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Sample records for bleeding duodenal ulcer

  1. Microcirculatory remodeling in marginal zone of duodenal ulcer after bleeding

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    Sulayeva О.N.

    2009-01-01

    Full Text Available To estimate objectively vessels network remodeling in duodenal mucosa after ulcer bleeding the morphometric analysis of marginal ulcer zone biopsies was performed in 32 patients. It was shown that reparation is accompanied with chronic inflammation and acute alteration of microcirculation. Injection hemostasis led to enhancement of microcirculation, development of edema and ischemic alteration of mucosal tissues. Acute neutrophilic infiltration during 1 day was changed on 3 day with granular tissue development and angiogenesis stimulation. Intensification and prolongation of angiogenesis paral-leled with lymphocytes infiltration after 7 days resulted to villi dysmorphogenesis and changes in cellular content of intestinal epithelium.

  2. Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer

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    Konstantinos Demertzis; Dimitrios Polymeros; Theodoros Emmanuel; Konstantinos Triantafyllou; Pericles Tassios; Spiros D Ladas

    2006-01-01

    AIM: To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer.METHODS: We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer.Omeprazole (20 mg/d) maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence.RESULTS: All the 15 ulcers were healed after being treated with omeprazole (40 mg/d) for 2 mo. Eleven patients with two (1-9) episodes of recurrent ulcer bleeding completed the follow-up (43, 12-72 mo). None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH <4 in patients was 80, 46-95% , and was reduced to 32, 13-70% by omeprazole (P = 0.002).CONCLUSION: Long-term maintenance therapy with omeprazole (20 mg/day) is effective in preventing recurrent ulcer bleeding.

  3. The р53 expression in cells of marginal zone of duodenal ulcers during acute bleeding

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    Sulayeva O.N.

    2009-01-01

    Full Text Available The aim of the work was to estimate the intensity and tissue distribution of proapoptogen p53 expression in duodenal mucosa in patients with acute bleeding caused by peptic ulcers. In 31 patients (1st group the healing of ulcer was detected after effective endoscopic hemostasis and in 15 patients rebleeding took place (2nd group. Performed immunocytochemical investigation allow to determine that acute ulcer bleeding was associated with activation of marginal zone cells apoptosis which was maximal in covering epithelium, vascular endothelium and regions infiltrated by lymphocytes. In patients with rebleeding the higher values of р53 expression were detected in crypts epithelium and in endothelium of dilatating vessels accompanied with intensive edema and lymphocytes infiltration of lamina propria and muscularis mucosae with perifocal activation of cells death. Additionally to apoptosis in 2nd group duodenum the necrosis of cells and epithelium desquamation were found, reflecting the tissue disintegration of duodenal mucosa.

  4. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

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    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  5. Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding

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    Jovanović Miodrag

    2004-01-01

    Full Text Available Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.

  6. Experimental and clinical application of laser doppler flowmetry in gastric and duodenal ulcerative bleedings

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    Afanasieva G.A.

    2011-12-01

    Full Text Available The research goal is to develop a new objective diagnostic method of prerecurrence syndrome that will prognose bleeding recurrence from gastroduodenal ulcers. Materials and methods. Method of laser Doppler flowmetry (LDF of the regional perfusion of tissue has been used. The experimental part has been done on 30 white laboratory rats. Characteristics of regional tissue perfusion in the simulation and laser hemostasis of bleeding have been studied. Gastroduodenal endoscopy has been performed with laser Doppler flowmetry (ELDF in clinical conditions to predict the recurrence of ulcerative bleeding. The prognostic method of gastroduodenal ulcerative bleeding was used in 58 patients hospitalized with such pathology and activity of bleeding Forrest II. Results. The study of microcirculation parameters and experimental hemostasis has showed the possibility of using LDF to measure its performance. Effective hemostasis has been accompanied by a significant decrease in perfusion. On the basis of microcirculation parameters in ulcerative bleeding, medical adrenaline test has been proposed for an objective verification pre-recurrence syndrome. To evaluate the effectiveness of endoscopic hemostasis perfusion has been measured before and after its implementation. Conclusion. ELDF has objectified the prognosis of ulcerative bleeding recurrence, verified pre-recurrence syndrome and evaluated the efficacy of endoscopic hemostasis

  7. Endoscopic laser Doppler flowmetry in the experiment and in the bleeding gastric and duodenal ulcer clinic

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    Kapralov, S. V.; Shapkin, Y. G.; Lychagov, V. V.; Tuchin, V. V.

    2007-05-01

    One of the most complex problems of emergency surgery is the choice of surgical tactics to deal with bleeding peptic ulcer. Endoscopic hemostasis is prescribed to patients with continuing bleedings and prerelapse syndrome. But till nowdays the objective verification of the prerelapse condition had not been worked out. What is more there are no objective criteria to judge the effectiveness of the carried endohemostasis. The aim of the study was to work out a new objective diagnostic method of pre-recurrence syndrome that can be able to make prognosis for possible gastroduodenal ulcer bleeding recurrence more precise. Laser Doppler flowmetry was the method of studies the regional perfusion. The device used in this work was made at the Optics and Biophysics Department of Saratov State University.

  8. Bleeding diathesis and gastro-duodenal ulcers in inherited cytosolic phospholipase-A2 alpha deficiency.

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    Faioni, E M; Razzari, C; Zulueta, A; Femia, E A; Fenu, L; Trinchera, M; Podda, G M; Pugliano, M; Marongiu, F; Cattaneo, M

    2014-12-01

    Arachidonic acid (AA), when cleaved from phospholipids by cytosolic phospholipase A2 alpha (cPLA2a), generates eicosanoids, with pro-hemostatic, pro-inflammatory, vasoactive and gastro-protective functions. We describe a patient (27-year-old man) and his twin-sister with early-onset bleeding diathesis and recurrent gastro-intestinal (GI) ulcers. Platelet aggregation/δ-granules secretion by collagen was impaired, but normal by AA; serum levels of thromboxane (Tx) B2 and 12-hydroxyeicosatetraenoic acid, and urinary levels of 11-dehydro-TxB2 were extremely low. Patients were homozygous for 1723G>C transition in PLA2G4A gene, which changed the codon for Asp575 to His. GI ulcers affected 5/14 heterozygous ( 60 years) family members; none had bleeding diathesis. The proband, his sister and mother also had mildly reduced factor XI levels. Platelet messenger RNA expression did not differ among subjects with different PLA2G4A genotypes. Conversely, platelet cPLA2a was undetectable by Western Blotting in the proband and his sister, and decreased in 1723G>C heterozygous subjects, suggesting that the variant is transcribed, but not translated or translated into an unstable protein. We described a syndromic form of deficiency of cPLA2a , characterised by recurrent GI ulcers and bleeding diathesis, associated with mild inherited deficiency of factor XI. Unlike other reported patients with cPLA2a deficiency, these patients had extremely low levels of platelet TxA2 biosynthesis.

  9. Emergency gastroduodenal artery embolization by sandwich technique for angiographically obvious and oblivious, endotherapy failed bleeding duodenal ulcers

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    Anil, G., E-mail: ivyanil10@gmail.com [Department of Diagnostic Imaging, National University Hospital (Singapore); Department of Radiology, Changi General Hospital (Singapore); Tan, A.G.S.; Cheong, H.-W.; Ng, K.-S.; Teoh, W.-C. [Department of Radiology, Changi General Hospital (Singapore)

    2012-05-15

    Aim: To determine the feasibility, safety, and efficacy of adopting a standardized protocol for emergency transarterial embolization (TAE) of the gastroduodenal artery (GDA) with a uniform sandwich technique in endotherapy-failed bleeding duodenal ulcers (DU). Materials and methods: Between December 2009 and December 2010, 15 patients with endotherapy-failed bleeding DU were underwent embolization. Irrespective of active extravasation, the segment of the GDA supplying the bleeding DU as indicated by endoscopically placed clips was embolized by a uniform sandwich technique with gelfoam between metallic coils. The clinical profile of the patients, re-bleeding, mortality rates, and response time of the intervention radiology team were recorded. The angioembolizations were reviewed for their technical success, clinical success, and complications. Mean duration of follow-up was 266.5 days. Results: Active contrast-medium extravasation was seen in three patients (20%). Early re-bleeding was noted in two patients (13.33%). No patient required surgery. There was 100% technical success, while primary and secondary clinical success rates for TAE were 86.6 and 93.3%, respectively. Focal pancreatitis was the single major procedure-related complication. There was no direct bleeding-DU-related death. The response time of the IR service averaged 150 min (range 60-360 min) with mean value of 170 min. Conclusion: Emergency embolization of the GDA using the sandwich technique is a safe and highly effective therapeutic option for bleeding DUs refractory to endotherapy. A prompt response from the IR service can be ensured with an institutional protocol in place for such common medical emergencies.

  10. Roxatidine in duodenal ulcer.

    OpenAIRE

    1995-01-01

    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates...

  11. Refractory duodenal ulcer

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    Al Freihi Hussein

    1995-01-01

    Full Text Available Refractory or intractable ulcer is defined as an ulcer that fails to heal completely after eight to twelve weeks, despite appropriate treatment with a modern antiulcer therapy in a compliant patient. Refractory ulcer should be suspected in individuals diagnosed to have peptic ulcer if their symptoms persist longer than usual: occurrence of complications or simply their ulcers fail to heal, since up to 25% of such patients remain asymptomatic. Conditions associated with refractory ulcer include noncompliance, continuous consumption of nonsteroidal anti-inflam-matory drugs, acid hypersecretion, smoking. male gender and other factors with questionable role like advanced age, large ulcer size, prolonged duration of symptoms and the presence of complication like bleeding. Nonpeptic ulcers like tuberculosis, malignancy, Crohn′s disease and primary intestinal lymphoma should always be considered in the differential diagnosis. Colonization with H. pylori which is well-known as a cause of frequent recurrences, has not been linked with refractoriness. Patients with refractory ulcers must undergo thorough re-evaluation including repeated endoscopies, obtaining biopsies for microbiology and histology and determination of serum-gastrin level. Once diseases with identifiable etiologies have been ruled out, aggressive medical management with single or multiple antiulcer drugs should be instituted. Such treatments will virtually heal all refractory ulcers. Surgery should be reserved for patients whose ulcers fail to respond to optimal medical therapy or those who develop com-plications necessitating surgical intervention.

  12. Roxatidine in duodenal ulcer.

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    Habibullah C

    1995-07-01

    Full Text Available Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid while 27 patients received ranitidine (150 mg bid for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26; roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p < 0.05. No adverse event was reported during 4 weeks of treatment with roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  13. Roxatidine in duodenal ulcer.

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    Habibullah, C M; Habeeb, M A; Singh, S P

    1995-01-01

    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26); roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  14. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

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    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  15. Abdominal compartment syndrome from bleeding duodenal diverticulum

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    Vakhtang Tchantchaleishvili

    2012-01-01

    Full Text Available Duodenal diverticuli are acquired false diverticuli of unknown etiology. Although mostly asymptomatic, they can occasionally cause upper gastrointestinal hemorrhage, rarely with massive bleeding. In this report, we present (to the best of our knowledge the first reported case of duodenal diverticular bleeding, causing abdominal compartment syndrome. Albeit a rare event, duodenal diverticular bleeding should be included in the differential diagnosis of upper gastrointestinal bleeding. As with our case, a multidisciplinary approach to managing such patients is crucial.

  16. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

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    R. Kadaba

    2011-04-01

    Full Text Available Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

  17. Perforated duodenal ulcer: Emerging pattern

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    Murtaza Ali Asger Calcuttawala

    2014-01-01

    Full Text Available Background: A total of 27 patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied. Materials and Methods: All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham′s omental patch was carried out. This was followed by triple regimen for Helicobacter pylori eradication. Results: All patients were male, maximum incidence (61.54% was noted in the age group of 21-30, ′O′ +ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between the start of symptoms and surgery was 43 h. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series. Conclusion: We conclude that although a number of definitive surgeries have been described for acid peptic disease, but the requirement of such procedures has come down due to increasing use of H. pylori eradication therapy and proton pump inhibitors. However, surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence is greater in young males.

  18. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

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    Hendra Koncoro; I Dewa Nyoman Wibawa

    2015-01-01

    Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms ...

  19. Genotypes of Helicobacter pylori in patients with peptic ulcer bleeding

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    Chin-Lin Perng; Hwai-Jeng Lin; Wen-Ching Lo; Guan-Ying Tseng; I-Chen Sun; Yueh-Hsing Ou

    2004-01-01

    AIM: Helicobacter pyloricauses chronic gastritis, peptic ulcer,gastric cancer and MALT-lymphoma. Different genotypes of Helicobacter pylori are confirmed from diverse geographic areas. Its association with bleeding peptic ulcer remains controversial. The aim of this study was to investigate the Helicobacter pylori vac4 alleles, cagA and iceA in patients with bleeding peptic ulcer.METHODS: We enrolled patients with bleeding, nonbleeding peptic ulcers and chronic gastritis. Biopsy specimens were obtained from the antrum of the stomach for rapid urease test, bacterial culture and PCR assay. DNA extraction and polymerase chain reaction were used to detect the presence or absence of cagA and to assess the polymorphism of vac4 and iceA.RESULTS: A total of 168 patients (60.4%) (25 patients with chronic gastritis, 26 patients with bleeding gastric ulcer,51 patients with non-bleeding gastric ulcer, 26 patients with bleeding duodenal ulcer, and 40 patients with non-bleeding duodenal ulcer) were found to have positive PCR results between January 2001 and December 2002. Concerning genotypes, we found cagA (139/278, 50%), vacA s1a (127/278, 45.7%), and iceA1 (125/278, 45%) predominated in all studied patients. In patients with bleeding peptic ulcers,vac4 s1a and m1T were fewer than those in patients with non-bleeding peptic ulcers (37/106 vs69/135, P=0.017, and 4/106 vs21/135, P=0.002).CONCLUSION: In patients with peptic ulcers, Hpylori vacA s1a and m1T prevent bleeding complication.

  20. Endoscopic biopsy: Duodenal ulcer penetrating into liver

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    Baybora Kircali; Tülay Saricam; Aysegul Ozakyol; Eser Vardareli

    2005-01-01

    @@ TO THE EDITOR We have read with interest the recent report by E Kayacetin and S Kayacetin of Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy[1] since we diagnosed the duodenal ulcer which penetrated into liver similarly. This is a rather unusual case because of the fifth case in the literature and responding to medical therapy.

  1. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

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    Hendra Koncoro

    2015-12-01

    Full Text Available Despite decrease frequency of Helicobacter pylori (H. pylori due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology.

  2. Cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients.

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    Kataoka, S

    1982-01-01

    Cholecystokinin-like activity in the duodenal mucosa was measured by the bioassay method described by Ljungberg to elucidate its significance in 14 duodenal ulcer patients as well as in 13 normal subjects with no evidence of gastrointestinal diseases. The stage of duodenal ulceration was determined endoscopically according to the criterion of the Japanese Gastroenterological Endoscopic Society. The cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients in active stage...

  3. Perforated duodenal ulcer: A rare complication of deferasirox in children

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    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    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. PMID:23833377

  4. Perforated duodenal ulcer: a rare complication of deferasirox in children.

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    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    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.

  5. Perforated duodenal ulcer: A rare complication of deferasirox in children

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    Sunil Kumar Yadav

    2013-01-01

    Full Text Available 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.

  6. Patients with Helicobacter pylori positive and negative duodenal ulcers have distinct clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    Kent-Man Chu; Ka-Fai Kwok; Simon Law; Kam-Ho Wong

    2005-01-01

    AIM: To assess the clinical characteristics of Helicobacterpylori(H pylori) negative duodenal ulcer.METHODS: Patients with an endoscopic diagnosis of duodenal ulcer between 1996 and 2002 were included in the present study. Patients were considered to be negative for Hpylori, if both histological examination and rapid urease test of biopsy specimens were negative. A comparison was made between patients with H pyloripositive and negative duodenal ulcers.RESULTS: A total of 1 343 patients were studied. Their mean age was 54.7±0.5 years. There was a male preponderance (M:F = 2.5:1). Three hundred and ninetyeight patients (29.6%) did not have H pylori infection. The annual proportion of patients with H pylori negative duodenal ulcers increased progressively from 1996 to2002. On multivariate analysis, patients with H pylorinegative duodenal ulcer were more likely to be older, have concomitant medical problem, pre-existing malignancy, recent surgery, underlying sepsis, or taken non-steroidal anti-inflammatory drugs. In terms of clinical presentations, patients with H pylori negative duodenal ulcer were more likely to present with bleeding, multiple ulcers and larger ulcers.CONCLUSION: The proportion of patients with H pylori negative duodenal ulcers is on the rise because of a continued drop in incidence of H pylori positive duodenalulcers in recent years. Such patients have distinct clinical characteristics and it is important to ascertain the H pylori status before starting eradication therapy.

  7. Multiple giant duodenal ulcers associated with duodenal gastrinoma.

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    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Kobara, Hideki; Masaki, Tsutomu

    2012-02-01

    A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection. The patient's symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor by inverting a transnasal endoscope into the duodenal bulb.

  8. Duodenal bleeding from metastatic renal cell carcinoma.

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    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-04-20

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  9. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

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    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-01-01

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested. PMID:21577373

  10. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

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    Tarun Rustagi

    2011-04-01

    Full Text Available Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  11. [Surgical management of duodenal ulcer with hemorrhage from the gastroduodenal artery: antrectomy versus conservative surgery?].

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    Brehant, O; Fuks, D; Sabbagh, C; Wouters, A; Mention, C; Dumont, F; Regimbeau, J M

    2008-01-01

    When surgery is indicated for bleeding duodenal ulcer, the traditional standard of care has been "radical surgical treatment is preferable to conservative therapy since the risk of rebleeding is reduced without an augmentation in morbidity and mortality". This principle is based on two prospective studies published before 1995. Radical surgery at that time consisted of antrectomy, while conservative therapy included oversewing of the bleeding vessel in the ulcer bed and ligation of the gastroduodenal artery (Weinberg procedure). This strategy must be re-evaluated in 2008 in view of our better understanding of the role of Helicopacter pylori in the causation of duodenal ulceration and the decreased risk of post-operative re-bleeding with the use of proton pump inhibitors. The role of surgery has changed. Its aim is no longer to cure the ulcer diathesis but rather to urgently control bleeding in anticipation of ulcer cure with medical therapy.

  12. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  13. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.

    2012-01-01

    -risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  14. DRAGSTEDT, GASTRIC-ACID AND DUODENAL-ULCER

    OpenAIRE

    Hobsley, M.

    1994-01-01

    Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than u...

  15. [Piracetam in combined pathogenetic therapy of recurrent duodenal ulcer].

    Science.gov (United States)

    Tsimmerman, Ia S; Shchetkin, D I

    2002-01-01

    Duodenal ulcer cure, as a systemic gastroenterologic disease, can be achieved in some patients by the addition of the nootropic drug piracetam to current antisecretory and antihelicobacter therapy. Piracetam corrects vegetative and psychoemotional disorders in duodenal ulcer, normalizes gastric motility, has an antioxidant effect and improves cerebral circulation. An optimal effect on clinico-endoscopic manifestations of recurrent duodenal ulcer was achieved in combination of piracetam with current antisecretory (omeprazole) and antihelicobacter (de-nol, amoxicillin, metronidazole) medicines. Such combination improves both short- and long-term outcomes of duodenal ulcer treatment.

  16. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    Directory of Open Access Journals (Sweden)

    Shoko Natsuda

    2015-01-01

    Full Text Available Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  17. Incidence and Clinical Features of Peptic Ulcer Disease In Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit-

    Directory of Open Access Journals (Sweden)

    Y. Cherradi

    2015-12-01

    Full Text Available Introduction: Peptic ulcer disease (PUD has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB. This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527 (table I. 25% were located at duodenal mucosa (n= 347 and 13% were gastric ulcers (n=180. No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department, incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB.

  18. Pantoprazole before Endoscopy in Patients with Gastroduodenal Ulcer Bleeding: Does the duration of Infusion and Ulcer Location Influence the Effects?

    Directory of Open Access Journals (Sweden)

    Istvan Rácz

    2012-01-01

    Full Text Available The aim of this study was to investigate the effect of preemptive pantoprazole infusion on early endoscopic findings in patients with acute ulcer bleeding. Records of 333 patients admitted with acute ulcer bleeding were analyzed. Ulcer bleeders were given either 80 mg bolus of pantoprazole followed by continuous infusion of 8 mg per hour or saline infusion until endoscopy. In 93 patients saline infusion whereas in 240 patients bolus plus infusion of pantoprazole was administrated with mean (±SD durations of 5.45±12.9 hours and 6.9±13.2 hours, respectively (P=0.29. Actively bleeding ulcers were detected in 46/240 (19.2% of cases in the pantoprazole group as compared with 23/93 (24.7% in the saline infusion group (P=0.26. Different durations of pantoprazole infusion (0–4 hours, >4 hours, and >6 hours had no significant effect on endoscopic and clinical outcome parameters in duodenal ulcer bleeders. Gastric ulcer bleeders on pantoprazole infusion longer than 4 and 6 hours before endoscopy had actively bleeding ulcers in 4.3% and 5% compared to the 19.5% active bleeding rate in the saline group (P=0.02 and P=0.04. Preemptive infusion of high-dose pantoprazole longer than 4 hours before endoscopy decreased the ratio of active bleeding only in gastric but not in duodenal ulcer patients.

  19. Perforated duodenal ulcer in Asir central hospital

    Directory of Open Access Journals (Sweden)

    Jastaniah Suleiman

    1997-01-01

    Full Text Available In a study of 27 cases of perforated duodenal ulcer seen at Asir Central Hospital over a period of seven years, two patients were females and 25 males. The highest incidence was in the fourth decade and the average age was 36.3 years. The Saudi-foreigner ratio was 1:2.9 in an area where the Saudi-foreigner population ratio was 1:3. Nine patients (33.3% were previously diagnosed as having peptic ulcer and had received treatment at one time or the other before perforation. Eighteen patients (66.7% were first diagnosed to peptic ulcer after the perforation. All the identified perforations were located anteriorly and anterosuperiorly. Only one case occurred in the second part of duodenum. The rest occurred in the first part. Two patients were treated successfully conservatively. The month perforations occurred most was the month of Shaaban. The fasting period during the month of Ramadhan did not show any increase in the prevalence of perforation in this hospital.

  20. Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers

    Institute of Scientific and Technical Information of China (English)

    Hwai-Jeng Lin; Wen-Ching Lo; Chin-Lin Perng; Guan-Ying Tseng; Anna Fen-Yau Li; Yueh-Hsing Ou

    2005-01-01

    AIM: Helicobacter pylori(Hpylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma.Conventional invasive tests are less sensitive than noninvasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers.METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test,histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of Hpylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2),iceA1,iceA2 and cag A.RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%)and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity,positive predictive value and diagnostic accuracy of mucosal polymerase reaction for Hpylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79%and 81%) than in

  1. Helicobacter pylori in duodenal ulcer disease and its eradication

    Directory of Open Access Journals (Sweden)

    Sengupta S

    2002-01-01

    Full Text Available Antral biopsy specimens were processed for Helicobacter pylori by Gram staining, rapid urease test (RUT and culture from 25 patients with symptoms of duodenal ulcer, amongst whom the positivity rate was 84%. Follow up of 16 patients after appropriate therapy showed complete regression of the disease in 87.5% of cases whereas in 12.5% of cases a decrease in the extent of duodenal ulceration was noted.

  2. Helicobacter pylori and gastric or duodenal ulcer.

    Science.gov (United States)

    2016-01-01

    In patients with gastric or duodenal ulcer associated with Helicobacter pylori, treatment of the infection improves healing and prevents complications and recurrences. The drug regimen generally consists of a high-dose proton-pump inhibitor (PPI) such as omeprazole plus antibiotics. Using the standard Prescrire methodology, we conducted a review of the literature in order to determine the standard empirical antibiotic regimen for H. pylori infection in adults with gastric or duodenal ulcer in France. In 2015, due to an increase in H. pylori resistance to clarithromycin, a 7-day course of the PPI + clarithromycin + amoxicillin combination is effective in only about 70% of cases. A Cochrane systematic review and meta-analysis of trials involving thousands of patients suggests that prolonging treatment with a PPI + amoxicillin + clarithromycin or a PPI + amoxicillin + metronidazole to 10 or 14 days improves the rate of H. pylori eradication by 5% to 10%. A metanalysis of seven trials including a total of about 1000 patients showed that combination therapy with a PPI + amoxicillin + clarithromycin + metronidazole for 5 days eradicates H. pylori in about 90% of cases, compared to about 80% of cases with a PPI + amoxicillin + clarithromycin given for 7 days. Sequential treatment with amoxicillin for 5 days, followed by clarithromycin + metronidazole for 5 days, has also been tested in thousands of patients. Efficacy and adverse effects were similar to those observed when the same antibiotics were taken simultaneously for 5 days. In randomised trials, replacing clarithromycin or amoxicillin with a fluoroquinolone yielded conflicting results. In 2009, nearly 20% of H. pylori isolates were resistant to levofloxacin in France. Tetracycline has only been evaluated in combination with bismuth. The few available data on doxycycline suggest that its efficacy is similar to that of tetracycline. A fixed-dose combination of bismuth subcitrate potassium + metronidazole

  3. Acyclovir in the prevention of duodenal ulcer recurrence

    DEFF Research Database (Denmark)

    Rune, S J; Linde, J; Bonnevie, O;

    1990-01-01

    This study tests the hypothesis that reactivation of a latent herpes simplex virus infection may be a cause of recurrent duodenal ulceration. Patients with recently healed duodenal ulcer were entered into a double blind, randomised study of maintenance treatment with the antiviral drug acyclovir...... (400 mg bid) versus placebo, to determine if suppression of herpes virus infection would influence the natural history of the ulcer disease. One hundred and fifteen patients entered the trial and 76 patients completed it according to the protocol. Endoscopy was performed when ulcer symptoms recurred...... and at the end of the 25 week trial period. In the acyclovir group the cumulated relapse rate was 63% compared with 56% in the placebo group (NS). This result suggests that reactivation of herpes simplex virus is not a cause of recurrent duodenal ulcer....

  4. Acid inhibition and peptic ulcer bleeding.

    Science.gov (United States)

    Štimac, D; Franjić, N; Krznarić, Ž

    2011-01-01

    Peptic ulcer bleeding is one of the most common emergency situations in medicine. Combined pharmacological and endoscopic therapy together with emerging interventional radiological procedures are successfully treating peptic ulcer disease, reserving surgical procedures for only a small portion of patients unresponsive to 'conventional' therapy. Technological advancement has seen a great improvement in the field of endoscopic treatment in the form of various methods of hemostasis. However, pharmacological therapy with proton pump inhibitors still plays the central role in the peptic ulcer bleeding treatment algorithm.

  5. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2007-01-15

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.

  6. Does Ramadan Fasting Increase duodenal ulcer perforation?

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-03-01

    Full Text Available Introduction: In Ramadan, healthy adult Muslims are obliged to fast. Prolonged fasting increase gastric acid and pepsin levels, which promote the risk of duodenal ulcer perforation (DUP. Effects of Ramadan fasting on DUP have not been thoroughly studied yet, and the limited number of studies investigating the impact of Ramadan fasting on DUP yielded discrepant results. This study aimed to evaluate DUP frequency during Ramadan 2011-2015 and compare it with other months. Methods: This cross-sectional study was performed in 82 patients undergoing surgery due to DUP during July 2011-September 2015. The demographics, history of addiction, use of nonsteroidal and antiinflammatory drugs, previous history of acid peptic disease, as well as complications and outcomes of treatment were recorded and analyzed, and the obtained results were compared between Ramadan and other lunar months. Results: The majority of patients were male (86.6%, 71 patients, with a mean age of 43.9±16.5 years (age range: 20-75 years. Male to female ratio was 6:1. Cases with less than 30 years of age were less frequent (22%, 18 patients. DUP was more frequent during Rajab with nine cases (11%, while during Ramadan, six cases were reported, the difference between Ramadan and other months regarding the incidence of DUP was not significant (P=0.7. Risk factors such as smoking (60% and addiction (44%; especially to crystal and crack were noted. Consumption of nonsteroidal antiinflammatory drugs in 20 (24% patients, and use of antacids in 17 (25% patients. Distribution of DUP in different blood types was as follows: O+=41%, A+=28%, B+=23%, AB=5%, and O-=3%; moreover, post-operative Helicobacter pylori antibody was present in 67% of the patients. Conclusion: Ramadan fasting did not escalate DUP incidence, and those with DUP risk factors can fast with the use of antacids.

  7. Upper gastrointestinal bleeding from duodenal vascular ectasia in a patient with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a cirrhotic patient with duodenal vascular ectasia and spontaneous bleeding. The bleeding was successfully controlled with argon plasma coagulation.Duodenal vascular ectasia may be a cause of upper gastrointestinal bleeding in patients with cirrhosis, and argon plasma coagulation may be effective and safe to achieve hemostasis of this lesion.

  8. An uncommon cause of gastro-duodenal ulceration

    Institute of Scientific and Technical Information of China (English)

    Sebastian Mallach; Uwe Ramp; Andreas Erhardt; Marcus Schmitt; Dieter H(a)ussinger

    2008-01-01

    Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection.In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT).SIRT is a palliative treatment for unresectable liver tumours.During SIRT,90Y-microspheres are infused into the hepatic artery.Pretreatment evaluation for the presence of arterial shunts to neighbouring organs should be determined in order to avoid complications of SIRT.

  9. Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child

    Institute of Scientific and Technical Information of China (English)

    Na Mi Lee; Sin Weon Yun; Soo Ahn Chae; Byoung Hoon Yoo; Seong Jae Cha; Byung Kook Kwak

    2009-01-01

    Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.

  10. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

    Directory of Open Access Journals (Sweden)

    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Perforated duodenal ulcer, the most catastrophic complication was Associated with high mortality in the past due to late presentation of the patients, delay in surgery and lack of antibiotics. Various authors state that the incidence of peptic ulcer disease and perforation has been declining for the past 3 decades. Because of advances in the medical therapy of peptic ulcer with a wide range of drugs the management of peptic ulcer disease has been changing and the role of surgery has been declining. Perforation is usually seen in 3rd and 4th decades with a male preponderance and the epidemiological trend is not the same worldwide. Incidence is slightly declining in western countries. The present study has been done during the period between 2013 and 2014 in S. V. R. R. Government general hospital Tirupati. AIMS AND OBJECTIVES The aim of the present study is to analyze the probable factors for increase in incidence of duodenal ulcer perforation, with particular emphasis on assessment of impact of H2 receptor antagonists and Proton Pump inhibitors on the incidence of perforation. STUDY SETTING S. V. Medical College, Department of General Surgery, Tirupati. STUDY PERIOD Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2013 to October 2014. INCLUSION CRITERIA Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have peritonitis due to duodenal ulcer perforation. EXCLUSION CRITERIA Patients with peritonitis due causes other than duodenal ulcer. STUDY METHOD Prospective Observational study among the selected patients. Total numbers of peptic ulcer cases that were admitted in this hospital and treated either medically or surgically were noted. The details of their clinical history and findings, investigation reports, operative findings, post-operative complications were recorded. Simple closure was performed for all the

  11. Platelet aggregation measurement for assessment of hemostasis failure mechanisms in patients with gastroduodenal ulcer bleeding

    Science.gov (United States)

    Barinov, Edward; Sulaieva, Oksana; Lyakch, Yuriy; Guryanov, Vitaliy; Kondratenko, Petr; Radenko, Yevgeniy

    2013-01-01

    Background The purpose of this study was to identify factors associated with the risk of unsustainable hemostasis in patients with gastric and duodenal ulcer bleeding by in vitro assessment of platelet reactivity using artificial neural networks. Methods Patients with gastroduodenal ulcers complicated by bleeding were studied. Platelet aggregation was measured using aggregometry with adenosine diphosphate 5 μM, epinephrine 2.5 μM, 5-hydroxytryptophan 10 μM, collagen 1 μM, and thrombin 0.06 NIH Unit/mL as agonists. Multiple logistic regression was used to evaluate the independent relationship between demographic, clinical, endoscopic, and laboratory data and in vitro assessment of platelet reactivity and local parameters of hemostasis in patients with ulcer bleeding. Results Analysis of platelet aggregation in patients with gastroduodenal ulcer bleeding allowed the variability of platelet response to different agonists used in effective concentration which induces 50% platelet aggregation (EC50) to be established. The relationship between platelet aggregation and the spatial-temporal characteristics of ulcers complicated by bleeding was demonstrated. Adrenoreactivity of platelets was associated with time elapsed since the start of ulcer bleeding and degree of hemorrhage. The lowest platelet response to collagen and thrombin was detected in patients with active bleeding (P < 0.001) and unsustainable recent bleeding (P < 0.01). Decreased adenosine diphosphate-induced platelet aggregation in patients with ulcer bleeding was correlated with the platelet response to thrombin (r = 0.714, P < 0.001) and collagen (r = 0.584, P < 0.01). Conclusion Estimation of platelet reactivity in vitro indicates the key mechanisms of failure of hemostasis in patients with ulcer bleeding. In addition to gender, an important determinant of unsustainable hemostasis was a decreased platelet response to thrombin and adenosine diphosphate. PMID:23950655

  12. Endoscopic hemoclip treatment for bleeding peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    Yung Chih Lai; Sien Sing Yang; Chi Hwa Wu; Tzen Kwan Chen

    2000-01-01

    AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

  13. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.

    Science.gov (United States)

    Graham, David Y

    2014-05-14

    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

  14. Effect of oral epidermal growth factor on mucosal healing in rats with duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Jane CJ Chao; Kuo-Yu Liu; Sheng-Hsuan Chen; Chia-Lang Fang; Chih-Wei Tsao

    2003-01-01

    AIM: To investigate the effect of epidermal growth factor (EGF) on mucosal healing in rats with duodenal ulcer.METHODS: Male Sprague-Dawley rats were randomly divided into sham operation without EGF, sham operation with EGF, duodenal ulcer without EGF, or duodenal ulcer with EGF groups. Additionally, normal rats without operation served as the control group. Duodenal ulcer was induced in rats by 300 mL/L acetic acid. Rats with EGF were orally administered at a dose of 60 μg/kg/day in drinking water on the next day of operation (day 1). Healing of duodenal ulcer was detected by haematoxylin and eosin staining. Cell growth of damaged mucosa was determined by the contents of nucleic acids and proteins. The level of EGF in duodenal mucosa was measured by ELISA.RESULTS: The pathological results showed that duodenal ulcer rats with EGF improved mucosal healing compared with those without EGF after day 5. Duodenal ulcer rats with EGF significantly increased duodenal DNA content compared with those without EGF on day 15 (6.44±0.54mg/g VS 1.45±0.52 mg/g mucosa, P<0.05). Duodenal RNA and protein contents did not differ between duodenal ulcer rats with and without EGF during the experimental period.Sham operation and duodenal ulcer rats with EGF significantly increased duodenal mucosal EGF content compared with those without EGF on day 5 (76.0±13.7 ng/g VS 35.7±12.9ng/g mucosa in sham operation rats, and 68.3±10.9 ng/gVS 28.3±9.2 ng/g mucosa in duodenal ulcer rats, P<0.05).CONCLUSION: Oral EGF can promote mucosal healing of the rats with duodenal ulcer by stimulating mucosal proliferation accompanied by an increase in mucosal EGF content.

  15. Laparoscopic Repair for Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  16. Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis.

    Science.gov (United States)

    Riggle, Kevin M; Wahbeh, Ghassan; Williams, Elizabeth M; Riehle, Kimberly J

    2015-11-28

    Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.

  17. Superoxide dismutase phenotypes in duodenal ulcers: A genetic marker?

    Directory of Open Access Journals (Sweden)

    Sulekha S

    2006-01-01

    Full Text Available Background:Cu-Zn superoxide dismutases are antioxidative defensive enzymes that catalyze the reduction of superoxide anions to hydrogen peroxide. Aim:The study focuses on the association of electromorph of superoxide dismutase with duodenal ulcers, which result due to an imbalance between aggressive and defensive factors. Materials and Methods:Endoscopically confirmed 210 duodenal ulcer patients and 185 healthy individuals for comparative analysis were considered for the present study. Phenotyping of superoxide dismutase was carried out by subjecting the RBC membranes to polyacrylamide gel electrophoresis, using appropriate staining protocols. Results:Statistical analysis of SOD phenotypes revealed a significant increase of SOD AFNx012 allele and Superoxide dismutases (SOD 2-2 phenotype in duodenal ulcer group. Among these individuals, a predominance of Helicobacter pylori infection was observed. The increased preponderance of homozygotes can be explained on the basis of reduced and altered enzyme activity, which may lead to disturbance in homeostasis of antioxidant/oxidant culminating in high lipid peroxidative gastric mucosal tissue damage and ulceration. No variation in the distribution of SOD phenotypes with respect to Helicobacter pylori indicates the role of Mn-SOD rather than Cu-Zn SOD in the Helicobacter pylori infected cases as reported earlier. Conclusions:Superoxide dismutase as a genetic marker / gene modifier, encoding for an antioxidant enzyme in maintaining tissue homeostasis of the gastric mucosa is discussed.

  18. [Cycloferon in treating duodenal ulcers in rats].

    Science.gov (United States)

    Bul'on, V V; Khnychenko, L K; Sapronov, N S; Kuznetsova, N N; Anikin, V B; arinenko, R Iu; Kovalenko, A L; Alekseeva, L E

    2001-01-01

    The possibility of using cycloferon (interferon inductor) for a complex treatment (in combination with the main drug solcoseryl possessing pronounced therapeutic properties) of duodenum ulcers was experimentally studied in male rats. The experiments showed a considerable difference in the interferon status of animals with model duodenum ulcers treated with cycloferon, solcoseryl, their combination, and placebo (control). The healing effect of solcoseryl administered in combination with cycloferon exceeded that of each component administered separately.

  19. Diagnosis of Helicobacter pylori infection using urease rapid test in patients with bleeding duodenal ulcer: influence of endoscopic signs and simultaneous corporal and antral biopsies Diagnóstico de la infección por Helicobacter pylori mediante el test rápido de la ureasa en pacientes con hemorragia por úlcera duodenal: influencia de los signos endoscópicos de sangrado y de la obtención simultánea de biopsias de cuerpo y antro gástrico

    Directory of Open Access Journals (Sweden)

    M. Castro Fernández

    2004-09-01

    Full Text Available Introduction: the sensitivity of invasive diagnostic methods for Helicobacter pylori (H. pylori infection, particularly of urease rapid test, is decreased in cases of gastroduodenal ulcer and upper gastrointestinal bleeding. Objectives: to assess the influence of blood in the stomach or recent bleeding endoscopic signs in the diagnostic sensitivity of urease rapid test among patients with bleeding duodenal ulcer, as well as the influence of simultaneously collected corporal and antral biopsy samples. Patients and methods: 120 patients, 85 male and 35 female, with an average age of 62 (18-88 years, who were admitted to our Hospital due to bleeding duodenal ulcer and who received an endoscopic diagnosis within 24 hours of admission were included. None of the patients had been under treatment with non-steroideal antiinflammatory drugs, proton-pump inhibitors or antimicrobial drugs in the two weeks prior to the bleeding event, and none had received eradicating therapy for H. pylori. In this group of selected patients an H. pylori infection rate nearing 100% was assumed. H. pylori infection was ruled out using antral biopsy (69 cases or both antral and fundic biopsies (51 cases for urease rapid testing (Jatrox®-H.p.-Test. Patients were classified in three groups according to their endoscopic bleeding signs: a presence of blood in the stomach or recent bleeding ulcer (21 cases; b ulcer showing non-recent bleeding signs (38 cases; and c ulcer without bleeding signs (61 cases. The sensitivity of the urease rapid test was compared between patient groups. Similarly, urease test results with an antral biopsy sample were compared in 100 patients with non-bleeding duodenal ulcer. Results: urease test was positive in 93% of patients with non-bleeding duodenal ulcer, and in 83% of patients with upper gastrointestinal bleeding, which reached statistical significance (p = 0.019. This test was positive in 82.6% of patients with an antral biopsy, and in 82.3% of

  20. NSAID-induced gastro-duodenal bleeding: risk of development and patient management

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    A P Rebrov

    2008-01-01

    Full Text Available A.P. Rebrov, E.l. Koshkina, A.A. Antonyan, R.V. Lyakisheva NSAID-induced gastro-duodenal bleeding: risk of development and patient management. Retrospective analysis of gastro-duodenal bleeding (GDB report forms was performed. Pts admitted to the department of internal diseases of Saratov regional clinical hospital from 1999 to 2004 were included. 354 cases of GDB were recorded ( 282 from 1999 to 2001 and 72 from 2002 to 2004. Cause ofbleeding, influence of NSAID administration on appearance and relapse ofbleeding, source ofbleeding and pt management were assessed. NSAJD administration was considered trigger factor of GDB in 24% in 1999-2001 and in 18% in 2002-2004. The results of the study show some tendency to decrease of NSAID- induced gastropathy frequency among causes of GDB. The main risk factors ofbleeding during NSAID treatment were age of more than 30 years, ulcer history, the first month of NSAID administration. GDB frequency did not depend on regularity of treatment and NSAID dosage.

  1. [The prognostic value of gastric metaplasia in the duodenal mucosa in patients with Helicobacter pylori positive duodenal bulb ulcer].

    Science.gov (United States)

    Marshalko, O V; Konorev, M R

    2008-01-01

    The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.

  2. Roxatidine acetate in the long term maintenance of duodenal ulcers.

    Science.gov (United States)

    Brunner, G

    1988-01-01

    A non-comparative multicentre study of 105 patients with healed duodenal ulcers was conducted to determine the effect on ulcer recurrence of 6 months' maintenance treatment with roxatidine acetate 75 mg daily. All patients had previously received roxatidine acetate treatment. 31 patients out of 89 had 32 relapsed ulcers after 6 months of treatment, which represents an overall relapse rate of around 30%; the relapse rate in smokers was double that of non-smokers. The overall incidence of epigastric pain did not increase significantly over the period of the trial, although some patients complained of mild pain when they entered the study despite having endoscopically confirmed healed ulcers. At the end of the study continuous poor appetite and pyrosis were reported by 17% and 6% of patients, respectively. Side effects, which included constipation and diarrhoea, were reported by 4 patients, 1 of whom withdrew from therapy. There were no clinically significant changes in laboratory values. Thus, maintenance treatment with roxatidine acetate 75 mg daily proved a safe and effective method of preventing symptomatic duodenal ulcer relapse.

  3. Dysfunction of neutrophils in patients with peptic ulcers, complicated with bleeding

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    Sulayeva O.N.

    2011-01-01

    Full Text Available To analyze a role of leukocytes dysfunction in the pathogenesis of ulcer bleeding the oxygen dependent metabolism, phagocytic activity and cytochemical indices of neutrophils were estimated in 100 patients with gatric and duodenal ulcers bleeding with effective hemostasis (group 1, n = 77 and rebleeding (group 2, n = 23. It was shown that peptic ulcer bleeding in patients of group 1 was associated with moderate increase of spontaneous production of active oxygen radicals, restriction of induced NADPH oxidase activity, decrease of acid phosphatase and myeloperoxidase activity but enhancement of phagocytic index. Sharp increase of spontaneous NBT-reaction with lost of oxidize functional reserve in neutrophils with significant inhibition of ability to phagocytosis and decreased of lysosomal enzymes activity were risk factors for rebleeding in patients of group 2.

  4. Gastro-duodenal ulcers with perforation caused by short-term acetylsalicylic acid ingestion: Case report

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    Ćulafić Đorđe

    2009-01-01

    Full Text Available Introduction. Acetylsalicylic acid ingestion may cause serious gastrointestinal toxicity, in particular bleeding or perforated peptic ulcer. Case Outline. A 72-year-old male patient presented with diffuse abdominal pain, malaise, and dark stools. Several days before hospitalization, he had cerebrovascular insult and began to use acetylsalicylic acid of 100 mg per day. In physical findings a diffusely painful sensitivity of the abdomen was detected on palpation. Laboratory findings revealed hyposideremic anaemia with inflammatory syndrome. Native abdominal x-ray did not show the presence of pneumoperitoneum. Upper endoscopy of the gastric corpus and antrum revealed several ulcerations 10-11 mm in diameter covered with fibrin, with bleeding ulceration in the angulus region of the lesser gastric curvature. The bulbus was oedematous and hyperaemic with a perforated ulcer on the anterior wall. Upper central laparotomy showed a perforated duodenal bulbus. The posterior wall of the bulbus was normal, while the anterior wall was without scarring. Given the general condition of the patient and local findings, interrupted suture of the ulcer was performed with omentoplasty. Postoperative course was uneventful. A peroral diet was initiated on the 4th postoperative day, and the patient was discharged on the 8th postoperative day. Conclusion. Elderly people who use acetylsalicylic acid in prophylaxis should take it in lower doses, with proton pump inhibitors, especially during the first two months.

  5. Situs inversus totalis with perforated duodenal ulcer: a case report

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    Khan Faiz

    2011-07-01

    Full Text Available Abstract Introduction Situs inversus is an uncommon anomaly. Situs inversus viscerum can be either total or partial. Total situs inversus, also termed as mirror image dextrocardia, is characterized by a heart on the right side of the midline while the liver and the gall bladder are on the left side. Patients are usually asymptomatic and have a normal lifespan. The exact etiology is unknown but an autosomal recessive mode of inheritance has been speculated. The first case of perforated duodenal ulcer with situs inversus was reported in 1986; here, we report the second case of this nature in the medical literature. Case presentation A 22-year-old Pakistani man presented with severe epigastric and left hypochondrial pain. Examination and investigations (chest X-ray and ultrasonography confirm peritonitis in a case of situs inversus totalis. On exploratory laparotomy, a diagnosis of situs inversus totalis with perforated duodenal ulcer was confirmed. Graham's patch closure of the duodenal ulcer was performed with absorbable sutures, and a thorough peritoneal lavage was also performed; an incidental appendectomy was also performed to avoid further diagnostic problems. Our patient had an uneventful recovery. Conclusions A diagnostic dilemma arises whenever abdominal pathology occurs in patients with situs inversus. Although an uncommon anomaly, to choose a proper surgical incision site for abdominal exploration pre-operative recognition of the condition is important.

  6. Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started

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    Marcel JM Groenen

    2009-01-01

    Full Text Available BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.

  7. A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer

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    Khaleghian Farzaneh

    2006-01-01

    Full Text Available Abstract Background Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran. The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients. Methods In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day. Results No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p Conclusion This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074, shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization.

  8. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Ahmet Karaman; Mevlut Baskol; Sebnem Gursoy; Edip Torun; Alper Yurci; Banu Demet Ozel; Kadri Guven; Omer Ozbakir; Mehmet Yucesoy

    2011-01-01

    AIM: To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding. METHODS: Eighty-five (18 female, 67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study. Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding. Initial hemostasis and rebleeding rates were primary and secondary end-points of the study. RESULTS: Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups, respectively (P 0.05). CONCLUSION: APC is an effective hemostatic method in bleeding peptic ulcers. Larger multicenter trials are necessary to confirm these results.

  9. Determination of the Risk of Recurrent Gastroduodenal Ulcer Bleeding

    OpenAIRE

    2016-01-01

    Despite the advances in endoscopic haemostasis, the incidence of recurrent ulcer bleeding remains to be high. It necessitates further search for its prognosis and methods of treatment.The objective of the research was to analyse risk factors for recurrent gastroduodenal ulcer bleeding.Materials and methods. The study included 203 patients with gastroduodenal ulcer bleeding. There were 135 (66.5%) males and 68 (33.3%) females. All the patients were examined and received conservative treatment ...

  10. Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

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    Carlos H.F. Chan

    2011-04-01

    Full Text Available Acute upper gastrointestinal (UGI bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later.

  11. Epidermal growth factor inhibits cysteamine-induced duodenal ulcers

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1983-01-01

    The effect of the duodenal ulcerogen cysteamine on secretion of epidermal growth factor from Brunner's gland pouches was studied in the rat. Total output of immunoreactive epidermal growth factor was reduced to approximately 55%, compared with controls, 5 h after administration of cysteamine (300...... mg/kg, s.c.). Furthermore, measurements on tissue extracts of the pouches revealed that 5 h after cysteamine treatment, Brunner's glands were depleted of epidermal growth factor. The effect on ulcer development of intraduodenally applied exogenous epidermal growth factor (1 micrograms/kg . h) also...... factor used, when tested on chronic fistula rats, had no effect on acid secretion and did not influence bicarbonate secretion from Brunner's gland pouches. These results demonstrate that epidermal growth factor has a cytoprotective effect on the duodenal mucosa, and it is suggested that inhibition...

  12. The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

    DEFF Research Database (Denmark)

    Jess, P; von der Lieth, L; Matzen, Peter;

    1989-01-01

    stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lower ego-strength to cope with such events (P less than 0.05). The results indicate that personality assessments make it possible to distinguish between subgroups of duodenal ulcer patients...

  13. Portal Hypertensive Duodenopathy Manifesting as “Kissing” Duodenal Ulcers in a Nigerian with Alcoholic Cirrhosis: A Case Report and Brief Review of the Literature

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    Aderemi Oluyemi

    2012-01-01

    Full Text Available Multiple duodenal ulcers are an uncommon finding in portal hypertensive duodenopathy (PHD. They represent a potential source of clinically significant bleeding from the upper gastrointestinal system in patients with cirrhosis. As this particular ulcer entity in relation to PHD has no distinguishing symptoms aside from those relating to the consequent bleeding, most of them are found either on routine endoscopic screening for cirrhotics or on endoscopic examination for cause(s of bleeding in this patient population. The case documented below highlights many of the aspects of pathogenesis, associations, and consequences of this unique endoscopic finding in cirrhotic patients.

  14. Platelet aggregation measurement for assessment of hemostasis failure mechanisms in patients with gastroduodenal ulcer bleeding

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    Barinov E

    2013-08-01

    Full Text Available Edward Barinov,1 Oksana Sulaieva,1 Yuriy Lyakch,2 Vitaliy Guryanov,2 Petr Kondratenko,3 Yevgeniy Radenko3 1Department of Histology, Cytology, and Embryology, 2Department of Medical, Biological Physics, Medical Informatics, and Biostatistics, 3Department of Surgery and Endoscopy, M Gorky Donetsk National Medical University, Donetsk, Ukraine Background: The purpose of this study was to identify factors associated with the risk of unsustainable hemostasis in patients with gastric and duodenal ulcer bleeding by in vitro assessment of platelet reactivity using artificial neural networks. Methods: Patients with gastroduodenal ulcers complicated by bleeding were studied. Platelet aggregation was measured using aggregometry with adenosine diphosphate 5 µM, epinephrine 2.5 µM, 5-hydroxytryptophan 10 µM, collagen 1 µM, and thrombin 0.06 NIH Unit/mL as agonists. Multiple logistic regression was used to evaluate the independent relationship between demographic, clinical, endoscopic, and laboratory data and in vitro assessment of platelet reactivity and local parameters of hemostasis in patients with ulcer bleeding. Results: Analysis of platelet aggregation in patients with gastroduodenal ulcer bleeding allowed the variability of platelet response to different agonists used in effective concentration which induces 50% platelet aggregation (EC50 to be established. The relationship between platelet aggregation and the spatial-temporal characteristics of ulcers complicated by bleeding was demonstrated. Adrenoreactivity of platelets was associated with time elapsed since the start of ulcer bleeding and degree of hemorrhage. The lowest platelet response to collagen and thrombin was detected in patients with active bleeding (P< 0.001 and unsustainable recent bleeding (P < 0.01. Decreased adenosine diphosphate-induced platelet aggregation in patients with ulcer bleeding was correlated with the platelet response to thrombin (r = 0.714, P < 0.001 and collagen (r

  15. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers.

    Science.gov (United States)

    Søgaard, Kirstine K; Farkas, Dóra K; Pedersen, Lars; Lund, Jennifer L; Thomsen, Reimar W; Sørensen, Henrik T

    2016-06-01

    Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994-2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori-related) and gastric ulcers (dominantly lifestyle-related) compared with the general population. We started follow-up 1-year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1-5-year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31-1.44) and 1.30 (95% CI: 1.23-1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking- and alcohol-related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized.

  16. Prevalence of non- Helicobacter pylori duodenal ulcer in Karachi,Pakistan

    Institute of Scientific and Technical Information of China (English)

    Javed Yakoob; Wasim Jafri; Nadim Jafri; Muhammad Islam; Shahab Abid; Saeed Hamid; Hasnain AliShah; Hizbullah Shaikh

    2005-01-01

    AIM: To determine the prevalence of non-Helicobacter pylori (H pylori)-related duodenal ulcer in patients with acid-peptic diseases.METHODS: Medical records of patients who attended the Gastroenterology Department at Aga Khan University Hospital from 1999 to 2001 and had endoscopic diagnosis of duodenal ulcers were reviewed. Duodenal ulcer associated with H pylori was diagnosed on the basis of endoscopy,rapid urease test and histopathology whereas histories of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) related duodenal ulcers. Non-H pylori, non-NSAID duodenal ulcers were those without H pylori infection and history of NSAID intake. Co-morbid conditions associated were noted.RESULTS: Of 2 260 patients, 10% (217/2 260) had duodenal ulcer. Duodenal ulcer related to H pylori infectionaccounted for 53% (116/217), NSAID-related 10% (22/217),non-H pylori non-NSAID 29% (62/217), and 8% (17/217) had both Hpyloriinfection and histories of NSAID intake. Fifteen percent (18/116)_patients had past histories of peptic ulcer disease in Hpyloriinfection, while 8% (5/62) in non-Hpylorinon-NSAID ulcer. Co-morbid conditions in H pylori infection were seen in 23% (27/116) and 34%(21/62) in non-H pylori non-NSAID ulcer.CONCLUSION: Incidence of H pylori infection related with duodenal ulcer is common. In the presence of co-morbids, non-Hpyloriand non-NSAID duodenal ulcer is likely to be present.

  17. Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

    Institute of Scientific and Technical Information of China (English)

    Christopher; Steevens; Maisa; Abdalla; Truptesh; H; Kothari; Vivek; Kaul; Shivangi; Kothari

    2015-01-01

    Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

  18. [Clinical pathway for bleeding peptic ulcers].

    Science.gov (United States)

    Mizuki, Akira; Tatemichi, Masayuki; Nikaido, Mitsuhiro; Hosoe, Naoki; Funakoshi, Sinsuke; Fukui, Kazuto; Maeda, Norio; Shigematsu, Takeharu; Nishiya, Hiromi; Hayashi, Tatsuhiko; Nagata, Hiroshi; Hibi, Norifumi; Tsukada, Nobuhiro

    2006-03-01

    We devised and evaluated a clinical pathway (CP) protocol for patients with bleeding peptic ulcers (BPU). Patients without severe comorbidities, who had been diagnosed with BPU and who had undergone endoscopic treatment, were enrolled in our study. The CP adaptation rate for BPU patients was 78.8% (89/113). The variance rate was 13.5% (12/89). The median length of admission was 10.0 +/- 4.6 days (n = 78) before and 7.4 +/- 2.9 days (n = 77) after introducing CP. Our CP for BPU was safe and resulted in shorter hospital stays and, therefore, cost reductions. In elder patients, our CP was also successful, but the variance rate was higher than in younger patients.

  19. A brief analysis of patients suffering from stomach or duodenal ulcers in Almaty hospital №1

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    Aryzbekova Aliya

    2015-12-01

    Full Text Available Peptic ulcers are a serious problem worldwide, and affect about 4 million people each year. Their etiology is connected with the presence of Helicobacter pylori, the act of smoking, drinking alcohol, being stress, and taking excessively nonsteroidal anti-inflammatory drugs, as well as steroids. The most common symptoms are abdominal pain, nausea, chest pain and fatigue, while less frequent symptoms include vomiting and weight loss. Helicobacter pylori is responsible for about 80% of gastric and 90% of duodenal ulcer cases. In this work, an analysis is made of a correlation between stomach or duodenal ulcer and gender, residence and number of patients hospitalized in the Almaty hospital №1, from 2009-2012, in order to learn about trends in the incidence of these diseases in Kazakhstan. A total number of 950 patients with stomach and duodenal ulcers, in 2009-2012, were questioned. The patient’s residence, gender and stomach or duodenal ulcer problem were taken into account in the study. The result of this work reveals that the largest amount of hospitalized patients suffering from stomach or duodenal ulcers came from urban areas. Moreover, more women than men suffered from peptic ulcers. Furthermore, the number of patients admitted to the hospital due to duodenal ulcers did not show any variation throughout the study. However, the least number of patients suffering from gastric ulcers was noticed in December 2009, and the greatest was in October and November 2011. The obtained data show that ulcers are a serious problem in Kazakhstan.

