Effect of tyrosine administration on duodenal ulcer induced by cysteamine in the rat

International Nuclear Information System (INIS)

Oishi, T.; Szabo, S.

1987-01-01

Duodenal ulcers were produced by administering cysteamine to rats. Pretreatment with the catecholamine precursor, L-tyrosine (40 mg/100 g i.p. for 5 days), decreased the intensity of duodenal ulcers induced by cysteamine. Equimolar doses of tyrosine methyl ester (51.2 mg/100 g i.p. or s.c.) were equally effective in reducing ulcer intensity. Other amino acids (i.e., alanine, aspartic acid, glutamic acid, glycine, leucine, lysine, tryptophan and valine) did not prevent experimental duodenal ulcers. Coadministration of other large neutral amino acids (e.g., leucine and valine) that compete with tyrosine for uptake into the brain did not inhibit the effect of tyrosine on duodenal ulcers induced by cysteamine. Gastric, duodenal and brain dopamine concentrations were increased 1 hr after the injection of tyrosine methyl ester (25.6 mg/100 g s.c.). These results suggest that the effect of tyrosine on duodenal ulcer induced by cysteamine may be mediated by changes in gastrointestinal dopamine metabolism

Why is the coexistence of gastric cancer and duodenal ulcer rare? Examination of factors related to both gastric cancer and duodenal ulcer.

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Ubukata, Hideyuki; Nagata, Hiroyuki; Tabuchi, Takanobu; Konishi, Satoru; Kasuga, Teruhiko; Tabuchi, Takafumi

2011-03-01

The coexistence of gastric cancer with duodenal ulcer has been found empirically to be rare, but why it is rare is difficult to explain satisfactorily. To elucidate this question, we carried out a literature review of the subject. The frequency with which the two diseases coexist is 0.1-1.7%, and the main factor associated with both gastric cancer and duodenal ulcer is Helicobacter pylori infection. However, there are marked differences between the disorders of hyperchlorhydria in duodenal ulcer, and hypochlorhydria in gastric cancer. The most acceptable view of the reason for the difference may be that the acquisition of H. pylori infection occurs mainly in childhood, so that the time of acquisition of atrophic gastritis may be the most important, and if atrophic gastritis is not acquired early, high levels of gastric acid may occur, and consequently acute antral gastritis and duodenal ulcer may occur in youth, whereas, in elderly individuals, persistent H. pylori infections and the early appearance of atrophic gastritis may be the causes of low gastric acid, and consequently gastric cancer may occur. In patients with duodenal ulcer, factors such as nonsteroidal anti-inflammatory drugs (NSAIDs) and dupA-H. pylori strains may contribute to preventing the early acquisition of atrophic gastritis, while acid-suppressive therapy and vascular endothelial growth factor and other entities may inhibit atrophic gastritis. In contrast, in gastric cancer, factors such as excessive salt intake, acid-suppressive therapy, polymorphisms of inflammatory cytokines, and the homB-H. pylori strain may contribute to the early acquisition of atrophic gastritis, while factors such as NSAIDs; fruits and vegetables; vitamins A, C, and E; and good nutrition may inhibit it.

Management of the difficult duodenal stump in penetrating duodenal ulcer disease: a comparative analysis of duodenojejunostomy with "classical" stump closure (Nissen-Bsteh).

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Vashist, Yogesh K; Yekebas, Emre F; Gebauer, Florian; Tachezy, Michael; Bachmann, Kai; König, Alexandra; Kutup, Asad; Izbicki, Jakob R

2012-12-01

Duodenal stump insufficiency after surgery for penetrating gastroduodenal ulcer is associated with substantial mortality. "Classical" technique of closing a difficult duodenal stump (Nissen-Bsteh) has, up to now, not been compared with duodenojejunostomy (DJ) in larger patient sets. This also refers to the potential benefit of a gastric and biliary diversion under such conditions. The aim of the present study was to compare classical duodenal closure (CC) with DJ and to evaluate the impact of gastric and biliary diversion on postoperative outcome after surgery for penetrating, high-risk duodenal ulcer in a matched control study. Out of 321 patients, treated for penetrating duodenal ulcer disease, the perioperative outcome of 62 DJ patients was compared with 62 patients undergoing CC matched for age, gender, biliary diversion, and the operating surgeon collective. A total of 70 patients, equally distributed between DJ and CC subsets, received temporary biliary diversion. Overall perioperative mortality was 10.5%. However, DJ significantly reduced the mortality rate (4.8%) associated with penetrating duodenal ulcer compared to CC (16.1%, P management of penetrating duodenal ulcer.

Perforated Duodenal Ulcer in a Young Child: An Uncommon Condition

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Rohit Prasad Yadav

2009-04-01

Full Text Available Duodenal ulcer is an uncommonly diagnosed entity in children. H. pyloriinfection, blood group ‘O’ or secondary to medications like non steroidal anti-infl ammatory drugs (NSAID and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer. Key Words: duodenal ulcer, laparotomy, perforation

A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

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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

Roentgenologic image of penetrating duodenal bulb ulcer

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Strunin, A.E.

1986-01-01

When studying a series of aimed roentgenograms in patients with peptic ulcer a gas bubble of irregular spherical configuration or two-layer niche were determined near the bulb medial contour. Gas bubble was from 0.5-0.7 to 3.5 cm in diameter. In such cases penetrating ulcers were determined in operations. Along with other signs gas bubble symptom, sometimes two-layer signs may be used for timely and exact roentgenological diagnosis of penetrating duodenal bulb ulcer in peptic ulcer disease

Recurrent peptic ulcers in patients following successful Helicobacter pylori eradication: a multicenter study of 4940 patients.

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Miwa, Hiroto; Sakaki, Nobuhiro; Sugano, Kentaro; Sekine, Hitoshi; Higuchi, Kazuhide; Uemura, Naomi; Kato, Mototsugu; Murakami, Kazunari; Kato, Chieko; Shiotani, Akiko; Ohkusa, Toshifumi; Takagi, Atsushi; Aoyama, Nobuo; Haruma, Ken; Okazaki, Kazuichi; Kusugami, Kazuo; Suzuki, Masayuki; Joh, Takashi; Azuma, Takeshi; Yanaka, Akinori; Suzuki, Hidekazu; Hashimoto, Hiroshi; Kawai, Takashi; Sugiyama, Toshiro

2004-02-01

Although curative treatment of Helicobacter pylori infection markedly reduces the relapse of peptic ulcers, the details of the ulcers that do recur is not well characterized. The aim of this study is to describe the recurrence rate and specific features of peptic ulcers after cure of H. pylori infection. This was a multicenter study involving 4940 peptic ulcer patients who were H. pylori negative after successful eradication treatment and were followed for up to 48 months. The annual incidence of ulcer relapse in H. pylori-cured patients, background of patients with relapsed ulcers, time to relapse, ulcer size, and site of relapsed ulcers were investigated. Crude peptic ulcer recurrence rate was 3.02% (149/4940). The annual recurrence rates of gastric, duodenal and gastroduodenal ulcer were 2.3%, 1.6%, and 1.6%, respectively. Exclusion of patients who took NSAIDs led annual recurrence rates to 1.9%, 1.5% and 1.3%, respectively. The recurrence rate was significantly higher in gastric ulcer. Recurrence rates of patients who smoked, consumed alcohol, and used NSAIDs were significantly higher in those with gastric ulcer recurrence compared to duodenal ulcer recurrence (e.g. 125 of 149 [83.9%] relapsed ulcers recurred at the same or adjacent sites as the previous ulcers). Curative treatment of H. pylori infection is useful in preventing ulcer recurrence. Gastric ulcer is more likely to relapse than duodenal ulcer. Recurrent ulcer tended to recur at the site of the original ulcers.

Perforated duodenal ulcer: an unusual complication of gastroenteritis.

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Wilson, J M; Darby, C R

1990-01-01

A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare.

Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology

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Haruna Lois

2012-10-01

Full Text Available Abstract Background Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology. Case presentation We report a unique case of a 53 year old Italian lady who presented with acute mesenteric ischaemia and duodenal perforation. This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation. Conclusion Early management in the intensive care unit and appropriate surgical intervention maximised the patient’s chances of survival despite the poor prognosis associated with her dual pathology. The rare pathology of the patient described can be explained by two possible hypotheses: peptic ulcer disease causing duodenal ulceration, which precipitated ischaemic infarction of the small bowel. The second hypothesis is the patient developed a stress related ulcer following ischaemic bowel infarction secondary to arterial thrombosis.

The incidence of duodenal and gastric ulcers in a large health maintenance organization.

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Kurata, J H; Honda, G D; Frankl, H

1985-06-01

We report the incidence of peptic ulcers (duodenal, pyloric canal, gastric, and combined) verified by radiologic, endoscopic, or surgical evidence in a large Health Maintenance Organization (HMO) in Los Angeles, California. For members age 15 and above, the peptic ulcer incidence rate was 0.86 per 1,000 person-years (p-y) (males 1.10, females 0.63). The male to female sex ratio was 1.7. Two hundred twenty-two duodenal, 17 pyloric canal, 89 gastric, and 21 combined first-time diagnosed ulcer cases were located. For duodenal and pyloric canal ulcer, the incidence rate for members age 15 and above was 0.58 per 1,000 p-y (males 0.76, females 0.40). For gastric ulcer, the incidence rate for members age 15 and above was 0.21 per 1,000 p-y (males 0.23, females 0.18). The combined ulcer rate was 0.05 per 1,000 p-y (males 0.07, females 0.02). Gastric ulcer rates were two times higher in 1980 than in 1977. Peptic ulcer age-specific incidence rates increased with age. Incidence rates were much lower than those reported in previous studies, but the gastric to duodenal ulcer ratio and the age and sex relation to ulcer incidence were similar to those previously reported.

Surgical management of perforated duodenal ulcer: the changing scene.

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Plummer, J M; McFarlane, M E C; Newnham

2004-12-01

To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58% of cases presented before age 50 years. Perforations in acute ulcers occurred in 80% of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11% of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers.

Perforated Duodenal Ulcer: Has Anything Changed?

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Koskensalo, Selja; Leppäniemi, Ari

2010-04-01

To assess the current management and outcome of perforated duodenal peptic ulcer managed with open repair, a focused analysis was conducted, excluding gastric, traumatic and iatrogenic perforations. A retrospective study of a 6-year period identified 61 patients. Mean age was 59 (range 19-87) years and 33 (54%) were male. Medical history included nonsteroidal anti-inflammatory drugs in 46%, smoking in 30%, atherosclerosis in 26% and excessive alcohol use in 23%. Generalized abdominal tenderness was recorded in 64% of the cases. The mean (SD) C-reactive protein value was 100 (141) g/l and white blood cell count was 12.8 (7.9) E9/l. Plain abdominal X-ray was positive for air in 87% (41/47) and CT scan in 86% (18/21). Four patients (7%) were operated without radiological imaging. There were 31 patients (51%) with a delay of 24 h or more from the start of symptoms to surgery. The mean (SD) delay from admission to surgery was 9 (3) (range 3-12) h. The treatment consisted of open suture repair in 92%, peritoneal lavage in 92%, external drainage in 80% and nasogastric decompression in 92%. The overall hospital mortality and morbidity rates were 11 and 21%, respectively. The duodenal suture leak rate was 7% and intra-abdominal abscess rate was 2%. The majority of patients with perforated duodenal ulcer can be diagnosed with conventional clinical and radiological methods, and treated according to established surgical principles. The mortality and duodenal morbidity rates have remained unchanged for the last decade. Shortening preoperative delay could improve the prognosis.

Cost effective management of duodenal ulcers in Uganda: interventions based on a series of seven cases.

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Nzarubara, Gabriel R

2005-03-01

Our understanding of the cause and treatment of peptic ulcer disease has changed dramatically over the last couple of decades. It was quite common some years ago to treat chronic ulcers surgically. These days, the operative treatment is restricted to the small proportion of ulcer patients who have complications such as perforation. The author reports seven cases of perforated duodenal ulcers seen in a surgical clinic between 1995 and 2001. Recommendations on the criteria for selecting the appropriate surgical intervention for patients with perforated duodenal ulcer are given. To decide on the appropriate surgical interventions for patients with perforated duodenal ulcer. These are case series of 7 patients who presented with perforated duodenal ulcers without a history of peptic ulcer disease. Seven patients presented with perforated duodenal ulcer 72 hours after perforation in a specialist surgical clinic in Kampala were analyzed. Appropriate management based on these patients is suggested. These patients were initially treated in upcountry clinics for acute gastritis from either alcohol consumption or suspected food poisoning. There was no duodenal ulcer history. As a result, they came to specialist surgical clinic more than 72 hours after perforation. Diagnosis of perforated duodenal ulcer was made and they were operated using the appropriate surgical intervention. Diagnosis of hangovers and acute gastritis from alcoholic consumption or suspected food poisoning should be treated with suspicion because the symptoms and signs may mimic perforated peptic ulcer in "silent" chronic ulcers. The final decision on the appropriate surgical intervention for patients with perforated duodenal ulcer stratifies them into two groups: The previously fit patients who have relatively mild physiological compromise imposed on previously healthy organ system by the perforation can withstand the operative stress of definitive procedure. The Second category includes patients who are

[Effects of Electroaupuncture Stimulation of "Xiajuxu" (ST 39), etc. on Duodenal Mucosal Injury, Serum Pro-inflammatory Factors Levels and Duodenal Nicotinic Acetylcholine Receptor alpha 7 Expression in Duodenal Ulcer Rats].

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Ling, Xi; Zhang, Hong; Yi, Xi-qin; Wu, Jin-feng

2016-04-01

To observe the relatively specific effect of electroacupuncture (EA) of "Xiajuxu" (ST 39, the lower hesea paint of the small intestine), etc. on the level of serum TNF-alpha, lnterleukin-1 P (IL-1 P) and high mobility group protein B 1 (HMGB 1) contents, and duodenum a7 nicotinic acetyicholine receptor (nAchR) expression in duodenal ulcer rats, so as to explore its mechanisms underlying improving duodenal ulcer. Sixty SD rats were randomly divided into 6 groups: normal control, model, Xiajuxu (ST 39), Zusanli (ST 36), Shangjuxu (ST 37) and Yanglingquan (GB 34). The duodenal ulcer model was established by subcutaneous injection of 10% Cysteamine Hydrochloride (300 mg/kg), following by giving the rats with access to water containing Cysteamine. EA (10 Hz/50 Hz, 1- 3 mA) was applied to bilateral ST 39, ST 36, ST 37 and GB 34 for 30 min, once daily for 10 days. The ulcer scores (0-5 points) of the duodenal mucosa were assessed according to modified Moraes' methods. Serum TNF-alpha, IL-1 beta and HMGB 1 levels were assayed by ELISA and the expression of neuronal a7 nAchR in the duodenal tissue was detected by Western blot. After modeling, the ulcer score, serum TNF-alpha, IL-i p and HMGB 1 contents were significantly increased (P0.05). EA stimulation of ST 36, ST 37 and ST 39 can reduce ulcer injury in duodenal ulcer model rats, which may be associated with their effects in down-regulating serum TNF-alpha, IL-1 beta and HMGB 1 contents and up-regulating alpha7 nAchR expression of the duodenal tissue, possibly by suppressing immune and inflammatory reactions and regulating nicotinic activity.

A Study of Changes in Stomach Wall at Sites Other Than the Ulcer in Chronic Duodenal Ulcer Patients

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Mishra, Jagmohan; Panigrahi, Souvagya

2011-01-01

It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease (Rosengren, Br J Gen Pract 46(409):491–492, 1996). To study the different changes if any in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients by upper Gastro-Intenstinal Endoscopy followed by histopathological examination of different parts of stomach. This study was a retros...

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.

Pathohistologic characteristics of gastric and duodenal mucosa in liquidators of Chernobyl accident with peptic duodenal ulcer

International Nuclear Information System (INIS)

Degtyar'ova, L.V.

2000-01-01

Pathomorphological characteristics of gastric and duodenal mucosa associated with the dose of ionizing radiation at peptic duodenal ulcer in participants of the Chernobyl accident clean-up was determined. Our findings suggest that the doses of external irradiation exceeding 25 cGy (together with the other harmful effects of the Chernobyl accident) represent a danger of helicobacter infection development

Peptic and duodenal ulcer imaging using 99mTc-sucralfate

International Nuclear Information System (INIS)

Ahonen, A.; Groenfors, R.; Leino, R.; Luukko, J.; Aeaerimaa, M.

1984-01-01

Sucralfate is a basic aluminium salt of sucrose octasulphate which has been used in the treatment of peptic ulcers already for several years. Sucralfate administrated orally, coats selectively areas of ulceration, both gastric and duodenal, providing protection against acids and other irritants. The protective layer probably consists of sucralfate-protein complexes in the ulcerated areas. (orig.)

Experience with acute perforated duodenal ulcer in a West African population.

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Nuhu, A; Kassama, Y

2008-01-01

The advent of proton pump inhibitors and helicobacter pylori eradication in the management of chronic peptic ulcer disease has reduced the operative treatment of this condition to its complications. Perforated duodenal ulcer remains a major life threatening complication of chronic peptic ulcer disease. This retrospective study reviews our experience at the Royal Victoria Teaching Hospital. All patients with clinical diagnosis of perforated duodenal ulcer seen in this hospital between June 2003 and October 2005 were included in this study. Data extracted from their hospital records were analyzed for age, sex, duration of symptoms, previous history of peptic ulcer disease, use of NSAIDS, main presenting features, investigations, resuscitative measures, time of surgery, operative findings, and type of surgery offered, complications and mortality. After resuscitation, laparotomy followed by simple closure or definitive ulcer surgery and helicobacter pylori eradication therapy was given to all the patients. Duration of follow up ranged 8 to 12 months with endoscopy in some patients. There were 41 patients with intraoperative diagnosis of acute perforated duodenal ulcer seen over the study period, comprising 34 males (82.9%) and 7 females (17.1%), a male female ratio of 4.8:1, age range of 18-77 years and a mean age of 45.49 +/- 14.46 years. Previous history of peptic ulcer disease was found in 32 (78.6%) of the patient and the main presenting features were sudden onset of severe abdominal pain in 95.1% of cases and fever in 65.8%. Features of frank peritonitis were demonstrable in all the patients and 11 (26.8%) presented in shock. Plain chest x-rays demonstrated gas under the diaphragm in 21(65.6%) of the patients. After adequate resuscitation, all the patients underwent laparotomy where the abdomen was explored, the diagnosis of perforated duodenal ulcer was confirmed and 29 (70.7%) had simple closure of the perforation with omentum (after Graham). The average time

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.

Laparoscopic management of duodenal ulcer perforation: is it advantageous?

