Symptoms Of Peptic Ulcer Disease Research Articles

Eagle’s syndrome in tertiary health institution, southern region of Nigeria

Eagle’s syndrome is a condition caused by elongation of the styloid process or ossification of the styloid ligament resulting in non-specific symptoms related to pressure on vital blood vessels of the neck, the internal carotid artery, internal jugular vein, and nerves; the glossopharyngeal and vagus nerves. Eagle’s syndrome may have varied presentations with numerous symptoms: Pain in the throat/neck radiating to the ear and pharynx, foreign body sensation in the throat, dysphagia, otalgia, trismus, and intense facial pain. A high index of suspicion with a prompt resort to a three-dimensional CT skull could be helpful to give a quick diagnosis of Eagle’s syndrome amid numerous differential diagnoses. We present a 59-year-old male with an 18-month history of left-sided neck pain, cheek pain, and the feeling of a foreign body in the throat. He had pain relievers and other drugs to no avail. A three-dimensional CT scan of his skull revealed features of Eagle’s syndrome. The excision of the styloid process through the extraoral route relieves his symptoms. The second patient is a 42-year-old female with symptoms of peptic ulcer disease, dysphagia, pain in the throat, and sometimes fainting attacks when she moves her neck swiftly to the left side. A three-dimensional CT skull scan confirmed features of an elongated styloid process bilaterally suggestive of Eagle’s syndrome. Treatment offered to her was conservative, with a diclofenac suppository only because she refused surgery. Restricted and limited neck movement relieved her of syncope attacks.

S3534 A Unique Presentation of Gastrinoma Complicated by Duodenal Perforation

Introduction: Neuroendocrine tumors are uncommon neoplasms with multiple different characteristics. They can be benign but also proliferate into malignant tumors with different pathological scenarios such as intestinal obstruction/ intraluminal mass. Gastrinomas are type of NET originating from pancreatic islet cells but can also arise from gastrin-producing cells in the duodenum. We present a case of gastrinoma, in which clinical period was complicated by small bowel perforation. Case Description/Methods: A 55-year-old lady with no significant past medical presented with complaints of abdominal pain, diarrhea and nausea/vomiting that was uncontrolled with symptomatic management. The patient underwent an EGD that showed esophagitis, gastritis, and duodenitis, and she was transferred to our facility for further work-up. She underwent a workup for Zollinger Ellison Syndrome in view of persistent symptoms. Her gastrin level came back elevated at 4,180 pg/ml after her medications were stopped to get the correct lab readings. A nuclear scan was scheduled for the patient to localize the gastrinoma lesion, but suddenly the patient became altered, hypotensive, and developed an acute abdomen. On further investigation with CT scan of the abdomen, patient was found to have pneumoperitoneum, secondary to bowel perforation. She underwent an emergent exploratory laparotomy, was found to have large perforations of the 3rd, 4th portion of the duodenum and several small perforations throughout the small bowel. A Para duodenal lymph node was taken and sent for pathology. Pathology revealed a well-differentiated neuroendocrine tumor: histological subtype gastrinoma. The patient underwent duodenal resection, gastrojejunostomy, cholecystectomy and feeding tube placement. Post-op period was complicated by patient having persistent dysphagia, initially to solids and progressed to have dysphagia to liquids as well. The patient underwent an EGD again which showed presence of esophageal stricture and had to undergo dilatation 6 times in a span of 2 months for symptom relief. She follows up with oncology and gastroenterology regularly and is scheduled to get a PET scan soon to rule out metastasis. (Figure) Discussion: Gastrinomas manifest with peptic ulcer disease symptoms but some patients present with diarrhea. Serum gastrin levels of > 1000 pg/ml with symptoms is diagnostic of gastrinoma. A secretin provocative test is used for diagnosis if gastrin levels are < 1000 pg/ml. As clinicians, we must be aware of the complications of gastrinoma.Figure 1.: Histopathological slides.