  20. The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

    DEFF Research Database (Denmark)

    Jess, P; von der Lieth, L; Matzen, Peter

    1989-01-01

    One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were characterist......One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were...... characteristics of duodenal ulcer patients, and whether the presence of such possible personality disorders might influence the prognosis of the disease. Neuroticism occurred in 53% of the patients, but only in 5% of controls (P less than 0.0001). Overall, personality disorders were present in 69% of the patients...... compared with 30% of the controls (P less than 0.0001). Neuroticism was connected with a high frequency of relapse (P less than 0.05) whereas failure of spontaneous ulcer healing had no certain relation to personality disorders. Patients with non-neurotic personality disorders had more frequently suffered...

  1. Longitudinal study of influence of Helicobacter pylori on current risk of duodenal ulcer relapse. The Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Clausen, M R; Franzmann, M B; Holst, C;

    1992-01-01

    acid output, time of healing of the preceding ulcer, treatment of the present ulcer (cimetidine, antacids, or no treatment), or type and degree of gastritis. Thus, although H. pylori is prevalent in patients with duodenal ulcer disease, the present study indicates that H. pylori does not have...

  2. Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

    Institute of Scientific and Technical Information of China (English)

    M Hobsley; Fl Tovey

    2001-01-01

    @@INTRODUCTION It is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

  3. Helicobacter pylori virulence factors in duodenal ulceration: A primary cause or a secondary infection causing chronicity

    Institute of Scientific and Technical Information of China (English)

    Frank I Tovey; Michael Hobsley; John Holton

    2006-01-01

    Reports from countries with a high prevalence of Helicobacter pylori (H pylori) infection do not show a proportionately high prevalence of duodenal ulceration,suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of H pylori infection and virulence factors. Although virulent strains of H pylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pyloriinfection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, non- ulcer dyspepsia or normal subjects in many countries, where the prevalence of both H pylori infection and of virulence factors was high.In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low,only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.

  4. THE CLINICAL MANIFESTATIONS AND COURSE OF DUODENAL ULCER DISEASE AFTER PERFORATED ULCER

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    L. A. Lyubskaya

    2014-01-01

    Full Text Available Objective: to compare clinical manifestations, course, mental status in duodenal ulcer (DU patients with a history of perforated ulcer and its uncomplicated course.Subjects and methods. One hundred and thirteen patents with DU were examined. Group 1 included 61 patients with uncomplicated DUand Group 2 comprised 52 patients with a history of perforated ulcer. A comparison group consisted of 20 patients who had undergone laparotomy. Physical and mental status examinations, esophagogastroduodenoscopy (EGDS, and 24-hour pH-metry were performed.Results. Classical pain syndrome was observed in 75 % of the patients with uncomplicated DU. Prior to perforation, the pain and dyspeptic syndromes were distinguished only by a significantly lower degree in Group 2; following perforation, the pain syndrome was recorded more frequently, it was more extensive, meal-unrelated, and similar to that in the patients who had undergone laparotomy and had diminished appetite (36.5 %. EGDS showed that the complicated course was accompanied by the significantly higher incidence of erosive esophagitis (21.2 %, gastritis (51.9 %, duodenitis (25.0 %, multiple ulcers (28.8 %, and larger ulcers. 24-hour pH-metry indicated that the level of hyperacidity in Group 2 was higher and the circadian intragastric pH variations were less marked than those in uncomplicated DU. The patients with a history of perforated ulcer showed a high rate of anxiety and depressive changes. Conclusion. In complicated DU, marked monotonic hyperacidity causes common erosive-ulcerative lesions in the gastroduodenal area in relatively mild pain syndrome, late referrals, and long-term ulcer healing. After perforation followed by wound closure, the pain and dyspeptic syndromes become more pronounced, which is associated with anxiety and depressive changes in the mental status, as well as with early referrals and less healing time.

  5. The personality patterns in patients with duodenal ulcer and ulcer-like dyspepsia and their relationship to the course of the diseases. Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Jess, P; Eldrup, J

    1994-01-01

    OBJECTIVES. To compare personality characteristics in duodenal ulcer patients and patients with ulcer-like dyspepsia from the primary health sector with duodenal ulcer patients from a hospital and to evaluate the relationship of the personality characteristics to the course of the diseases. DESIGN....... A prospective study using the Minnesota Multiphasic Personality Inventory (MMPI) with retesting of a subgroup of patients after a median observation period of 14 months. SETTING. Departments of Medical and Surgical Gastroenterology, Hvidovre University Hospital, and the primary health sector in Roskilde County......, Denmark. SUBJECTS. Sixty hospital patients with duodenal ulceration and 17 patients with duodenal ulceration plus 25 patients with ulcer-like dyspepsia from the primary health sector. MAIN OUTCOME MEASURES. MMPI scores. RESULTS. The hospital patients differed from the two other groups of patients...

  6. Modern issues on the treatment of peptic ulcer bleedings

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  7. Photocoagulation in the treatment of bleeding peptic ulcer

    Science.gov (United States)

    Otto, Wlodzimierz; Paczkowski, Pawel M.

    1996-03-01

    The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

  8. Formulation and evaluation of omeprazole tablets for duodenal ulcer

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    Choudhury A

    2010-01-01

    Full Text Available Omeprazole pellets containing mucoadhesive tablets were developed by direct punch method. Three mucoadhesive polymers namely hydroxypropylemethylcellulose K4M, sodium carboxy methylcellulose, carbopol-934P and ethyl cellulose were used for preparation of tablets which intended for prolong action may be due to the attachment with intestinal mucosa for relief from active duodenal ulcer. Mucoadhesive tablets were coated with respective polymer and coated with Eudragit L100 to fabricate enteric coated tablets. The prepared tablets were evaluated for different physical parameters and dissolution study were performed in three dissolution mediums like 0.1N hydrochloric acid for 2h, pH 6.5 and pH 7.8 phosphate buffer solution for 12hr. Sodium carboxymethylcellulose showed above 95% release within 10 h where as carbopol-934P showed slow release about 88% to 92% over a period of 12 h. having excellent mucoadhesive strength but ethyl cellulose containing tablets showed less than 65% release. The release mechanism of all formulation was diffusion controlled confirmed from Higuchi′s plot. Thus, the present study concluded that, carbopol-934P containing mucoadhesive tablets of omeprazole pellets can be used for local action in the ulcer disease as well as for oral controlled release drug delivery.

  9. Perforated duodenal ulcer a rare cause of acute abdomen in infancy: A report of two cases

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    Kadian Yogender

    2008-01-01

    Full Text Available Duodenal ulcer perforation is very uncommon in infants and children, that is why it is not usually considered in the differential diagnosis of acute abdomen in this age group. Moreover, the diagnosis of this condition is usually overlooked because of vague and variable symptoms and low index of suspicion on the part of the treating physicians. In this brief report, we are reporting two cases of successfully managed perforated duodenal ulcer in infancy.

  10. Effects of Ginkgo biloba extract on cytoprotective factors in rats with duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Jane C.-J. Chao; Huei-Chen Hung; Sheng-Hsuan Chen; Chia-Lang Fang

    2004-01-01

    AIM: To investigate the effects of Ginkgo biloba extract on cytoprotective factors in rats with duodenal ulcer.METHODS: Sprague-Dawley rats were randomly divided into four groups: sham operation without ginkgo, sham operation with ginkgo, duodenal ulcer without ginkgo, and duodenal ulcer with ginkgo. Rats with duodenal ulcer were induced by 500 mL/L acetic acid. Rats with ginkgo were intravenously injected with Ginkgo biloba extract from the tail at a dose of 0.5 mg/(kg.d) for 7 and 14 days.RESULTS: Pathological result showed that duodenal ulcer rats with ginkgo improved mucosal healing and inflammation compared with those without ginkgo after 7 d treatment. After 14 d treatment, duodenal ulcer rats with ginkgo significantly increased weight gain (34.0±4.5 g versus 24.5±9.5 g,P<0.05) compared with those without ginkgo. Duodenal ulcer rats significantly increased cell proliferation (27.4l±4.0and 27.8±2.3 BrdU-labeled cells in duodenal ulcer rats with and without ginkgo versus 22.4±3.5 and 20.8±0.5 BrdUlabeled cells in sham operation rats with and without ginkgo,P<0.05) compared with sham operation rats. Mucosal prostaglandin E2 concentration significantly increased by 129% (P<0.05) in duodenal ulcer rats with ginkgo compared with that in those without ginkgo. Duodenal ulcer rats without ginkgo significantly decreased superoxide dismutase activity in the duodenal mucosa and erythrocytes (19.4±6.7 U/mg protein versus 38.1±18.9 U/mg protein in the duodenal mucosa,and 4.87±1.49 U/mg protein versus 7.78±2.16 U/mg protein in erythrocytes, P<0.05) compared with sham operation rats without ginkgo. However, duodenal ulcer rats with ginkgo significantly increased erythrocyte superoxide dismutase activity (8.22±1.92 U/mg protein versus 4.87±1.49 U/mg protein,P<0.05) compared with those without ginkgo. Duodenal ulcer rats without ginkgo significantly increased plasma lipid peroxides (4.18±1. 12 μmol/mL versus 1.60±1.10 μmol/mL and 1.80±0.73

  11. Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

    Directory of Open Access Journals (Sweden)

    Aly Saber

    2012-01-01

    Full Text Available Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.

  12. Clinical Outcomes of Endoscopic Hemostasis in Marginal Ulcer Bleeding.

    Science.gov (United States)

    Yamasaki, Yasushi; Takenaka, Ryuta; Hori, Keisuke; Takemoto, Koji; Kawano, Seiji; Kawahara, Yoshiro; Fujiki, Shigeatsu; Okada, Hiroyuki

    2016-12-01

    The usefulness of endoscopy in marginal ulcer bleeding has rarely been studied, and the optimal method for preventing rebleeding is unclear. Here we assessed the efficacy of endoscopy in marginal ulcer bleeding and examined the efficacy of proton pump inhibitors (PPIs) in the prevention of rebleeding. A total of 28 patients with marginal ulcer bleeding (21 men, 7 women; median age 58.5 years) were treated by endoscopy. We analyzed the clinical characteristics, results of endoscopic therapy, characteristics of rebleeding patients, and relation between the use of PPIs and the duration of rebleeding. Sixteen patients had active bleeding. Initial hemostasis was achieved in all patients. There were no procedure-related adverse events. Rebleeding occurred in one patient within the first month and in 7 patients thereafter. There was a significant difference in the rebleeding rate between the patients who received a PPI and those who did not. In a multivariate analysis, the non-use of PPIs was a risk factor for rebleeding (hazard ratio, 6.22). Therapeutic endoscopy is effective in achieving hemostasis from marginal ulcer bleeding. PPIs may prevent rebleeding from marginal ulcers.

  13. Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Panagiotis; Tsibouris; Chissostomos; Kalantzis; Periklis; Apostolopoulos; Antonios; Zalonis; Peter; Edward; Thomas; Isaacs; Mark; Hendrickse; Georgios; Alexandrakis

    2014-01-01

    AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration(cases) and 60 matched patients with a non-bleeding peptic ulcer(controls) underwent small bowel capsule endoscopy, after a negative colonoscopy(compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowellesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy.RESULTS: Forty(67%) cases and 18(30%) controls presented small bowel erosions(P = 0.0001), while 22(37%) cases and 4(8%) controls presented small bowel ulcers(P < 0.0001). Among non-steroidal antiinflammatory drug(NSAID) consumers, 39(95%) cases and 17(33%) controls presented small bowel erosions(P < 0.0001), while 22(55%) cases and 4(10%) controls presented small bowel ulcers(P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3(SD = 1.4) g/d L in cases with small bowel ulcerative lesions and 10.5(SD = 1.3) g/dL in those without(P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6(27%) cases with small bowel ulcers presented bleeding recurrence most

  14. [Guidelines of treatment for non-bleeding peptic ulcer disease].

    Science.gov (United States)

    Cheung, Dae Young; Jung, Hwoon Yong; Song, Ho June; Jung, Sung Woo; Jung, Hyun Chae

    2009-11-01

    Over the past century, since the introduction of non steroidal anti-inflammatory drugs (NSAID), antacid, histamine H2-receptor antagonists (H2RA), proton pump inhibitors (PPI), and discovery of Helicobacter pylori infection, the paradigm of peptic ulcer disease has changed with marked decrease in morbidity and mortality. However, peptic ulcer disease still occupies a position as a major health problem with increase of aged population and NSAIDs usage. In daily general practice, the management of peptic ulcer disease is directed according to the presence of bleeding or not. For non-bleeding peptic ulcer disease, proper acid suppression and the correction of underlying causes such as Helicobacter pylori infection and NSAID use is the main stay of treatment. Though a complete understanding of pathophysiology and a perfect treatment strategy are still a challenge, this guideline aims to provide practical recommendations based on evidences or consensus of experts through in-depth literature review and expert meeting.

  15. Challenges in the management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lau, James Y W; Barkun, Alan; Fan, Dai-ming; Kuipers, Ernst J; Yang, Yun-sheng; Chan, Francis K L

    2013-06-08

    Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.

  16. Dramatic regression and bleeding of a duodenal GIST during preoperative imatinib therapy: case report and review

    Directory of Open Access Journals (Sweden)

    Schwandner Thilo

    2010-06-01

    Full Text Available Abstract Background Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the digestive tract. The majority of GISTs is located in the stomach. Only 3-5% of GISTs are located in the duodenum associated with an increased risk of gastrointestinal bleeding as primary manifestation. With response rates of up to 90%, but complications like bleeding due to tumor necrosis in 3%, imatinib mesylate dramatically altered the pre- and postoperative therapy for GIST patients. Case presentation A 58-year-old female patient presented with acute upper gastrointestinal bleeding 2 weeks after a giant GIST of the duodenum had been diagnosed. Neoadjuvant imatinib therapy had been initiated to achieve a tumor downsizing prior to surgery. During emergency laparotomy a partial duodenopancreatectomy was performed to achieve a complete resection of the mass. Histology revealed a high-malignancy GIST infiltrating the duodenal wall. Adjuvant imatinib therapy was initiated. At follow-up (19 months the patient is still alive and healthy. Conclusion Giant GISTs of the duodenum are rare and - in contrast to other localizations - harbour a higher risk of serious bleeding as primary manifestation. Tumor necrosis and tumor bleeding are rare but typical adverse effects of imatinib therapy especially during treatment of high-malignancy GIST. In GIST patients with increased risk of tumor bleeding neoadjuvant imatinib therapy should thoroughly be performed during hospitalization. In cases of duodenal GIST primary surgery should be considered as treatment alternative.

  17. A STUDY OF DUODENAL ULCER PERFORATION: RISK FACTORS AND PROGNOSTIC DETERMINANTS IN BTGH, GULBARGA

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    Rajshekhar

    2015-11-01

    Full Text Available : BACKGROUND AND OBJECTIVES: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in BTGH, Gulbarga. MATERIAL AND METHODS: The study was conducted in the Department of Surgery, Basaveshwara Teaching and General Hospital, Gulbarga Karnataka during the period of Nov. 2011 - Sep.2013. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confirm at operation. Surgery was defined as urgent less as 4 hours between admission and surgery, same day (4-24 hours and delayed at a later time during the same admission. This study comprises of 60 cases of duodenal ulcer perforation admitted in the Department of Surgery, Basaveshwar Teaching & General Hospital. Operative details included the site and nature of operation performed. Mortality was defined as death following surgical procedure. Post-operative morbidity was defined in terms of duration of hospital stay and associated complications following surgery. INCLUSION CRITERIA: All patients in whom a diagnosis of duodenal ulcer perforation was established on admission and confirmed by investigations between November 2011-September 2013 are included in this study. EXCLUSION CRITERIA: 1. Cases of gastric antral perforation. 2. Cases of traumatic duodenal perforation

  18. Precise role of H pylori in duodenal ulceration

    Institute of Scientific and Technical Information of China (English)

    Michael Hobsley; Frank I Tovey; John Holton

    2006-01-01

    The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured,have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease,and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur.Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.

  19. Cysteamine-induced duodenal ulcer and acid secretion in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1980-01-01

    Duodenal ulcers can be produced in rats within 24 h by a single subcutaneous administration of cysteamine. To determine the role of gastric acid secretion in the pathogenesis of these ulcers, secretory and pathoanatomic studies were performed in chronic fistula rats ater an ulcerogenic dose...... of cysteamine. A prolonged increase of acid secretion was seen after cysteamine, reaching fourfold the basal level after 5 h. The acid response lasted for 10 to 11 h. After vagotomy cysteamine-induced acid secretion was markedly reduced. Ulcer formation was prevented by vagotomy and by drainage of the gastric...... for ulcer formation, the hypersecretion of acid induced by cysteamine is not the only factor responsible for the development of duodenal ulcer....

  20. Oral administration of synthetic human urogastrone promotes healing of chronic duodenal ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier; Nexø, Ebba

    1986-01-01

    The effect of oral administration of synthetic human epidermal growth factor/urogastrone (EGF/URO) on healing of chronic duodenal ulcers induced by cysteamine in rats was investigated and compared with that of cimetidine, a H2-receptor antagonist. After 25 and 50 days of treatment, synthetic human...... EGF/URO significantly increased healing of chronic duodenal ulcers to the same extent as cimetidine. Combined treatment with synthetic human EGF/URO and cimetidine for 25 days was more effective than synthetic human EGF/URO given alone, whereas combined treatment for 50 days was significantly more...... effective than cimetidine alone. These results show that a combination of an agent inhibiting gastric acid secretion and the cytoprotective and growth-stimulating peptide EGF/URO seems to be more effective with regard to duodenal ulcer healing than individual administration of the two substances. Synthetic...

  1. The Helicobacter pylori theory and duodenal ulcer disease. A case study of the research process

    DEFF Research Database (Denmark)

    Christensen, A H; Gjørup, T

    1995-01-01

    OBJECTIVES: To describe the medical research process from the time of the generation of a new theory to its implementation in clinical practice. The Helicobacter pylori (H. pylori) theory, i.e. the theory that H. pylori plays a significant causal role in duodenal ulcer disease was chosen as a case....... MATERIAL: Abstracts from 1984 to 1993, identified in the CD-Rom, Medline system, ("Silverplatter"), using the search terms Campylobacter pylori and Helicobacter pylori, and reviews and editorials about H. pylori in some of the most widespread clinical journals. RESULTS: 2204 papers on H. pylori were....... pylori in duodenal ulcer disease had been published in some of the most widespread clinical journals. In half of the papers the authors were convinced of the causal role of H. pylori in duodenal ulcer disease, while in the remainder they were sceptical. In seven cases the authors stated which patients...

  2. Update on the endoscopic management of peptic ulcer bleeding

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)

    2011-01-01

    textabstractUpper gastrointestinal bleeding is the most common gastrointestinal emergency, with peptic ulcer as the most common cause. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of

  3. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  4. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal\\/localised peritoneal irritation or when the patient\\'s premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV\\/V, mortality was 54.5% (6\\/11) following operative management and 52.9% (9\\/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV\\/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.

  5. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population.

    Science.gov (United States)

    Lee, Yeong Yeh; Noridah, Nordin; Syed Hassan, Syed Abdul Aziz; Menon, Jayaram

    2014-01-01

    Aim. Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  6. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

    Directory of Open Access Journals (Sweden)

    Yeong Yeh Lee

    2014-02-01

    Full Text Available Aim. Helicobacter pylori (H. pylori infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years. In-hospital mortality (3.6%, recurrent bleeding (9.6% and need for surgery (4.0% were uncommon in this population with a largely low risk score (85.2% with score ≤5. Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01 especially in the presence of duodenal ulcers (P = 0.04 despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  7. Is Helicobacter pylori Infection the Primary Cause of Duodenal Ulceration or a Secondary Factor? A Review of the Evidence

    Directory of Open Access Journals (Sweden)

    Vikram Kate

    2013-01-01

    Full Text Available Helicobacter pylori (H. pylori has a role in the multifactorial etiology of peptic ulcer disease. A link between H. pylori infection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication of H. pylori infection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. Against this concept there are issues that need explanation such as the reason why only a minority of infected persons develop duodenal ulceration when infection with H. pylori is widespread. There is evidence that H. pylori infection has been prevalent for several centuries, yet duodenal ulceration became common at the beginning of the twentieth century. The prevalence of duodenal ulceration is not higher in countries with a high prevalence of H. pylori infection. This paper debate puts forth the point of view of two groups of workers in this field whether H. pylori infection is the primary cause of duodenal ulcer disease or a secondary factor.

  8. Treatment of duodenal ulceration with Furazolidine in China preceded the discovery of its association with H pylori

    Institute of Scientific and Technical Information of China (English)

    Frank Ivor Tovev

    2007-01-01

    @@ It is not generally known that patients with duodenal ulceration were being treated with an antibiotic, Furazolidone, in China five or more years before Marshall and Warren published their seminal paper in 1984 about the association between duodenal ulceration and Campylobacter like organisms in the stomach, later named Hpylori. Marshall and Warren won the 2005 Nobel Prize in physiology or medicine for their work on how a bacterium can relate to gastric inflammation or peptic ulceration.

  9. Active bleeding from a periampullary duodenal diverticulum that was difficult to diagnose but successfully treated using hemostatic forceps: a case report

    Directory of Open Access Journals (Sweden)

    Nishiyama Noriko

    2012-10-01

    Full Text Available Abstract Introduction Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis. Case presentation We report the case of a 71-year-old Asian woman with bleeding from a periampullary duodenal diverticulum. She presented with severe anemia and tarry stools. Two examinations using a forward-viewing endoscope did not identify the source of the bleeding. However, examination using a side-viewing endoscope found an exposed bleeding vessel overlying the bile duct within a periampullary diverticulum of the descending part of the duodenum. The bleeding was successfully controlled by using hemostatic forceps. Conclusions Bleeding periampullary duodenal diverticula are rare, and a bleeding point in the mucosa overlying the bile duct within a large periampullary duodenal diverticulum is very rare. Identification of a bleeding point within a duodenal diverticulum often requires repeated examination and may require the use of a side-viewing endoscope. Use of hemostatic forceps to control bleeding from a periampullary duodenal diverticulum is very rare but, for bleeding lesions overlying the bile duct within a periampullary duodenal diverticulum, is the best way to prevent obstructive jaundice.

  10. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Izaki, Kenta; Fukuda, Tetsuya; Matsumoto, Shinichi; Kawasaki, Ryota; Taniguchi, Takanori; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Kuwata, Yoichiro [Nishi-Kobe Medical Center, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Hirota, Shozo [Hyogo Medical College, Department of Radiology, Nishinomiya-shi, Hyogo-ken (Japan)

    2006-01-01

    The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source. (orig.)

  11. Predicting Chemically Induced Duodenal Ulcer and Adrenal Necrosis with Classification Trees

    Science.gov (United States)

    Giampaolo, Casimiro; Gray, Andrew T.; Olshen, Richard A.; Szabo, Sandor

    1991-07-01

    Binary tree-structured statistical classification algorithms and properties of 56 model alkyl nucleophiles were brought to bear on two problems of experimental pharmacology and toxicology. Each rat of a learning sample of 745 was administered one compound and autopsied to determine the presence of duodenal ulcer or adrenal hemorrhagic necrosis. The cited statistical classification schemes were then applied to these outcomes and 67 features of the compounds to ascertain those characteristics that are associated with biologic activity. For predicting duodenal ulceration, dipole moment, melting point, and solubility in octanol are particularly important, while for predicting adrenal necrosis, important features include the number of sulfhydryl groups and double bonds. These methods may constitute inexpensive but powerful ways to screen untested compounds for possible organ-specific toxicity. Mechanisms for the etiology and pathogenesis of the duodenal and adrenal lesions are suggested, as are additional avenues for drug design.

  12. Longitudinal study of influence of Helicobacter pylori on current risk of duodenal ulcer relapse. The Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Clausen, M R; Franzmann, M B; Holst, C;

    1992-01-01

    Seventy-four patients with duodenal ulcer were followed up longitudinally for 2 years after initial ulcer healing. Endoscopy including biopsy of the antral mucosa was performed every 3rd month and whenever clinical symptoms of relapse occurred. The presence of Helicobacter pylori in the biopsy...... specimens was scored as 0 (none), 1 (sporadic occurrence), 2 (clusters), and 3 (numerous bacteria found diffusely in the mucus layer). The incidence rates of ulcer relapse per patient-month, grouped in accordance with these scores, were (with 95% confidence intervals) 0.073 (0.048-0.111), 0.083 (0.......052-0.133), 0.123 (0.096-0.157), and 0.069 (0.041-0.116), respectively. No significant differences in incidence rates across H. pylori scores were observed when taking into account the observation period after healing of the first ulcer, number of ulcer recurrence (1st, 2nd, 3rd), sex, age, smoking habits, peak...

  13. Density of Helicobacter pylorimay affect the efficacy of eradication therapy and ulcer healing in patients with active duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Yung-Chih Lai; Teh-Hong Wang; Shih-Hung Huang; Sien-Sing Yang; Chi-Hwa Wu; Tzen-Kwan Chen; Chia-Long Lee

    2003-01-01

    AIM: To evaluate the association of pre-treatment Helicobacter pylori (H. pylori) density with bacterial eradication and ulcer healing rates in patients with active duodenal ulcer.METHODS: One hundred and four consecutive duodenal ulcer outpatients with H, pylori infection ascertained by gastric histopathology and 13C-urea breath test (UBT) were enrolled in this study. H. pylori density was graded histologically according to the Sydney system (normal, mild,moderate, and marked). In each patient, lansoprazole (30rng b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1g b.i.d.) were used for 1 week, then 30 mg lansoprazole once daily was continued for an additional 3 weeks. Followup endoscopy was performed at 4 weeks after completion of the therapy, and UBT was done at 4 and 8 weeks after completion of the therapy.RESULTS: The H. pylorieradication rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 69.7 %/85.2 %; and the ulcer healing rates were 88.9 %/100.0 %, 94.3 %/100.0 %,and 63.6 %/77.8 % (intention-to-treat/per protocol analysis)in the mild, moderate, and marked H. pyloridensity groups,respectively. The association of pretreatment H. pyloridensity with the eradication rate and ulcer healing rate was both statistically significant (P=0.013/0.006 and 0.002/<0.001,respectively; using results of intention-to-treat/per protocol analysis).CONCLUSION: Intragastric bacterial load may affect both the outcome of eradication treatment and ulcer healing in patients with active duodenal ulcer disease.

  14. Age Features Of Peptic And Duodenal Ulcer Disease

    Directory of Open Access Journals (Sweden)

    Е.А. Islamova

    2009-12-01

    Full Text Available Peptic ulcer disease is one of the most widespread diseases. 6-10 % of adult population in Russia suffer from it. Demographic processes in the Russian Federation determine the increase of patients' number aged over 60 with peptic ulcer disease. It counts 10-35 % of all patients with this disease. The modern views on pathogenesis of peptic ulcer disease, including factor of Helicobacter pylori, in patients of different age groups have been highlighted in the article. Pathogenetic features and clinical morphological manifestations of peptic ulcer disease in young and aged patients have been considered

  15. Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site☆

    Science.gov (United States)

    Hayashi, Hironori; Kitagawa, Hirohisa; Shoji, Masatoshi; Nakanuma, Shin-ichi; Makino, Isamu; Oyama, Katsunobu; Inokuchi, Masafumi; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Tajima, Hidehiro; Takamura, Hiroyuki; Ninomiya, Itasu; Fushida, Sachio; Fujimura, Takashi; Tani, Takashi; Ohta, Tetsuo

    2013-01-01

    INTRODUCTION Duodenal ulcer penetration into the liver is a rare, but serious complication. Its frequency was thought to have decreased owing to advances in therapies for peptic ulcers. However, we encountered a case in which the duodenal ulcer had penetrated into a previous hemihepatectomy site. PRESENTATION OF CASE A 69-year-old man with a history of left hemihepatectomy 20 months previously presented to the emergency room with sudden-onset abdominal pain and nausea. An upper gastrointestinal examination with a fiberscope revealed a giant ulcer in the duodenal bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature from previous hemihepatectomy. DISCUSSION The presence of a gas-filled liver mass and bowel wall thickening with inflammatory changes are important imaging findings for prompt diagnosis of such a condition, but in this case, none of these were reported. Further, no definite abscess was found. Thus, the patient was treated conservatively with a proton pump inhibitor. CONCLUSION This case demonstrates the importance of using absorbable suture materials, adequate lavage in the postoperative peritoneal space and gastroduodenal mucosal protection postoperatively. PMID:24240081

  16. Healing of cysteamine-induced duodenal ulcers in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1985-01-01

    layer of Brunner's glands in the submucosa. Healing was complete within 15 days. Penetrated ulcers healed very slowly by formation of new epithelium and Brunner's glands from the ulcer edges. The newly formed epithelium was desquamated unless protected by underlying Brunner's glands and the regeneration...

  17. Expression of macrophage migration-inhibitory factor in duodenal ulcer and its relation to Helicobacter pylori infection.

    Science.gov (United States)

    Yu, X H; Zhang, Q; Yang, X P; Yang, W; Dai, F; Qian, Z; Wang, Z L; Wu, C F; Zhao, H Z; Wang, G H

    2015-10-30

    The aim of this study was to examine the expression of macrophage migration-inhibitory factor (MIF) in duodenal ulcer epithelial cells and its relation to Helicobacter pylori (Hp) infection, and to discuss the pathogenic roles of MIF expression and Hp infection in duodenal ulcer. MIF protein and mRNA expression was examined in samples from patients with duodenal ulcer with and without Hp infection (N = 40 each, experimental group), and in normal duodenal bulb mucosal tissue (N = 40, control group) using immunohistochemistry and in situ hybridization. Patients without Hp infection received routine treatment, and treatment was provided to the patients positive for Hp to eradicate Hp infection. Hp and MIF expression levels before treatment and after the ulcer had been cured were compared. The positive rates of MIF protein and mRNA in patients with Hp infection before treatment were 67.5 and 65%, respectively, and were 18.9 and 21.6% in the 37 patients from whom Hp was eliminated. These were statistically different both before and after treatment compared with controls (P 0.05). The results of this study suggested that MIF is related to the development of duodenal ulcer, and that the presence of Hp is closely related with the expression of MIF in the duodenal mucosa and the development of duodenal ulcer.

  18. Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum - a case report and literature review

    Science.gov (United States)

    2014-01-01

    Background Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed. Case presentation A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful. We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients. Conclusion Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention

  19. Duodenal Perforation Precipitated by Scrub Typhus.

    Science.gov (United States)

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  20. Duodenal perforation precipitated by scrub typhus

    Directory of Open Access Journals (Sweden)

    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  1. Excessive bleeding from genital ulcers of Behçet's disease.

    Science.gov (United States)

    Bostankolu, A; Aksungur, V L; Aksungur, E H; Ozpoyraz, M; Yücel, A; Memisoglu, H R

    1997-09-01

    Although genital ulcers are a common manifestation of Behçet's disease, bleeding from these lesions is unusual. In this report, a patient with excessive bleeding from genital ulcers is presented. A 22-year-old man with recurrent oral and genital ulcers, erythema nodosum, folliculitis, positive pathergic reaction, uveitis, superior vena cava syndrome, and generalized lymphadenopathy fulfilled the diagnostic criteria of Behçet's disease. Three years after presenting he was admitted to our clinic with excessive bleeding from large ulcers on the scrotum and upper thighs and with a leg ulcer. Bleeding was controlled with compresses. Examination of a biopsy specimen obtained from the leg ulcer showed findings consistent with Kaposi-like acroangiodermatitis. Results of various radiologic investigations showed thrombosis of the inferior vena cava, peritesticular varicosities, and venous insufficiency of the lower extremities. We suggest that the bleeding was secondary to the extension of genital ulcers to the varicose veins.

  2. Effect of curing Helicobacter pylori infection on intragastric acidity during treatment with ranitidine in patients with duodenal ulcer.

    OpenAIRE

    Labenz, J; Tillenburg, B; Peitz, U; Verdú, E.; Stolte, M; Börsch, G; Blum, A L

    1997-01-01

    BACKGROUND: In patients with duodenal ulcer cure of Helicobacter pylori infection resulted in a pronounced decrease in intragastric pH during treatment with omeprazole. AIM: To test the hypothesis that treatment of H pylori adversely affects the pH response to ranitidine. PATIENTS: Eighteen patients with duodenal ulcer who were infected with H pylori were studied. METHODS: Twenty four hour pH recordings were performed during treatment with ranitidine (300 mg) at night before and four to six w...

  3. New H2-receptor antagonist--roxatidine acetate--in treatment of duodenal ulcer.

    Science.gov (United States)

    Amarapurkar, D N; Parikh, S S; Desai, H G

    1993-08-01

    A double blind randomised trial, comparing a new H2-receptor antagonist, Roxatidine acetate, with Cimetidine was carried out in 47 patients of uncomplicated, endoscopically proven duodenal ulcer. Twenty seven patients were treated with Roxatidine 75 mg twice daily and 20 patients were treated with Cimetidine 200 mg 3 times a day and 400 mg at bed time for 4 weeks. At the end of 4 weeks, total pain relief was obtained in 74% and 70% patients receiving Roxatidine and Cimetidine respectively. Complete endoscopic healing at the end of 4 weeks was observed in 92.3% patients receiving Roxatidine and 85% patients receiving Cimetidine. These differences were statistically not significant. No significant side effects were observed in either group. We conclude that Roxatidine acetate is comparable to cimetidine in relieving pain and endoscopic healing of duodenal ulcer and has an excellent safety profile.

  4. The role of colloidal bismuth subcitrate in the short-term treatment of duodenal ulcer.

    Science.gov (United States)

    Barbara, L; Corinaldesi, R; Rea, E; Paternicò, A; Stanghellini, V

    1986-01-01

    Colloidal bismuth subcitrate (CBS) is a drug used in the treatment of duodenal ulcer; it acts mainly by increasing mucosal resistance against endoluminal aggressive agents, without inhibiting gastric secretion. In previous clinical trials, CBS solution induced healing rates significantly higher than placebo and similar to those observed with cimetidine. In spite of these promising results, the drug has never been widely employed, mainly because of its unpleasant taste, which greatly reduced patient compliance. For this reason, chewing tablets have been introduced. CBS tablets have been reported to induce healing rates significantly higher than placebo and similar to those obtained with CBS solution, cimetidine, and ranitidine. CBS may therefore represent an important alternative to antisecretory drugs in the therapy of duodenal ulcer patients.

  5. Stereomicroscopic and ultrastructural characterization of propionitrile-induced duodenal ulcer in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1978-01-01

    Acute duodenal ulcer produced by subcutaneous injection of propionitrile in rats was studied by stereo, light, and electron microscopy in order to gain insight into the localization and mechanism of initial cell injury. Stereomicroscopy revealed an initial fissuring and splitting of the tips...... of the villus folds within 4 hours after two injections of propionitrile. This was followed by sloughing of the epithelium, shortening and effacement of the villus folds, and within 24 hours the appearance of discrete ulcers in the mucosa of the proximal duodenum. In most of the rats, two ulcers developed......: the first and larger ulcer was on the antimesenteric side of the duodenum, and the other, a small and more superficial one, was on the opposite wall. Ultrastructural lesions appeared in the absorptive epithelial cells of the proximal duodenum within 5 hours following a single dose of propionitrile...

  6. Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation

    Institute of Scientific and Technical Information of China (English)

    Se-Jin Baek; Jin Kim; Sung-Ho Lee

    2012-01-01

    Here,we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation.On admission,the patient complained of severe acute abdominal pain,with physical examination findings suspicious for a perforated peptic ulcer.Of note,the patient had no history of other medical conditions or recent trauma,and the initial chest radiography and laboratory findings were not specific.A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver,gallbladder,transverse colon and omentum through a right diaphragmatic defect.The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation.A primary repair of the duodenal perforation was performed,and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated.This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose.Additionally,the best treatment for such large diaphragmatic defects is still controversial,especially in cases of intrathoracic or intra-abdominal contamination.

  7. PERFORATED DUODENAL ULCER ASSOCIATED WITH SITUS INVERSUS AND DEXTROCARDIA.

    Science.gov (United States)

    Ibrahim, Mumtaz; Hussain, Dildar; Waheed, Seema; Tahir, Raazia; Haider, Ghulam; Ali, Nauvan; Sarfraz, Shahid Latif

    2016-01-01

    A 32 years old gentleman, presented in emergency department, with complaints of sudden onset of severe upper abdominal pain, associated with nausea and vomiting. He was a known case of acid peptic disease. His abdominal examination showed signs of peritonitis. X-ray chest showed pneumoperitoneum, with dextrocardia. Ultrasound showed situs inversus. Exploration confirmed the diagnosis of perforated ulcer and situs inversus. Grahm's patch repair of perforation was done. His postoperative recovery was smooth.

  8. Gastric acid secretion in relation to personality, affect and coping ability in duodenal ulcer patients. A multivariate analysis. Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Jess, P

    1994-01-01

    The role of personality, mood state (affect) and coping ability (ego strength) on basal and stimulated gastric acid secretion were assessed in 56 duodenal ulcer patients using the Minnesota, Multiphasic Personality Inventory. The patients had high scores on most MMPI scales, but basal acid output...... disorders found in peptic ulcer patients may evidently be consequences of the disease rather than causal factors....

  9. Roxatidine versus ranitidine in the treatment of patients with duodenal ulcer: a randomized, double-masked, multicenter study.

    Science.gov (United States)

    Zuberi, S J; Khan, A Q; Irshad-ul-Haque, I; Hussain, A; Hasnain, S S; Shah, S; Sadick, A; Yusuf, M Z; Reuter, M

    1996-01-01

    The comparative efficacy of roxatidine and ranitidine in the treatment of patients with acute duodenal ulcer was assessed at 4 and 6 weeks in this multicenter study. Ninety-four of 192 patients were given roxatidine in a single nightly dose of 150 mg, and 98 patients were given ranitidine in a single nightly dose of 300 mg. All the patients had endoscopically proven duodenal ulcer. Of the 171 assessable patients, ulcers were healed in 88% of the roxatidine group (73 of 83) and in 84% of the ranitidine group (74 of 88). No serious adverse events were reported in either group. We conclude that roxatidine 150 mg once daily is as effective and safe for the treatment of acute duodenal ulcer as ranitidine 300 mg once daily.

  10. Paroxysmal nocturnal hemoglobinuria associated with venous thrombosis and papillary endothelial hyperplasia presenting as ulcerated duodenal mass.

    Science.gov (United States)

    Dunphy, C H; Sotelo-Avila, C; Luisiri, A; Chu, J Y

    1994-08-01

    Paroxysmal nocturnal hemoglobinuria is an acquired clonal expansion of bone marrow stem cells that are deficient in the decay-accelerating factor, which is a complement regulatory glycoprotein (CD55), as well as in the membrane inhibitor of reactive lysis (CD59) and the C8-binding protein. These proteins are deficient on the membranes of red blood cells, granulocytes, monocytes, and platelets. The disorder is associated with intermittent hemolytic anemia, hemoglobinuria, infection, a tendency toward bone marrow aplasia, and venous thromboses. The thromboses, on resolution, may give rise to endothelial proliferation that may cause ischemia and ulceration, or, alternatively, the thromboses may cause ulceration leading to a granulation tissue response with exaggerated endothelial proliferation. We report a second case of paroxysmal nocturnal hemoglobinuria that presented roentgenographically as an ulcerated circumferential duodenal mass secondary to venous thrombosis accompanied by florid papillary endothelial hyperplasia. We also review the literature concerning this phenomenon.

  11. Transarterial embolization of massive gastric ulcer bleeding in gastrostomy patients caused by a balloon replacement tube: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Youn, Byong Jong; Hur, Jin; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2007-02-15

    We present the case of a 77-year-old woman with massive gastric ulcer bleeding caused by a balloon replacement tube that required emergent transcatheter left gastric arterial embolization in stop the ulcer bleeding.

  12. Comparative efficiency of endoscopic hemostasis methods in bleeding undercomplicated peptic ulcer in children

    OpenAIRE

    Сокольник, Сергій Олександрович

    2015-01-01

    Aim. To compare the effectiveness of endoscopic hemostasis in complex treatment of gastrointestinal bleeding in children of Chernovtsy region with peptic ulcer disease.Methods. 43 cases of bleeding in peptic ulcer disease in children are analyzed. Argon plasma coagulation is undergone in order to stop the bleeding for 11 patients, for others – aminocaproic acid irrigation.Results. Using argon plasma coagulation, in contrast to the aminocaproic acid irrigation reduces the risk of rebleeding 0....

  13. [Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helicobacter pylori].

    Science.gov (United States)

    Khayat, Olfa; Kilani, Afef; Chedly-Debbiche, Achraf; Zeddini, Abdelfattah; Gargouri, Dalila; Kharrat, Jamel; Souissi, Adnene; Ghorbel, Abdel Jabbar; Ben Ayed, Mohamed; Ben Khelifa, Habib

    2006-06-01

    It's a prospective study leaded between September 1997 and july 1999 (23 months ) in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one month later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realised. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomisation in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concering activity 80%, intestinal metaplasia 12%. inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus (pomeprazol, amoxcillin, metronidazol by comparison with the others 3 groups (p<0.005).

  14. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen Jais; Møller, Morten H; Larsson, Heidi

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included.......10-1.61)), and fewer patients underwent open surgery (4% vs. 6%, RR 0.72 (0.59-0.87)). After controlling for time changes in prognostic factors, rebleeding rates improved (13% vs. 18%, adjusted RR 0.77 (0.66-0.91)). Crude 30-day mortality was unchanged (11% vs. 11%), whereas adjusted mortality decreased...

  15. Reflux esophagitis and hiatal hernia as concomitant abnormality in patients presenting with active duodenal or gastric ulcer: cross-sectional endoscopic study in consecutive patients.

    Science.gov (United States)

    Loffeld, R J.L.F.; van der Putten, A B.M.M.

    2002-05-01

    BACKGROUND: Follow-up studies have shown that patients with ulcer disease are at risk of developing reflux esophagitis (RE) after successful eradication of Heliobacter pylori. It is still not clear whether this is induced by eradication of H. pylori or whether RE is already present at the time the ulcer is diagnosed. A cross-sectional study was done in consecutive patients suffering from active ulcer disease in order to assess coincidental RE. METHODS: Patients with an active duodenal or gastric ulcer were included in the study. Concomitant RE and the presence of hiatal hernia (HH) were scored. Biopsy specimens were taken for detection of H. pylori. RESULTS: In 375 patients (77%), an active duodenal ulcer was the only abnormality. In 43 patients (8.8%), duodenal ulcer and concomitant RE were present and 69 patients (14.2%) had a duodenal ulcer with concomitant HH. Patients with a duodenal ulcer were significantly younger than patients with concomitant RE or HH. From 374 patients (76.8%) with a duodenal ulcer, biopsy specimens were available for the detection of H. pylori. The majority of duodenal ulcer patients were H. pylori-positive. H. pylori was significantly more often present in patients with an active duodenal ulcer than it was in duodenal ulcer patients suffering from concomitant RE (P=0.04). In 218 patients (76%), a gastric ulcer was the only abnormality. Fifteen patients (5.2%) also had RE and 54 patients (18.8%) had a concomitant HH. There was no difference in H. pylori status in these three groups of patients. CONCLUSIONS: Given the low prevalence of concomitant RE, it is concluded that this condition is likely to occur in a large percentage of patients suffering from H. pylori-positive ulcer disease after successful eradication therapy.

  16. A comparison of roxatidine and ranitidine for the acute treatment of duodenal ulcer.

    Science.gov (United States)

    Walt, R P; Logan, R F; Hawkey, C J; Daneshmend, T K; Long, R G; Cooper, B T; Langman, M J; Collins, M; Street, R

    1991-06-01

    Roxatidine acetate is a new histamine H2-antagonist of about twice the potency of ranitidine on a weight-for-weight basis. Two hundred and thirty-two patients participated in a double-blind randomized trial of duodenal ulcer healing comparing 300 mg ranitidine nocte with 150 mg roxatidine nocte. Endoscopy was repeated fortnightly to 4 weeks in each of four participating centres. Usual exclusion criteria applied but NSAID users were allowed. There were no important demographic differences between treatment recipients. Three analyses were used: protocol (dropouts and violators not included), intention-to-treat I (dropouts considered failures), and intention-to-treat II (dropouts considered failures, but violators outcome included). Healing rates differed markedly (but not significantly) with each analysis. After 2 weeks of treatment ulcers had healed in 51% versus 45% using the intention to treat I analysis with roxatidine and ranitidine, respectively; by the protocol analysis the healing proportions were 60% and 55%. These differences between treatments were not significant. After 4 weeks of treatment healing rates ranged from 71% to 83% on roxatidine and between 69% and 84% on ranitidine depending on the analysis. Differential healing proportions of smokers and non-smokers were non-significant (83% vs. 79%). Both drugs were well tolerated and adverse events were similar with each agent. Roxatidine should prove as effective as ranitidine for acute duodenal ulcer treatment.

  17. A comparison of roxatidine acetate and ranitidine in duodenal ulcer healing.

    Science.gov (United States)

    Hüttemann, W

    1988-01-01

    A randomised double-blind study was conducted to compare the efficacy of roxatidine acetate 75 mg twice daily with ranitidine 150 mg twice daily in 308 patients with endoscopically confirmed uncomplicated duodenal ulcers. After 6 weeks of treatment ulcer healing was found in 93.5% of the roxatidine acetate group and 89.2% of the ranitidine group, with no significant differences between treatment groups. The relief of day and night-time epigastric pain assessed at clinic visits or on diary cards by patients was comparable for both treatment groups, as was the consumption of antacid tablets for relief of symptoms of dyspepsia. There were no significant differences in the healing rates of smokers and non-smokers for either roxatidine acetate or ranitidine treatment, and no clinically significant alterations in laboratory values. Eight patients in the roxatidine acetate group and 1 in the ranitidine group complained of mild side effects, which included diarrhoea, constipation and headache. One patient on roxatidine acetate withdrew from treatment because of a mild skin rash. The results confirm that roxatidine acetate is a safe and effective treatment for duodenal ulcer disease.

  18. Helicobacter pylori genotyping from positive clotests in patients with duodenal ulcer

    Directory of Open Access Journals (Sweden)

    Mattar Rejane

    2000-01-01

    Full Text Available Even though the seroprevalence of H. pylori may be high in the normal population, a minority develops peptic ulcer. Colonization of the gastric mucosa by more pathogenic vacA strains of H. pylori seems to be associated with enhanced gastric inflammation and duodenal ulcer. H. pylori genotyping from positive CLOtests was developed to determine the vacA genotypes and cagA status in 40 duodenal ulcer patients and for routine use. The pathogenic s1b/ m1/ cagA genotype was the most frequently occurring strain (17/42.5%; only two (5% patients presented the s2/ m2 genotype, the less virulent strain. Multiple strains were also detected in 17 (42.5% patients. Multiple strains of H. pylori colonizing the human stomach have been underestimated, because genotyping has been performed from cultures of H. pylori. We concluded that genotyping of H. pylori from a positive CLOtest had the advantages of reducing the number of biopsies taken during endoscopy, eliminating the step of culturing H. pylori, and assuring the presence of H. pylori in the specimen being processed.

  19. Absence of tolerance in duodenal ulcer patients treated for 28 days with a bedtime dose of roxatidine or ranitidine.

    Science.gov (United States)

    Savarino, V; Mela, G S; Zentilin, P; Cutela, P; Vigneri, S; Termini, R; Di Mario, F; Ferrana, M; Malesci, A; Belicchi, M; Celle, G

    1996-01-01

    There is much experimental work on the occurrence of tolerance to the antisecretory effect of H2-receptor antagonists in healthy subjects, while data on its development in patients with duodenal ulcer are poor and conflicting. Moreover, this phenomenon has not been studied previously with 24 h gastric pH-metry in patients with active duodenal ulcer. For these reasons, we carried out a prospective pharmacodynamic investigation in 48 patients with endoscopically proven duodenal ulcer using the well-established once daily dosing schedule of H2 blockers. They were studied by means of 24 h continuous endoluminal pH-metry which was performed before, on d1 and d28 after receiving an oral bedtime dose (2200 hours) of either roxatidine 150 mg or ranitidine 300 mg, given in randomized and single-blind fashion. Eight patients did not complete the study for various reasons and 82% of ulcers healed after 4 weeks of therapy. Gastric pH was higher (P roxatidine and ranitidine. There was also no difference in pharmacodynamic data between the two active treatments. We conclude that tolerance does not develop after 1 month's treatment with a bedtime dose of H2 antagonist in patients with active duodenal ulcer and therefore data gathered on this phenomenon in healthy subjects are not applicable to ulcer patients.

  20. Anterior seromyotomy with posterior truncal vagotomy in uncomplicated chronic duodenal ulcer.

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    Supe A

    1995-07-01

    Full Text Available Thirty cases of uncomplicated duodenal ulcer treated by anterior superficial lesser curvature seromyotomy and posterior truncal vagotomy were studied to evaluate the efficacy of this procedure. There was completeness of vagotomy in all the cases as shown by endoscopic Congo Red test. Twenty-seven cases were asymptomatic at 1-48 months (Mean 22.3 follow up, while 3 patients had controllable side effects such as dumping and diarrhoea. There was no mortality. This procedure is safe, effective and is a favourable alternative to highly selective vagotomy.

  1. Perforated peptic duodenal ulcer in a paraesophageal hernia – a case report of a rare surgical emergency

    Directory of Open Access Journals (Sweden)

    Willner Julian

    2006-01-01

    Full Text Available Abstract Background Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare. Case presentation An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge. Conclusion This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia.

  2. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    Directory of Open Access Journals (Sweden)

    Wever Jan

    2004-01-01

    Full Text Available Abstract Background Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. Case presentation A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Conclusion Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  3. Do clinicians accept the role of Helicobacter pylori in duodenal ulcer disease: a survey of European gastroenterologists and general practitioners

    DEFF Research Database (Denmark)

    Christensen, A H; Logan, R P; Noach, L A;

    1994-01-01

    OBJECTIVES. To examine to what extent clinicians in Europe accepted the theory of the casual role of Helicobacter pylori (H.pylori) in duodenal ulcer disease in the year 1992, and to what extent the theory had influenced their diagnostic and therapeutic habits in the management of duodenal ulcer...... patients at that time. DESIGN. Postal questionnaire. SETTING. Three European countries: the UK, the Netherlands, and Denmark. SUBJECTS. Three hundred and three gastroenterologists, 250 general practitioners, 83 junior hospital doctors. MAIN OUTCOME MEASURES. Number of doctors believing H. pylori...... to be a significant cause of duodenal ulcer disease, use of diagnostic tests for detection of H. pylori and therapeutic regimens for eradicating H. pylori. RESULTS. Four hundred and forty-two doctors replied. Eighty-four per cent of the British doctors, 73% of the Dutch doctors, and 47% of the Danish doctors accepted...

  4. Epidemiological Clinical Features and Evolution of Gastroduodenal Ulcer Bleeding in a Tertiary Care Hospital in Spain, during the Last Seven Years.

    Science.gov (United States)

    Lauret, Eugenia; Herrero, Jesús; Blanco, Lorena; Castaño, Olegario; Rodriguez, Maria; Pérez, Isabel; Alvarez, Verónica; Suárez, Adolfo; Rodrigo, Luis

    2013-01-01

    Background. Gastroduodenal ulcer bleeding is a common medical emergency. The aim of this study was to analyze the characteristics of bleeding episodes and to identify changes in the clinical trends over seven years. Methods. Retrospective observational clinical study on a cohort of 272 consecutive adult patients with peptic ulcer bleeding, during the 2006-2012 period. Results. Mean annual admission rate was 12.8 per 100.000 inhabitants. Men were predominant (71%), with a mean age of 66.6 years. Comorbidities were present in 131 cases (48.2%) and 156 patients (57.4%) had received ulcerogenic drugs. Duodenal ulcer was the commonest location (61%). Endoscopic therapy was necessary in 183 cases (67.3%) and rebleeding occurred in 30 patients (11%). Overall mortality rate was 5.5%, with a significant association with the presence of comorbidities (P ulcer bleeding have remained unchanged in the study period. This may be due to the fact that the effect of improved approach on this condition is probably counteracted by risk factors such as older age, severe comorbidities, and ulcerogenic drugs consumption, which have also remained stable over recent years.

  5. Epidemiological Clinical Features and Evolution of Gastroduodenal Ulcer Bleeding in a Tertiary Care Hospital in Spain, during the Last Seven Years

    Directory of Open Access Journals (Sweden)

    Eugenia Lauret

    2013-01-01

    Full Text Available Background. Gastroduodenal ulcer bleeding is a common medical emergency. The aim of this study was to analyze the characteristics of bleeding episodes and to identify changes in the clinical trends over seven years. Methods. Retrospective observational clinical study on a cohort of 272 consecutive adult patients with peptic ulcer bleeding, during the 2006–2012 period. Results. Mean annual admission rate was 12.8 per 100.000 inhabitants. Men were predominant (71%, with a mean age of 66.6 years. Comorbidities were present in 131 cases (48.2% and 156 patients (57.4% had received ulcerogenic drugs. Duodenal ulcer was the commonest location (61%. Endoscopic therapy was necessary in 183 cases (67.3% and rebleeding occurred in 30 patients (11%. Overall mortality rate was 5.5%, with a significant association with the presence of comorbidities (P<0.01. There were no differences in trends of annual hospitalization, clinical features at presentation, and outcomes during this 7-years period. Conclusions. Annual hospitalization rates and prognosis of peptic ulcer bleeding have remained unchanged in the study period. This may be due to the fact that the effect of improved approach on this condition is probably counteracted by risk factors such as older age, severe comorbidities, and ulcerogenic drugs consumption, which have also remained stable over recent years.

  6. Aspectos clínicos e histológicos da úlcera duodenal em crianças e adolescentes Clinical and histological features of duodenal ulcer in children and adolescents

    Directory of Open Access Journals (Sweden)

    Elisabete Kawakami

    2004-08-01

    : Diagnostic age ranged from 4 years and 8 months to 17 years and 4 months (mean age: 12 years and 4 months. Abdominal pain was the main symptom (39/43, 90.7%, which was epigastric in 31/39, periumbilical in 7/39, and nocturnal in 27/39. Other symptoms were loss of appetite (32/43, 74.4%, vomiting (30/43, 69.8%, postprandial fullness (23/43, 53.5%, weight loss (22/43, 51.2%, and abdominal tenderness (19/43, 44.2%. Upper gastrointestinal bleeding occurred in 19/43 (44.2%, whereas anemia occurred in (21/43, 48.8%. Helicobacter pylori infection was detected in 41/43 (95.3%. All infected patients presented acute chronic gastritis in antrum, with lymphomononuclear infiltrate predominance in 92% of them. Eradication of the bacterium occurred in 68.3%. Ulcer healing occurred in all eradicated patients and in 89% of non-eradicated patients. CONCLUSION: Duodenal ulcer was associated with chronic gastritis due to Helicobacter pylori in the majority of patients. Many complications occurred, especially upper digestive bleeding.

  7. [Endorphin-containing cells in the gastric antral mucosa in duodenal ulcer].

    Science.gov (United States)

    Zverkov, I V; Vinogradov, V A; Smagin, V G

    1983-10-01

    Immunohistochemical staining with the use of peroxidase-antiperoxidase was applied to study cells producing gamma- and alpha-endorphines in the gastric antral mucosa in duodenal ulcer. The cells producing gamma-endorphines were discovered to be mainly located in the epithelium of the cervical and upper third of the pyloric glands and to be alike G-cells producing gastrin. The cells producing alpha-endorphine were found both in the epithelium of the upper third of the gastric pyloric glands and in the gastric mucosa lamina proper. In peptic ulcer, there was an almost two-fold increase in the amount of gamma-endorphine-producing cells and diminution of epithelial endocrine cells producing alpha-endorphine.

