Treatment Of Peptic Ulcer Disease Research Articles

Review of Ethnobotanical and Ethnopharmacological Evidence of Some Ethiopian Medicinal Plants Traditionally Used for Peptic Ulcer Disease Treatment.

A peptic ulcer is described as the rupture of the mucosal integrity of the stomach, the duodenum, and, in certain cases, the lower esophagus as a result of contact with chloridopeptic secretions. The two most common kinds of peptic ulcer disorders are referred to as “gastric ulcer” and “duodenal ulcer.” The name is derived from the location of the ulceration. Despite the promise of a wide range of antiulcer treatments, these therapies are associated with several adverse reactions, including hypersensitivity, arrhythmia, impotence, gynecomastia, galactorrhea, hematological abnormalities, and kidney disease, which are intolerable for many patients. Nowadays, there is a lot of emphasis on finding new and innovative agents. As a result, herbal medicines are commonly utilized in circumstances when drugs are used for long periods and are also cost-efficient, effective, and readily available. In this review paper, a total of 82 medicinal plants have been identified and reported for their use in the treatment of peptic ulcer disease. The majority of these medicinal plants are widely used throughout Ethiopia. However, only the safety and efficacy of Plantago lanceolata, Osyris quadripartita, Rumex nepalensis, Cordia africana, Croton macrostachyus, and Urtica simensis have been scientifically studied in animal models. Despite this, many medicinal plants’ pharmacological effects and chemistry have not been well studied scientifically. As a result, further bioactive compound characterization, efficacy, mechanism of action evaluation, and toxicity evaluation of medicinal plants should be carried out. A study that can improve the documentation of indigenous knowledge and contribute to drug development and future self-reliance is also recommended.

Review on Peptic ulcer and its effective Management and Treatment with Herbals

Peptic Ulcer Disease (PUD) is one of the major problems of the gastrointestinal tract occurs in the stomach, duodenum and oesophagus. PUD is characterized by mucosal damage either by pepsin, gastric acid secretion or bacterial infection. Apart from infection due to gram negative bacteria-Helicobacter pylori, regular consumptions of the medications like, NSAIDS, steroids and excessive stress are also some major causes of the PUD. Complications of PUD may include bleeding, perforation, and blockage of the stomach. The PUD is an emerging health challenge in the developed and developing countries. Commonly use of potent synthetic antiulcer chemotherapy arises with adverse effects that might be a cause of serious health challenge. Traditional utilization and scientific reports of medicinal plants in the management of peptic ulcer-like-symptoms urge to redesign the existing clinical approach of using synthetic drugs for the treatment of PUD and adopt the scientifically proven plant drugs for the treatment of PUD which might free or have lesser adverse effects as compared to the synthetic chemotherapy. The review might bestow a strategic planning for the treatment of PUC to the medical practitioners and a newer scope to the researchers to explore the traditional claims of the plant drugs.

Electroacupuncture ameliorates peptic ulcer disease in association with gastroduodenal microbiota modulation in mice.

Peptic ulcer disease (PUD) is a common disease and frequently encountered in the clinic. Accumulating evidence suggests that PUD is associated with the gastrointestinal microbiota. Electroacupuncture (EA) is an improved version of acupuncture, which can improve the clinical effect by increasing the stimulation and delivering appropriate electrical pulses to needles. This method has been widely used in the treatment of peptic ulcer disease. However, its effect on gastrointestinal microbiota remains unclear. Therefore, in the present study, the ameliorative effect of EA was evaluated on the gastroduodenal mucosa, and the regulatory effect of the gastroduodenal microbiota was assessed in PUD mice. A total of 48 male Kun Ming mice were randomly divided into the following groups: normal control group (NC), PUD model group (PUD), Shousanli group (LI10), and Zusanli group (ST36) (n=12). The mice in groups LI10 and ST36 were treated with EA at LI10 and ST36, respectively. This intervention was continued for 7 days. Subsequently, we evaluated the morphological changes in the gastric and duodenal mucosa, and specific indices were measured, including the contents of serum dopamine (DA), the trefoil factor (TFF), and the vasoactive intestinal peptide (VIP). In addition, the gastric and duodenal microbiota were assessed via 16S ribosomal DNA sequencing. The results indicated that EA at LI10 or ST36 significantly reduced the injury of the gastroduodenal mucosa in PUD mice. The gastric microbial community structure of the groups LI10 and ST36 was similar to that of the NC group following comparison with the microbial community structure of the PUD model group. Moreover, the abundance of Firmicutes in the stomach was decreased, whereas that of Bacteroidetes was increased, and the abundance of Firmicutes in the duodenum was decreased. Furthermore, the microbial diversity and richness of the gastric microbiota in group LI10 were also significantly increased, and the serum dopamine and trefoil factor levels in group ST36 were significantly increased. Therefore, it is suggested that EA ameliorating PUD is in association with improving the levels of DA and TFF and regulating the relative abundances of Firmicutes and Bacteroidetes in the gastric microbiota.