Sero-prevalence of and risk factors associated with Helicobacter pylori infections among individuals with peptic ulcer in Owerri, Imo State, Nigeria during 2020-2021

Background: Helicobacter pylori, which is a causative agent of chronic gastritis, duodenal ulcer and gastric cancer, presently affects approximately one half of the world population. This study was conducted to assess the epidemiology and risk factors for acquisition of H. pylori among individuals with and without peptic ulcer symptoms in Owerri, Nigeria, in order to provide baseline data and create awareness for effective management and prevention of infection caused by this pathogen.&#x0D; Methodology: A total of 384 participants, symptomatic and asymptomatic for peptic ulcer, were recruited from the three Local Government Areas (LGAs) of Owerri, Imo State, Nigeria. The symptomatic participants were randomly recruited among patients attending outpatient clinics with symptoms of peptic ulcer disease at the Federal Medical Center Owerri, general hospitals and primary healthcare centers across Owerri LGAs, while asymptomatic patients were recruited from the community. Information on socio-demographic characteristics of each participant and potential risk factors were collected with a pre-tested structured questionnaire. Blood samples were collected for detection of antibodies (IgG) using a one-step H. pylori test device while faecal samples were collected for detection of occult blood (from peptic ulceration) using faecal occult blood (FOB) test. Data were analyzed using SPSS version 25.0 and association of risk factors with H. pylori sero-prevalence was determined by the Chi-square or Fisher Exact test (with Odds ratio). P value &lt; 0.05 was considered statistically significant.&#x0D; Results: The sero-prevalence of H. pylori infection among the study participants was 72.4% (285/384) while the prevalence of ulcer by FOB test was 71.1% (273/384). A total of 78.4% (214/273) of those with ulcers were seropositive for H. pylori while 64.0% (71/111) of those without ulcers were sero-positive for H. pylori (p=0.0045). Factors significantly associated with high sero-prevalence of H. pylori were age groups 41-50 (100%), 21-30 (78.4%) and 31-40 (67.6%) years (X2=66.964, p&lt;0.0001), illiteracy (OR=6.888, p&lt;0.0001), unemployment (OR=2.427, p&lt;0.0001), low social class status (X2=28.423, p=0.0003), drinking of unclean water (OR=5.702, p&lt;0.0001), living in crowded rooms (OR=2.720, p&lt;0.0001), eating food bought from food vendors (OR=3.563, p&lt;0.0001), family history of ulcer (OR=12.623, p&lt;0.0001), habits of eating raw vegetables and unwashed fruits (OR=6.272, p&lt;0.0001), non-regular hand washing practices before meal (OR=2.666, p&lt;0.0001) and presence of ulcer (OR=2.043, p=0.0045). However, smoking (OR=0.7581, p=0.2449) and gender (OR=0.6538, p=0.0796) were not significantly associated with sero-prevalence of H. pylori.&#x0D; Conclusion: There is need for comprehensive strategy including public health education campaign to create awareness on H. pylori, improve personal hygiene and environmental sanitation, provision of safe drinking water by the government to the populace, and discourage indiscriminate and open defecation.

Follow-Up Clinico-Endoscopic Study among Young Patients with Peptic Ulcer Perforation: A Prospective Analysis

Background: One of the most common difficulties in the operation fatality is perforation peritonitis. The goal of this study was to identify risk factors for peptic ulcer disease (PUD) in young patients. Materials and method: In this study, 70 patients were evaluated and clinical examinations and endoscopies were performed at 8 weeks and 6 months. Place and Duration: A population‐based cohort study was conducted at the Gastroenterology department of Sharif Medical College, Lahore for one-year duration from January 2021 to December 2021. Result: Six patients died, and 4 patients were not followed up on, out of a total of 80 patients. There were 62 men and 8 women among the remaining 70 patients. The majority of the patients were between the ages of 35 and 40. After eight weeks, 34 (50%) had no infections on endoscopy, with 34 patients (48.6%) on treatment and 1 (1.4%) not on any therapies. The residual 35 patients (50%) had active ulcers and other positive endoscopic outcomes. Six months after surgery, 56 patients (80%) had no ulcers on endoscopy, with 34 on treatment and 12 without treatment. The rest 14 had some positive endoscopic findings. The study also revealed other factors linked with peptic ulcer perforation and impacting healing in the postoperative phase. Preoperative PUD symptoms, alcohol consumption, comorbidities, chronic drug consumption (NSAIDs/steroids), smoking, postoperative treatment given and H. pylori infection were all variables. Conclusion: All patients with peptic ulcer perforation should receive H2 blockers or proton pump inhibitors as a post - operative therapies, as well as an anti-Helicobacter pylori regimen. Postoperative follow-up should include routine endoscopic examinations of these patients to detect ulcer healing. Keywords: peptic ulcer disease, endoscopies, chronic drug consumption.