  8. [Early evening and late evening administration of roxatidine acetate in therapy of duodenal ulcer].

    Science.gov (United States)

    Bosseckert, H; Ernst, R; Kriech, W; Schunter, C

    1993-11-15

    In a multicenter, placebo-controlled, comparative trial with 196 general practitioners and internists 730 18 to 70 year-old patients with endoscopic evidence of a duodenal ulcer were enrolled. Each group of 365 patients received 150 mg Roxatidine acetate once daily, either late in the evening (bedtime administration, between 10.00 p.m. and 11.00 p.m.) or early in the evening (after dinner, between 6.00 p.m. and 7.00 p.m.). The endoscopic control revealed that the ulcers healed after four weeks of treatment in 74% (bedtime administration) and 77% (administration early in the evening), respectively. There was no significant difference ascertained between both groups. At the last visit, epigastric pain was removed during the day in 86% and during the night in 90% in both groups.

  9. Application mexidol in treatment patients of inflammatory periodontal diseases in the combination to peptic ulcer of stomach and duodenal intestine

    Directory of Open Access Journals (Sweden)

    Charish N.A.

    2011-03-01

    Full Text Available For the purpose to determine the clinical pathogenetic efficacy of Mexidol in the combined therapy of parodontitis in patients with peptic ulcer of stomach and duodenal intestine medical examination and treatment of 296 patients was carried out. It was established that use of Mexidol in the combined treatment of patients with parodontitis against peptic ulcer of stomach and duodenal intestine allowed to decrease infection load (Helicobacter pylori in parodontal recess and evidence of local inflammation with reduction of activity of interleukin-6, -10, -18, that provided acceleration of recovery processes, lowering in frequency of periodontitis recurrences

  10. Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review

    Science.gov (United States)

    Makker, Jasbir; Bajantri, Bharat; Sakam, Sailaja; Chilimuri, Sridhar

    2016-01-01

    Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding. PMID:27610026

  11. Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.

    Science.gov (United States)

    Makker, Jasbir; Bajantri, Bharat; Sakam, Sailaja; Chilimuri, Sridhar

    2016-08-21

    Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

  12. The results of Helicobacter pylori eradication on repeated bleeding in patients with stomach ulcer.

    Science.gov (United States)

    Horvat, Darko; Vcev, Aleksandar; Soldo, Ivan; Timarac, Jasna; Dmitrović, Branko; Misević, Tonci; Ivezić, Zdravko; Kraljik, Nikola

    2005-06-01

    The triple therapy of Helicobacter pylori eradication prevents repeated bleeding from stomach ulcer. The aim of this one-way blind prospective study was to evaluate the efficiency of the two-week triple therapy for Helicobacter pylori eradication in preventing renewed bleeding in patients with stomach ulcer within one year. This research included 60 hospitalized patients with bleeding stomach ulcer and positive Helicobacter pylori infection, 34 men and 26 women (average age 59.7 years). The patients were given therapeutic scheme of omeprazol--amoxicilin--metrodinazol (OAM) eradication for 14 days. Eradication of H. pylori infection was defined as lack of proof of the infection one month or several months after therapy suspension. By applying triple OAM therapy within two weeks the eradication was successful in 72%. In the group of 17 H. pylori positive patients there were 8 patients (47.6%) with repeated stomach ulcer and 3 patients (18%) with bleeding. Within the group of 43 H. pylori negative patients there were only 2 patients (4.65%) with repeated stomach ulcer and 1 patient (2%) with bleeding, during the observed period of 12 months. This research confirms the hypothesis about the necessity of eradication of Helicobacter pylori infection in patients with bleeding stomach ulcer as prevention of repeated bleeding.

  13. The evolution of surgical procedures in the management of duodenal and gastric ulcers.

    Science.gov (United States)

    Ajao, O G; Ugwu, B T

    2013-01-01

    Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant.

  14. Double-blind randomized multicenter study comparing Maalox TC tablets and ranitidine in healing of duodenal ulcers.

    Science.gov (United States)

    Hunter, J O; Walker, R J; Crowe, J; Gillies, R R; Gillies, K R; Gough, K R; Lorber, S

    1991-07-01

    The efficacy of ranitidine 150 mg twice daily and Maalox TC three tablets four times daily were compared in patients with endoscopically confirmed duodenal ulcer. Seventy-nine patients were randomly allocated to double-blind, double-dummy treatment, stratified for smokers. Endoscopy was repeated after four weeks. Those unhealed continued treatment for a further two weeks before final endoscopy. Per protocol analysis in 53 patients showed ulcer healing rates at week 4 and at weeks 4 and 6 combined of 78 and 89% on Maalox TC, and of 81 and 91% on ranitidine, respectively. The same analysis gave overall healing rates of 81% in smokers and 100% in nonsmokers, irrespective of treatment. Both treatments provided early ulcer pain relief. Diarrhea was a commoner side effect in patients on Maalox TC. The study showed Maalox TC and ranitidine were equally effective in healing duodenal ulceration.

  15. [Comparative assessment of truncal and selective vagotomy combined with gastric drainage in the treatment of duodenal ulcer].

    Science.gov (United States)

    Kurygin, A A; Zhuk, A M

    1977-01-01

    Comparative estimation of trunk and selective vagotomy associated with stomach drainage operations in treatment of duodenal ulcer revealed no essential advantages of selective vagotomy in comparison with trunk one. At the same time, technically trunk vagotomy is a more simple procedure and a more reliable one in relation to ulcer cure. The question concerning high-risk of calculi formation in the gallbladder after trunk vagotomy in females is unsolved yet and needs further studies.

  16. Diagnosis, Treatment, and Outcome in Patients with Bleeding Peptic Ulcers and Helicobacter pylori Infections

    Directory of Open Access Journals (Sweden)

    Ting-Chun Huang

    2014-01-01

    Full Text Available Upper gastrointestinal (UGI bleeding is the most frequently encountered complication of peptic ulcer disease. Helicobacter pylori (Hp infection and nonsteroidal anti-inflammatory drug (NSAID administration are two independent risk factors for UGI bleeding. Therefore, testing for and diagnosing Hp infection are essential for every patient with UGI hemorrhage. The presence of the infection is usually underestimated in cases of bleeding peptic ulcers. A rapid urease test (RUT, with or without histology, is usually the first test performed during endoscopy. If the initial diagnostic test is negative, a delayed 13C-urea breath test (UBT or serology should be performed. Once an infection is diagnosed, antibiotic treatment is advocated. Sufficient evidence supports the concept that Hp infection eradication can heal the ulcer and reduce the likelihood of rebleeding. With increased awareness of the effects of Hp infection, the etiologies of bleeding peptic ulcers have shifted to NSAID use, old age, and disease comorbidity.

  17. Diagnosis, treatment, and outcome in patients with bleeding peptic ulcers and Helicobacter pylori infections.

    Science.gov (United States)

    Huang, Ting-Chun; Lee, Chia-Long

    2014-01-01

    Upper gastrointestinal (UGI) bleeding is the most frequently encountered complication of peptic ulcer disease. Helicobacter pylori (Hp) infection and nonsteroidal anti-inflammatory drug (NSAID) administration are two independent risk factors for UGI bleeding. Therefore, testing for and diagnosing Hp infection are essential for every patient with UGI hemorrhage. The presence of the infection is usually underestimated in cases of bleeding peptic ulcers. A rapid urease test (RUT), with or without histology, is usually the first test performed during endoscopy. If the initial diagnostic test is negative, a delayed (13)C-urea breath test (UBT) or serology should be performed. Once an infection is diagnosed, antibiotic treatment is advocated. Sufficient evidence supports the concept that Hp infection eradication can heal the ulcer and reduce the likelihood of rebleeding. With increased awareness of the effects of Hp infection, the etiologies of bleeding peptic ulcers have shifted to NSAID use, old age, and disease comorbidity.

  18. Roxatidine versus ranitidine in the treatment of duodenal ulcers: a randomized double-blind controlled multicentre study in Singapore.

    Science.gov (United States)

    Fock, K M; Kang, J Y; Ng, H S; Ng, T M; Gwee, K A; Lim, C C

    1995-01-01

    Roxatidine acetate, a new H2 receptor antagonist, was compared with ranitidine in the treatment of duodenal ulcers in a double-blind multicentre study. Eighty-four patients with endoscopically proven duodenal ulcer were randomized to receive 150 mg roxatidine acetate or 300 mg ranitidine at bedtime. Repeat endoscopy was performed after 4 weeks (25-33 days) and if the ulcer had not healed, another endoscopy was performed after a further 4 weeks of treatment. Using per protocol analysis 73.6% of ulcers treated with roxatidine healed at 4 weeks compared to 72.2% of ulcers treated with ranitidine (P = NS). The healing rates at 8 weeks were 92% with roxatidine and 83.3% with ranitidine (P = NS). Using equivalence tests, the healing rate of roxatidine was found to be equivalent to that of ranitidine within a 20% region. Roxatidine users took significantly less antacids than ranitidine users (P roxatidine or ranitidine. Roxatidine is a safe effective drug in the treatment of duodenal ulcers with a healing rate comparable to that of ranitidine.

  19. Role of delayed gastric emptying in the pathogenesis of cysteamine-induced duodenal ulcer in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1982-01-01

    Cysteamine is a potent duodenal ulcerogen in rats. It has been demonstrated to inhibit gastric empyting, whose role in ulcer formation is unknown. In the present study the effect of cysteamine on gastric motility and emptying rate in rats was studied by direct fluoroscopic observation. The delaye...

  20. Duodenal ulcer healing on 2 g of sucralfate daily at bedtime compared to 1 g four times daily

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Ebbehøj, N; Fallingborg, J;

    1990-01-01

    Seventy-seven patients with endoscopically verified duodenal ulcers were randomized to treatment with either 2 g sucralfate daily at bedtime or 1 g sucralfate q.d.s. in a controlled double-blind comparative study. After a 4-week treatment period, the healing rate was 68% for the former and 69...

  1. Assay of gastrin and somatostatin in gastric antrum tissues of children with chronic gastritis and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Xiao-Zhi Xie; Zhi-Guang Zhao; Dan-Si Qi; Zong-Min Wang

    2006-01-01

    AIM: To study the expressions of gastrin (GAS) and somatostatin (SS) in gastric antrum tissues of children with chronic gastritis and duodenal ulcer and their role in pathogenic mechanism.METHODS: Specimens of gastric antrum mucosa from 83 children were retrospectively analyzed. Expressions of GAS and SS in gastric antrum tissues were assayed by the immunohistochemical En Vision method.RESULTS: The expressions of GAS in chronic gastritis Hp+ group (group A), chronic gastritis Hp- group (group B), the duodenal ulcer Hp+group (group C), duodenal ulcer Hp- group (group D), and normal control group (group E) were 28.50+4.55, 19.60+2.49, 22.69+2.71,25.33 + 4.76, and 18.80 + 2.36, respectively. The value in groups A-D was higher than that in group E. The difference was not statistically significant. The expressions of SS in groups A-E were 15.47 + 1.44, 17.29 + 2.04,15.30 + 1.38, 13.11 + 0.93 and 12.14 + 1.68, respectively.The value in groups A-D was higher than that in group E.The difference was also not statistically significant.CONCLUSION: The expressions of GAS and SS are increased in children with chronic gastritis and duodenal ulcer.

  2. Intravenous proton pump inhibitors for peptic ulcer bleeding: Clinical benefits and limits.

    Science.gov (United States)

    Cheng, Hsiu-Chi; Sheu, Bor-Shyang

    2011-03-16

    Peptic ulcer bleeding is a common disease and recurrent bleeding is an independent risk factor of mortality. Infusion with proton pump inhibitors (PPIs) prevents recurrent bleeding after successful endoscopic therapy. A gastric acidic environment of less than pH 5.4 alters coagulation function and activates pepsin to disaggregate platelet plugs. Gastric acid is secreted by H(+), K(+)-ATPase, naming the proton pump. This update review focuses on the mechanism and the role of PPIs in the clinical management of patients with peptic ulcer bleeding. An intravenous omeprazole bolus followed by high-dose continuous infusion for 72 h after successful endoscopic therapy can prevent the recurrent bleeding. In the Asian, however, the infusion dosage can possibly be diminished whilst preserving favorable control of the intragastric pH and thereby still decreasing rates of recurrent bleeding. Irrespective of the infusion dosage of PPIs, rates of recurrent bleeding remain high in patients with co-morbidities. Because recurrent peptic ulcer bleeding may be prolonged in those with co-morbidities, a low-dose infusion of IV PPIs for up to 7-day may result in better control of recurrent bleeding of peptic ulcers. Due to the inter-patient variability in CYP2C19 genotypes, the infusion form of new generation PPIs, such as esomeprazole, should be promising for the prevention of recurrent bleeding. This article offers a comprehensive review of clinical practice, highlighting the indication, the optimal dosage, the duration, and the potential limitation of PPIs infusion for peptic ulcer bleeding.

  3. An upper gastrointestinal ulcer still bleeding after endoscopy : what comes next?

    NARCIS (Netherlands)

    Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.

    2013-01-01

    Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence

  4. Immediate Results of Omentopexy in Perforated Duodenal Ulcer: A Study of 186 Cases

    Directory of Open Access Journals (Sweden)

    Nishikant Gujar*, Jilani Awati, Sajid Mudhol, Salahuddin Contractor, Ravikumar Choudhari and Sushila Garag

    2012-01-01

    Full Text Available Aim of the Study: The study was conducted to determine short term results in view of associated diseases, complications, mortality and hospital stay in patients with duodenal ulcer perforation treated by omentopexy. Main Findings: Age of patients range from 15 to 85 years; mean age was 45.58 years; In all cases, perforation was present on the anterior surface of the first part of the duodenum. Size of perforation varied from 0.3 to 2.5 cm. 50 (26.88% patients had co-existing illnesses. Among the complications, the commonest complication was wound infection. 53 patients (28.49% had wound infection, 45 patients (24.19% had lung infections, 5 patients (2.68% had re-perforation of the ulcer, 2 patients (1.07% had burst abdomens, 2 patients (1.07% had pelvic abscesses and 1 patient (0.53% had DIC. Mortality was 18 patients(9.67%. Median hospital stay was 10 days. Conclusion: Perforation is one of the most catastrophic complications of peptic ulcer. In spite of modern advances in surgical, anesthetic and ancillary facilities, it still assumes life threatening dimensions. Omentopexy is a simple and safe procedure. The most important factors predisposing to complications are delay in admission to the hospital, associated diseases and shock on admission. Mortality and morbidity can be reduced by early admission, prompt resuscitation, treatment of associated diseases, early surgical intervention and prophylaxis of complications.

  5. [Results of the morphological examination of stomach in the different terms after stitching of a perforation duodenal ulcer].

    Science.gov (United States)

    Tumanidze, G Z; Khardzeishvili, O M; Chkhikvadze, T F; Khazaradze, D V

    2005-01-01

    Analyses of 184 cases of morphological examination of resected part of stomach in the different terms after stitching of a perforative duodenal ulcer is presented. The authors confirm, that ulcerative disease of duodenum and it's various complications including perforation is associated with antrum gastritis in all cases, which has superficial character. The authors are confirming that a gastric metaplasia of a mucosa of duodenum assists to the helicobacterial colonization, which represents one of the main factors of an ulcer formation along with a fast transition of acid gastric contents into the duodenum. The authors consider the gastric metaplasia as preulcerative pathological condition of duodenum.

  6. Comparative study on highly selective vagotomy and its combination with mucosal antrectomy in treatment of duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    WEN Ya-yuan; WANG Dai-ke; LIU Bao-hua

    2001-01-01

    Objective: To compare the therapeutic effects of highly selective vagotomy and mucosal antrectomy (HSV-MA) with those single HSV on 48 cases of duodenal ulcer in order to confirm that HSV could not result in hypergastrinemia and ulcer recurrence. Methods: Forty-eight patients with duodenal ulcer were carefully examined. Randomly,28 of them were operated on with HSV-MA and 20 with simple HSV. Postoperatively, the level of gastric acid, serum gastrin and the positive rate of helicobacter pylori (Hp) were determined. Results: It was found that the level of gastric acid was significantly lower in the postoperative periods of the HSV-MA and simple HSV groups than in the preoperative stage; the level of serum gastrin was significantly lower in the HSV group than in the HSV-MA group postoperatively and than in the preoperative stage. The positive rate of Hp infection was marked reduced in the HSV-MA group than in the cases of preoperative stage. Conclusion: On the basis of the above mentioned findings, it is considered that HSV-MA would not result the occurrence of ulcer recurrence and suggested that HSV-MA is a better approach to treat chronic duodenal ulcer.

  7. [Antisecretory therapy as a component of hemostasis in acute gastroduodenal ulcer bleedings].

    Science.gov (United States)

    Gostishchev, V K; Evseev, M A

    2005-01-01

    Results of antisecretory therapy (pyrenzepin, H(2)-blockers, inhibitors of proton pump, octreotid) in 962 patients with acute gastroduodenal ulcer bleedings (AGDUB) were analyzed over 14-years period. Antisecretory treatment in AGDUB has principally different goals and potential depending on risk of bleeding's recurrence and morphological changes in tissue of gastroduodenal ulcer. Antisecretory therapy is the main treatment in high risk of AGDUB recurrence or before urgent surgery. Intravenous infusion of omeprazol has demonstrated the highest clinical efficacy due to maximal inhibition of gastric secretion and absence of negative influences on oxygen regimen in tissue of ulcer.

  8. PERFORATION OF A DUODENAL ULCER IN A 10 YEAR OLD BOY: A CASE REPORT

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    Prasenjit

    2014-04-01

    Full Text Available In this modern era of medicine, perforation of duodenal or gastric ulcer in pediatric patients is very rare. Here we are presenting a 10 year boy presented in emergency department of our rural tertiary care hospital with complaints of diffuse abdominal pain, nausea, vomiting of 36 hours and mild fever of 12 hours duration. O/E he had tachycardia, raised temperature, generalized abdominal tenderness, guarding, rigidity and rebound tenderness. On chest x-ray, free gas under diaphragm was seen. He had undergone exploratory laparotomy showing perforation at the 1st part of duodenum which was repaired by Graham’s patch repair. Post-operative recovery was uneventful. We suggested Helicobacter pylori workup on discharge but patient didn’t turn up in follow up.

  9. [Prevalence and treatment of Helicobacter pylori in gastro-duodenal ulcers. An experience in Liege].

    Science.gov (United States)

    Lutgen, N; Delforge, M; Bastens, B; Demoulin, J C; Fontaine, F; Gillard, V; Gerard, A

    2001-01-01

    Between April 1998 and July 1999, we prospectively investigated 152 patients with gastric or duodenal ulcer and we observed concomitant H. pylori infection in 72.8% and 78.5% respectively. We proposed to the GPs of these patients the recommended triple therapy (omeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg (OAC) twice daily for 7 or 10 days). H. pylori eradication was tested using the C13-urea breath test. Our results showed a modest overall eradication rate of about 70%. We have to persuade the patients and the GPs of the benefit of antibiotics and of the importance of the correct dosages. We have to continue to follow the resistance against antibiotics.

  10. Comparative efficiency of endoscopic hemostasis methods in bleeding undercomplicated peptic ulcer in children

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    Сергій Олександрович Сокольник

    2015-05-01

    Full Text Available Aim. To compare the effectiveness of endoscopic hemostasis in complex treatment of gastrointestinal bleeding in children of Chernovtsy region with peptic ulcer disease.Methods. 43 cases of bleeding in peptic ulcer disease in children are analyzed. Argon plasma coagulation is undergone in order to stop the bleeding for 11 patients, for others – aminocaproic acid irrigation.Results. Using argon plasma coagulation, in contrast to the aminocaproic acid irrigation reduces the risk of rebleeding 0.59 times when the number of patients who must be treated – 2.99.Conclusions. The most effective method of endoscopic hemostasis of bleeding in peptic ulcer disease in children is argon plasma coagulation, which allows you to achieve a stable hemostasis and reduce the risk of rebleeding

  11. Matrix metalloproteinase-3 promoter polymorphisms but not dupA-H. pylori correlate to duodenal ulcers in H. pylori-infected females

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    Yeh Yi-Chun

    2010-08-01

    Full Text Available Abstract Background This study investigated if the H. pylori dupA genotype and certain host single nucleotide polymorphisms (SNPs of matrix metalloproteinases (MMPs and their inhibitors (TIMPs, including MMP-3, MMP-7, MMP-9, TIMP-1 and TIMP-2, might correlate with ulcer risk of H. pylori-infected Taiwanese patients. Results Of the 549 H. pylori-infected patients enrolled, 470 patients (265 with gastritis, 118 with duodenal ulcer, and 87 with gastric ulcer received SNPs analysis of MMP-3-1612 6A > 5A, MMP-7-181 A > G, MMP-9exon 6 A > G, TIMP-1372 T > C and TIMP-2-418 G > C by PCR-RFLP. The 181 collected H. pylori isolates were detected for the dupA genotype by PCR. The rates of dupA-positive H. pylori infection were similar among patients with duodenal ulcer (22.8%, gastric ulcer (20.0%, and gastritis (25.5% (p > 0.05. Males had higher rates of duodenal ulcer and gastric ulcer than females (p H. pylori-infected patients, the MMP-3 6A6A genotype were more common in patients with duodenal ulcers than in those with gastritis (87.7% vs. 74.9%, p p H. pylori-infected females. Conclusions The MMP-3 promoter polymorphism, but not the dupA-status, may correlate with susceptibility to duodenal ulcer after H. pylori infection in Taiwanese females.

  12. Effect of antisecretory agents and vagotomy on healing of "chronic" cysteamine-induced duodenal ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1986-01-01

    Penetrated cysteamine-induced duodenal ulcers in rats have a very prolonged course of healing. In this study, it was investigated how much the healing of these ulcers is accelerated by some treatments. The treatments included omeprazole, cimetidine, and truncal vagotomy. In addition, the effect...... of omeprazole and cimetidine on gastric acid secretion was investigated in chronic gastric fistula rats. After 25 days of treatment, significantly more rats in the treated groups had healed ulcers than in the control group. There was little further improvement up to 100 days of treatment, and the difference...... between treated and untreated groups decreased. The morphology of healing ulcers in treated and untreated rats was also compared. In controls, there was a simultaneous regeneration of mucosa and the submucosal Brunner's glands from the edges of the ulcer, the slow proliferation rate of the latter probably...

  13. Duodenal Perforation Precipitated by Scrub Typhus

    OpenAIRE

    Raghunath Rajat; David Deepu; Arul Jeevan Jonathan; Abhilash Kundavaram Paul Prabhakar

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical explora...

  14. Gastrointestinal bleeding in the pediatric patient.

    OpenAIRE

    Hillemeier, C.; Gryboski, J. D.

    1984-01-01

    Gastrointestinal hemorrhage in infants and children is a catastrophic event but is not associated with significant mortality except in those with a severe primary illness. Upper gastrointestinal bleeding in infants and young children is most often associated with stress ulcers or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Lower gastrointestinal bleeding may be caused by a variety of lesions among which are infectious colitides...

  15. Late anastomotic perforation following surgery for gastric neuroendocrine tumor complicated by perforated duodenal ulcer: a case report.

    Science.gov (United States)

    Han, Jun; He, Zhenyu

    2013-03-01

    Neuroendocrine tumors (NETs) are a group of neoplasms that are characterized by the secretion of a variety of hormones and diverse clinical syndromes. NETs are considered to be rare, but the incidence of NETs has increased rapidly in recent years. NETs provide a clinical challenge for physicians because they comprise a heterogeneous group of malignancies with a wide range of morphological, functional, and behavioral characteristics. Subtotal gastrectomy with Billroth II reconstruction is the mainstay of therapy in the management of gastric NETs complicated by perforated duodenal ulcer. Late perforation of anastomotic stoma as a long-term complication has been rarely reported. Here, we report a case of anastomotic perforation 5 years after subtotal gastrectomy due to perforated duodenal ulcer and gastric NETs.

  16. Azithromycin in a triple therapy for H. pylori eradication in active duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Vladimir T. Ivashkin; Tatiana L. Lapina; Oksana Yu. Bondarenko; Olga A. Sklanskaya; Petr Ya. Grigoriev; Yuri V. Vasiliev; Emilia P. Yakovenko; Pavel V. Gulyaev; Valeri I. Fedchenko

    2002-01-01

    AIM: To assess and compare the efficacy and safety of twotriple regimes: A) metronidazole, amoxicillin and omeprazole,which is still widely used in Russia, and B) azithromycin,amoxicillin and omeprazole in healing active duodenal ulcerand H.pylori eradication. METHODS: 100 patients with active duodenal ulcer wereincluded in the open, multicentre, randomized study withcomparative groups. Patients were randomly assigned toone of the following one-week triple regimes: A)metronidazole 500 mg bid, amoxicillin 1 g bid and omeprazole20 mg bid (OAM, n=50) and B) azithromycin 1 g od for thefirst 3 days (total dose 3 g), amoxicillin 1 g bid andomeprazole 20 mg bid (OAA, n=50). Omeprazole 20 mg odwas given after the eradication course as a monotherapyfor three weeks. The control endoscopy was performed 8weeks after the entry. H. pylori infection was determined inthe entry of the study and four weeks after the cessation oftreatment by means of histology and CLO-test.RESULTS: 97 patients completed the study according tothe protocol (1 patient of the OAM group did not come tothe control endoscopy, 2 patients of the OAA group stoppedthe treatment because of mild allergic urticaria). Duodenalulcers were healed in 48 patients of the OAM group (96 %;CI 90.5-100 %) and in 46 patients of the OAA group (92 %;CI 89.5-94.5 %) (p=ns). H. pylori infection was eradicatedin 15 out of 50 patients with OAM (30 %; CI 17-43 %) andin 36 out of 50 patients treated with OAA (72 %; CI 59-85 %)(P<0.001)-ITT analysis.CONCLUSION: The triple therapy with omeprazole,amoxicillin and metronidazole failed to eradicate H. pylori inthe majority of patients, which is an essential argument towithdraw this regimen out of the national recommendations.Macrolide with amoxicillin are preferable to achieve highereradication rates. Azithromycin (1 g od for the first 3 days)can be considered as a successful component of the triplePPI-based regimen.

  17. Octreotide in the Control of Post-Sclerotherapy Bleeding from Oesophageal Varices, Ulcers and Oesophagitis

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    Spencer A. Jenkins

    1996-01-01

    Full Text Available Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure 100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.

  18. Therapeutic Options for Patients Bleeding with Peptic Ulcers

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    ABR Thomson

    1994-01-01

    Full Text Available It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies.

  19. Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge.

    Science.gov (United States)

    Ram, Duvuru; Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ali, Sheik Manwar

    2014-03-06

    Gastrointestinal (GI) haemorrhage is a common surgical emergency accounting for approximately 1% of acute hospital admissions. Lower GI bleed is less common and less severe than upper GI bleed and is usually caused by diverticulosis, neoplasms, angiodysplasia and inflammatory bowel disease. A 51-year-old man presented with massive lower GI bleed. He had no history of tuberculosis. He underwent colonoscopy and an isolated caecal ulcer was noted. Segmental ileocaecal resection was performed and no specific cause was identifiable on histopathology. PCR was performed on this specimen and it was positive for Mycobacterium tuberculosis. This case reports the unusual presentation of tuberculosis as solitary caecal ulcer with massive lower GI bleed and highlights the role of PCR as an adjuvant diagnostic tool for its diagnosis when characteristic histopathological findings are absent.

  20. Endoscopic Injection Therapy in Bleeding Peptic Ulcers. Low Mortality in a High Risk Population

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    Joaqulm Balanzó

    1992-01-01

    Full Text Available Endoscoric injection therapy was performed in 341 patients consecutively admitted with a bleeding peptic ulcer at high risk of further hemorrhage, assessed by the presence of active arterial bleeding or a nonbleeding visible vessel at emergency endoscopy. Initial hemostasis was achieved in 111 of 119 actively bleeding patients (93%. Rebleeding ocurred in 75 cases (23%, at a mean interval of 53±52 h. A second emergency injection was a ttempted in 36 therapeutic failures, and was successful in 20 (55%. Emergency surgery was finally required in 52 patients (15%. Overall mortality was 4.9%. Major complications occurred in four patients (1.2% (two perforations and two aspiration pneumonia; therefore, injection therapy is an effective and simple method for treating bleeding ulcers, achieving the initial control of hemorrhage in a majority of cases although the rate of further hemorrhage is not negligible and complications are not irrelevant.

  1. Study of responsible arteries of duodenal ulcer hemorrhage and the significance of transcatheter arterial embolization%十二指肠溃疡出血责任动脉的研究及在栓塞治疗中的意义

    Institute of Scientific and Technical Information of China (English)

    李强; 吴亮; 汤继军

    2014-01-01

    Objective To study the responsible arteries of duodenal ulcer hemorrhage and the significance of transcatheter arterial embolization.Methods There were 1 7 patients of massive bleeding of duodenal ulcer,in which 1 6 patients were diagnosed and 8 ca-ses were treated by endoscope initially.DSAs were performed at gastr-oduodenal arteries or their ramus in all patients.DSA signs were analysed by two salted docters together.At first the responsible ar-teries for duodenal ulcer hemorrhage were affirmed,and then endo-vascular embolization was performed.Results The responsible arteries for duodenal ampulla ulcer hemorrhage were the ascending duodenal artery(ADA)、the pancreaticoduodenal trunk(PDT)、the supraduodenal artery(SDA)and the retroduodenal artery (RDA).The responsible arteries for descendant duodenum ulcer hemorrhage were the anterior superior pancreaticoduodenal artery (ASPDA)and the posterior superior pancreaticoduodenal artery(PSPDA).The positive rate of bleeding that showed the signs of bleeding was 100%,the s-uccess rate of the operations was 100%,the complete efficiency ra-te of hemostasis was 88.2%,the par-tial efficiency rate of hemostas was 1 1.8%.Conclusion The responsible arteries of duodenal ulcer hemorrhage are multiples,which is important for guiding transcatheter arterial embolization of the responsible arteries of duodenal ulcer hemorrhage accurately.%目的:探讨十二指肠溃疡出血的责任动脉及在栓塞治疗中的意义。方法17例十二指肠溃疡大出血患者,分析其 DSA表现,判定出血的责任动脉,然后实施栓塞治疗。结果十二指肠球部溃疡出血的责任动脉为十二指肠升动脉(ADA)、十二指肠胰干(PDT)、十二指肠上动脉(SDA)、十二指肠后动脉(RDA),十二指肠降部溃疡出血的责任动脉为胰十二指肠上前动脉(ASPDA)和胰十二指肠上后动脉(PSPDA)。结论十二指肠溃疡出血的责任动脉众多,准确判定十二指肠溃疡出血的责任动

  2. Indistinguishable cellular changes in gastric mucosa between helicobacter pylori infected asymptomatic tribal and duodenal ulcer patients

    Institute of Scientific and Technical Information of China (English)

    Dhira Rani Saha; Simanti Datta; Santanu Chattopadhyay; Rajashree Patra; Ronita De; Krishnan Rajendran; Abhijit Chowdhury; Thandavaryan Ramamurthy; Asish Kumar Mukhopadhyay

    2009-01-01

    AIM: To investigate the changing pattern of different histological parameters occurring in the stomach tissue of Helicobacter pylori (H pylori) infected tribal populations and duodenal ulcer patients among ethnic Bengalis and correlation of the genotypes of H pylori with different histological parameters.METHODS: One hundred and twelve adult individuals were enrolled into this study between 2002 and 2004. Among them, 72 had clinical features of duodenal ulcer (DU) from ethnic Bengali population and 40 were asymptomatic ethnic tribals. Endoscopic gastric biopsy samples were processed for histology, genotyping and rapid urease test. Histologically,haematoxylin and eosin staining was applied to assess the pathomorphological changes and a modified Giemsa staining was used for better detection of Hpylori. For intestinal metaplasia, special stainings, i.e.AIcian blue periodic acid-Schiff and high iron diamineAIcian blue staining, were performed. PCR was performed on bacterial DNA to characterize the presence or absence of virulence-associated genes, like cagA, and distribution of different alleles of vacA and iceA .RESULTS: Intraglandular neutrophil infiltration, a hallmark of activity of gastritis, was present in 34 (94%) of tribals (TRs) and 42 (84%) of DU individuals infected with Hpylori. Lymphoid follicles and aggregates, which are important landmarks in H pylori infection, were positive amongst 15 (41%) of TRs and 20 (40%) of DU subjects. Atrophic changes were observed in 60% and 27.7%, respectively, among DU cases and tribals (P > 0.003). Metaplastic changes were detected in low numbers in both groups. Moderate to severe density distribution of Hpylori in the gastric mucosa was 63% among TRs, whereas it was 62% in DU subjects. There were no significant differences in the distribution of virulence-associated genes like cagA, vacA and iceA of Hpylori strains carried by these two populations.CONCLUSION: Our study showed almost similar distribution of inflammatory

  3. A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

    Science.gov (United States)

    Temiz, Abdulkerim; Tander, Burak; Temiz, Muhyittin; Barış, Sancar; Arıtürk, Ender

    2011-03-01

    Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

  4. Perforated duodenal ulcer; management in a resource poor, semi-urban Nigerian hospital

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    Felix O Oribabor

    2013-01-01

    Full Text Available Introduction: Perforated duodenal ulcer (PDU is still seen frequently in the study center inspite of the free use of effective medical curative therapy. We then set out to ascertain the pattern of presentation, peculiar risk factors in the study environment, re-evaluate our method of management, and to see if it is adequate for patients in a developing country. Materials and Methods: This is a retrospective study of patients admitted and managed for PDUs, between January 2004 and December 2011 at the Federal Medical Centre, IdoEkiti, Southwest Nigeria. The records of patients were retrieved and demographic data relating to age, sex, symptoms, duration, diagnosis, intra-operative findings, and management outcome were extracted. The results were analyzed. Results: A total of 30 patients were admitted and operated during this period. Twenty-eight of them were males and two were females. The mean age was 47 years and the male: female ratio was 14:1. The duration of symptoms before presentation ranged from 2 to 7 days. None of the patients had a prior diagnosis of their ulcers, by an upper gastro intestinal endoscopy before presentation; although most had dyspeptic symptoms, with inadequate or no medical treatment. The notable peculiar risk factor was the abuse of local herbal concoction for body pains by all the patients. Seven patients smokes, 15 consumes alcohol, and only two take non-steroidal anti-inflammatory drugs for body pains. Most of the managed patients; 26 were satisfactorily discharged home and later followed-up at the surgical out-patient department. Four mortality was recorded during the period of study. Conclusion: PDU is still a major complication of chronic peptic ulcer disease. Simple omental patch and H. pylori eradication is no longer appropriate as a mode of treatment for the youths who are mostly affected in the center. We therefore, suggest a more wide spread use of definitive ulcer surgery for most of our patients with no

  5. [Relapse of bleeding ulcer in a 15 year-old boy with collagenous gastritis].

    Science.gov (United States)

    Haase, Anne-Mette; Kelsen, Jens

    2012-06-18

    Collagenous gastritis (CG) is a rare disorder. Two patient groups are known: 1) Children and young adults, presenting with anaemia and abdominal pain, and 2) adults presenting with watery diarrhoea. In the latter group, CG is frequently associated with collagenous colitis and/or coeliac disease. This case concerns a 15-year-old boy with a bleeding ulcer. The biopsies from corpus ventriculi showed a thickened subepithelial collagen band (> 10 micrometres), and the patient was diagnosed with CG. Ulcers are rarely linked to CG. CG should be considered when ulcers are found in children and young adults.

  6. Association of the myeloperoxidase-468G→A polymorphism with gastric inflammation and duodenal ulcer risk

    Institute of Scientific and Technical Information of China (English)

    Ping-I Hsu; Jin-Liang Chen; Yu-Shan Chen; Angela Chen; Jyh-Jen Jwo; Hui-Hwa Tseng; Kwok-Hung Lai; Gin-Ho Lo; Ching-Chu Lo; Chung-Jen Wu; Seng-Kee Chuah; Il- Ran Hwang

    2005-01-01

    AIM: To eluddate the relations between the myeloperoxidase -468G→A polymorphism and the development of duodenal ulcer (DU), and to investigate the impacts of this host genetic polymorphism on the histopathological featuresof Helicobacter pylori ( H pylori)-related gastritis. METHODS: In a case-control study of 115 consecutive DU patients and 182 controls, the myeloperoxidase-468G→A polymorphism was genotyped. Additionally, gastric mucosal changes were examined according to the updated Sydney System.RESULTS: The two study groups differed in the distributionsof myelperoxidase genotypes (P= 0.008). All six individuals carrying myeloperoxidase A/A genotypes were in the DU group. The carriage of myeloperoxidase allele A and H pylori infection were associated with an increased risk of DU with odds ratios (OR) of 2.3 and 5.8, respectively. Thecombined risk of the carriage of myeloperoxidase allele A and H pylori infection for DU was 8.7 (95% CI, 3.5-21.8). In the H pylori-infected individuals, allele A carriers displayed higher bacterial density scores (P = 0.04) inthe antrum than did non-carriers.CONCLUSION: This work verifies for the first time the association of myeloperoxidase-468G→A polymorphism with antral H pyloridensity and DU disease. The mechanisms underlying this genetic polymorphism in developing DU disease merit further investigations.

  7. [Is it possible to expand the indications for primary radical operations for perforated gastric and duodenal ulcer?].

    Science.gov (United States)

    Vachev, A N; Adyshirin-Zade, E E; Frolova, E V; Dergal', S V; Kozlov, A A

    2010-01-01

    A retrospective analysis of 365 completed patient records received by the duty surgical hospital with perforated gastric ulcer and duodenal ulcer. All the patients were operated on urgently. Diagnosis of purulent peritonitis was set 17% of patients, "serous"--47.4%, "seroplastic"- 35.6%. 75.3%, perform suturing of perforated openings, regardless of the form of peritonitis. The remaining 24.7%--interventions that address as a perforation, and the impact on the pathogenesis of peptic ulcer. When radical surgery, which were performed in selected patients even with purulent peritonitis, deaths were reported. And when suturing the ulcer defect lethality was 14.5%. In this group of patients were comparable in age and severity of general condition. It is concluded that that the operations of suturing perforated ulcers were used unnecessarily broad, and the majority of patients admitted to hospital with a perforated stomach ulcer and duodenum may increase the volume of surgical benefit for radical treatment of complications as well as most of peptic ulcer.

  8. National consensus on management of peptic ulcer bleeding in Denmark 2014

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2014-01-01

    endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) within 24 hours from primary endoscopy. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put...

  9. Sequential versus concomitant therapy for eradication of Helicobacter Pylori in patients with perforated duodenal ulcer: A randomized trial

    Directory of Open Access Journals (Sweden)

    Roby Das

    2016-01-01

    Full Text Available Objectives: Comparison of Helicobacter pylori eradication rates, side effects, compliance, cost, and ulcer recurrence of sequential therapy (ST with that of concomitant therapy (CT in patients with perforated duodenal ulcer following simple omental patch closure. Methods: Sixty-eight patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori positive on three months follow-up were randomized to receive either ST or CT for H. pylori eradication. Urease test and Giemsa stain were used to assess for H. pylori eradication status. Follow-up endoscopies were done after 3 months, 6 months, and 1 year to evaluate the ulcer recurrence. Results: H. pylori eradication rates were similar in ST and CT groups on intention-to-treat (ITT analysis (71.43% vs 81.80%,P = 0.40. Similar eradication rates were also found in per-protocol (PP analysis (86.20% vs 90%,P = 0.71. Ulcer recurrence rate in ST groups and CT groups at 3 months (17.14% vs 6.06%,P = 0.26, 6 months (22.86% vs 9.09%,P = 0.19, and at 1 year (25.71% vs 15.15%,P = 0.37 of follow-up was also similar by ITT analysis. Compliance and side effects to therapies were comparable between the groups. The most common side effects were diarrhoea and metallic taste in ST and CT groups, respectively. A complete course of ST costs Indian Rupees (INR 570.00, whereas CT costs INR 1080.00. Conclusion: H. pylori eradication rates, side effects, compliance, cost, and ulcer recurrences were similar between the two groups. The ST was more economical compared with CT.

  10. A comparison of roxatidine acetate 150 mg once daily and 75 mg twice daily in duodenal ulcer healing.

    Science.gov (United States)

    Hentschel, E; Schütze, K

    1988-01-01

    A randomised multicentre, double-blind study of the efficacy and safety of roxatidine acetate 150 mg at bedtime or 75 mg twice a day was conducted in 300 outpatients with endoscopically confirmed duodenal ulcers. After 14 days' treatment with roxatidine acetate substantial reductions in ulcer sizes had been obtained, in addition to healing rates of 87 to 89%, with no significant differences between the dosage regimens. There were graded reductions in day and night-time assessment of epigastric pain for both treatment groups and no differences in the mean numbers of antacid tablets consumed. In addition, cigarette smoking did not influence the healing rates produced by either treatment schedule. 11 patients reported 12 mild adverse reactions, with gastrointestinal symptoms the most frequent, and no clinically significant alterations in laboratory values. The present data suggests that a single bedtime dose of roxatidine acetate 150 mg produces effective duodenal ulcer healing and pain relief equivalent to that produced by a twice daily dosage regimen.

  11. Typhoid fever with caecal ulcer bleed: managed conservatively.

    Science.gov (United States)

    Boopathy, Vinoth; Periyasamy, Sivakumar; Alexander, Thomas; Balasubramanian, Padhmini

    2014-03-31

    Typhoid fever is caused by enteroinvasive Gram-negative organism Salmonella typhi. The well-known complications of typhoid fever are intestinal haemorrhage and perforation. In the pre-antibiotic era, these complications were quite common, but in the current antibiotic era the incidence of these complications is on the decline. We report a case of a patient with typhoid fever who developed haematochezia during the hospital stay and was found to have caecal ulcer with an adherent clot on colonoscopy. He was managed successfully with conservative measures without endotherapy and there was no rebleed.

  12. Bleeding gastroduodenal ulcers in patients without Helicobacter pylori infection and without exposure to non-steroidal anti-inflammatory drugs

    Directory of Open Access Journals (Sweden)

    Smolović Brigita

    2014-01-01

    Full Text Available Background/Aim. A high risk of bleeding in Helicobacter pylori (H.pylori-negative, non-steroidal anti-inflammatory drugs (NSAID-negative ulcers highlights the clinical importance of analysis of the changing trends of peptic ulcer disease. The aim of the study was to investigate the risk factors for ulcer bleeding in patients with non-H. pylori infection, and with no NSAIDs use. Methods. A prospective study included patients with endoscopically diagnosed ulcer disease. The patients were without H. pylori infection (verified by pathohistology and serology and without exposure to NSAIDs and proton pump inhibitors (PPI within 4 weeks before endoscopy. After endoscopy the patients were divided into 2 groups: the study group of 48 patients with bleeding ulcer and the control group of 47 patients with ulcer, but with no bleeding. Prior to endoscopy they had completed a questionnaire about demographics, risk factors and habits. The platelet function, von Willebrand factor (vWF and blood groups were determined. Histopathological analysis of biopsy samples were performed with a modified Sydney system. The influence of bile reflux was analyzed by Bile reflux index (BRI. Results. Age, gender, tobacco and alcohol use did not affect the bleeding rate. The risk of bleeding did not depend on concomitant diseases (p = 0.509 and exposure to stress (p = 0.944. Aspirin was used by 16/48 (33.3% patients with bleeding ulcer, as opposed to 7/47 (14.9% patients who did not bleed (p = 0.036. Abnormal platelet function had 12/48 (25.0% patients who bled, as opposed to 2/47 (4.3% patients who did not bleed (p = 0.004. Patients with BRI < 14 bled in 79.2%, and did not bleed in 57.4% of the cases (p = 0.023. There was no statistical difference between groups in regards to blood groups and range of vWF. Antrum atrophy was found in 14/48 (29.2% patients with bleeding ulcer and in only 5/47 (10.6% patients who had ulcer without bleeding (p = 0.024. Conclusion. Abnormal

  13. Once-Daily Bedtime Dose of Roxatidine and Ranitidine in Acute Duodenal Ulcer: A Combined Assessment of Acid Inhibitory Activity and Healing Rate.

    Science.gov (United States)

    Savarino, Vincenzo; Mela, Giuseppe Sandro; Zentilin, Patrizia; Mele, Maria Raffaella; Vigneri, Sergio; Termini, Rosanna; Di Mario, Francesco; Ferrana, Marina; Malesci, Alberto; Belicchi, Monica

    1995-12-01

    This study was carried out in order to compare the antisecretory effect of a single bedtime dose of roxatidine 150 mg and ranitidine 300 mg and to assess the relationship between the degree and the duration of acid suppression and the healing rates obtained in duodenal ulcer patients treated with the above regimens. Sixty-three patients with endoscopically proven ulcer underwent 24-h gastric pH-metry on day 0, day 1, and day 28 of treatment with both roxatidine and ranitidine. Ulcer healing was checked endoscopically after 4 weeks of therapy. RESULTS: Eight patients did not complete the study, leaving 55 patients eligible for final analysis, 28 in the roxatidine group and 27 in the ranitidine group. Duodenal ulcers were healed in 24--28 (85%) patients of the former and in 22--27 (81%) patients of the latter group (p minus sign NS). Gastric pH was significantly higher (p roxatidine and ranitidine. There was also do difference between the two active treatments. The pattern of gastric acidity significantly differed (p roxatidine 150 mg and ranitidine 300 mg was able to heal more than 80% of duodenal ulcers within 4 weeks of treatment. The lack of tolerance to H2-blockers in duodenal ulcer patients contributes to this good result. The antisecretory effect of H2-antagonists is reduced in nonresponder patients with respect to responder patients and this is mainly due to an impaired control of nocturnal acidity.

  14. [Perforated duodenal ulcer in a Roux-en-Y gastric bypass operated patient can be a diagnostic challenge].

    Science.gov (United States)

    Wied, Christian; Akralið, Guðny B; Lauritsen, Morten Laksáfoss; Naver, Lars Peter Skat

    2013-02-25

    Roux-en-Y gastric bypass (RYGBP) is an increasingly used procedure when treating morbid obesity. Due to the extensive gastrointestinal rearrangement, diagnostic evaluation of patients with gastric bypass and acute abdominal pain can be difficult. We present a case of a perforated duodenal ulcer in a RYGBP operated patient, where free abdominal fluid, but hardly any pneumoperitoneum was seen on a computed tomography. Free intraperitoneal fluid is an important finding and should give suspicion of the need for emergency surgery in RYGBP operated patients with abdominal pain.

  15. Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch Perforación de ulcus gigante duodenal: reparación innovadora mediante una plastia del antro gástrico

    Directory of Open Access Journals (Sweden)

    Javier A. Cienfuegos

    2012-08-01

    Full Text Available Backgrounds: the treatment of a perforated giant duodenal ulcer (GUDs represents a formidable surgical challenge regarding the duodenal wall defect repair in severe peritonitis setting. A high incidence of dehiscence and hospital mortality (15-40%- has been reported with the majority of the techniques. We report a case of GUDs perforation successfully treated with a subtotal gastrectomy and a gastric patch with the remnant antrum, for repairing the duodenal defect. Case report: a 63-years-old man with antecedents of peptic ulcer disease presents a large duodenal ulcer perforation with 48 hrs delay and associated with severe peritonitis and a retroperitoneal collection. A subtotal gastrectomy with Billroth II reconstruction and reconstruction of the duodenal defect with a patch of the remnant antrum was carried out. The patient was discharged at 17th postoperative day with good tolerance. Discussion: the duodenal defect repair with a patch of the remant antrum, represents a valid alternative in similar circumstances. To our knowledge, it appears to be the first clinical description of this technique.Antecedentes: el tratamiento de un ulcus duodenal gigante (UDG; > 2 cm perforado entraña una gran dificultad técnica, por la reparación del gran defecto duodenal; y por la peritonitis sobreañadida. Todas las técnicas descritas se asocian con un índice elevado de dehiscencias y una mortalidad del 15-40%. Describimos por primera vez el caso de un UDG perforado, tratado mediante una gastrectomía subtotal y con una plastia del antro gástrico remanente. Caso clínico: varón de 63 años que se interviene de un UDG perforado en la 2ª porción duodenal asociado con peritonitis severa y disección de la gotiera parieto-cólica derecha retroperitoneo. Se realiza gastrectomía tipo Bilroth II y reparación del defecto duodenal mediante una plastia con la pared del antro gástrico remanente. El paciente fue dado de alta a los 17 días. Discusión: la

  16. Duodenal lipoma associated with ectopic duodenal glands

    Directory of Open Access Journals (Sweden)

    Dianbo Cao

    2011-12-01

    Full Text Available Duodenal lipomas are relatively uncommon and are rarely responsible for clinical symptoms. Occasionally, searching for aetiology of gastrointestinal bleeding leads to the final diagnosis of duodenal lipomas. Here, we present the case of a 68-year-old woman who suffered with repeated melena and weight loss. Endoscopy, abdominal computed tomography (CT and histopathological outcomes are described in this case of duodenal lipoma with ectopic duodenal glands.

  17. A Rare Cause of Chronic Life Threatening Bleeding in a Girl: The Ulcerated Blind Loops

    Directory of Open Access Journals (Sweden)

    Abhijeet D Sawant

    2016-04-01

    Full Text Available Ulceration in a blind loop can lead to massive gastrointestinal tract (GIT bleeding. A 13-year old girl presented with symptomatic melena requiring repeated blood transfusion since childhood. She was an operated case of small bowel atresia in neonatal life. Her upper and lower gastrointestinal endoscopies were normal. Operation showed presence of multiple ulcers in two blind loops (parts of previous side to side anastomosis and at the anastomotic site. She underwent resection and end-to-end anastomosis of the small bowel leading to complete resolution of melena and anemia.

  18. A Rare Cause of Chronic Life Threatening Bleeding in a Girl: The Ulcerated Blind Loops.

    Science.gov (United States)

    Sawant, Abhijeet D; Shah, Rasik; Shah, Nitin; Gupta, Tarun

    2016-01-01

    Ulceration in a blind loop can lead to massive gastrointestinal tract (GIT) bleeding. A 13-year old girl presented with symptomatic melena requiring repeated blood transfusion since childhood. She was an operated case of small bowel atresia in neonatal life. Her upper and lower gastrointestinal endoscopies were normal. Operation showed presence of multiple ulcers in two blind loops (parts of previous side to side anastomosis) and at the anastomotic site. She underwent resection and end-to-end anastomosis of the small bowel leading to complete resolution of melena and anemia.

  19. Association between ulcer site and outcome in complicated peptic ulcer disease

    DEFF Research Database (Denmark)

    Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais

    2016-01-01

    OBJECTIVE: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). MATERIALS AND METHODS: Design: a nationwide cohort study with prospective...... and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. RESULTS: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality...... was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p 

  20. Laparoscopic Surgery in the Treatment of Gastric Perforation of Duodenal Ulcer%腹腔镜手术治疗胃十二指肠球部溃疡穿孔临床观察

    Institute of Scientific and Technical Information of China (English)

    陈宗玮; 袁江; 张薇

    2016-01-01

    目的:分析患有胃十二指肠球部溃疡穿孔的患者实施腹腔镜下手术治疗效果。方法收集我院收治的胃十二指肠球部溃疡穿孔的患者60例作为研究对象,25例实施腹腔镜下手术治疗,35例患者使用开腹手术治疗。结果腹腔镜组术中出血量少于开腹组,治疗效果优于开腹组治疗效果。结论对患有胃十二指肠球部溃疡穿孔的患者,实施腹腔镜下手术治疗的效果较好。%Objective To analyze the effect of laparoscopic surgery on the treatment of gastric perforation of duodenal ulcer.Methods 60 patients with gastric duodenal ulcer in our hospital were taken as the research object. 25 patients were treated with laparoscopic surgery, and 35 patients were treated with open surgery.Results The amount of bleeding in patients undergoing laparoscopic surgery was less than that in the open group, and the treatment effect was better than that of the patients in the laparotomy group.Conclusion Perforation of gastro duodenal ulcer patients undergoing laparoscopic surgery treatment can achieve great effect.

  1. Giant lipoma of posterior neck with bleeding decubitus ulcer: A rare entity

    Directory of Open Access Journals (Sweden)

    Manish Varma

    2010-01-01

    Full Text Available Giant lipomas are benign soft tissue tumours. They are found relatively rarely on the posterior part of the neck. Bleeding pressure ulcer in this giant tumour is a rare presentation. Surgical interventions in these tumours are very challenging because, sometimes, extension to the spinal cord and malignant change may occur, especially in old age. Knowledge of the anatomy and meticulous surgical techniques are needed for such giant lipomas.

  2. Wavelet-based analysis of gastric microcirculation in rats with ulcer bleedings

    Science.gov (United States)

    Pavlov, A. N.; Rodionov, M. A.; Pavlova, O. N.; Semyachkina-Glushkovskaya, O. V.; Berdnikova, V. A.; Kuznetsova, Ya. V.; Semyachkin-Glushkovskij, I. A.

    2012-03-01

    Studying of nitric oxide (NO) dependent mechanisms of regulation of microcirculation in a stomach can provide important diagnostic markers of the development of stress-induced ulcer bleedings. In this work we use a multiscale analysis based on the discrete wavelet-transform to characterize a latent stage of illness formation in rats. A higher sensitivity of stomach vessels to the NO-level in ill rats is discussed.

  3. Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2015-09-01

    Full Text Available Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK, proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.

  4. Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed

    Institute of Scientific and Technical Information of China (English)

    Samir Kapadia; Sophia Jagroop; Atul Kumar

    2012-01-01

    Cameron lesions represent linear gastric erosions and ulcers on the crests of mucosal folds in the distal neck of a hiatal hernia (HH).Such lesions may be found in upto 50% of endoscopies performed for another indication.Though typically asymptomatic,these may rarely present as acute,severe upper gastrointestinal bleed (GIB).The aim is to report a case of a non-anemic 87-year-old female with history of HH and atrial fibrillation who presented with hematemesis and melena resulting in hypovolemic shock.Repeat esophagogastroduodenoscopy was required to identify multiple Cameron ulcers as the source.Endoscopy in a patient with HH should involve meticulous visualization of hernia neck and surrounding mucosa.Cameron ulcers should be considered in all patients with severe,acute GIB and especially in those with known HH with or without chronic anemia.

  5. Comparison of tri-potassium di-citrato bismuthate tablets with ranitidine in healing and relapse of duodenal ulcers.

    Science.gov (United States)

    Lee, F I; Samloff, I M; Hardman, M

    1985-06-08

    120 patients were randomly allocated to receive ranitidine 150 mg twice daily or a tri-potassium di-citrato bismuthate (TDB) tablet four times a day in a trial comparing the effects of these drugs in the short-term healing and post-healing relapse rates of duodenal ulceration. At 4 weeks 81% of those on ranitidine and 90% of those on TDB had healed ulcer craters. At 8 weeks 97% of those on ranitidine and 97% of those on TDB had healed. These differences are not significant. After ulcer healing, the cumulative rates of relapse, as determined endoscopically, for symptomatic and symptomless ulcers were 74% for ranitidine and 41% for TDB at 4 months (p less than 0.001), 87% for ranitidine and 55% for TDB at 8 months (p less than 0.001), and 89% for ranitidine and 62% for TDB at 12 months (p less than 0.001). Females had significantly lower relapse rates than males. In the ranitidine group smokers had a higher rate of early relapse and failure to remain healed at 12 months than did non-smokers; no such difference occurred in the TDB-treated group.

  6. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia? A pilot study

    Institute of Scientific and Technical Information of China (English)

    Spiros D. Ladas; Dimitrios Polymeros; Thomas Pagonis; Konstantinos Triantafyllou; Gregorios Paspatis; Maria Hatziargiriou; Sotirios A.Raptis

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from posthaemorrhage anaemia. This prospective, randomised, open,pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.METHODS: We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive blood transfusions. One day after the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20 000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100 mg im, on days 1- 6, (G1) or iron only (G2). Haematocrit was measured on days 0, 6, 14,30, 45, and 60, respectively.RESULTS: One patient from G1 and two from G2 were lost to follow-up. Therefore, 14 and 13 patients from G1 and G2respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study.Median reticulocyte counts were significantly different between groups on day six (G1: 4.0, 3.0-6.4 vsG2: 3.5, 2.1-4.4%,P=0.03) and median haematocrit on day fourteen [G1: 35.9,30.7-41.0 vsG2: 32.5, 29.5-37.0% (median, range), P=0.04].CONCLUSION: Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.