Aktivitas Antiulseratif Berbagai Tanaman Herbal dan Prospek Masa Depan Sebagai Tanaman Budidaya

Peptic ulcer disease (PUD) is one of the most common gastrointestinal disorders in individuals aged 20-50 with 1081 cases of death (0.08%) in Indonesia. The main risk factors for PUD include the use of non-steroidal anti-inflammatory drugs, Helicobacter pylori infection, alcohol, smoking, and physical stress. Nowadays, PUD treatment has transformed using secondary metabolites of herbal plants to compete with allopathic treatment adverse effects. Through this systemic review, several herbal plant metabolites from various studies are responsible for gastroprotective, inhibition of certain neurotransmitters, proton pump repression, or different anti-inflammatory effects. The literature search was carried through extensive databases (PubMed, Science Direct, Semantic Scholar, Springer Link, SAGE, and Google Scholar) with keywords linked with PUD. The scope of the data investigated included plant species, groups of metabolites, in vivo application doses, metabolites mechanism of action, and analytical methods.

Determination of Omeprazole, Esomeprazole and Pantoprazole by Quenching the fluorescence of Eosin Y

A non-extractive, simple and sensitive spectrofluorimetric method with good selectivity has been described for the determination of the proton pump inhibitors namely; Omeprazole, Esomeprazole magnesium and Pantoprazole sodium that are used for the treatment of peptic ulcer disease. The method is based on the quenching the fluorescence intensity of the eosin Y dye, as the result of the ion-pair complex formation of the studied drugs with the dye in the presence of acetate buffer solution of pH 3.5. The quenching of the eosin Y fluorescence intensity was measured spectrofluorimetrically at 540 nm after excitation at 352 nm. At the optimum reaction conditions, the quenching values of fluorescence (∆F) and concentrations were rectilinear over the concentration ranges of 0.5–13.0, 0.7-15 and 0.3-15 µg/mL for Omeprazole, Esomeprazole magnesium and Pantoprazole sodium respectively. The recovery % values were in the range 99.92-100.56% and relative standard deviation values range was0.430-2.521 for all the studied drugs. The method was applied successfully for determination of above drugs in their pharmaceutical formulations as capsule, tablet and injectables. The method was free from interferences of common excipients.

Peptic ulcer: the current state of the problem

Peptic ulcer disease (PUD) is a chronic polyetiological recurrent disease of gastroduodenal region. In most cases, the pathogenesis of PU is caused by imbalance between the aggressive factors and protective factors of the gastric or duodenal mucosa. Helicobacter pylori (H. pylori) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the major causative factors leading to PUD development. 65% of gastric ulcers and 80% of duodenal ulcers were found to be associated with H. pylori infection. In turn, NSAIDs account for 30% of gastric ulcers and 15% of duodenal ulcers. About 0.1–1% of all PUs are caused by Zollinger-Ellison syndrome. Abdominal pain is the leading symptom in the clinical findings of patients with exacerbation of PUD. Dyspeptic syndrome (vomiting, nausea, belching, abnormal bowel pattern) is much less common in patients with PUD. Endoscopic examination of the upper gastrointestinal tract is currently the gold standard test used in the diagnosis of PUD and is recommended for all patients suspected of having this disease (unless contraindicated). Antisecretory therapy including proton pump inhibitors is the main approach to the treatment of PUD, as well as the prevention of its complications. Integral to the treatment of patients with H. pylori-associated PU is the eradication therapy of the infection. It is reasonable to use a cytoprotector rebamipide, which accelerates ulcer healing and improves the resulting scar quality, as part of the pharmacotherapy of PUD. In addition, the use of rebamipide in H. pylori eradication therapy regimens contributes to increased efficiency of elimination of the microorganisms.

