas makes them highly responsive to somatostatin analogs, supporting their use as anti-proliferative agents in patients not amenable to surgical cure. Other medical options for advanced disease are super-imposable to other neuroendocrine neoplasms, and studies specifically focused on gastrinomas only are scant and often limited to case reports or small retrospective series. The multidisciplinary approach remains the cornerstone for the proper management of this composite disease. Herein, we reviewed available literature about gastrinoma-associated ZES with a specific focus on differential diagnosis, providing potential diagnostic and therapeutic algorithms.

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.

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

1: ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2: ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3-5 days.Strong recommendation, moderate quality evidence. 3: ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4: ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5: ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6: ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 : ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8: ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9: ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (A): PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (B): High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10: ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

Vonoprazan in the management of erosive oesophagitis and peptic ulcer-induced medication: a systematic review.

IntroductionVonoprazan has been found to promote a better antisecretory effect addressing acid-related diseases’ unmet needs.AimTo assess if vonoprazan effectively treats patients diagnosed with gastroesophageal reflux disease esophagitis or with peptic ulcers induced by chronic use of aspirin or non-steroidal anti-inflammatory drugs.Material and methodsA literature search was conducted (April/2021) using Medline via PubMed, Cochrane library, Lilacs, Scielo, and Centre for Reviews and Dissemination electronic databases.ResultsWe retrieved 55 titles. Of these, 13 met the eligibility criteria and were included in this review. Of these 13 articles, 4 were prospective cohort studies, 1 was a follow-up analysis of a preceding prospective study, 1 was a retrospective cohort study, and 6 were randomized clinical trials.ConclusionsOur findings suggest that vonoprazan was effective and non-inferior to proton pump inhibitors in healing and maintaining healed reflux oesophagitis, leading to faster symptom relief. Vonoprazan may also be considered for preventing aspirin- or non-steroidal anti-inflammatory drug-related peptic ulcer recurrence.