  7. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kyriakos Neofytou

    2014-01-01

    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  8. Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Tai-Cherng Liou; Shee-Chan Lin; Horng-Yuan Wang; Wen-Hsiung Chang

    2006-01-01

    AIM: To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers.METHODS: This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers (spurting or oozing) were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1:10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups.RESULTS: There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups (P < 0.05). The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group (20.3%) than in the 30 (5.3%) and 40 mL (2.8 %) epinephrine groups (P < 0.01). There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group (51/76) than in the 20 (2/76) and 30 mL (5/76) epinephrine groups (P < 0.001). Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group (P < 0.01). Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups (P < 0.01).CONCLUSION: Injection of 30 mL diluted epinephrine (1:10000) can effectively prevent recurrent

  9. Independent risk factors of 30-day outcomes in 1264 patients with peptic ulcer bleeding in the USA

    DEFF Research Database (Denmark)

    Camus, M.; Jensen, D. M.; Kovacs, T. O.;

    2016-01-01

    were predictors of 30-day surgery. Risk factors for 30-day death were major SRH, in-patient bleeding, and any initial platelet transfusion or fresh frozen plasma transfusion ≥2 units. Among patients with major SRH and out-patient start of bleeding, larger ulcer size was also a risk factor for death (OR...

  10. [Principal characteristics of the endoscopic programmed hemostasis in ulcerative gastroduodenal bleedings in patients with high operational-anesthesiological risk].

    Science.gov (United States)

    Timen, L Ia; Trubitsyna, I E; Chikunova, B Z

    2013-01-01

    Application of the endoscopic programmed hemostasis for patients with ulcer gastroduodenal bleedings and with high operational-anesthetic risk provided metabolic rehabilitation (5% solutions of glucose and ascorbic acid) for the purpose of prevention of recurrence of the bleedings which have arisen after a hemostasis at 5.5% of patients.

  11. Planned second look endoscopy in patients with bleeding duodenal or gastric ulcers

    DEFF Research Database (Denmark)

    Trap, R; Skarbye, M; Rosenberg, J

    2000-01-01

    1998. Planned second look endoscopy and repeated sclerotherapy were standard care. The effects were evaluated by comparing the expected number of rebleeders with actual rebleeders. At the same time we assessed predicting factors for rebleeding. RESULTS: Fifteen of the admitted seventy patients were...... found to rebleed after initial sclerotherapy. The overall success rate of endoscopic therapy was 63/70 patients (90%). Six patients (9%) had to undergo surgery to obtain haemostasis, and one patient died suddenly after the second endoscopic sclerotherapy. Perforation was seen in two patients (3...... of the present study suggests a beneficial effect on rebleeding rate of patients treated with planned second look endoscopy. Future controlled trails should verify this hypothesis....

  12. Comparison of esomeprazole enteric-coated capsules vs esomeprazole magnesium in the treatment of active duodenal ulcer: A randomized, double-blind, controlled study

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yan Liang; Qing Gao; Neng-Ping Gong; Li-Ping Tang; Pi-Long Wang; Xiao-Hong Tao

    2008-01-01

    AIM: To evaluate the efficacy and tolerability of two different preparations of esomeprazole in healing duodenal ulcers.METHODS: A total of 60 patients with active duodenal ulcers were enrolled and randomized to receive esomeprazole enteric-coated capsules (40 mg) or esomeprazole magnesium (40 mg), once daily, for 4 consecutive wk, with ulcer healing being monitored by endoscopy. Safety and tolerability were also assessed.RESULTS: Fifty seven patients completed the whole trial. The ulcer healing rates at the end of wk 2 were 86.7% and 85.2% in the esomeprazole enteric-coated capsules and esomeprazole magnesium groups, respectively (P = 0.8410), and reached 100% at the end of wk 4 in both groups. Symptom relief at the end of wk 2 was 90.8% in the esomeprazole enteric-coated capsules group and 86.7% in the esomeprazole magnesium group (P = 0.5406); at the end of wk 4 symptom relief was 95.2% and 93.2%, respectively (P = 0.5786). Adverse events occurred in 16.7% of the esomeprazole enteric-coated capsules group and 14.8% of the esomeprazole magnesium group (P = 1.0000).CONCLUSION: The efficacies of esomeprazole enteric-coated capsules and esomeprazole magnesium in healing duodenal ulcer lesions and relieving gastrointestinal symptoms are equivalent. The tolerability and safety of both drugs were comparable.

  13. Sudden fetal death associated with both duodenal atresia and umbilical cord ulcer: a case report and review.

    Science.gov (United States)

    Anami, Ai; Morokuma, Seiichi; Tsukimori, Kiyomi; Kondo, Haruhiko; Nozaki, Masahiro; Sueishi, Katsuo; Nakano, Hitoo

    2006-04-01

    We encountered one case of duodenal atresia complicated by massive intrauterine hemorrhage due to the perforation of an umbilical cord ulceration (UCU). UCU is an extremely rare complication in the perinatal period. Although the prenatal diagnosis of upper intestinal atresia has been established, little is known about the association between UCU and upper intestinal atresia. In this article, we report our case, review past articles, and discuss the underlying pathophysiological mechanisms of the cause of an UCU. Given the characteristic sites of upper intestinal atresia, we speculate that regurgitation of gastric or intestinal juice into the amniotic fluid could be responsible for the development of UCU. We also believe that close observation is required for patients who have upper intestinal atresia.

  14. The effect of tri-potassium di-citrato bismuthate (De-Nol) on the healing of chronic duodenal ulcers.

    Science.gov (United States)

    Coughlin, G P; Kupa, A; Alp, M H

    1977-02-26

    Forty-six patients suffering from chronic duodenal ulcer, proven endoscopically, were treated in a randomized double-blind cross-over trial with either tri-potassium di-citrato bismuthate (De-Nol) or placebo for four weeks and assessed symptomatically and endoscopically. Those patients who failed to heal after treatment with either agent were crossed over to the alternative preparation and reassessed after a further 28 days. Forty-two patients completed the study involving 57 patient treatments. A highly significant improvement in both symptomatic response (P less than 0.01) and endoscopic healing (P less than 0.01) was seen in those patients receiving tri-potassium di-citrato bismuthate (De-Nol) as against placebo therapy.

  15. UPPER GASTRO-INTESTINAL BLEEDING IN THE YOUNG - GASTRIC GIST TUMOR OR PEPTIC ULCER DISEASE?

    Directory of Open Access Journals (Sweden)

    Ayodele Atolagbe

    2015-09-01

    Full Text Available GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young. We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

  16. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Sørensen Henrik T

    2007-04-01

    Full Text Available Abstract Background Mortality after perforated and bleeding peptic ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding peptic ulcer and to determine the impact of comorbidity on this association. Methods In this population-based cohort study in three Danish counties between 1991 and 2003 we identified two cohorts of patients: those hospitalized with a first-time discharge diagnosis of perforated peptic ulcer and those with bleeding peptic ulcer. The diagnoses were ascertained from hospital discharge registries and mortality through the Danish Civil Registration System. Information on comorbidity and use of ulcer-related drugs was obtained through administrative medical databases. We computed age-, gender- and comorbidity-standardized 30-day mortality rates and used Cox's regression to estimate adjusted 30-day mortality rate ratios (MRR for elderly compared with younger patients. Results Among 2,061 patients with perforated peptic ulcer, 743 (36% were 65–79 years old and 513 patients (25% were aged 80+ years. Standardized 30-day mortality was 8.9% among patients younger than 65 years rising to 44.6% among patients aged 80+ years, corresponding to an adjusted MRR of 5.3 (95% CI: 4.0–7.0. Among 7,232 patients with bleeding peptic ulcer 2,372 (33% were aged 80+ years. Standardized 30-day mortality among patients younger than 65 was 4.3% compared with 16.9% among patients aged 80+ years, corresponding to an adjusted MRR of 3.7 (95% CI: 2.9–4.7. Analyses stratified by comorbidity consistently showed high MRRs among elderly patients, regardless of comorbidity level. Conclusion Ageing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity.

  17. Clinical and histological features of duodenal ulcer in children and adolescents

    OpenAIRE

    Elisabete Kawakami; Machado, Rodrigo S. [UNIFESP; Fonseca,Jacqueline A.; Francy R. S. PATRÍCIO

    2004-01-01

    OBJETIVO: Avaliar as características clínicas e histológicas de crian��as e adolescentes com úlcera duodenal. MÉTODOS: Foram avaliadas prospectiva e consecutivamente 43 pacientes com úlcera duodenal ao longo de 6 anos (7,2 pacientes por ano). A avaliação consistiu de questionário clínico de sintomas dispépticos, exame físico e endoscopia digestiva com biópsias gástricas para exame histológico e detecção do Helicobacter pylori. RESULTADOS: A idade no diagnóstico variou de 4 anos e 8 meses a 17...

  18. Synchronous perforation of a duodenal and gastric ulcer: a case report

    Directory of Open Access Journals (Sweden)

    Karangelis Dimos

    2010-08-01

    Full Text Available Abstract Introduction Peritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity. Case presentation We present a rare case of a 54-year-old Caucasian man who underwent an emergency laparotomy for peritonitis caused by perforation of two peptic ulcers. The first was located on the anterior wall of the duodenum and the second was posterior, pre-pyloric, close to the lesser curvature. Conclusion To the best of our knowledge, this is only the second report in the medical literature of a simultaneous perforation of two peptic ulcers; though rare, every surgeon performing open or laparoscopic repair of a perforated peptic ulcer should be aware of the possibility of simultaneous perforation.

  19. [Which therapeutic regimen for eradicating Helicobacter pylori and cicatrization of a duodenal ulcer. Is there a role for short-term treatment?].

    Science.gov (United States)

    Chassany, Olivier; Duracinsky, Martin

    2002-08-24

    CURRENT REGIMENS: The regimen recommended for the eradication of Helicobacter pylori and cicatrization of a duodenal ulcer is the association, for 7 days, of a double-dose of gastric anti-secretory drug and 2 antibiotics, followed by a usual dose of an anti-secretory for a further 3 weeks. During randomized studies, this therapeutic regimen led to an eradication rate of 80 to 90%. However, in current practice in France, the eradication rate is of only 60 to 75%. THE QUESTIONS RAISED: Phenomena of resistance to antibiotics are not the only cause. Lack of compliance is frequent, partly generated by poor tolerance to the antibiotherapy. Many recently published studies have provided elements of response to several questions concerning the eradication of Helicobacter pylori: can one reduce the duration of treatment by associating a triple antibiotherapy or, to the contrary, should one prolong treatment to be sure that patients fully comply to the 7 days of treatment? Should the dose of anti-secretory drug be doubled? And, with regard to cicatrizing the duodenal ulcer: can one reduce the duration of the anti-secretory agent? WITH THE RESULTS OF RECENTLY PUBLISHED CLINICAL TRIALS: It is legitimate today to prescribe double antibiotherapy for 10 to 14 days, associated with a double dose of an anti-secretory, without having to prolong the anti-secretory after this initial period, in order to cicatrize the duodenal ulcer. Further studies will specify the optimal duration between 10 and 14 days. However, till now, this therapeutic regimen for eradicating Helicobacter pylori and cicatrizing a duodenal ulcer has not obtained marketing authorization and is not appropriate for treating gastric ulcers and for complicated (notably hemorrhagic) gastroduodenal lesions.

  20. Bleeding peptic ulcer. Prevalence of Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs/acetylsalicylic acid

    DEFF Research Database (Denmark)

    Vestergard, A.; Bredahl, K.; Muckadell, O.B. de

    2009-01-01

    INTRODUCTION: Helicobacter pylori (HP) infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs)/acetyl salicylic acid (ASA) are risk factors for bleeding peptic ulcer. HP eradication reduces the risk of rebleeding. Antibiotics, proton pump inhibitors (PPI) and presence of blood in the s......INTRODUCTION: Helicobacter pylori (HP) infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs)/acetyl salicylic acid (ASA) are risk factors for bleeding peptic ulcer. HP eradication reduces the risk of rebleeding. Antibiotics, proton pump inhibitors (PPI) and presence of blood...

  1. Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

    Institute of Scientific and Technical Information of China (English)

    Francesco Manguso; Elena Trimarco; Antonio Balzano; Elisabetta Riccio; Germana de Nucci; Maria Luisa Aiezza; Gerardino Amato; Linda Degl'Innocenti; Maria Maddalena Piccirillo; Gianfranco De Dominicis; Tara Santoro

    2011-01-01

    AIM: To establish the prevalence of Helicobacter pylori (H. pylori ) infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs (NSAIDs). METHODS: A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease (CLO) test, histological examination, and bacterial culture. IgG anti- CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections. RESULTS: Eighty patients, 61 males (76.3%), mean age 61.2 ± 15.9 years, were consecutively enrolled. Forty-seven (58.8%) patients occasionally consumed NSAIDs, while 33 (41.3%) were on chronic treatment with low-dose aspirin (LD ASA). Forty-four (55.0%) patients were considered infected by H. pylori . The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The highest accuracy (92.5%) was obtained with the culture of biopsy specimens. CONCLUSION: Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

  2. COMPARISON OF RANITIDINE AND PANTOPRAZOLE FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS REQUIRING MECHANICAL VENTILATION

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia (HAP)....

  3. Five-day bismuth-free triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse

    Energy Technology Data Exchange (ETDEWEB)

    Coelho, L.G.; Passos, M.C.; Chausson, Y.; Castro L de, P. (Gastroenterology, Nutrition and Digestive Surgery Unit, University Hospital, Federal University of Minas Gerais (Brazil))

    1991-08-01

    Previous studies have demonstrated that the eradication of Helicobacter pylori (H. pylori) is associated with a significant reduction of the rate of duodenal ulcer (DU) relapse. The aim of this study was to assess the long-term effect of a bismuth-free triple therapy on the eradication of H. pylori and reduction of DU relapse. After informed consent, 61 patients with endoscopically proven DU and H. pylori infection detected on 14C-urea breath test (BT) were included in the study. All patients received a combination of furazolidone, amoxicillin, and metronidazole, three times a day, for 5 days, in addition to eventual classical antiulcer agents prescribed by their attending physicians. BT was repeated after an interval of at least 60 days to evaluate H. pylori eradication. Endoscopy and another BT were performed again at 6.5 months after therapy to detect possible recurrences. Forty-eight patients completed the trial: 26 (54%) patients were negative for H. pylori at 6.5 months after the end of treatment, and 22 (46%) persisted H. pylori positive. Ninety-two percent of the patients in whom the bacteria were eradicated showed endoscopically healed ulcers and were asymptomatic, and two that were symptomatic presented only occasional pain not requiring therapy. Among the 22 patients who persisted H. pylori positive, six (27%) showed endoscopically active ulcers (p = 0.012) and eight (36%) patients continued to be symptomatic (p less than 0.01), and were still using antiulcer drugs (p = 0.002) 6.5 months after treatment. It is concluded that combined treatment with furazolidone, amoxicillin, and metronidazole for 5 days represents a well-tolerated, inexpensive, and effective therapeutic regime for the eradication of H. pylori and abolition of DU relapse in more than 50% of the patients during a follow-up period of 6.5 months.

  4. Distal Gastrectomy of Gastric and Duodenal Ulcer%胃十二指肠溃疡远端胃部分切除术

    Institute of Scientific and Technical Information of China (English)

    陈中成

    2014-01-01

    目的:探讨胃十二指肠溃疡患者行胃部分切除术治疗效果。方法对30例胃十二指肠溃疡患者行远端胃部分切除术治疗资料进行分析。结果30例十二指肠患者Bil roth I式10例,Bil roth II式20例,重建手术时间40~90 min。吻合口溃疡2例,反流性胃炎1例,残胃炎4例,经治疗所有患者均痊愈出院。结论胃十二指肠溃疡常用的手术方式是远端胃大部切除术,Bil roth I式胃十二指肠吻合或Bil roth I式胃空肠吻合重建,具体视切除的范围和十二指肠残端的情况而定。%Objective The distal gastrectomy effect on patients with gastric and duodenal ulcer to be investigated. Methods Analyze the treatment data selected from 30 patients with gastric and duodenal ulcer who are operated with distal gastrectomy. Results Among 30 patients, 10 patients with duodenal ulcer are categorized into Bil roth I Type, and the other 20 patients are categorized into Bil roth II Type, the operation reconstruction time is from 40 minutes to 90 minutes. And there are two cases of anastomotic ulcer, one case of reflux gastric and 4 cases of residual gastritis. Al of patients are cured and discharged from hospital after treatment. Conclusion The distal gastrectomy, gastric and duodenal anastomosis of Bil roth I Type or gastrojejunostomy reconstruction of Bil roth II Type is the common surgical method to cure gastric and duodenal ulcer, the choice of the surgical method is determined by resection scope and duodenal stump condition.

  5. [Influence of three point mutations in TNF-alpha promoter gene in clinical manifestations and complications of stomach and duodenal ulcer].

    Science.gov (United States)

    Polonikov, A V; Ivanov, V P; Solodilova, M A; Shveĭnov, A I; Manuĭlova, O S; Kozhukhov, M A; Tutochkina, M P; Stepchenko, A A; Bulgakova, I V

    2009-01-01

    The purpose of our study was to investigate whether polymorphisms -238G/A, -308G/A, and -863C/A within the promoter of the TNF-alpha gene are associated with clinical features of gastric and duodenal ulcer disease in a Russian population. DNA samples of 381 unrelated patients with gastric and duodenal ulcer disease and 216 sex- and age-matched healthy controls were used to determine the TNF-alpha gene polymorphisms by PCR-RFLP assay. Logistic regression analysis has revealed significant associations of polymorphism -308G/A with size of ulcerous defect (p=0.03) and intestinal dyspepsia (p=0.05), polymorphism -238G/A with gastric dyspepsia (p=0.04) and reflux-esophagitis (p=0.05), polymorphism -863C/A with perforation of ulcer (p=0.04). The study results highlight impact of the TNF-alpha gene polymorphisms on various clinical features in patients with peptic ulcer disease.

  6. Epidemiological Clinical Features and Evolution of Gastroduodenal Ulcer Bleeding in a Tertiary Care Hospital in Spain, during the Last Seven Years

    OpenAIRE

    2013-01-01

    Background. Gastroduodenal ulcer bleeding is a common medical emergency. The aim of this study was to analyze the characteristics of bleeding episodes and to identify changes in the clinical trends over seven years. Methods. Retrospective observational clinical study on a cohort of 272 consecutive adult patients with peptic ulcer bleeding, during the 2006–2012 period. Results. Mean annual admission rate was 12.8 per 100.000 inhabitants. Men were predominant (71%), with a mean age of 66.6 year...

  7. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Laursen, Stig B; Leontiadis, Grigorios I; Stanley, Adrian J;

    2017-01-01

    BACKGROUND AND AIMS: The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB. METHODS: A nationwide cohort study based on a database of consecutive patients...... admitted to hospital with PUB in Denmark. Patients were stratified according to presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy...... and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors. RESULTS: A total of 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA...

  8. Ebrotidine versus ranitidine in the treatment of acute duodenal ulcer. A multicentre, randomized, double-blind, controlled clinical trial.

    Science.gov (United States)

    Matov, V; Metchkov, G; Krastev, Z; Tchernev, K; Mitova, R; Márquez, M; Torres, J; Herrero, E; Fillat, O; Ortiz, J A

    1997-04-01

    A total of 478 patients with endoscopically confirmed duodenal ulcer entered this randomized, parallel, double-blind trial. Patients were randomly assigned to receive ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]- 4-thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfona mid e, CAS 100981-43-9, FI-3542) 400 mg or ranitidine 300 mg tablets (4:1) respectively, administered in single evening doses. Endoscopy, clinical examination and symptom assessment were performed at baseline and at weeks 4 and 8. Safety evaluations including laboratory tests, treatment compliance and antacid consumption checks were conducted at the beginning and/or at the 4 and 8 week visits. Patients whose ulcer showed endoscopic healing at the 4-week control left the study. Both groups were matched in all parameters studied. The healing rates at 4 weeks were 76.4% and 75.3% for ebrotidine and ranitidine respectively, while at 8 weeks the final rates were 95% and 91.8% respectively. Accompanying symptoms disappeared rapidly and the patients returned to normal. Smoking proved to be a highly significant negative risk factor, since healing rates were 83.4% and 71.2% at 4 weeks and 97.4% and 92.3% at 8 weeks in non-smokers and smokers respectively (p = 0.0046). Smokers treated with ranitidine showed significantly lower final healing rates than non-smokers (86% vs 100%; p = 0.0358), while the healing rates among patients treated with ebrotidine were similar regardless of whether they were smokers or not (93.9% and 96.7% N.S.). Ebrotidine (94%) proved to be more effective than ranitidine (86%) in smokers with higher healing rates (p < 0.05). Alcohol intake showed no significant relationship with the healing rates. Both drugs demonstrated an excellent safety. There were no changes in blood parameters, and no significant adverse events were reported.

  9. Eradication of Helicobacter pylori infection in patients with duodenal ulcer and non-ulcer dyspepsia and analysis of one-year reinfection rates

    Directory of Open Access Journals (Sweden)

    Della Libera E.

    2001-01-01

    Full Text Available Helicobacter pylori (HP infection is endemic worldwide. The proposed treatment is expensive and there are few reports regarding reinfection rates in Brazil. The aim of this study was to compare the eradication rates obtained with two therapeutic options and to evaluate reinfection one year after treatment. This was a prospective randomized trial with 55 patients. Thirty-nine patients had active duodenal ulcer (DU and 16 non-ulcer dyspepsia (NUD, and all tested positive for HP. Diagnosis was based on at least two positive tests: ultrarapid urease test, histology and/or culture. Patients were randomized to two groups: group OMC treated with 40 mg omeprazole (once a day, 500 mg metronidazole and 250 mg clarithromycin (twice daily for 7 days, or group NA treated with 300 mg nizatidine (once a day and 1000 mg amoxicillin (twice daily for 14 days. Those patients in whom HP was eradicated were followed up for one year to evaluate reinfection. Twenty-five patients were randomized for OMC and 30 for NA. HP eradication occurred in 20/25 patients (80% treated with OMC and 13/30 (43% treated with NA (P = 0.01. After reallocation because of initial treatment failure, the overall eradication rate was 44/51 patients (86%. After an average follow-up of one year, we evaluated 34 patients (23 with DU and 11 with NUD. Reinfection occurred in 3/34 patients (7.6%. We conclude that OMC is effective for HP eradication, and that NA should not be used. Reinfection occurs in 7.6% of the patients in the first year after eradication.

  10. Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    A. Karaman

    2010-09-01

    Full Text Available Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10–20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

  11. A therapeutic dose of ketoprofen causes acute gastrointestinal bleeding, erosions, and ulcers in rats.

    Science.gov (United States)

    Shientag, Lisa J; Wheeler, Suzanne M; Garlick, David S; Maranda, Louise S

    2012-11-01

    Perioperative treatment of several rats in our facility with ketoprofen (5 mg/kg SC) resulted in blood loss, peritonitis, and death within a day to a little more than a week after surgery that was not related to the gastrointestinal tract. Published reports have established the 5-mg/kg dose as safe and effective for rats. Because ketoprofen is a nonselective nonsteroidal antiinflammatory drug that can damage the gastrointestinal tract, the putative diagnosis for these morbidities and mortalities was gastrointestinal toxicity caused by ketoprofen (5 mg/kg). We conducted a prospective study evaluating the effect of this therapeutic dose of ketoprofen on the rat gastrointestinal tract within 24 h. Ketoprofen (5 mg/kg SC) was administered to one group of rats that then received gas anesthesia for 30 min and to another group without subsequent anesthesia. A third group was injected with saline followed by 30 min of gas anesthesia. Our primary hypothesis was that noteworthy gastrointestinal bleeding and lesions would occur in both groups treated with ketoprofen but not in rats that received saline and anesthesia. Our results showed marked gastrointestinal bleeding, erosions, and small intestinal ulcers in the ketoprofen-treated rats and minimal damages in the saline-treated group. The combination of ketoprofen and anesthesia resulted in worse clinical signs than did ketoprofen alone. We conclude that a single 5-mg/kg dose of ketoprofen causes acute mucosal damage to the rat small intestine.

  12. Efficacy Observation on Yunnan Baiyao (云南白药) Combined with Antibiotics in Treating Helicobacter Pylori Related Duodenal Ulcer

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To observe the clinical efficacy of Yunnan Baiyao (云南白药, YNBY) combined with antibiotics in treating Helicobacter pylori (HP) related duodenal ulcer (DU). Methods: Eighty-two HP positive DU patients were randomly divided into two groups: Treated group (44 cases) used YNBY plus amoxicillin and metronidazole; control group (38 cases) used de-nol plus amoxicillin and metronidazole). Results: After a 2-week treatment course, the effect of epigastric pain relief was 68.3% in treated group, and 44.4% in control group, the difference between them was significant (P<0.05). Marked effect in acid regurgitation and belching relief was observed in both groups. The rate of DU healing in treated and control group was respectively 88.6% and 89.5%; the clearance of HP 84.1% and 89.5%; and the side-effects 4.5% and 13.5%, with insignificant difference between these two groups. Conclusion: YNBY combined with antibiotics in treating DU, and clearance of HP is an economic, safe and effective therapy.

  13. [A multicenter clinical trial. Zinc acexamate versus famotidine in the treatment of acute duodenal ulcer. Study Group of Zinc acexamate (new UP doses)].

    Science.gov (United States)

    García-Plaza, A; Arenas, J I; Belda, O; Diago, A; Domínguez, A; Fernández, C; Martín, L; Pallarés, A; Rodrigo, L; de la Santa, J w

    1996-11-01

    A multicentric double-blind trial comparing 600 mg/d of Zinc Acexamate (ACZ) and 40 mg/d of Famotidine (FMT) in the short term treatment of acute duodenal ulcer included 199 patients, diagnosed by endoscopy. One-hundred and five patients received ACZ and 94 FMT, during four weeks. A clinical control took place at two weeks and a second clinical and endoscopic control at the end of the treatment (4 weeks). Complete cicatrization of the ulcer was observed in 56.5% of patients on ACZ and in 69.5% of patients of FMT (N.S.). A reduction of more than 50% of the ulcer diameter was recorded in 78.8% of the ACZ group and in 79.9% of the FMT group. Alcohol and smoking did not influence the results. Both treatments were equally effective in the disappearance of symptoms. The incidence of adverse reactions was very low in both groups (< 5%) and no patient dropped from the trial for this reason. In conclusion, a dosage of 600 mg/d of ACZ has shown to be as effective as 40 mg/d of FMT in the healing of duodenal ulcer.

  14. Periodic activity of secretory glands of stomach in ulcer erosion of gastro-duodenal zone

    Directory of Open Access Journals (Sweden)

    A. I. Rudenko

    2005-12-01

    Full Text Available It was fixed, that development of atophanum-carbacholimun ulcer of the gastroduodenal zone invoked various changes of secretory activity of the stomach. The changes directly depend on a progress of pathological process. As this takes place the reaction of stomach secretory glands varies under the stimulation with histamine: the decrease of stomach secretory glands’ work capacity till 10th day and its increase after 10–15th day were observed. Disorders of the glands’ ultradian rhythms at initial stages of modeling of gastrointestinal nervous regulation disturbances testify to dependence of periodic activity of gastrointestinal tract on resistance of regulatory mechanisms correlation.

  15. Parameters of proliferation and apoptosis of epithelial cells in the gastric mucosa in indigenous and non-indigenous residents of Khakassia with Helicobacter pylori positive duodenal ulcer disease.

    Science.gov (United States)

    Tsukanov, V V; Shtygasheva, O V; Vasyutin, A V; Amel'chugova, O S; Butorin, N N; Ageeva, E S

    2015-02-01

    We evaluated parameters of apoptosis in the mucosa of the gastric antrum and body of indigenous and non-indigenous residents of Khakassia with duodenal ulcer disease associated with Helicobacter pylori infection. In the gastric antrum, apoptotic index was significantly increased in patients with ulcer disease in comparison with healthy individuals in both populations. The ratio of proliferation index to apoptotic index was lower in patients with ulcer disease in comparison with healthy individuals in both populations. Similar, but less pronounced processes were recorded in the body of the stomach. Significant changes in the parameters of proliferation and apoptosis were noted in the gastric antrum and body of the stomach in both populations, but they were more pronounced in Caucasians in comparison with Khakasses.

  16. Differences in Genome Content among Helicobacter pylori Isolates from Patients with Gastritis, Duodenal Ulcer, or Gastric Cancer Reveal Novel Disease-Associated Genes▿ †

    Science.gov (United States)

    Romo-González, Carolina; Salama, Nina R.; Burgeño-Ferreira, Juan; Ponce-Castañeda, Veronica; Lazcano-Ponce, Eduardo; Camorlinga-Ponce, Margarita; Torres, Javier

    2009-01-01

    Helicobacter pylori establishes a chronic infection in the human stomach, causing gastritis, peptic ulcer, or gastric cancer, and more severe diseases are associated with virulence genes such as the cag pathogenicity island (PAI). The aim of this work was to study gene content differences among H. pylori strains isolated from patients with different gastroduodenal diseases in a Mexican-Mestizo patient population. H. pylori isolates from 10 patients with nonatrophic gastritis, 10 patients with duodenal ulcer, and 9 patients with gastric cancer were studied. Multiple isolates from the same patient were analyzed by randomly amplified polymorphic DNA analysis, and strains with unique patterns were tested using whole-genome microarray-based comparative genomic hybridization (aCGH). We studied 42 isolates and found 1,319 genes present in all isolates, while 341 (20.5%) were variable genes. Among the variable genes, 127 (37%) were distributed within plasticity zones (PZs). The overall number of variable genes present in a given isolate was significantly lower for gastric cancer isolates. Thirty genes were significantly associated with nonatrophic gastritis, duodenal ulcer, or gastric cancer, 14 (46.6%) of which were within PZs and the cag PAI. Two genes (HP0674 and JHP0940) were absent in all gastric cancer isolates. Many of the disease-associated genes outside the PZs formed clusters, and some of these genes are regulated in response to acid or other environmental conditions. Validation of candidate genes identified by aCGH in a second patient cohort allowed the identification of novel H. pylori genes associated with gastric cancer or duodenal ulcer. These disease-associated genes may serve as biomarkers of the risk for severe gastroduodenal diseases. PMID:19237517

  17. High prevalence of ulcer bleeding risk factors in dual antiplatelet-treated patients after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Berit Elin S; Hansen, Jane M; Junker, Anders B;

    2015-01-01

    . The following characteristics were considered risk factors: increasing age (age 60-69 years and ≥ 70 years); dyspepsia; previous peptic ulcer; use of non-steroidal anti-inflammatory drugs (NSAIDs) (weekly or daily), corticosteroids, selective serotonin reuptake inhibitors (SSRIs) and anticoagulants. RESULTS......: A total of 1,358 patients with a mean age of 64.1 years (range: 33-92 years) were included. The distribution of risk factors was as follows: dyspepsia: 681 patients (50.1%); previous ulcer: 110 (8.1%; 2.3% with bleeding); use of NSAIDs: 214 (15.8%); corticosteroids (2.9%), SSRIs (5.8%) and anticoagulants...

  18. Effect of centrally administered oxytocin on gastric and duodenal ulcers in rats%脑室注射催产素对大鼠胃和十二指肠溃疡的作用

    Institute of Scientific and Technical Information of China (English)

    Mohammed ASAD; Deepak Gopal; Kallasam KOUMARAVELOU; Benny K ABRAHAM; Sadashivam VASU; Subramanian RAMASWAMY

    2001-01-01

    AIM: To investigate the effect of centrally administered oxytocin and its receptor antagonist, atosiban, on gasuic acid secretion and on experimentally induced gastric and duodenal ulcers. METHODS: The acute gastric ulcer models, such as pylorus ligation, indomethacin-induced and ethanol-induced gastric ulcers were used. Chronic gastric ulcers were induced by acetic acid and duodenal ulcers by cysteamine HC1. RESULTS: In pylorus ligated rats, oxytocin ( 10 μg/kg, icv) showed signifi cant antisecretory and antiulcer activity (P<0.01 ). However, it aggravated the ethanol-induced gastric ulcers and did not show any effect on indomethacin-induced gas tric ulcers. Oxytocin increased gastric ulcer healing in acetic acid-induced chronic gastric ulcers. The effect of oxytocin was reversed by atosiban (10 μg/kg, icy), a selective oxytocin receptor antagonist. Atosiban when given alone increased gastric acid secretion and ulcer index in pylorus-ligated rats and also aggravated acetic acid-induced chronic gastric ulcers. It seems the antiul cer activity of oxytocin was due to its anti-secretory ef fect. CONCLUSION: Centrally administered oxytocin possesses gastric anti-secretory and anti-ulcer activity and oxytocin antagonist, atosiban, is pro-ulcerogenic in rats.

  19. Gastric bicarbonate secretion and release of prostaglandin E2 are increased in duodenal ulcer patients but not in Helicobacter pylori-positive healthy subjects

    DEFF Research Database (Denmark)

    Mertz-Nielsen, A; Hillingsø, Jens; Frøkiaer, H;

    1996-01-01

    was present also in the stomach of DU patients. METHODS: Simultaneous determinations of gastric and duodenal bicarbonate secretion and luminal release of PGE2 were performed in 16 healthy volunteers (5 Helicobacter pylori-positive) and 8 inactive DU patients (all H. pylori-positive). RESULTS: In healthy...... volunteers the rates of gastroduodenal bicarbonate secretion and the release of PGE2 were not influenced by H. pylori status. In inactive DU patients the rates of basal (704 +/- 84 versus 356 +/- 40 mumol/h; mean +/- SEM) and vagally stimulated (modified sham feeding) (1724 +/- 376 versus 592 +/- 52 mumol...... for the abnormally high gastric secretion of bicarbonate in inactive DU patients. The defective duodenal secretion of bicarbonate observed in these patients may be a consequence of previous ulceration rather than the mere presence of H. pylori infection....

  20. Gastric bicarbonate secretion and release of prostaglandin E2 are increased in duodenal ulcer patients, but not in Helicobacter pylori positive healthy subjects

    DEFF Research Database (Denmark)

    A, Mertz-Nielsen; Hillingsø, Jens; Frøkiær, Hanne;

    1996-01-01

    was present also in the stomach of DU patients. Methods: Simultaneous determinations of gastric and duodenal bicarbonate secretion and luminal release of PGE(2) were performed in 16 healthy volunteers (5 Helicobacter pylori-positive) and 8 inactive DU patients (all H. pylori-positivr). Results: In healthy...... volunteers the rates of gastroduodenal bicarbonate secretion and the release of PGE(2), were not influenced by H. pylori status. In inactive DU patients the rates of basal (704 +/- 84 versus 356 +/- 40 mu mol/h: mean +/- SEM) and vagally stimulated (modified sham feeding) (1724 +/- 376 versus 592 +/- 52 mu...... be responsible for the abnormally high gastric secretion of bicarbonate in inactive DU patients. Th; defective duodenal secretion of bicarbonate observed in these patients may be a consequence of previous ulceration rather than the mere presence of H. pylori infection....

  1. [Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

    Science.gov (United States)

    Razarenova, T G; Koshel', A P; Klokov, S S; Dibina, T V

    2010-01-01

    The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

  2. A multicenter, double-blind, randomized, placebo-controlled comparison of nocturnal roxatidine in the treatment of active duodenal ulcer disease. Multicenter Roxatidine Cooperative Study Group.

    Science.gov (United States)

    Gilinsky, N H; Bright-Asare, P; Cobert, B L; Fitch, D D; Lanza, F L; Kerr, R M; Savitsky, J P

    1992-07-01

    This multicenter randomized, double-blind, 4-wk study compared the new H2-receptor antagonistic roxatidine (R) to placebo (P) for treatment of endoscopically diagnosed active duodenal ulcer disease. Subjects were evaluated after 2 and 4 wk of treatment. Those whose ulcer was unhealed at 2 wk received 2 more weeks of treatment before final evaluation. Ulcer healing (endoscopically determined) with roxatidine was more effective than placebo at both wk 0-2 (R = 33.9%, P = 21.9%, p = 0.018) and wk 2-4 (R = 68.2%, P = 29.7%, p less than 0.001), with an overall 4-wk effectiveness of 78.9% compared to 44.8% (p less than 0.001). At the end of treatment, average maximum ulcer diameter diminished 83% in R and 50% in P (p less than 0.001). Roxatidine was also more effective than placebo in decreasing abdominal pain (p less than 0.001), decreasing the number of antacid tablets taken for pain relief (p less than 0.001), improving dyspeptic symptoms (p less than 0.001), and permitting return to a normal routine for subjects with previous illness-imposed restrictions on work and/or other daily activities. The profile of laboratory values and adverse experiences demonstrated roxatidine to be safe and well-tolerated. The efficacy of roxatidine as evaluated by the healing rate of duodenal ulcer and reduction in abdominal pain emphasize its value as an addition to the family of H2-receptor antagonists.

  3. Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial

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    Seyed Alireza Taghavi

    2009-01-01

    Full Text Available BACKGROUND/OBJECTIVE: Several combination endoscopic therapies are currently in use. The present study aimed to compare argon plasma coagulation (APC + adrenaline injection (AI with hemoclips + AI for the treatment of high-risk bleeding peptic ulcers.

  4. The interest of the {sup 13}C urea breath test for the diagnostic and monitoring of chronic duodenal ulcer; Interet du test respiratoire a l`uree {sup 13}C dans le diagnostic et le suivi de l`ulcere duodenal chronique

    Energy Technology Data Exchange (ETDEWEB)

    Rousseau-Tsangaris, M. [INBIOMED, 69 - Lyon (France); Centarti, M.; Mion, F.; Minaire, Y. [Hopital Edouard-Herriot, 69 - Lyon (France); Brazier, J.L. [Faculte de Pharmacie, 69 - Lyon (France)

    1994-12-31

    Duodenal ulcer is very frequently associated with Helicobacter pylori (Hp) present in the gastric mucous membrane. Breath tests with {sup 13}C-labelled urea have been carried out for the detection of Hp; these tests could be more sensitive than gastric biopsies, because of the heterogenous distribution of the bacteria in the mucous membrane. This breath test may be used repetitively and allows for a non-intrusive monitoring of the Hp eradication after treatment. 12 refs.

  5. Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy.

    Science.gov (United States)

    Raithel, Martin; Hahn, Markus; Donhuijsen, Konrad; Hagel, Alexander F; Nägel, Andreas; Rieker, Ralf J; Neurath, Markus F; Reinshagen, Max

    2014-09-17

    Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.

  6. 十二指肠溃疡导致巨大肠系膜脓肿1例%A case of duodenal ulcer resulting in huge mesenteric abscess

    Institute of Scientific and Technical Information of China (English)

    孙运秀; 陈立波

    2013-01-01

    Although the perforation caused by ulcer on posterior wall of duodenal is common,the perforation which locates in mesentery and leads to mesenteric abscess is rare. The clinical manifestation is not typical in this case. So it is easy to make missed or incorrect diagnosis. With the report of this case,there will be important mirror meaning on the diagnosis and treatment of mesenteric abscess merger duodenal fistula.

  7. Wavelet-analysis of gastric microcirculation in rats with ulcer bleedings

    Science.gov (United States)

    Pavlov, A. N.; Semyachkina-Glushkovskaya, O. V.; Pavlova, O. N.; Bibikova, O. A.; Kurths, J.

    2013-10-01

    Nitric oxide (NO) plays an important role in regulation of central and peripheral circulation in normal state and during hemorrhagic stress. Because the impaired gastric mucosal blood flow is the major cause of gastroduodenal lesions including ulcer bleeding (UB), we study in this work the NO-ergic mechanism responsible for regulation of this blood flow. Our study is performed in rats with a model of stress-induced UB using laser Doppler flowmetry (LDF) that characterizes the rate of blood flow by measuring a Doppler shift of the laser beam scattered by the moving red blood cells. Numerical analysis of LDF-data is based on the discrete wavelet-transform (DWT) using Daubechies wavelets aiming to quantify influences of NO on the gastric microcirculation. We show that the stress-induced UB is associated with an increased level of NO in the gastric tissue and a stronger vascular sensitivity to pharmacological modulation of NO-production by L-NAME. We demonstrate that wavelet-based analyses of NO-dependent regulation of gastric microcirculation can provide an effective endoscopic diagnostics of a risk of UB.

  8. Adrenergic mechanism responsible for pathological alteration in gastric mucosal blood flow in rats with ulcer bleeding

    Science.gov (United States)

    Semyachkina-Glushkovskaya, O. V.; Pavlov, A. N.; Semyachkin-Glushkovskiy, I. A.; Gekalyuk, A. S.; Ulanova, M. V.; Lychagov, V. V.; Tuchin, V. V.

    2014-09-01

    The adrenergic system plays an important role in regulation of central and peripheral circulation in normal state and during hemorrhage. Because the impaired gastric mucosal blood flow (GMBF) is the major cause of gastroduodenal lesions, including ulcer bleeding (UB), we studied the adrenergic mechanism responsible for regulation of GMBF in rats with a model of stress-induced UB (SUB) using the laser Doppler flowmetry (LDF). First, we examined the effect of adrenaline on GMBF in rats under normal state and during UB. In all healthy animals the submucosal adrenaline injection caused a decrease in local GMBF. During UB the submucosal injection of adrenaline was accompanied by less pronounced GMBF suppression in 30,3% rats with SUB vs. healthy ones. In 69,7% rats with SUB we observed the increase in local GMBF after submucosal injection of adrenaline. Second, we studied the sensitivity of gastric β2-adrenoreceptors and the activity of two factors which are involved in β2-adrenomediated vasorelaxation-KATP -channels and NO. The effects of submucosal injection of isoproterenol, ICI118551 and glybenclamide on GMBF as well as NO levels in gastric tissue were significantly elevated in rats with SUB vs. healthy rats. Thus, our results indicate that high activation of gastric β2-adrenoreceptors associated with the increased vascular KATP -channels activity and elevated NO production is the important adrenergic mechanism implicated in the pathogenesis of UB.

  9. Multicenter evaluation of dual-therapy (omeprazol and amoxycillin) for Helicobacter pylori-associated duodenal and gastric ulcer (two years of the observation).

    Science.gov (United States)

    Gabryelewicz, A; Laszewicz, W; Dzieniszewski, J; Ciok, J; Marlicz, K; Bielecki, D; Popiela, T; Legutko, J; Knapik, Z; Poniewierka, E

    1997-09-01

    Treatment with the proton pump inhibitor (omeprazole) and single antibiotic (amoxycillin), two synergistic compounds, can cure Helicobacter pylori (H. pylori) infection, but this therapy is not as effective as had been expected. However, some studies show promising results. The aim of our study was to evaluate the effect of two weeks dual-therapy with omeprazole (O) and amoxycillin (A) on gastric (GU) and duodenal ulcer (DU) patients: ulcer healing, eradication of the H. pylori and recurrence rate of the ulcer. We studied 216 patients (aged 18-70) endoscopically proven GU (58 patients) and DU (158 patients). Rapid urease test from the two antrum biopses and two antral and two corporeal biopses using Giemsa stain method for confirmation of the H. pylori infection were used. The patients were treated with omeprazole 20 mg BID and amoxycillin 1.0 g BID for 2 weeks and investigated every 4 months during 2 years. Clearance effect of Hp infection was achieved in 65.1% GU and 66.4% DU patients. Eradication ("check point" after 4 months) in 43% DU and 56.6% GU patients was confirmed. Reinfection rate was found in 16% during 2 years. We conclude--dual-therapy (O and A) is not sufficiently effective to be recommended as an anti-H. pylori treatment. H. pylori eradication prevents recurrence of peptic ulcer and is an important issue in attempts to achieve permanent ulcer healing.

  10. Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management

    Institute of Scientific and Technical Information of China (English)

    Johnny CA Ong; Pierce KH Chow; Weng-Hoong Chan; Alex YF Chung; Choon Hua Thng; Wai-Keong Wong

    2007-01-01

    Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices.BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC enbloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.

  11. Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

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    Alexander Shaw

    2013-01-01

    Full Text Available Background. Duodenal gastrointestinal stromal tumours (GISTs are an uncommon malignancy of the gastrointestinal (GI tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.

  12. Recurrent lower gastrointestinal bleeding secondary to cytomegalovirus-associated colonic ulcer in a non human immunodeficiency virus infected patient: timely diagnosis and treatment averted surgery.

    Science.gov (United States)

    Lim, L-G; Rajnakova, A; Yan, B; Salto-Tellez, M; Lim, L-L

    2009-11-01

    Mr C, a 68-year-old Chinese male with diabetes mellitus, previous stroke and ischaemic cardiomyopathy on clopidogrel, presented with haematochezia. Colonoscopy showed a sigmoid ulcer, which was treated endoscopically. Histology of the biopsy from the ulcer revealed non-specific changes. However, he presented with recurrent bleeding from this non-healing sigmoid ulcer. A review of the histologic specimen revealed CMV intranuclear inclusion bodies. He was treated with intravenous ganciclovir, with no further hematochezia.

  13. Comparison of Omeprazole with Ranitidine for Treatment of Symptoms Associated with Gastroesophageal Reflux Disease and Uncomplicated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Andre P Archambault

    1996-01-01

    Full Text Available This randomized, single-blind, parallel group study was conducted to compare omeprazole with ranitidine for the treatment of symptoms associated with gastroesophageal reflux disease (GERD, uncomplicated duodenal ulcer (DU or both. After baseline assessments, patients were randomized to receive daily treatment with either 20 mg omeprazole or 300 mg ranitidine for four weeks. In total, 1481 patients (1001 omeprazole, 480 ranitidine with a diagnosis of GERD (n=904 and/or DU (n=577, confirmed by endoscopy or barium meal and reporting moderate to severe symptoms, were included in the analyses. The seventy of overall daytime symptoms reported by the omeprazole group at clinic visits was lower than that reported by the ranitidine group at week 2 for the entire patient group (P=0.0002 and at both weeks 2 and 4 for the subgroup of patients with GERD (P=0.0001 and P=0.001, respectively. The severity of overall night-time symptoms reported by the omeprazole group was lower than that reported by the ranitidine group at week 4 for all patients as a whole (P=0.042 and at both weeks 2 and 4 for the subgroup of patients with GERD (P=0.035 and P=0.010, respectively. There were no significant differences in reports of adverse events. In the omeprazole group, 19% of patients at week 2 and 15% of patients at week 4 reported adverse events, while the corresponding results from the ranitidine group were 21% and 11%. In conclusion, patients with GERD, DU or both treated with omeprazole 20 mg daily for four weeks showed statistically significant reductions in symptoms compared with patients treated with ranitidine 300 mg daily for the same period of time. The percentage of patients with any remaining daytime symptoms was 12% lower in the omeprazole group compared with the ranitidine group at week 2, and 7% lower at week 4. Five per cent fewer patients in the omeprazole group experienced night-time symptoms at either week 2 or week 4.

  14. Efficacy of Proton Pump Inhibitors for Patients with Duodenal Ulcers: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Hu, Zhan-Hong; Shi, Ai-Ming; Hu, Duan-Min; Bao, Jun-Jie

    2017-01-01

    Background/Aim: To compare the efficacy and tolerance of different proton pump inhibitors (PPIs) in different doses for patients with duodenal ulcers. Materials and Methods: An electronic database was searched to collect all randomized clinical trials (RCTs), and a pairwise and network meta-analysis were performed. Results: A total of 24 RCTs involving 6188 patients were included. The network meta-analysis showed that there were no significant differences for the 4-week healing rate of duodenal ulcer treated with different PPI regimens except pantoprazle 40 mg/d versus lansoprazole 15 mg/d [Relative risk (RR) = 3.57; 95% confidence interval (CI) = 1.36–10.31)] and lansoprazole 30 mg/d versus lansoprazole 15 mg/d (RR = 2.45; 95% CI = 1.01–6.14). In comparison with H2 receptor antagonists (H2 RA), pantoprazole 40 mg/d and lansoprazole 30 mg/d significantly increase the healing rate (RR = 2.96; 95% CI = 1.78–5.14 and RR = 2.04; 95% CI = 1.13–3.53, respectively). There was no significant difference for the rate of adverse events between different regimens, including H2 RA for a duration of 4-week of follow up. Conclusion: There was no significant difference for the efficacy and tolerance between the ordinary doses of different PPIs with the exception of lansoprazle 15 mg/d. PMID:28139495

  15. Pre-treatment urea breath test results predict the efficacy of Helicobacter pylori eradication therapy in patients with active duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Yung-Chih Lai; Jyh-Chin Yang; Shih-Hung Huang

    2004-01-01

    AIM: To evaluate the association of pre-treatment 13C-urea breath test (UBT) results with H pyloridensity and efficacy of eradication therapy in patients with active duodenal ulcers.METHODS: One hundred and seventeen consecutive outpatients with active duodenal ulcer and H pyloriinfection were recruited. H pylori density was histologically graded according to the Sydney system. Each patient received lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) for 1 week. According to pre-treatment UBT values, patients were allocated into low (<16%o),intermediate (16-35%o), and high (>35%o) UBT groups.RESULTS: A significant correlation was found between pre-treatment UBT results andHpyloridensity (P<0.001).H pylorieradication rates were 94.9%, 94.4% and 81.6%in the low, intermediate and high UBT groups, respectively (per protocol analysis, P=0.11). When patients were assigned into two groups (UBT results ≤35%o and >35%o),the eradication rates were 94.7% and 81.6%, respectively (P=0.04).CONCLUSION: The intragastric bacterial load of H pylori can be evaluated by UBT, and high pre-treatment UBT results can predict an adverse outcome of eradication therapy.

  16. Efficacy of ebrotidine and ranitidine combined with amoxicillin and metronidazole in the eradication of Helicobacter pylori in patients with duodenal ulcer.

    Science.gov (United States)

    Popiela, T; Kulig, J; Karcz, D; Tabor, J; Torres, J; Márquez, M; Fillat, O; Herrero, E; Ortiz, J A

    1997-04-01

    This double-blind, randomized, phase III clinical trial was carried out in two parallel groups to assess the efficacy of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene) amino]-4-thiazolyl]methyl]thio]ethyl]amino] methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) 400 mg and ranitidine 300 mg given in single evening dose, combined with amoxicillin 750 mg and metronidazole 500 mg three times daily for 14 days, in the eradication of Helicobacter pylori in patients with duodenal ulcer. Thirty patients were included, divided into two groups of 15, to whom one of the study therapies was administered based on a randomization code. Clinical and endoscopic controls were performed 4, 6 and 8 weeks after the onset of the treatment. No differences were seen between the two treatment groups with regard to demographic parameters and clinical histories. They were both perfectly homogeneous. There were no differences between the eradication of both therapies in both the antrum and gastric body samples (over 80% eradication), allowing the results to be classified as satisfactory. Moreover, perfect control was achieved through the study of clinical symptoms, which even disappeared in some cases. There were no differences in the healing rate of the duodenal ulcer after four weeks, 86.7% being achieved for both groups.

  17. Real-time PCR improves Helicobacter pylori detection in patients with peptic ulcer bleeding.

    Directory of Open Access Journals (Sweden)

    María José Ramírez-Lázaro

    Full Text Available BACKGROUND AND AIMS: Histological and rapid urease tests to detect H. pylori in biopsy specimens obtained during peptic ulcer bleeding episodes (PUB often produce false-negative results. We aimed to examine whether immunohistochemistry and real-time PCR can improve the sensitivity of these biopsies. PATIENTS AND METHODS: We selected 52 histology-negative formalin-fixed paraffin-embedded biopsy specimens obtained during PUB episodes. Additional tests showed 10 were true negatives and 42 were false negatives. We also selected 17 histology-positive biopsy specimens obtained during PUB to use as controls. We performed immunohistochemistry staining and real-time PCR for 16S rRNA, ureA, and 23S rRNA for H. pylori genes on all specimens. RESULTS: All controls were positive for H. pylori on all PCR assays and immunohistochemical staining. Regarding the 52 initially negative biopsies, all PCR tests were significantly more sensitive than immunohistochemical staining (p<0.01. Sensitivity and specificity were 55% and 80% for 16S rRNA PCR, 43% and 90% for ureA PCR, 41% and 80% for 23S rRNA PCR, and 7% and 100% for immunohistochemical staining, respectively. Combined analysis of PCR assays for two genes were significantly more sensitive than ureA or 23S rRNA PCR tests alone (p<0.05 and marginally better than 16S rRNA PCR alone. The best combination was 16S rRNA+ureA, with a sensitivity of 64% and a specificity of 80%. CONCLUSIONS: Real-time PCR improves the detection of H. pylori infection in histology-negative formalin-fixed paraffin-embedded biopsy samples obtained during PUB episodes. The low reported prevalence of H. pylori in PUB may be due to the failure of conventional tests to detect infection.

  18. Stomach ulcer

    Science.gov (United States)

    ... the acid and enzymes by a mucous lining. Ulcers are caused when there is an imbalance between ... protect the lining of the stomach. Symptoms of ulcers may include bleeding. On rare occasions, an ulcer ...

  19. Outcome of Holiday and Nonholiday Admission Patients with Acute Peptic Ulcer Bleeding: A Real-World Report from Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Tsung-Chin Wu

    2014-01-01

    Full Text Available Background. Recent findings suggest that patients admitted on the weekend with peptic ulcer bleeding might be at increased risk of adverse outcomes. However, other reports found that there was no “holiday effect.” The purpose of this study was to determine if these findings hold true for a real-life Taiwanese medical gastroenterology practice. Materials and Methods. We reviewed the medical files of hospital admissions for patients with peptic ulcer bleeding who received initial endoscopic hemostasis between January 2009 and March 2011. A total of 744 patients were enrolled (nonholiday group, n=615; holiday group, n=129 after applying strict exclusion criteria. Holidays were defined as weekends and national holidays in Taiwan. Results. Our results showed that there was no significant difference in baseline characteristics between the two groups. We also observed that, compared to the nonholiday group, patients in the holiday group received earlier endoscopy treatment (12.20 hours versus 16.68 hours, P=0.005, needed less transfused blood (4.8 units versus 6.6 units, P=0.02, shifted from intravenous to oral proton-pump inhibitors (PPIs more quickly (5.3 days versus 6.9 days, P=0.05, and had shorter hospital stays (13.05 days versus 17.36 days, P=0.005. In the holiday and nonholiday groups, the rebleeding rates were 17.8% and 23.41% (P=0.167, the mortality rates were 11.63% versus 13.66% (P=0.537, and surgery was required in 2.11% versus 4.66% (P=0.093, respectively. Conclusions. Patients who presented with peptic ulcer bleeding on holidays did not experience delayed endoscopy or increased adverse outcomes. In fact, patients who received endoscopic hemostasis on the holiday had shorter waiting times, needed less transfused blood, switched to oral PPIs quicker, and experienced shorter hospital stays.

  20. Epinephrine injection therapy versus a combination of epinephrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

    Institute of Scientific and Technical Information of China (English)

    Tju-Siang Chua; Kwong-Ming Fock; Tay-Meng Ng; Eng-Kiong Teo; Jessica Yi-Lyn Tan; Tiing-Leong Ang

    2005-01-01

    AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

  1. Comparison of Hemostatic Efficacy of Argon Plasma Coagulation with and without Distilled Water Injection in Treating High-Risk Bleeding Ulcers

    Directory of Open Access Journals (Sweden)

    Yuan-Rung Li

    2014-01-01

    Full Text Available Background. Argon plasma coagulation (APC is useful to treat upper gastrointestinal bleeding, but its hemostatic efficacy has received little attention. Aims. This investigation attempted to determine whether additional endoscopic injection before APC could improve hemostatic efficacy in treating high-risk bleeding ulcers. Methods. From January 2007 to April 2011, adult patients with high-risk bleeding ulcers were included. This investigation compared APC plus distilled water injection (combined group to APC alone for treating high-risk bleeding ulcers. Outcomes were assessed based on initial hemostasis, surgery, blood transfusion, hospital stay, rebleeding, and mortality at 30 days posttreatment. Results. Totally 120 selected patients were analyzed. Initial hemostasis was accomplished in 59 patients treated with combined therapy and 57 patients treated with APC alone. No significant differences were noted between these groups in recurred bleeding, emergency surgery, 30-day mortality, hospital stay, or transfusion requirements. Comparing the combined end point of mortality plus the failure of initial hemostasis, rebleeding, and the need for surgery revealed an advantage for the combined group (P=0.040. Conclusions. Endoscopic therapy with APC plus distilled water injection was no more effective than APC alone in treating high-risk bleeding ulcers, whereas combined therapy was potentially superior for patients with poor overall outcomes.