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Palanivelu, C; Jani, Kalpesh; Senthilnathan, P

2007-01-01

Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. Retrospective analysis of 120 consecutive patients (mean age 44.5 years; 111 men) with duodenal ulcer perforation who had undergone laparoscopic surgery. 87 patients had history of tobacco consumption, 12 were chronic NSAID users, 72 had Helicobacter pylori infection and 36 had a co-morbid condition. The mean time to surgery from onset of symptoms was 28.4 hours. The median operating time was 46 minutes. All patients underwent laparoscopic closure of the perforation with Graham's patch omentopexy; 12 patients underwent additional definitive ulcer surgery. The morbidity rate was 7.5%; no patient needed conversion to open surgery or died. The mean postoperative hospital stay was 5.8 days. Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.

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

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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.

Duodenal ulcers as an abscopal effect of thoracic irradiation in mice

International Nuclear Information System (INIS)

Michalowski, A.; Burgin, J.

1982-01-01

Female CFLP mice irradiated to their thorax with either x-rays or fast neutrons developed peptic ulcers within 8 days of exposure. The steep x-ray dose/response curve for induction of duodenal ulcer gave an ED 50 of approximately 14.5 Gu. As little as 6 Gy of fast neutrons was effective in some cases, but the neutron ED 50 exceeded that for x-rays. The ulcers represented an abscopal effect of thoracic irradiation. Scattered radiation as simulated by whole-body x-ray treatment (1 to 5 Gy) caused a dose-dependent decrease in the frequency of duodenal lesions, possibly by decreasing gastric secretion. The greater amount of scattered radiation accompanying fast neutron exposure of the thorax was presumably responsible for the shallower dose/response curve of ulcer induction than that seen with x-rays

Helicobacter pylori hrgA, A Novel Discriminatory Biomarker for Duodenal Ulcer Patients

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Amin Talebi-Bezmin-Abadi

2015-10-01

Full Text Available Background: Helicobacter pylori is a major human gastric for various gastro duodenal diseases.A number of putative virulence factors such as dupA, homB, tnpA have been described. To date,none were found to be significantly associated with specific H. pylori-related diseases (e.g. gastric cancer and duodenal ulcer.Methods: the primary aim of this study was to test the H. pylori hrgA genotype isolated from 253 Iranian symptomatic patients to investigate possible association with clinical outcomes. The positive culture results were confirmed by glmM (genetic control for H. pylori PCR assay.Results: The results showed hrgA gene was detected in 44/253 strains (17.3%. Prevalence of the hrgA gene was relatively high in strains isolated from duodenal ulcer patients (P=0.0063; Odd ratio: 3.54; CI 95%: 1.42-8.77.Conclusions: In contrast our findings showed that the prevalence of hrgA in our control group (gastritis patients was 22.7% (P>0.05. Conclusively, hrgA gene is a good candidate as a discriminatory biomarker for patients with duodenal ulcer

The Helicobacter pylori duodenal ulcer promoting gene, dupA in China

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Liu Wenzhong

2008-10-01

Full Text Available Abstract Background The prevalence of H. pylori is as high as 60–70% in Chinese population. Although duodenal ulcer and gastric cancer are both caused by H. pylori, they are at opposite ends of the spectrum and as such are considered mutually exclusive. Duodenal ulcer promoting (dupA gene was reported to be associated with duodenal ulcer development. The aim of this study was to determine the prevalence of dupA gene of Helicobacter pylori in patients with various gastroduodenal diseases and to explore the association between the gene and other virulence factors. Methods H. pylori were isolated from gastric biopsies of patients with chronic gastritis, duodenal ulcer (DU, gastric ulcer (GU, or non-cardia gastric carcinoma. The dupA, cagA, vacA, iceA and babA2 genotypes were determined by polymerase chain reaction. Histological features of gastric mucosal biopsy specimens were graded based on the scoring system proposed by the updated Sydney system. IL-1β polymorphism was investigated using restriction fragment length polymorphism. Results Isolates from 360 patients including 133 with chronic gastritis, 101 with DU, 47 with GU, and 79 with non-cardia gastric carcinoma were examined. The dupA gene was detected in 35.3% (127/360 and the prevalence DU patients was significantly greater than that in gastric cancer or GU patients (45.5% vs. 24.1% and 23.4%, P dupA-positive strains had higher scores for chronic inflammation compared to those with dupA-negative strains (2.36 vs. 2.24, p = 0.058. The presence of dupA was not associated with the cagA, vacA, iceA and babA 2 genotypes or with IL-1β polymorphisms. Conclusion In China the prevalence of dupA gene was highest in DU and inversely related to GU and gastric cancer.

The Helicobacter pylori duodenal ulcer promoting gene, dupA in China.

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Zhang, Zhiyu; Zheng, Qing; Chen, Xiaoyu; Xiao, Shudong; Liu, Wenzhong; Lu, Hong

2008-10-25

The prevalence of H. pylori is as high as 60-70% in Chinese population. Although duodenal ulcer and gastric cancer are both caused by H. pylori, they are at opposite ends of the spectrum and as such are considered mutually exclusive. Duodenal ulcer promoting (dupA) gene was reported to be associated with duodenal ulcer development. The aim of this study was to determine the prevalence of dupA gene of Helicobacter pylori in patients with various gastroduodenal diseases and to explore the association between the gene and other virulence factors. H. pylori were isolated from gastric biopsies of patients with chronic gastritis, duodenal ulcer (DU), gastric ulcer (GU), or non-cardia gastric carcinoma. The dupA, cagA, vacA, iceA and babA2 genotypes were determined by polymerase chain reaction. Histological features of gastric mucosal biopsy specimens were graded based on the scoring system proposed by the updated Sydney system. IL-1beta polymorphism was investigated using restriction fragment length polymorphism. Isolates from 360 patients including 133 with chronic gastritis, 101 with DU, 47 with GU, and 79 with non-cardia gastric carcinoma were examined. The dupA gene was detected in 35.3% (127/360) and the prevalence DU patients was significantly greater than that in gastric cancer or GU patients (45.5% vs. 24.1% and 23.4%, P dupA-positive strains had higher scores for chronic inflammation compared to those with dupA-negative strains (2.36 vs. 2.24, p = 0.058). The presence of dupA was not associated with the cagA, vacA, iceA and babA 2 genotypes or with IL-1beta polymorphisms. In China the prevalence of dupA gene was highest in DU and inversely related to GU and gastric cancer.

Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications.

Science.gov (United States)

Ichiro, Ikushima; Shushi, Higashi; Akihiko, Ishii; Yasuhiko, Iryo; Yasuyuki, Yamashita

2011-07-01

To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease

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Massimo Tonolini

2013-01-01

Full Text Available Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.

Diagnosis of celiac trunk compression stenosis in ischemic gastric and duodenal ulcer

International Nuclear Information System (INIS)

Potashov, L.V.; Morozov, V.P.; Chekhuta, S.M.; Rodionov, K.K.

1986-01-01

Chronic gastric and duodenal ulcers may result from ischemia determined by celiac trunk compression stenosis (CTCS). In such cases angiography is necessary to specify diagnosis, to bring to light the causes of ulceration and to define therapeutic tactics. An analysis of angiograms of 75 patients with gastric and duodenal mucosa ulcers in CTCS and its characteristics have presented. The opening and proximal part of the celiac trunk are more frequently subjected to compression. The length of a narrow part of the celiac trunk is on an average of 6.62±0.31 mm. Enlargement in the diameter of the gastroduodenal artery was noted. Simultaneous narrowing of the celaic trunk and the upper mesenteric artery was found in 18 patients

Radioimmunoassay of gastrin level in duodenal ulcer, atrophic gostritis and Addison-Biermer's disease

International Nuclear Information System (INIS)

Hasik, J.; Kozal, H.; Kosowicz, J.; Hansz, J.

1975-01-01

Radioimmunoassay of gastrin level in the blood was performed in 20 controls, 12 patients with duodenal ulcer, 13 patients with atrophic gastritis and 14 patients with Addison-Biermer's disease. Gastrin level in the serum of the patients with duodenal ulcer did not differ significantly from that of controls. In atrophic gastritis and particularly in Addison-Biermer's disease gastrin level was found to be several times higher. This is probably a result of chronic gastrin secretion stimulation which is normally inhibited by gastric juice. (author)

A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals.

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Boylan, Matthew R; Khalili, Hamed; Huang, Edward S; Michaud, Dominique S; Izard, Jacques; Joshipura, Kaumudi J; Chan, Andrew T

2014-02-13

Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer. We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40-75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24-2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26-2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21-2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98-2.19). Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.

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.

A study of changes in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients.

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Mishra, Jagmohan; Panigrahi, Souvagya

2011-08-01

It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease (Rosengren, Br J Gen Pract 46(409):491-492, 1996). To study the different changes if any in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients by upper Gastro-Intenstinal Endoscopy followed by histopathological examination of different parts of stomach. This study was a retrospective study conducted in the Department of General surgery, V.S.S. Medical College, Burla, Sambalpur, odisha during the period of June 2007 to May 2009. Subjects were patients with chronic duodenal ulcer who underwent endoscopic examination, gastric biopsy and rapid urease test. Chronic gastritis of antrum, followed by erythematous pangastritis was the prominent feature both in endoscopy and histopathological examination. The Inflammatory change affected the mucosa and submucosa of the stomach wall. The prevalence rate of Helicobacter pylori was 84%, the antrum being the most common affected part (84%) followed by gastric fundus (41%). Chronic superficial atrophic gastritis of antrum, followed by pangastritis is the most common pathological abnormality in stomach wall in CDU cases. Gastric antrum is the most common site for H. pylori colonization followed by fundus. Presence of H. pylori in stomach wall is associated with active on chronic gastritis.

Duodenal ulcer promoting gene of Helicobacter pylori.

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Lu, Hong; Hsu, Ping-I; Graham, David Y; Yamaoka, Yoshio

2005-04-01

Identification of a disease-specific H pylori virulence factors predictive of the outcome of infection remains unachieved. We used the polymerase chain reaction and Southern blot to compare the presence of 14 vir homologue genes with clinical presentation of H pylori infection, mucosal histology, and mucosal interleukin (IL)-8 levels. We examined 500 H pylori strains from East Asia and South America, including 120 with gastritis, 140 with duodenal ulcer (DU), 110 with gastric ulcer (GU), and 130 with gastric cancer. Only 1 gene that encompassed both jhp0917 and jhp0918 called dupA (duodenal ulcer promoting gene) was associated with a specific clinical outcome. dupA was present in 42% of DU vs. 21% of gastritis (adjusted odds ratio [OR] = 3.1, 95% confidence interval [CI]: 1.7-5.7). Its presence was also associated with more intense antral neutrophil infiltration and IL-8 levels and was a marker for protection against gastric atrophy, intestinal metaplasia, and gastric cancer (OR for gastric cancer = 0.42, 95% CI: 0.2-0.9 compared with gastritis). In vitro studies in gastric epithelial cells using dupA -deleted and -complemented mutants showed that the dupA plays roles in IL-8 production, in activation of transcription factors responsible for IL-8 promoter activity, and in increased survivability at low pH. dupA is a novel marker associated with an increased risk for DU and reduced risk for gastric atrophy and cancer. Its association with DU-promoting and -protective effects against atrophy/cancer was evident in both Asian and Western countries.

Thyroid Storm Precipitated by Duodenal Ulcer Perforation

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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.

Thyroid storm precipitated by duodenal ulcer perforation.

Science.gov (United States)

Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Ando, Takao; Kawakami, Atsushi

2015-01-01

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.

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

Science.gov (United States)

Yeh, Yi-Chun; Cheng, Hsiu-Chi; Chang, Wei-Lun; Yang, Hsiao-Bai; Sheu, Bor-Shyang

2010-08-13

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. 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 dupA-status, may correlate with susceptibility to duodenal ulcer after H. pylori infection in Taiwanese females.

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.

Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralfate alone.

Science.gov (United States)

Bianchi Porro, G; Parente, F; Lazzaroni, M

1993-01-01

Thirty two patients with Helicobacter pylori positive duodenal ulcers resistant to treatment were randomly assigned to 4 weeks' treatment with sucralphate 4 g/day or colloidal bismuth subcitrate 480 mg/day plus amoxycillin from days 1 to 7 and tinidazole from days 8 to 14. After 4 weeks, patients with unhealed ulcers were crossed over to the other form of treatment for a further 4 week period. Patients with healed ulcers were followed up for 1 year without maintenance therapy with clinical and endoscopic investigations 3, 6, and 12 months after healing. Complete healing rates at 4 weeks were 88% (15 of 17) in the colloidal bismuth subcitrate plus antibiotics group and 40% (six of 15) in the sucralphate group (p < 0.05). After cross over, overall healing rates were 88% (22 of 25) and 47% (eight of 17), respectively (p < 0.05). H pylori eradication occurred in 83% of patients treated with the triple therapy. Cumulative relapse rates at 12 months were 12% (two of 17) in patients in whom H pylori had been eradicated and 100% (10 of 10) in those with persistent infection after short term therapy (p < 0.05). These results show that a colloidal bismuth subcitrate plus antibiotics regimen is highly effective in the short term treatment of resistant duodenal ulcers and that H pylori eradication can change the natural tendency to early recurrence of these ulcers. PMID:8491391

Alternative types of duodenal ulcer induced in mice by partial X irradiation of the thorax

International Nuclear Information System (INIS)

Michalowski, A.; Uehara, S.; Yin, W.B.; Burgin, J.; Silvester, J.A.

1983-01-01

The present study extends our earlier observations on gastrointestinal pathology in thorax-irradiated female CFLP mice. It shows that exposure of the lower mediastinum to single doses of 14-30 Gy X rays results in the formation of the proximal duodenal ulcer accompanied frequently by erosion of the antral gastric mucosa. X irradiation of the lateral thoracic fields is responsible for single ulcers in the proximity of duodenal papilla, often associated with a circumscribed area of degeneration of the fundic mucosa of the stomach. In view of the small amount of radiation received by the subdiaphragmatic parts of the alimentary tract, these gastro-duodenal lesions represent abscopal effects of thoracic irradiation

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 ....../315) of the doctors. CONCLUSIONS. H.pylori treatment is frequently used in some countries. However, the role of H. pylori in duodenal ulcer disease has not been accepted to the same extent in different European countries.......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...

[The spa and resort-based health-promoting treatment of the vehicle drivers suffering from duodenal ulcer disease: the effectiveness and safety].

Science.gov (United States)

El'garov, A A; Kalmykova, M A; El'garova, R M; Betuganova, L V; El'garov, M A

2015-01-01

To evaluate the effectiveness and the safety of the spa and resort-based health-promoting treatment of the vehicle drivers (VD) presenting with duodenal ulcer disease. A total of 67 men suffering from duodenal ulcer disease (DUD) were allocated to two groups. The patients of group 1 (n = 35) were given the courses of balneotherapy that included bromine-iodine mineral baths with a temperature of 36-37 degrees C (8-9 procedures 10-15 min long each every second day) in combination with 8-9 peloid applications to the epigastric region (temperature 38-40 degrees C for 10-15 min every second day). The patients of group 2 (n = 32) were given the similar courses of therapy that included nitric thermal mineral baths with a temperature of 36-37 degrees C (8-9 procedures 10-15 min long each every second day) in combination with 8-9 peloid applications to the epigastric region (38-40 degrees C for 10-15 min every second day). The effectiveness and safety of these balenotherapeutic procedures for the treatment of duodenal ulcer disease in the subjects of the study and control (n = 47) groups were evaluated based on the results of the routine clinical and endoscopic examination, psychological and psychophysiological tests, and the comparative analysis of medical aid appeal-ability and disability cases during twelve months. Dynamics of clinical and instrumental characteristics (subjective, objective, clinical, endoscopic, psychophysiological) suggested the improvement of the health status in 88.6% and 84.4% of the drivers with duodenum ulcer in the two study groups respectively. Some of the patients comprising group 1 showed significant negative dynamics of the operative reaction system while the patients of group 2 demonstrated the marked improvement of the professionally significant functions and properties (PSF&P). The comparative analysis of medical aid appealability, disability cases, frequency of relapses and complications revealed the favorable clinical course of duodenal

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.......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...

A review of the management of perforated duodenal ulcers at a ...

African Journals Online (AJOL)

EB

, Ile-Ife, Nigeria. 2. Department ... Key words: Duodenal ulcers, perforations, management, Nigeria. African Health ..... However, there was a strong association between the interval ... to financial constraint on the part of the patients, or clinicians ...

[Risk factors for adverse course of gastric and duodenal peptic ulcer].

Science.gov (United States)

Komar, Olena M; Kizlova, Nataliya M; Trylevych, Oleksandra D; Kravchenko, Vasyl V

2018-01-01

Introduction: High morbidity rate, frequent relapses, and significant economic losses give reasons for highlighting the peptic ulcer disease as the most topical medical-statistical problem. The aim of the study is to assess the influence of the main risk factors on the course of gastric and duodenal peptic ulcer. Materials and methods: We formed up the risk groups consisted of patients with 12 modified (4) and regular (8) factors, each characterized with its own signs and gradations. We performed the quantitative evaluation of the factors and scored the signs thereof, the results of which were used for determination of the most informative ones. Results: Among the regular factors, we placed emphasis on gender, age, burdened heredity, and 0(I), Rh+ blood type. The risk of peptic ulcer in hereditary tainted young men of the working age with parental lineage (+2.3) and in males with 0(I) Rh+ blood type (+1.4) was proved. Helicobacter pylori (Hp) infection is a key contributor (a predictor of) to severity of the disease course (+9.7) among the modified risk factors. Negative effect of a concomitant pathology (+5.0), including hepatobiliary lesions (+3.8), hypertension (+4.0), and diabetes mellitus (+1.3) is also significant. Diet violation (+3.7), tobacco smoking (+3.2) and stress (+3.0) were ranked third. Conclusions: The results of quantitative evaluation of the factors scoring suggest of the underlying H.pylori infection (the significance of which is growing along with the growth of the disease incidence) and irrational diet as the most informatively important ones. We have established the direct dependence between the most important peptic ulcer risk factors, severity of the disease, and duration and periodicity of treatment thereof.

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria.

Science.gov (United States)

Etonyeaku, A C; Agbakwuru, E A; Akinkuolie, A A; Omotola, C A; Talabi, A O; Onyia, C U; Kolawole, O A; Aladesuru, O A

2013-12-01

Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure. To determine the patterns of presentation and mode of management of duodenal ulcer perforations. Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients' records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0. Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15-78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham's omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities. Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham's omentopexy with broad spectrum antibiotics is still commonly practiced.