A prospective cohort study of patients with peptic perforation to identify high-risk clinical characteristics

Introduction: Peptic ulcer perforation is the most common complication in peptic ulcer disease and can lead to serious complications and mortality; however, despite the widespread use of antisecretory agents and eradication of Helicobacter pylori, the incidence of peptic ulcer perforation remains largely unchanged. This study aimed to evaluate the risk factors for perioperative morbidity and mortality in patients with peptic ulcer perforation. Methods: This was a prospective, observational study involving patients with perforated peptic ulcer disease admitted to the Al-Basra Teaching Hospital from January 2017 to December 2019. A total of 100 patients were followed for 4 weeks. Patients’ demographic data, history of chronic diseases, American Society of Anesthesiologist (ASA) score, nonsteroidal anti-inflammatory drug (NSAID) and steroid use, duration before surgery, preoperative shock status, previous symptoms of peptic ulcer disease, smoking habits, and fasting status were evaluated, and significant correlations with postoperative complications were analyzed statistically. Results: A total of 100 patients aged 16–87 years were included in the study, and the male-to- female ratio was 3:1. Sixty-seven (67%) patients underwent surgery within 12 h after admission, 41% of patients had a history of chronic disease, 54% of patients had an ASA score of 1, 57% of patients were smokers, 45% of patients reported previous peptic ulcer symptoms, and 22% of patients had preoperative shock status. Thirty-seven (37%) patients developed postoperative complications, and 8% of patients died. Conclusion: This study confirmed that advanced age, a high ASA score, preoperative shock, comorbidities, and delayed presentation before surgery were all risk factors for postoperative complications and mortality in patients with perforated peptic ulcer disease. Habitual smoking, fasting status, and NSAID and steroid use were not correlated with mortality.

The content of nonspecific immune complexes and the level of oxidative processes in the organs of the goldfish of the Don River

The study of the content of immune complexes, products of lipid peroxidation and antioxidant activity in the goldfish Carassius auratus inhabiting the r. Don. Fish were caught in the water area of the city of Kalacha-na-Donu, about 13 lock of the Volga-Don canal and downstream. Analysis of the results showed insignificant differences in size and weight parameters. A visual examination on the body of crucians living downstream revealed reddening of the skin and ulcers near the caudal, abdominal and dorsal fins, indicating symptoms of peptic ulcer disease. Significant differences in the content of nonspecific immune complexes and the level of malondialdehyde between fish caught at different stations were recorded. The high content of immune complexes in the kidney and spleen extracts of the crucian carp inhabiting the area of the 13 gateway indicates a violation of the mechanisms for the elimination of these complexes. An increase in the level of immune complexes indicates the presence of pathological and autoimmune processes in fish. The highest indicators of malondialdehyde were recorded in the organs of fish living in the area of the 13th lock and downstream of the river. The increased content of malondialdehyde indicates a high level of lipid peroxidation processes and a decrease in the level of antioxidants in the studied tissues. However, the low values of the constant of inhibition of substrate oxidation in fish organs from different stations indicates the activity of antioxidant structures in the studied tissues. The study showed that crucians from different parts of the Don River differed in the content of immune complexes and the level of malondialdehyde in the organs.