  2. Modified Sequential Therapy Regimen versus Conventional Triple Therapy for Helicobacter pylori Eradication in Duodenal Ulcer Patients in China: A Multicenter Clinical Comparative Study

    Directory of Open Access Journals (Sweden)

    Ying-Qun Zhou

    2012-01-01

    Full Text Available Objective. Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide. To observe the effect of eradicating Helicobacter pylori (H. pylori and the treatment of duodenal ulcer by 2 kinds of modified sequential therapy through comparing with that of 10-day standard triple therapy. Methods. A total of 210 patients who were confirmed in duodenal ulcer active or heal period by gastroscopy and H. pylori positive confirmed by rapid urease test, serum anti-H. pylori antibody (ELASE, or histological examination enrolled in the study. All the patients were randomly divided into three groups: group A (70 cases and group B (70 cases were provided 10-day modified sequential therapy; group C (70 cases was provided 10-day standard triple therapy. Patients of group A received 20 mg of Esomeprazole, 500 mg of Clarithromycin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group B received 20 mg of Esomeprazole, 1000 mg of Amoxicillin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group C received 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for standard 10-day therapy. All drugs were given twice daily. H. pylori eradication rate was checked four to eight weeks after taking the medicine by using a 13C urea breath test. In the first, second, third, seventh, twenty-first, thirty-fifth days respectively, the symptoms of patients such as epigastric gnawing, burning pain, and acidity were evaluated simultaneously. Results. Overall, 210 patients accomplished all therapy schemes, 9 case patients were excluded. The examination result indicated that the H. pylori eradication rate of each group was as follows: group A 92.5% (62/67, group B 86.8% (59/68, and group C 78.8% (52/66. The H. pylori

  3. The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

    Institute of Scientific and Technical Information of China (English)

    Peter Schemmer; Frank Decker; Genevieve Dei-Anane; Volkmar Henschel; Klaus Buhl; Christian Herfarth; Stefan Riedl

    2006-01-01

    AIM: To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI)bleeding under today's therapeutic regimen.METHODS: From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital.Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis:age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time (PT), gastric ulcer (small curvature), duodenal ulcer (bulbus back wall), Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding,conservative and surgical therapy.RESULTS: Seventy male (58%) and 51 female (42%)patients with a median age of 70 (range: 21-96) years were treated. Their in-hospital mortality was 14%. While 12% (11/91) of the patients died after conservative therapy, 20% (6/30) died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer (n = 36; 30%), gastric ulcer (n = 35; 29%), esophageal varicosis (n = 12; 10%), Mallory-Weiss syndrome (n = 8; 7%), erosive lesions of the mucosa (n = 20;17%), cancer (n = 5; 4%), coagulopathy (n = 4; 3%),lymphoma (n = 2; 2%), benign tumor (n = 2; 2%)and unknown reason (n = 1; 1%). A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer (bulbus back wall)were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis,the location of a bleeding ulcer (bulbus back wall) and patients' gender (male) were of prognostic importance for the clinical outcome (mortality) of patients with a bleeding ulcer.CONCLUSION: Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by

  4. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia.

    Science.gov (United States)

    Lakhwani, M N; Ismail, A R; Barras, C D; Tan, W J

    2000-12-01

    Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit

  5. Management of Bleeding Duodenal Varices with Combined TIPS Decompression and Trans-TIPS Transvenous Obliteration Utilizing 3% Sodium Tetradecyl Sulfate Foam Sclerosis

    Directory of Open Access Journals (Sweden)

    Wael E Saad

    2014-01-01

    Full Text Available Objectives: Endoscopic experience in the management of duodenal varices (DVs is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. Materials and Methods: This is a retrospective study (case series of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013. TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis from the systemic and/or portal venous circulation was performed utilizing 3% sodium tetradecyl sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs and clinical outcomes (rebleeding rate and survival were evaluated. Results: Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days. After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months

  6. Frequency and risk factors of gastric and duodenal ulcers or erosions in children: a prospective 1-month European multicenter study

    DEFF Research Database (Denmark)

    Kalach, Nicolas; Bontems, Patrick; Koletzko, Sibylle;

    2010-01-01

    There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors.......There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors....

  7. Anti-CagA positivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment

    Directory of Open Access Journals (Sweden)

    Yaşar Nazlıgül

    2011-03-01

    Full Text Available Objectives: CagA positive H. pylori strains are considered to be more virulent than other strains. In this study, we aimed to investigate the rate of CagA positivity in duodenal ulcer (DU and functional dyspepsia (FD, and its effect on H. pylori eradication response.Materials and methods: The study was performed on H. pylori positive 60 patients with DU and 50 patients with FD, who underwent upper gastrointestinal endoscopy. H. pylori infection was identified by histology. All patients received a quadriple therapy consisted of esomeprazole 20 mg b.i.d., colloidal bismuth subcitrate 600 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. for 7 days. H.pylori status was rechecked using C14-urea breath test 6 weeks after the end of treatment to confirm cure. Specific IgG antibodies for CagA status were determined by enzyme linked immunosorbent assay.Results: CagA positivities in the patients with DU and FD were calculated respectivily 70% and 68% (P>0.05. H. pylori was eradicated in 85.5% of the patients infected with CagA (+ strains, in 50% of those infected with CagA (- strains (P=0.001. The eradication rates were 95.2% and 55.6% in CagA positive and negative DU subgroups (P=0.001, and 73.5% and 43.8% in CagA positive and negative FD subgroups (P=0.04.Conclusion: CagA positivities were not different in duodenal ulcer and functional dyspepsia. CagA (+ strains was susceptible to the eradication treatment. The titres of serum anti-CagA antibodies may be used in the prediction of eradication outcome, and the modification of eradication therapy.

  8. A STUDY ON UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Salla Surya Prakasa Rao

    2016-10-01

    Full Text Available BACKGROUND Vomiting of blood almost always proximal to the ligament of Treitz is the upper gastrointestinal haemorrhage. The incidence of acute upper gastrointestinal haemorrhage has been estimated to be 50-100 per 1,00,000 person per year, with an annual hospitalization rate of approximately 100 per 1, 00,000 hospital admission. This study is to find out the prevalence of nature of lesion on Upper Gastrointestinal Endoscopy in patients admitted for Gastrointestinal bleeding. (UGI Bleed. MATERIALS AND METHODS Place of Study- Department of General Medicine, Andhra Medical College, Visakhapatnam, India. Type of Study- Prospective study. Period of Study- July 2015 to August 2016. RESULTS The Results Study on Endoscopic Findings in Upper Gastro Intestinal Bleed are 1. The peptic ulcer disease was the most common lesion found on endoscopy with prevalence of 54%. 2. Varices contributes second common lesion, next to peptic ulcer disease in UGI bleed with prevalence of 16%. 3. Minor UGI bleed was the commonest presentation. Majority of lesions (60% presented with minor UGI bleed, 28% lesions presented as moderate UGI bleed. Only 8% presented as major UGI bleed. 4. Varices account for the most common cause for major UGI bleed contributing 50%. 5. Gastric ulcer was commonest lesions accounting for 37 cases (37% among 72 cases having single acid peptic lesions on endoscopy. The second most common is duodenal ulcer (31%. 6. Multiple lesions were found in 10% of cases. Peptic ulcer lesions were found in 20% of total number of varices cases. CONCLUSION Peptic ulcer disease was found to be most common lesion causing UGI bleed, with most common presentation as minor UGI bleed and variceal bleed being most common cause of major UGI bleed.

  9. Transarterial embolotherapy in patients with duodenal hemorrhage using microcoils and gelfoam particles

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom [School of Medicine, Donga Univ., Busan (Korea, Republic of); Kim, Young Hwan; Seong, Chang Kyu [School of Medicine, Kyeongpook National Univ., Daegu (Korea, Republic of)] [and others

    2004-07-01

    To assess the efficacy and safety of arterial embolotherapy in patients with massive duodenal hemorrhage. Between January 1999 and June 2002, 25 patients (age: 34-81, mean 58, male: 19, female: 6) underwent arterial embolization for duodenal hemorrhage after failed endoscopic therapy. The hemorrhage originated from duodenal ulcer in sixteen patients, from cancer with duodenal invasion in five patients, from endoscopic sphincterectomy in two patients, and from pseudoaneurysm complicating acute pancreatitis in two patients. Hemorrhage was detected at endoscopy and an attempt was made to treat it endoscopically in all patients, but failed in each case. At angiography, direct bleeding signs such as contrast extravasation or pseudoaneurysm were demonstrated in nineteen patients. In the six patients without angiographic evidence of bleeding, blind embolization of the gastroduodenal artery was performed based on the endoscopic examination. Microcoil and gelfoam particles were used as embolic agents. Hemostasis was achieved immediately after embolotherapy in 21 patients (84%). Bleeding recurred in 4 patients (16%), and of these cases, one was successfully treated purely by endoscopic means, a second was reembolized three times due to bleeding from the collateral vessels of the tumor and the two others were treated by surgery. After the procedure, six patients died (24%). The causes of death were disseminated intravascular coagulopathy, multiorgan failure, sepsis and acute renal failure. The underlying diseases of the deceased patients were cancers with duodenal invasion (n=4) and abdominal aortic aneurysm with ischemic colitis (n=1). Transarterial embolotherapy in the case of massive duodenal hemorrhage is a safe and effective procedure. Even in the absence of angiographic evidence of bleeding, blind embolization of the gastroduodenal artery is effective for patients in the surgically high risk group.

  10. CT of gastro-duodenal obstruction.

    Science.gov (United States)

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  11. [Various mechanisms of cytoprotective effect of omeprazole and low intensity laser radiation on the gastroduodenal mucosa in the treatment of patients with duodenal ulcer].

    Science.gov (United States)

    Akhmadkhodzhaev, A M

    2002-01-01

    Clinical studies were made in 130 patients with duodenal ulcer in the phase of exacerbation of the disease. There were 98 men and 32 women who ranged from 17 to 50 years old. Results of examination of 7 essentially healthy subjects were regarded as control. The patients were divided into three groups. Group I patients (n = 48) received a conventional therapy; in group II patients, the adopted therapy was supplemented by omeprazol, 20 mg twice daily, group III patients (n = 43) were (in addition to the above therapeutic regimen) exposed to a session of endoscopic low-intensity laser irradiation (LILI) for 5 min (overall 6 to 8 LILI procedures). It has been ascertained that omeprazol exerts a cytoprotective effect on the mucozal barrier of the gastroduodenal zone brought about by increase in the synthesis of glucoproteins in the mucous membrane, improvement of the water-and-elastic properties, and enhancement of resistance of the mucosal barrier to the action of the aggressive factors. Administration of endoscopic LILI treatments in DU patients has also been found out to have a cytoprotective effect but superior to omeprazol. A protective action of LILI is believed to be caused by stimulation of synthesis of the most important components of glycoproteins. A cytoprotective effect of omeprazol and endoscopic LILI is ccompanied by a significant shortening of time for the clinical symptoms to get dispelled, the ulcer cicatrization frequency increased.

  12. THE CONTENT OF PROTECTIVE BARRIER OF THE STOMACH IN PATIENTS WITH DUODENAL ULCER ASSOCIATED AND NON-ASSOCIATED WITH H. PYLORI INFECTION

    Directory of Open Access Journals (Sweden)

    Abdujalol Vahabovich Yakubov

    2014-12-01

    Full Text Available The condition of the protective barrier of the stomach in patients with duodenal ulcer associated and non-associated with H. pylori infection has been studied. The state of gastric mucosal barrier was studied in 72 patients with peptic ulcer disease association with H. pylori and 26 patients without H. pylori by determining the content of insoluble glycoproteins and its fractions in the basal portion of the gastric juice. In a comparative perspective the state of these indicators were studied depending on the association with H. pylori and the severity of the disease.In patients with H. pylori, damages of protective mucus barrier are characterized by the significant shortage of fucose, which is considered to be the main component of the insoluble glycoproteins.  In patients without H. pylori, status of mucosal barrier is characterized by uniform and less significant reduction in the content of fractions of insoluble glycoproteins. In this patients the reduction of insoluble glycoproteins is not dependent on the frequency of exacerbation.The content of fucose in the mucous gel of gastric juice is a diagnostic criterion for determining the frequency of recurrence of the disease in patients with H. pylori infection.

  13. Vacuolating cytotoxin genotypes are strong markers of gastric cancer and duodenal ulcer-associated Helicobacter pylori strains: a matched case-control study.

    Science.gov (United States)

    Memon, Ameer A; Hussein, Nawfal R; Miendje Deyi, Véronique Y; Burette, Alain; Atherton, John C

    2014-08-01

    The Helicobacter pylori virulence gene, cagA, and active forms of the vacuolating cytotoxin gene, vacA, are major determinants of pathogenesis. However, previous studies linking these factors to disease risk have often included patients using aspirin/nonsteroidal anti-inflammatory agents (NSAIDs) or acid-suppressing drugs, both of which may confound results. Also, particularly for gastric cancer (GC), controls have often been of quite different ages. Here, we performed a careful study in a "clean" Belgian population with gastric cancer cases age and sex matched to 4 controls and with a parallel duodenal ulcer (DU) group. As in other populations, there was a close association between the presence of cagA and the vacA s1 genotype. For GC, associations were found for vacA s1-positive (P = 0.01, odds ratio [OR], 9.37; 95% confidence interval [CI], 1.16 to 201.89), i1-positive (P = 0.003; OR, 12.08; 95% CI, 1.50 to 259.64), and cagA-positive status (P ulcer-associated strains are the vacA s1 and i1 genotypes. This fits with experimental data showing that the s and i regions are the key determinants of vacuolating cytotoxin activity.

  14. Gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery successfully treated with coil embolization: a case report and review of the literature.

    Science.gov (United States)

    Namikawa, Masashi; Kakizaki, Satoru; Takakusaki, Satoshi; Saito, Shuichi; Yata, Yutaka; Mori, Masatomo

    2011-12-01

    Endoscopic hemostasis is a useful treatment modality for gastric ulcer bleeding. However, it is sometimes difficult to achieve hemostasis in cases with arterial bleeding, especially those complicated with vascular abnormalities. We describe a case with gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery. A 50-year-old female was admitted to our hospital with dizziness and tarry stools. Upper gastrointestinal endoscopy revealed bleeding from a gastric ulcer, and endoscopic hemostasis by endoscopic clipping was carried out. Computed tomography and abdominal angiography revealed the variant left gastric artery running below the gastric ulcer. In spite of endoscopic hemostasis and medication, re-bleeding from the gastric ulcer occurred. A transcatheter coil embolization for the variant left gastric artery was performed and successfully achieved hemostasis. This case was accompanied by congenital absence of the splenic artery, which is an extremely rare condition. We herein describe this rare case and review previously reported cases.

  15. Usefulness of angiographic embolization endoscopic metallic clip placement in patient with non-variceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Inje University College of Medicine, Pusan Paik Hospital, Busan (Korea, Republic of)

    2013-08-15

    The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

  16. A head to head comparison of oral vs intravenous omeprazole for patients with bleeding peptic ulcers with a clean base, flat spots and adherent clots

    Institute of Scientific and Technical Information of China (English)

    (S)erif Y(i)lmaz; Kadim Bayan; Yekta Tüzün; Mehmet Dursun; Fikri Canoru(c)

    2006-01-01

    AIM: To compare the effect of intravenous and oral omeprazole in patients with bleeding peptic ulcers without high-risk stigmata.METHODS: This randomized study included 211 patients [112 receiving iv omeprazole protocol (Group 1),99 receiving po omeprazole 40 mg every 12 h (Group 2)] with a mean age of 52.7. In 144 patients the ulcers showed a clean base, and in 46 the ulcers showed fiat spots and in 21 old adherent clots. The endpoints were re-bleeding, surgery, hospital stay, blood transfusion and death. After discharge, re-bleeding and death were reevaluated within 30 d.RESULTS: The study groups were similar with respect to baseline characteristics. Re-bleeding was recorded in 5 patients of Group 1 and in 4 patients of Group 2 (P = 0.879). Three patients in Group 1 and 2 in Group 2 underwent surgery (P = 0.773). The mean length of hospital stay was 4.6 ± 1.6 d in Group 1 vs 4.5 ± 2.6 d in Group 2 (P = 0.710); the mean amounts of blood transfusion were 1.9 ± 1.1 units in Group 1 vs 2.1 ± 1.7 units in Group 2 (P = 0.350). Four patients, two in each group died (P = 0.981). After discharge, a new bleeding occurred in 2 patients of Group 1 and in 1 patient of Group 2, and one patient from Group 1 died.CONCLUSION: We demonstrate that the effect of oral omeprazole is as effective as intravenous therapy in terms of re-bleeding, surgery, transfusion requirements,hospitalization and mortality in patients with bleeding ulcers with low risk stigmata. These patients can be treated effectively with oral omeprazole.

  17. Comparative Study on Laparoscopic and Open Surgery Perforated Gastric or Duodenal Ulcer%胃十二指肠溃疡穿孔腹腔镜与开腹手术的对比研究

    Institute of Scientific and Technical Information of China (English)

    靳猛

    2016-01-01

    目的:比较胃十二指肠溃疡穿孔腹腔镜与开腹手术的优缺点和临床效果。方法收集分析我院消化外科收治的114例行胃十二指肠溃疡穿孔手术患者的资料,根据患者病情及意愿分为开腹式组和腹腔镜组。其中开腹式组51例,腹腔镜组63例,比较两组患者的手术时间、出血量住院时间及住院费用等。结果两组患者手术均顺利完成。腹腔镜组中有1例患者中转开腹,未发生电灼伤、脏器损伤等手术并发症。腹腔镜组出血量、住院时间、术后感染率显著少于开腹式手术,且差异均具有统计学意义(P<0.05)。开腹式手术时间较短,住院费用略少,但与腹腔镜组比无统计学差异(P>0.05)。结论腹腔镜手术治疗胃十二指肠溃疡穿孔与开腹式手术相比有出血量少、住院时间短、术后感染率小等优点。%Objective Comparison of gastroduodenal ulcer perforation laparoscopy with the advantages and disadvantages of open surgery and clinical results.Methods Digestive surgery in our hospital treated 114 patients with perforated gastric or duodenal ulcer surgery were collected and analyzed, according to the patient's condition and will divided into open and laparoscopic groups. Open Group 51, 63 cases of laparoscopic group, compared two groups of patients, surgery, blood loss in hospital and medical expenses, and so on.Results Two groups of patients were successfully completed. Laparoscopic conversion to laparotomy in Group 1 patients and no electric Burns, organ damage and other complications. Bleeding laparoscopic group, length of stay, postoperative infection rate is signiifcantly lower than the open abdominal surgery, and the difference is statistically significant (P0.05).Conclusion The laparoscopic surgery for gastric and duodenal perforated ulcer compared with open abdominal surgery has less blood loss, shorter hospital stay, postoperative infection rate advantages.

  18. Role of testosterone in resistance to development of stress-related vascular diseases in male and female organisms: models of hypertension and ulcer bleeding

    Science.gov (United States)

    Semyachkina-Glushkovskaya, O.; Pavlov, A.; Semyachkin-Glushkovskiy, I.; Zinchenko, E.; Kassim, M.; Al-Fatle, F.; Al Hassani, L.; Ulanova, M.; Gekaluk, A.

    2015-03-01

    In this paper, we discuss a relationship between stress-induced formation of hypertension and ulcer bleeding and the level of serum testosterone in female and male rats. We show that the secretion of testosterone is an important sign of severity of stress-induced damages of vascular homeostasis in males but not in females.

  19. Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs : a nested case-control study

    NARCIS (Netherlands)

    Vonkeman, Harald E; Fernandes, Robert W; van der Palen, Job; van Roon, Eric N; van de Laar, Mart A F J

    2007-01-01

    Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is hampered by gastrointestinal ulcer complications, such as ulcer bleeding and perforation. The efficacy of proton-pump inhibitors in the primary prevention of ulcer complications arising from the use of NSAIDs remains unproven. Selectiv

  20. Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Lohse, N; Lundstrøm, L H; Vestergaard, T R;

    2015-01-01

    index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care. RESULTS: The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90...

  1. Accuracy of three diagnostic tests used alone and in combination for detecting Helicobacter pylori infection in patients with bleeding gastric ulcers

    Institute of Scientific and Technical Information of China (English)

    廖健仲; 李嘉龙; 赖永智; 黄世鸿; 李瑞成; 吴启华; 涂天健; 陈振宽; 白其卉

    2003-01-01

    Objective Accuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs.Methods A total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and 13C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests.Results The prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P=0.02) as opposed to RUT (P=0.11), UBT had significantly higher sensitivity than RUT (P<0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis.Conclusions UBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

  2. Management of Peptic Ulcer Bleeding in Different Case Volume Workplaces: Results of a Nationwide Inquiry in Hungary

    Directory of Open Access Journals (Sweden)

    István Rácz

    2012-01-01

    Full Text Available The aim of this study was to conduct a national survey to evaluate the recent endoscopic treatment and drug therapy of peptic ulcer bleeding (PUB patients and to compare practices in high and low case volume Hungarian workplaces. A total of 62 gastroenterology units participated in the six-month study. A total of 3033 PUB cases and a mean of 8.15±3.9 PUB cases per month per unit were reported. In the 23 high case volume units (HCV, there was a mean of 12.9±5.4 PUB cases/month, whereas in the 39 low case volume units (LCV, a mean of 5.3±2.9 PUB cases/month were treated during the study period. In HCV units, endoscopic therapies for Forrest Ia, Ib, and IIa ulcers were significantly more often used than in LCV units (86% versus 68%; P=0.001. Among patients with stigmata of recent haemorrhage (Forrest I, II, bolus + continuous infusion PPI was given significantly more frequently in HCV than in LCV units (49.6% versus 33.2%; P=0.001. Mortality in HCV units was less than in LCV units (2.7% versus 4.3%; P=0.023. The penetration of evidence-based recommendations for PUB management is stronger in HCV units resulting lower mortality.

  3. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Duc Trong Quach

    2017-01-01

    Full Text Available Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD. Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests and group B (only noninvasive tests. Results. The overall H. pylori infection rate was 94.2% (161/171. Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p=0.004. The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p<0.05. Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken.

  4. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

    Science.gov (United States)

    Quach, Duc Trong; Luu, Mai Ngoc; To, Thuy-HuongThi; Bui, Quy Nhuan; Tran, Tuan Anh; Tran, Binh Duy; Vo, Minh-Cong Hong; Tanaka, Shinji; Uemura, Naomi

    2017-01-01

    Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD). Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT) with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT) and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests) and group B (only noninvasive tests). Results. The overall H. pylori infection rate was 94.2% (161/171). Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p = 0.004). The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p < 0.05). Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken. PMID:28133477

  5. [Omeprazol and ezomeprazol pharmacokinetics, duration of antisecretory effect, and reasons for their probable changes in duodenal ulcer].

    Science.gov (United States)

    Serebrova, S Iu; Starodubtsev, A K; Pisarev, V V; Kondratenko, S N; Vasilenko, G F; Dobrovol'skiĭ, O V

    2009-01-01

    There were authentic distinctions between the groups of healthy volunteers and patients with a peptic ulcer disease in Cmax, Tmax, AUC(0-t), AUC(0-infinity), CIt, Vd of omeprazole and Cmax of esomeprazole (Nexium, AstraZeneca). When the pharmacokinetics of omeprazole and ezomeprazole were compared in both groups, there were authentic distinctions in Cmax, AU(0-t), AUC(0-infinity), CIt, T1/2. The patients who had taken omeprazole the time of hypoacide condition was much shorter than in other groups. Disintegration test modeling pHmax for pH oscillation with large amplitude, that is typical for ulcer disease, demonstrated a possibility of early partial release of omeprazole, its acid-depended degradation and reduction of its bioavailability.

  6. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: a cross-sectional study of 8,013 healthy subjects in Japan.

    Directory of Open Access Journals (Sweden)

    Takeshi Shimamoto

    Full Text Available Probably due to caffeine-induced gastric acid secretion, negative effects of coffee upon various upper-gastrointestinal diseases have been precariously accepted, despite the inadequate epidemiological evidence. Our aim is to evaluate the effect of coffee consumption on four major acid-related diseases: gastric ulcer (GU, duodenal ulcer (DU, reflux esophagitis (RE, and non-erosive reflux disease (NERD based on the large-scale multivariate analysis. Of the 9,517 healthy adults, GU, DU, and RE were diagnosed by endoscopy, and NERD was diagnosed by the symptoms of heartburn and regurgitation without esophageal erosion. Associations between coffee consumption and the four disorders were evaluated, together with age, gender, body mass index (BMI, Helicobacter pylori (HP infection status, pepsinogen I/II ratio, smoking, and alcohol. We further performed meta-analysis using the random effects model to redefine the relationship between coffee intake and peptic ulcer disease. The eligible 8,013 study subjects comprised of 5,451 coffee drinkers and 2,562 non-coffee drinkers. By univariate analysis, age, BMI, pepsinogen I/II ratio, smoking, and alcohol showed significant associations with coffee consumption. By multiple logistic regression analysis, positively correlated factors with significance were HP infection, current smoking, BMI, and pepsinogen I/II ratio for GU; HP infection, pepsinogen I/II ratio, and current smoking for DU; HP non-infection, male, BMI, pepsinogen I/II ratio, smoking, age, and alcohol for RE; younger age, smoking, and female for NERD. The meta-analyses could detect any association of coffee consumption with neither GU nor DU. In conclusion, there are no significant relationship between coffee consumption and the four major acid-related upper gastrointestinal disorders.

  7. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  8. State-of-the-art management of acute bleeding peptic ulcer disease

    Directory of Open Access Journals (Sweden)

    Hisham Al Dhahab

    2013-01-01

    Full Text Available The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.

  9. [Prognosis of the hemorrhage recurrence in the patients suffering from acute gastroduodenal ulcer bleeding].

    Science.gov (United States)

    Iaroshenko, E A; Didenko, V I; Tsipko, V I; Grabchuk, V N; Cherednichenko, E I; Bendetskiĭ, A M; Pisareva, N N; Gasparian, N G

    2013-06-01

    The prognostication method for the hemorrhage recurrence, permitting to estimate the risk of its occurrence and to prescribe an adequate antirecurrence treatment, was proposed. Among numerous predictors of recurrence the most significant clinical, endoscopic and laboratory factors were selected to raise the prognostication precision. Depending on therisk degree of a recurrent hemorrhage, different methods of treatment were prescribed to the patients. The proposed method was applied in 112 patients, suffering ulcer gastroduodenal hemorrhage. The hemorrhage recurrence have had occurred in 45 (43.3%) of them, in 5 (4.46%)--operative intervention was conducted, using organpreserving methods. General lethality have had constituted 0.89%, postoperative one in a control group--7.14%, and in the main all the patients were alive. The method proposed permits with a high precision to prognosticate and to determine effective tactics of treatment. Taking into account the additional factors of risk raises the prognosis precision and permits to prescribe antihelicobacter therapy and the proton pump inhibirors in a rational dosage soundly.

  10. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ji Soo; Kwak, Hyo Sung; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2011-08-15

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  11. Comparative study of the safety and efficacy of liquid and dry monopolar electrocoagulation in experimental canine bleeding ulcers using computerized energy monitoring.

    Science.gov (United States)

    Swain, C P; Mills, T N; Dark, J M; Lewin, M R; Bown, S G; Northfield, T C; O'Sullivan, J P; Salmon, P R

    1984-01-01

    The drawbacks of monopolar electrocoagulation in the control of gastrointestinal bleeding include tissue adherence, unpredictable energy deposition, and a high incidence of tissue damage. Introduction of a conductive interfacial film of liquid between the monopolar electrode and the bleeding point during electrocoagulation may overcome these drawbacks. A prospective, controlled study was undertaken to evaluate the efficacy and safety of a monopolar electrode in liquid and dry modes when used to coagulate experimental canine bleeding ulcers. All experiments were done in open fashion via a gastrotomy with hand-held electrodes. An analog computer, which could be connected between a standard electrosurgical generator and the electrode, was designed and built to monitor and control the energy delivered to the tissue. Both liquid and dry electrodes were highly effective in stopping bleeding. The liquid electrode was found to be superior to the dry electrode in that tissue adherence was eliminated and energy deposition was more predictable, varying less with angle of incidence. The liquid electrode caused less macroscopic serosal damage and less full-thickness histologic damage if the total energy or number of pulses was limited; however, both caused microscopic full-thickness damage in one-half of the experimental ulcers treated, although no perforations occurred.

  12. Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Shi-Bin Guo; Ai-Xia Gong; Jing Leng; Jing Ma; Lin-Mei Ge

    2009-01-01

    AIM: To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping. METHODS: Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy's lesion (11 cases), Mallory-Weiss syndrome (six cases), postoperative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy's lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy's lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy's lesion 10 mo later, but in a different location. CONCLUSION: Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.

  13. Analysis of serum antibody profile against H pylori VacA and CagA antigens in Turkish patients with duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Yusuf Erzin; Sibel Altun; Ahmet Dobrucali; Mustafa Aslan; Sibel Erdamar; Ahmet Dirican; Murat Tuncer; Bekir Kocazeybek

    2006-01-01

    AIM:To investigate the frequency of seropositivity against CagA, VacA proteins and to determine their independent effects on the development of duodenal ulcer (DU) in Turkish patients.METHODS:The study was designed as a prospective one from a tertiary referral hospital. Dyspeptic patients who were referred to our endoscopy unit for upper gastrointestinal endoscopy between June 2003 and March 2004 and diagnosed to have DU or nonulcer dyspepsia (NUD) were included. Biopsies from the antrum and body of the stomach were taken in order to assess the current H pylori status by histology, rapid urease test and culture.Fasting sera were obtained from all patients and H pylori status of all sera was determined by IgG antibodies using an enzyme-linked immunosorbent assay (ELISA) kit. All seropositive patients were further analysed using Western blot assays detecting IgG antibodies against CagA and VacA proteins. The x2 test was used for statistical comparison of the values and age-sex adjusted multiple regression analysis was used to determine the independent effects of CagA and VacA seropositivities on the development of DU.RESULTS:Sixty-three patients with DU and 62 patients with NUD were eligible for the final analysis. Seropositivity for anti-CagA was detected in 51 of 62 (82%), and in 55 of 63 (87%) patients with NUD and DU, respectively (P = no significance), and seropositivity for antiVacA was found in 25 of 62 (40%) and in 16 of 63 (25%) patients, with NUD and DU, respectively.CONCLUTSION: These findings suggest that none of these virulence factors is associated with the development of DU in the studied Turkish patients with dyspepsia.

  14. Cushing's ulcer: Further reflections

    OpenAIRE

    Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available litera...

  15. Intravenous Proton Pump Inhibitors before Endoscopy in Bleeding Peptic Ulcer with High-Risk Stigmata: A Multicentre Comparative Study

    Directory of Open Access Journals (Sweden)

    Christopher N Andrews

    2005-01-01

    Full Text Available BACKGROUND: It is not clear if starting intravenous proton pump inhibitors (IV PPI before endoscopic therapy provides additional benefit over starting it afterward in patients with high-risk ulcer stigmata of peptic ulcer disease.

  16. Clinical Medical Treatment of Peptic Ulcer Bleeding%消化性溃疡并发出血的临床内科治疗分析

    Institute of Scientific and Technical Information of China (English)

    鲁林东

    2015-01-01

    目的:探讨消化性溃疡病并发出血在的临床内科治疗方法效果。方法选取2014年1月~2015年3月收治的消化性溃疡出血21例临床药物治疗资料方法进行分析。结果本组21例患者经药物和内镜治疗,20例患者止血成功,1例患者转外科行手术治疗,成功率为95.24%;住院时间平均为(13±2.5)d。结论多数胃十二指肠溃疡大出血,经内科治疗可以止血。稳定生命体征,抗休克治疗,局部使用止血药物,全身用药采取H2受体拮抗剂和PPI抑制胃酸分泌。%ObjectiveTo investigate the clinical medical effect of peptic ulcer disease complicated by bleeding.MethodsTwenty-one cases of peptic ulcer bleeding were treated in January 2014 to March 2015,then clinical drug treatment data were analyzed.ResultsThe group of 21 patients after drug and endoscopic therapy,20 patients hemostasis,and 1 patient underwent surgery surgical revolution,the success rate was 95.24%,the average length of stay was(13±2.5)d.Conclusion Most gastric ulcer bleeding,the medical treatment can stop the bleeding. Stable vital signs,anti-shock therapy, topical hemostatic agents,systemic medication taken H2 receptor antagonists and PPI inhibition of gastric acid secretion.

  17. 老年胃十二指肠溃疡急性穿孔92例诊治分析%Treatment analysis of 92 cases of gastric and duodenal ulcer perforation in the aged

    Institute of Scientific and Technical Information of China (English)

    杨建武; 姜福全; 闫洪锋; 李晓鸥

    2013-01-01

    Objective To investigate the treatment experience and clinical characters of gastric and duodenal ulcer perforation in the aged. Methods Taking analysis to 92 old patients with gastric and duodenal ulcer perforation cases that received by our clinical depart -ment from 2008 to 2012 which be made up with 68 gastric and 24 duodenal ulcer perforation cases. Results There are 64 cases healed (69.6% ) ,8 cases of death(8. 70% )and 20 cases with all sorts of complications (21. 7% ) ,all symptoms significantly improved compared with the previous (P <0. 05). Conclusions The gastric and duodenal ulcer perforation in the aged have many types of clinical characters just like atypical clinical symptoms and signs ,easy to misdiagnosis and misdiagnosis and lots of complications and complica -tions,etc. We should get enough preparation ,choose the best ways of anesthesia and surgery ,intraoperative and postoperative monitoring closely and strengthen postoperative nursing care and a variety of effective treatment so that the old patients can well tolerate surgery .%目的 介绍老年人胃十二指肠溃疡急性穿孔的临床特点及治疗方法.方法 对2008-2012年间该科收治的92例老年胃十二指肠溃疡急性穿孔患者进行分析,其中胃溃疡68例,十二指肠溃疡24例.结果 治愈64例(69.6%),死亡8例(8.70%).术后并发症20例(21.7%).各类症状较治疗前有明显改善(P<0.05).结论 老年人胃十二指肠溃疡急性穿孔患者具有临床症状与体征不典型,容易误诊漏诊、合并症及并发症多等特点.只要围手术期准备充分,麻醉方式和术式选择得当,术中、术后观察严密,并给予合理的术后护理和有效治疗,老年患者也能对手术较好地耐受.

  18. Ulcers

    Science.gov (United States)

    ... someone's risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more ... endoscopy is given anesthesia and will have no memory of the procedure. For an endoscopy, the doctor ...

  19. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Erwin; Biecker

    2015-01-01

    Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.

  20. Clinical studies of laparoscopic repair and laparotomy surgery in the treatment of gastric or duodenal ulcer%腹腔镜与开腹胃十二指肠溃疡穿孔修补手术临床研究

    Institute of Scientific and Technical Information of China (English)

    代学峰; 崔海燕

    2015-01-01

    Objective:To observe the curative effect of laparoscopic repair and laparotomy surgery in the treatment of gastric or duodenal ulcer.Methods:The clinical data of 75 cases with gastric or duodenal ulcer from February 2012 to May 2014 were analyzed retrospectively.38 cases were treated with laparoscopic repair in perforated gastric or duodenal ulcer(the laparoscope group).37 cases were treated with laparotomy gastric or duodenal ulcer perforation repair(the open group).We observed the intraoperative and postoperative general index,the recovery time of the postoperative intestinal function and the incidence of postoperative complications and etc in the two groups.Results:The operation time,the hospitalization time,the recovery time of the postoperative intestinal function and the leaving bed time in the laparoscopic group were all shorter than those of the open group, and there were statistical significant differences(P<0.05).The incidence of postoperative complications in the laparoscopic group was 5.26% (2/38);that of the open group was 24.32% (9/37);there was statistical significant difference( χ 2=4.03,P<0.05).The postoperative VAS scores of the laparoscopic patients were significantly lower than that of the open group(t=9.50,P<0.05). Conclusion:Laparoscopic repair in perforated gastric or duodenal ulcer has the advantages of shorter surgery time,quick recovery and lower complication rates comparing with the traditional laparotomy,which is a kind of safe and effective treatment.%目的:观察腹腔镜与开腹行胃十二指肠溃疡穿孔修补术的临床疗效。方法:回顾性分析2012年2月-2014年5月收治胃十二指肠溃疡穿孔患者75例的临床资料,其中38例行腹腔镜胃十二指肠溃疡穿孔修补术(腹腔镜组),37例行胃十二指肠溃疡穿孔修补术(开腹组),观察两组术中、术后一般指标、术后肠道功能恢复时间及术后并发症发生率等。结果:腹腔镜组手术时间

  1. Study on the clinical treatment of laparoscopy in 70 patients with perforation of gastric and duodenal ulcer%胃十二指肠溃疡穿孔患者70例腹腔镜临床治疗研究

    Institute of Scientific and Technical Information of China (English)

    汪中举; 周正; 白林

    2016-01-01

    Objective:To compare the efficacy of laparoscopic and open operation in the treatment of gastric and duodenal perforation with hypertension.Methods:70 cases with perforation of gastric and duodenal ulcer merger hypertension were randomly divided into the control group and the observation group,with 35 cases in each group.Patients in the control group were given open operation,while in the observation group were given laparoscopic operation.Results:The amount of bleeding,postoperative drainage and hospitalization time in the observation group were significantly less than those in the control group(P<0.05),and the postoperative scar in the observation group was significantly better than in the control group(P<0.05).The blood pressure of the observation group was more stable than that of the control group.Conclusion:Compared with open surgery,laparoscopic surgery can be more effective in the treatment of gastric and duodenal perforation with hypertension,and it also has higher aesthetic value.%目的:比较腹腔镜与开腹手术治疗胃十二指肠穿孔伴高血压的效果。方法:收治胃十二指肠穿孔伴高血压患者70例,随机分为对照组和观察组各35例。对照组给予开腹手术,观察组给予腹腔镜手术。结果:观察组手术中的出血量、手术后的引流量、住院时间均明显少于对照组(P<0.05),观察组术后瘢痕情况明显优于对照组(P<0.05)。手术过程中观察组的血压较对照组更为稳定。结论:与开腹手术相比,腹腔镜手术能够更为有效地治疗胃十二指肠穿孔伴高血压,具有较高的美学价值。

  2. [Psychosocial factors in duodenal ulcer].

    Science.gov (United States)

    de la Gándara Martín, J J; de Dios Francos, A; de Diego Herrero, E; Goñi Labat, A I; Hernández Herrero, H; Pozo de Castro, J V

    1994-01-01

    "Burn-out" is a kind of assistential laboral stress which affects the professions which involve an interpersonal relationship with beneficiaries of the job, such us health workers. It originates emotional alterations which lead to feelings of emptiness and personal failure or laboral inability. The revisions about studies of mental disorders in health workers fall upon such laboral stress and remark that in such professional people there is a bigger prevalence of disorders because of the use of substances and of depression. To analyse the mental disorders in health workers by means of the retrospective study of a sample in a general hospital which asked for a psychiatric consultation, sociodemographic variables, clinico-diagnostic and variables related to laboral activity were analysed. The sample is constituted by 112 patients of an average age of forty years old and preferentially females (79.5%). In the sample, some professions are represented above all expectations; they are nurses, physicians, the laboral category of "boss and managers" and the laboral regimen of "permanents". The more frequent psychiatric disorders were the adjustment disorders and code V, the affective disorders and the anxiety disorders (23-33%), the disorders caused by the use of substances and the psychotic disorders are limited (5%). The laboral activity was considered an important factor in 43% of the cases and the mental disorder caused laboral inability, transitory or permanent in half of the patients. It is detected a relationship between the diagnostic and variables such as sex, laboral category, laboral inability, psychosocial stress level and GAF and there hasn't been detected any association between mental disorders and age, profession, laboral regimen and laboral stress.

  3. Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Patrick; Das, Prajnan; Pinnix, Chelsea C.; Beddar, Sam; Briere, Tina; Pham, Mary; Krishnan, Sunil; Delclos, Marc E. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Crane, Christopher H., E-mail: ccrane@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-03-01

    Purpose: Improving local control is critical to improving survival and quality of life for patients with locally advanced unresectable pancreatic cancer (LAPC). However, previous attempts at radiation dose escalation have been limited by duodenal toxicity. In order to guide future studies, we analyzed the clinical and dosimetric factors associated with duodenal toxicity in patients undergoing fractionated chemoradiation for LAPC. Methods and Materials: Medical records and treatment plans of 106 patients with LAPC who were treated with chemoradiation between July 2005 and June 2010 at our institution were reviewed. All patients received neoadjuvant and concurrent chemotherapy. Seventy-eight patients were treated with conventional radiation to 50.4 Gy in 28 fractions; 28 patients received dose-escalated radiation therapy (range, 57.5-75.4 Gy in 28-39 fractions). Treatment-related toxicity was graded according to Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to assess prognostic influence of clinical, pathologic, and treatment-related factors by using Kaplan-Meier and Cox regression methods. Results: Twenty patients had treatment-related duodenal toxicity events, such as duodenal inflammation, ulceration, and bleeding. Four patients had grade 1 events, 8 had grade 2, 6 had grade 3, 1 had grade 4, and 1 had grade 5. On univariate analysis, a toxicity grade ≥2 was associated with tumor location, low platelet count, an absolute volume (cm{sup 3}) receiving a dose of at least 55 Gy (V{sub 55} {sub Gy} > 1 cm{sup 3}), and a maximum point dose >60 Gy. Of these factors, only V{sub 55} {sub Gy} ≥1 cm{sup 3} was associated with duodenal toxicity on multivariate analysis (hazard ratio, 6.7; range, 2.0-18.8; P=.002). Conclusions: This study demonstrates that a duodenal V{sub 55} {sub Gy} >1 cm{sup 3} is an important dosimetric predictor of grade 2 or greater duodenal toxicity and establishes it as a

  4. CLINICAL STUDY OF DUODENAL PERFORATION

    Directory of Open Access Journals (Sweden)

    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  5. The value of gastric muscle layer vagotomy in the treatment of duodenal ulcer perforation%胃肌层内迷走神经切断术治疗十二指肠溃疡穿孔疗效评价

    Institute of Scientific and Technical Information of China (English)

    王瑞; 胡孝海; 魏学峰; 张华英

    2009-01-01

    Objective To evaluate the effect of gastric muscle layer vagotomy for the treatment of duo-denal ulcer perforation. Methods Since 1998 February,have treated 52 cases patients of duodenal ulcer perfo-ration by gastric muscle layer vagotomy and,41 cases treated with simplicity suture of the perforation duodenal ulcer. Results A(therapy groups), B (comparison groups)With postoperative pentagastrin stimulation:the base acid output (BAO), maximum acid output (MAO) and peak acid output (PAO), There were significant difference between in two groups (P < 0. 01). All patients were followed up from 3 months to six years. There was no ulcer recurrence in the therapy groups. Recurrence was found of 12 cases (29. 3%)in the comparison groups, again surgical operation 7 cases(17%). Using a Visick grading,94. 2% of patients were classified as Ⅰ and Ⅱ in the therapy groups and 48.8% in the comparison groups. Conclusion The gastric muscle layer vagotomy is an easy and rapid procedure with less complications, The curative effect is better than simplicity suture of the duodenal ulcer perforation.%目的 评价胃肌层内迷走神经切断术式治疗十二指肠溃疡穿孔患者的疗效.方法 胃肌层内迷走神经切断术治疗十二指肠溃疡穿孔患者52例,并与同期十二指肠溃疡穿孔行单纯缝合修补术41例患者对比分析.结果 A(治疗组)、B(对照组)二组病例术后5-肽胃泌素胃酸分泌试验:基础排酸量(BAO)、最大排酸量(MAO)、高峰排酸量(PAO),两组差异有统计学意义(P<0.01),所有患者随访3个月至6年,治疗组无1例复发,对照组复发12例(29.3%),再次手术7例(17%).治疗效果按Visick分级:Ⅰ、Ⅱ级治疗组达94.2%对照组为48.8%.结论 胃肌层内迷走神经切断术治疗十二指肠溃疡穿孔具有迷走神经切断彻底、操作简捷、并发症少,疗效优于单纯缝合修补术.

  6. Drug combination recuperation nursing therapy for the treatment of duodenal ulcer%药物联合休养护理疗法治疗十二指肠溃疡的效果观察

    Institute of Scientific and Technical Information of China (English)

    吴婷容; 安碧; 李兴芳

    2013-01-01

    Objective to investigate the drug combination for therapy for the treatment of duodenal ulcer. Methods 100 cases of clinical diagnosed with duodenal ulcer patients were randomly divided into observation group and control group,control group routine treatment and nursing according to the doctor's advice,the observation group in the routine drug treatment and nursing on the basis of recuperation therapy,according to doctor's advice after three months of instruction review two groups of patients with gastroscope,then statistics,contrast the curative effect of observation group and control group two groups of patients. Results the curative effect of observation group was better than the control group patients,two groups compare differences had statistics meaning (P<0.01). Conclusions drug recuperation therapy to treat duodenal ulcer the curative effect is superior to conventional treatment,is worth in clinical promotion.%  目的观察药物联合休养护理疗法治疗十二指肠溃疡的临床效果。方法将100例我院临床确诊为十二指肠溃疡的患者随机分为观察组和对照组,对照组行常规治疗及护理,观察组在常规药物治疗及护理的基础上联合休养护理疗法,3个月后复查胃镜,观察比较2组患者的治疗效果。结果观察组总有效率显著优于对照组,2组比较差异有统计学意义(P<0.01)。结论药物联合休养护理疗法治疗十二指肠溃疡较常规治疗及护理疗效显著,值得在临床推广。

  7. Observation of Pantoprazole Sodium Enteric Coated Tablets on the Treatment of Duodenal Ulcer%泮托拉唑钠肠溶片对十二指肠溃疡的治疗效果观察

    Institute of Scientific and Technical Information of China (English)

    秦小波

    2016-01-01

    Objective To explore the clinical effect of duodenal ulcer by pantoprazole sodium enteric coated tablets.Methods 70 cases of duodenal ulcer in our hospital from October 2014 to October 2015 were selected and randomly divided into two groups,35 cases in each group,cases in each group. Study group given oral pantoprazole sodium enteric coated tablets in the treatment,the control group was given omeprazole,to observe the change of clinical indexes of two groups of patients.ResultsAfter treatment,the total effective rate of the observation group was 97.14%,significantly better than the reference group of 74.29%,the difference was significant,with statistical significance(P<0.05).Conclusion Oral pantoprazole sodium enteric coated tablets in treatment of duodenal ulcer,can effectively control the progression of the disease,the effect is significant.%目的:探究十二指肠溃疡采用半托拉唑钠肠溶片治疗的临床效果。方法选取我院2014年10月~2015年10月收治的十二指肠溃疡患者70例,采取随机数字表法将其分为两组,每组各35例。研究组给予口服泮托拉唑钠肠溶片治疗,对照组给予奥美拉唑治疗,观察两组患者的临床指标变化。结果经治疗,观察组总有效率为97.14%,优于对照组的74.29%,数据比较差异具有统计学意义(P<0.05)。结论口服泮托拉唑钠肠溶片治疗十二指肠溃疡,能够有效控制病情发展,效果显著。

  8. 泮托拉唑治疗十二指肠溃疡临床观察与护理%Clinical observation of pantoprazole on the treatment of patients with duodenal ulcer and the related nursing

    Institute of Scientific and Technical Information of China (English)

    农静; 王艺桦; 刘青华

    2013-01-01

    目的 探讨泮托拉唑治疗十二指肠溃疡的临床疗效及护理措施.方法 选取十二指肠溃疡患者286例作为研究对象,根据治疗方法的不同将其随机分为使用常规治疗的对照组和使用泮托拉唑治疗的观察组各143例,所有患者均接受针对性的护理干预措施.比较2组患者的治疗效果、疼痛评分、负面情绪评分等差异.结果 观察组患者的治疗效果明显优于对照组患者(P<0.05);接受治疗后,观察组患者的疼痛评分、负面情绪评分均明显低于对照组患者(P<0.05).结论 对十二指肠溃疡患者应用泮托拉唑及针对性护理干预,可明显提高患者的临床治疗效果,并减轻患者疼痛及负面情绪.%Objective To explore the clinical effect of pantoprazole on the treatment of patients with duodenal ulcer and the related nursing measures. Methods 286 patients with duodenal ulcer were selected and randomly divided into control group and observation group, 143 cases in each group. Both groups were conducted with directed nursing intervention measures, and the control group was treated with conventional therapy while the observation group was treated with pantoprazole. Therapeutic effect, score of pain and score of negative emotions were compared between two groups. Results The therapeutic effect in the observation group was significantly better than the control group(P<0.05); after treatment, the score of pain and score of negative emotions in the observation group were lower than the control group(P<0.05). Conclusion Application of pantoprazole and directed nursing intervention in the treatment of patients with duodenal ulcer can significantly improve the clinical therapeutic effect and relieve pain as well as the negative emotions.

  9. Postoperative Care Experience of Patients With Gastric and Duodenal Ulcer Perforation%胃十二指肠溃疡患者穿孔术后护理体会

    Institute of Scientific and Technical Information of China (English)

    吕凤芹

    2015-01-01

    Objective Postoperative care experience of patients with gastric and duodenal ulcer perforation is to be summarized. Methods Selected 41 patients of gastric and duodenal ulcer perforation who were received and treated in hospital from February 2013 to February 2014;patients in study group were given care intervention,while patients in control group were given conventional treatment and then compared treatment efficacy between two groups. Results Patients’mastery of health knowledge and the score of patients’life quality and their satisfaction with treatment in study group were a bit higher than counterparts in control group;besides,patients’hospitalization days in study group was less than that in control group,there was a treatment differential between two groups and such a differential had statistic value(P<0.05). Conclusion Strengthening postoperative care of patients with gastric and duodenal ulcer perforation is conducive to patients’recovery and shortening their treatment course.%目的:总结胃十二指肠溃疡穿孔术后护理体会。方法选取2013年2月~2014年2月间我院收治的胃十二指肠溃疡穿孔患者41例,实验组给予护理干预,对照组给予传统护理,对比两组患者护理效果。结果实验组健康知识、生命质量、满意度评分相对较高,住院时间与并发症少于对照组,两组患者护理效果差异有统计学意义(P<0.05)。结论加强胃十二指肠溃疡患者穿孔术后护理能够促进患者病情恢复,缩短康复进程,切实可行。

  10. Study on Nursing Care Intervention of Patients With Gastric and Duodenal Ulcer Perforation%胃十二指肠溃疡致穿孔手术的护理干预探析

    Institute of Scientific and Technical Information of China (English)

    杜立荣

    2015-01-01

    Objective Nursing care intervention of patients with gastric and duodenal ulcer perforation is to be explored. Methods Selected 44 patients of gastric and duodenal ulcer perforation who were received and treated in hospital from September 2013 to October 2014 and separated them into two groups at random with 24 patients in study group and 20 patients in control group. Patients in control group were given conventional care intervention,while patients in study group were given comprehensive care intervention,and then compared treatment efficacy between two groups. Results Rate of patients’satisfaction with treatment as wel as patients’score of SAS and SDS in study group were much higher than counterparts in control group;there was a treatment differential between two groups,and such a differential had statistic value(P<0.05). Conclusion Treating patients of gastric and duodenal ulcer perforation with comprehensive care is effective to increase patients’satisfaction and reduce their hospitalization days,which is conducive to patients’recovery;therefore,such a care method is quite worthwhile to be widespread promoted.%目的:探讨胃十二指肠溃疡致穿孔手术的护理干预探析。方法选取2013年9月~2014年10月我院接诊的44例胃十二指肠溃疡致穿孔的患者,随机分为两组,实验组24例和对照组20例,对照组采用常规护理干预,实验组采用综合护理干预,观察两组患者的护理效果。结果实验组患者的满意度、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分高于对照组,差异有统计学意义(P<0.05)。结论胃十二指肠溃疡致穿孔手术采用综合护理的效果显著,可以提高患者的满意度、缩短住院时间,加快恢复。

  11. Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: a case-control study

    DEFF Research Database (Denmark)

    Aalykke, C; Lauritsen, Jens; Hallas, J

    1999-01-01

    Peptic ulcer complications related to use of nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common serious adverse drug reactions. Whether Helicobacter pylori infection potentiates this gastrointestinal toxicity of NSAIDs is still unresolved. In this study, we investigated...

  12. Redução da prevalência de úlcera duodenal: um estudo brasileiro (análise retrospectiva na última década: 1996-2005 Prevalence reduction of duodenal ulcer: a Brazilian study. (retrospective analysis in tha last decade: 1996-2005

    Directory of Open Access Journals (Sweden)

    Carlos Saul

    2007-12-01

    gradativa voltou a ser observada. O valor médio de queda anual, aplicando o teste de regressão linear, foi da ordem de 1,3% ao ano, no período analisado (10 anos. Este teste mostrou também significância estatística. A raça branca representou a maioria, com 78% dos pacientes, em relação a raça negra. O sexo masculino, em todos os períodos analisados, exceto em um (1997, foi o sexo mais acometido, com uma relação final masculino/feminino da ordem de 1.17/1.0. CONCLUSÕES: Observou-se então, neste estudo efetuado no Brasil, também uma redução da prevalência da úlcera duodenal, já apontada pela literatura em outros países. Estudos posteriores devem ser efetuados no sentido de apontar as razões desta importante observação.BACKGROUND: The duodenal ulcer always represented a very prevalent pathology among the gastrointestinal tract diseases worldwide. The average prevalence is approximately 10% of the world population. In the 90s the literature (both European and North American begin to show a crescent reduction of this prevalence in many countries. AIM: To show through a retrospective analysis the annual prevalence of the duodenal ulcer in the last 10 years in a Digestive Endoscopy Service which is referred to public medical system in Porto Alegre and its suburban area and countryside of the State of Rio Grande do Sul, Brazil. The data analyzed is from March 1996 to December 2005. Specific data: transversal retrospective study with documented analysis of endoscopic diagnosis of upper gastrointestinal endoscopy. METHODS: A retrospective analysis of the diagnosis of the 13.130 procedures of upper gastrointestinal endoscopy between 1996 and 2005. The Sakita classification was used to verify the duodenal ulcer activity taking into consideration the patients who have lesions on A1 to S1 levels. To verify if there was a statistical significant results, a linear regression test was done (linear regression model. RESULTS: A gradate decrease of the prevalence

  13. 胃、十二指肠溃疡急性穿孔手术治疗的术前、术后护理%Preoperative and postoperative nursing care for patients with acute perforation of gastric and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    王瑞梅

    2016-01-01

    Objective:Acute perforation of gastric and duodenal ulcer is a common clinical emergency, and the nursing care of patients before and after surgery plays an important role in the rehabilitation of patients.The nursing of acute perforation of stomach and duodenum will be briefly introduced in this paper.%胃、十二指肠溃疡急性穿孔是临床常见的急症,手术前后的护理对患者的康复起着至关重要的作用.本文简要介绍胃、十二指肠急性穿孔手术前后的护理.