Emergency transcatheter arterial embolization for critical massive bleeding due to duodenal bulb ulcer

International Nuclear Information System (INIS)

Li Qiang; Li Yiyun; Zhao Chunmei

2011-01-01

Objective: To evaluate the efficacy and feasibility of emergency transcatheter arterial embolization (ETAE) in treating critical massive bleeding due to duodenal bulb ulcer. Methods: ETAE was carried out in seven patients with acute massive bleeding due to endoscopically-proved duodenal bulb ulcer, who failed to respond conservative measures and were critically ill clinically. Super-selective catheterization of gastroduodenal artery or right gastroepiploic artery was performed, which was followed by arterial angiography to identify the bleeding site. According to the angiographic findings, ETAE with Gelfoam particles and coils was carried out. After the operation medical management was given and endoscopy re-examination was conducted. All the patients were follow up for 3∼6 months. Results: Angiographically, gastroduodenal artery bleeding was detected in all seven patients. ETAE was successfully accomplished in all cases. Complete clinical effectiveness was obtained in six patients while partial effectiveness in one case. No procedure-related complications occurred. Conclusion: For critical massive bleeding due to duodenal bulb ulcer ETAE is a highly effective and safe treatment, which can be regarded as an alternative to surgery. It is worth popularizing this technique in clinical practice. (authors)

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.

[Features of deontology in patient with duodenal ulcer].

Science.gov (United States)

Firsova, L D

2002-01-01

The presented data demonstrate the frequency and variety of different disorders of mental response to the fact of the disease among patients with duodenal ulcer. It may be seen from experience the doctor's deontology assists essentially to patients in restoring their mental functions disturbed in the period of exacerbation. A psychodiagnostic examination allows detecting patients that require a psychotherapeutic consultation (and a psychiatrist's consultation in a number of cases).

Controversies in the Helicobacter pylori/duodenal ulcer story.

Science.gov (United States)

Hobsley, Michael; Tovey, Frank I; Holton, John

2008-12-01

In patients with Helicobacter pylori-positive duodenal ulcer (DU), the organism must be eradicated to achieve rapid, stable healing. However, evidence is against much else that is commonly accepted. (1) Does H. pylori cause the ulcer? Evidence against includes archaeopathology, geographical prevalence, temporal relationships and H. pylori-negative DU patients. DU can recur after eradication of H. pylori infection, and DUs may remain healed after reduction of acid secretion despite persistent infection. The faster healing of ulcers when H. pylori has been eradicated is due to the organism's interference with neoangiogenesis and the healing of wounded epithelial cells. (2) Does H. pylori infection persist until pharmacologically eradicated? Studies based on current infection show that H. pylori infection is a labile state that can change in 3 months. High rates of gastric acid secretion result in spontaneous cure, whereas low rates permit re-infection. Hydrochloric acid, necessary for producing a DU, is strongly associated with the likelihood of an ulcer. At the start, patients owe their ulcer to gastric hypersecretion of hydrochloric acid; approximately 60% may be H. pylori-negative. If acid is suppressed, the less acid milieu encourages invasion by H. pylori, especially if the strain is virulent.

Effect of dopamine-related drugs on duodenal ulcer induced by cysteamine or propionitrile: prevention and aggravation may not be mediated by gastrointestinal secretory changes in the rat

International Nuclear Information System (INIS)

Gallagher, G.; Brown, A.; Szabo, S.

1987-01-01

Dose- and time-response studies have been performed with dopamine agonists and antagonists using the cysteamine and propionitrile duodenal ulcer models in the rat. The experiments demonstrate that the chemically induced duodenal ulcer is prevented by bromocriptine, lergotrile and reduced by apomorphine or L-dopa. Aggravation of cysteamine-induced duodenal ulcer was seen especially after (-)-butaclamol, (-)-sulpiride, haloperidol and, less effectively, after other dopaminergic antagonists. The duodenal antiulcerogenic action of dopamine agonists was more prominent after chronic administration than after a single dose, whereas the opposite was found concerning the proulcerogenic effect of dopamine antagonists. In the chronic gastric fistula rat, both the antiulcerogens bromocriptine or lergotrile and the proulcerogens haloperidol, pimozide or (-)-N-(2-chlorethyl)-norapomorphine decreased the cysteamine- or propionitrile-induced gastric secretion. No correlation was apparent between the influence of these drugs on duodenal ulcer development and gastric and duodenal (pancreatic/biliary) secretions. In the chronic duodenal fistula rat, decreased acid content was measured in the proximal duodenum after haloperidol, and diminished duodenal pepsin exposure was recorded after bromocriptine. Furthermore, the aggravation by dopamine antagonists of experimental duodenal ulcer probably involves a peripheral component. The site of dopamine receptors and physiologic effects which modulate experimental duodenal ulcer remain to be identified, but their elucidation may prove to be an important element in the pathogenesis and treatment of duodenal ulcer

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...... human EGF/URO is a potent inhibitor of gastric acid secretion when administered intravenously, but had no effect on acid secretion when given intraduodenally, which suggests that the effect of synthetic human EGF/URO is a direct action on the duodenal mucosa. In conclusion, this study showed that oral...

Experience with Acute Perforated Duodenal Ulcer in a West African ...

African Journals Online (AJOL)

Plain chest x-rays demonstrated gas under the diaphragm in 21(65.6%) of the patients. After adequate resuscitation, all the patients underwent laparotomy where the abdomen was explored, the diagnosis of perforated duodenal ulcer was confirmed and 29(70.7%) had simple closure of the perforation with omentum (after ...

The mechanism of gastrin release in cysteamine-induced duodenal ulcer

DEFF Research Database (Denmark)

Poulsen, Steen Seier

1982-01-01

a rise in serum gastrin from 29 +/- 5 pg/ml to a maximum of 203 +/- 62 pg/ml after 3 h in unoperated rats, whereas no rise was seen in vagotomized or antrectomized rats. The beta-adrenergic blocking agent propranolol strongly inhibited cysteamine-induced gastrin release, whereas atropine dependent......Duodenal ulcer can be induced in rats by a single dose of cysteamine. The ulcer formation is accompanied by acid hypersecretion and elevated serum gastrin levels. This study was performed to elucidate the mechanisms of gastrin release after an ulcerogenic dose of cysteamine. Cysteamine induced...

Testing of 99mTc labelled sucralfate in induced gastric and duodenal ulcers

International Nuclear Information System (INIS)

Pallagi, Katalin; Janoki, Gyoezoe

1988-01-01

The conditions of in vitro labelling of sucralfate available in medical practice were established according to literature data including some modifications. Labelling efficiency proved to be 98.1%. The radiopharmaceutical is stable over 6 hours in vitro. 99m Tc-sucralfate accumulates in experimentally induced gastric and duodenal ulcers thus tracing the site of the ulcerous lesion. (author) 14 refs.; 3 tabs

Geographic and temporal variations in the occurrence of peptic ulcer disease.

Science.gov (United States)

Sonnenberg, A

1985-01-01

The epidemiology of peptic ulcer is characterised by marked geographic and temporal variations. Gastric ulcer occurs about 5-10 times more often than duodenal ulcer in Japan. In most European countries and the USA, duodenal ulcer is about twice as frequent as gastric ulcer. The variation among different European countries does not show any clear-cut relationship to European geography. The reported differences in healing rate, relapse rate after discontinuation of treatment with histamine2 (H2)-blockers, and harmful effects of smoking are probably related to the varying fraction of bad healers recruited for controlled clinical trials in different countries. In male migrant workers who emigrated from Southern to Central Europe, duodenal ulcer occurs twice as frequent as in the native population. A similar phenomenon has been reported from South Africa. Peptic ulcer used to be a rare disease before the 19th century. In the beginning of the 19th century acute perforations of gastric ulcers were first reported in young girls. With progress of the 19th century peptic ulcer became more frequent also in men. By the end of the century the incidence of duodenal ulcer had surpassed that of gastric ulcer. Studies from the USA and England reported that the number of hospital admissions, surgical operations, and deaths due to duodenal or gastric ulcer had declined during the last 20 years. A cohort analysis demonstrates that the temporal changes of peptic ulcer in all European countries, in Japan, and in the USA occur in a fashion characteristic of those due to changes in birth-cohort risks. Generations born in the last 30 years of the 19th century manifested the highest risk of developing peptic ulcer and carried it throughout their lives. The birth-cohorts with a high risk for duodenal ulcer lagged 10-30 years behind those with a high risk for gastric ulcer. The cohort phenomenon starts at an age below 5 years for both gastric and duodenal ulcer. The cohort phenomenon implies

A new prognostic scoring system for perforation peritonitis secondary to duodenal ulcers

International Nuclear Information System (INIS)

Nomani, A.Z.; Qureshi, M.S.

2014-01-01

Objective: To identify prognostic factors for perforated duodenal ulcers and to devise and assess a new scoring system. Methods: The observational prospective study was conducted at the Mayo Hospital, Lahore in two phases: from March 2010 to September 2011; and from October 2011 to July 2012. It included patients with duodenal ulcer perforation who were observed for identifying factors predicting 30-day prognosis. Each of the predictive factor was given a score based on its severity to devise a new scoring system. Chi-square was used for univariate analysis. Multivariate analysis was done using forward stepwise regression. Accuracy of the new scoring system was calculated using receiver operating curve analysis and its validity was evaluated in the second phase of the study. Results: Predictors of poor prognosis included multiple gut perforations, size of largest perforation >0.5cm, amount of peritoneal fluid >1000ml, simple closure, development of complications, post-operative systemic septicaemia and winter/autumn season of presentation. Overall 30-day mortality rate was 32.3% (n=32) and morbidity rate was 21.2% (n=21). The mean score was higher in the ones with poor prognosis (p=0.001). Similarly, the mean score was greater in those with grave prognosis (p=0.001). The scoring system had an overall sensitivity of 85.12% and specificity of 80.67% and was favourably comparable to other scoring systems. Conclusion: The new scoring system is a useful tool in predicting 30-day prognosis for perforated duodenal ulcers in acid peptic disease. (author)

Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia: a systematic overview.

Science.gov (United States)

Veldhuyzen van Zanten, S J; Sherman, P M

1994-01-15

To evaluate current evidence for a causal relation between Helicobacter pylori infection and gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia. A MEDLINE search for articles published in English between January 1983 and December 1992 with the use of MeSH terms Helicobacter pylori, gastritis, duodenal ulcer, gastric cancer, dyspepsia and clinical trial; abstracts were excluded. Six journals and Current Contents were searched manually for pertinent articles published in that time frame. Original studies with at least 25 patients, case reports and reviews that examined the relation between H. pylori and the four gastrointestinal disorders; 350 articles were on gastritis, 122 on duodenal ulcer, 44 on gastric cancer and 96 on nonulcer dyspepsia. The quality of the studies was rated independently on a four-point scale. The strength of the evidence was assessed using a six-point scale for each of the eight established guidelines for determining a causal relation. There was conclusive evidence of a causal relation between H. pylori infection and histologic gastritis. Koch's postulates for the identification of a microorganism as the causative agent of a disease were fulfilled for H. pylori as a causative agent of gastritis. There was strong evidence that H. pylori is the main cause of duodenal ulcers not induced by nonsteroidal anti-inflammatory drugs, but all of Koch's postulates were not fulfilled. There was moderate epidemiologic evidence of an association between chronic H. pylori infection and gastric cancer. There was a lack of convincing evidence of a causal association between H. pylori and nonulcer dyspepsia. The evidence supports a strong causal relation between H. pylori infection and gastritis and duodenal ulcer and a moderate relation between such infection and gastric cancer. Further studies are needed to clarify the role of H. pylori in these disorders. Thus far, there is no evidence of a causal relation between H. pylori and nonulcer

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 o...

[Laparoscopic suture or open suture in perforated duodenal ulcer].

Science.gov (United States)

Nicolau, A E; Ionescu, G; Iordache, F; Mehic, R; Spătaru, A

2002-01-01

Between Nov. 1994-Jan. 2001 we performed laparoscopic suture with omentoplasty of perforated duodenal ulcer (PDU) in 51 patients out of 56 it was intended (this constituted the laparoscopic group--LG). The selection criteria were young patients, age < 40 years, no associated diseases, onset of the operation under 12 hours from the occurrence of the perforation, absence of clear ulcer history. In the same period, we performed an open suture based on the same criteria in 105 patients (open group--OP). The results showed a difference between needed analgesia (2.8 days for LG vs. 5.2 days for OG) and a hospital stay of 6.1 days in LG vs. 7.7 days in OG. The incidence of postoperative complications was 5.88% in the LG and 7.61% in the OG with 1.96% and respective 1.90% reoperation rate. In conclusion laparoscopic suture of PDU with associated postoperative modern therapy of ulcer disease could be the treatment of choice in young patients.

Significant association of the dupA gene of Helicobacter pylori with duodenal ulcer development in a South-east Indian population

OpenAIRE

Alam, Jawed; Maiti, Sankar; Ghosh, Prachetash; De, Ronita; Chowdhury, Abhijit; Das, Suryasnata; Macaden, Ragini; Devarbhavi, Harshad; Ramamurthy, T.; Mukhopadhyay, Asish K.

2012-01-01

A novel virulence factor, duodenal ulcer-promoting gene A (dupA), in Helicobacter pylori has been found to be associated with disease in certain populations but not in others. This study analysed a South-east Indian population as part of the debate about the relevance of dupA for the prediction of clinical outcomes. A total of 140 H. pylori strains isolated from duodenal ulcer (DU) (n=83) and non-ulcer dyspepsia (NUD) patients (n=57) were screened by PCR and dot-blot hybridization to determin...

Gastroduodenal safety of Nimesulid (Nimesil, Berlin Chemie in rheumatic patients with history of ulcer

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A. E. Karateyev

2003-01-01

Full Text Available Objective. To assess safety of nimesulid in rheumatic pts with history of ulcer or multiple erosions (ME of stomach and/or duodenal mucosa. Methods. 42 pts with rheumatic diseases aged 22-73 years were included. AH had gastric or duodenal ulcers or ME (n>10 connected with NSAID treatment and confirmed by endoscopy no more than 6 months before the beginning of the study. Pts were included after healing of ulcers and erosions. The pts were randomized to receive Nimesulid 200 mg/day (group 1 or Diclofenac suppositoria 100 mg/day + ranitidine 150 mg/day (group 2. Esophagogastroduodenoscopy was performed before and 12 weeks after the beginning of treatment. Results. Relapse of stomach ulcer was observed in I pts of group 1 (5,6%. Relapse of NSAID-induced ulcers and ME was noted in 6 pts of group 2 (33,3%: in 4 cases stomach ulcers, in 1 case stomach ME, in 1 case duodenal ulcer (p=0,0424. Presence of gastralgias and dyspepsia was noted in 36,8% pts of group 1 and in 20% pts of group 2 (p=0,0539. In 1 pts of group 2 gastralgias were the reason for premature endoscopy. Conclusion. Nimesil (Nimesulid can be considered as a more safe drug than classical NSAIDs with smaller risk of serious gastroduodenal complications development in rheumatic pts with ulcer history. The results of the study allow to recommend Nimesulid as a drug of choice for treatment of pts with history of NSAID-induced gastropathy.

Effect of Pithecellobium dulce (Roxb.) Benth. fruit extract on cysteamine induced duodenal ulcer in rats.

Science.gov (United States)

Megala, Jayaraman; Geetha, Arumugam

2015-10-01

The edible fruits of Pithecellobium dulce (Roxb.) Benth. are traditionally used for various gastric complications in India. Here, we investigated the antiulcer activity of hydroalcoholic fruit extract of P. dulce (HAEPD) by applying cysteamine induced duodenal ulcer model in rats. Duodenal ulcer was induced in male albino Wistar rats by oral administration of cysteamine @ 420 mg/kg body wt. as a single dose. The rats were pre-administered orally with HAEPD @ 200 mg/kg body wt. for 30 days prior to ulcer induction. Rats pre-administered with ranitidine @ 30 mg/kg body wt. served as reference drug control. Ulcer score, thiobarbituric acid reactive substances (TBARS), glycoproteins, superoxide dismutase, catalase and glutathione peroxidase and reduced glutathione levels were measured in the duodenum. Rats pre-administered with the HAEPD showed significantly reduced ulcer score comparable to that of ranitidine pretreated rats. The co-administration of HAEPD lowered the TBARS level and also restored the levels of glycoproteins, enzymatic and non-enzymatic antioxidants. Histopathological observations confirmed the presence of inflammation, necrosis and hemorrhagic spots in the duodenum of ulcer control rats which were significantly reduced due to HAEPD treatment. No abnormal alterations were observed in normal rats treated with HAEPD at the dosage studied. The results demonstrated antioxidant and cytoprotective nature of P. dulce, and thereby its significant anti ulcer property.

The use of laser therapy in complex treatment of ulcer diseases in participants of Chernobyl accident clean-up

International Nuclear Information System (INIS)

Simonova, L.Yi.; Rozdyil's'kij, S.Yi.; Kulyinyich, G.V.; Fertman, V.Z.; Krapivnij, O.O.; Abramova, L.P.; Byilogurova, L.V.; Levchenko, A.P.

2001-01-01

The study involved 59 male patients with relapsing duodenal ulcer who had participated in Chernobyl accident clean-up. Laser therapy was administrated daily on the projection of the zone of the ulcer and acupuncture zones. The obtained results allow to conclude that transcutaneous laser therapy is an effective method of treatment of ulcer disease

Selye's general adaptation syndrome: stress-induced gastro-duodenal ulceration and inflammatory bowel disease.

Science.gov (United States)

Fink, George

2017-03-01

Hans Selye in a note to Nature in 1936 initiated the field of stress research by showing that rats exposed to nocuous stimuli responded by way of a 'general adaptation syndrome' (GAS). One of the main features of the GAS was the 'formation of acute erosions in the digestive tract, particularly in the stomach, small intestine and appendix'. This provided experimental evidence for the view based on clinical data that gastro-duodenal (peptic) ulcers could be caused by stress. This hypothesis was challenged by Marshall and Warren's Nobel Prize (2005)-winning discovery of a causal association between Helicobacter pylori and peptic ulcers. However, clinical and experimental studies suggest that stress can cause peptic ulceration in the absence of H. pylori Predictably, the etiological pendulum of gastric and duodenal ulceration has swung from 'all stress' to 'all bacteria' followed by a sober realization that both factors play a role, separately as well as together. This raises the question as to whether stress and H. pylori interact, and if so, how? Stress has also been implicated in inflammatory bowel disease (IBD) and related disorders; however, there is no proof yet that stress is the primary etiological trigger for IBD. Central dopamine mechanisms seem to be involved in the stress induction of peptic ulceration, whereas activation of the sympathetic nervous system and central and peripheral corticotrophin-releasing factor appears to mediate stress-induced IBD. © 2017 Society for Endocrinology.