Peptic ulcer disease among dyspeptic patients at endoscopy unit, University of Gondar hospital, Northwest Ethiopia

BackgroundDyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Globally, peptic ulcer disease occurs in 3.5–32% of patients with dyspepsia. Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs/aspirin use are the widely known risk factors for peptic ulcer disease. There was no recent document on H. pylori infection rate among patients with peptic ulcer disease in Ethiopia. This study aimed to determine magnitude and associated factors of peptic ulcer disease among dyspeptic patients in Northwest Ethiopia.MethodsAn institutional-based cross sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit 218 study subjects. A pre-designed semi-structured questionnaire was used to extract clinical information. Olympus flexible fiber-optic endoscope (Olympus, GIF-E 600, Olympus Corp., Hamburg, Germany) was used to confirm the presence of peptic ulcer disease. Diagnosis of active H. pylori infection was made using the fecal H. pylori Antigen 25 T Card Test (Anamol Lab., Pvt. Ltd., Palghar, India). The Data were entered into EPI Info version 4.6.0.2, and then exported to SPSS version 20 for analysis. Explanatory variables associated with peptic ulcer disease were analyzed by applying logistic regression model. P value < 0.05 was used to declare significant association.ResultA total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The mean (+ SD) age of patients was 42 ± 16.4 years. Forty nine percent (95% CI 42.4–56.2) of dyspeptic patients had active H. pylori infection. Peptic ulcer disease was diagnosed in 35% (95% CI 31.4–39.2) of patients with dyspepsia. H. pylori infection (AOR = 6.298, 95% CI 2.965–13.378, P value < 0.001) and NSAIDs/ASA use (AOR = 6.252, 95% CI 2.925–13.362, P value < 0.001) were identified as risk factors for peptic ulcer disease.ConclusionMedical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.

The surgical management of complicated peptic ulcer disease: An EAST video presentation.

Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations. A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy. Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction. Video procedure and technique, not applicable.

Economic and health impacts of Helicobacter pylori eradication strategy for the treatment of peptic ulcer disease: A cost-effectiveness analysis.

BackgroundMost peptic ulcer cases are associated with Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti‐inflammatory drugs (NSAIDs). H. pylori eradication therapy is recommended for the treatment of H. pylori‐positive peptic ulcers. We aimed to assess and validate the cumulative economic and health effects of H. pylori eradication strategy for the treatment of peptic ulcers compared with PPI therapy strategy.Materials and MethodsWe developed a cohort state‐transition model for H. pylori eradication strategy and PPI therapy strategy over a lifetime horizon from a healthcare payer perspective. We targeted two hypothetical cohorts of H. pylori‐positive patients with gastric and duodenal ulcers aged 20, 30, 40, 50, 60, 70, and 80. The main outcomes were costs, quality‐adjusted life‐years (QALYs), life expectancy life‐years (LYs), incremental cost‐effectiveness ratios, ulcer recurrence cases, and ulcer‐associated deaths. One‐way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty.ResultsIn the base‐case analysis, H. pylori eradication strategy was less costly with greater benefits than PPI therapy strategy in all age groups. Cost‐effectiveness was not sensitive to any variables in all age groups. Sensitivity analyses showed strong robustness of the results. From 2000 to 2020, H. pylori eradication strategy saved US$14.07 billion over a lifetime, increased 8.65 million QALYs and 1.23 million LYs over a lifetime, and prevented 551,298 ulcer recurrence cases and 59,465 ulcer‐associated deaths, compared with PPI therapy strategy.Conclusions H. pylori eradication strategy not only has contributed significantly to preventing ulcer recurrence and reducing ulcer‐associated deaths but also has resulted in great cost savings. All over the world, H. pylori eradication strategy is likely to have yielded a comparable magnitude of economic and health benefits, depending on the epidemiology of H. pylori‐related peptic ulcers and the healthcare environment in each country.