1911 Acquired Double Pylorus: The Road Less Traveled

INTRODUCTION: A double pylorus channel can be congenital or acquired. Acquired double pylorus is thought to be the result of a gastric or duodenal ulcer forming a fistula between the prepyloric antrum and the duodenal bulb. Although it is a rare endoscopic finding, seen in only 0.001%–0.4% of upper gastrointestinal endoscopies1, when acquired, it signifies peptic ulcer disease (PUD) which needs risk factor modification and treatment. CASE DESCRIPTION/METHODS: A 50-year-old man with alcohol use disorder, newly diagnosed alcoholic cirrhosis and recent NSAID use presented with confusion, melena and dark emesis. His physical exam was notable for hypotension (BP 86/55 mmHg), somnolence, confusion and positive asterixis. Laboratory values were remarkable for hemoglobin of 5 g/dL, BUN of 48 mmol/L, platelets of 271 × 109/L and INR of 2. Management included fluid resuscitation, blood transfusion, proton pump inhibitor and octreotide drip. Once hemodynamically stabilized, an upper endoscopy was performed revealing blood in the gastric body, two antral ulcers with visible vessels, but no endoscopic stigmata of liver disease. Adjacent to the pylorus, a slit-like channel connecting the prepyloric antrum to the duodenal bulb was noted and traversed with the endoscope. Helicobacter pylori work up revealed a positive serum antibody. Patient did well post-procedure and received Helicobacter pylori eradication treatment and counseling on alcohol cessation and NSAID avoidance. DISCUSSION: In contrast to congenital double pylorus which is an incidental finding, patients with acquired double pylorus often present with symptoms of PUD. In this case, likely culprits included NSAIDs and Helicobacter pylori. It should be distinguished from other similar appearing endoscopic findings such as gastric diverticulum, as risk factors for PUD need to be investigated in patients with an acquired double pylorus. While treatment with acid suppression and Helicobacter pylori eradication should be pursued, the fistula tract often persists despite treatment2. Endoscopic recognition and familiarity are key to ensure appropriate risk modification, treatment and prevention of endoscopic complications with side-viewing scopes.

Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease.

1. Desiree Sierra, MD* 2. Mary Wood, MD* 3. Sneha Kolli, MD* 4. Lina Maria Felipez, MD† 1. *Department of Medical Education and 2. †Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL * Abbreviations: H2RA: : histamine 2 receptor antagonist IBD: : inflammatory bowel disease NSAID: : nonsteroidal anti-inflammatory drug PPI: : proton pump inhibitor PUD: : peptic ulcer disease Providers should be able to identify the signs and symptoms of peptic ulcer disease in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment regimens to start once the diagnosis is confirmed. After completing this article, readers should be able to: 1. Understand the mechanism and pathogenesis of gastritis, gastropathy, and peptic ulcer formation. 2. Recognize the symptoms of and risk factors for gastritis, gastropathy, and peptic ulcer disease. 3. Understand which patients warrant referral to a gastroenterologist for possible endoscopy. 4. Review the role of Helicobacter pylori in peptic ulcer disease. 5. Review the treatment of peptic ulcer disease with and without the presence of H pylori. Gastritis, gastropathy, and peptic ulcer disease (PUD), collectively known as acid peptic disease, are often described as a spectrum of the same disease. Although these conditions are more common in adults, their incidence in the pediatric population is clinically significant. Left untreated, gastritis can progress to PUD, which can result in serious complications such as perforation, bleeding, bowel strictures, and obstruction. Studies describing the role of Helicobacter pylori , nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other causes have helped to further expand our understanding of gastritis and PUD in children. Direct visualization and the ability to biopsy with endoscopy have revolutionized the diagnosis and treatment of these diseases. The incidence of PUD in children is lower than that in adults. Based on several international studies, the incidence in children varies from 2% to 8%. (1)(2) The incidence of bleeding ulcers is lower and is estimated to be between 0.5 and 4.4 of 100,000 individuals. (3) These rates …

Evaluation of H. pylori - Eradication Triple Therapy in Iraqi Peptic Ulcer Patients according to ABO Phenotypes: a New Study

Infection with H. pylori is an up growing public health problem that affects approximately 50% of people in industrialized nations, and up to 80% in developing countries. Helicobacter pylori (H. pylori) infection had been identified as the main causes of peptic ulcer disease (PUD). Blood group A phenotype was associated with gastric ulcer (GU) and gastric carcinoma, while blood group O phenotype found to be associated with duodenal ulcer DU predominantly; however, no explanation for this association was received. This study was conducted to, first, determine the relationship between ABO blood groups and H. pylori infection in peptic ulcer patients, and second, to study the response to the two weeks H. pylori eradication triple therapy in peptic ulcer patients carrying different blood groups. A total of 84 patients who presented with symptoms of PUD and showed positive endoscopic examination of PUD and evidence of H. pylori infection by histology and stool antigen test, were divided into four groups according to ABO blood group phenotype. All H. pylori infected patients received standard H. pylori eradication triple therapy for 14 days duration. Patients were followed up by re- endoscopic examination after 2 months of treatment course. The percentage of H. pylori infection in patients with peptic ulcer disease carrying blood group O was higher than other blood group phenotype. In H. pylori-infected peptic ulcer patients, higher incidence of gastric ulcer (GU) was noticed among blood group A carriers, while higher incidence of duodenal ulcer (DU) was found among blood group O carriers when compare with other blood group phenotypes. Fourteen days triple therapy showed lower eradication rate in H. pylori infected blood group O peptic ulcer patients, while a higher response to the standard H. pylori eradication triple therapy was found among patients with blood group B phenotype.

Study of incidence of peptic ulcer perforation in young adults

Background: Peptic ulcer perforation is the commonest perforation of the gastrointestinal tract affecting 2-10% population showing a shift from older to the younger population. With this statistics a study for incidence of peptic ulcer perforation in young adults 18-30 years was carried out. Methods: Prospective study of patients admitted on emergency basis and diagnosed as peptic ulcer perforation either gastric or duodenal perforation intraoperatively in patients 18-30 years were studied from June 2009 to October 2011. Results: Of 175 patients, 70 (40%) patients were between 18 and 30 years age. 58 (82.85%) were males and 12 (17.14%) were females. Twenty-three (32.85%) patients had history suggestive of acute peptic disease/ulcer and had taken some treatment in the form of antacid H-2 blocker or proton pump inhibitor while 47 (67.14%) patients had no history. Pain was the consistent symptom while tachycardia, tenderness, and guarding were the signs present in all 70 (40%) patients. Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). Ultrasonography abdomen S/O pyoperitoneum was found that all 70 (100%). 57 (81.42%) patients had an anterior duodenal perforation, 12 (17.14%) patients had a gastric perforation with a ratio of 4.7:1, and 1 patient had a combined gastric and duodenal perforation. 1 (2.43%) patient expired in the post-operative period, 55 (78.57%) patients come for regular follow and 14 (20%) patients were lost to follow-up. Only 4 (7.2%) patients had mild to moderate symptoms of peptic ulcer disease which were controlled by anti-ulcer drugs. Conclusion: Peptic ulcer perforation is a disease more common in the young population with a male preponderance.

AB0957 Efficacy of rebamipide in prevention of COX-2 inhibition induced gastrointestinal injuries (gastropathy) in older adults with knee osteoarthritis: A randomized placebo-controlled study

BackgroundOsteoarthritis (OA), particularly knee OA, represents a major cause of disability and pain. Selective COX-2 inhibitors are frequently used in the treatment of OA to control pain and inflammation. These...

Perforated duodenal ulcer: A rare complication of deferasirox in children

Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

Randomised clinical trial: rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel for the healing of aspirin-related peptic ulcer

Clopidogrel does not inhibit prostaglandin synthesis. As a result, clopidogrel's incidence of peptic ulcer disease (PUD) and ulcer bleeding is lower than aspirin's. To compare the healing rate in aspirin-related dyspeptic ulcer patients who were given proton pump inhibitor (PPI) plus aspirin or PPI plus clopidogrel. Patients with aspirin-related nonbleeding symptomatic ulcers were randomised to receive rabeprazole (20 mg/day) plus aspirin (100 mg/day) or rabeprazole (20 mg/day) plus clopidogrel (75 mg/day) for 12 weeks. The primary endpoint was the successful treatment of PUD as characterised by intention-to-treat at the end of therapy. Two hundred and eighteen patients (109 in the aspirin group and 109 in the clopidogrel group) were enrolled. There were no statistical demographic differences between the group that received aspirin and the group that received clopidogrel. The PUD treatment success rate was also statistically equal between the clopidogrel and aspirin groups (86.2% vs. 90.0%, P = 0.531). Neither group experienced ulcer-related bleeding. Multivariate logistic regression analysis showed that large ulcer size (>10 mm) (OR: 6.29, 95% CI: 2.58-15.37) and past history of PUD (OR: 3.69, 95% CI: 1.24-10.97) were important predictors of unsuccessful therapy for aspirin-related PUD. Rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel in treating aspirin-related symptomatic PUD. Large ulcer size (>10 mm) and past history of PUD are important predictors of unsuccessful therapy (NCT 01037491).

S1215 Quality of Life Impairment in Community Subjects with Functional Dyspepsia Defined According to the ROME III Criteria

Background and aims: Major changes were made in the Rome III criteria for functional dyspepsia where two distinct syndromes were postulated, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was to explore if quality of life, using the validated SF-36, is impaired in functional dyspepsia and among functional dyspepsia subgroups defined according to the Rome III definition. Method: A random sample (n=2,860) of the adult population of two northern Swedish municipalities (n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms (ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality (VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%). The mean values of SF-36 domains in different dyspepsia categories were calculated. Multivariate logistic regression analysis, adjusting with age and sex, was used to analyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results: SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) were classified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD); 52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandial distress syndrome. FD was significantly associated with low scores in every SF-36 domain (all p≤0.01); EPS was associated only with worse Bodily Pain (p<0.05) but PDS was associated with impairment in all domains (all p ≤ 0.01). Symptomatic peptic ulcer disease (PUD) impaired quality of life significantly more than FD only in domain RP (p<0.05). Conclusions: Functional dyspepsia appears to seriously impair quality of life in adult nonpatients, and PDS is associated with more quality of life impairment than EPS. Table. SF-36 domain scores in different dyspepsia groups

S1216 Bone Mineral Density and Bone Turnover Markers in Patients with Inflammatory Bowel Disease

Background and aims: Major changes were made in the Rome III criteria for functional dyspepsia where two distinct syndromes were postulated, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was to explore if quality of life, using the validated SF-36, is impaired in functional dyspepsia and among functional dyspepsia subgroups defined according to the Rome III definition. Method: A random sample (n=2,860) of the adult population of two northern Swedish municipalities (n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms (ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality (VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%). The mean values of SF-36 domains in different dyspepsia categories were calculated. Multivariate logistic regression analysis, adjusting with age and sex, was used to analyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results: SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) were classified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD); 52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandial distress syndrome. FD was significantly associated with low scores in every SF-36 domain (all p≤0.01); EPS was associated only with worse Bodily Pain (p<0.05) but PDS was associated with impairment in all domains (all p ≤ 0.01). Symptomatic peptic ulcer disease (PUD) impaired quality of life significantly more than FD only in domain RP (p<0.05). Conclusions: Functional dyspepsia appears to seriously impair quality of life in adult nonpatients, and PDS is associated with more quality of life impairment than EPS. Table. SF-36 domain scores in different dyspepsia groups

Spontaneous gastrojejunal fistula is a complication of gastric ulcer

Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula. Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also, gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25 cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration. Postoperative course was uneventful. Per oral intake started on the 4(th) postoperative day, and the patient was discharged on the 8(th) postoperative day. In summary, this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.

Helicobacter pylori eradication prior to initiation of long-term non-steroidal anti-inflammatory drug therapy in Chinese patients – a cost-effectiveness analysis

Recent randomized clinical trials suggested that eradication of Helicobacter pylori prior to initiation of non-steroidal anti-inflammatory drug (NSAID) therapy would reduce the rate of peptic ulcer disease (PUD). To analyze the cost-effectiveness of H. pylori eradication prior to initiation of long-term NSAID therapy for prevention of NSAID-induced PUD in a cohort of Chinese patients at high risk for PUD. Clinical and economic data of 100 participants from a previously reported clinical trial conducted in Hong Kong were analyzed. Patients with a history of peptic ulcers were randomized to 1-week omeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg twice daily (eradication group; n = 51) or 1-week omeprazole 20 mg twice daily (omeprazole group; n = 49) before initiation of diclofenac 100 mg daily for 6 months. The rates of PUD and healthcare utilization for routine follow-up as well as for management of symptomatic PUD of the 2 groups were retrieved from medical records. The rate of symptomatic ulcers in eradication group and omeprazole group were 3.9% and 18%, respectively. The mean direct medical cost of the eradication group was significantly lower than that of the omeprazole group by 30% (US dollar 797 (95% CI = 685 - 909) versus US dollar 1,128 (95% CI = 879 - 1,377)) (p = 0.018). The results were robust to variation of all the cost items. H. pylori eradication prior to initiation of NSAID therapy appeared to reduce the ulcer rate and mean direct medical cost when compared to no eradication for Chinese H. pylori-infected NSAID users at high risk for PUD.

Otolaryngologic manifestations of gastro-oesophageal reflux disease in Lagos

Gastro-oesophageal reflux disease(GERD) is not an uncommon disease in Nigeria. The otolaryngologic (ORL) symptoms associated with GERD are varied. In the management of patients with ORL symptoms and disease, GERD is often not considered as a differential diagnosis The aim of this study is to identify patients with ORL complications of GERD from patients with ORL disease who have symptoms that mimic GERD using defined criteria in the light of limited diagnostic facilities. A prospective study was conducted over a two year period at Lagos University Teaching Hospital Lagos and two private Otolaryngology clinics,within Lagos, among patients who presented primarily with laryngeal and pharyngeal symptoms . They were evaluated using structured questionnaire for duration of regurgitation, heartburn ,symptoms of peptic ulcer disease, clinical examination, esophagogastro - duodenoscopy findings and outcome of laryngopharyngeal symptoms following anti-reflux therapy. A total of 92 patients were evaluated over a two year period .ORL diseases and symptoms at presentation were chronic laryngitis, chronic pharyngitis, globus pharyngeus, globus and chronic laryngitis, laryngeal carcinoma, cricopharyngeal spasm and throat hawking. History of symptoms of peptic ulcer disease and regurgitation was obtained in 47.8% and 65.2% respectively. Endoscopic findings revealed oesophageal reflux with gastroduodenits in 4.3%, Non specific gastritis in 17.4%, duodenal ulcer in 56.4%, and normal findings in 21.7%. Patients were treated medically with antacids, H2 antagonists, proton pump inhibitors and were followed up for 9-12 months. GERD was diagnosed in 4 (4.34%), 68 (73.9%) were diagnosed as non erosive reflux disease (NERD) and 20 (21.74%) with probable acid related problem that will need further evaluation . Following anti-reflux therapy 68 (73.9%) had disappearance of their laryngopharygeal symptoms for up to a year. ORL complications of GERD/NERD was seen in 72 (78.3%). GERD should be a differential diagnosis in patient with pharyngeal and laryngeal symptoms not associated with sinus disease in the presence or absence of positive peptic ulcer disease or regurgitation and the management should be multidisciplinary.

A Humble Bacterium Sweeps This Year's Nobel Prize

Earlier this month, the Nobel Prize in Physiology or Medicine was awarded to the Australians Barry Marshall and Robin Warren for their discovery of the bacterium Helicobacter pylori and its role in peptic ulcer disease and gastric cancer. It is the first time since 1928 that the Nobel Prize has been awarded for the discovery of a bacterium, and H. pylori is the first bacterium to be associated with cancer.

Silent peptic ulcer disease: frequency, factors leading to “silence,” and implications regarding the pathogenesis of visceral symptoms

Background Peptic ulcer disease may occur in the absence of dyspeptic symptoms. The pathogenesis of dyspepsia in peptic ulcer disease is unclear. Whether the presence of Helicobacter pylori infection or use of non-steroidal anti-inflammatory drugs affects dyspeptic symptoms in patients with peptic ulcer disease has not been determined. The aim of the study was to determine the frequency and risk factors for peptic ulcer disease in a cohort of asymptomatic, unselected patients undergoing routine screening EGD. Methods This was a prospective study of a cohort of Chinese subjects undergoing screening EGD as part of a routine health maintenance program. Routine EGD screening was performed in 6457 consecutive subjects who underwent a self-paid, health evaluation. Those with endoscopy-confirmed peptic ulcer disease were enrolled to assess the risk factors that distinguish asymptomatic patients with peptic ulcer disease from patients with symptoms because of peptic ulcer disease. Results A total of 704 (10.9%) patients were found to have peptic ulcer disease, of which two thirds (n = 496) were asymptomatic. Both uni- and multivariate analysis showed that the asymptomatic patients tended to have a larger body mass index, to be habitual tea drinkers, and to have an ulcer that was less than 1 cm in diameter and in a healing stage. Gender, blood group, history of hypertension and/or diabetes, ulcer location, Helicobacter pylori status, use of non-steroidal anti-inflammatories or sedative medications, habitual coffee drinking, and habits with respect to smoking of tobacco or ingestion of alcohol, had no association with symptoms. Conclusions The results of this study suggest that silent peptic ulcer disease is common in Taiwan. Dyspeptic symptoms because of peptic ulcer disease may be influenced by intrinsic (body mass index and ulcer characters) and extrinsic (habitual tea drinking) factors. Non-steroidal anti-inflammatory drug use and Helicobacter pylori status had no significant effect on the symptomatology of peptic ulcer disease. These findings may contribute to the understanding of the pathogenesis in the visceral symptoms of peptic ulcer disease.