The evolution of anti-ulcer therapy with cimetidine. Is a single large nocturnal dose of cimetidine the right therapy for duodenal ulcer?

Science.gov (United States)

Barbara, L; Corinaldesi, B; Stanghellini, V; Paternicò, A; Fabbri, L; Sacco, T

1986-01-01

Peptic ulcer results from the prevalence of agents causing endoluminal lesions over the defence mechanisms of the mucosa of the upper GI tract. Particularly, in the case of duodenal ulcer, the pathogenetic relevance of non-buffered acid secretion of the early nighttime period has been emphasized. This is indeed confirmed by the fact that a single night dose of 800 mg cimetidine has apparently been proved able--in numerous controlled clinical trials--to provide results that are similar to those obtained with the classic dose of 1 g daily or 400 mg twice daily. Our centre carried out a crossover double-blind controlled trial aimed at evaluating titrable acidity and pH during the 24-h period in seven patients with active duodenal ulcer. The single nighttime dose of cimetidine resulted in a significant and long-lasting inhibition of acid secretion during the entire night. During the day, secretory values returned to levels similar to those obtained with placebo, hence allowing normal digestive functions.

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

BACKGROUND: Duodenal ulcer (DU) patients have impaired proximal duodenal mucosal bicarbonate secretion at rest and in response to luminal acid with higher acid-stimulated mucosal release of prostaglandin (PG) E2 than healthy subjects. Our purpose was to determine whether this abnormality was pres......BACKGROUND: Duodenal ulcer (DU) patients have impaired proximal duodenal mucosal bicarbonate secretion at rest and in response to luminal acid with higher acid-stimulated mucosal release of prostaglandin (PG) E2 than healthy subjects. Our purpose was to determine whether this abnormality...... 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...... 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....

The presence of dupA in Helicobacter pylori is not significantly associated with duodenal ulceration in Belgium, South Africa, China, or North America.

Science.gov (United States)

Argent, Richard H; Burette, Alain; Miendje Deyi, Véronique Y; Atherton, John C

2007-11-01

A previous study suggested that Helicobacter pylori strains possessing dupA are positively associated with duodenal ulceration and negatively associated with gastric adenocarcinoma. We determined the prevalence of dupA in H. pylori strains recovered from 4 independent populations and found a significant association with gastric cancer but not with duodenal ulceration.

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...

[Traumatic rupture of the pancreas and duodenum in pre-existing penetrating duodenal ulcer].

Science.gov (United States)

Schröder, W; Krüger, I; Mönig, S P; Hölscher, A H

2000-01-01

Pancreatic injuries are rare complications after blunt abdominal trauma and usually the result of a direct force separating the pancreatic body in front of the vertebral column. This case report describes the uncommon event of a severe pancreatic and duodenal injury (stage IV b of Lukas) in which the combination of a direct force and the setting of a preexisting penetrating ulcer of the duodenum caused the extent of the pancreatic and duodenal injury [9]. Because of the preexisting lesion a Whipple procedure had to be performed. This case report demonstrates the influence of chronic abdominal diseases on the outcome of blunt abdominal trauma.

Association of Intact dupA (dupA1) rather than dupA1 cluster with duodenal ulcer in Indian population

OpenAIRE

Alam, Jawed; Ghosh, Prachetash; Ganguly, Mou; Sarkar, Avijit; De, Ronita; Mukhopadhyay, Asish K

2015-01-01

Background The duodenal ulcer promoting gene (dupA) and dupA cluster in Helicobacter pylori have been described as a risk factor for duodenal ulcer development in some populations. Polymorphic gene dupA can be divided into two groups, intact dupA1 (long or short type based on the presence or absence of 615-bp extra sequences at the 5? region) having complete reading frame and other truncated dupA2 having frame-shift mutation. This study was aimed to elucidate the role of dupA of H. pylori and...

Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term low-dose aspirin therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial.

Science.gov (United States)

Sugano, Kentaro; Matsumoto, Yasushi; Itabashi, Tsukasa; Abe, Sumihisa; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Chiba, Tsutomu; Matsui, Shigeyuki; Kanto, Tatsuya; Shimada, Kazuyuki; Uchiyama, Shinichiro; Uemura, Naomi; Hiramatsu, Naoki

2011-06-01

The efficacy of low-dose lansoprazole has not been established for the prevention of recurrent gastric or duodenal ulcers in those receiving long-term low-dose aspirin (LDA) for cardiovascular and cerebrovascular protection. This study sought to examine the efficacy of low-dose lansoprazole (15 mg once daily) for the secondary prevention of LDA-associated gastric or duodenal ulcers. Patients were randomized to receive lansoprazole 15 mg daily (n = 226) or gefarnate 50 mg twice daily (n = 235) for 12 months or longer in a prospective, multicenter, double-blind, randomized active-controlled trial, followed by a 6-month follow-up study with open-label lansoprazole treatment. The study utilized 94 sites in Japan and 461 Japanese patients with a history of gastric or duodenal ulcers who required long-term LDA therapy for cardiovascular and cerebrovascular disease. The primary endpoint was the development of gastric or duodenal ulcers. The cumulative incidence of gastric or duodenal ulcers on days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 1.5, 2.1, and 3.7%, respectively, in the lansoprazole group versus 15.2, 24.0, and 31.7%, respectively, in the gefarnate group. The risk of ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.099 (95% confidence interval [CI] 0.042-0.230). Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term LDA therapy.

Cure of Helicobacter pylori-associated ulcer disease through eradication.

Science.gov (United States)

Malfertheiner, P; Leodolter, A; Peitz, U

2000-02-01

The eradication of Helicobacter pylori (H. pylori) infection has led to a dramatic benefit for patients with gastroduodenal ulcer disease, as the majority of these patients receive a lifelong cure. Relapses after successful H. pylori cure may be caused by either recrudescence or reinfection, both rare events nowadays, or be attributed to non-steroidal anti-inflammatory drugs or aspirin intake. In certain geographical areas, H. pylori-negative relapses are proposed as a new, pathophysiological and not yet elucidated entity. The cure of H. pylori infection in uncomplicated duodenal ulcer diseases consists of 7 days of proton pump inhibitor (PPI) based triple therapy, containing two antibiotics from clarithromycin, amoxicillin and metronidazole. In gastric ulcer, it is recommended that the PPI is continued for a further 3 weeks as these ulcers have a prolonged healing time. Rescue therapies after failure need to take into consideration the resistance pattern of the micro-organism and are offered in the form of quadruple therapy or a high-dose PPI with amoxicillin.

Gastroscintigraphy for the evaluation of stomach evacuatory function in patients with duodenal ulcer prior to and following surgery

Energy Technology Data Exchange (ETDEWEB)

Uskov, I.A.; Krylov, N.N.; Postolov, P.M.; Kuzin, N.M. (Pervyj Moskovskij Meditsinskij Inst. (USSR))

1984-07-01

While analysing 246 gastroscintigrams in 186 patients with duodenal ulcer prior to and at varying times after surgery 6 types of the evacuatory curves in preoperative examination have been defined (normal, degree 1 acceleration, degree 1-4 evacuatory retardation) as well as 8 types of the curves after different types of organ sparing operations with vagotomies (degree 1-2 acceleration, a curve which was close to normal and 1-4 degree evacuatory retardation). Gastroscintigraphy results make it possible to specify and quantify changes in stomach evacuatory function in order to select an optimum surgical method and to give an objective evaluation of the results of different types of vagotomy Used for the treatment of duodenal ulcer.

Gastroscintigraphy for the evaluation of stomach evacuatory function in patients with duodenal ulcer prior to and following surgery

International Nuclear Information System (INIS)

Uskov, I.A.; Krylov, N.N.; Postolov, P.M.; Kuzin, N.M.

1984-01-01

While analysing 246 gastroscintigrams in 186 patients with duodenal ulcer prior to and at varying times after surgery 6 types of the evacuatory curves in preoperative examination have been defined (normal, degree 1 acceleration, degree 1-4 evacuatory retardation) as well as 8 types of the curves after different types of organ sparing operations with vagotomies (degree 1-2 acceleration, a curve which was close to normal and 1-4 degree evacuatory retardation). Gastroscintigraphy results make it possible to specify and quantify changes in stomach evacuatory function in order to select an optimum surgical method and to give an objective evaluation of the results of different types of vagotomy Used for the treatment of duodenal ulcer

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

Background: Duodenal ulcer (DU) patients have impaired proximal duodenal mucosal bicarbonate secretion at rest and in response to luminal acid with higher acid-stimulated mucosal release of prostaglandin (PG) E(2) than healthy subjects. Our purpose was to determine whether this abnormality...... 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...... 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....

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.

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.

CLINICAL STUDY OF DUODENAL PERFORATION

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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

Characteristics and changes of gastric mucosal blood flow in patients with duodenal ulcer following highly selective vagotomy

International Nuclear Information System (INIS)

Doebroente, Zoltan; Kahan, Zsuzsanna; Baltas, Bela; Lang, Jenoe; Varro, Vince; Orvostudomanyi Egyetem, Szeged

1985-01-01

In patients with duodenal ulcer, mucosal blood flow of pentagastrin-stimulated stomach was studied using sup(99m)Tc-methylaminophenazone clearance technique published previously by the authors. Comparative investigations were carried out in active and inactive phases of the disease and in operated patients before and after highly selective vagotomy. The relation between gastric mucosal blood flow and acid secretion proved to be different from that of the normacid controls: in duodenal ulcer patients the secretory capacity in relation to the blood supply proved to be increased. Both the mucosal blood flow and acid secretion values were elevated in the active stage as compared to the inactive phase, while the proportion between them remained unchanged. The relation of secretion to mucosal blood flow after highly selective vagotomy became similar to that of the normal controls. It is suggested that the sup(99m)Tc-methylaminophenazone clearance method is a suitable tool to evaluate the effectiveness of vagotomy. (author)

Characteristics and changes of gastric mucosal blood flow in patients with duodenal ulcer following highly selective vagotomy

Energy Technology Data Exchange (ETDEWEB)

Doebroente, Z.; Kahan, Z.; Baltas, B.; Lang, J.; Varro, V. (Orvostudomanyi Egyetem, Szeged (Hungary). 1. Belklinika; Orvostudomanyi Egyetem, Szeged (Hungary). Koezponti Izotopdiagnosztikai Lab.)

1985-02-01

In patients with duodenal ulcer, mucosal blood flow of pentagastrin-stimulated stomach was studied using sup(99m)Tc-methylaminophenazone clearance technique published previously by the authors. Comparative investigations were carried out in active and inactive phases of the disease and in operated patients before and after highly selective vagotomy. The relation between gastric mucosal blood flow and acid secretion proved to be different from that of the normacid controls: in duodenal ulcer patients the secretory capacity in relation to the blood supply proved to be increased. Both the mucosal blood flow and acid secretion values were elevated in the active stage as compared to the inactive phase, while the proportion between them remained unchanged. The relation of secretion to mucosal blood flow after highly selective vagotomy became similar to that of the normal controls. It is suggested that the sup(99m)Tc-methylaminophenazone clearance method is a suitable tool to evaluate the effectiveness of vagotomy.

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

Directory of Open Access Journals (Sweden)

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.

Gastric emptying of 99mTc tagged solid food in gastric and duodenal ulceration

International Nuclear Information System (INIS)

Engler-Pinto Junior, Paulo; Gama-Rodrigues, Joaquim; Lopasso, Fabio P.; Cordeiro, Anoi C.; Pinotti, Henrique W.

1995-01-01

This study is to analyze gastric emptying (GE) of 99m Tc tagged solid meals in 43 gastric ulcer (GU), 16 duodenal ulcer (DU) patients, and 15 normal subjects. Diagnosis of active ulcers had been made through high gastrointestinal endoscopy. The patients with GU were divided in three groups according to Johnson's classification. Gastric contents were measured at 15 minutes intervals over a period of 150 minutes, with the person standing in front of a gamma-counter. The ge curve was obtained from the mean percentile of radioactive of all the groups measured at 15 minutes intervals. results were submitted to statistical analysis. Significant delay in GE in DU patients compared to normals, type II and type III group. However, GE of type I GU was not statistically different from the DU group nor of types II and III, occupying an intermediate e position. (author)

Biochemical changes in tissue catecholamines and serotonin in duodenal ulceration caused by cysteamine or propionitrile in the rat

International Nuclear Information System (INIS)

Szabo, S.; Horner, H.C.; Maull, H.; Schnoor, J.; Chiueh, C.C.; Palkovits, M.

1987-01-01

Previous structure-activity and pharmacologic studies with duodenal ulcerogens cysteamine and propionitrile implicating catecholamines in the pathogenesis of duodenal ulceration have now been followed up by dose- and time-response biochemical investigations to assess the importance of monoamines in the development of duodenal ulcers. The concentrations of norepinephrine (noradrenaline), dopamine, serotonin and their metabolites were measured in total brain, brain regions, stomach, duodenum, pancreas and adrenals in the rat. Turnover of catecholamines was determined in rats pretreated with the inhibitor of tyrosine hydroxylase alpha-methyl-p-tyrosine. The duodenal ulcerogens caused a dose- and time-dependent depletion of norepinephrine in virtually all the tissues examined. The effect was maximal 4 or 7 hr after cysteamine or propionitrile, and norepinephrine levels returned to normal in 24 hr. Dopamine changes were selective and often biphasic, e.g., elevation in adrenals, biphasic in brain cortex, hippocampus and midbrain, but uniformly decreasing in glandular stomach and duodenum. In the median eminence dopamine levels decreased by 181 and 324% at 15 and 30 min, respectively, after cysteamine, but neither dopamine nor 3,4-dihydroxyphenylacetic acid was modified in the periventricular nucleus. Serotonin levels were relatively stable, revealing slight elevations or no changes in most of the tissues. The turnover of norepinephrine was accelerated by both chemicals in virtually all brain regions, but dopamine turnover was affected only in a few areas, e.g., in the corpus striatum and medulla oblongata cysteamine decreased dopamine turnover, whereas propionitrile first (at 1 hr) accelerated then (at 8 hr) significantly suppressed it.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful Endoscopic Management of Non-Healing Perforated Duodenal Ulcer with Polyglycolic Acid Sheet and Fibrin Glue.

Science.gov (United States)

Mishiro, Tsuyoshi; Shibagaki, Kotaro; Matsuda, Kayo; Fukuyama, Chika; Okada, Mayumi; Mikami, Hironobu; Izumi, Daisuke; Yamashita, Noritsugu; Okimoto, Eiko; Fukuda, Naoki; Aimi, Masahito; Fukuba, Nobuhiko; Oshima, Naoki; Takanashi, Toshihiro; Matsubara, Takeshi; Ishimura, Norihisa; Ishihara, Shunji; Kinoshita, Yoshikazu

2016-08-01

In recent years, treatment techniques in which polyglycolic acid sheets are applied to various situations with fibrin glue have exhibited great clinical potential, and previous studies have reported safety and efficacy. We describe closure of a non-healing perforated duodenal ulcer with the use of a polyglycolic acid sheet and fibrin glue in an elderly patient who was not a candidate for surgery.

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

OpenAIRE

Prasenjit; Himadri Sekhar; Amalesh; Tanumoy

2014-01-01

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 ...

Life event stress in duodenal ulcer compared with functional dyspepsia: A case-control study

OpenAIRE

Abdel Hafeiz Hassan; Al Quorain Abdulaziz; Karim Ahmed; Al-Mangoor Shuaa

1997-01-01

This is a prospective study of life event stress in 80 duodenal ulcer patients compared with 80 patients with functional dyspepsia and 80 healthy controls; matched for age, sex and marital status. A semi structured psychiatric interview was used in the psychiatric assessment of the dyspeptic patients and controls. A modified version of Life Events Scale by Tennant and Andrews was used in the assessment of life event stress. More dyspeptic patients reported life events than the controls, but, ...

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...

Prevalence of duodenal ulcer-promoting gene (dupA) of Helicobacter pylori in patients with duodenal ulcer in North Indian population.

Science.gov (United States)

Arachchi, H S Jayasinghe; Kalra, Vijay; Lal, Banwari; Bhatia, Vikram; Baba, C S; Chakravarthy, S; Rohatgi, S; Sarma, Priyangshu M; Mishra, V; Das, Bimal; Ahuja, Vineet

2007-12-01

The duodenal ulcer (DU)-promoting gene (dupA) of Helicobacter pylori has been identified as a novel virulent marker associated with an increased risk for DU. The presence or absence of dupA gene of H. pylori present in patients with DU and functional dyspepsia in North Indian population was studied by polymerase chain reaction (PCR) and hybridization analysis. One hundred and sixty-six patients (96 DU and 70 functional dyspepsia) were included in this study. In addition, sequence diversity of dupA gene of H. pylori found in these patients was analyzed by sequencing the PCR products jhp0917 and jhp0918 on both strands with appropriate primers. PCR and hybridization analyses indicated that dupA gene was present in 37.5% (36/96) of H. pylori strains isolated from DU patients and 22.86% (16/70) of functional dyspepsia patients (p dupA was significantly associated with the cagA-positive genotype (p dupA gene with DU in this population. The dupA gene can be considered as a novel virulent marker for DU in this population.

Promotion of ulcerative duodenitis in young ferrets by oral immunization with Helicobacter mustelae and muramyl dipeptide.

Science.gov (United States)

Whary, M T; Palley, L S; Batchelder, M; Murphy, J C; Yan, L; Taylor, N S; Fox, J G

1997-06-01

The purpose of this study was to determine whether oral immunization of ferret kits with a whole-cell sonicate of Helicobacter mustelae lysate (Hml) and the adjuvant muramyl dipeptide (MDP) would reduce the incidence of natural colonization with H. mustelae and the extent of Helicobacter-associated gastritis by enhancing the host mucosal immune response. Between the ages of 4 and 11 weeks, 44 ferret kits were gavaged with Hml and various doses of MDP. The extent of gastritis and duodenitis and the immune response to H. mustelae were evaluated. All kits became colonized naturally with H. mustelae and the majority developed mild to severe gastritis and duodenitis. Kits that received Hml with MDP developed significantly greater inflammation of the gastric antrum and duodenum, as compared to kits vaccinated with Hml alone. Vaccination with Hml and 50 micrograms of MDP was associated with severe lesions in the proximal duodenum characterized by accumulation of mononuclear inflammatory cells, mucosal erosion, and ulceration. Although serum antibody specific for H. mustelae in 4-week-old kits was approximately 50% of adult levels, a finding attributable to passively acquired maternal antibody, both systemic and mucosal antibody levels became depressed over time despite oral vaccination. The humoral immune response was sufficiently low to prevent detection of any significant dose effect of MDP on antibody levels among experimental groups. Oral vaccination of young ferrets with Hml and 50 micrograms MDP increased the risk of Helicobacter-associated mucosal ulceration in the proximal duodenum, which was associated with low humoral (but significant cell-mediated) immune responses to H. mustelae. In retrospect, the frequency of vaccination may have suppressed the systemic humoral immune response, thereby promoting mucosal damage by H. mustelae. The 50-microgram dose of MDP enhanced the cell-mediated immune response, which indirectly contributed to development of severe lesions

Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term non-steroidal anti-inflammatory drug (NSAID) therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial.