  14. Diagnosis of Helicobacter pylori infection in patients with bleeding ulcer disease: rapid urease test and histology Diagnóstico mediante endoscopia de la infección por Helicobacter pylori en pacientes con úlcera gastroduodenal y hemorragia digestiva: test rápido de ureasa e histología

    Directory of Open Access Journals (Sweden)

    M. Castro-Fernández

    2004-06-01

    Full Text Available Introduction: the endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests. Aims: to evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori in patients with bleeding peptic ulcer. Patients and methods: we included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88, with upper gastrointestinal bleeding secondary to duodenal ulcer (115 or gastric ulcer (58, diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin and one or two antral biopsies for rapid urease test (Jatrox®-H.p.-test. In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection. Results: 152 patients (88% showed H. pylori infection, 104 patients (90% with duodenal ulcer and 48 patients (83% with gastric ulcer. In all 119 cases (78% were diagnosed by the urease test and 112 cases (74% by histology. Both methods were used to diagnose 134 of 152 cases (88% (p Introducción: el diagnóstico de la infección por Helicobacter pylori, mediante endoscopia, en pacientes con úlcera gastroduodenal y hemorragia digestiva está limitado por la disminución de la sensibilidad de los métodos invasivos habituales, test de la ureasa e histología. Existen

  15. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices

    Institute of Scientific and Technical Information of China (English)

    Lee-Guan Lim; Yin-Mei Lee; Lenny Tan; Stephen Chang; Seng-Gee Lim

    2009-01-01

    A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy ident i f ied the bleeding s i te in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.

  16. 腹腔镜下胃十二指肠溃疡穿孔修补术的临床疗效评价%Clinical effect evaluation of laparoscopic repair surgery for gastric and duodenal ulcer perforation

    Institute of Scientific and Technical Information of China (English)

    王永强; 李海军; 陈峰

    2016-01-01

    Objective to evaluate clinical effect of laparoscopic repair surgery for gastric and duodenal ulcer perforation. Methods regard 48 gastric and duodenal ulcer perforation patients in our hospital from January 2013 to December 2015 as research subjects, and divide them into 2 groups: observation and control group. Observation group was treated with laparoscopic repair surgery, and control group with traditional laparotomy surgery. Compare curative effect of two groups.Results operation time, blood amount during operation, postoperative out of bed time and hospital stay of observation group was significantly less than control group, complications incidence was 4.16%, and that of control group was 16.67%. Ulcer healing rate of observation group was 91.67%, and that of control group was 87.5%.Conclusion Laparoscopic perforation repair has obvious effect for gastric ulcer perforation, which can reduce complications, shorten hospital stay and promote patient’s recovery, and is worthy of clinical promotion.%目的:评价腹腔镜穿孔修补术应用在胃十二指肠溃疡穿孔治疗中的临床效果。方法将2013年1月到2015年12月本院收治的48例胃十二指肠溃疡穿孔患者视作研究对象,将其分成观察、对照2个组。观察组给予腹腔镜穿孔修补术治疗,对照组给予传统开腹手术治疗,比较两组治疗效果。结果观察组手术时间、术中出血量、术后下床时间、住院时间均明显少于对照组;观察组并发症发生率为4.16%,对照组为16.67%。观察组溃疡愈合率为91.67%,对照组为87.5%。结论腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔的效果明显,能够减少并发症,缩短住院时间,促进患者恢复,值得临床推广。

  17. Duodenal polyposis secondary to portal hypertensive duodenopathy

    Institute of Scientific and Technical Information of China (English)

    Ananta; Gurung; Philip; E; Jaffe; Xuchen; Zhang

    2015-01-01

    Portal hypertensive duodenopathy(PHD) is a recognized, but uncommon finding of portal hypertension in cirrhotic patients. Lesions associated with PHD include erythema, erosions, ulcers, telangiectasia, exaggerated villous pattern and duodenal varices. However, duodenal polyposis as a manifestation of PHD is rare. We report a case of a 52-year-old man who underwent esophagogastroduodenoscopy and was found with multiple small duodenal polyps ranging in size from 1-8 mm. Biopsy of the representative polyps revealed polypoid fragments of duodenal mucosa with villiform hyperplasia lined by reactive duodenal/gastric foveolar epithelium and underlying lamina propria showed proliferating ectatic and congested capillaries. The features were diagnostic of polyps arising in the setting of PHD.

  18. Omeprazole versus ranitidine in the medical treatment of acute upper gastrointestinal bleeding: assessment by early repeat endoscopy.

    Science.gov (United States)

    Fasseas, P; Leybishkis, B; Rocca, G

    2001-12-01

    The purpose of this study was to assess the effects of acid suppression in patients with upper gastrointestinal bleeding using early repeat endoscopy. Ninety-two patients with the diagnosis of acute upper gastrointestinal bleeding (endoscopically verified), entered a single-blind, randomised study comparing two treatment groups: omeprazole (40 mg orally daily) to ranitidine (50 mg intravenously four times daily). The lesions considered were gastric ulcers, duodenal ulcers and erosive gastritis. All patients were candidates for medical treatment. The parameters assessed included: 1) stabilisation of the lesion by repeat endoscopy at 7.0 +/- 3.0 days, 2) bleeding recurrence, 3) duration of stay in the intermediate medical care unit. For erosive gastritis only parameters 2 and 3 were considered. The study was limited to the hospitalisation period. Endoscopic stabilisation rate at 7.0 +/- 3.0 days for duodenal lesions was higher in the omeprazole group (71% vs 37%, p=0.03), but there was no significant difference for gastric lesions (50% vs 54%, NS). The overall bleeding recurrence rate (0% vs 17%, p=0.013) and the duration of stay (3.9 vs 6.4 days, p<0.01) were significantly lower in the omeprazole group. Our study suggests that omeprazole is more effective than ranitidine in the pharmacological treatment of acute upper gastrointestinal bleeding.

  19. Endoscopic treatment of duodenal varices with cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Ana Mora-Soler

    2013-12-01

    Full Text Available Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.

  20. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis.

    Science.gov (United States)

    Del Hierro, Piedad Magdalena

    2011-12-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved.

  1. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.

  2. Perforated duodenal diverticulum caused by Bezoar: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2013-11-15

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

  3. Laparoscopic and Open Gastroduodenal Perforation repair in the Treatment of Duodenal Ulcer Perforation Patients and Observe the Curative Effect%腹腔镜与开放式十二指肠穿孔修补术治疗十二指肠溃疡合并穿孔患者的临床疗效

    Institute of Scientific and Technical Information of China (English)

    黄海; 梁绍诚; 骆剑华; 郑富强; 张焕彬

    2015-01-01

    目的 探讨腹腔镜与开放式十二指肠穿孔修补术治疗十二指肠溃疡合并穿孔患者的临床疗效.方法 选取 70例十二指肠溃疡合并穿孔的患者,将其采用随机数字表法分为两组,每组35例.研究组患者行腹腔镜十二指肠穿孔修补术,对照组行开放式十二指肠穿孔修补术,比较两组患者临床指标及并发症情况.结果 两组患者均顺利实施手术并康复出院,对照组患者住院费用和手术时程上明显低于研究组;而研究组患者在住院时间、排气时间、术中出血量、术后并发症、术后镇痛药物使用率指标均明显低于对照组,差异均有统计学意义(均P<0.05).结论 腹腔镜十二指肠穿孔修补术治疗十二指肠溃疡并穿孔,对患者的创伤小,恢复快,并发症少,安全性高,疗效确切.%Objective To investigate the laparoscopic and open gastroduodenal perforation repair in the treatment of duodenal ulcer and perforation in patients with clinical efficacy.Methods A total of 70 patients with duodenal ulcer perforation in our hospital and patients,which were randomly divided into two groups,35 patients in each group.The study group were treated with laparoscopic gastroduodenal perforation repair,the control group open gastroduodenal perforation repair surgery,compared two groups of patients with clinical indicators and complications.Results Two groups of patients were operated successfuly and were discharged from the hospital,hospitalization expenses and the control group was significantly lower than that of group process;while the study group in hospitalization time, exhaust time,intraoperative bleeding volume,postoperative complications,postoperative analgesia drug use rate were significantly lower than the control group,the differences were statisticaly significant(P<0.05).Conclusion Laparos- copic gastroduodenal perforation repair in the treatment of peptic ulcer perforation patients,for patients with minor trauma

  4. Duodenal metastases of renal cell carcinoma: a case report

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    HE Xiang-hui; LU Ning; ZHANG Rui; ZHU Li-wei

    2010-01-01

    @@ Malignancy accounts for about 5% of upper gastrointestinal hemorrhage and needs to be treated by surgical intervention. Duodenal metastases are a rare and peculiar cause of upper gastrointestinal bleeding.

  5. Duodenal ulcer promoting gene 1 (dupA1) is associated with A2147G clarithromycin-resistance mutation but not interleukin-8 secretion from gastric mucosa in Iraqi patients

    Science.gov (United States)

    Hussein, N.R.; Tunjel, I.; Majed, H.S.; Yousif, S.T.; Aswad, S.I.; Assafi, M.S.

    2015-01-01

    Helicobacter pylori causes peptic ulceration and gastric adenocarcinoma. The aims were to study the influence of dupA1 positivity upon interleukin-8 (IL-8) secretion from gastric mucosa and determine the prevalence of mutations responsible for clarithromycin and fluoroquinolone resistance. DNA was extracted from 74 biopsies and the virulence factors were studied. Levels of IL-8 in gastric mucosa were measured using ELISA and the mutations responsible for clarithromycin and fluoroquinolone resistance were determined using a GenoType-HelicoDR assay. The prevalence of cagA in strains isolated from gastric ulcer (GU) and duodenal ulcer (DU) was significantly higher than those isolated from non-ulcer disease (NUD) (90% and 57.9% versus 33.3%; p 0.01). The vacA s1m1 genotype was more prevalent in patients with DU (73.7%) and GU (70%) than in those with NUD (13.3%) (p 0.01). The prevalence of dupA1 was higher in DU patients (36.8%) than those with GU (10%) and NUD (8.9%) (p 0.01). Multivariate analysis showed that a cagA+/vacA s1i1m2 virulence gene combination was independently associated with the developing peptic ulcer disease (PUD) with increased odds of developing PUD (p 0.03; OR = 2.1). We found no significant difference in the levels of IL-8 secretion in gastric mucosa infected with H. pylori dupA-negative and H. pylori dupA1-positive strains (dupA-negative: mean ± median: 28 ± 26 versus 30 ± 27.1 for dupA1; p 0.6). While 12 strains were clarithromycin resistant, only three isolates were levofloxacin resistant. A significant association was found between dupA1 genotype and A2147G clarithromycin resistance mutation (p <0.01). Further study is needed to explore the relationship between virulence factors and disease process and treatment failure. PMID:26042186

  6. Duodenal ulcer promoting gene 1 (dupA1 is associated with A2147G clarithromycin-resistance mutation but not interleukin-8 secretion from gastric mucosa in Iraqi patients

    Directory of Open Access Journals (Sweden)

    N.R. Hussein

    2015-07-01

    Full Text Available Helicobacter pylori causes peptic ulceration and gastric adenocarcinoma. The aims were to study the influence of dupA1 positivity upon interleukin-8 (IL-8 secretion from gastric mucosa and determine the prevalence of mutations responsible for clarithromycin and fluoroquinolone resistance. DNA was extracted from 74 biopsies and the virulence factors were studied. Levels of IL-8 in gastric mucosa were measured using ELISA and the mutations responsible for clarithromycin and fluoroquinolone resistance were determined using a GenoType-HelicoDR assay. The prevalence of cagA in strains isolated from gastric ulcer (GU and duodenal ulcer (DU was significantly higher than those isolated from non-ulcer disease (NUD (90% and 57.9% versus 33.3%; p 0.01. The vacA s1m1 genotype was more prevalent in patients with DU (73.7% and GU (70% than in those with NUD (13.3% (p 0.01. The prevalence of dupA1 was higher in DU patients (36.8% than those with GU (10% and NUD (8.9% (p 0.01. Multivariate analysis showed that a cagA+/vacA s1i1m2 virulence gene combination was independently associated with the developing peptic ulcer disease (PUD with increased odds of developing PUD (p 0.03; OR = 2.1. We found no significant difference in the levels of IL-8 secretion in gastric mucosa infected with H. pylori dupA-negative and H. pylori dupA1-positive strains (dupA-negative: mean ± median: 28 ± 26 versus 30 ± 27.1 for dupA1; p 0.6. While 12 strains were clarithromycin resistant, only three isolates were levofloxacin resistant. A significant association was found between dupA1 genotype and A2147G clarithromycin resistance mutation (p <0.01. Further study is needed to explore the relationship between virulence factors and disease process and treatment failure.

  7. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

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    Alam Mohammed

    2000-01-01

    Full Text Available This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding Unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-year period (May 1996-April 1998. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men (82% and Saudis (54%. Their mean age was 52.46 + 17.8 years. Esophageal varices (45% were the main causes of bleeding followed by duodenal ulcers (24%. Overall mortality in this series was 15.8% (89 patients. Comorbid diseases were responsible for death in 68 (76% patients, whereas, bleeding was considered to be directly responsible for death in 21 (24% patients. On analysis of data from this study, old age (>60 years, systolic pressure < 90 mm Hg on admission, comorbid disease, variceal bleeding and Child′s grade C in patients with chronic liver disease were associated with adverse outcome.

  8. Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

    Science.gov (United States)

    Satoh, Kiichi; Yoshino, Junji; Akamatsu, Taiji; Itoh, Toshiyuki; Kato, Mototsugu; Kamada, Tomoari; Takagi, Atsushi; Chiba, Toshimi; Nomura, Sachiyo; Mizokami, Yuji; Murakami, Kazunari; Sakamoto, Choitsu; Hiraishi, Hideyuki; Ichinose, Masao; Uemura, Naomi; Goto, Hidemi; Joh, Takashi; Miwa, Hiroto; Sugano, Kentaro; Shimosegawa, Tooru

    2016-03-01

    The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

  9. Clinical Curative Effect of Octreotide Combined with Pantozol in Treatment of Bleeding Gastroduodenal Ulcer%奥曲肽联合泮托拉唑治疗胃十二指肠溃疡出血的临床疗效探讨

    Institute of Scientific and Technical Information of China (English)

    孙绍伟; 毕永辉

    2015-01-01

    Objective To study the clinical curative effect of octreotide combined with pantozol in treatment of bleeding gastroduo-denal ulcer. Methods Medical records of 100 cases of gastric duodenal ulcer hemorrhage patients admitted to our hospital from December 2012 to February 2014 were retrospectively analyzed and randomly divided into control group and treatment group, 50 cases in control group patients taking panxi tora azole treatment, the treatment group patients taking the octreotide combined with panxi tora azole treatment. Hemostatic effect of two groups of patients, clinical efficacy and adverse reactions were compared. Re-sults The treatment group patients after treatment of 1 d hemostatic effect was obvious due to the control group,P0.05, no significant difference. The clinical total effective rate of treatment group patients was significantly greater than the control group, P0.05,差异无统计学意义。治疗组患者的临床总有效率明显大于对照组,P<0.05,治疗组患者不良反应发生率小于对照组,P<0.05。结论胃十二指肠溃疡出血患者实施奥曲肽联合泮托拉唑治疗,有较好的止血效果和较少的不良反应,临床疗效显著,有一定的安全性和可行性,值得临床推广应用。

  10. 序贯疗法治疗幽门螺杆菌阳性十二指肠溃疡疗效观察%Sequential therapy for duodenal ulcer complicated with Helicobacter pylori

    Institute of Scientific and Technical Information of China (English)

    谭瑞明

    2011-01-01

    目的 评估序贯疗法治疗幽门螺杆菌(Hp)阳性十二指肠溃疡的疗效与安全性.方法 选取70例经胃镜检查确诊且1个月内14C尿素呼气试验阳性的十二指肠溃疡患者,随机分为两组:治疗组前5 d给予雷贝拉唑、阿莫西林,后 5 d给予雷贝拉唑、替硝唑、克拉霉素治疗;对照组予雷贝拉唑加阿莫西林、克拉霉素治疗7 d.两组均继续予雷贝拉唑治疗3周,记录用药后患者症状缓解情况.疗程结束1个月后复查胃镜并行14C尿素呼气试验检测.结果 治疗组Hp根除率为94.1%,对照组根除率为77.8%,两组比较差异有统计学意义(P0.05).两组不良反应发生率比较差异无统计学意义(P>0.05).结论 序贯疗法治疗Hp阳性十二指肠溃疡具有疗效高、耐受性和依从性好等优点.%Objective To evaluate the efficacy and safety of sequential therapy in the treatment of duodenal ulcer complicated with Helicobacter pylori(Hp). Methods Seventy patients with Hp positive duodenal ulcer were randomly divided into two groups. The treatment group were treated with rabeprazole,amoxillin at first five days; rabeprazole, clarithromycin and tinidazole at the second five days. The control group were treated with rabeprazole,amoxillin and clarithromycin for seven days. Two groups were treated with rabeprazole for 3 weeks sequentially. Gastroscopy and Hp test were performed in the fourth week after the end of the treatment. Results The Hp eradication rate was 94.1%in treatment group,while it was 77.8% in control group. There was significant difference between the two groups(P0.05). Conclusions Sequential therapy is more effective, well tolerated and with higher rate of eradication.

  11. Endoscopic band ligation for bleeding lesions in the small bowel

    Institute of Scientific and Technical Information of China (English)

    Takashi; Ikeya; Naoki; Ishii; Yuto; Shimamura; Kaoru; Nakano; Mai; Ego; Kenji; Nakamura; Koichi; Takagi; Katsuyuki; Fukuda; Yoshiyuki; Fujita

    2014-01-01

    AIM: To investigate the safety and efficacy of endo-scopic band ligation(EBL) for bleeding lesions in the small bowel.METHODS: This is a retrospective study evaluating EBL in six consecutive patients(three males, three fe-males, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, je-junal bleeding diverticulum; 1, ileal Dieulafoy’s lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding(within 30 d after EBL), and complications such as perforation and abscess for-mation. Follow-up endoscopies were performed in four patients.RESULTS: Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and arepeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case(13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45(range, 2-83) mo.CONCLUSION: EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.

  12. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

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    Pranaya Kumar

    2016-03-01

    Full Text Available CONTEXT Upper gastrointestinal bleeding (UGIB is one of the commonest gastrointestinal emergencies encountered by clinicians. Peptic ulcers are the most common cause of UGIB. Endoscopy has become the preferred method for diagnosis in patients with acute UGIB. This study is done in a diagnostic upper gastrointestinal endoscopy (UGIE setup of a tertiary care hospital to ascertain the causes of UGIB prevalent in this part of our country which might differ from other studies. AIM To ascertain prevalent causes of UGIB in patients of this part of India admitted to a Govt. Tertiary Hospital with a provisional diagnosis of UGIB. METHOD One hundred consecutive patients with UGIB were subjected to UGIE to find out the aetiology. The clinical profile and endoscopic findings were analysed and compared with the data on UGIB from other studies. RESULTS The mean age of patients was 47.03 years with male: female ratio of 2.33:1. 58% of patients were first time bleeders. Majority of patients presented with melaena. Visualisation of active bleeding achieved to 85.7% when endoscopy was done within first 24 hrs. The commonest cause of UGIB was duodenal ulcer (DU which accounted for 41% cases. Gastric ulcer was responsible in 13% of cases. Portal hypertension was responsible for bleed in only 13%. Neoplasms accounted for 25% of cases. Other less common causes were erosive gastritis (3%, gastric polyp (3%, Mallory-Weiss tear (1%, and Dieulafoy’s lesion (1%. Among bleeding peptic ulcers, 27.8% of cases were classified as Forrest IIa and 20.4% in Forrest IIb & IIc each. Acid peptic disease was past history elicited in majority (33% followed by NSAID (26% and alcohol (26%. CONCLUSION The present study has diagnosed various causes of upper gastrointestinal bleeding in this part of country. The incidence of gastric carcinoma as a cause of upper gastrointestinal bleeding is significantly high compared to those in other studies. UGI endoscopy should be done in every case

  13. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

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    Oguz Dilek

    2007-07-01

    Full Text Available Abstract Background Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. Methods The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening. Results A total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4. Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95% and 23 of them (59% had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53. History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33% cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70% with choledocholithiazis. Remaining eight patients had undergone surgery (30%. Clinical symptoms were resolved with medical treatment in 16(32% patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients

  14. [The effect of calcium antagonists on the rate of gastric emptying in patients with duodenal peptic ulcer and the dumping syndrome].

    Science.gov (United States)

    Saakian, A G

    1990-10-01

    Comparative evaluation of single-dose finoptin, corinfar and falicor by effect on gastric evacuation was conducted in 33 peptic ulcer and 48 postgastrectomy dumping syndrome patients. Finoptin was found to prolong the evacuation in contrast to corinfar which stimulated it. Nonsignificant delay in gastric evacuation occurred in falicor administration. When designing therapy of cardiovascular diseases associated with gastric evacuation, due consideration should be given to pharmacokinetic action of calcium antagonists and functional status of gastric evacuation. Finoptin is preferable in dumping syndrome, corinfar in slow gastric evacuation. In view of the above corinfar treatment is undesirable in postgastrectomy patients, otherwise they could develop rapid gastric stump evacuation and dumping syndrome.

  15. Duodenal Intracellular Bicarbonate and the 'CF Paradox'

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    Kaunitz JD

    2001-07-01

    Full Text Available HCO(3(- secretion, which is believed to neutralize acid within the mucus gel, is the most studied duodenal defense mechanism. In general, HCO(3(- secretion rate and mucosal injury susceptibility correlate closely. Recent studies suggest that luminal acid can lower intracellular pH (pH(i of duodenal epithelial cells and that HCO(3(- secretion is unchanged during acid stress. Furthermore, peptic ulcers are rare in cystic fibrosis (CF, although, with impaired HCO(3(- secretion, increased ulcer prevalence is predicted, giving rise to the 'CF Paradox'. We thus tested the hypothesis that duodenal epithelial cell protection occurs as the result of pH(i regulation rather than by neutralization of acid by HCO(3(- in the pre-epithelial mucus. Cellular acidification during luminal acid perfusion, and unchanged HCO(3(- secretion during acid stress are inconsistent with pre-epithelial acid neutralization by secreted HCO(3(-. Furthermore, inhibition of HCO(3(- secretion by 5-nitro-2-(3-phenylpropylamino benzoic acid (NPPB despite preservation of pH(i and protection from acid-induced injury further question the pre-epithelial acid neutralization hypothesis. This decoupling of HCO(3(- secretion and injury susceptibility by NPPB (and possibly by CF further suggest that cellular buffering, rather than HCO(3(- exit into the mucus, is of primary importance for duodenal mucosal protection, and may account for the lack of peptic ulceration in CF patients.

  16. The causes and prevention methods of severe burn patients complicated with stress ulcer bleeding%重度烧伤并发应激性溃疡出血的原因及防治

    Institute of Scientific and Technical Information of China (English)

    李峥; 张兵; 李巍; 王强

    2014-01-01

    目的:探讨重度烧伤并发应激性溃疡出血发生的原因及防治方法。方法我院2008年1月至2013年12月共收治892例重度烧伤患者,回顾分析其中53例并发应激性溃疡出血患者的临床资料。结果重度烧伤并发应激性溃疡出血的53例患者中,经积极治疗,显效24例,有效22例,总有效率为87%;休克患者出血发生率明显高于无休克患者(χ2=138.20,P<0.05),应激性溃疡出血与休克之间存在较强关联性(χ2=62.82,P<0.05,r=0.65)。结论对于存在休克的重度烧伤患者需提高警惕,注意监测有无应激性溃疡出血发生,早期行综合治疗,防治休克是预防应激性溃疡出血的有利措施。%Objective To study the causes and prevention methods of severe burn patients complicated with stress ulcer bleed -ing.Methods From January 2001 to December 2012 , a total of 892 cases of severe burn patients were treated in our hospital .Clinical data of 53 cases complicated with stress ulcer bleeding were retrospectively analyzed .Results Of the 53 patients, therapy was marked-ly effective in 24 cases and effective in 22 patients.The total effective rate was 87%.The incidence of bleeding in shock patients was significantly higher than that in non-shock patients (χ2=138.20 , P<0.05 ) .There was a significant correlation between shock and stress ulcer bleeding (χ2=62.82 ,P<0.05 ,r=0.65 ) .Conclusion It should be wary of severe burn patients with shock to monitor the presence of stress ulcer hemorrhage , so that to carry out early comprehensive treatment .The prevention and treatment of shock are fa-vorable measures for stress ulcer bleeding .

  17. Evaluation of Results in Patients with Acute Upper Gis Bleeding: A Goverment Hospital Experience

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    Bilge Bas

    2016-01-01

    Full Text Available Aim: The aim was to assess the characteristics of patients with upper gastrointestinal system (GIS bleeding in our clinic. Material and Method: The patients who admitted to Usak State Hospital Gastroenterology Department with upper gastrointestinal system bleeding were retrospectively evaluated between May 2009 and March 2012. The patients were assessed for age, sex, complaints, history of medication, management, history of bleeding, laboratory findings, endoscopic findings, need for transfusion, hospitalization duration and mortality. Results: 392 patients admitted to our department with upper gastrointestinal system bleeding. 263 (67.1% of the patient were male and 129 (32.9% were female. It was presented only melena in 120 (%30.6 patients, hematemesis in 140 (%35.7 patients and both hematemesis and melena in 132 (%33.7 patients at admission. The mean hemoglobin level was 7.8±1.5 g/dl, and the mean hematocrit level was 27.4±4%. It was established coronary artery disease in 50 (12.8% patients, diabetes mellitus in 20 (5.1% patients, cerebrovascular disease in 8 (2% patients and peripheral arterial disease in 4 (1% patients. We presented 194 (49.5% bulbus ulcer, 117 (29.8% erosive gastritis, 35 (8.9% gastric ulcer in patients at upper gastrointestinal system endoscopy. We established Helicobacter pylori infection in 264 (67.3 % patients. Discussion: Duodenal ulcer and eritematous gastritis are the most common causes of upper GIS bleedings. In addition, Helicobacter pylori infection is keep in mind as a important bleeding cause in that patients. It is useful to give stomach acid suppressor therapy to the patients who have coronary heart disease, cerebrovascular disease and diabetes mellitus, especially if they have gastric complaints.

  18. Early outcome after emergency gastrectomy for complicated peptic ulcer disease.

    Science.gov (United States)

    Cheng, Mina; Li, W H; Cheung, M T

    2012-08-01

    OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease. DESIGN. Prognostic study on a historical cohort. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital. MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities. RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors. CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

  19. Optimal management of peptic ulcer disease in the elderly.

    Science.gov (United States)

    Pilotto, Alberto; Franceschi, Marilisa; Maggi, Stefania; Addante, Filomena; Sancarlo, Daniele

    2010-07-01

    Recent data report that the incidence of peptic ulcer is decreasing in the general population; conversely, the rates of gastric and duodenal ulcer hospitalization and mortality remain very high in older patients. Two major factors that might explain this epidemiological feature in the elderly population are the high prevalence of Helicobacter pylori infection and the increasing prescriptions of gastroduodenal damaging drugs, including NSAIDs and/or aspirin (acetylsalicylic acid). The main goals for treating peptic ulcer disease in old age are to reduce recurrence of the disease and to prevent complications, especially bleeding and perforation. The available treatments for peptic ulcer are essentially based on gastric acid suppression with antisecretory drugs and the eradication of H. pylori infection. The aim of this article is to report the available data on clinical efficacy and tolerability of peptic ulcer treatments in elderly patients and provide recommendations for their optimal use in this special population. Proton pump inhibitor (PPI)-based triple therapies for 7 days are highly effective for the cure of H. pylori-positive peptic ulcers as well as for reducing ulcer recurrence. Antisecretory drugs are also the treatment of choice for NSAID- or aspirin-related peptic ulcers and are useful as preventive therapy in chronic users of NSAIDs and low-dose aspirin as antiplatelet therapy. Antisecretory PPI therapy has a favourable tolerability profile in geriatric patients; however, monitoring is suggested in older patients with frequent pulmonary infections, gastrointestinal malabsorption, unexplained chronic diarrhoea, osteoporosis or those taking concomitant cytochrome P450 2C19-metabolized medications. The overall approach to the geriatric patient should include a comprehensive geriatric assessment that ensures multidimensional evaluation of the patient in order to better define the clinical risk of adverse outcomes in the older patient with peptic ulcer and

  20. Relative Frequency of Peptic Ulcer and Erosion in Patients with Different Types of Cholestasis

    Directory of Open Access Journals (Sweden)

    F Joukar

    2008-04-01

    Full Text Available Introduction: Cholestasis is impairment of normal bile excretion into the duodenum and classified as mechanical and non mechanical cholestasis. Mechanical Cholestasis presents with increase in bile duct diameter or obstruction in bile duct in an ERCP. Cholestasis leads to different complications. One of these complications is mucosal peptic erosion leading to gastrointestinal bleeding, perforation and even obstruction due to stricture. We therefore carried out this study to assess the relative frequency of peptic ulcer and erosion in patients with different type of cholestasis. Methods: In a case control study, 170 patients with mechanical cholestasis on the basis of physical examination, liver function tests, radiologic and serologic assay were candidates for ERCP as final therapeutic and diagnostic test. Collected data was registered in questionnaire and evaluated by the Fisher Test. Later, sonography (common bile duct diameter in the two groups: mechanical (85 patients and non mechanical (85 patients and endoscopy was done for exact survey and location of mucosal erosions. Results: Frequency of mucosal peptic erosions in mechanical cholestatic groups was42.6% ( 36 patients and significantly more than frequency of mucosal peptic erosion in non mechanical cholestatic groups (15 patients, 17.6% (P=0.02. 51 patients (30% of the total patients with cholestasis had mucosal erosion. From these patients, 25 patients had peptic ulcer [frequency of duodenal ulcer was 17 patients (68% and gastric ulcer was 8 patients (32% ](P=0.01. There was significant difference in prevalence of duodenal ulcer in patients with mechanical (12 cases, 70.6% and non mechanical (5 cases, 29.4% cholestasis(P=0.01. There was a significant difference between prevalence of duodenal ulcer (12 cases, 70.6% and gastric ulcer(5 cases, 29.4% in patients with mechanical cholestasis (P=0.01 but this was not so in patients with non mechanical cholestasis. Conclusion: According to

  1. Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

    Directory of Open Access Journals (Sweden)

    Bora Koc

    2014-09-01

    Full Text Available In recent years, cytomegalovirus (CMV has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.

  2. Post-operative duodenal fistula: percutaneous treatment and review

    Directory of Open Access Journals (Sweden)

    D.Huerta

    2015-04-01

    Full Text Available Duodenal fistula is a complex condition, relatively frequent presentation, being in most cases of postoperative origin. Among the latter, 6% to 11% are secondary to surgical treatment of perforated duodenal ulcer, and more unusual, as a complication of cholecystectomy. Two cases treated percutaneous at the Polyclinic Bank city of Buenos Aires are presented. The first, a female patient with a duodenal fistula as a postoperative complication of a perforated duodenal ulcer and the second one patient male with the same pathology but as a complication of cholecystectomy. Percutaneous treatment of this disease has been reported sporadically without having proven its usefulness. Once diagnosed the same Fistulography and obliteration were performed percutaneously achieving complete remission of the disease.

  3. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high,duodenal trauma should be treated in time and tactfully.And application of new technology can help improve the management. In this review, we discussed the incidence,diagnosis, management, and complications as well as mortality of duodenal trauma.

  4. Effects of Alanyl-glutamine Enriched Parenteral Nutrition Treatment on Peptic Ulcer Bleeding%丙氨酰谷氨酰胺辅助治疗消化性溃疡出血的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    钟碧莹; 张国安; 汤茵

    2015-01-01

    目的:观察全肠外营养(total parenteral nutrition,TPN)添加丙氨酰谷氨酰胺治疗消化性溃疡所致上消化道出血的疗效。方法以2011年1月-2013年12月间入住该院的198例消化性溃疡出血患者为研究组,以2011年1月-2013年12月间入住该院的74例消化性溃疡出血患者为对照组,所有患者均于入院24 h内行急诊胃镜检查,明确诊断后两组均经常规治疗,根据病情给予禁食、补液、营养支持、抑酸、止血、保护胃粘膜等治疗。研究组给予丙氨酰谷氨酰胺(力太)20 g加入500 mL全肠外营养液中静脉输注Qd。对照组给予同样500 mL全肠外营养液但不加入力太。一周后复查胃镜,观察两组患者胃镜下的溃疡分期及再出血情况。结果272例消化性溃疡出血患者初次检查镜下溃疡均为活动期,其中研究组A1期182例(91.92%),A2期16例(8.08%);复查胃镜有142例(71.72%)患者进入愈合期,其中H期140例(70.70%),S期2例(1.01%),溃疡愈合率为71.72%。对照组初次检查镜下溃疡分期:A1期52例(70.27%),A2期22例(29.73%);复查胃镜有38例(51.35%)患者进入愈合期,其中H期26例(35.14%),S期12例(16.22%),溃疡愈合率为51.35%。两组愈合率比较差异有统计学意义。研究组一周内再出血18例(9.09%);对照组一周内再出血20例(27.03%);两组再出血率比较差异有统计学意义。结论对于消化性溃疡合并出血患者,常规治疗的同时加用含丙氨酰谷氨酰胺肠外营养可以促进溃疡愈合,降低再出血率。%Objective Efficacy of Alanyl Glutamine total parenteral nutrition treatment of upper gastrointestinal hemorrhage caused by peptic ulcer. Methods 198 cases of peptic ulcer bleeding in patients admitted to our hospital from Jan 2011 to Dec 2013 as the study group, 64 cases of peptic ulcer bleeding in patients admitted to our hospital from Jan 2011 to Dec 2013 as the control group, All patients were

  5. Presentation and Surgical Management of Duodenal Duplication in Adults

    Directory of Open Access Journals (Sweden)

    Caroline C. Jadlowiec

    2015-01-01

    Full Text Available Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.

  6. 消化性溃疡出血患者76例临床诊治分析%Clinical analysis of diagnosis and treatment of 7 6 cases of patients with peptic ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    赵丽娟; 鲍斯琴

    2014-01-01

    peptic ulcer hemorrhage is the most common complication of peptic ulcer patients physical sign depends on the patients with hemorrhage parts,speed and the bleeding.Panxi tora thiazole is gastric acid secretion inhibitor,choice,they the stomach membrane proton pump H+-K+ atpase,thereby blocking the final steps of the gastric acid secretion,suppressing gastric acid secretion.On basis of gastric acid and hydrochloric acid in gastric juice and promote secretin and other stimulus are inhibition caused by gastric acid secretion,work quickly,function is strong and durable,can maintain stomach pH levels higher,build good environment for patients stop bleeding,the drug combination is better anti Hp treatment of peptic ulcer bleeding.%消化性溃疡出血是消化性溃疡患者最常见的并发症,体征表现取决于患者出血的部位,速度和出血量。泮托拉唑是胃酸分泌的抑制剂,可选择性、竞争性地抑制胃壁细胞膜上的质子泵 H+-K+-ATP 酶,从而阻断胃酸分泌的终末步骤,产生抑制胃酸分泌作用。对基础胃酸和胃酸促分泌素等各种刺激引起的胃酸分泌均有抑制作用,起效迅速,作用强而持久,可维持胃内 pH 较高水平,为患者止血造就良好的环境,该药联合抗 Hp 治疗消化性溃疡出血效果更好。

  7. Risk Factors Analysis and Prevention of Head Injury Complicated with Stress Ulceration and Bleeding%颅脑损伤后并发应激性溃疡出血的危险因素分析及预防

    Institute of Scientific and Technical Information of China (English)

    谭欣

    2011-01-01

    目的 分析颅脑损伤后并发应激性溃疡出血的危险因素,为临床实施有效的预防措施提供参考信息.方法 选择2009年2月-2011年6月本院收治的颅脑损伤患者148例,观察患者是否并发应激性溃疡出血并分析发生的危险因素.结果 本组148例颅脑损伤患者中并发应激性溃疡出血29例,其发生与患者的性别、年龄一般资料无关(P>0.05),与患者的损伤程度、体温、血糖、血压相关(P<0.05).结论 颅脑损伤患者的损伤程度严重、发热、高血糖、低血压均为并发应激性溃疡出血的危险因素,临床上针对以上危险因素采取相应的预防措施,可以促进颅脑损伤患者的康复.%Objective To analyze the risk factors of head injury complicated with stress ulceration and bleeding, and to provide the evidence for effective implementation of prevention measures in clinical practice. Methods Totally 148 patients with head injury hospitalized in the Hospital of Tanghai County from February 2009 to June 2011 were enrolled in the study. The development of stress ulceration and bleeding was observed and the risk factors for the occurrence were analyzed. Results Among the 148 cases of head injury, 29 cases complicated with stress ulceration and bleeding, its occurrence was unrelated to the patients' gender, age and general information (P>0.05), but correlated with the patients' degree of injury, body temperature, blood glucose, and blood pressure (P<0.05). Conclusions Severe head injury, fever, high blood sugar, and hypotension are the risk factors of head injury complicated with stress ulceration and bleeding. Adopting the appropriate preventive measures based on the above risk factors in clinical practice can promote the recovery of the patients with traumatic brain injury.

  8. Portal hypertensive duodenal polyp: A case report

    Institute of Scientific and Technical Information of China (English)

    Jean-David Zeitoun; Ariane Chryssostalis; Benoit Terris; Frederic Prat; Marianne Gaudric; Stanislas Chaussade

    2007-01-01

    Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding.Endoscopic treatment turned out to be successful.

  9. Ultrastructural changes in non-specific duodenitis

    Institute of Scientific and Technical Information of China (English)

    Cheng-Xin Wang; Li-Jiang Liu; Jing Guan; Xiao-Ling Zhao

    2005-01-01

    AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions.METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and Ⅰ-Ⅲ of NSD diagnosed and graded by histology) selected from the 44patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV.RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells,occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori(H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells.CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum.

  10. 老年人上消化道出血病因分析%Analysis of Gastrointestinal Bleeding in the Elderly

    Institute of Scientific and Technical Information of China (English)

    杨韬

    2013-01-01

      目的:探讨老年性上消化道出血的病因.方法:回顾性分析本院2007-2011年间收治的220例上消化道出血患者的临床资料,其中老年性(60岁以上患者)上消化道出血患者110例,非老年性(小于60岁)出血患者110例,对两组患者的上消化道出血病因进行对比分析.结果:110例老年性上消化道出血患者中胃溃疡所致出血最多23例,占20.91%,其次为胃癌18例,占16.35%,其他常见的病因还有复合型溃疡、十二指肠溃疡、门脉高压出血,老年组患者肿瘤发生率、胃溃疡发生率明显高于非老年组,而十二指肠溃疡及肝硬化发生率明显低于非老年组.结论:胃及十二指肠溃疡是老年性上消化道出血最常见的病因,其次是胃癌.%Objective:To investigate the cause of upper gastrointestinal bleeding senile. Method:A retrospective analysis of clinical data of upper gastrointestinal bleeding in patients admitted to 220 cases in our hospital between 2007-2011 years,110 cases of upper gastrointestinal bleeding in patients with senile patients(above 60 years),the non-elderly(less than 60 years old)the bleeding 110 patients,a comparative analysis of the two groups of patients with upper gastrointestinal bleeding causes. Result:110 patients with senile upper gastrointestinal bleeding in patients with stomach ulcers caused by bleeding accounted for 20.91%,followed by up to 23 cases of 18 cases of gastric cancer accounting for 16.35%,and other common causes compound ulcer,duodenal ulcer,the door The clock high pressure bleeding,old age group,the incidence of tumors in patients with gastric ulcer incidence was significantly higher than the non-elderly group and duodenal ulcer and cirrhosis of the liver was significantly lower than the non-elderly group. Conclusion:Gastric and duodenal ulcers are senile,the most common cause of gastrointestinal bleeding,followed by stomach cancer.

  11. Changes in birth-cohort pattern of peptic ulcer mortality in England and Wales.

    OpenAIRE

    Katschinski, B. D.; Logan, R. F.

    1991-01-01

    Previous epidemiological studies have described the secular trends in peptic ulcer mortality in England and Wales as being characteristic of a cohort phenomenon. The most recent data on ulcer mortality, however, show increasing mortality rates from duodenal ulcer in women over 65 and from gastric ulcer in women over 75 years. While the rise in mortality rates in the oldest age groups is partly explained by their greater life expectancy, the increase in mortality from duodenal ulcer in older w...

  12. Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    An ectopic opening of the common bile duct into the duodenal bulb is a very rare congenital malformation of the bile duct, which may cause a recurrent duodenal ulcer or biliary diseases including choledocholithiasis or cholangitis. ERCP plays major role in the diagnosis of this biliary malformation. We report a case of an ectopic opening of the common bile duct into the duodenal bulb, which was detected on the upper gastrointestinal series.

  13. Risk factors and therapeutic response in Chinese patients with peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    Shou-Wu; Lee; Teng-Yu; Lee; Hong-Zen; Yeh; Chun-Fang; Tung; Yen-Chun; Peng

    2010-01-01

    AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retrospectively collected between January 2008 and December 2008.The differences were compared.RESULTS:Among all 448 cases,254(56.6%) and 194(43.4%) patients had gastric ulcers and duodenal ulcers respectively.Patients with gastric ulcers were younger than those with duodenal ulcers.Although more me...

  14. A Real World Report on Intravenous High-Dose and Non-High-Dose Proton-Pump Inhibitors Therapy in Patients with Endoscopically Treated High-Risk Peptic Ulcer Bleeding

    Directory of Open Access Journals (Sweden)

    Lung-Sheng Lu

    2012-01-01

    Full Text Available Background and Study Aims. The optimal dose of intravenous proton-pump inhibitor (PPI therapy for the prevention of peptic ulcer (PU rebleeding remains controversial. This study aimed to understand the real world experiences in prescribing high-dose PPI and non-high-dose PPI for preventing rebleeding after endoscopic treatment of high-risk PU. Patients and Methods. A total of 220 subjects who received high-dose and non-high-dose pantoprazole for confirmed acute PU bleeding that were successfully treated endoscopically were enrolled. They were divided into rebleeding (n=177 and non-rebleeding groups (n=43. Randomized matching of the treatment-control group was performed. Patients were randomly selected for non-high-dose and high-dose PPI groups (n=44 in each group. Results. Univariate analysis showed, significant variables related to rebleeding were female, higher creatinine levels, and higher Rockall scores (≧6. Before case-control matching, the high-dose PPI group had higher creatinine level, higher percentage of shock at presentation, and higher Rockall scores. After randomized treatment-control matching, no statistical differences were observed for rebleeding rates between the high-dose and non-high-dose groups after case-control matching. Conclusion. This study suggests that intravenous high-dose pantoprazole may not be superior to non-high-dose regimen in reducing rebleeding in high-risk peptic ulcer bleeding after successful endoscopic therapy.

  15. Gastrointestinal bleeding

    Science.gov (United States)

    ... refers to any bleeding that starts in the gastrointestinal tract. Bleeding may come from any site along the GI tract, but is often divided into: Upper GI bleeding: The upper GI tract includes the ...

  16. 研究分析泮托拉唑在上消化道溃疡出血治疗中的效果%The Effect of Treating the Upper Gastrointestinal Ulcer Bleeding by Pantoprazole

    Institute of Scientific and Technical Information of China (English)

    孙敏; 王俊平

    2016-01-01

    目的探讨泮托拉唑对上消化道溃疡出血的治疗效果。方法将上消化道溃疡出血患者116例分为对照和观察组,对照组在常规治疗基础上采用奥美拉唑治疗,观察组在常规治疗基础上采用泮托拉唑治疗。结果两组患者治疗有效率对比,差异不具有统计学意义(P>0.05);观察组止血时间短于对照组,且住院时间及日治疗费用均短于对照组、不良反应发生率低于对照组,差异具有统计学意义(P<0.05)。结论泮托拉唑在治疗上消化道溃疡出血中的应用效果良好。%Objective To investigate the effect of treating the upper gastrointestinal ulcer bleeding by using the pantoprazole. Methods To randomly divide 116 cases who suffer from the upper gastrointestinal ulcer bleeding into control group and observation group. The control group adopted omeprazole treatment on the base of the conventional treatment, the observation group adopted the pan pantoprazole treatment on the base of the conventional treatment.ResultsWe compared the effective rate of the two groups,it had no signiifcant difference (P>0.05). The bleeding time, the hospital stay, the cost of treatment and the adverse reaction incidence rate of the observation group were shorter and lower than the control group (P<0.05).Conclusion It has remarkable effect in the treatment the upper gastrointestinal ulcer bleeding by using the pantoprazole.

  17. Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum

    OpenAIRE

    2014-01-01

    The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding or technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnos...

  18. 合并幽门螺杆菌感染的十二指肠溃疡治疗中左氧氟沙星和甲硝唑的疗效对比%Comparethe application of the combined effect of Helicobacter pylori infection in duodenal ulcer treatment of levofloxacin and metronidazole

    Institute of Scientific and Technical Information of China (English)

    赵嘉莉; 张慧敏

    2016-01-01

    Objective To compare the application effect of Helicobacter pylori infection in patients with duodenal ulcer treatment left ofloxacin and metronidazole. Methods In our hospital from March 2014 to March 2016,76 cases of duodenal ulcer with Helicobacter pylori infection were selected as the research object,and randomly divided into the control group and the experimental group.The control group was treated with metronidazole,the experimental group was treated with levofloxacin,and the effects of the two groups were compared. Results Two groups of patients after treatment,the clinical symptoms of duodenal relief compared with no significant difference (P>0.05),no statistically significant; test group of patients with Helicobacter pylori infection eradication rate significantly due to the control group,two groups of data compared with statistical significance (P<0.05). Conclusion Helicobacter pylori infection in patients with duodenal ulcer treatment,left ofloxacin and metronidazole in the compound can effectively alleviate the clinical symptoms,but levofloxacin can better eradication of Helicobacter pylori infection,in patients with Helicobacter pylori infection in duodenal ulcer treatment effect significantly,with higher clinical value.%目的:研究合并幽门螺杆菌感染的十二指肠溃疡治疗中左氧氟沙星和甲硝唑的疗效。方法选取我院2014年3月~2016年3月三组的合并幽门螺杆菌感染的十二指肠溃疡患者76例为研究对象,将其随机分为对照组和试验组。对照组采用甲硝唑治疗,试验组采用左氧氟沙星治疗,比较两组疗效。结果两组患者经治疗后十二指肠临床症状缓解情况相比较,差异无统计学意义(P>0.05);试验组患者幽门螺杆菌感染根除率明显由于对照组,差异有统计学意义(P<0.05)。结论合并幽门螺杆菌感染的十二指肠溃疡治疗中,左氧氟沙星和甲硝唑均能有效缓解临床症状,

  19. An unusual cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    C K Adarsh

    2014-01-01

    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  20. Adult duodenal intussusception associated with congenital malrotation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Enteroenteric intussusception is a condition in which full-thickness bowel wall becomes telescoped into the lumen of distal bowel. In adults, there is usually an abnormality acting as a lead point, usually a Meckels' diverticulum, a hamartoma or a tumour. Duodenoduodenal intussusception is exceptionally rare because the retroperitoneal situation fixes the duodenal wall.The aim of this report is to describe the first published case of this condition. A patient with duodeno-duodenal intussusception secondary to an ampullary lesion is reported. A 66 year-old lady presented with intermittent abdominal pain, weight loss and anaemia. Ultrasound scanning showed dilated bile and pancreatic ducts.CT scanning revealed intussusception involving the full-thickness duodenal wall. The lead point was an ampullary villous adenoma. Congenital partial (type Ⅱ)malrotation was found at operation and this abnormality permitted excessive mobility of the duodenal wall such that intussusception was possible. This condition can be diagnosed using enhanced CT. Intussusception can be complicated by bowel obstruction, ischaemia or bleeding,and therefore the underlying cause should be treated as soon as possible.

  1. An Overview of History, Pathogenesis and Treatment of Perforated Peptic Ulcer Disease with Evaluation of Prognostic Scoring in Adults

    OpenAIRE

    Prabhu, V; Shivani, A

    2014-01-01

    Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discov...

  2. 快速康复外科在38例十二指肠球部溃疡穿孔患者中的应用分析%Application of fast track surgery in 38 cases with perforation of duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    高林; 黄建明; 钱雷敏

    2012-01-01

    Objective To reduce physiological and psychological trauma stress of patients with perforation of duodenal ulcer, and to achieve the goal of fast recovery by using a series of optimized measures based on evidence-based medicine during the perioperative management. Methods Seventy-six patients with perforation of duodenal ulcer were selected from January 2008 to December 2011, and randomly divided into fast track surgery group (FTS group, n = 38)and control group (n =38). Results After operation, the time of off -bed activity, food intake, first anal flatulence and defecation and hospital stay in the fast track surgery group were significantly shorter than those in the control group. Treatment cost was also less in FTS group, while the postoperative complications of the two groups showed no significant difference. Conclusion Compared with the conventional surgery treatment, fast track surgery occupies a dominant position in curing the patients with perforation of duodenal ulcer.%目的 采用一系列有循证医学依据的围术期处理的优化措施,以减少十二指肠球部溃疡穿孔患者的生理及心理的创伤应激,达到患者快速康复的目的.方法 选择2008年1月-2011年12月72例十二指肠球部溃疡穿孔患者,随机分为快速康复外科组(FTS组)和对照组,其中38例FTS组采用快速康复外科处理措施.结果 快速康复外科组患者术后下床活动时间、进食时间、首次肛门恢复排气排便时间、住院时间均短于对照组,痛苦程度和治疗费用均明显低于对照组,2组术后并发症发生率差异无统计学意义.结论 十二指肠球部溃疡穿孔患者采用快速康复外科处理措施,与常规处理比较,有着较为明显的优势.

  3. Comparative study on therapeutic effect of open and laparoscopic repair of perforated gastric and duodenal ulcer%开腹与腹腔镜下行胃十二指肠溃疡穿孔修补术的综合疗效比较观察

    Institute of Scientific and Technical Information of China (English)

    王朝江

    2016-01-01

    目的:比较开腹与腹腔镜下行胃十二指肠溃疡穿孔修补术的综合疗效。方法:收治胃十二指肠溃疡穿孔患者80例,随机分为观察组和对照组。观察组给予腹腔镜手术治疗,对照组给予开腹手术治疗,比较两组手术客观指标及并发症发生情况。结果:两组手术时间、术中出血量、住院时间、胃肠通气时间比较,差异具有统计学意义(P<0.05)。观察组并发症发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论:腹腔镜下行胃十二指肠溃疡穿孔修补术的临床疗效显著。%Objective:To compare the clinical effect of open and laparoscopic repair of perforated gastric and duodenal ulcer. Methods:80 cases of patients with perforated gastric and duodenal ulcer were divided into the observation group and the control group randomly.The observation group was treated with laparoscopic surgery.The control group was treated with open surgery.The objective indexes and complications of the two groups were compared.Results:The operation time,blood loss,length of stay and duration of ventilation between groups were compared,and the differences were statistically significant (P<0.05).The complication rate of the observation group was significantly higher than that of the control group,and the difference was statistically significant (P<0.05).Conclusion:Laparoscopic repair of perforated gastric and duodenal ulcer had remarkable curative effect.

  4. 老年患者消化性溃疡并出血或穿孔临床分析%The Clinical Analysis on Elderly Patients with Peptic Ulcer Bleeding or Perforation

    Institute of Scientific and Technical Information of China (English)

    向阳; 杨力

    2013-01-01

    目的:通过分析近十余年医院收治的232例老年消化性溃疡并出血或穿孔的临床资料,以加深对本病的认识,提高诊断及治疗水平。方法:采用回顾性研究的方法,对2000年1月-2012年6月收治的符合消化性溃疡并出血或穿孔诊断标准的老年患者进行分析。结果:232例老年消化性溃疡中198例合并出血,34例合并穿孔,212例幽门螺杆菌阳性,73例有服用NSAID类药物史,26例恶性溃疡。结论:老年性消化性溃疡的发病机制是综合,复杂的,出血及穿孔是常见的两个并发症。由于老年人胃黏膜防御因子减弱,动脉硬化,器官组织退行性变,服用NSAID类药物,加之合并有其他疾病如冠心病,高血压等,导致症状不典型,病变愈合慢,易复发,病情严重,复杂。临床医师对老年患者要高度重视,要加深对本病的认识,提高诊断及治疗水平。%Objective:To analyze the last ten years of 232 elderly patients admitted to hospital and peptic ulcer bleeding or perforation of the clinical data in order to deepen the understanding of the disease,improve diagnosis and treatment standards. Method:A retrospective study method of elderly patients who were treated by peptic ulcer bleeding or perforation meet diagnostic criteria from January 2000 to June 2012 were analyzed. Result:Two hundred and thirty-two cases of elderly peptic ulcer hemorrhaged in 198 cases,34 cases with perforation,212 cases of H. pylori positive,73 cases had history of NSAID use drugs,26 cases of malignant ulcers. Conclusion:The pathogenesis of senile peptic ulcer is a comprehensive,complex. Bleeding and perforation is common to both complications due to gastric mucosal defensive factors weakened the elderly,atherosclerosis,organ and tissue degeneration,taking NSAID drugs,coupled associated with other diseases such as coronary heart disease,high blood pressure,leading to atypical symptoms,lesions heal

  5. Acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Kurien, Matthew; Lobo, Alan J

    2015-10-01

    Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered medical emergency with an incidence of 84-160/100000 and associated with mortality of approximately 10%. Guidelines from the National Institute for Care and Care Excellence outline key features in the management of AUGIB. Patients require prompt resuscitation and risk assessment using validated tools. Upper gastrointestinal endoscopy provides accurate diagnosis, aids in estimating prognosis and allows therapeutic intervention. Endoscopy should be undertaken immediately after resuscitation in unstable patients and within 24 hours in all other patients. Interventional radiology may be required for bleeding unresponsive to endoscopic intervention. Drug therapy depends on the cause of bleeding. Intravenous proton pump inhibitors should be used in patients with high-risk ulcers. Terlipressin and broad-spectrum antibiotics should be used following variceal haemorrhage. Hospitals admitting patients with AUGIB need to provide well organised services and ensure access to relevant services for all patients, and particularly to out of hours endoscopy.

  6. Significance of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in patients with bleeding from upper part of the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2007-01-01

    Full Text Available Background/Aim. Helicobacter pylori (H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs use are considered to be the most important risk factors having influence on the onset of bleeding gastroduodenal lesions. Whether there is an interaction between H. pylori infection and the use of NSAIDs in the development of peptic ulcer disease is still controversial. The aim of the present study was to evaluate the prevalence of NSAIDs use and H. pylori infection in patients presented with bleeding gastroduodenal lesions. Methods. During the period from January 2003 - December 2003 we prospectively obtained data of all the patients (n=106 presented with signs of upper gastrointestinal bleeding. All the patients were admitted to the intensive care unit, with the endoscopy performed within 12 hours after admission. Histologic analysis was used for the detection of H. pylori infection. The NSAIDs and aspirin use data were obtained by anamnesis. Results. The results of our study revealed that the most common sources of upper gastrointestinal bleeding were duodenal (57 patients, 53.77% and ventricular (36 patients, 33.96% ulcers. The majority of the examined cases were associated with both H. pylori infection and NSAIDs use. A statistically significant difference among the studied groups of patients was proven. Conclusion. The majority of bleeding gastroduodenal lesions were associated with the coexistence of H. pylori infection and NSAIDs use, while their independent influences were statistically less important. Eradication of H. pylori infection in patients using NSAIDs might prevent upper gastrointestinal hemorrhage and reduce peptic ulcer bleeding risk. .

  7. Clinical effect of laparoscopic and open repair in patients with perforation of gastric and duodenal ulcer%腹腔镜与开腹穿孔修补术治疗胃十二指肠溃疡穿孔患者的临床效果

    Institute of Scientific and Technical Information of China (English)

    黄文伟; 劳日初; 黄永泰; 叶卫东

    2016-01-01

    Objective To explore the clinical effect of laparoscopic and open repair in patients with perforation of gastric and duodenal ulcer.Methods From November 2014 to June 2010,Sixth People's Hospital of Nanhai District, Foshan City,146 cases of gastric duodenal ulcer perforation patients as the research object,according to the random number table method is divided into observation group (70 cases) and control group (76 cases).The control group were treated with traditional open operation,the observation group were treated with laparoscopic gastric duodenal ulcer perforation repair,compared with the two groups of patients with operation time,hospitalization time,hospitalize- ation expenses and postoperative complications.Results The hospitalization time of the observation group was significantly shorter than that of the control group,the incidence of postoperative complications was significantly lower than that of the control group,the difference was statisticaly significant(P<0.05).Conclusions Compared with traditional open surgery, laparoscopic gastric duodenal perforation repair is less trauma,can shorten the length of hospital stay,reduce postoperative complications,is currently the main means of treatment of ulcerative perforation.%目的:探讨腹腔镜与开腹穿孔修补术治疗胃十二指肠溃疡穿孔患者的临床治疗效果。方法选取2010年6月至2014年11月佛山市南海区第六人民医院收治的146例胃十二指肠溃疡穿孔患者为研究对象,按随机数字表法将其分为观察组(70例)和对照组(76例)。对照组患者采用传统开腹术,观察组患者采用腹腔镜胃十二指肠溃疡穿孔修补术,比较两组患者的手术时间、住院时间、住院费用及术后并发症发生情况。结果观察组患者的住院时间明显短于对照组,术后并发症发生率明显低于对照组,差异均有统计学意义(均P<0.05)。结论与传统开腹手术相比

  8. Bleeding disorders

    Science.gov (United States)

    ... can occur when certain factors are low or missing. Bleeding problems can range from mild to severe. Some bleeding disorders are present at birth and are passed through families (inherited). Others develop from: Illnesses such as vitamin ...