The global burden of peptic ulcer disease in 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

Peptic ulcer disease is one of the most common diseases in gastroenterology clinics. However, reported data about the global burden of peptic ulcer disease are still scarce. This was a secondary data analysis on the prevalence, mortality and disability-adjusted life years (DALYs) due to peptic ulcer disease by sex, age group and socio-demographic index (SDI) at the global level in 21 regions and 204 countries and territories between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Globally, the prevalence cases of peptic ulcer disease increased from 6 434 103 (95% uncertainty interval 5 405 963 to 7 627 971) in 1990 to 8 090 476 (6 794 576 to 9 584 000) in 2019. However, the age-standardized prevalence rate decreased from 143.4 (120.5 to 170.2) per 100 000 population in 1990 to 99.4 (83.9 to 117.5) per 100 000 population in 2019. Moreover, the age-standardized mortality rate decreased by 59.4% (55.3 to 63.1) and the DALYs rate fell by 60.6% (56.8 to 63.9) from 1990 to 2019. Across SDI quintiles, low-middle and low SDI quintiles had the highest age-standardized prevalence, mortality and DALYs rates from 1990 to 2019. The age-standardized prevalence, mortality and DALYs estimates of peptic ulcer disease decreased from 1990 to 2019 globally, but more efforts are needed for the prevention, early diagnosis and treatment of peptic ulcer disease in low SDI and low-middle SDI groups of countries.

A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children.

Proton pump inhibitors (PPIs) are among the most prescribed drugs worldwide and include omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole. Their use in pediatrics is approved for children older than 1 year, for the short-term treatment of symptomatic gastroesophageal reflux disease (GERD), healing of erosive esophagitis, treatment of peptic ulcer disease, and eradication of Helicobacter pylori. PPIs are also considered the standard of care for pediatric eosinophilic esophagitis. Despite the strict range of indications, the use of this class of molecules has increased in all pediatric age ranges. The long-term gastric acid suppression in children has been linked to increased risks of gastrointestinal and lower respiratory tract infections, bone fractures, and allergy. This study aims to provide a comprehensive overview of the mechanism of actions, use (and misuse) in infants and children, and safety of PPIs.

Emerging Trends and their Impacts on Peptic Ulcer Diseases: Treatments and Techniques

Background: Peptic ulcer disease (PUD) is prevalent in almost all parts of the world. PUD complications are creating a major source of preventable health care expenses. The major factors responsible for the incidence of PUD and its complication have changed over the past few decades after the identification of non-steroidal inflammatory drugs (NSAIDs) and Helicobacter pylori bacterial infection along with a marked increase in the use of proton-pump inhibitors (PPIs) as drug therapy. The management of PUD has become more complex and challenging due to antimicrobial resistance. Objective: The objective of the study was to highlight current therapy and novel techniques used in the treatment of peptic ulcer diseases. Methods: An exhaustive literature search has been conducted across PubMed, Google, Scopus and Web of Science as an electronic database to add the crucial information from the relevant literature. Results: In the present review, we have discussed PUD and its pathophysiology. The recent trends in PUD and possible treatments with novel techniques have also been discussed. The type and presence of ulcers cannot be predicted accurately based on symptoms. The available treatment approaches for peptic ulcers based on their clinical presentation and etiology are anti-secretary therapy, endoscopy to reveal ulcers followed by drug therapy, and triple therapy for H pylori infection. Conclusion: Thus, the popular and effective methods are very beneficial in controlling PUD. The treatment based on diagnosis is the foremost requirement for ameliorating any disorder. In this article, the emerging techniques and development in the treatment and diagnosis of PUD have been reviewed.

Peptic ulcer disease during pregnancy

Peptic ulcer disease during pregnancy has to be separated from its management and treatment in the general populations. It was demonstrated to have a low incidence rate, with symptoms, frequency and complications decreasing due to maternal hormones. We aimed to outline the actual management and treatment of peptic ulcer disease (PUD) during pregnancy. We performed a literature review by searching relevant information on the subject in PubMed database using the keywords: peptic ulcer disease, pregnancy, H2 receptor antagonists, proton-pump inhibitors, fetal, congenital abnormalities. Current literature studies show a decreased rate of both incidence and symptoms in pregnant women compared to the general population. Step by step therapy combines both lifestyle modifications and medical drugs for the benefit of both mother and fetus. It is difficult to differentiate from the beginning between PUD and gastroesophageal reflux (GERD) or hyperemesis gravidarum, due to similar symptoms. An accurate anamnesis and a good understanding of serological and paraclinical investigations can define the right diagnosis. Management of this pathology in a pregnancy state can be difficult, but a compliant attitude of the mother together with an organized medical approach can facilitate treatment.