Science.gov (United States)

Sugano, Kentaro; Kontani, Teiji; Katsuo, Shinichi; Takei, Yoshinori; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Asaka, Masahiro; Matsui, Shigeyuki; Kanto, Tatsuya; Soen, Satoshi; Takeuchi, Tsutomu; Hiraishi, Hideyuki; Hiramatsu, Naoki

2012-05-01

Low-dose lansoprazole has not been intensively evaluated for its efficacy in the prevention of recurrent gastric or duodenal ulcers in patients receiving long-term non-steroidal anti-inflammatory drug (NSAID) therapy for pain relief in such diseases as rheumatoid arthritis, osteoarthritis, and low back pain. This multi-center, prospective, double-blind, randomized, active-controlled study involving 99 sites in Japan was designed to compare the efficacy of lansoprazole (15 mg daily) with gefarnate (50 mg twice daily). Patients with a history of gastric or duodenal ulcers who required long-term NSAID therapy were randomized to receive lansoprazole 15 mg daily (n = 185) or gefarnate 50 mg twice daily (n = 181) and followed up for 12 months or longer prospectively. The cumulative incidence of gastric or duodenal ulcer at days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 3.3, 5.9, and 12.7%, respectively, in the lansoprazole group versus 18.7, 28.5, and 36.9%, respectively, in the gefarnate group. The risk for ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.2510 (95% CI 0.1400-0.4499). A long-term follow-up study showed an acceptable safety profile for low-dose lansoprazole therapy, with diarrhea as the most frequent adverse event. Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term NSAID therapy.

The protective role of Aegle marmelos on aspirin-induced gastro-duodenal ulceration in albino rat model: a possible involvement of antioxidants.

Science.gov (United States)

Das, Shyamal K; Roy, Chandan

2012-01-01

Gastro duodenal ulcer is a common disorder of the gastrointestinal tract. Several Indian medicinal plants have been traditionally and extensively used to prevent different diseases. In the present research studies, Bael fruit (Aegle marmelos (AM), family: Rutaceae) which are also called as Bilva in ancient Sanskrit was used as a herbal drug and its antioxidative role in aspirin- induced gastroduodenal ulceration in albino rat was evaluated using essential biochemical parameters. Mucosal thickness (MT), ulcer index (UI), different biochemical parameters, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH), and lipid peroxidation (LPO) were measured in all the groups, to study the possible involvement of antioxidants with gastroduodenal protection. A significant decrease in MT, SOD and CAT activities and GSH level and a significant increase in UI, AST, ALT, and ALP activities and LPO level were observed in aspirin treated stomach and duodenum of albino rats. Pretreatment with AM fruit pulp extract for 14 consecutive days showed the reverse effects of aspirin suggesting gastro-duodenal protective and anti- ulcerogenic properties of AM through its antioxidant mechanism.

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

Directory of Open Access Journals (Sweden)

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.

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

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Elisabete Kawakami

2004-08-01

Full Text Available 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 anos e 4 meses (mediana = 12 anos e 4 meses. O sintoma mais freqüente foi dor abdominal (39/43, 90,7%: no epigástrio em 31/39, periumbilical em 7/39 e noturna em 27/39. Outros sintomas freqüentes foram: diminuição do apetite (32/43, 74,4%, vômitos (30/43, 69,8%, plenitude pós-prandial (23/43, 53,5%, perda de peso (22/43, 51,2% e sensibilidade abdominal (19/43, 44,2%. Hemorragia digestiva alta ocorreu em 19/43 pacientes (44,2%, e anemia em 21/43 (48,8%. H. pylori foi detectado em 41/43 (95,3%, e todos esses pacientes apresentaram gastrite crônica ativa de antro, 92% deles com predomínio do infiltrado linfomononuclear. A erradicação da bactéria ocorreu em 68,3% dos pacientes infectados, mas houve cicatrização da lesão em 100% dos pacientes erradicados e em 89% dos não-erradicados. CONCLUSÃO: Úlcera duodenal foi associada à gastrite crônica por H. pylori na grande maioria dos pacientes. Houve grande freqüência de complicações, especialmente hemorragia digestiva alta.OBJECTIVE: To evaluate clinical and histological features of duodenal ulcer in children and adolescents. METHODS: Forty-three children with duodenal ulcer were prospectively and consecutively evaluated in a 6-year period (7.2 patients per year. Evaluation included clinical questionnaire focused on dyspeptic symptoms, physical examination, and digestive endoscopy with gastric biopsies for histological examination and Helicobacter pylori detection. RESULTS

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana.

Science.gov (United States)

Archampong, Timothy N A; Asmah, Richard H; Wiredu, Edwin K; Gyasi, Richard K; Nkrumah, Kofi N

2016-06-01

There is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 - 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana. This study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana. This study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy. Of 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAID-use. H. pyloriwas associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003. H. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.

Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people.

Science.gov (United States)

Ford, Alexander C; Gurusamy, Kurinchi Selvan; Delaney, Brendan; Forman, David; Moayyedi, Paul

2016-04-19

Peptic ulcer disease is the cause of dyspepsia in about 10% of people. Ninety-five percent of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H. pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain. This is an update of Ford AC, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive patients. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003840. DOI: 10.1002/14651858.CD003840.pub4. To assess the proportion of peptic ulcers healed and the proportion of participants who remained free from relapse with eradication therapy against placebo or other pharmacological therapies in H. pylori-positive people.To assess the proportion of participants that achieved complete relief of symptoms and improvement in quality of life scores.To compare the incidence of adverse effects/drop-outs (total number for each drug) associated with the different treatments.To assess the proportion of participants in whom successful eradication was achieved. In this update, we identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1950 to March 2016) and Ovid EMBASE (1980 to March 2016). To identify further relevant trials, we handsearched reference lists from trials selected by electronic searching, and published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology). The search was last updated in March 2016. We contacted members of Cochrane Upper GI and Pancreatic Diseases, and experts in the field and asked them to provide details of outstanding clinical trials and any relevant unpublished materials. We analysed randomised controlled trials of short- and long-term treatment of peptic ulcer disease in H. pylori-positive adults. Participants received at least one week of H. pylori

A Prospective Study of Periodontal Disease and Risk of Gastric and Duodenal Ulcer in Male Health Professionals

OpenAIRE

Boylan, Matthew R; Khalili, Hamed; Huang, Edward S; Michaud, Dominique S; Izard, Jacques; Joshipura, Kaumudi J; Chan, Andrew T

2014-01-01

OBJECTIVES: Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer. METHODS: We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40–75 years at enrollment in 1986. Biennially, we assessed periodo...

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 

Anatomical distribution of peptic ulcer in high incidence gastric cancer area

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Anuar Alonso Cedeño-Burbano

2014-12-01

Full Text Available Background: Peptic ulcer makes reference to the solution of continuity of gastric or duodenal wall beyond muscularis mucosae. Previously, duodenal location was more common than gastric, in a ratio ranging from 2:1 to 4:1. Despite this, after the discovery of the association between peptic ulcer and Helicobacter pylori, relationship between gastric and duodenal ulcer has spread to the equality. However, in areas with high incidence of gastric cancer, peptic ulcer seems to have a different behavior, existing predominance of gastric ulcer. Department of Cauca is have the highest incidence of gastric cancer in Colombia, with an annual rate of 42.5 /100,000 for males and 28.6 / 100,000 for women; however, it is unknown how peptic ulcer anatomically are distributed. Objective: To determine the anatomical distribution of peptic ulcer at endoscopy service of San José University Hospital of Popayán-Cauca, Colombia 2006-2012. Methods: A descriptive cross-sectional study was realized. Database of endoscopy service of San José University Hospital of Popayán was reviewed and reports with diagnosis of peptic ulcer were studied. Data were analyzed using SPSS-15. Results: Gastric ulcer was more common than duodenal ulcer. Gastric ulcer was more common in men (gastric and duodenal ulcer 1:1. In women duodenal ulcer is 1:1. Conclusion: At endoscopy service of San José University Hospital, gastric ulcer is more common than duodenal ulcer, with differences in gender, as in other areas with high incidence of gastric cancer. That fact are suggests in current literature could be related with the presence of stumps of Helicobacter pylori with combined virulence for cancer and ulcer at gastric level seems to be related to the presence in the medium of common virulence strains of Helicobacter pylori for stomach cancer and ulcer gastric, although the current literature is unclear about it, and still needs more validations.

Stress Ulcer Disease in the Burned Patient

Science.gov (United States)

1981-03-01

appearance of gastritis and duodenitis and their morphologic and histologic characteristics point to impaired mucosal blood flow and focal is...Gastric Duodenal disease disease study study Total number of patients 54 37 Gastritis 45 18 Duodenitis 34 15 Acute gastric ulcer 14 6...early mucosai slough, which ap- peared to be incipient ulcerations, showed in- farction necrosis on histologic examination. The le- sions of each of

Challenging diagnosis — Icterus associated with a single perforating duodenal ulcer after long-term nonsteroidal antiinflammatory drug administration in a dog

Science.gov (United States)

2004-01-01

Abstract A dog developed icterus, vomiting, and anorexia 2 wk after orthopedic surgery and treatment with meloxicam for approximately 1 y. Exploratory laparotomy revealed a single perforated duodenal ulcer. The most likely cause of the hyperbilirubinemia was intrahepatic cholestasis resulting from peritonitis associated with the perforation. PMID:15283521

Cost effectiveness of Alternative Helicobacter pylori Eradication Strategies in the Management of Duodenal Ulcer

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Bernie O'Brien

1997-01-01

Full Text Available Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin are more costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

Factors associated with gastro-duodenal disease in patients ...

African Journals Online (AJOL)

Background: There is a high prevalence of gastro-duodenal disease in sub Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 – 25%). Limited data exists regarding its associated risk ...

Peptic ulcer disease - discharge

Science.gov (United States)

... or raw area in the lining of the stomach (gastric ulcer) or upper part of the small intestine (duodenal ... You have peptic ulcer disease (PUD). You may have had tests to help diagnose your ulcer. One of these tests may have ...

Peptic ulcer pathophysiology: acid, bicarbonate, and mucosal function

DEFF Research Database (Denmark)

Højgaard, L; Mertz Nielsen, A; Rune, S J

1996-01-01

The previously accepted role of gastric acid hypersecretion in peptic ulcer disease has been modified by studies showing no correlation between acid output and clinical outcome of ulcer disease, or between ulcer recurrence rate after vagotomy and preoperative acid secretion. At the same time......, studies have been unable to demonstrate increased acidity in the duodenal bulb in patients with duodenal ulcer, and consequently more emphasis has been given to the mucosal protecting mechanisms. The existence of an active gastric and duodenal mucosal bicarbonate secretion creates a pH gradient from...... cell removal and repair regulated by epidermal growth factor. Sufficient mucosal blood flow, including a normal acid/base balance, is important for subepithelial protection. In today's model of ulcer pathogenesis, gastric acid and H. pylori work in concert as aggressive factors, with the open question...

Gastric Outlet Obstruction from Duodenal Lipoma in an Adult ...

African Journals Online (AJOL)

Gastric Outlet Obstruction from Duodenal Lipoma in an Adult. ... Nigerian Journal of Surgery ... 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 ...

Anti-ulcer Activity.

Science.gov (United States)

2016-01-01

This chapter explains the procedure of ethanol-induced ulcer to check the protective effect of drugs over induced ulcer in rats. Ulcer is defined as the erosion in the lining of the stomach or duodenum and is caused by the disruptions of the gastric mucosal defence and repair systems. Ulceration of stomach is called gastric ulcer and that of duodenum is called duodenal ulcer and together peptic ulcer. In clinical practice, peptic ulcer is one of the most prevalent gastrointestinal disorders, which commonly occurs in developed countries.

Laparoscopic pyloroplasty for perforated peptic ulcer.

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Grišin, Edvard; Mikalauskas, Saulius; Poškus, Tomas; Jotautas, Valdemaras; Strupas, Kęstutis

2017-09-01

Peptic ulcer is a common disease affecting millions of people every year. Despite improved understanding and treatment of the disease, the number of patients admitted with duodenal peptic ulcer perforation has not decreased. Deaths from peptic ulcer disease overcome other common emergency situations. Laparoscopic repair of the perforated peptic ulcer (PPU) is the gold standard approach for simple perforation. However, in patients with large perforated chronic ulcers laparotomy with pyloroplasty is the standard treatment. It is generally accepted to perform open surgery in PPU emergencies because of the greater knowledge and experience gathered over the past decades and less potential harm for the patient or surgical complications. We present a case of successful laparoscopic pyloroplasty of a perforated duodenal ulcer with stenosis.

Campylobacter pylori as possible factor in peptic ulcer recurrence

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Rauws, E. A.

1989-01-01

The author reviews the literature up to 1988 about the close association of Campylobacter pylori with chronic active gastritis, duodenitis and peptic ulcer disease. No firm data however demonstrate that Campylobacter pylori causes duodenal ulcer but long term eradication of this bacterium prevents

Acute perforated duodenal ulcer in Maiduguri: experience with simple closure and Helicobacter pylori eradication.

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Nuhu, A; Madziga, A G; Gali, B M

2009-01-01

Effective medical management of peptic ulcer disease (PUD) has reduced the incidence of gastric outlet obstruction (GOO) as a complication, but perforation especially in the elderly remains unchanged and is in fact on the increase. There is a changing trend in emergency surgery for perforated duodenal ulcer (PDU) from definitive anti ulcer surgery to simple closure followed by Helicobacter pylori eradication. To present our experience in managing PDU with simple closure followed by Helicobacter pylori eradication. This was a chart review of patients managed for PDU over a nine year period (Jan 1999 to Dec 2007) using information obtained from ward admission registers, theatre operation registers, and patients case files from the medical records department. The patients biodata, clinical, and operative findings as well as treatment outcome were extracted for analysis. Of 55 patients eligible for analysis, 44 (80%) were males and 11(20%) females (M to F, 4:1). Their ages ranged between 18 and 65 years with a mean(SD) of 39.9 (13.5) years. Most of the patients, 34 (61.8%), were below 40 years of age and majority 39(71.0%) had a history suggestive of chronic peptic ulcer disease. Twenty six (47.3%) patients presented within 24 hours of perforation, while nine (16.4%) presented more than 72 hours afterwards. The latter group accounted for most, five(55.6%), of the mortality. All the perforations were anterior pyloroduodenal and all except one had simple closure with omental patch followed by a course of a proton pump inhibitor and Helicobacter pylori eradication therapy. Simple closure with omental patch followed by Helicobacter pylori eradication is effective in managing PDU with low morbidity and mortality despite patients late presentation in our center. This technique is recommended in place of a definitive ulcer surgery.

Perforated duodenal diverticulum caused by Bezoar: A case report

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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.

Perforated duodenal diverticulum caused by Bezoar: A case report

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Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae

2013-01-01

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.

[Circadian rhythms of acid production and alkalization in the stomach of healthy subjects and duodenal ulcer patients].

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Kolesnikova, I Iu; Beliaeva, G S; Leint'eva, V A; Smirnova, A A

2008-01-01

We studied 24-h rhythms of acid production and alkalization in 30 patients with duodenal ulcer (DU) and 30 healthy subjects using upper endoscopic examination and computer intragastric pH-metry. Gastric acid production was higher in DU patients and was more intensive in the daytime than at night. Healthy subjects had low and monotonous acid production. In DU decompensation of alkalization in the antral stomach and suppression of duodenogastric reflux is total. In healthy subjects antrum alkalization is more evident and intensive at night due to, among other causes, duodenogastric reflux.

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

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Oribabor, Felix O; Adebayo, Bamidele O; Aladesanmi, Tunde; Akinola, David O

2013-01-01

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. 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. 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. 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 pre-operative risk factors.

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

Morphological peculiarities of duodenal peptic ulcer and leucocytes functional activity in the persons who were present in the zone of the accident at Chernobyl Atomic Power Station

International Nuclear Information System (INIS)

Babak, O.Ya.; Kushnyir, Yi.E.; Bobro, L.M.; Karamishev, D.V.

1994-01-01

36 persons with duodenal peptic ulcer (DPU) who were in the zone of the accident at Chernobyl Atomic Power Station (experimental group) and 20 patients who were not exposed to small doses of ionizing radiation were examined to study morphological peculiarities of DPU and blood leucocytes functional activity in the persons who were present in the zone of the accident. The finding have shown that in the persons, exposed to small doses of ionizing radiation, peptic ulcer is often accompanied by erosive changes of gastric and duodenal mucosa. Disturbance of mucus formation in myocytes and secret evacuation from the cells, epithelium large-intestine-type metaplasia, were revealed. Shift of cellular correlation balance in inflammatory infiltrate to the side of monocytes number increase as well as decrease of leucocytes functional activity, manifesting itself by slowing a granulocytes migration to the focus of inflammation, were noted, which is necessary to take into account at administration of effective peptic ulcer therapy in the persons who were in the zone of the accident at Chernobyl Atomic Power Station

Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

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Ramon Banos Madrid; Fernando Alberca de las Parras; Angel Vargas Acosta and others

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

International Nuclear Information System (INIS)

Banos Madrid, Ramon; Alberca de las Parras, Fernando; Vargas Acosta, Angel and others

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

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.

[ENDOSCOPIC ANATOMY AND MORPHOLOGICAL CHANGES OF THE GASTRODUODENAL JUNCTION IN ULCER OF THE DUODENUM].

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Kolesnikova, E V; Dronova, O B; Kagan, Il; Tretjakov, A A; Kogan, E L

2015-01-01

To Improve the diagnosis of duodenal ulcer and preneoplastic changes of gastroduodenal transition. 112 patients with duodenal ulcer, 208 healthy pearsons of three age periods: second period of mature age, elderly and senile age were examined. Video endoscopy equipment company "OLYMPUS" (Japan), morphological methods and the determination of Helicobacter pylori (Hp) were used. The connecting line of gastric and duodenal mucous membrane can be located on the gastric side of the pylorus (13% in normal cases and 22.3% in cases of ulcer disease), on pylorus and go into the bulbus of duodenum (87% and 77.7 %, respectively), in cases of duodenal ulcer the connecting line more often has jagged and tongue-shaped form. Mucous membrane forms folds in prepyloric part of the stomach most often on the front wall in healthy pearsons in 14.4% of cases, in patients with duodenal ulcer--in 75.9%. The number of folds decreases with age. HP, atrophy, intestinal metaplasia of the mucous membrane is more often found in duodenal ulcer disease--76.8%, 69.7% and 62.5% comparing with healthy persons: 51.4%, 5.3% and 47.7% respectively. Frequency of preneoplastic changes increases with age. The individual differences of the mucous membrane of the gastroduodenal transition are identified. They are expressed in the particular location and shape of the connecting line of gastric and duodenal mucous membranes in normal cases and in cases of ulcer disease in different age groups. Some endoscopic changes requiring biopsy and morphological studies are revealed.