  9. Bleeding gums

    Science.gov (United States)

    ... periodontal exam. DO NOT use tobacco, since it makes bleeding gums worse. Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water. If you have been diagnosed with a ...

  10. Misoprostol in peptic ulcer disease.

    Science.gov (United States)

    Watkinson, G; Akbar, F A

    1987-01-01

    Misoprostol, a synthetic prostaglandin E1 (PGE1) methyl ester analog has potent antisecretory and cytoprotective effects on the gastric and duodenal mucosa which should make it an effective drug in the treatment of gastric and duodenal ulcer. In two multicenter, randomised, double-blind, controlled studies involving over 900 patients with endoscopically proven benign gastric ulcer and in six similar studies involving over 2000 patients with active duodenal ulcers, differing doses of misoprostol have been compared with either placebo therapy or with conventional doses of cimetidine. In these studies misoprostol 800 mcg daily given as two or four divided doses has been shown to produce rates of complete ulcer healing and pain relief which were significantly superior to placebo therapy and comparable to those achieved with cimetidine. Drug related adverse effects were infrequent. A dose related diarrhea occurred in a small proportion of patients which seldom necessitated suspension of therapy. Because of the known uterotropic effect of prostaglandins the drug should not be used in pregnant women or women of child bearing age unless they are using adequate contraceptive measures. No clinically significant adverse, hematological or biochemical effects have been reported. Two studies suggested that misoprostol reduced the adverse effect of smoking on the healing of duodenal ulcer. In addition, misoprostol has been shown to protect the gastro-duodenal mucosa from the damaging effects of alcohol and non-steroidal anti-inflammatory drugs. This action may prove of value in the treatment of ulcer patients who are inveterate smokers, alcohol users or who are compelled to consume non-steroidal anti-inflammatory drugs for pain relief from rheumatic and allied diseases.

  11. Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup

    Directory of Open Access Journals (Sweden)

    Paola Angela Moro

    2011-01-01

    Full Text Available We report the case of a 4-years-old boy who was admitted with hypovolemic shock due to a severe gastrointestinal bleeding. The esophagogastroduodenoscopy (EGDS showed hiatus hernia, erosions and ulcerations of the lower esophagus, possibly due to a gastroesophageal reflux, and a small duodenal erosion. The child was previously healthy and he had never shown any symptoms related to this condition. The only product taken by the child in the previous days was a syrup containing several herbs, among which Filipendula ulmaria (L. Maxim. and Salix spp. (known to contain salicylates, marketed as food and prescribed by his paediatrician to treat a mild cold accompanied by fever. Quali-quantitative analysis confirmed the presence of salicylates in the syrup. Naranjo algorithm showed a probable correlation between the onset of symptoms and the consumption of the herbal remedy. The child recovered after receiving intensive care. The product was withdrawn from Italian market.

  12. Campylobacter-like organisms and Candida in peptic ulcers and similar lesions of the upper gastrointestinal tract: a study of 247 cases.

    OpenAIRE

    Kalogeropoulos, N K; Whitehead, R.

    1988-01-01

    Campylobacter-like organisms were detected by light microscopy in association with 57 of 102 (56%) of gastric ulcers, all the gastric erosions associated with gastritis, three of five (60%) of gastric erosions without gastritis, five of 13 (39%) of mild superficial gastritis and two of 36 (6%) of normal gastric mucosa. They were also seen in four of 20 (20%) of duodenal ulcers, but not in duodenal erosions with duodenitis or normal duodenal biopsy specimens. They were seen in association with...

  13. Gastroduodenal Perforation and Ulcer Associated With Rotavirus and Norovirus Infections in Japanese Children: A Case Report and Comprehensive Literature Review.

    Science.gov (United States)

    Ueda, Norishi

    2016-01-01

    Background.  There is no literature review on gastroduodenal perforation or ulcer (GDPU) with rotavirus (RV) and norovirus (NoV) gastroenteritis. Methods.  Pediatric cases of GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were searched from September 1974 until October 2015 using PubMed, Google for English, other-language-publications, and Ichushi (http://www.jamas.or.jp) for Japanese-language publications. All reports confirming GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were eligible for inclusion in the study. In addition, clinical characteristics were reviewed. Results.  A boy with duodenal ulcer (DU) and NoV gastroenteritis was described. There were 32 GDPU cases (23 RVs and 9 NoVs cases), including our case; with the exception of 1 case, all were Japanese. Mean age, male/female ratio, and symptoms' duration before admission were 21.6 months, 2.2, and 4.0 days, respectively. Vomiting was the most common symptom, followed by diarrhea, lethargy, fever, abdominal distension, and convulsion. Dehydration, hematemesis, melena, drowsiness or unconsciousness, shock, metabolic acidosis, leukocytosis, anemia, positive C-reactive protein, high blood urea nitrogen, and hyponatremia commonly occurred. Helicobacter pylori was a minor cause of GDPU. Duodenal (DP) or gastric perforation (GP) developed in 14 cases (10 DP/RVs, 1 GP/RV, and 3 DP/NoVs). Duodenal ulcer or gastric ulcer (GU) developed in 18 cases (10 DU/RVs, 4 DU/NoVs, 1 GU/RV, 1 GU + DU/NoV, and 2 upper gastrointestinal bleeding/RVs). The predominant perforation or ulcer site was in the duodenum. With the exception of 2 deaths from DU, all cases recovered. Conclusions.  Race, young age, male, severe dehydration, metabolic acidosis, drowsiness and unconsciousness, and shock may be potential risk factors of GDPU associated with RV and NoV gastroenteritis. Limitation of this descriptive study warrants further investigations to determine the risk factors in

  14. Effect of Pantoprazole and Omeprazole in the treatment of olderly peptic ulcer bleeding%泮托拉唑与奥美拉唑治疗老年消化性溃疡出血疗效对比

    Institute of Scientific and Technical Information of China (English)

    万晓林

    2016-01-01

    Objective To investigate the clinical effect of pantoprazole and omeprazole on elderly peptic ulcer bleeding. Methods 52 cases of elderly patients with peptic ulcer hemorrhage were divided into pantoprazole group(28 cases, give pantoprazole)and omeprazole group (24 cases, give omeprazole), bleeding stop time, pH of gastric juice, the clinical efficacy of two groups was observed, and the cost-effectiveness was calculated. Results In pantoprazole group, bleeding stop time was shorter than that of omeprazole, and gastric juice pH value was higher than that of omeprazole group,the differences between groups were statistically significant (P<0.05).The total efficiency of pantoprazole group was 96.4% (27/28), and was91.7% in omeprazole group (22/24), cost of omeprazole group was significantly higher than that of pantoprazole group, C/E was 13.046, and △C/△E was 117.723. Conclusion Using pantoprazole in elderly patients with peptic ulcer bleeding has good curative effect with less adverse reaction and low cost of medical , it is worth of farther explore and promote to use.%目的:对比泮托拉唑和奥美拉唑对老年消化溃疡出血的临床疗效。方法将52例老年消化溃疡出血患者分为泮托拉唑组(28例,给予泮托拉唑)和奥美拉唑组(24例,给予奥美拉唑),观察2组出血停止时间、胃液 pH、临床疗效,并进行成本-效果分析。结果泮托拉唑组患者出血停止时间短于奥美拉唑组,胃液pH 值高于奥美拉唑组,组间比较差异均有统计学意义(P<0.05)。泮托拉唑组总有效率96.4%(27/28),奥美拉唑组91.7%(22/24),奥美拉唑组成本明显高于泮托拉唑组,C/E 为13.046,△C/△E 为117.723。结论泮托拉唑用于老年患者消化溃疡出血疗效较好,不良反应少,医疗费用低,值得临床进一步研究推广。

  15. Gastric outlet obstruction from duodenal lipoma in an adult

    Directory of Open Access Journals (Sweden)

    Promise N Wichendu

    2013-01-01

    Full Text Available The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO, duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

  16. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  17. [An elderly woman with macrocytic anemia and acute high-output heart failure following acute bleeding due to a gastric ulcer].

    Science.gov (United States)

    Matsuzaki, Gen; Ashida, Terunao; Akanuma, Masao; Fujii, Jun; Seko, Yoshinori

    2013-01-01

    Although macrocytic anemia can develop in patients with acute blood loss, such anemia in very old patients is uncommon. In this report, we describe the course of an 89-year-old woman who had a rapid recovery from macrocytic anemia by medication only after acute blood loss due to a gastric ulcer. She had been treated with antihypertensive drugs for the previous 28 years at our outpatient clinic, and was admitted because of acute anemia 6 days after she had experienced tarry stool. Her hemoglobin (Hb) count and mean corpuscular volume (MCV) were 8.4 g/dl, and 103 fl, respectively. A gastroscopic examination indicated that the tarry stool originated from a fresh gastric ulcer. She was treated with an iron preparation, a diuretic and a proton pump inhibitor. The anemia was rapidly improved to Hb 10.5 g/dl and MCV 106 fl in one week, and to Hb 14.5 g/dl and MCV 99 fl in 4 weeks. At admission, she had slight pleural effusion and slight edema associated with an increase in her plasma brain natriuretic peptide (BNP) level (323 pg/ml), and her left ventricular ejection fraction was 76% based on the echocardiography findings, which are signs of the high-output heart failure without remarkable left ventricular diastolic dysfunction (E/e': 11.2). However, these signs improved rapidly, and her BNP level thereafter decreased to 114 pg/ml within four weeks.

  18. Endoscopic injection sclerotherapy in non-variceal upper gastrointestinal bleeding. A comparative study of polidocanol and thrombin.

    Science.gov (United States)

    Benedetti, G; Sablich, R; Lacchin, T

    1991-01-01

    To date several agents have been used to achieve haemostasis in patients with non-variceal upper gastrointestinal bleeding using endoscopic sclerotherapy techniques. Polidocanol has been widely used but local complications have been reported after treatment. We have compared the efficacy and safety of thrombin and polidocanol in 82 consecutive patients with ongoing or recent bleeding from duodenal, gastric, or anastomotic ulcers. Primary control of haemostasis from spurting vessels was achieved in 90% of cases using polidocanol and in 86.6% using thrombin. Definitive haemostasis was obtained in 80% of patients in both groups. When a non-bleeding vessel was visible, injection of polidocanol or thrombin effectively prevented rebleeding in 90.9% and 85.7% of cases, respectively. When a non-bleeding sentinel clot was present, injection of polidocanol or thrombin provided definitive haemostasis in 100% and 92.8% of cases, respectively. No statistically significant difference was evident between the two agents. In the polidocanol group, one local haemorrhagic complication was noted. No general or local complications were recorded in the thrombin group.

  19. Marjolin ulcer with multifocal origin

    Directory of Open Access Journals (Sweden)

    Das Sudip

    2009-01-01

    Full Text Available Marjolin ulcer developed from a twenty years old post burn scar. The patient presented with chronic ulceration followed by multifocal development of squamous cell carcinoma with different growth pattern. One nodular lesion grew rapidly to produce a large lesion with history of a little bleeding after trauma but without any pain. Excision followed by skin grafting resulted in good cosmetic scar.

  20. A case of civil pilot with small intestine diverticulosis complicated by ulcer bleeding and literature review%民航飞行员小肠憩室伴溃疡出血一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    李银喜; 黄连顺; 岑跃进; 许燕; 王云

    2013-01-01

    Objective To explore the diagnosis,treatment and medical assessment of the pilot suffering from small intestine diverticulosis,and provide the reference to aeromedical assessment of military and civil pilots and physical examination of pilot recruitment.Methods A case of civil pilot suffering from small intestine diverticulosis with ulcer bleeding was analyzed.By referring to the literature review,the pathophysiologic features,clinical manifestations,diagnosis and treatments for intestine diverticulosis were summarized.Results The intestine diverticulosis with ulcer bleeding was diagnosed by the capsule endoscopy and double-balloon enteroscopy.With the treatments of hemostasis,anti-infection and the consolidation of dietary nutrition,the pilot was recovered and qualified for flying.18months follow up showed that he was in normal physical condition.Conclusion Pilots suffering from small intestine diverticulosis and obscure gastrointestinal bleeding can be diagnosed by capsule endoscopy and double balloon enteroscopy.If small intestine diverticulosis was in stable,it wouldn't affect flying and treatment wouldn't be required.If small intestine diverticulosis combined with ulcer bleeding and infection,the hemostatic and anti-infection treatments would be required.If small intestine diverticulosis was with ulcer bleeding and had been affected,treatment of hemostasis and anti-infective treatment should be taken.Military transporter pilot and civil pilot can be qualified for flying in case of blood loss stopped and fitness recovered.The surgery should be considered if conservative treatment failed,or recurrent diverticulosis complication appeared.The assessment should be individually issued according to pilot's postoperative recovery.Routine capsule endoscopy examination is recommended due to its effective diagnosis and reference value to the physical examination of pilot recruitment.%目的 探讨飞行员小肠憩室的诊断、治疗和医学鉴定,为军事及民航

  1. Laparoscopic gastric partitioning gastrojejunostomy for an unresectable duodenal malignant tumor

    Directory of Open Access Journals (Sweden)

    Matsumoto Toshifumi

    2005-01-01

    Full Text Available As a palliative bypass for unresectable gastric or periampullary cancer, gastrojejunostomy (GJ is sometimes associated with postoperative delayed gastric emptying. We report the successful laparoscopic application of this procedure in a 78-year-old man with duodenal obstruction. Computed tomography revealed a mass in the duodenum along with multiple masses in the liver. A radiological image showed an ulcerative tumour in the third portion of the duodenum occluding the lumen. He was diagnosed as having an unresectable duodenal cancer with multiple liver metastases. He needed palliative bypass surgery. Laparoscopically, the stomach was partially divided using an endoscopic autosuture device, and end-to-side GJ was performed successfully. He was given a normal diet on the fourth postoperative day, and there was no delayed gastric emptying. Laparoscopic gastric partitioning GJ is a feasible and safe procedure to prevent postoperative delayed gastric emptying in case of malignant duodenal obstruction.

  2. Evaluate the effect to omeprazole in preventing treatment of hypertensive cerebral hemorrhage with stress ulcer bleeding%奥美拉唑对脑出血应激性溃疡的预防效果

    Institute of Scientific and Technical Information of China (English)

    丁凤英; 罗伟良

    2008-01-01

    Objective To evaluate the effect of omeprazole in preventing treatment of hypertensive cerebral hemorrhage with stress ulcer bleeding. Methods A total of 100 patients with hypertensive cerebral hemorrhage were treated with conventional therapy including dehydration, antihypertensive and supporting treatment. The patients were randomly divided into omeprazole group(n=50) and control group( n = 50). The control group received conventional therapyonly, while the omeprazole group received additional omeprazole 40mg, iv, qd, for 14d. Results Omeprazole group stress ulcer 6 eaess(12.0% ) was significantly lower than the control group 12 cases(24.0% );two groups stress ulcer incidence of severity are increasing with the increase of the disease; the mortalities of cerbral hemorrhage were 6.0 % in the omeprazole group and 16.0 % in the control group and the difference had significant meaning(P>0.05). Conclusion Omeprazole has significant beneficial effect in preventing upper gastrointestinal hemorrhage after hypertensive cerebral hemorrhage.%目的 观察奥美拉唑治疗高血压性脑出血并发应激性溃疡出血的疗效.方法 将100例高血压性脑出血患者分为奥美拉唑组(50例)和对照组(50例),均予常规脱水、降颅压及对症支持治疗,奥美拉唑组加用奥美拉唑40 mg,静脉注射,1次/d,共14 d.结果 奥美拉唑组应激性溃疡6例(12.0%),明显低于对照组12例(24.0%);两组应激性溃疡发生率均随病情程度加重而增加;奥美拉唑组死亡3例(6.0%),明显低于对照组8例(16.0%)(P<0.05).结论 奥美拉唑静脉注射预防高血压性脑出血并发应激性溃疡出血疗效确切,且未见不良反应发生.

  3. Association studies of Helicobacter pylori and non-steroidal anti-inflammatory drugs in patients with bleeding peptic ulcer%幽门螺杆菌感染及非甾体抗炎药致消化性溃疡并出血的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王莹; 王秀英; 王敏琴

    2011-01-01

    OBJECTIVE To explore the association studies of Helicobacter pylori and non-steroidal anti-inflammatory drug in patients with bleeding peptic ulcer. METHODS The clinical dates of 188 cases of peptic ulcer were reviewed retrospectively. Each parameters were evaluated with univariate and multivariate analysis.RESULTS Univariate analysis identified 4 statistically significant variables, including aged ≥60 years, the history of peptic ulcer, cardio cerebral vascular diseases and NSAIDs use(P<0.05). Logistic regression analysis showed that aged 60 years, the history of peptic ulcer, bleeding peptic ulcer and cardio cerebral vascular diseases, H. pylori infection alone, NSAIDs alone and combined H. pylori infection and NSAIDs were the risk factors of bleeding peptic ulcer(P<0. 01). CONCLUSION H. pylori infection is not a risk factor for bleeding peptic ulcer, but combination of aged 60 years, H. pylori, the history of peptic ulcer, bleeding peptic ulcer and cardio cerebral vascular diseases increases in risk factors of bleeding peptic ulcer.%目的 探讨服用非甾体抗炎药及幽门螺杆菌感染与消化性溃疡并出血的相关性.方法 对188例消化性溃疡患者的临床资料进行回顾性分析,将其所有的危险因素行单因素和多因素分析.结果 在单因素分析中,出血组中年龄≥60岁、既往有消化道出血史、心脑血管史、口服非甾体抗炎药所占比例高于未出血组,两组比较差异有统计学意义(P<0.05);进一步行多因素logistic回归分析,发现年龄≥60岁、既往有消化性溃疡史、消化道出血史、心脑血管病史、单纯Hp感染、单纯服用非甾体抗炎药及Hp感染+服用非甾体抗炎药均为消化性溃疡并出血的危险因素(P<0.01).结论 单纯Hp感染并不能增加消化性溃疡并出血的危险性,但若与年龄≥60岁、服用非甾体抗炎药、既往有消化性溃疡史、消化道出血史、心脑血管史等因素同时出现可增加其危险性.

  4. Observation on the influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation%腹腔镜手术对胃十二指肠溃疡穿孔患者术后机体应激及炎性状态的影响

    Institute of Scientific and Technical Information of China (English)

    刘海舟; 张卫峰; 马军杰

    2015-01-01

    Objective To observe and investigate the influence degree of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation.Methods 76 patients with gastric and duodenal ulcer perforation were selected as study subjects,and they were divided into control group(conventional open operation group)and observation group(laparoscopic operation group)according to the random number table,38 cases in each group.The serum body stress hormones and antiinflammatory,proinflammatory related indexes of the two groups at first day before operation and at first,third,seventh day after operation were respectively detected and compared.Results The serum IL -2 levels of the observation group at first,third and seventh day after operation were (3.53 ±0.24)μg/mL,(3.25 ±0.22)μg/mL and (4.37 ±0.33)μg/mL,which were higher than those of the control group(F =5.876,P <0.05),while other serum body stress hormones and antiin-flammatory,proinflammatory related indexes were all obviously lower than those of the control group (all P <0.05), there were significant differences between those postoperative evaluation results of the two groups.Conclusion The influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation is relatively small,and it shows that the bad body stress degree caused by the operation is relatively smaller.%目的:观察及探讨腹腔镜手术对胃十二指肠溃疡穿孔患者术后机体应激及炎性状态的影响程度。方法选取手术治疗的76例胃十二指肠溃疡穿孔患者为研究对象,随机数字表法分组,分别为对照组(传统开腹手术组)38例和观察组(腹腔镜手术组)38例。分别检测及比较两组术前1 d 及术后1 d、3 d、7 d的血清机体应激激素及抑炎、促炎状态相关指标。结果观察组术后1 d、3 d、7 d 的血清 IL-2

  5. Chronic ulcerative gastroduodenitis as a first gastrointestinal manifestation of Hermansky-Pudlak syndrome in a 1O-year-old child

    Institute of Scientific and Technical Information of China (English)

    Anselm Chi-Wai Lee; Kin-Hung Poon; Wing-Hong Lo; Lap-Gate Wong

    2008-01-01

    A 10-year-old Chinese boy who had a history of congenital thrombocytopathy presented with severe iron deficiency anemia secondary to chronic gastric inflammation and duodenal ulcerations. Subtle oculocutaneous albinism led to the finding of diminished dense bodies in the platelets under electron microscopy,hence the diagnosis of Hermansky-Pudlak syndrome (HPS). Biopsies from the stomach and duodenumrevealed a lymphocytic infiltration in the submucosa,but H pylori infection was absent. The gastroduodenitis responded to the treatment with omeprazole while iron deficiency anemia was corrected by oral iron therapy.HPS is a rare cause of congenital bleeding disorder with multisystemic manifestations. Upper gastrointestinal involvement is rare and should be distinguished from a mere manifestation of the bleeding diathesis.

  6. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serra Kayacetin

    2004-01-01

    Liver penetration is a rare but serious complication of peptic ulcer disease. Usually the diagnosis is made by operation or autopsy. Clinical and laboratory data were no specific. A 64-year-old man was admitted with upper gastrointestinal bleeding. Hepatic penetration was diagnosed as the cause of bleeding. Endoscopy showed a large gastric ulcer with a pseudotumoral mass protruding from the ulcer bed. Definitive diagnosis was established by endoscopic biopsies of the ulcer base.

  7. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Jie Ling

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumor (GIST in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB. Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.

  8. [Duodenal complications of rheumatoid purpura. Endoscopic aspects].

    Science.gov (United States)

    Chapoy, P; Guidon, M J; Louchet, E

    1984-01-01

    The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

  9. Safety Analysis of Emergency Treatment of Acute Perforation of Gastric and Duodenal Ulcer%浅析胃十二指肠溃疡急性穿孔急诊治疗安全性

    Institute of Scientific and Technical Information of China (English)

    熊清平

    2015-01-01

    Objective Ef ect of acute perforation of gastroduodenal ulcer emergency treatment and safety observation analysis.Methods Data of selected self court in July 2012~July 2014 treated 62 cases of patients with acute perforation of gastroduodenal ulcer as the research object,randomly divided into control group and research group,control group underwent surgical treatment,traditional emergency perforation repair team line laparoscopic emergency perforation repair surgery,and the clinical data of two groups of patients were retrospectively analyzed.Results The treatment group ef ective rate was 96.77%,significantly higher than the control group treatment ef ective rate was 83.87%;And operative blood loss and operation time of the team were bet er than the control group,with significant dif erence ( <0.05).Conclusion Emergency perforation repair in laparoscopic surgery in the treatment of acute perforation of gastroduodenal ulcer curative ef ect,good safety,the incidence of complications is low,is an ef ective treatment for acute perforation of gastroduodenal ulcer.%目的对胃十二指肠溃疡急性穿孔急诊治疗的效果及安全性进行观察分析。方法资料选自我院2012年7月~2014年7月收治的胃十二指肠溃疡急性穿孔患者62例作为研究对象,随机均分为对照组及研究组,对照组行传统急诊穿孔修补手术治疗,研究组行腹腔镜急诊穿孔修补手术治疗,并对两组患者的临床资料进行回顾性分析。结果研究组治疗的有效率为96.77%,显著高于对照组治疗的有效率83.87%;且研究组手术出血量及手术时间均优于对照组,差异具有显著性(<0.05)。结论腹腔镜急诊穿孔修补手术治疗胃十二指肠溃疡急性穿孔的疗效确切,安全性好,并发症的发生率低,是胃十二指肠溃疡急性穿孔的有效治疗措施。

  10. Brunner's glands of the rat during cysteamine ulceration

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1981-01-01

    in the histologic appearance of the duodenal glands of Brunner during ulcer formation. The secretory cells became extremely flattened without mucus content and the lumina of the acini dilated. Changes became most pronounced between 4 and 8 h after administration of cysteamine. Repeated injections of pentagastrin...... in a dosage inducing an acid response equivalent to the one induced by cysteamine did not produce any histologic changes in Brunner's glands or any ulcerations. When cysteamine was administered to rats with chronic gastric fistulas draining the gastric secretions, no duodenal ulcerations were produced......, but Brunner's glands still became depleted of mucus. These findings suggest that the histologic changes in Brunner's glands are not secondary either to the increased acid secretion induced by cysteamine or to ulcer formation. Together with our previous demonstration of a marked reduction duodenal secretion...

  11. Benign (solitary) ulcer of the rectum -- another cause for rectal stricture.

    Science.gov (United States)

    Chapa, H J; Smith, H J; Dickinson, T A

    1981-01-15

    Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding. Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single (or multiple) ulcers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer(s) is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures.

  12. Peptic ulcer disease today.

    Science.gov (United States)

    Yuan, Yuhong; Padol, Ireneusz T; Hunt, Richard H

    2006-02-01

    Over the past few decades, since the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors, cyclo-oxygenase-2-selective anti-inflammatory drugs (coxibs), and eradication of Helicobacter pylori infection, the incidence of peptic ulcer disease and ulcer complications has decreased. There has, however, been an increase in ulcer bleeding, especially in elderly patients. At present, there are several management issues that need to be solved: how to manage H. pylori infection when eradication failure rates are high; how best to prevent ulcers developing and recurring in nonsteroidal anti-inflammatory drug (NSAID) and aspirin users; and how to treat non-NSAID, non-H. pylori-associated peptic ulcers. Looking for H. pylori infection, the overt or surreptitious use of NSAIDs and/or aspirin, and the possibility of an acid hypersecretory state are important diagnostic considerations that determine the therapeutic approach. Combined treatment with antisecretory therapy and antibiotics for 1-2 weeks is the first-line choice for H. pylori eradication therapy. For patients at risk of developing an ulcer or ulcer complications, it is important to choose carefully which anti-inflammatory drugs, nonselective NSAIDs or coxibs to use, based on a risk assessment of the patient, especially if the high-risk patient also requires aspirin. Testing for and eradicating H. pylori infection in patients is recommended before starting NSAID therapy, and for those currently taking NSAIDs, when there is a history of ulcers or ulcer complications. Understanding the pathophysiology and best treatment strategies for non-NSAID, non-H. pylori-associated peptic ulcers presents a challenge.

  13. Is herpes simplex virus associated with peptic ulcer disease?

    OpenAIRE

    Löhr, J M; Nelson, J. A.; Oldstone, M B

    1990-01-01

    To test the hypothesis that herpes simplex virus type 1 (HSV-1) may be associated with peptic ulcer disease, we examined ulcerative lesions of the distal stomach and proximal duodenum for the presence of nucleic acids and antibodies specific for HSV-1. Utilizing in situ hybridization, immunocytochemistry, and polymerase chain reaction with sequencing, gastric or duodenal tissues from 4 of 22 patients (18%) with documented peptic ulcer disease demonstrated the presence of both specific HSV-1 n...

  14. Spitz Naevus With Ulceration - A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Kanwar A. J

    2001-01-01

    Full Text Available A 25 year old female presented with an asymptomatic reddish brown nodule on the nose. History of ulceration and bleeding suggested a diagnosis of granuloma pyogenicum. The lesion was excised. Histology revealed features of Spitz naevus.

  15. Herpes simplex virus type 1 in peptic ulcer disease: An inverse association with Helicobacter pylori

    Institute of Scientific and Technical Information of China (English)

    Klisthenis Tsamakidis; Efstathia Panotopoulou; Dimitrios Dimitroulopoulos; Dimitrios Xinopoulos; Maria Christodoulou; Alexandra Papadokostopoulou; Ioannis Karagiannis; Elias Kouroumalis; Emmanuel Paraskevas

    2005-01-01

    AIM: To assess the frequency of herpes simplex virus type Ⅰ in upper gastrointestinal tract ulcers and normal mucosa with the modern and better assays and also with a larger number of well characterized patients and controls and its relationship to Helicobacter pylori(H pylori).METHODS: Biopsy specimens from 90 patients (34 with gastric ulcer of the prepyloric area and 56 with duodenal ulcer) were evaluated. Biopsies from 50 patients with endoscopically healthy mucosa were considered as the control group. The method used to identify herpes simplex virus-1 (HSV-1) was polymerase chain reaction.H pylori was detected by the CLO-test and by histological method.RESULTS: Herpes simplex virus-1 was detected in 28 of 90 patients with peptic ulcer (31%) [11 of 34 patients with gastric ulcer (32.4%) and 17 of 56 with duodenal ulcer (30.4%)] exclusively close to the ulcerous lesion.All control group samples were negative for HSV-1.The likelihood of H pylori negativity among peptic ulcer patients was significantly higher in HSV-1 positive cases than in HSV-1 negative cases (P = 0.009). Gastric ulcer patients with HSV-1 positivity were Strongly associated with an increased possibility of Helicobacter pylori negativity compared to duodenal ulcer patients (P= 0.010).CONCLUSION: HSV-1 is frequent in upper gastrointestinal tract ulcers but not in normal gastric and duodenal mucosa. There is an inverse association between HSV-1 and H pylori infection.

  16. Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding

    NARCIS (Netherlands)

    Tjwa, E.T.; Holster, I.L.; Kuipers, E.J.

    2014-01-01

    Upper gastrointestinal bleeding (UGIB) is the most common emergency condition in gastroenterology. Although peptic ulcer and esophagogastric varices are the predominant causes, other conditions account for up to 50% of UGIBs. These conditions, among others, include angiodysplasia, Dieulafoy and Mall

  17. Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Brij Sharma

    2014-01-01

    Full Text Available Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO on CT angiography and managed this case.

  18. A case report of a duodenal adenocarcinoma: a complication with Crohn's disease.

    Science.gov (United States)

    Sakakibara, Yuko; Yamada, Takuya; Kimura, Keiichi; Iwasaki, Ryuichirou; Iwasaki, Tetsuya; Ishihara, Akio; Nakazuru, Shoichi; Ishida, Hisashi; Kodama, Yoshinori; Mita, Eiji

    2016-03-01

    The prevalence of Crohn's disease (CD) in Japan is increasing, and so is the incidence of colorectal and small bowel cancers associated with CD. However, few reports have described the malignant transformation of duodenal lesions; moreover, such a diagnosis is rarely possible preoperatively. We present a case of malignant degeneration in the duodenal mucosa associated with CD. A 54-year-old man had been receiving treatment for CD for more than 20 years. Seven years ago, he was diagnosed with duodenal stenosis related to CD. He was asymptomatic, and biopsy results from the proximal stricture showed inflammatory changes without malignant transformation. The lesion was then monitored during follow-up. In 2013, he underwent an endoscopy, which revealed an ulcerated, nodular mucosa, immediately proximal to a high-grade obstruction of the descending duodenum. A biopsy of the ulcer lesion confirmed a diagnosis of adenocarcinoma. The patient then underwent duodenopancreatectomy. Histopathological results from the resected duodenum confirmed a poorly differentiated adenocarcinoma that had invaded the subserosa. The patient recovered, and no recurrence has been observed. Although the duodenum can be accessed without difficulty during endoscopy, it is challenging to preoperatively diagnose malignant transformation. There are only four reported cases of duodenal cancer stemming from CD-associated stricture, and only one of them received a preoperative diagnosis of malignancy based on endoscopic biopsy results. Progressive duodenal narrowing and ulceration in patients with CD should indicate a need for careful endoscopic evaluation and biopsy in order to exclude malignant degeneration of Crohn's duodenitis. Early diagnosis of cases of CD-associated cancers is necessary. We report the features of a rare and illustrative case of duodenal adenocarcinoma in a patient with CD.

  19. Regulation of duodenal bicarbonate secretion during stress by corticotropin-releasing factor and beta-endorphin.

    Science.gov (United States)

    Lenz, H J

    1989-02-01

    Proximal duodenal mucosal bicarbonate secretion is an important factor in the pathogenesis of duodenal ulcer disease. To examine the central nervous system regulation of duodenal bicarbonate secretion, an animal model was developed that allowed cerebroventricular and intravenous injections as well as collection of duodenal perfusates in awake, freely moving rats. The hypothalamic peptide corticotropin-releasing factor (CRF) and stress (physical restraint) significantly stimulated duodenal bicarbonate secretion. These responses were abolished by pretreatment of the animals with the CRF receptor antagonist alpha-helical CRF-(9-41), hypophysectomy, and naloxone. In contrast, blockade of autonomic efferents by surgical and pharmacological means did not prevent the stimulatory effects of stress and CRF. Intravenous, but not cerebroventricular, administration of beta-endorphin that produced plasma concentrations of beta-endorphin that were similar to those produced by exogenous CRF and stress significantly stimulated duodenal bicarbonate secretion. These results indicate that endogenous CRF released during stress and exogenously administered CRF stimulate duodenal bicarbonate secretion by release of beta-endorphin from the pituitary, thus, demonstrating a functional hypothalamus-pituitary-gut axis.

  20. Paraganglioma gangliocítico duodenal Duodenal gangliocytic paraganglioma

    Directory of Open Access Journals (Sweden)

    C. Prieto

    2005-04-01

    Full Text Available Se presenta el caso de un varón de 85 años que ingresó por dolor abdominal e ictericia, por lo cual se le realizaron diversas exploraciones, apreciandose en 2ª porción duodenal una masa cuyo estudio histológico demostró que se trataba de un paraganglioma gangliocítico duodenal. Se describen las características clínicas de este infrecuente tumor y revisamos su diagnóstico y tratamiento.We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histiological study showed that it was a duodenal gangliocytic paraganlioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.

  1. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  2. Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae.

    Science.gov (United States)

    van Ierland-van Leeuwen, Marloes; Peringa, Jan; Blaauwgeers, Hans; van Dam, Alje

    2014-10-29

    A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.

  3. High-altitude gastrointestinal bleeding: An observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula

    Institute of Scientific and Technical Information of China (English)

    Tian-Yi Wu; Shou-Quan Ding; Jin-Liang Liu; Jian-Hou Jia; Rui-Chen Dai; Dong-Chun Zhu; Bao-Zhu Liang; De-Tang Qi; Yong-Fu Sun

    2007-01-01

    AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workersevacuated to Golmud (2808 m) and Xining (2261 m).The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia,and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery.CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.

  4. Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital

    Directory of Open Access Journals (Sweden)

    A. Garrido

    Full Text Available Objectives: 1. To study transfusion requirements in the Department of Gastroenterology of a Tertiary Referral Hospital, and their evolution over the last seven years. 2. To analyze risk factors associated with greater erythrocyte transfusion requirements. Patients and methods: erythrocyte transfusion requirements were compared for patients admitted to the Department of Gastroenterology at Hospital Virgen del Rocío, Seville, from 1999 to 2005. Clinical data of interest have been analyzed in order to determine factors associated with greater transfusion requirements. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males. Gastric ulcers were the cause of bleeding in 18.4% of cases (with 69% requiring transfusions; duodenal ulcers caused 22.2% of cases (with 52.9% requiring transfusions, and portal hypertension caused 33.6% of cases (with 90.2% requiring transfusions. Upper and lower gastrointestinal bleeding of unknown origin requires transfusions in 88.9 and 96.2% of cases, respectively. A multivariate logistic regression analysis showed that clinical presentations such as hematemesis (odds ratio = 3.12, hematochezia (odds ratio = 33.17, gastrointestinal hemorrhage of unknown origin (odds ratio = 6.57, and hemorrhage as a result of portal hypertension (odds ratio = 3.43 were associated with greater transfusion requirements for erythrocyte concentrates. No significant differences were observed between the percentages of patients who received transfusions from 1999 to 2005. Conclusions: 1. No differences have been observed between the percentages of patients who received transfusions over the last seven years at our Department of Gastroenterology. 2. Patients presenting with hematemesis or hematochezia, in addition to those with bleeding of unknown origin or from portal hypertension, are prone to have greater transfusion requirements.

  5. Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)

    2012-01-01

    textabstractAcute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endosco

  6. Nonsteroidal anti-inflammatory drugs: add an anti-ulcer drug for patients at high risk only. Always limit the dose and duration of treatment with NSAIDs.

    Science.gov (United States)

    2011-09-01

    In addition to their cardiac, renal, hepatic, cutaneous and neuropsychological adverse effects, nonsteroidal anti-inflammatory drugs (NSAIDs) can have severe effects on the entire gastrointestinal tract, including bleeding, perforation and occlusion. Which anti-ulcer drugs reduce the risk of the severe gastrointestinal adverse effects of NSAIDs, and which patients should receive them? To answer these questions, we conducted a review of the literature, using the standard Prescrire methodology. The main risk factors for severe gastrointestinal adverse effects during NSAID therapy are: a high dose regimen; age over 65 years; a history of gastric or duodenal ulcer or gastrointestinal bleeding; heavy use of both alcohol and tobacco; and concomitant treatment with a corticosteroid, antiplatelet drug, anticoagulant, or selective serotonin reuptake inhibitor (SSRI) antidepressant. Gastrointestinal symptoms and ulceration (on endoscopy) are poor predictors of severe gastrointestinal reactions. A meta-analysis examined randomised placebo-controlled trials of misoprostol in more than 11 000 patients. The results were mainly based on a large trial including about 9000 rheumatoid arthritis patients with an average age of 68 years. Misoprostol (400 microg to 800 microg/day, in 4 doses) prevented about 4 severe gastroduodenal events when 1000 patients over 60 years of age were treated for 6 months. Diarrhoea and other mild gastrointestinal disorders were frequent. There are no randomised trials comparing proton pump inhibitors (PPIs) and histamine H2 receptor antagonists versus misoprostol or versus placebo therapy for the prevention of severe adverse effects associated with NSAIDs. PPIs and H2 antagonists both reduce the incidence of gastric or duodenal ulceration detected by routine endoscopy. A randomised trial compared an H2 antagonist (famotidine) versus a PPI (pantoprazole) in 128 patients with an average age of 69 years who had a very high risk of serious gastrointestinal

  7. Clinical and morphological features of peptic ulcer at men and women

    OpenAIRE

    Islamova Е.А.; Lipatova Т.Е.

    2010-01-01

    The aim of research was to study clinical and morphological features of peptic ulcer at men and women of various age. 166 patients with duodenal peptic ulcer (80 men and 86 women) and 138 with stomach peptic ulcer (80 men and 58 women) were inspected. Clinical displays, morphometrical analysis of components of diffuse neuroendocrine system and stomach receptors of sexual hormones were studied. It is defined, that peptic ulcer at women under 40 years has more favorable clinical current, than a...

  8. The effects of antidepressants on gastric ulcer

    Directory of Open Access Journals (Sweden)

    Mehmet Latif Güneş

    2013-12-01

    Full Text Available In their daily practice, psychiatrists often experience gastriccomplaints in patients beside psychiatric disorders.Peptic ulcer is one of the diseases, which accompanyto psychiatric disorders including mainly depression. Itis shown that antidepressants can inflame the bleedingsincluding gastrointestinal (GI bleedings, while they havepositive effect on ulcer healing. In this review, studies,which conducted about the positive or negative effects ofantidepressant drugs on ulcer treatment were examined.Accordingly; it was found that opipramol, amitriptyline,imipramine that of tricyclic antidepressants was found tobe helpful in healing of the ulcer. It was stated that SelectiveSerotonin Reuptake Inhibitors generally inflamedulcers, exceptionally fluvoxamine and fluoxetine reducedulcer; moclobemide that of monoamine-oxidase inhibitorand tianeptine and mirtazapine that of atypical antidepressantshad positive effect in ulcer healing. To be carefulin choosing the appropriate antidepressant in psychiatricpatients with gastric ulcer is important in the prognosisof both ulcer and depression.Key words: peptic ulcer; depression; antidepressant drugs

  9. [OMEPRAZOL VS RANITIDINE IN UPPER DIGESTIVE BLEEDING

    Science.gov (United States)

    Regis R, Regina; Bisso A, Aland; Rebaza, Segundo

    1999-01-01

    Pectic ulcer is the most frequent cause of gastrointestinal bleeding. The homeostatic mechanism of bleeding, and coagulation, does not happen with values of pH less than 5,0. Therefore neutralization of gastric acidity (pH more than 5,0) is a recourse of control, improve the evolution and healing of peptic ulcer and to avoid a new bleeding. The aim of this study was to compare the results of treatment with omeprazole and ranitidine, in 57 patients admitted at emergency room of the Hospital Central de la Polic a Nacional del Per with endoscopic diagnosis of peptic ulcer, using Forrest classification. Patients received omeprazole 40 mg in bolus IV, followed by continuos infusion of 8 mg/hour for 72 hours (group A) or ranitidine 50 mg IV each 8 hours for 72 hours (group B). A new endoscopy was made 72 hours after admission demostrated a succesful therapy in both group. Bleeding stopped in 26/27 patients in group A (96,2%) and in 23/30 patients in group B (76,6%) (pomeprazole IV is more effective than ranitidine IV in the control of UGB because of peptic ulcer and provides a faster healing.

  10. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors.

    Science.gov (United States)

    Gincul, Rodica; Ponchon, Thierry; Napoleon, Bertrand; Scoazec, Jean-Yves; Guillaud, Olivier; Saurin, Jean-Christophe; Ciocirlan, Mihai; Lepilliez, Vincent; Pioche, Mathieu; Lefort, Christine; Adham, Mustapha; Pialat, Jean; Chayvialle, Jean-Alain; Walter, Thomas

    2016-11-01

    Background and study aim: As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. Patients and methods: We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. Results: A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Conclusions: Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.

  11. Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

    Directory of Open Access Journals (Sweden)

    Emil Kohan

    2009-01-01

    Full Text Available Objectives. Zollinger-Ellison Syndrome (ZES results in hypersecretion of gastric acid (via gastrinoma leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we hypothesize results in an increased incidence of postbulbar ulcers in patients with ZES (a mechanism previously unreported. We determined the incidence of the novel finding of duodenal gastric oxyntic hypertrophic heterotopia (GOH in patients with ZES. Methods. Seven patients with ZES were enrolled. The diagnosis of ZES was established by hypergastrinemia, gastric acid hypersecretion, and a positive secretin test or based on biopsy specimens (evaluated via tissue staining. Basal acid output (BAO and baseline gastrin secretion were determined by established methods. Endoscopic examinations with methylene blue staining and biopsy of the gastric and duodenal mucosa were conducted in all patients every 3–6 months for an average of 5 years. Results. The duodenal mucosa demonstrated hypertrophic GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. Biopsies from the bowel mucosa demonstrated patchy replacement of surface epithelium by gastric-type epithelium with hypertrophic oxyntic glands in the lamina propria in 5 patients. Two of the patients had no evidence of GOH in the duodenal bulb. Patients with GOH had an average serum gastrin level of 1245 pg/mL and BAO of 2.92 mEq/hr versus 724 pg/mL and 0.8 mEq/hr in patients without GOH. Conclusions. This study demonstrated the presence of duodenal mucosa with GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. The presence of hypertrophic and heterotopic gastric mucosa is proposed to result from increased gastrin levels and may contribute to the increased incidence of postbulbar ulcers in these patients.

  12. [Risk factors influencing the development of gastroduodenal bleeding].

    Science.gov (United States)

    Orobeĭ, Iu A; Lazebnik, L B; Nikolaeva, É I; Selivanova, G B

    2010-01-01

    Bleedings of an ulcerative aetiology are an actual and multiplane problem many years. Obvious communication of the complicated current of a peptic ulcer with various risk factors, such as a tobacco smoking, abusing alcohol, uncontrolled and long reception of ulcerogenic agents (NSAID, anticoagulants etc.), mucosa of stomach H. pylori, is noted by a serious accompanying pathology of other organs and systems. The knowledge of influence of interaction of the facts of risk on development bleedings of an ulcerative aetiology, will allow to develop in due time the complex of medical actions referred on prevention of this terrible complication.

  13. Poppyfield bleeding

    DEFF Research Database (Denmark)

    Lorentzen, Henrik F; Weismann, Kaare; Rossen, Kristian;

    2007-01-01

    Dermatoscopy increases the accuracy of diagnosis of melanoma. An atypical vascular pattern may be an indicator of cutaneous malignant melanoma (CMM). During dermatoscopy of certain CMMs numerous ruby droplets of blood appear when the dermatoscope is pressed firmly against the lesion. The aim...... to two dermato-pathologists who assessed the lesions independently for confirmation of Breslow thickness, Clark level, ulceration and presence of dilated tumour vessels. There was no disagreement between the pathologists' assessments. Age of the patients and Breslow thickness of the cutaneous malignant...... melanoma were similar in the two groups. All 8 poppyfield CMMs had dilated tumour vessels compared with 25% (2/8) of the non-poppyfield CMMs (pulceration was observed in all poppyfield CMMs and none of the non-poppyfield CMMs (p

  14. A case-control study on non-steroidal anti-inflammatory drugs(NSAIDs)induced and NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding%NSAIDs相关性消化性溃疡出血与非NSAIDs消化性溃疡出血的临床对照研究

    Institute of Scientific and Technical Information of China (English)

    宗晔; 赵海英; 王青釭; 吴咏冬; 张澍田

    2012-01-01

    目的 探讨非甾体类抗炎药(NSAIDs)相关性溃疡出血与非NSAIDs消化性溃疡出血的差异.方法 通过临床对照研究,比较46例NSAIDs相关性溃疡出血与88例非NSAIDs消化性溃疡出血的临床资料.结果 NSAIDs组年龄显著高于非NSAIDs组,女性患者比率高于非NSAIDs组;NSAIDs组具有心脑血管和/或风湿免疫性疾病的患者多于非NSAIDs组,而既往具有消化性溃疡病史的患者低于非NSAIDs组;NSAIDs组上腹痛症状显著低于非NSAIDs组;NSAIDs组发病时血糖高于非NSAIDs组;NSAIDs组胃溃疡比率显著高于非NSAIDs组.以上差异均有统计学意义(P<0.05).结论 NSAIDs相关性溃疡出血发病年龄、性别、临床表现及溃疡的发生部位与非NSAIDs溃疡患者均有差异,熟悉NSAIDs相关性溃疡出血的特点有利于临床诊治.%Objective To explore the difference in clinical characteristics between non - steroidal anti - inflammatory drugs ( NSAIDs ) induced and NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding. Methods The case - control study was used to analyze the clinical data of forty - six patients with NSAIDs induced and eighty - eight patients with NSAIDs unrelated peptic ulcer with upper gastrointestinal bleeding. Results The age range of patients in NSAIDs induced group was older than that of NSAIDs unrelated group. Female patients in NSAIDs induced group were more than those in NSAIDs unrelated group. More patients in NSAIDs induced group had the history of cardio - cerebral - vascular diseases or rheumatic diseases, fewer patients in NSAIDs induced group had the history of peptic ulcer and epigastric pain. The level of blood sugar in NSAIDs induced group was higher than that of NSAIDs unrelated group. The number of patients with gastric ulcer in NSAIDs induced group was more than that of NSAIDs unrelated group. Their difference was significant( P < 0. 05 ). Conclusion There was significant difference between NSAIDs induced group and

  15. Aneurysm of the Superior Posterior Pancreatic-Duodenal Artery Presenting with Recurrent Syncopes

    Directory of Open Access Journals (Sweden)

    I.A.J. van Doesburg

    2009-08-01

    Full Text Available We present a 61-year-old woman with hypovolemic shock due to a ruptured aneurysm of the superior posterior pancreatic-duodenal artery in whom recurrent syncopes were the first presenting sign of pancreatic-duodenal artery aneurysm (PDAA. PDAA is a rare but life-threatening condition. The widely varying symptomatology may lead to a delay in diagnosis and treatment. Patients with atypical symptoms, such as vague abdominal pain, recurrent dizziness or syncope, may actually suffer from a sentinel bleeding of the vascular malformation. Radiological imaging, especially selective angiography, may provide a diagnostic as well as a therapeutic tool in these patients.

  16. 消化性溃疡合并上消化道出血的相关危险因素分析%Analysis of related risk factors for the upper-gastrointestinal bleeding in peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    向四国; 仰涢霞; 黄丽儿

    2015-01-01

    [目的]分析消化性溃疡合并上消化道出血的相关危险因素。[方法]将324例消化性溃疡患者,按是否合并上消化道出血分为观察组(75例)、对照组(249例),对2组临床资料中一般情况、生活习惯、饮食习惯和用药情况等进行回顾性分析。[结果]观察组性别、年龄、病程、职业以及有非甾体类抗炎药用药史和 Hp感染史患者比率均高于对照组,差异有统计学意义(P<0.05),而2组婚姻、家族史比较,差异无统计学意义(P>0.05)。观察组长期吸烟、嗜酒、喜食辛辣刺激食物、生活无规律患者比率均高于对照组,差异有统计学意义( P<0.05)。观察组溃疡直径≥20 mm、溃疡处于活动期、抑郁、失眠患者比率均高于对照组,差异有统计学意义(P<0.05),而2组溃疡部位比较,差异无统计学意义(P>0.05)。[结论]服用非甾体类抗炎药、有 H p感染及不良的生活习惯是消化性溃疡合并上消化道出血的危险因素。%Objective]To investigate the related risk factors for the upper‐gastrointestinal bleeding (UGIB)in peptic ulcer disease(PU).[Methods]A retrospective analysis was performed for 324 cases of PU patients in our hospital during 2010 January -2014 January ,in which 75 patients complicated with UGIB were considered as observation group(OG) ,and 249 patients without UGIB complication were considered as control group(CG).The clinical data of the general condition ,living habits ,diet and medication were competitively analyzed. [Results ] T he ratio of gender ,age ,disease duration ,occupation ,the history of NSAIDS intake and Hp positive rate in OG were significantly higher than those in CG(P0.05).Meanwhile ,the ratio of long‐term smoking ,drinking ,eating spicy food in OG were significantly higher than those in CG(P0.05).In an addition ,the ratio of depression ,insomnia and regular life were higher in OG than those in CG(P<0

  17. Upper gastrointestinal hemorrhage due to duodenal stromal tumor

    Directory of Open Access Journals (Sweden)

    Parreira José Gustavo

    2003-01-01

    Full Text Available BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage.

  18. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-11-17

    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding.

  19. A new candidate as a hemostatic agent for difficult situations during variceal bleeding: Ankaferd blood stopper

    Directory of Open Access Journals (Sweden)

    Ersan Ozaslan

    2011-01-01

    Full Text Available Variceal bleeding is the most challenging emergent situation among the causes of upper gastrointestinal bleeding. Despite substantial improvement, a need remains for therapeutic armamentarium of such cases, which is easy, effective and without side-effect. Ankaferd blood stopper (ABS is a standardized herbal extract acting as a hemostatic agent on the bleeding or injured areas. In this observational study, a total of four patients with variceal bleeding were treated with endoscopic ABS application. The lesions were bleeding gastric varices (n:3 and bleeding duodenal varix (n:1. ABS was selected as a bridge to definitive therapies due to unavailability or inappropriateness of bleeding lesions to conventional measures. ABS was instilled or flushed onto the bleeding areas by sclerotherotherapy needle or heater probe catheter. Periprocedural control of the bleeding was achieved in all instances. Thereafter, on an elective basis, two patients with gastric varices underwent cyanoacrylate injection, while third underwent Transjugular intrahepatic portosystemic shunt and embolization. The patient with duodenal varix refused further therapy, after a few hours after admission and was discharged. He again presented the same day with rebleeding, but died before any attempt could be made to control his bleeding. ABS seems to be effective in cases of variceal bleeding as a bridge to therapy. Its major advantages are the ease of use and lack of side-effects.

  20. Duodenal duplication cyst identified with MRCP

    Energy Technology Data Exchange (ETDEWEB)

    Carbognin, G.; Guarise, A.; Biasiutti, C.; Pagnotta, N.; Procacci, C. [Department of Radiology, University Hospital ' G.B. Rossi' , Verona (Italy)

    2000-08-01

    We report a case of a stalked cystic duodenal duplication. The lesion, hyperintense on T2-weighted GRE images, maintained the signal intensity after oral administration of a negative contrast agent (Lumirem, Guerbet, Aulnay-Sous-Bois, France), confirming its independence from the duodenal lumen. To our knowledge, this is the first demonstration of duodenal duplication by means of MR cholangiopancreatography. (orig.)

  1. [Radical operative treatment of perforative gastroduodenal ulcer disease].

    Science.gov (United States)

    Gostishchev, V K; Evseev, M A; Golovin, R A

    2009-01-01

    Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.

  2. Menorrhagia (Heavy Menstrual Bleeding)

    Science.gov (United States)

    Diseases and Conditions Menorrhagia (heavy menstrual bleeding) By Mayo Clinic Staff Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy ...

  3. Do We Eradicate Helicobacter pylori in Hospitalized Patients with Peptic Ulcer Disease?

    Directory of Open Access Journals (Sweden)

    Frank Wong

    2013-01-01

    Full Text Available BACKGROUND: Helicobacter pylori infection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates of H pylori-related ulcers as well as other complications such as gastric cancer.

  4. Gastric heterotopia of rectum in a child: a mimicker of solitary rectal ulcer syndrome.

    Science.gov (United States)

    Al-Hussaini, Abdulrahman; Lone, Khurram; Al-Sofyani, Medhat; El Bagir, Asim

    2014-01-01

    Bleeding per rectum is an uncommon presentation in pediatric patients. Heterotopic gastric mucosa in the rectum is a rare cause of rectal bleeding. Here, we report a 3-year-old child with a bleeding rectal ulcer that was initially diagnosed and managed as a solitary rectal ulcer syndrome. After 1 month, the patient persisted to have intermittent rectal bleed and severe anal pain. Repeat colonoscopy showed the worsening of the rectal ulcer in size. Pediatric surgeon excised the ulcer, and histopathological examination revealed a gastric fundic-type mucosa consistent with the diagnosis of gastric heterotopia of the rectum. Over the following 18 months, our patient had experienced no rectal bleeding and remained entirely asymptomatic. In conclusion, heterotopic gastric mucosa of the rectum should be considered in the differential diagnosis of a bleeding rectal ulcer.

  5. Peptic Ulcer

    Science.gov (United States)

    A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small ... and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...

  6. Peptic ulcer

    Science.gov (United States)

    ... result may be: Swollen and inflamed tissue, called ( gastritis ) An ulcer Watch this video about: Stomach ulcer ... PA: Elsevier Saunders; 2016:chap 51. Read More Gastritis Intestinal obstruction Peritonitis Zollinger-Ellison syndrome Patient Instructions ...

  7. Ulcerative Colitis

    Science.gov (United States)

    ... or worsen symptoms. Who is more likely to develop ulcerative colitis? Ulcerative colitis can occur in people ... any age. However, it is more likely to develop in people between the ages of 15 and ...

  8. Clinical care analysis of peptic ulcer disease in children%小儿消化性溃疡病临床护理分析

    Institute of Scientific and Technical Information of China (English)

    由利芬

    2013-01-01

    目的:分析与探讨小儿消化性疾病的临床护理措施。方法选取本院2008年2月~2010年2月期间收治的小儿消化性溃疡患儿共58例,对其临床病理资料进行回顾性分析,所有患儿均经精心护理。结果58例患者中有29例为十二指肠溃疡,22例为胃溃疡,7例为复合型溃疡。通过对患儿精心的护理与治疗,所有患儿均在7d内康复出院。结论对小儿消化性溃疡疾病进行准确的诊断、有效的护理,对于预防溃疡出血以及其他并发症的发生有着重要的意义。%Objective To analyze and discuss the clinical care measures of pediatric digestive disease. Methods 58 children with peptic ulcer disease from February 2008 to February 2010 in our hospital were seleted,their clinical datum were retrospectively analyzed,all the children were given meticulously care. Results Of 58 patients,there were 29 cases of duodenal ulcer,22 cases of gastric ulcer,7 cases of complex ulcers.Through meticulous care and treatment,all patients were discharged within seven days. Conclusion Acurate diagnosis and effective care for children with peptic ulcer disease,it has great significance in preventing ulcer bleeding and other complications.

  9. PEPTIC ULCER FREQUENCY DIFFERENCES RELATED TO H. PYLORI OR AINES

    Directory of Open Access Journals (Sweden)

    Diego Michelon de CARLI

    2015-03-01

    Full Text Available Background Peptic ulcer etiology has been changing because of H. pylori decline. Objectives To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000 and B (2007-2010, searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. Results Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000, increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000 and idiopathic peptic ulcer (P=0.002. The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002. Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. Conclusions After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer.

  10. Efficacy of intra-arterial treatment for massive gastrointestinal bleeding in hemodialysis patients.

    Science.gov (United States)

    Banshodani, Masataka; Kawanishi, Hideki; Moriishi, Misaki; Shintaku, Sadanori; Sato, Tomoyasu; Tsuchiya, Shinichiro

    2014-02-01

    The incidence of acute nonvariceal massive gastrointestinal bleeding (GIB) is higher in hemodialysis (HD) patients than in healthy individuals, and this is often a life-threatening event. We evaluated the efficacy of intra-arterial treatment for GIB in HD patients. Between January 2006 and June 2012, eight HD patients with GIB were treated with superselective transarterial embolization. Of the eight cases, one was duodenal bleeding, two were jejunal bleeding, one was ileocecum bleeding, two were ascending colonic bleeding, and two were sigmoid colonic bleeding. After examining the site of bleeding by endoscopy or contrast-enhanced computed tomography (CT), embolizations with microcoils, gelatin sponges, or N-butyl cyanoacrylate were performed through interventional radiology (IVR). In all cases, blood transfusions were frequently administered. Six of the eight patients with GIB were successfully salvaged by transarterial embolization. In one case, duodenal bleeding was refractory to endoscopic treatment. Embolization was performed twice in this case; however, the patient died of an aneurysm rupture at the embolization site 24 days after the embolizations. In another case, massive jejunal bleeding and disseminated intravascular coagulation were identified at the time of the first examination, and the patient died of multiorgan failure 26 days after the embolization. On the basis of our experience, we established an effective treatment strategy for HD patients with acute nonvariceal massive GIB, by immediately identifying the exact site and degree of bleeding using contrast-enhanced computed tomography and performing early treatment with transarterial embolization.

  11. 老年患者消化性溃疡穿孔及出血后短期病死率的研究%Research for short-term case fatality rate in gerontal patient after peptic ulcer perforation and bleeding

    Institute of Scientific and Technical Information of China (English)

    梁艳斌; 符宏宇; 陈辉; 蒋晓渠

    2012-01-01

    目的 研究消化性溃疡穿孔和出血后短期病死率与年龄的关系,并确定合并症对此关系的影响.方法 收集2004年4月~2010年12月住院治疗并首次被诊断为消化性溃疡穿孔的患者295例和消化性溃疡合并出血患者1032例.根据住院病史及出院记录确定其诊断结果及是否死亡,溃疡的合并症及相关药物的使用信息通过住院病史获得.将两组患者分别分为65岁以下组、65 ~79岁组、80岁及以上组.计算年龄、性别和合并症与标准30天病死率的关系,用COX回归的方法评价老年患者与年轻患者30天死亡比值比(MRR).结果 295例消化性溃疡穿孔患者中年龄在65 ~79岁者107例(36.3%),80岁以上者73例(24.7%);<65岁的患者中标准30天病死率为3.5%,年龄在80岁以上的患者达到21.9%,校正MRR值达5.2(95% CI:4.3 ~6.8).在1032消化性溃疡出血患者中,年龄在80岁以上者338例(32.8%),<65岁患者的标准30天病死率为1.7%,年龄> 80岁的患者达8.3%,调整后的MRR为3.6% (95%CI:2.8 ~4.9).分层分析显示,老年患者的高MRR与合并症的严重程度无关.结论 衰老是一个独立于合并症、与消化性溃疡穿孔或出血预后不良存在强关联的预测因素.%Objective To study the correlation of age with short-term case fatality rate in peptic ulcer perforation and bleeding,and to evaluate the effect of complications on this correlation. Methods Those hospitalized patients with a first-time discharge diagnosis of perforated peptic ulcer(295 cases) or bleeding peptic ulcer(1032 cases) from April 1st,2004 to December 31st,2010 were recruited. Information about diagnosis, death, complications and medicine was obtained through the patient' s medical records. We devided peptic ulcer perforation and bleeding peptic ulcer patients in 2 groups and each group was divided into 3 groups according to the age;under 65,65 to 79 and above 80 years. We analyzed the

  12. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  13. Clinical Analysis of 120 Cases of Elderly Patients with Acute Upper Gastrointestinal Bleeding%120例老年急性上消化道出血患者临床分析

    Institute of Scientific and Technical Information of China (English)

    伍煜伦; 赵青山; 陈素文

    2012-01-01

      目的:探讨老年急性上消化道出血的临床特点.方法:回顾性分析120例老年急性上消化道出血患者的临床资料,与同期收治的110例非老年急性上消化道出血患者进行比较.结果:与非老年人组比较,老年人组上消化道出血的病因中胃溃疡、急性胃黏膜病变、胃癌的患病率均较高(P<0.05),而十二指肠溃疡及食管静脉曲张破裂的患病率均较低(P<0.05).伴随疾病率、死亡率均较高(P<0.05).结论:掌握老年急性上消化道出血临床特点,有助于改善预后.%  Objective:To investigate the clinical features of elderly patients with acute upper gastrointestinal bleeding.Method:A retrospective analysis of 120 cases of elderly patients with acute upper gastrointestinal bleeding,110 cases of non-elderly patients with acute gastrointestinal bleeding at the same period were compared.Result:Compared with non-elderly group,the incidence rate of gastric ulcer,acute gastric mucosal lesions and gastric cancer in the elderly group were significant higher(P<0.05),duodenal ulcer and esophageal varices were significant lower(P<0.05).The rate of comorbidity and mortality were significant higher(P<0.05).Conclusion:Mastering the clinical characteristics of elderly patients with acute upper gastrointestinal bleeding can help to improve the prognosis.

  14. Perforated peptic ulcer following gastric bypass for obesity.

    Science.gov (United States)

    Macgregor, A M; Pickens, N E; Thoburn, E K

    1999-03-01

    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  15. Interpretation of Japan“Evidence-based Clinical Practice Guidelines for Peptic Ulcer Disease 2015”%日本《消化性溃疡循证临床实践指南(2015年)》解读

    Institute of Scientific and Technical Information of China (English)

    刘文忠

    2016-01-01

    2015年,日本胃肠病学会修订了消化性溃疡循证临床实践指南。修订的内容包括以下几项:出血性胃和十二指肠溃疡、幽门螺杆菌(Hp)根除治疗、非根除 Hp 治疗、药物诱发的溃疡、非 Hp-非非甾体消炎药(NSAID)溃疡和外科手术治疗。该指南详细陈述了上述内容,是我们临床实践中良好的参考材料。为此,本文对该指南作详细解读。%The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2015. The revised guidelines consist of the following items:bleeding gastric and duodenal ulcers, Helicobacter pylori(Hp)eradication therapy and non-eradication therapy,drug-induced ulcer,non-Hp/ non-nonsteroidal anti-inflammatory drug( NSAID)-induced ulcer,and surgical treatment. This guideline describes the abovementioned content in detail and is a good reference for clinical practice. A full interpretation of this guideline was performed in this paper.

  16. Characterization of Patients with Helicobacter pylori-Negative Peptic Ulcers

    Directory of Open Access Journals (Sweden)

    Roberto Hernández Conde

    2013-10-01

    Full Text Available Background: the rate of Helicobacter pylori-negative ulcers is increasing. Treatment with nonsteroidal anti-inflammatory drugs and other ulcerogenic drugs plays a significant role.Objective: to characterize patients with Helicobacter pylori-negative peptic ulcer. Methods: a case series study of patients attended by the Gastroenterology Service of the Hermanos Ameijeiras Hospital was conducted in the year 2009. Demographic, epidemiological, clinical, endoscopic and histological variables were studied. Mean and standard deviation were analyzed; logistic regression, t-Student and Chi-square tests were used. Results: A total of 269 gastric ulcers, 239 duodenal ulcers and 41 combined were diagnosed; 115 cases were Helicobacter pylori-negative and 434 were positive. Nonsteroidal anti-inflammatory drugs were associated with 33,9 % of H. pylori-negative patients and 22.8% of the positive patients. Ulcerative syndrome occurred in 47 % and 45% in both groups. All H. pylori-negative duodenal ulcers were located in the duodenal bulb as well as 96, 6 % of the positive. The antrum was the most common location for gastric ulcerations (92.3% negative; 90.5% positive. Multiple ulcers predominated in the duodenum while double ulcers prevailed in the stomach, all negative for H.pylori. Antral gastritis predominated (73. 0 % H. pilory- negative, the level of activity was higher in the positive cases (97. 0 % and intestinal metaplasia was similar for both groups. Conclusions: in patients with H. pylori-negative peptic ulcer, non-steroidal anti-inflammatory drugs should be taken into consideration as one of the main factors associated with this entity.

  17. Analysis of the Etiology of 135 Cases with Acute Upper Gastrointestinal Bleeding in Non Elderly Patients%135例非老年急性上消化道出血患者的病因分析

    Institute of Scientific and Technical Information of China (English)

    许田英; 葛彦成

    2014-01-01

    目的:分析探讨非老年患者上消化道出血的原因及相关因素。方法对我院2009年~2012年间收治的135例非老年上消化道出血患者的临床资料进行回顾性分析,并与同期住院86例老年患者的出血原因进行比较。结果在135例非老年上消化道出血病例中,饮酒、精神因素、不当饮食为主要相关诱发因素,老年组中以服用非甾体药物为主要诱因。而非老年组中最常见的出血病因为十二指肠溃疡占34.81%(47/135),第二位是食管胃底静脉曲张破裂占18.52%(25/135),其他常见的病因还有急性胃黏膜病变15.56%(21/135),胃溃疡11.58%(16/135),消化道肿瘤7.41%(10/135)等。其中十二指肠溃疡、食管胃底静脉曲张发病率明显高于老年组,而胃溃疡、消化道肿瘤发病率低于老年组患者(P<0.05)。结论与老年组有所不同,非老年上消化道出血诱因多与饮酒、精神因素、不当饮食有关,十二指肠溃疡、食管胃底黏膜曲张破裂是致出血的主要病因,且发病率男性多于女性。%Objective To investigate the cause of upper gastrointestinal bleeding and relevant factors in non elderly patients. Methods Clinical data of 135 non elderly patients with upper gastrointestinal bleeding during 2009 and 2012 in our hospital and 86 cases of elderly patients at the same period were retrospectively analyzed. The causes of acute gastrointestinal bleeding were compared. Results Drinking wines, mental factors and improper diets in non elderly patients were main inducements leading to gastrointestinal hemorrhage. The inducement of the elderly group was NSAID drug. The most common cause of gastrointestinal hemorrhage in the non elderly group was the duodenal ulcer accounted for 34.81%(47/135), the second was the esophageal gastric fundus varicosity burst accounted for 18.82%(25/135). Other causes were acute gastric mucosal lesion 15.56%(21/135), gastric ulcer 11.58%(16/135) and

  18. Another 'Cushing ulcer'.

    Science.gov (United States)

    Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

    2011-04-09

    The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing's disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background.

  19. A Rare Case of Hepatitis C-Associated Cryoglobulinemic Duodenal Vasculitis

    Science.gov (United States)

    Gomez, Alexandra; Dholaria, Kevin; Arosemena, Leopoldo R.; Ladino-Avellaneda, Marco A.; Barisoni, Laura; Bhamidimarri, Kalyan R.

    2016-01-01

    Intestinal involvement of cryoglobulinemia is an uncommon manifestation and marker of severe vasculitis. We describe the case of a woman admitted to our service for management of acute renal failure and progressive gastrointestinal symptoms after initiating hepatitis C virus treatment with ribavirin and sofosbuvir 4 weeks prior. With an undetectable hepatitis C viral load and persistent symptoms despite hepatitis C virus therapy cessation, an upper endoscopy revealed duodenal sloughing, erythema, and bleeding, sparking suspicion for recurrence of cryoglobulinemic vasculitis.

  20. Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Claudia Grasshof

    2012-01-01

    Full Text Available The development of intramural duodenal haematoma (IDH after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia.

  1. Zinc compounds, a new treatment in peptic ulcer.

    Science.gov (United States)

    Escolar, G; Bulbena, O

    1989-01-01

    Effects of zinc in gastric ulcer have been reviewed through investigations carried out on zinc acexamate (ZAC). ZAC is an organic compound that has been shown to possess an experimental antiulcer effect and a wide therapeutic index, making it a useful drug in the treatment of peptic ulcer disease. ZAC protects from ulceration in several experimental models such as pylorus occlusion, reserpine-induced ulcer, necrotizing agents, PAF-induced ulcer and cold-restraint stress. ZAC first reduces the gastric acid output by inhibiting the mast cell degranulation, an action likely to be mediated through a membrane stabilizing action. Secondly, it enhances the mucosal protection factors by increasing mucus secretion, inhibiting the H+ retrodiffusion and improving microcirculation. ZAC is also effective in acetic acid-induced chronic ulcer, restoring the continuity of the damaged mucosa. Several clinical trials have shown the usefulness of ZAC in acute and maintenance treatment of both gastric and duodenal ulcers. Endoscopic studies showed that ZAC reduced the inflammatory processes (gastritis and duodenitis) associated with ulcer healing. This reduction was statistically significant and not observed with other comparative treatments (H2-antagonists). The observed side-effects were minimal and affected less than 2% of treated patients. The pharmacological profile, clinical effectiveness and good tolerance of ZAC suggest this compound as an interesting option in the treatment of peptic disease.

  2. ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past?

    Directory of Open Access Journals (Sweden)

    Mariana Barbosa ARAÚJO

    2014-04-01

    Full Text Available Objectives To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori. Methods A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. Results It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. Discussion The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum.

  3. 十二指肠球部溃疡患者幽门螺杆菌感染的表型特征及其意义%Characteristic typing of Helicobacter pylori phenotypes and its clinical significance in patients with duodenal bulb ulcers

    Institute of Scientific and Technical Information of China (English)

    吴炎; 林木贤; 赵娅敏; 康文全; 高燕; 张厚德

    2008-01-01

    目的 研究十二指肠球部溃疡患者中Hp的表型特征及其亚型,并评价Hp表型分型在十二指肠球部溃疡患者中的临床意义.方法 用免疫印迹法检测135例十二指肠球部溃疡(研究组)及140例慢性浅表性胃炎(对照组)患者血清中细胞毒素相关蛋白A(CagA)抗体、空泡细胞毒素A(VacA)抗体和尿素酶(UreA、UreB)抗体及其亚型.结果研究组患者中,中间型Hp感染率为21.5%,明显低于对照组患者的27.9%,P0.05,但尿素酶抗体在研究组患者中的表达率明显高于对照组患者,P<0.05.I型Hp中尿素酶30ku亚基在研究组患者中的表达率(45.5%)亦明显高于对照组患者(33.3%),P<0.05.结论 CagA的表达不依赖于VaeA的表达.Hp多种亚型如128ku CacA、116ku CagA、95ku VaeA、91ku VneA、30ku UreA同时表达在致十二指肠球部溃疡中起综合作用.I型Hp且同时表达30 ku UreA的菌株可能有更强的毒力且更易致十二指肠球部溃疡.%Objective to study the characteristic typing of Helicobacter pylor(Hp)phenotypes and their sub-phenotypes in the patients with duodenal bulb ulcers(DU),and its clinical significance. Methods One hundred thirty-five cases with DU and 140 casses with chronic superficial gastritis were enrolled in this study. Determinations of serum cytotoxin-associated gene protein A (CagA),vacuolating cyto-toxin A(VacA),urease (Ure)A,UreB antibodies and their sub-phenotypes by immunoblotting were carried ou. Results Positive rate of middle-phenotypes of Hp infection in DU was significantly lower than that in chronic superficial gastritis (21.5%vs 27.9%,P<0.05).VacA and CagA antibodies might express alone. There had no significant difference among the expression rate of phenotype CagA, VacA antibodies and their sub-phenotype. But expression rate of Ure antibodies in Du was higher than that in chronic superficial gasstritis (P<0.05).In infection of Hp type I, the expression rate of sub-phenotypes 30ku UreA in DU was hronic

  4. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  5. Vernal ulcer

    OpenAIRE

    Srinivasan M.; Srinivasan S

    1990-01-01

    Vernal ulcer is a rare entity not reported in Indian ophthalmic literature. 76 patients in the age group ranging from 3-43 years diagnosed as having vernal conjunctivitis had been referred from general ophthalmology clinic to cornea service of the same institute during 1988-89. Among them 60 were males and 16 were females. 55 of the 76 patients had corneal involvement in the form of vernal keratitis or vernal ulcer. 16 had typical vernal ulcers. vernal ulcer was found more in the palpebral ty...

  6. [Obscure gastrointestinal bleeding].

    Science.gov (United States)

    Pastor, J; Adámek, S

    2013-08-01

    Obscure gastrointestinal bleeding represents 5% of all cases of bleeding into the gastrointestinal tract (GIT). The cause of this type of bleeding cannot be found by gastroscopy or colonoscopy - the most common cause being bleeding from the source in the small intestine. In other cases it is bleeding from other parts of the digestive tube which has already stopped or was not noticed during admission endoscopy. Imaging methods (X-ray, CT, MRI, scintigraphy) and endoscopic methods (flexible or capsule enteroscopy) are used in the diagnosis and treatment. If, despite having used these methods, the source of bleeding is not found and the bleeding continues, or if the source is known but the bleeding cannot be stopped by radiologic or endoscopic intervention, surgical intervention is usually indicated. The article provides an overview of current diagnostic and treatment options, including instructions on how to proceed in these diagnostically difficult situations.

  7. Acute necrotising ulcerative gingivitis in an immunocompromised young adult.

    Science.gov (United States)

    Hu, Jessie; Kent, Paul; Lennon, Joshua M; Logan, Latania K

    2015-09-16

    Acute necrotising ulcerative gingivitis is an acute onset disease characterised by ulceration, necrosis, pain and bleeding in gingival surfaces. It is predominantly seen in severely malnourished children and young adults with advanced HIV infection. We present a unique presentation in a young adult with high-grade osteogenic sarcoma.

  8. Pharmacotherapy of Peptic Ulcer Disease

    Directory of Open Access Journals (Sweden)

    F Molina

    1991-01-01

    Full Text Available The etiology of peptic ulcer is multifactorial; except for omeprazole, all drugs used for the treatment of peptic ulcer result in healing with no statistical difference at four weeks. The healing rare increases with time for active medication and placebo, and is lower among smokers than nonsmokers for all drugs but misoprostol. Mucosal protectives (or ‘cytoprotectives’ as a group seem to have a lower relapse rate than the H2 receptor antagonists at one year. Combination therapy has not yet proved to be better than single drug therapy; however, the number of studies is still small, and more clinical trials are necessary. Resistant ulcers have demonstrated that acid is one of several etiological factors and that more research is needed to elucidate the reason(s for refractoriness. The choice of therapeutic agent is generally made according to patient compliance, medication cost, side effects, effectiveness, relapse rate and physician experience with the drug. Long term maintenance therapy is effective in the prevention of ulcer relapse and is especially recommended for selected patient groups, including patients with recurrent or bleeding ulcer, patients with concomitant nonsteroidal anti-inflammatory drug use, and elderly women. Omeprazole is the treatment of choice for moderate to severe esophagitis and should be reserved for large and resistant ulcers.

  9. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding.

  10. Lipschutz ulcer

    Directory of Open Access Journals (Sweden)

    Bhat Ramesh

    2007-01-01

    Full Text Available Lipschütz first identified an acute disease with ulceration of the external genital organs of young women. The syndrome has been termed acute vulvar ulcer or ulcus vulvae acutum. The following typical case history of a 19-year-old girl is a good illustration of this interesting clinical entity.

  11. The Application Effect of Sucralfate Combined With Pantoprazole in Patients With Bleeding Peptic Ulcer%硫糖铝联合泮托拉唑在消化性溃疡并发出血中的应用效果

    Institute of Scientific and Technical Information of China (English)

    王建军

    2016-01-01

    Objective To study the effect of sucralfate combined with pantoprazole in the treatment of peptic ulcer complicated with hemorrhage. Methods 98 cases of peptic ulcer complicated with hemorrhage patients treated in our hospital from June 2014 to May 2015 were selected as the research object. Randomly divided them into control group and observation group, 49 cases in each group, both were treated with sucralfate, Yunnan Baiyao powder. The control group received intravenous infusion of Omeprazole, observation group received intravenous pantoprazole, two groups were treated for a week.Results Patients in the observation group ulcer cure, hemostatic effect were much higher than that of the control group, the difference was statistically signiifcant (P<0.05), the difference was statistically signiifcant (P<0.05).Conclusion Sucralfate combined with pantoprazole in the treatment of peptic ulcer complicated with hemorrhage, the effect is signiifcant.%目的:研究硫糖铝联合泮托拉唑治疗消化性溃疡并发出血的效果。方法将我院于2014年6月~2015年5月收治的98例消化性溃疡并发出血患者为对象研究。随机分为对照组和观察组,每组各49例,均口服硫糖铝、云南白药粉剂。对照组静脉输入奥美拉唑;观察组静脉输入泮托拉唑,两组均连续用药1周。结果观察组患者溃疡治愈情况、止血疗效均远高于对照组,差异有统计学意义(P<0.05)。结论硫糖铝联合泮托拉唑治疗消化性溃疡并发出血,效果显著。

  12. 护理干预对治疗消化性溃疡伴上消化道出血的临床价值%Clinical value of peptic ulcer with upper gastrointestinal bleeding contributed by nursing intervention

    Institute of Scientific and Technical Information of China (English)

    叶玉华

    2014-01-01

    目的:对应用全面护理干预模式对合并出现上消化道出血症状的消化性溃疡疾病患者在治疗期间实施护理的临床效果进行研究。方法:2012年5月-2014年5月收治消化性溃疡疾病患者84例,随机分为对照组和观察组,每组42例。对照组采用常规消化科护理服务模式实施护理;观察组采用全面护理干预模式实施护理。结果:观察组消化功能恢复正常时间和临床治疗总时间明显短于对照组;观察组治疗期间护理服务的满意度明显高于对照组。结论:应用全面护理干预模式对合并出现上消化道出血症状的消化性溃疡疾病患者在治疗期间实施护理的临床效果非常明显。%Objective:To study the clinical effect by applying comprehensive nursing intervention mode to the patients with peptic ulcer disease appearing merging symptom of hemorrhage of upper digestive tract during the treatment with implementation of nursing.Methods:84 patients with peptic ulcer disease appearing merging symptom of hemorrhage of upper digestive tract were selected from May 2012 to May 2014,who randomly divided into the control group and the observation group,each are averages for 42 patients.The control group were given routine gastroenterology nursing service mode.The observation group were given comprehensive nursing intervention model.Results:Compared with the control group, the patients in the observation group were obviously shorter on the recovery time of gastrointestinal function and total time of clinical treatment were more satisfying on nursing service of peptic ulcer disease merging with hemorrhage of upper digestive tract during the treatment.Conclusion:The clinical effect of applying comprehensive nursing intervention mode to the patients with peptic ulcer disease appearing merging symptom of hemorrhage of upper digestive tract during the treatment with implementation of nursing is very obvious.

  13. Endoscopic treatment of non-variceal gastrointestinal bleeding: hemoclips and other hemostatic techniques

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    Rossana M. Moura; Jamie S. Barkin

    2000-01-01

    @@ Although the number of hospitalizations for nonvariccal gastrointestinal bleeding has decreased in recent years, acute upper gastrointestinal hemorrhage continues to be a common reason for hospital admission, and peptic ulcers account for at least fifty percent of all cases. Despite the fact that bleeding from ulcers ceases spontaneously in approximately 80% of patients, it is still a diagnosis associated with substantial medical costs and significant morbidity and mortality, the latter ranging between 8 and 14%[1], especially in the elderly.

  14. Vernal ulcer

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    Srinivasan M

    1990-01-01

    Full Text Available Vernal ulcer is a rare entity not reported in Indian ophthalmic literature. 76 patients in the age group ranging from 3-43 years diagnosed as having vernal conjunctivitis had been referred from general ophthalmology clinic to cornea service of the same institute during 1988-89. Among them 60 were males and 16 were females. 55 of the 76 patients had corneal involvement in the form of vernal keratitis or vernal ulcer. 16 had typical vernal ulcers. vernal ulcer was found more in the palpebral type of vernal conjunctivitis and affects males more frequently. One patient had an inferior vernal ulcer. It also occurred in the bulbar type of spring catarrh.

  15. Peptic ulceration may be a hormonal deficiency disease.

    Science.gov (United States)

    Love, Jack W

    2008-01-01

    Evidence is reviewed that Helicobacter pylori infection may cause a deficiency of the hormone secretin that allows peptic ulcer disease to develop by impairing the body's defenses to gastric acid. Secretin is released into the circulation from the S-cells of the duodenal crypts in response to gastric acid entering the duodenum. Once in the circulation, secretin has five well-documented effects that protect the upper intestine from gastric acid: it stimulates secretion of bicarbonate rich exocrine pancreatic juice; it stimulates secretion of alkaline bile; it stimulates secretion of alkaline mucus from the duodenal submucosal glands of Brunner; it inhibits the humoral phase of gastric secretion; and it inhibits gastric motility, thereby delaying gastric emptying. Impaired secretin release and reduced duodenal S-cells have been documented in peptic ulcer patients compared with control patients. Clinical evidence that patients with H. pylori infection and peptic ulceration have increased gastric secretion and motility and decreased duodenal bicarbonate response to gastric acid, all of which normalize after eradication of the infection, could be explained by reversible impairment of the secretin mechanism. Gastric metaplasia in the duodenum with H. pylori infection is known to reduce the S-cell population. The fact that not all patients with H. pylori infection develop peptic ulceration suggests that degree of secretin deficiency determined by extent of the infection must reach a critical level for peptic ulceration to occur. Peptic ulceration may be a hormonal deficiency disease, a result of secretin deficiency caused by H. pylori infection. It may be the first example of a specific hormonal deficiency disease caused by a specific bacterial infection.

  16. An Unusual Cause of Anemia: Cameron Ulcer

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    Cenk Aypak

    2013-04-01

    Full Text Available Cameron ulcer is a linear gatric ulser on the mucosal folds in patients with a large hiatal hernia. Cameron ulcer could be seen in 5% of patients with hiatal hernia who undergo upper gastrointestinal system (GIS endoscopy examination. The clinical relevance of Cameron ulcer is due to its potential complications such as GIS bleeding and anemia. In this report a case who was applied to Family Medicine outpatient clinics with the diagnosis of iron deficiency anemia and determined Cameron ulser at upper gastroentestinal endoscopy was presented. [Cukurova Med J 2013; 38(2.000: 315-318

  17. Marjolin's Ulcer. A Case Report

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    Sergio Morales Piñeiro

    2016-02-01

    Full Text Available Marjolin's ulcer is rare and aggressive cutaneous malignancy that develops in previously traumatized or chronically inflamed skin. We present the case of a 43-year-old white man suffering from an exophytic bleeding ulcerated lesion on the distal third of the left leg where he already had a large scar from a compound fracture of the tibia and fibula complicated with chronic osteomyelitis. Surgical excision and biopsy were performed, showing a squamous cell carcinoma consistent with Marjolin's ulcer. We decided to present this case given the rare occurrence of the disease. We concluded that patients with this type of lesion should be subject to periodic examinations to prevent or treat potential recurrences.

  18. Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum.

    Science.gov (United States)

    Wilhelmsen, Michael; Andersen, Johnny Fredsbo; Lauritsen, Morten Laksafoss

    2014-05-13

    The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding or technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnose as they often require specialised endoscopy procedures such as endoscopy with a side-viewing scope. This case describes the first successful management of this rare condition with an upper GI endoscopy with a colonoscope and afterwards intravascular coiling.

  19. Duodenal pseudomelanosis (pseudomelanosis duodeni: a rare endoscopic finding

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    Aloísio Felipe-Silva

    2011-12-01

    Full Text Available Duodenal pseudomelanosis (or pseudomelanosis duodeni is a rare benigncondition characterized by black-brown speckled pigmentation of the duodenalmucosa. Collections of pigment−laden macrophages are found in the tips ofduodenal villi. The pigment is thought to be mostly composed of ferrous sulfide.Histochemichal stains for iron (Perl’s prussian blue or melanin (Masson-Fontana may be positive, but are usually negative or unpredictable. Duodenalpseudomelanosis occurs predominantly in middle-aged to old adults andmore commonly in females. It is associated with chronic renal failure, arterialhypertension, diabetes mellitus and gastrointestinal bleeding. Medications suchas ferrous sulfate, hydralazine, propranolol, hydrochlorothiazide and furosemideare thought to play a role as well. We report a case of a 86-year-old femalewho presented with a history of watery diarrhea and melena. The patient had ahistory of high blood pressure and ischemic stroke episodes. She was on multiplemedication including hidralazine, captopril, hydrochlorthiazide and aspirin. She wasdehydrated, her blood pressure was 96 × 60 mmHg and neurologic examinationshowed complete left hemiplegia with central VII nerve palsy. Laboratory testsshowed normal serum electrolytes and renal function. Hemoglobin level was10.7 g%. An upper endoscopy showed multiple diminutive black spots throughoutthe distal duodenal bulb and second portion. Histology showed multiple foci ofa brown-black granular pigment inside macrophages within the tips of the villi(pseudomelanosis. Stains for iron and melanin were negative. She was treatedwith omeprazol, parenteral fluid replacement with saline and partial fasting. Aftercomplete recovery she was discharged for ambulatory follow up.

  20. Serum positive cagA in patients with non-ulcer dyspepsia and peptic ulcer disease from two centers in different regions of Turkey

    Institute of Scientific and Technical Information of China (English)

    Ender Serin; U()ur Yilmaz; Ganiye Künefeci; Birol Ozer; Yüksel Gümürdülü; Mustafa Güclü; Fazilet Kayaselcuk; Sedat Boyacio( )lu

    2003-01-01

    AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One hundred and eighty Helicobacter pyloripositive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay.RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100% and 95.6%, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries.CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.

  1. Incidence of lactase deficiency (LD) in gastroduodenal ulcer and gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee; Ahn, Kwan Shik; Kim, Chung Ja [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

    1974-04-15

    Lactase deficiency (LD) has been described in associated with peptic ulcer disease of the upper gastrointestinal tract, but little has been known as to the incidence of LD in the patients with ulcer disease of the upper GI tract or with gastric carcinoma. The purpose of the present study is to investigate the incidence of LD in gastric and/or duodenal ulcer disease and in gastric carcinoma, and to hypothesize the possible effect of these diseases on LD. Clinical materials consisted of 40 cases of active duodenal ulcer disease, 19 cases of benign gastric ulcer, 5 cases of multiple ulcers both in the stomach and duodenum, and 32 cases of gastric carcinoma. We used the lactose-barium test in diagnosing LD. X-ray findings were assessed according to the criteria described by Laws et al. and Preger and Amberg in the small-bowel film obtained at 30 minutes after the ingestion of some 200 ml of lactose-barium meal which contained 50 gm of lactose. Our clinical study revealed that the incidence of LD in duodenal ulcer was 50%, in gastric ulcer 57.9%, in gastric and duodenal ulcer 60%, and in gastric carcinoma 46.9%. The difference of incidence between each disease were statistically not significant, but the difference between the disease group and normal control was highly significant. The incidence of LD in disease group was nearly twice as high as that of normal control (27.7%). It is speculated that high incidence of LD in peptic ulcer disease of upper GI tract in particular may be associated with high acidity, the analog of which is found in Zollinger-Ellison syndrome. But high acidity is not a prominent feature in gastric carcinoma which is attended by almost equally high incidence of LD. It is therefore likely that the intolerability to lactose is caused by much complicated mechanism of versatile factors.

  2. 老年急性上消化道出血临床特征观察%Observe clinical characteristics of elderly with acute upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    邱伟伟; 陈建荣

    2016-01-01

    Objective To explore the characteristics of elderly with acute upper gastrointestinal bleeding and treatment methods. Methods A retrospective analysis of 60 cases of elderly patients with acute upper gastrointestinal bleeding were made. The patients were diagnosised and treated in branch hospital of nantong university affiliated hospital from January 2012 to June 2015. Results 42 cases of patients were with epigastric pain and discomfort before bleeding, and 18 cases were without symptoms of digestive system;Before bleeding,15 cases had taken non-steroidal anti-inflammatory drugs like aspirin;38 cases were appear to Merge diseases such as heart,brain,kidney . 23 cases of acute upper gastrointestinal bleeding patients were melena ,17 cases hematemesis,10 cases hematemesis and melena,10 cases found during a medical or other inspection. 52 cases showed bleeding symptoms include fatigue,pale complexion, dizziness and other,8 cases of hemorrhage shock. In the course,12 cases were with onset. Cause of bleeding was 20 cases of gastric ulcer,acute gastric mucosal lesions in 15 cases,10 cases of gastric cancer and esophageal cancer,10 cases of duodenal bulb ulcers,stomach esophagus varicosity burst and other 5 cases;Treatment of bleeding stopped(9.23±4.34)days on average,4 cases died. Conclusion Clinical manifestation of Elderly patients with acute upper gastrointestinal bleeding is not typical with complex bleeding reason,much complications and poorer prognosis. The patients should be given timely effective treatment,and maintain vital organ function of the body at the same time.%目的:探讨老年急性上消化道出血特点及处理方法。方法回顾性分析2012年1月~2015年6月南通大学附属医院分院诊治的60例老年急性上消化道出血患者的临床资料。结果出血前有上腹疼痛及不适42例,无消化系统症状18例;出血前有服用非甾体抗炎药15例;合并心、脑、肾、肝等疾病38例。急性上

  3. Role of dietary phospholipids and phytosterols in protection against peptic ulceration as shown by experiments on rats.

    Science.gov (United States)

    Tovey, Frank I

    2015-02-07

    Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher in regions where the diet is based on milled rice, refined wheat or maize, yams, cassava, sweet potato, or green bananas, and is lower in regions where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs). It also promoted ulcer healing. The lipid from the pulse, Dolichos biflorus, horse gram which was highly protective was used to identify the fractions with protective activity in the lipid. The protective activity lay in the phospholipid, sterol and sterol ester fractions. In the phospholipid fraction phosphatidyl choline (lethicin) and phosphatidyl ethanolamine (cephalin) were predominant. In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol, stigmasterol, and an unidentified isomer of β-sitosterol. The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration, both singly and in combination. This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers. A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.

  4. Giant Brunner’s Gland Adenoma of the Duodenal Bulb Presenting with Ampullary and Duodenal Obstruction Mimicking Pancreatic Malignancy

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    Vishal Gupta

    2011-07-01

    Full Text Available Context Brunner’s gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice. Case report A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner’s gland adenoma was made on histopathological examination. Conclusion Giant Brunner’s adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.

  5. Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children

    Institute of Scientific and Technical Information of China (English)

    Chookhuan Nithiwathanapong; Sanit Reungrongrat; Nuthapong Ukarapol

    2005-01-01

    AIM: To assess the frequency and the risk factors of stress-induced gastrointestinal (GI) bleeding in children admitted to a pediatric intensive care unit (PICU).METHODS: The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed.Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding (mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy,thrombocytopenia, and intracranial pathology) were used as independent variables in a multivariate analysis.RESULTS: One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure (48.8%). Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis.The odds ratio and 95% confidence intervals were 5.13(1.86-14.12) and 2.26 (1.07-4.74), respectively. However, the logistic regression analysis showed that mechanicai ventilation was the only significant risk factor with the odds ratio of 14.1.CONCLUSION: The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

  6. Giant gastric ulcer penetrating into the pancreas.

    Science.gov (United States)

    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobara, Hideki; Masaki, Tsutomu

    2012-09-01

    A 57-year-old man developed haematemesis and was referred to our institution. His discomfort had begun 3 weeks earlier and localised to the upper abdomen. Abdominal CT showed a defect of gastric mucosa and gastric wall thickening. Oesophagogastroduodenoscopy showed that he had an active gastric ulcer, 40 mm in diameter, on the lesser curvature in the upper third of the corpus and the presence of a pancreatic body at the ulcer base, penetration to the pancreas. Open gastrectomy was performed with a preoperative diagnosis of localised peritonitis caused by penetration of the stomach into the pancreas. Histopathology of resected specimens showed a benign peptic ulcer, 40×40 mm in size, was found on the lesser curvature in the antrum, and this had penetrated through the pancreas. The most serious complications of PUD include haemorrhage, perforation, penetration, and gastric outlet obstruction. Approximately 7% of patients experience perforation, which occurs when an ulcer erodes through the wall and leaks air and digestive contents into the peritoneal cavity. Antral and duodenal ulcers can penetrate into the pancreas. We report a case of gastric ulcer penetrating into the pancreas.

  7. Ulcerative colitis - discharge

    Science.gov (United States)

    Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining ...

  8. [Periodontal status in children with various morphological forms of chronic gastritis and duodenitis].

    Science.gov (United States)

    Romanenko, E G

    2014-01-01

    The purpose of the study was to determine the condition of the periodontal tissues in 80 children with various morphological forms of gastritis and duodenitis. The examination included determination of oral hygiene and periodontal status by the simplified Green-Vermillion index, Silness-Low index, papillary-marginal-alveolar index, gingival Muhlemann-Cowell bleeding index, Schiller-Pisarev iodine index. In children with chronic gastritis and duodenitis high incidence of chronic catarrhal gingivitis (85.0%) was revealed. At the same time it was pointed out that inflammation in the periodontal tissues correlated with changes in the gastroduodenal mucosa. In 65.4% of children with superficial gastritis and duodenitis, chronic catarrhal gingivitis (localized in 38.5% of cases, generalized in 26.9%) was observed. In 94.4% of all children with diffuse and erosive gastritis and duodenitis, chronic generalized catarrhal gingivitis was observed, and low oral hygiene level was revealed. The severity and duration of the underlying disease aggravated clinical manifestations of chronic catarrhal gingivitis in children with lesions of the upper gastrointestinal tract.

  9. Adenocarcinoma of the Minor Duodenal Papilla: Report of a Case

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    Kazuhiro Takami

    2011-04-01

    Full Text Available An 81-year-old male was found to have a duodenal tumor by screening upper gastrointestinal endoscopy. The tumor was located in the minor duodenal papilla. Pathological examination of the biopsy specimen revealed adenocarcinoma, and endoscopic ultrasound showed an elevated hypoechoic mass in the minor duodenal papilla. The preoperative diagnosis was therefore considered to be either adenocarcinoma of the minor duodenal papilla or duodenal cancer. We performed a subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination of the resected specimen showed the tumor cells to be primarily located in the submucosa of the minor duodenal papilla, with slight invasion into the pancreatic parenchyma through the accessory pancreatic duct. We therefore diagnosed a primary adenocarcima of the minor duodenal papilla. Adenocarcinoma of the minor duodenal papilla is considered to be a rare disease, but it may be underestimated because of the difficulty in distinguishing advanced adenocarcinoma of the minor duodenal papilla from primary duodenal cancer and cancer of the pancreatic head.

  10. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  11. Histopathological evaluation of gastric mucosal environments in peptic ulcer using the endoscopic 5-point gastric biopsy method.

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    Kobayashi,Hisataka

    1995-08-01

    Full Text Available Although a strong association has been established between chronic Helicobacter pylori infection and peptic ulcers, the role of H. pylori is not necessarily causative because there are many patients infected with H. pylori who do not develop peptic ulcer. Therefore, we studied the relationship between the gastric mucosal environment and the development of peptic ulcers. We examined 165 endoscopic biopsy specimens from the gastric mucosa of 33 patients with peptic ulcers using the 5-point gastric biopsy method. The follow-up biopsies done within 3 weeks were well correlated with the first biopsy samples. We also reviewed the clinicohistopathological findings of 2250 endoscopic biopsy specimens from 450 patients with active gastric and/or duodenal ulcers. Over 90% of the patients with duodenal ulcer, with or without gastric ulcer, had no fundic gland atrophy, and a high incidence of intestinal metaplasia and pyloric mucosal atrophy was found in the patients with gastric ulcer. These findings suggest that patients with concomitant active gastric and duodenal ulcers exhibit severe atrophic changes in the antral mucosa but not in the fundic mucosa.

  12. [ASSOCIATION OF DUODENAL DIVERTICULUM PRESENCE WITH CHOLEDOCHOLITHIASIS

    Science.gov (United States)

    Machado Mayurí, Alberto; Gómez, Aldo; Yriberry, Simón; Valdiviezo, Alfredo; Lozano, Adelina; Villena, Ovidio

    1998-01-01

    OBJECTIVES: The aim of this study was to investigate in aretrospective way the frequency of duodenal diverticulum and its association with choledocholithiasis. Methods:This study included 2728 consecutive patients who underwent ERCP during the period 1993-1997. Duodenal diverticulum was discovered in 122 cases (4.5%). In 22 patients cannulation was not achieved since it was not technically possible. Results: In 100 patients with successful cannulation, 54 cases with juxtapapillary diverticulum were encountered associated with choledocholithiasis. CONCLUSION: These data suggestthat duodenal diverticulum is associated with choledocholithiasis.

  13. Ampullary duodenal diverticulum and cholangitis

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    Joaquim Mendes Castilho Netto

    Full Text Available CONTEXT: Ampullary duodenal diverticulum complicated by cholangitis is little known in clinical practice, especially when there are no gallstones in the common bile duct or there is no biliary tree ectasia or hyperamylasemia. A case of this association is presented, in which the surgical treatment was a biliary-enteric bypass. CASE REPORT: A 74-year-old diabetic white woman was admitted to the Taubaté University Hospital, complaining of pain in the right upper quadrant, jaundice and fever with chills (Charcot's triad. She had had cholecystectomy 30 years earlier. She underwent clinical treatment with parenteral hydration, insulin, antibiotics and symptomatic drugs. Imaging examinations were provided for diagnosis: ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography. The surgical treatment consisted of choledochojejunostomy utilizing a Roux-en-y loop. The postoperative period progressed without incidents, and a DISIDA scan demonstrated the presence of dynamic biliary excretion. The patient remained asymptomatic when seen at outpatient follow-up.

  14. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

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    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  15. Endoscopic duodenal biopsy in children

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    El Mouzan Mohammad

    2006-01-01

    Full Text Available Background: Biopsy of the small bowel is frequently obtained by endoscopic forceps instead of the classical suction capsule, yet reports from developing countries are scarce. Aim of the study: to report our experience on the diagnostic value of this procedure in our community. Patients and methods: A retrospective analysis of all endoscopic duodenal biopsies (EDB, performed on all patients below 18 years of age. Data retrieved from the records included age, gender, nationality, indication for biopsy, the endoscopic findings, and the results of histopathology. Results: From 1993 to 2002, 241 endoscopic biopsies were performed on 241 consecutive children. Most of the children (96% were Saudi nationals, the age range between six weeks to 18 years, and male to female ratio was 0.7: 1. All of the biopsy material was adequate for routine histopathology. The commonest indications for biopsy were short stature and chronic diarrhea in 116/241 (48% and 102/241 (43% of the children respectively. Refractory rickets accounted for 11/241 (5% of the indications. The prevalence of villous atrophy was highest in children presenting with chronic diarrhea (40%, compared to short stature (22%. Other less common, but important findings were villous atrophy in three unusual conditions (one refractory rickets, one unexplained anemia, and one polyendocrinopathy, two cases of intestinal Giardia lamblia infestation, three cases of intestinal lymphangiectasis and one case of Mycobacterium avium intracellulare. Unexpected endoscopic findings were documented in 34/241 (14% of the children. Conclusions: Endoscopic duodenal biopsy is adequate not only for the diagnosis of villous atrophy, but also for the detection of other gastroenteropathies. Accordingly, when expertise and equipments are available, EDB should be the procedure of choice not only in industrialized but also in developing countries.

  16. Comparison of solcoseryl and epidermal growth factors (EGF) in healing of chronic gastroduodenal ulcerations and mucosal growth in rats.

    Science.gov (United States)

    Konturek, S J; Brzozowski, T; Dembinski, A; Warzecha, A; Drozdowicz, D

    1988-02-01

    Solcoseryl, a deproteinized extract of calf blood, and EGF, produced by salivary glands, have been shown to enhance the healing of peptic ulcerations, but the mechanism of this effect is unknown. Since both solcoseryl and EGF have been reported to stimulate cell proliferation, we designed the study to compare the ulcer healing and growth promoting actions of these two agents in the same animals. Gastric and duodenal ulcerations were produced by serosal application of 100% acetic acid on an area of 13.8 mm2 of gastric and duodenal wall, respectively. In the control animals, 7 days after ulcer induction, the mean ulcer area was reduced to 7.1 +/- 1.2 mm2 in the stomach, and to 6.1 +/- 0.8 mm2 in the duodenum. After 14 days all ulcers were healed, both in the stomach and duodenum. Oral administration of solcoseryl (10 ml/kg-day) or EGF (30 micrograms/kg-day) for 7 days after ulcer induction resulted in a significant reduction in the ulcer area in the stomach, and to a greater extent in the duodenum. This enhancement of ulcer healing by solcoseryl was accompanied by a significant increase in the weight of the duodenal mucosa and the total contents of DNA and RNA after 7 days of treatment, and in the weight and nucleic acid contents in both the gastric and duodenal mucosa after 14 days of treatment. EGF also increased the weights and the nucleic acid contents in gastric and duodenal mucosa, but this was significant only after 14 days of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Duodenal diverticulitis. computed tomography findings; Diverticulities duodenal. Hallazgos en la TC

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, E.; Martin, S.; Garcia, J.; Dominguez, A. [Hospital Ramon y Cajal. Madrid (Spain)

    2001-07-01

    Duodenal diverticular occur very frequently among the general public. However, duodenal diverticulitis is a very uncommon clinical entity, the diagnosis of which requires radiological studies since the clinical signs cam mimic a great number of disease processes with different treatments. We present a case of duodenal diverticulitis in which the diagnosis according to ultrasound and computed tomography (CT) studies was confirmed intraoperatively. We also review the few cases of this entity reported in the literature. The CT findings are highly suggestive of duodenal diverticulitis given their similarity to those associated with diverticulitis at other sites. (Author) 5 refs,.

  18. Preventive Effect of Periplaneta Americana Extract on Stress Ulcer Bleeding in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome%美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征患者应激性溃疡出血的预防作用

    Institute of Scientific and Technical Information of China (English)

    张宏伟; 魏立友; 张振宇; 刘淑正; 张静

    2012-01-01

    目的 探讨美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应激性溃疡出血的预防作用.方法 选取2009年1月-2010年1月我院中心ICU住院的严重创伤后ALI/ARDS患者64例为研究对象,随机数字表法分为治疗组和对照组,各32例,对照组给予积极常规综合治疗,治疗组在常规综合治疗基础上,于入院当天给予美洲大蠊提取物康复新液预防应激性溃疡出血,经胃管注入,10 ml/次,3次/d,连用7 d.分别于给药前及给药第7天,测定胃液pH值,测定氧分压,计算氧合指数(PaO2/FiO2);同时记录两组应激性溃疡出血发生率及病死率.结果 治疗前,两组患者胃液pH值、PaO2/FiO2比较,差异均无统计学意义(P>0.05);治疗后,两组患者胃液pH值、PaO2/FiO2比较,差异均有统计学意义(P<0.05).两组患者应激性溃疡出血发生率比较,差异有统计学意义(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05).结论 美洲大蠊提取物可改善ALI/ARDS患者胃液pH值、PaO2/FiO2,对应激性溃疡出血有预防作用.%Objective To study the preventive effect of periplaneta americana extract on stress ulcer bleeding in patients with acute lung injury and acute respiratory distress syndrome. Methods 64 in - patients with acute lung injury ( ALI ) or acute respiratory distress syndrome ( ARDS ) hospitalized in ICU from January 2009 to January 2010 were randomly divided into treatment group and control group with each group 32 cases. The control group was given positive routine treatment, while the treatment group was given periplaneta americana extract on the admission day to prevent stress ulcer bleeding in addition to routine treatment. The periplaneta americana extract was injected via gastronomy tube by 10 ml per time for seven consecutive days with each day three times. The pH value of gastric juice and oxygen partial pressure were detected before treatment and seven days after

  19. Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

    Directory of Open Access Journals (Sweden)

    Shahsanam Gheibi

    2016-10-01

    Full Text Available Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation  The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

  20. Angiodysplasia in gaint diverticulum of transverse duodenum causing massive gastrointestinal bleeding: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Pil Yeob; Lee, Sang Wook; Kwon, Jae Soo; Sung, Young Soon; Rho, Myoung Ho; Hwon, Oh Joon [Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-12-01

    The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographic examination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5 cm of the ampulla of Vater. The majority of duodenal diverticual are asymptomatic, but in some cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in the third and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum, revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.=20.

  1. [Diagnosis, treatment and prophylaxis of acute ulcero-erosive gastroduodenal bleedings at cardiosurgical patients].

    Science.gov (United States)

    Kazymov, I L; Kirilenko, A S; Faĭbushevic h, A G; Kurbanov, F S; Tarichko, Iu V

    2007-01-01

    Results of treatment of 495 patients who has undergone various cardiac operations with artificial circulation are analyzed. The complex program "Blood-free surgery" was used at 388 (78.4%) of them. Among the patients treated traditionally the acute gastroduodenal erosions and ulcers were diagnosed at 25.7% patients, the rate of gastroduodenal bleedings was 3.0%. Complex of prophylactic measures permits to reduce the rate of acute erosions and ulcers in 1.5 times (18.4%) and the rate of postoperative gastroduodenal bleedings--to 0.7%. Control of risk factors, timely diagnosis, complex prophylaxis and treatment of acute gastroduodenal erosions and ulcers are effective way to improvement of operations results at cardiosurgical patients. "Blood-free" program doesn't lead to increase of acute postoperative gastroduodenal erosions and ulcers rate. Endoscopic (including repeated) hemostasis at acute ulcero-erosive gastroduodenal bleedings is available method and permits to achieve the stable hemostasis.

  2. [Persistent duodenal septum in an adult].

    Science.gov (United States)

    Helwing, E; Echtermeyer, V; Otten, G

    1977-02-01

    A case of duodenal obstruction by a congenital duodenal web in a 34-year-old woman is presented. A mucosal diaphragm obstructed the duodenum. It showed an excentric opening of 0.8 cm diameter, but the dilated diaphragm caused a total stop during the last months. Despite a typical history, exact X-ray, and endoscopic examination, the correct preoperative diagnosis was not found, because nobody thought it possible, that a mucosal diapharm of the duodenum could persist for 34 years.

  3. Role of dietary polyphenols in the management of peptic ulcer.

    Science.gov (United States)

    Farzaei, Mohammad Hosein; Abdollahi, Mohammad; Rahimi, Roja

    2015-06-07

    Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.

  4. Gastrointestinal Bleeding in Athletes.

    Science.gov (United States)

    Eichner, Edward R.

    1989-01-01

    Describes the scope and importance of gastrointestinal bleeding in runners and other athletes, discussing causes, sites, and implications of exercise-related bleeding. Practical tips to mitigate the problem, potentially more troublesome in women because of lower iron stores, are presented (e.g., gradual conditioning and avoidance of prerace…

  5. Multiple early gastric cancer with duodenal invasion

    Directory of Open Access Journals (Sweden)

    Okino Tetsuya

    2007-10-01

    Full Text Available Abstract Background Early gastric cancers with duodenal invasion are rare, and no previous case of multiple early gastric cancer, one invading the duodenal bulb, has been reported. Case presentation A 79-year-old woman was investigated for upper abdominal discomfort. Endoscopic examination revealed an irregular nodulated lesion in the antrum area, and a reddish aggregated-type semi-circumferential nodulated lesion extending from the prepyloric area to the duodenal bulb through the normal mucosa with the antrum lesion. Biopsy revealed a tubular adenoma for the antrum lesion and a well-differentiated tubular adenocarcinoma for the prepyloric lesion. Distal gastrectomy with sufficient duodenal resection was performed. Microscopically, the antrum lesion appeared as a papillary adenocarcinoma, and the prepyloric lesion as a mainly papillary adenocarcinoma which partially invaded the submucosa without any sequential elongation for endoscopic findings. The lesion extended into the duodenal bulb, and was 12 mm in length from the oral end of Brunner's gland's area and limited within the duodenal mucosa. Conclusion Here, we present an unusual case of multiple early gastric cancer, one of which invaded the duodenum with relative wide mucosal spreading. This case illustrates that even early stage cancers located in the gastric antrum, particularly in the prepyloric area can invade the duodenum directly.

  6. Secondary prophylaxis for esophageal variceal bleeding.

    Science.gov (United States)

    Albillos, Agustín; Tejedor, Marta

    2014-05-01

    Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulcer bleeding, which explains why overall rebleeding is reduced when beta-blockers are added to EBL, and not when EBL is added to beta-blockers. TIPS is the rescue treatment, but it could be considered as first choice in patients that first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and those with fundal varices.

  7. Surgical bleeding in microgravity

    Science.gov (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  8. 南昌地区消化性溃疡的临床特点和季节变化规律%Clinical characteristics and the regularity of seasonal changes of peptic ulcer in Nanchang area

    Institute of Scientific and Technical Information of China (English)

    舒徐; 李国华; 吕农华; 朱萱; 陈幼祥; 王崇文

    2008-01-01

    Objectives To investigate the clinical characteristics and the regularity of seasonal changes that influence peptic ulcer (PU) in Nanehang area and to provide a theoretical basis for the treatment and prevention of PU.Methods Data collected from patients with PU diagnosed by clinic and gastroendoseopy between October 2003 to May 2008 were retrospectively analyzed.The PU was further divided into gastric ulcer,duodenal ulcer and complex ulcer.The lesion of gastric ulcer was calculated by five locations that were antral,angular,corporal,pyloric canal,fundic and cardia.The lesion of duodenal ulcer was calculated by five locations that were anterior wall of bulb,posterior wall,lesser curvature, greater curvature and postbulbar.The climate changes that influnced the incidence of PU disease were also observed.The detective rates of different types of PU were analyzed and its association with gender,age, lesion locations,seasons,Helicobacter pylori (Hp) infection and complications were also investigated. Results Among 83 888 patients who underwent endoscopy,PU was found in 21 308 patients (25.4%) including 66.33% duodenal ulcer,24.88% gastric ulcer and 8.79% complex ulcer.The male and femal ratio was 2.44 : 1 in PU,2.53 : 1 in duodenal ulcer,2.26 : 1 in gastric ulcer,and 2.33 : 1 in complex ulcer.The average age of patients with gastric ulcer was 48.0 years that was about 6.7 years higher than that of patients with duodenal ulcer.The prevalence of duodenal ulcer and gastric ulcer peaked in the 30- 39 years and 50-59 years,respectively.PU was more common from December to February (30.17%) and less common from June to August (22.54%) (P<0.01) .The 57.43% of duodenal ulcer was found on anterior wall of bulb,18.26% on greater curvature,13.21% on lesser curvature,7.34% on posterior wall and 3.76% on postbulbar.The 45.69% of gastric ulcer was found on antral,20.54% on angular, 15.54% on corporal,9.36% on pyloric canal,and 8.87% on fundic and cardia.The 91.83% (12 318/ 13 414

  9. Double Pylorus After a Peptic Ulcer in the Gastric Antrum: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jang hyeon; Shin, Sang Soo; Heo, Young Hoe [Chonnam National University Medical School, Gwangju (Korea, Republic of); Kim, Jin Woong; Jeong, Yong Yeon; Heo, Suk Hee; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2010-06-15

    Double pylorus is an accessory channel between the gastric antrum and duodenal bulb with a normal pyloric canal. It is understood that the etiology of double pylorus is a congenital anomaly or an acquired complication after the occurrence of peptic ulcer disease. We report the CT findings with CT gastrography of double pylorus as a complicati