Knowledge, Attitude, and Practice of Health Care Workers in the Management of Peptic Ulcer at the Paul VI and the Bogodogo District Hospitals, in Burkina Faso

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD. Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives. Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Know­ledge levels were good to excellent for general knowledge, symptoms and treatment of PUD. Depending on the agent's qualification, knowledge levels were excellent in all areas for two-thirds to three-quarters of the general practitioners, except for knowledge of additional investigation analyses, where only 47.8% had an excellent knowledge. Depending on the level of education, the level of knowledge was at least good for more than 50% of the agents except for the knowledge of additional investigation analyses where only 45.2 % of the agents of secondary school level had a good knowledge. The main attitudes consisted in managing the patients in emergency and out of an emergency context in 45.8% and 42.2% of the cases, respectively. Regarding the practices, 51.5% of the HCWs systematically requested investigation analyses before starting an aetiological therapy. Conclusion: The PUD knowledge ranks from good to excellent. However, the frequent pre­scription of symptomatic treatments could be the cause of many complications. The promotion of continuous medical education is a good mitigation plan to resolve the issues of knowledge and competence regarding the PUD. Keywords: attitude, knowledge, peptic ulcer disease, practice Correspondence: Eric Nagaonlé Somé. Institut de Recherche en Sciences de la Santé (IRSS)/CNRST 10 BP 250 Ouagadougou 10 Burkina Faso. Email: eric.some@gmail.com. Mobile phone: +226 70 75 13 33. Journal of Epidemiology and Public Health (2021), 07(04): 507-519 https://doi.org/10.26911/jepublichealth.2022.07.04.08

Burden of peptic ulcer disease among patients with upper gastrointestinal bleeding

Background: Peptic ulcer disease continues to be the most common cause of non-variceal upper gastrointestinal bleeding. The clinical presentation varies depending on the intensity of bleeding. It can range from an occult bleed to melena or hematemesis and haemorrhagic shock. The diagnostic procedure Esophagogastroduodenoscopy is gold standard for confirmation of peptic ulcer disease and is also helpful in identification of bleeding source. Irrespective of recent advances in medical treatment of peptic ulcer disease, it is important to quickly identify any signs and symptoms of bleeding. This allows for appropriate management of the bleed at an early stage. Therefore, it is important to know the frequency of peptic ulcer disease amongst upper GI bleeds. Aims and Objectives: The main aim of the current study is to identify the burden of peptic ulcer disease amongst patients with upper gastro-intestinal bleeding. Methodology: This retrospective study on 100 selected patients was conducted at the gastrointestinal unit, department of General Medicine, in a South Asian tertiary care centre, over a period of 6 months between May 2020 to December 2020.This period includes review of literature, collection and analysis of data, discussion and finalization of the report. 100 selected patients presenting to the outpatient department with GI symptoms and upper gastrointestinal bleeding, both male and female and above 18 years of age were enrolled in the study. The patient’s medical history was recorded and diagnosis of peptic ulcer disease was confirmed by Esophagogastroduodenoscopy (EGD). Results: Out of 100 investigated cases of upper gastrointestinal bleeding, frequency of peptic ulcer disease was 53, of which 24 were duodenal ulcer, 21 were gastric ulcer,7 were with both gastric and duodenal ulcer and 1 was an esophageal ulcer. The age distribution in the study population ranged from 30 years to 90 years. With the youngest being 33 years of age and oldest 86years. The mean age was 55 years. Out of 100 cases 76 were males and 24 were females, giving a M: F ratio of 3:1.Risk factors included alcohol intake which was seen in 32 patients, smoking was seen in 41, and NSAID’s use was seen in 8 patients; out of a total of 100 patients. Conclusion: Knowing the burden of peptic ulcer disease amongst upper gastrointestinal bleeds makes us aware of the morbidity it can cause. This makes us more alert and ensures mandatory evaluation for bleeding in any suspected or confirmed case of peptic ulcer disease.

S659 Peptic Ulcer With Adherent Clot—Treat It or Leave It: A Systematic Review and Metanalysis of Randomized Trials

Introduction: Peptic ulcer diseases (PUD) remain the most common cause of hospitalized upper GI bleeding patients (30%-60%). Upper endoscopy is needed for diagnosis, stratification, and endoscopic hemostatic therapy of these ulcers depending on the presence of stigmata of increased risk of rebleeding. PUDs with adherent clot (Forrest classification IIb) are at 20-30% risk of rebleeding with a 7% mortality rate. Recent ACG guidelines could not reach a recommendation for or against endoscopic interventions for ulcers with adherent clot resistant to vigorous irrigation. This systematic review and meta-analysis aims to analyze the randomized studies for the treatment of PUD with adherent clot. Methods: The OVID/Medline and Google Scholar databases were screened through June 2021 for randomized studies reporting outcomes (rebleeding and mortality rates) in patients with adherent clot undergoing either endoscopic or medical intervention. Random effects models were used for the meta-analysis. I2 statistics were used to interpret heterogeneity, with I2>75% indicating substantial inter-study variation. A sensitivity analysis was performed using the leave one out method. A p-value < 0.05 was considered statistically significant. Results: Initial database search yielded 1568 articles, of which 8 randomized studies were finally included (Table 1). The total sample size consisted of 713 patients with adherent clot; of which 359 underwent endoscopic intervention while 354 were treated with medical therapy alone (proton pump inhibitors). Meta-analysis of re-bleeding and mortality rates between endoscopic and medical treatment groups revealed a decreased risk of rebleeding with endoscopic intervention (OR 0.247, 95%CI: 0.122-0.498, P=< 0.001) (Figure 1A). Mortality rates (OR 0.573, 95% CI: 0.273-1.204, P=0.151) (Figure 1B), and rates of surgery did not differ significantly between the two cohorts (OR 1.177, 95%CI: 0.598-2.317, P=0.638). However, there was heterogeneity in the type of endoscopic interventions used. Conclusion: The results of our meta-analysis show that endoscopic interventions could benefit patients presenting to the hospital with UGIB due to PUD with adherent clot by decreasing risk of rebleeding. However, there was no effect of endoscopic therapy on mortality. Further, high-quality randomized controlled studies are needed to guide the endoscopists about managing PUD with adherent clot.Table 1.: Mortality in post-bariatric surgery patients that had UGIB (OR).Figure 1.: A. Demographics and mean ago of the study population. B. Group comparisons using a post hoc test.

Оцінка ефективності терапії виразкової хвороби шлунка та дванадцятипалої кишки в дітей підліткового віку з позиції критеріїв якості життя

У статті наведено результати дослідження якості життя в дітей віком 14–17 років, які страждають від виразкової хвороби шлунка та/або дванадцятипалої кишки. Актуальність. При оцінці ефективності різних методів лікування доведено, що клінічних параметрів недостатньо для повноцінної верифікації відповіді на терапію. У перелік необхідних критеріїв оцінки ефективності лікування слід включати показники якості життя. Мета дослідження: оцінити ефективність медикаментозної терапії виразкової хвороби шлунка/дванадцятипалої кишки в дітей віком 14–17 років за допомогою міжнародного опитувальника PedsQL™ 4.0 та визначити доцільність його застосування в педіатричній практиці. Матеріали та методи. Обстежено 50 дітей з діагнозом «виразкова хвороба шлунка та/або дванадцятипалої кишки, стадія загострення» віком 14–17 років. Оцінка якості життя пацієнтів здійснювалась при надходженні в стаціонар та через 1 місяць після лікування за допомогою опитувальника PedsQL™ 4.0 з використанням окремо дитячої та батьківської форми. Результати. При порівнянні показників якості життя на початку лікування та через місяць можна зробити висновок, що вірогідно вищими стали показники як фізичного функціонування, так і емоційного, психосоціального та шкільного функціонування, як при опитуванні дітей, так і при заповненні анкети їх батьками. При заповненні опитувальника дітьми їх показники якості життя виявилися вірогідно вищими, ніж при заповненні опитувальника їх батьками, за шкалами фізичного функціонування, шкільного життя, психосоціального функціонування й за середнім показником за всіма шкалами. Така різниця виявлена і на етапі до лікування, і через місяць після отриманої терапії. Висновок. Вірогідне підвищення більшості показників за даними опитувальника PedsQL™ 4.0 через 1 місяць після отриманого лікування, згідно із затвердженими протоколами, свідчить про можливість застосування даного інструмента оцінки якості життя як додаткового критерію ефективності медикаментозної терапії виразкової хвороби шлунка та дванадцятипалої кишки в дітей підліткового віку.

Diagnosis and Management of Benign Gastric and Duodenal Disease

The diagnosis of uncomplicated peptic ulcers is difficult to make on a solely clinical basis. Whereas radiographic upper gastrointestinal (UGI) series remain useful, endoscopy is the most accurate method of establishing the diagnosis of peptic ulcer disease. Laboratory tests play an important role in the diagnosis of Helicobacter pylori infection and Zollinger-Ellison syndrome. Figures showing UGI series with double contrast and H. pylori organisms on gastric biopsy samples are provided. The improved medical management of peptic ulcer disease has decreased the need for surgical intervention, which is now largely reserved for urgent management of complications such as hemorrhage, bleeding, and perforation, or the management of obstruction from intractable disease. The appropriate extent of preoperative evaluation for a patient undergoing surgery for a benign gastroduodenal disorder is dictated primarily by the nature of the presenting problem. Endoscopy is the main diagnostic tool to identify the source of bleeding, and in many cases endoscopic therapy can control the bleeding. Angiographic transarterial embolization may be considered following failed endoscopic hemostasis, particularly in high-risk surgical patients. Operative planning is described. The steps of the operative technique, complications, and outcome evaluations are provided for the main surgical interventions for peptic ulcer disease, including vagotomy and pyloroplasty for bleeding duodenal ulcer; resection of bleeding gastric ulcer; omental patch for duodenal perforation (Graham patch); antrectomy; highly selective vagotomy; laparoscopic treatment of peptic ulcer disease; and duodenal diverticulectomy. Operative figures show a Kocher maneuver; omental patch; truncal vagotomy; highly selective vagotomy; Taylor procedure; Heineke-Mikulicz pyloroplasty; Finney pyloroplasty; Billroth I and II antrectomy; Braun enteroenterostomy; and duodenal diverticulectomy. This review contains 15 figures, 2 tables, and 43 references.

Esomeprazole in the treatment of equine glandular gastric disease

Background:Equine glandular gastric disease is a highly prevalent disease, for which there is no universally effective treatment. Given the widespread use of esomeprazole in the treatment of peptic ulcer disease in humans, its use in horses warrants further investigation.Objective:To assess rates of healing of equine glandular gastric disease using oral esomeprazole.Study design:Retrospective case series.Methods:Medical records and gastroscopy images of horses diagnosed with equine glandular gastric disease and treated with esomeprazole by Avon Ridge Equine Veterinary Services were reviewed.Results:Out of four horses treated with esomeprazole for 28 days, 75% (three) healed and 25% (one) did not improve. Out of three horses treated with esomeprazole for 14 days, 67% (two) healed and 33% (one) did not improve.Main limitations:The study was limited by its retrospective nature and small sample size.Conclusions:Esomeprazole may be a valid first-line treatment option for equine glandular gastric disease. Larger and more robust studies of esomeprazole are warranted.

Mechanism of Magnoliae Officinalis Cortex in treatment of peptic ulcer based on network pharmacology and molecular docking

Magnoliae Officinalis Cortex(Houpo) can treat peptic ulcer disease(PUD), the mechanism of which remains unclear. In this study, network pharmacology and molecular docking were employed to predict the mechanism of Houpo in the treatment of PUD. Through literature review and TCMSP screening, 15 main active ingredients were obtained. The SwissTargetPrediction database was used to predict the potential targets of the ingredients, and Therapeutic Target Database(TTD), DrugBank, and Human Phenotype Ontology(HPO) to screen the disease-related targets. A total of 49 potential targets were obtained by the intersection of active ingre-dients-related targets and disease-related targets. Cytoscape 3.6.1 was employed to construct the protein-protein interaction network for the targets with high confidence(score&gt;0.700) screened out by STRING. The DAVID database was used for GO and KEGG pathway enrichment of potential targets. GO enrichment analysis showed that the treatment mechanism was mostly related to nuclear receptor activity, ligand-activated transcription factor activity, and G protein-coupled acetylcholine receptor activity. KEGG enrichment analysis found that Houpo could regulate material metabolism, endocrine system, p53 signaling pathway, and PPAR signaling pathway. Molecu-lar docking verified that all 15 ingredients had good binding activities with key targets(CHRM1, CHRM2, FABP1, mTOR, and STAT3). The results mean that Houpo can treat PUD by participating in cell metabolism, inhibiting inflammatory cytokines, and regulating cell proliferation and apoptosis.