Gastric ulceration in dog: A review

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J. D. Parrah

Full Text Available The common acid related diseases of the upper gastrointestinal tract could be considered as primarily due to the defect in barrier function either of the gastric mucosal or duodenal epithelium leading to the formation of gastric or duodenal ulcers. An attempt was made in this review to discuss the classification, pathophysiology, diagnosis and treatment of gastric ulcer in dogs. Early surgical advances in the management of peptic ulcers are emphasized that were then subsequently replaced by pharmacological treatment (histamine H2-receptor antagonists, proton pump inhibitors and considered as the major strategy against the acid disorders. [Vet World 2013; 6(7.000: 449-454

[Epidemiological changes in peptic ulcer and their relation with Helicobacter pylori. Hospital Daniel A Carrion 2000-2005].

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Montes Teves, Pedro; Salazar Ventura, Sonia; Monge Salgado, Eduardo

2007-01-01

Peptic ulcer disease is a frequent pathological condition. In the last few years there have been reports describing changes in its epidemiology and its association with Helicobacter pylori infection. To describe epidemiological characteristics of peptic ulcers during the study period from January 2000 through December 2005 in Hospital Daniel Carrion. Cross sectional analitical study. All patients with an endoscopic diagnosis of peptic ulcer were included. Patients with gastric cancer or previous surgery were excluded. Data were processed using the SPSS 9.0 software. We reviewed 10,819 endoscopy reports with 899 peptic ulcer cases diagnosed during the study period. 67.8% were male, age average 54 years. Age was higher in females (59.8 y), as was in those with gastric and pyloric ulcers (68.7 y). Most frequent endoscopic indications were upper gastrointestinal bleeding (53.3%) and dyspepsia (43.8%). Duodenal location was the most frequent (49.5%) although in recent years gastric ulcers have become more prevalent. Gastric ulcers were more commonly located in the antrum lesser curvature, while duodenal ulcers were located in the anterior wall of the duodenal bulb. Gastric ulcers were larger in size and more in number than duodenal ones. Helicobacter pylori was present in 65.3% of all ulcers, 74.3% for duodenal and 55.4% for gastric ulcers. Prevalence of peptic ulcers during the study period was 83.09 cases per 1,000 endoscopies. Duodenal ulcers were the most frequent although there is a decline in the last years. There is also a decrease in the frequency of Helicobacter pylori infection as compared to what is usually described.

Association of Intact dupA (dupA1) rather than dupA1 cluster with duodenal ulcer in Indian population.

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Alam, Jawed; Ghosh, Prachetash; Ganguly, Mou; Sarkar, Avijit; De, Ronita; Mukhopadhyay, Asish K

2015-01-01

The duodenal ulcer promoting gene (dupA) and dupA cluster in Helicobacter pylori have been described as a risk factor for duodenal ulcer development in some populations. Polymorphic gene dupA can be divided into two groups, intact dupA1 (long or short type based on the presence or absence of 615-bp extra sequences at the 5' region) having complete reading frame and other truncated dupA2 having frame-shift mutation. This study was aimed to elucidate the role of dupA of H. pylori and their clusters in the disease manifestation of Indian population. A total of 170 H. pylori strains were screened for the presence of dupA, dupA alleles and dupA cluster by PCR and sequencing. Pro-inflammatory cytokine (IL-8) with different dupA variant H. pylori stimulated gastric epithelial cells (AGS cells) was measured by ELISA. A total of 50 strains (29.4%) were positive for dupA among the tested 170 strains. The prevalence of dupA1 in duodenal ulcer (DU) and non-ulcer dyspepsia (NUD) populations was found to be 25.5% (25/98) and 11.1% (8/72), respectively and 16.4% (28/170) of the tested strains had dupA1, cagA and vacAs1m1 positive. The distribution of long and short type dupA1 has not been significantly associated with the disease outcome. The dupA cluster analysis showed that 10.2% (10/98) and 8.3% (6/72) strains were positive among DU and NUD, respectively. IL-8 production was significantly higher in dupA1(+) , cagA (+), vacA (+) (902.5 ± 79.01 pg/mL) than dupA2 (+) , cagA (+) , vacA (+) (536.0 ± 100.4 pg/mL, P = 0.008) and dupA (-), cagA (+), vacA (+) (549.7 ± 104.1 pg/mL, P = 0.009). Phylogenetic analysis of dupA indicated that the Indian H. pylori strains clustered with East Asian strains but distinct from Western strains. This is the first known genetic element of Indian H. pylori that is genetically closer to the East Asian strains but differed from the Western strains. The intact dupA1 was significantly associated with DU than NUD (P = 0

Peptic Ulcer Disease in Bangladesh: A Multi-centre Study.

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Ghosh, C K; Khan, M R; Alam, F; Shil, B C; Kabir, M S; Mahmuduzzaman, M; Das, S C; Masud, H; Roy, P K

2017-01-01

The incidence of peptic ulcer has steadily declined through out the world. This decreasing trend is also noticeable in this subcontinent. The point prevalence of peptic ulcer (PUD) in Bangladesh was around 15% in eighties. The aim of this study was to see the present prevalence of peptic ulcer at endoscopy and to identify changing trends in the occurrence of peptic ulcer in Bangladesh. This retrospective analysis of the endoscopic records of multiple tertiary referral centres of Dhaka city were done from January 2012 to July 2013. A total of 5608 subjects were the study samples. We included those patients having peptic ulcer in the form of duodenal ulcer, benign gastric ulcer including pre-pyloric ulcer and gastric outlet obstruction due to peptic ulcer. Duodenal ulcer and benign gastric ulcer were found in 415(7.4%) and 184(3.28%) patients respectively and gastric outlet obstruction due to peptic ulcer was found in 23(0.40%) patients.

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.

Does Ramadan Fasting Increase duodenal ulcer perforation?

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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.

[Treatment of disbacteriosis of gastroduodenal mucous microflora in mucosa inflammation, ulcer and erosion].

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Chernin, V V; Chernivets, V M; Bondarenko, V M; Bazlov, S N

2011-01-01

To propose pharmacotherapy of disbacteriosis of gastroduodenal mucous microflora in gastroduodenal inflammation, erosion and ulcer. The study enrolled 30 healthy volunteers, 130 ulcer patients and 36 patients with chronic gastritis (27% of the latter had chronic duodenitis). In addition to general clinical examination, fibrogastroduodenoscopy, we made histological and microbiological examinations of biopsy specimens of the mucosa from different parts of the stomach and duodenum, determined sensitivity of the microflora to antibacterial drugs. We found that recurrent ulcer, chronic gastritis and duodenitis are accompanied with overgrowth of pathogenic microflora in gastric and duodenal mucosa. We developed an effective method of the treatment of gastroduodenal mucosa microflora disbacteriosis in gastroduodenal inflammation, erosion and ulcer including antibacterial, antifungal drugs and probiotics.

Dietary Phytosterols Protective Against Peptic Ulceration

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Tovey, Frank I; Capanoglu, Doga; Langley, G. John; Herniman, Julie M; Bor, Serhat; Ozutemiz, Omer; Hobsley, Michael; Bardhan, Karna Dev; Linclau, Bruno

2011-01-01

Background In developing countries the prevalence of duodenal ulceration is related to the staple diet and not to the prevalence of Helicobacter pylori. Experiments using animal peptic ulcer models show that the lipid fraction in foods from the staple diets of low prevalence areas gives protection against ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs), and also promotes healing of ulceration. The lipid from the pulse Dolichos biflorus (Horse gram) was highly active and used for further investigations. Further experiments showed the phospholipids, sterol esters and sterols present in Horse gram lipid were gastroprotective. Dietary phospholipids are known to be protective, but the nature of protective sterols in staple diets is not known. The present research investigates the nature of the protective phytosterols. Methods Sterol fractions were extracted from the lipid in Dolichos biflorus and tested for gastroprotection using the rat ethanol model. The fractions showing protective activity were isolated and identification of the components was investigated by Gas Chromatography-Mass Spectrometry (GC-MS). Results The protective phytosterol fraction was shown to consist of stigmasterol, β-sitosterol and a third as yet unidentified sterol, isomeric with β-sitosterol. Conclusions Dietary changes, affecting the intake of protective phospholipids and phytosterols, may reduce the prevalence of duodenal ulceration in areas of high prevalence and may reduce the incidence of recurrent duodenal ulceration after healing and elimination of Helicobacter pylori infection. A combination of phospholipids and phytosterols, such as found in the lipid fraction of ulceroprotecive foods, may be of value in giving protection against the ulcerogenic effect of NSAIDs. PMID:27942332

Perforated peptic ulcer following gastric bypass for obesity.

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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.

Perforated Duodenal Ulcer

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Jessa Baker

2016-09-01

Full Text Available History of present illness: A 53-year-old male with a history of daily alcohol abuse presented with sudden onset epigastric pain. The pain radiated to the right upper abdominal quadrant and was associated with shortness of breath and nausea. The patient’s vitals were notable for blood pressure of 181/107 and a heart rate of 124. He was in moderate distress and had a firm, distended abdomen with diffuse tenderness to palpation, without rebound or guarding. Significant findings: In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver and the left diaphragm, consistent with pneumoperitoneum. Discussion: A perforated ulcer is a surgical emergency. Overall mortality has been shown to be approximately 6.2%.1 Rapid diagnosis is essential as prognosis improves if treatment is initiated within the first six hours and worsens after 12 hours.2 The sensitivity for detecting pneumoperitoneum on plain radiography ranges from 50%-80%3-8 with specificity of 53%.7 An upright chest radiograph can detect as little as one to two milliliters of air.9,10 If free air is not seen on a posteroanterior (PA upright chest radiograph, an upright lateral chest radiograph can be obtained, which is more sensitive (98% sensitivity.8,11 About 10%-20% of ruptured ulcers will not present with visible free-air under the diaphragm on plain x-ray.12 In this case, given the free air seen on chest radiograph and peritoneal signs on exam, the patient was taken straight to the operating room for general surgery.

Perforated duodenal ulcer -a rare cause of acute abdomen in pregnancy.

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Goel, Bharti; Rani, Jyotsna; Huria, Anju; Gupta, Pratiksha; Dalal, Usha

2014-09-01

Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind while dealing with cases of acute abdomen in pregnancy and to proceed with multidisciplinary approach for better feto-maternal outcome.

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

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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.

Helicobacter Pylori Associated Antral Gastritis in Peptic Ulcer Disease Patients and Normal Healthy Population of Kashmir, India

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Gh. Jeelani Romshoo; G. M. Malik; M. Youssuf Bhat; Ab. Rashid rather; Javaid Ahmad Basu; Khursheed Ahmad Qureshi

1998-01-01

Aim: To study the association of Helicobacter pylori infection with chronic antral gastritis in peptic ulcer disease patients and healthy population of Kashmir. Methods: 50 peptic ulcer patients (duodenal ulcer = 46, gastric ulcer = 2 and combined duodenal and gastric ulcer = 2) and 30 asymptomatic healthy volunteers were included in this study. Peptic ulcer was diagnosed on endoscopic examination. 4–6 punch biopsies were taken from gastric antrum in all the individuals and in case of gastric...

Diagnostic value of determination of serum pepsinogen and gastrin levels in patients with peptic ulcer

International Nuclear Information System (INIS)

Xiao Zhansen; Li Jingrong; Feng Jiandong; Wang Yuqiong; Fu Xiufeng; Zhang Lanfeng

2005-01-01

Objective: To investigate the clinical significance of changes of serum pepsinogen and gastrin levels in patients with gastric/duodenal ulcer. Methods: Serum pepsinogen I (PG I), pepsinogen II (PGII), gastrin levels and PG I/PG II ratio were determined with RIA in 100 controls, 61 patients with duodenal ulcer, 46 patients with gastric ulcer, 66 patients with gastric cancer and 101 patients with chronic gastritis. Results: In patients with peptic ulcer (gastric/duodenal), the serum levels of PG I, PG II and PG I/PG II ratio were significantly higher than those in controls (P<0.001); the serum gastrin levels were also significantly higher than those in controls and patients with chronic gastritis (P<0.001), but lower than those in patients with gastric cancer (P<0.001). Among patients with peptic ulcer, the serum PG I level and PG I/PG II ratio were significantly higher in patients with duodenal ulcer than those in patients with gastric ulcer (P<0.001). Conclusion: Excessive high serum levels of PG I, PG II, gastrin and PG I/PG II ratio were some of the high risk factors for peptic ulcer. Those were useful serum markers for diagnosis and follow-up of the disease. (authors)

Pancreatic-induced Intramural Duodenal Haematoma

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Julius K. Ma

2008-04-01

Full Text Available Spontaneous intramural duodenal haematoma (IDH is an uncommon pathology and it is usually related to anticoagulant therapy. Other causes include various pancreatic diseases, connective tissue disease, peptic ulcer disease and pancreaticoduodenal aneurysm. IDH of pancreatic origin has been infrequently reported. The disease course can be life-threatening and serious complications may occur, including gastric outlet obstruction, duodenal perforation and septicaemia. A case of pancreatic-induced IDH is presented, for which pancreaticoduodenectomy was performed as definitive treatment. In general, medical treatment with continuous nasogastric aspiration and total parenteral nutrition is recommended as initial management strategy. Surgical interventions (evacuation of blood clot or surgical resection are reserved for patients in whom medical treatment fails or complications occur.

Duodenal perforation: an unusual complication of sickle cell anemia.

Science.gov (United States)

Acıpayam, Can; Aldıç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; Aşkar, Hasan; Dorum, Bayram Ali

2014-01-01

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

Gastroduodenal ulceration in foals.

Science.gov (United States)

Becht, J L; Byars, T D

1986-07-01

Gastroduodenal ulceration is becoming recognised as an important disease in foals during the first few months of life. Aetiopathogenesis is presumed to be similar to peptic disease in humans associated with back diffusion of hydrogen ions into the mucosa. Many factors have been incriminated as predisposing foals to ulceration but few have been proven. To date, use of non-steroidal anti-inflammatory agents has been the only documented cause of gastroduodenal ulceration in foals. The clustering of affected foals on certain farms suggests an infectious aetiology but attempts to identify a causative organism have been unsuccessful. Four clinical syndromes defined for foals with gastroduodenal ulceration include: silent ulcers, which occur most often in the non-glandular stomach along the margo plicatus and are identified as incidental findings at necropsy; active ulcers which are often manifested by abdominal pain, excessive salivation and bruxism; perforating ulcers which usually result in a severe, diffuse peritonitis; and pyloric or duodenal obstruction from a healing ulcer. General approaches to therapy of a foal with active ulceration consist of reduction of gastric acidity and enhancement of mucosal protection. Antacids and type 2 histamine receptor antagonists are used most often to neutralise or decrease acid secretion, respectively. Sucralfate, a locally active sulphated sucrose preparation, is commonly used as a cytoprotective agent. The efficacy and safety of many products used have not been evaluated adequately in foals. Perforating ulcers are usually associated with death or humane destruction of the foal because of fulminating peritonitis. Surgical intervention and bypass procedures are indicated in foals that develop pyloric or duodenal obstructions from healing ulcers.

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

should be selected for H. pylori eradication treatment. CONCLUSION: Descriptive clinical studies and laboratory studies of disease mechanisms were the prevailing types of research about H. pylori. Comparatively few therapeutic intervention studies were done; this fact may have hampered the acceptance......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...

Helicobacter pylori infection and duodenal ulcer disease

NARCIS (Netherlands)

Tytgat, G. N.; Noach, L. A.; Rauws, E. A.

1993-01-01

H. pylori is undoubtedly the dominant factor in the multifactorial peptic ulcer diathesis. We should not ignore the other contributing factors but rather try to identify how they interact with the organism and initiate the ulcerative process. The interplay of acid attack and mucosal defence is

X-ray diagnostic features of giant bleeding ulcers in the stomach and duodenum

International Nuclear Information System (INIS)

Shcherbatenko, M.K.; elina, I.E.

1997-01-01

The study was based on the analysis of clinical, X-ray, and morphological examinations made in 64 patients with giant gastric and duodenal ulcers. The methods of X-ray examinations and the X-ray symptomatology of giant ulcers of the stomach and duodenum is given. Gastroscopic and X-ray examinations were comparative analyzed. The paper gives evidence that the X-ray examination has many advantages in estimating the size and ratio of ulcers to the adjacent organs and tissues. The paper outlines giant duodenal ulcers. 9 refs., 5 figs

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.

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

Diagnosis of the ulcerous and erosive gastroduodenal lesions with radioisotopes

International Nuclear Information System (INIS)

Zuccaro, A.M.; Rocha, A.F.G. da; Palencia, I.I.B.

1989-01-01

The use of gastric scintigraphy with technetium 99-m labeled sucralfate is analysed in a study of 25 cases evolving: controls (five), duodenal ulcer (six case), gastric ulcer (four), gastric and duodenal ulcer (two) and gastric mucous acute erosive lesion (eight). All patients were previously submitted to endoscopy and biopsy. Changes in the techniques of other authors were performed. An accurate diagnosis was achieved in 95% of the cases with a specificity of 100%. It is concluded that the method is indicated for the investigation of critical patients, elderly patients, children for the control of lesions identified through endoscopy. (author)

Current management of peptic ulcer perforations

International Nuclear Information System (INIS)

Menakuru, S.R.

2004-01-01

Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

Significant association of the dupA gene of Helicobacter pylori with duodenal ulcer development in a South-east Indian population.

Science.gov (United States)

Alam, Jawed; Maiti, Sankar; Ghosh, Prachetash; De, Ronita; Chowdhury, Abhijit; Das, Suryasnata; Macaden, Ragini; Devarbhavi, Harshad; Ramamurthy, T; Mukhopadhyay, Asish K

2012-09-01

A novel virulence factor, duodenal ulcer-promoting gene A (dupA), in Helicobacter pylori has been found to be associated with disease in certain populations but not in others. This study analysed a South-east Indian population as part of the debate about the relevance of dupA for the prediction of clinical outcomes. A total of 140 H. pylori strains isolated from duodenal ulcer (DU) (n = 83) and non-ulcer dyspepsia (NUD) patients (n = 57) were screened by PCR and dot-blot hybridization to determine the presence of the ORFs jhp0917 and jhp0918. Part of jhp0917-jhp0918 was sequenced to search for the C/T insertion that characterizes dupA and the levels of dupA transcripts were also assessed. The PCR and dot-blot results indicated the presence of jhp0917 and jhp0918 in 37.3 % (31/83) and 12.2 % (7/57) of H. pylori strains isolated from DU and NUD patients, respectively. Sequencing analysis showed insertion of a C at nt 1386 in the 3' region of jhp0917, forming the dupA gene in 35 strains. RT-PCR analysis detected the dupA transcript in 28 of these 35 strains. The expression level of the dupA transcript varied from strain to strain, as shown by real-time PCR. The results demonstrated that analysis based on PCR only for dupA may produce an erroneous interpretation. The prevalence of dupA was significantly greater among strains isolated from patients with DU than from patients with NUD in this population (P = 0.001, odds ratio = 4.26, confidence interval = 1.60-11.74). Based on these findings, dupA can be considered a biomarker for DU patients in India. The reported discrepancies for this putative virulence marker in different populations may be due to the genome plasticity of H. pylori.

Campylobacter pylori and its role in peptic ulcer disease

NARCIS (Netherlands)

Tytgat, G. N.; Rauws, E. A.

1990-01-01

In almost all patients with genuine nondrug-induced duodenal or gastric ulcer there is evidence of gastric Campylobacter pylori colonization and concomitant inflammation. C. pylori is only demonstrable in the duodenal cap when there is "gastric mucus metaplasia." Suppression or eradication of C.

Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

Science.gov (United States)

Kohan, Emil; Oh, David; Wang, Hank; Hazany, Salar; Ohning, Gordon; Pisegna, Joseph R.

2009-01-01

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. PMID:19587828

Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

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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.

PERFORATED PEPTIC ULCER: A CLINICAL ANALYSIS AND OUTCOME

OpenAIRE

Bijit

2016-01-01

BACKGROUND The incidence of perforated peptic ulcer is approximately 7-10 cases per one lakh population per year. Perforation is seen in about 7% of patients hospitalized for peptic ulcer disease. Peptic ulcer perforation, which can be gastric/duodenal perforation can be a serious life-threatening condition if not detected early and treated urgently. Peptic ulcer disease has decreased considerably worldwide with the advent of potent anti-ulcer medicines, but its complication l...

Effect of sucralfate on gastric emptying in duodenal ulcer patients

International Nuclear Information System (INIS)

Petersen, J.M.; Caride, V.J.; Prokop, E.K.; Troncale, F.; McCallum, R.W.

1985-01-01

Duodenal ulcer (DU) patients may have accelerated gastric emptying (GE) suggesting that there is an increase in unbuffered gastric acid reaching the duodenum contributing to DU disease. Aluminum-containing antacids were shown to delay GE. The authors' aim was to investigate whether another aluminum-containing compound, Sucralfate, affects GE in normal and DU patients. Nine normal volunteers and 10 patients with documented DU disease were studied. For each test the subject ingested a meal composed of chicken liver Tc-99m-S-C mixed with beef stew and eaten with 4 oz. of water labelled with 100μCi of III-in-DTPA. On two separate days, subjects received 1 gram of Sucralfate (190 mg of aluminum per gram) or placebo in a randomized double-blind fashion one hour prior to the test meal. GE of liquids and solids in normal subjects was not significantly changed by Sucralfate. Sucralfate in the DU patients significantly slowed liquid emptying in the initial 40 min and solid food throughout the study compared to placebo (p<0.05). This paper summarizes that; GE of solids but not liquids is accelerated in DU patients compared to normal subjects; and sucralfate delays GE of both liquid and solid components of a meal in DU patients but has no effect on GE in normals. The authors conclude that a slowing of gastric emptying possibly mediated by aluminum ions, may be one mechanism by which Sucralfate enhances healing and decreases recurrence of DU

Effect of sucralfate on gastric emptying in duodenal ulcer patients

Energy Technology Data Exchange (ETDEWEB)

Petersen, J.M.; Caride, V.J.; Prokop, E.K.; Troncale, F.; McCallum, R.W.

1985-05-01

Duodenal ulcer (DU) patients may have accelerated gastric emptying (GE) suggesting that there is an increase in unbuffered gastric acid reaching the duodenum contributing to DU disease. Aluminum-containing antacids were shown to delay GE. The authors' aim was to investigate whether another aluminum-containing compound, Sucralfate, affects GE in normal and DU patients. Nine normal volunteers and 10 patients with documented DU disease were studied. For each test the subject ingested a meal composed of chicken liver Tc-99m-S-C mixed with beef stew and eaten with 4 oz. of water labelled with 100..mu..Ci of III-in-DTPA. On two separate days, subjects received 1 gram of Sucralfate (190 mg of aluminum per gram) or placebo in a randomized double-blind fashion one hour prior to the test meal. GE of liquids and solids in normal subjects was not significantly changed by Sucralfate. Sucralfate in the DU patients significantly slowed liquid emptying in the initial 40 min and solid food throughout the study compared to placebo (p<0.05). This paper summarizes that; GE of solids but not liquids is accelerated in DU patients compared to normal subjects; and sucralfate delays GE of both liquid and solid components of a meal in DU patients but has no effect on GE in normals. The authors conclude that a slowing of gastric emptying possibly mediated by aluminum ions, may be one mechanism by which Sucralfate enhances healing and decreases recurrence of DU.

Incidence of lactase deficiency (LD) in gastroduodenal ulcer and gastric carcinoma

International Nuclear Information System (INIS)

Bahk, Yong Whee; Ahn, Kwan Shik; Kim, Chung Ja

1974-01-01

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

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.

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...

Positive predictive value of peptic ulcer diagnosis codes in the Danish National Patient Registry.

Science.gov (United States)

Viborg, Søren; Søgaard, Kirstine Kobberøe; Jepsen, Peter

2017-01-01

Diagnoses of peptic ulcer are registered in the Danish National Patient Registry (DNPR) for administrative as well as research purposes, but it is unknown whether the coding validity depends on the location of the ulcer. To validate the International Classification of Diseases, 10 th revision diagnosis codes of peptic ulcer in the DNPR by estimating positive predictive values (PPVs) for gastric and duodenal ulcer diagnoses. We identified all patients registered with a hospital discharge diagnosis of peptic ulcer from Aarhus University Hospital, Denmark, in 1995-2006. Among them, we randomly selected 200 who had an outpatient gastroscopy at the time of ulcer diagnosis. We reviewed the findings from these gastroscopies to confirm the presence of peptic ulcer and its location. We calculated PPVs and corresponding 95% confidence intervals (CIs) of gastric and duodenal ulcer diagnoses, using descriptions from the gastroscopic examinations as standard reference. In total, 182 records (91%) were available for review. The overall PPV of peptic ulcer diagnoses in DNPR was 95.6% (95% CI 91.5-98.1), with PPVs of 90.3% (95% CI 82.4-95.5) for gastric ulcer diagnoses, and 94.4% (95% CI 87.4-98.2) for duodenal ulcer diagnoses. PPVs were constant over time. The PPV of uncomplicated peptic ulcer diagnoses in the DNPR is high, and the location of the ulcers is registered correctly in most cases, indicating that the diagnoses are useful for research purposes.

Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

Science.gov (United States)

Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

2017-12-01

The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

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Miriam Eddyani

2015-11-01

Full Text Available Increased availability of Next Generation Sequencing (NGS techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU episodes.We compared the number and location of single nucleotide polymorphisms (SNPs identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well characterized clinical samples from one BU treatment center in Benin.The findings suggest that after surgical treatment-without antibiotics-the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced for the treatment of BU, the one patient with a culture available from both disease episodes had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was most likely reinfected rather than having a relapse.To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence, and has implications for vaccine development.

Modeling the cost-effectiveness of ilaprazole versus omeprazole for the treatment of newly diagnosed duodenal ulcer patients in China.

Science.gov (United States)

Xuan, J W; Song, R L; Xu, G X; Lu, W Q; Lu, Y J; Liu, Z

2016-11-01

To evaluate the cost-effectiveness of 10 mg ilaprazole once-daily vs 20 mg omeprazole once-daily to treat newly-diagnosed duodenal ulcer patients in China. A decision tree model was constructed and the treatment impact was projected up to 1 year. The CYP2C19 polymorphism distribution in the Chinese population, the respective cure rates in the CYP2C19 genotype sub-groups, the impact of Duodenal Ulcer (DU) on utility value and drug-related side-effect data were obtained from the literature. The total costs of medications were calculated to estimate the treatment costs based on current drug retail prices in China. Expert surveys were conducted when published data were not available. Probabilistic sensitivity analysis was performed to gauge the robustness of the results. Ilaprazole, when compared with omeprazole, achieved a better overall clinical efficacy. For the overall population, ilaprazole achieved an incremental cost effectiveness ratio (ICER) of ¥132 056 per QALY gained. This is less than the WHO recommended threshold of 3-times the average GDP per capita in China (2014). Furthermore, sub-group analysis showed that ilaprazole is cost-effective in every province in CYP2C19 hetEM patients and in the most developed provinces in CYP2C19 homEM patients. Probabilistic sensitivity analysis suggests that the results are robust with 97% probability that ilaprozole is considered cost-effective when a threshold of 3-times China's average GDP per capita is considered. This study didn't have the data of ilaprazole combined with Hp eradication therapy. Caution should be taken when extrapolating these findings to DU patients with an Hp eradication therapy. The cost-effectiveness analysis results demonstrated that ilaprazole would be considered a cost-effective therapy, compared with omeprazole, in Chinese DU patients based on the efficacy projections in various CYP2C19 polymorphism types.

Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

Energy Technology Data Exchange (ETDEWEB)

Mistiaen, W.; Van Hee, R.; Blockx, P.; Hubens, A. (Univ. of Antwerp (Belgium))

1990-03-01

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with (99mTc)stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

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Aliev, M A; Kabdrakhmanov, T K; Kashkin, K A; Darmenov, O K; Kuspangaljeva, Sh U [Kazakhskij Inst. Klinicheskoj i Ehksperimental' noj Khirurgii Minzdrava Kazakhskoj SSR, Alma-Ata

1983-06-01

Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures.

Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

International Nuclear Information System (INIS)

Aliev, M.A.; Kabdrakhmanov, T.K.; Kashkin, K.A.; Darmenov, O.K.; Kuspangaljeva, Sh.U.

1983-01-01

Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures

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

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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.

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

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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

Perforation of a duodenal ulcer into a non-parasitic liver cyst: a rare case of a penetrate hole blockaded with conservative medical management.

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Ono, Koichi; Takeda, Masaharu; Makihata, Eiichi; Okazaki, Junji; Nagai, Akira

2014-01-01

An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded.

Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study.

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

2016-10-01

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). a nationwide cohort study with prospective and consecutive data collection. all patients treated for PUB and PPU at Danish hospitals between 2003 and 2014. demographic and clinical data reported to the Danish Clinical Registry of Emergency Surgery. 90- and 30-d mortality and re-intervention. the crude and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. 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 ulcers (DUs) in PPU patients: adjusted OR 0.99 (0.84-1.16); p = 0.698, OR 0.93 (0.78 to 1.10); p = 0.409, and OR 0.97 (0.80-1.19); p = 0.799, respectively. DU site is a significant predictor of death and re-intervention in patients with PUB, as compared to GU site. This does not seem to be the case for patients with PPU.

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog

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Johannes J. Nel

2015-12-01

Full Text Available A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure, but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog.

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Nel, Johannes J; du Plessis, Cornelius J; Coetzee, Gert L

2015-12-09

A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure), but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

Rising trends of gastric cancer and peptic ulcer in the 19th century.

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Sonnenberg, A; Baron, J H

2010-10-01

The risk of dying from gastric cancer appears to have increased among consecutive generations born during the 19th century. To follow the time trends of hospitalization for gastric cancer and test whether they confirm such increase. Inpatient records of the last two centuries from four hospitals in Scotland and three US hospitals were analysed. Proportional rates of hospitalization for gastric cancer, gastric ulcer and duodenal ulcer were calculated during consecutive 5-year periods. The data from all seven cities revealed strikingly similar patterns. No hospital admissions for gastric cancer or peptic ulcer were recorded prior to 1800. Hospital admissions for gastric cancer increased in an exponential fashion throughout the 19th and the beginning of the 20th century. In a majority of cities, the rise in hospitalization for gastric cancer preceded a similar rise in hospitalization for gastric ulcer. Hospitalization for these two latter diagnoses clearly preceded hospitalization for duodenal ulcer by 20-40 years. The occurrence of gastric cancer, gastric ulcer and duodenal ulcer markedly increased during the 19th century. Improvements in hygiene may have resulted in the decline of infections by other gastrointestinal organisms that had previously kept concomitant infection by Helicobacter pylori suppressed. Published 2010. This article is a US Government work and is in the public domain in the USA.

Therapeutics for Equine Gastric Ulcer Syndrome.

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Zavoshti, Fereydon Rezazadeh; Andrews, Frank M

2017-04-01

Equine gastric ulcer syndrome (EGUS) is an umbrella term used to describe ulcers in the nonglandular squamous and glandular mucosa, terminal esophagus, and proximal duodenum. Gastric ulcers in the squamous and glandular regions occur more often than esophageal or duodenal ulcers and likely have a different pathogenesis. At present, omeprazole is accepted globally as the best pharmacologic therapy for both regions of the stomach; however, the addition of coating agents and synthetic prostaglandins could add to its effectiveness in treatment of EGUS. Dietary and environmental management are necessary for prevention of recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

Peptic ulcer frequency differences related to h. Pylori or aines.

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Carli, Diego Michelon de; Pires, Rafael Cardoso; Rohde, Sofia Laura; Kavalco, Caroline Mayara; Fagundes, Renato Borges

2015-01-01

Peptic ulcer etiology has been changing because of H. pylori decline. 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. 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. 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.

PEPTIC ULCER FREQUENCY DIFFERENCES RELATED TO H. PYLORI OR AINES

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Diego Michelon de CARLI

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.

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

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Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Risk factors for peptic ulcer in patients with acute pancreatitis

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LIAO Juan

2013-07-01

Full Text Available ObjectiveTo investigate the clinical characteristics of acute pancreatitis (AP associated with peptic ulcer (PU and to analyze the risk factors for PU in AP patients. MethodsA retrospective analysis was performed on the clinical data of 156 AP patients who were admitted to our hospital from January 2008 to January 2012. All patients underwent gastroscopy within 48 h after admission to detect PU and Helicobacter pylori (Hp infection. The severity of AP was assessed by Ranson score, APACHE Ⅱ score, and CT severity index. The clinical characteristics of AP patients with or without PU were statistically analyzed using independent samples t-test and chi-square test. The univariate and multivariate logistic regression analyses were used to determine the risk factors for PU in AP patients. ResultsAmong the 156 AP patients, 88 (56.4% had PU, but only 28 (31.8% of the 88 cases were infected with Hp. Of the 28 patients, 22 had gastric ulcer, and 6 had both gastric ulcer and duodenal ulcer. Of the 60 PU patients not infected with Hp, 25 had gastric ulcer, 26 had duodenal ulcer, and 9 had both gastric ulcer and duodenal ulcer. The univariate logistic regression analysis showed that male gender, alcohol-induced pancreatitis, smoking, alcohol consumption, high triglyceride level, high C-reactive protein level, and APACHE Ⅱ score ≥8 were significantly associated with PU in AP patients. However, the multivariate logistic regression analysis showed that APACHE Ⅱ score ≥8 was the independent risk factor for PU in AP patients (OR=8.54, 95% CI: 4.52-16.15, P＜0.01. ConclusionAP patients are susceptible to PU, but the infection rate of Hp is low. APACHE Ⅱ score ≥8 is the independent risk factor for PU in AP patients.

EFFECTS OF PLUMERIA OBTUSA LINN. IN PEPTIC ULCER INDUCED BY PYLORUS LIGATION & INDOMETHACIN

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Amit Pratap Singh; Vaibhav Shukla; Piuesh Khare

2012-01-01

Peptic ulcer disease refers to pathological lesions and ulcers of any portion of gastrointestinal tract exposed to acid activated pepsin. Gastric ulcer refers to ulcer in the stomach where as duodenal ulcer is a ulcer found in duodenum of small intestine. Helicobacter pylori infection, a spiral shaped type of bacteria, is present in more than 90% of the patients with intestinal ulcers and more than 80% of patients with stomach ulcers. Helicobacter pylori weaken the protective mucous coating o...

Tactics of a roentgenoendoscopic study in gastric and duodenal ulcer

International Nuclear Information System (INIS)

Strunin, A.E.

1986-01-01

During an X-ray study the niche symptom was established in 244 patients with peptic ulcer. The X-ray findings were compared with those of gastroduodenofibroscopy (GDFS) in 111 patients (45.5 %), and with those of operation in 84 (34.2 %). By the operative findings X-ray and GDFS results coincided in all cases of gastric ulcer. With ulcer in the pyloroduodenal zone, X-ray errors were found in 2 (2.3 %) patients whereas in GDFS in 8(5.8 %). The X-ray method was shown to be the most important in the diagnosis of penetration and stenosis of ulcer. The tactics of a roentgenoendoscopic study in peptic ulcer should be based on the diagnostic potentialities of these methods taking a stage into account

No Helicobacter pylori, no Helicobacter pylori-associated peptic ulcer disease

NARCIS (Netherlands)

Tytgat, G. N.

1995-01-01

Virtually all duodenal ulcers (DUs) and the vast majority of gastric ulcers (GUs) are the consequence of Helicobacter pylori-associated inflammation. In DUs, the inflammation is maximal in the antrum and is associated with gastric metaplasia in the bulb. Gastrin homeostasis is disturbed by H. pylori

Hormonal assay in gastric secretion of portal hypertension and peptic ulceration by radioimmunoassay

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Megahed, Y.M.; El-Haieg, M.O.; Abdel-Aziz, S.M.; Moustafa, N.A.; Refaat, M.A.

1991-01-01

This paper aims to study the relation between the plasma levels and the gastric secretion in cases of portal hypertension and the duodenal ulcer. The relation between gastrin levels and bleeding in case of duodenal ulcer was also studied regarding the role of acidity, gastrin level, and the portal pressure on the pathogenesis of bleeding from oesophageal varices. Finally, the relation between gastrin secretion and state of liver functions was tested. The radioimmunoassay ( RIA ) is the basic test in assessment of the gastrin. The obtained results revealed the following: 1. The fasting serum gastrin was increased in case of liver cirrhosis 2. The level of gastrin was markedly increased in case of peptic ulceration 3. The incidence of peptic ulceration was increased in case of liver cirrhosis.3 tab

Determination of relative frequency of eosinophils and mast cells in gastric and duodenal mucosal biopsies in adults with non-ulcer dyspepsia

International Nuclear Information System (INIS)

Binesh, F.; Rajabzadeh, Y.; Pourmirafzali, H.; Akhondei, M.

2013-01-01

Objective: To determine eosinophil and mast cell populations in gastric and duodenal mucosal biopsies of adults with nonulcer dyspepsia (NUD) as compared to non-dyspeptic adults. Study Design: A case control study. Place and Duration of Study: Shahid Sadoughi University of Medical Sciences, Yazd, Iran, from January 2010 to June 2011. Methodology: A total of 52 (25 non-ulcer dyspeptic patients as case and 27 non-dyspeptic patients as control) patients underwent endoscopy. All patients had a minimum of 2 forceps biopsies obtained from stomach and duodenum. Routine histological evaluation was performed and additionally evaluated to determine eosinophil and mast cell counts. The statistical analysis was performed on SPSS version 17.0, using Mann-Whitney test with significance at p < 0.05. Results: The mean age in the case and control groups was 31.72 +- 12.17 and 35.74 +- 12.42 years respectively. The median eosinophil density in gastric mucosa in case group was 5.0 (ranging from 1 to 20) and 4.0 in control group (ranging from 0 to 16; p = 0.140). The median eosinophil density in duodenal mucosa in case group was 16.0 (ranging from 2 to 24) and 13 in control group (ranging from 2 to 45; p = 0.147). The median mast cell density in gastric mucosa in case group was 4.0 (ranging from 0 to 33) and 4.0 in control group (ranging from 0 to 26; p = 0.827). The median mast cell density in duodenal mucosa in case group was 4.0 (ranging from 0 to 31) and 3.0 in control group (ranging from 1 to 23; p = 0.704). The frequency of Helicobacter pylori infection in both the groups was similar. Conclusion: Although there were not statistically significant differences in eosinophil and mast cell densities between case and control groups, there was a trend toward mild eosinophilia in gastric and duodenal mucosa. The specific role of eosinophils and mast cells in NUD is yet to be completely defined. (author)

Radiological analysis of peptic ulcer in pediatric age group

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Kim, Pyo Nyun; Han, Soon Im; Chung, Moo Chan; Kwon, Kui Hyang; Suh, Won Hyuck [Soon Chun Hyang University College of Medicine, Seoul (Korea, Republic of)

1984-03-15

The UGI studies had been performed to 238 patients below the age of 15 years during the period from Jan. 1979 to Jul. 1983 in SCH hospital. The results are as follows: 1. Among 238 cases, 48 cases revealed peptic ulcers of stomach or duodenum (20.2%). The ulcer was in 31/37 cases of male patients (22.6%), and in 17/101 cases of female (16.8). Below the age of 5 years, ulcer was noted in 9 cases among 61 cases (14.8%), whereas above 5 years, in 39 cases among 177 patients (22.0%). 2. In the age group below 5 years, mostly the objective symptoms were discovered (8/9), but above 5 years, complained of subjective symptoms (30/39). 3. The predominant site of peptic ulcer was gastric antrum in the age group below 5 years (7/9), whereas duodenal bulb above 5 years (33/43). 4. Gastric antrum or duodenal bulb deformity was revealed in 13 cases and most of them were in the age group above 5 years. 5. All lesions of peptic ulcers in this study were benign in nature. 6. In follow up study after 1 or 2 months, ulcer was decreased in size strikingly (9/11)

Radiological analysis of peptic ulcer in pediatric age group

International Nuclear Information System (INIS)

Kim, Pyo Nyun; Han, Soon Im; Chung, Moo Chan; Kwon, Kui Hyang; Suh, Won Hyuck

1984-01-01

The UGI studies had been performed to 238 patients below the age of 15 years during the period from Jan. 1979 to Jul. 1983 in SCH hospital. The results are as follows: 1. Among 238 cases, 48 cases revealed peptic ulcers of stomach or duodenum (20.2%). The ulcer was in 31/37 cases of male patients (22.6%), and in 17/101 cases of female (16.8). Below the age of 5 years, ulcer was noted in 9 cases among 61 cases (14.8%), whereas above 5 years, in 39 cases among 177 patients (22.0%). 2. In the age group below 5 years, mostly the objective symptoms were discovered (8/9), but above 5 years, complained of subjective symptoms (30/39). 3. The predominant site of peptic ulcer was gastric antrum in the age group below 5 years (7/9), whereas duodenal bulb above 5 years (33/43). 4. Gastric antrum or duodenal bulb deformity was revealed in 13 cases and most of them were in the age group above 5 years. 5. All lesions of peptic ulcers in this study were benign in nature. 6. In follow up study after 1 or 2 months, ulcer was decreased in size strikingly (9/11)

Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

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V. V. Izbitsky

2013-06-01

Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

Ulcerative Proctitis

OpenAIRE

Whitlow, Charles B.

2004-01-01

Ulcerative proctitis is an idiopathic mucosal inflammatory disease involving only the rectum and is therefore an anatomically limited form of ulcerative colitis. Diagnosis is made based on clinical presentation, endoscopic appearance, and histopathology. Additionally, other etiologies of proctitis are excluded. The course of the disease is variable ranging from complete resolution to easily maintained remission to frequent relapses or refractory disease. Extension of inflammatory changes invo...

Indications for treatment of Helicobacter pylori infection: a systematic overview.

Science.gov (United States)

Veldhuyzen van Zanten, S J; Sherman, P M

1994-01-15

To determine (a) the advantages and disadvantages of treatment options for the eradication of Helicobacter pylori and (b) whether eradication of H. pylori is indicated in patients with duodenal ulcer, nonucler dyspepsia and gastric cancer. A MEDLINE search for articles published in English between January 1983 and December 1992 with the use of MeSH terms Helicobacter pylori (called Campylobacter pylori before 1990) and duodenal ulcer, gastric cancer, dyspepsia and clinical trial. Six journals and Current Contents were searched manually for pertinent articles published in that time frame. For duodenal ulcer the search was limited to studies involving adults, studies of H. pylori eradication and randomized clinical trials comparing anti-H. pylori therapy with conventional ulcer treatment. For nonulcer dyspepsia with H. pylori infection the search was limited to placebo-controlled randomized clinical trials. The quality of each study was rated independently on a four-point scale by each author. For the studies of duodenal ulcer the outcome measures assessed were acute ulcer healing and time required for healing, H. pylori eradication and ulcer relapse. For the studies of nonulcer dyspepsia with H. pylori infection the authors assessed H. pylori eradication, the symptoms used as outcome measures and whether validated outcome measures had been used. Eight trials involving duodenal ulcer met our inclusion criteria: five were considered high quality, two were of reasonable quality, and one was weak. Six trials involving nonulcer dyspepsia met the criteria, but all were rated as weak. Among treatment options triple therapy with a bismuth compound, metronidazole and either amoxicillin or tetracycline achieved the highest eradication rates (73% to 94%). Results concerning treatment indications for duodenal ulcer were consistent among all of the studies: when anti-H. pylori therapy was added to conventional ulcer treatment acute ulcers healed more rapidly. Ulcer relapse rates

Epstein-Barr Virus Association with Peptic Ulcer Disease

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María G. Cárdenas-Mondragón

2015-01-01

Full Text Available Background. Helicobacter pylori (HP infection and nonsteroidal anti-inflammatory drugs (NSAID use are considered the main risk to develop peptic ulcer disease (PUD. However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129, and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers. Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5, while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1. Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD.

Perforated gastric and duodenal ulcers in an urban African population

African Journals Online (AJOL)

Background: Perforations of the stomach and duodenum are frequent causes of acute generalized peritonitis in our environment. This is a prospective study of 331 cases of gastric and duodenal perforations. Study design: A consecutive series of adult patients admitted and treated for acute generalized peritonitis due to ...

Helicobacter pylori eradication in complicated peptic ulcer: Beneficial in most?

Directory of Open Access Journals (Sweden)

Subair Mohsina

2016-01-01

Full Text Available Helicobacter pylori eradication therapy has a role in minimizing the complications of peptic ulcer disease, namely, bleeding, perforation, and obstruction. However, the precise role of H. pylori eradication therapy in the complicated ulcers remains inconclusive, especially in perforation and gastric outlet obstruction. The prevalence of H. pylori in peptic ulcer bleeding patients has been widely underestimated owing to the differences in diagnostic tests and patient characteristics, and hence, it is recommended that an initial negative test should be followed up by a delayed repeat testing to rule out false negativity. It is well established now that eradication of H. pylori in patients with bleeding ulcers reduces rebleeding and ulcer recurrence. Multiple studies have attributed high recurrence rates of duodenal ulcer following simple closure to a high prevalence of H. pylori infection. Eradication therapy decreases the recurrence rate of perforated ulcers, thus justifying the role of H. pylori eradication therapy following the primary surgical management of perforated ulcers. The role of H. pylori in duodenal ulcer with gastric outlet obstruction is yet to be evaluated clearly. There are some reports of resolution of gastric outlet obstruction following therapy for H. pylori, obviating the need for surgery. Clarithromycin-containing regimens are recommended as first-line in areas of low resistance, whereas bismuth-containing quadruple therapy is the first-line empirical treatment in areas of high clarithromycin resistance. Treatment of H. pylori is beneficial in most of the patients with complicated peptic ulcer disease, especially in reducing recurrence of ulcer with or without complications.

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.

Science.gov (United States)

Shimamoto, Takeshi; Yamamichi, Nobutake; Kodashima, Shinya; Takahashi, Yu; Fujishiro, Mitsuhiro; Oka, Masashi; Mitsushima, Toru; Koike, Kazuhiko

2013-01-01

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.

Mucosa protectives: sucralfate and colloidal bismuth subcitrate in peptic ulcer disease

NARCIS (Netherlands)

Tytgat, G. N.; Nio, C. Y.

1987-01-01

Mucosa protective drugs are thought to have an important role in the treatment of both duodenal (DU) and gastric ulcer (GU) disease by means of correcting the disturbed defensive factors. Sucralfate as well as colloidal bismuth subcitrate (CBS) form a layer on the ulcer base and in this way protect

[The prevalence of dupA (duodenal ulcer-promoting gene) of Helicobacter pylori in children and adolescents--own observation].

Science.gov (United States)

Parzecka, Monika; Szaflarska-Popławska, Anna; Gasiorowska, Joanna; Gorzkiewicz, Marta; Grzybowski, Tomasz

2013-05-01

The strains of Helicobacter pylori are described by many common features which determine their virulence. The genes which are connected with much higher virulence of some strains are vacA, cagA, oipA, dupA. Duodenal Ulcer Promoting Gene--dupA is the new virulence factor coexisting with a duodenum ulcer. There is a rationale that shows a protective character of dupA with reference to a stomach cancer. The dupA gene probably causes increasingly higher releasing of pro-infectious IL-8 via stomach cells and it influences the production of IL-12 and other cytokines. The aim of the study was to determine the frequency of dupA gene's appearance in the Polish children's group and in the Polish teenagers' group infected with H. pylori. The research was also aimed to determine the coexistence of dupA gene and duodenum ulcer disease or erosion infection of duodenum's mucous membrane. The endoscopic examination of the upper part of digestive duct was performed in 119 qualified patients with dyspeptic symptoms and with suspicion of stomach and duodenum's mucous membrane infection. The segments were taken for histopathological identification of H. pylori and for genetic indicating via PCR method. To confirm the presence of H. pylori in the extract the amplification of DNA fragment sized 860 pz was used. The presence of dupA gene was detected by PCR reaction with using the starters which include the fragment of jhp0917-jhp0918 sequence in the plastic H. pylori's genome area. To confirm the infection the urea breathing test was taken. 88 patients confirm the infection of H. pylori. The presence of dupA gene was found in 20 patients--a group A (22.7%), whereas in 68 patients dupA gene was not found--a group B (77.2%). Pathological changes in duodenum was found in 20 patients infected with H. pylori (22.7%), included 4 patients in the group A (20%) and 16 in the group B (23.5%). There was an infection (swelling, redness, congestion) in duodenum was found in the group A in all cases

Normal villous architecture with increased intraepithelial lymphocytes: a duodenal manifestation of Crohn disease.

Science.gov (United States)

Patterson, Emily R; Shmidt, Eugenia; Oxentenko, Amy S; Enders, Felicity T; Smyrk, Thomas C

2015-03-01

To assess a possible association between inflammatory bowel disease (IBD) and the histologic finding in duodenal biopsy specimens of increased intraepithelial lymphocytes (IELs) with normal villous architecture. We identified all patients with duodenal biopsy specimens obtained between 2000 and 2010 showing increased IELs and normal architecture. Among the 74 such patients who also had IBD, we characterized the clinical features of IBD and reviewed all available upper gastrointestinal biopsy specimens. Fifty-eight patients had Crohn disease, 13 had ulcerative colitis, and three had IBD, type unclassified. No duodenal sample with increased IELs had other histologic features of IBD. Among gastric biopsy specimens from 34 patients with Crohn disease, nearly half (16) had focal gastritis. We propose that Crohn disease be included in the differential diagnosis for increased IELs with normal villous architecture in duodenal biopsy specimens, particularly when gastric biopsy specimens show focal gastritis. Copyright© by the American Society for Clinical Pathology.

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.

Duodenal X-ray diagnostics

International Nuclear Information System (INIS)

Scheppach, W.

1982-01-01

The publication provides an overview of duodenal X-ray diagnostics with the aid of barium meals in 1362 patients. The introducing paragraphs deal with the topographic anatomy of the region and the methodics of X-ray investigation. The chapter entitled ''processes at the duodenum itself'' describes mainly ulcers, diverticula, congenital anomalies, tumors and inflammations. The neighbourhood processes comprise in the first place diseases having their origin at the pancreas and bile ducts. As a conclusion, endoscopic rectograde cholangio-pancreaticography and percutaneous transhepatic cholangiography are pointed out as advanced X-ray investigation methods. In the annex of X-ray images some of the described phenomena are shown in exemplary manner. (orig./MG) [de

Confocal laser endomicroscopy in ulcerative colitis

DEFF Research Database (Denmark)

Karstensen, John Gásdal; Săftoiu, Adrian; Brynskov, Jørn

2016-01-01

BACKGROUND AND AIMS: Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study...... was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment. METHODS: Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were...

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.

Validation of binding of SE-75 labeled sucralfate to sites of gastrointestinal ulceration

Energy Technology Data Exchange (ETDEWEB)

Maurer, A.H.; Knight, L.C.; Kollman, M.; Krevsky, B.; Pleet, D.; D' Ercole, F.; Siegel, J.A.; Fisher, R.S.; Malmud, L.S.

1985-05-01

This study was performed to determine if and for how long sucralfate (SU) binds selectively to sites of gastro-intestinal (GI) ulceration. Se-Su was prepared by sulfating sucrose with tracer Se-75 and precipitating it as the basic Al salt. All patients (pts) had endoscopy to confirm the presence of either: esophagitis (n=5), gastritis (GA) (n=5), gastric ulcers (GU) (n=5), duodenal ulcers (DU) (n=5), or no ulceration (NU) (n=5). Following an overnight fast the pts swallowed 1 gm with 100 ..mu..Ci of Se-SU and were imaged continuously over 24 hours or until no activity remained in the upper GI tract. Pts with GU visually demonstrated focal SU binding at the ulcers for an average of 3.9 +- 1.1 hrs. with a mean GET of 68 +- 25 min. Mean GET for pts with DU was prolonged, 171 +- 63 min, however focal binding at duodenal ulcers was not seen. All pts with GA had diffuse retention of SU in the stomach with a mean GET of 118 +- 34 min. Focal binding of SU at all sites of esophagitis was seen with a T-1/2 of 65 +- 32 min at the ulcerations. In conclusion these data support the theory that the mechanism of ulcer healing with SU is related to its ability to adhere to the ulcer site forming a protective barrier. In addition Se-SU is a potential ulcer imaging agent which can be used to noninvasively assess healing.

Validation of binding of SE-75 labeled sucralfate to sites of gastrointestinal ulceration

International Nuclear Information System (INIS)

Maurer, A.H.; Knight, L.C.; Kollman, M.; Krevsky, B.; Pleet, D.; D'Ercole, F.; Siegel, J.A.; Fisher, R.S.; Malmud, L.S.

1985-01-01

This study was performed to determine if and for how long sucralfate (SU) binds selectively to sites of gastro-intestinal (GI) ulceration. Se-Su was prepared by sulfating sucrose with tracer Se-75 and precipitating it as the basic Al salt. All patients (pts) had endoscopy to confirm the presence of either: esophagitis (n=5), gastritis (GA) (n=5), gastric ulcers (GU) (n=5), duodenal ulcers (DU) (n=5), or no ulceration (NU) (n=5). Following an overnight fast the pts swallowed 1 gm with 100 μCi of Se-SU and were imaged continuously over 24 hours or until no activity remained in the upper GI tract. Pts with GU visually demonstrated focal SU binding at the ulcers for an average of 3.9 +- 1.1 hrs. with a mean GET of 68 +- 25 min. Mean GET for pts with DU was prolonged, 171 +- 63 min, however focal binding at duodenal ulcers was not seen. All pts with GA had diffuse retention of SU in the stomach with a mean GET of 118 +- 34 min. Focal binding of SU at all sites of esophagitis was seen with a T-1/2 of 65 +- 32 min at the ulcerations. In conclusion these data support the theory that the mechanism of ulcer healing with SU is related to its ability to adhere to the ulcer site forming a protective barrier. In addition Se-SU is a potential ulcer imaging agent which can be used to noninvasively assess healing

Duodenal perforation: an unusual complication of sickle cell anemia

OpenAIRE

Acıpayam, Can; Aldıç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; Aşkar, Hasan; Dorum, Bayram Ali

2014-01-01

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presente...

Preoperative chest x-ray findings in peptic ulcer perforation

Energy Technology Data Exchange (ETDEWEB)

Kim, T. H.; Kim, S. W.; Lim, J. S.; Kim, Y. J. [Kyungpook National University School of Medicine, Taegu (Korea, Republic of)

1981-12-15

This study was carried out to analyze the distribution of age, sex, chief complaint, physical examination and findings of chest x-ray films before operation in 59 cases of peptic ulcer perforation. The ratio of male to female was 1.7 : 1 and incidence of the ulcer perforation was most common in 5th decades. Thirty five among 59 cases showed pleural effusion, segmental atelectasis and pneumonic infiltration on chest x-ray film. Twenty nine among 50 cases of duodenal ulcer perforation and 6 of 9 cases of stomach ulcer perforation showed positive chest x-ray findings. No relationship was found between fever and preoperative chest x-ray findings.

Preoperative chest x-ray findings in peptic ulcer perforation

International Nuclear Information System (INIS)

Kim, T. H.; