Risk Factors For Peptic Ulcer Disease Research Articles

Peptic Ulcer Disease Associated with Central Obesity.

This retrospective cross-sectional study aimed to evaluate associations between peptic ulcer disease (PUD), bone mineral density, and metabolic syndrome (MetS) and its components in healthy populations. Data were collected from the health examination database of a tertiary medical center in southern Taiwan from January 2015 to December 2016. Subjects who had undergone metabolic factors assessment, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scans were enrolled. In total, 5102 subjects were included, with mean age 52.4 ± 12.0 years. Among them, 1332 (26.1%) had PUD. Multivariate logistic regression analysis showed that age (OR 1.03, p < 0.001), male (OR 1.89, p < 0.001), diabetes (OR 1.23, p = 0.004), BMI (OR 1.03, p = 0.001), and GOT (OR 1, p = 0.003) are risk factors for PUD. Regarding MetS parameters, larger waist circumference (OR 1.26, p = 0.001) is associated with PUD, and high triglycerides (OR 1.20, 95% CI 1.01-1.43) is associated with gastric ulcer, while low HDL (OR 1.31, 95% CI 1.07-1.59) and osteoporosis (OR 1.44, 95% CI 1.08-1.91) are associated with duodenal ulcer. In conclusion, central obesity is associated with PUD in a middle-aged healthy population. Subjects with high triglycerides are prone to gastric ulcers, and those with osteoporosis and low HDL are prone to duodenal ulcers.

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.

Study on Socio-Demographic Profile of Peptic Ulcer Disease in A Tertiary Care Teaching Hospital, Dhaka, Bangladesh

Background: The prevalence and socio-demographic factors of peptic ulcer disease (PUD) have changed remarkably now a day. Currently, peptic ulcer disease has considered as a multifactorial health problem.&#x0D; Objective: To determine the socio-demographic factors of Peptic ulcer disease among patients attending Bangladesh Medical College, Dhanmondi, Dhaka, Bangladesh.&#x0D; Methods: This is a hospital-record based cross sectional descriptive study executed in a tertiary care teaching hospital, Dhanmondi, Dhaka. The study group comprises 200 PUD patients enrolled in our Bangladesh Medical College Hospital from July 2019 to December 2020. Analysis of data was done by using SPSS 15 software. Prevalence of PUD patients among study population was calculated by using percentage and the strength of association of socio- demographic factors were evaluated in our study.&#x0D; Results: Total prevalence of PUD among the studied group was 83.5%; gastric ulcer 54.5% and duodenal ulcer 29%. Majority 56% were female patients in the age group of 41-50 years. Most prevalent endoscopic finding was erosive antral gastritis (48.50%). PUD was diagnosed predominantly among unemployed population (48.50%) in the urban locality (62%). The cardinal features were pain precipitated by certain food (55.69%) and loss of appetite (52. 09%).Regarding risk factors spicy food (55.69%) has secured the first position in our study followed by smoking (34.13%) and stress (18.56%).&#x0D; Conclusion: Multifactorial variables were considered as risk factors for PUD. Population based endoscopic studies can detect PUD at its earliest possible stage and create awareness among population to prevent its further progression.

Peptic ulcer disease: a cross-sectional study of symptoms and risk factors among students at Jimma University, Ethiopia

Background: Peptic ulcer disease (PUD), which includes gastric and duodenal ulcers, is a common condition with symptoms including epigastric or abdominal pain. It is multifactorial, with physiological, demographic and environmental risk factors, some of which make it more prevalent in developing countries. Aims: This study aims to assess the symptoms of and risk factors for PUD among students at Jimma University, Jimma, Ethiopia. Methods: This institutional based cross-sectional study design used a self-administered questionnaire to collect data for analysis. This included logistic regression analysis, in which a p-value of &lt;0.05 at 95% CI indicated statistical significance. Findings: Of the 240 respondents, 41.3% had symptoms indicative of PUD. Most students developed symptoms after enrolling at university and primarily managed them with medication. PUD-like symptoms were found to be associated with year of study, frequent Non-steroidal anti-inflammatory drugs(NSAIDs use, smoking, prolonged fasting and anxiety. Conclusions: PUD is highly prevalent in this setting. Therefore, the university may wish to raise awareness of PUD and aim to reduce anxiety among students.

Current status of peptic ulcer disease in Port Harcourt metropolis, Nigeria.

Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in hospital admissions in Western countries. This paper aimed to study the current status and risk factors of PUD in a Nigerian metropolis. A cross-sectional study of symptomatic patients at upper gastrointestinal (GI) endoscopy diagnosed with PUD from February 2014 to September 2019 at a referral endoscopy facility in Port Harcourt, Niger delta region of Nigeria. The variables studied included demographics, symptoms and duration, blood group, chronic non-steroidal anti-inflammatory (NSAID) use, smoking, endoscopic and histology findings. Statistical analysis was performed using SPSS version 20. A total of 434 upper GI endoscopies were performed during the study period with thirty-one diagnosis of PUD made. The mean age of gastric ulcer (GU) and duodenal ulcer (DU) cases were 54.4 ± 20.2yrs and 48.1 ± 14.5yrs respectively (p = 0.367). GU to DU ratio was 1.4:1. H. pylori infection, chronic NSAID use and blood group O were seen in 7(22.5%), 8(25.8%) and 18(72.0%) respectively. Major indication in 21(67.7%) cases was gastrointestinal bleeding. There is a low diagnostic rate of PUD (6.7%) with pre-pyloric antral gastric ulcers as most common type and multifactorial aetiology.

Peptic Ulcer Disease in Elderly Population of Arar City, Northern Saudi Arabia

Background: peptic ulcer disease (PUD) is a common disease of the digestive system. Peptic ulcer disease is a problem of the gastrointestinal tract characterized by mucosal damage secondary to pepsin and gastric acid secretion. It usually occurs in the stomach and proximal duodenum; less commonly, it occurs in the lower esophagus, the distal duodenum, or the jejunum. IT is a multifactorial health problem affecting almost all populations worldwide. The number of people who are ≥ 60 years old increased worldwide. The elderly population is susceptible to various benign and malignant diseases. Peptic ulcer is among the common health problems that affect the elderly. Aim of the study: this study aimed to determine the prevalence and risk factors of PUD in elderly population of Arar city, Northern Saudi Arabia. Subjects and methods: this was a cross sectional study and conducted in five randomly selected primary healthcare centers in Arar city (KSA), from September 2017 to March 2018. It included 217 elderly patients. A questionnaire was designed for data collection about socio-demographic variables, smoking, BMI, chronic diseases and physician diagnosed peptic ulcer among participants. Results: our findings showed that out of 217 of the studied elders, 55.3% were females and 21.2% were suffered from peptic ulcer. There were significant relations between peptic ulcer with gender, marital status, educational level and smoking status, while there was an insignificant relation between peptic ulcer with age group and BMI group. On the other hand, there were significant relations between peptic ulcer and musculoskeletal disorders, kidney diseases and insomnia. While, there was insignificant relations between peptic ulcer and cardiovascular diseases, ischemic heart diseases, hypertension, neurological disorders, diabetes mellitus and psychological disorders. Conclusion: among the elderly participants 21.2% were suffered from peptic ulcer. There was a significant relation between peptic ulcer with gender, smoking status, musculoskeletal disorders, kidney diseases and insomnia. While, there was insignificant relations between peptic ulcer with age group and BMI group.

Evaluation of risk factors for perforated peptic ulcer

BackgroundThe aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU).MethodsAt St. Luke’s International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression.ResultsA total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70–100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13–36.2). The sensitivity analysis showed consistent results, with an OR of 23.8–366.2 for muscular defense and an OR of 3.67–7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03–22.3).ConclusionsThe evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain.

Mitochondrial DNA deletion Δ4977 in peptic ulcer disease

Reactive oxygen species (ROS) play a critical role in peptic ulcer disease (PUD). Due to the high rate of ROS production and limited capacity for DNA repair within mitochondria, mtDNA is susceptible to oxidative damage and mutations. mtDNA deletion Δ4977 is one of the most common deletion events identified in mitochondria. We examined the association of 4977-bp mtDNA deletion with PUD. Genotypes were determined in bioptic samples of 150 PUD patients and 190 controls. The 4977-bp mtDNA deletion was found more frequently among patients with PUD (52%) than among controls (22.63%). The strong association between the mtDNA 4977-bp deletion and PUD was confirmed (OR = 3.7; 95% CI, 2.32-5.91; P = 0.0001). The 4977-bp deletion in mitochondrial DNA may be a risk factor for PUD, or may reflect an increase in oxidative stress that commonly accompanies underlying PUD disease. Larger population-based studies are needed to uncover the possible causal relationship between this deletion and peptic ulcer disease.

Letter: peptic ulcer bleeding in patients with cirrhosis

SIRS, The study by Rudler et al. on the aetiology and outcomes of peptic ulcer bleeding in cirrhotic and noncirrhotic patients has several limitations. First, the study recruited only 203 patients, the majority (85%) of whom were noncirrhotic. These were compared with only 29 (14%) cirrhotic patients, who were loosely defined using clinical, biochemical and radiological parameters. Based on the very small numbers in the cirrhosis group, and as the patients in the two groups were not matched, the study was not sufficiently powered to address the questions they set out to answer. The gold standard test for diagnosing cirrhosis is a liver biopsy, although hepatic elastography is an acceptable alternative. Reliance on tests such as radiology, blood parameters and endoscopic findings can be misleading and lack specificity. For instance, noncirrhotic idiopathic portal hypertension can mimic cirrhosis both clinically and radiologically. Hence, it is conceivable that some of the patients they considered cirrhotic were not. Second, the authors throughout the manuscript refer to ‘idiopathic’ peptic ulcer disease (PUD), meaning those patients who had no evidence of Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID)/aspirin use. This gives the erroneous impression that these two factors are the only causes of PUD. Before an ulcer can be labelled as idiopathic, one has to exclude other known but rare causes of peptic ulcers (such as other ulcerogenic drugs and diseases including Crohn’s and Zollinger–Ellison syndrome). The authors made no such attempts in their study; hence, it is impossible to know whether other aetiologies were involved. Moreover, recent alcohol intake in cirrhotic patients has been implicated in the pathogenesis of gastroduodenal ulcers; hence, it is misleading to disregard alcohol as a causative factor for ulcers in these patients. Third, the use of H. pylori serology to diagnose H. pylori infection in this study is questionable. It is well known that serological tests for H. pylori are unreliable in patients with cirrhosis and portal hypertension, with high sensitivity but low specificity (83.6 and 55.9, respectively). 5 Gastric biopsies for H. pylori histology and/or rapid urease test would have been preferable due to their higher accuracy in this setting. Thus, the figures they quote for H. pylori infection rate in the study are likely to be inaccurate. Moreover, the authors’ make no mention of whether the patients had received any prior H. pylori eradication therapy, which makes it impossible to determine whether the patients who were positive had current or prior infection, as H. pylori antibodies can take several months to years to disappear following eradication. In addition, noncirrhotic patients were much older than cirrhotic patients, and the differences seen in H. pylori infection rate between the two groups could have been influenced by the age difference. It is well known that the prevalence of H. pylori infection increases with age. Peptic ulcer disease, particularly gastric ulcer, is found more commonly in patients with portal hypertension. Although the exact pathogenetic mechanisms are unknown, it is generally believed that portal hypertension leads to impairment of gastric mucosal defences, hence rendering the gastric lining more susceptible to injury by aggressors such as NSAIDs alcohol and bile salts, culminating in peptic ulcers. Although a high alcohol intake alone has not been unequivocally identified as a risk factor for PUD in noncirrhotic patients, Aurox et al. found that in cirrhotic patients, recent alcohol intake prior to endoscopy was independently associated with gastroduodenal erosions. Almost all cirrhotic patients in this study had a history of excessive alcohol intake. Thus, the only

Association between acute pancreatitis and peptic ulcer disease.

To evaluate the relationship between peptic ulcer disease (PUD) and acute pancreatitis. A cohort of 78 patients with acute pancreatitis were included in this study. The presence of PUD and the Helicobacter pylori (H. pylori) status were assessed by an endoscopic method. The severity of acute pancreatitis was assessed using Ranson's score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, computed tomography severity index and the clinical data during hospitalization, all of which were compared between the patients with and without PUD. The risk factors for PUD were also evaluated. Among 78 patients, 41 patients (52.6%) with acute pancreatitis suffered from PUD, but only 13 (31.7%) patients with PUD were infected by H. pylori. On univariate analysis, male gender, an etiology of alcohol-induced pancreatitis, a history of smoking or alcohol consumption, elevated triglyceride and C-reactive protein levels, and high APACHE II score were significantly associated with PUD. However, on multivariate logistic regression analysis, the APACHE II score (odds ratio: 7.69; 95% confidence interval: 1.78-33.33; P < 0.01) was found to be the only independent risk factor for PUD. Patients with acute pancreatitis are liable to suffer from PUD. PUD is associated with severe acute pancreatitis according to the APACHE II score, and treatment for PUD should be considered for patients with severe acute pancreatitis.

The value of gastrointestinal endoscopy in diagnosis of patients with typical heartburn

Objective To evaluate the value of endoscopic profile in an adult population with typical heartburn. Methods Clinical and endoscopic data were collected from 5042 consecutive outpatients who underwent routine upper endoscopy without any alarm features between March 2006 and Feb. 2007. Results Three hundred and thirteen (6.2%) patients were diagnosed as having typical heartburn. Of these, erosive esophagitis (EE) was found in 99 (31.6%) patients, Barrett's esophagus (BE) in 10 (3. 2%) patients, peptic ulcer disease (PUD) in 21 (6. 7%) patients and carcinoma in three (0.9 %) patients (1 with esophageal carcinoma and 2 with gastric adenocarcinoma).Multivariate analysis revealed that age＞50, male, overweight and alcohol use were independent risk factors for positive endoscopy findings (P＜0.05) and EE (P＜0.05) in heartburn patients. Male and Helicobacter pylori infection were independent risk factors for PUD (P＜ 0.05). Conclusions In China, patients with typical heartburn but without alarm features, early endoscopic examination may be helpful in avoiding missing diagnosis of tumor. Key words: Gastroesophageal reflux; Heartburn; Endoscopy

Does Helicobacter pylori infection explain all socio‐economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults

Background: Peptic ulcer epidemiology has changed considerably within the past century. The aim of this study was to assess the 11‐year cumulative incidence of peptic ulcer disease and examine the relationship between ulcer incidence and psychosocial and genetic factors. Methods: A random sample of 2416 Danish adults with no history of peptic ulcer disease residing in Copenhagen County, Denmark, attended a population‐based prospective cohort study in 1983 and 1994. All participants reported whether they had had an ulcer diagnosed within the observation period. Information on socio‐economic factors, family history of peptic ulcer disease (PUD) and lifestyle practices was obtained from a questionnaire. Lewis blood group antigens were assessed from blood samples and Helicobacter pylori infection status was determined with an in‐house IgG ELISA. Results: The overall 11‐year cumulative incidence proportion of PUD was 2.9% (95% CI (2.2; 3.6)), i.e. 1.6% (95% CI (1.1; 2.1)) for duodenal ulcer, and 1.3% (95% CI (0.8; 1.7)) for gastric ulcer. Poor socio‐economic status increased the risk of PUD independently of H. pylori infection (odds ratio 2.7, 95% CI (1.1; 6.1)) and accounted for 17% of all ulcer cases. High physical activity at work increased the risk of PUD in people infected with H. pylori (odds ratio 2.6, 95% CI (0.8; 8.0)). Family history of PUD or Lewis blood group antigens did not relate to ulcer incidence. Conclusions: Poor socio‐economic status is an important risk factor for PUD that exerts its effect independently of H. pylori infection. Strenuous work may increase the risk of PUD in people with H. pylori infection. Genetic factors do not influence the risk of PUD in Danish adults.

Alpha1-Antitrypsin Deficiency May Be a Risk Factor for Duodenal Ulcer in Patients with Helicobacter pylori Infection

Most individuals with Helicobacter pylori infection in Western countries have no evidence of peptic ulcer disease (PUD). We therefore assessed the PiZ deficiency variant of the major plasma protease inhibitor alpha1-antitrypsin (alpha1AT) as a risk factor for PUD in H. pylori-infected individuals. The cohort comprised 100 patients with endoscopically or surgically proven PUD (30 patients with duodenal ulcer (DU) and 70 patients with gastric ulcer (GU)) and 162 age- and sex-matched controls with PUD-negative endoscopic findings and no history of PUD. Plasma samples were screened for alpha1AT deficiency (PiZ) with an enzyme-linked immunosorbent assay (ELISA) and phenotyped by isoelectric focusing. H. pylori infection was evaluated with an IgG ELISA technique. Among the 262 patients 17 (6.5%) were positive for the PiZ alpha1AT deficiency, a frequency of the same magnitude as in the Swedish general population (4.7%). Of the PiZ carriers 76% (13 of 17) had H. pylori antibodies compared with 61% (151 of 245) of the non-PiZ carriers (NS). The prevalence of DU tended to be higher in H. pylori-positive PiZ carriers than in non-PiZ carriers (15.4%, 4 of 26 versus 0 of 4). Furthermore, among patients with DU a high PiZ allele frequency (13.3%, 4 of 30) was found compared with the general population (4.7%) (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.09-8.94; P = 0.02). All DU patients carrying the PiZ allele were positive for H. pylori. In addition, four of five PiZ carriers with H. pylori infection and PUD had DU. The PiZ allele may be a contributing factor in the development of DU in H. pylori-positive individuals.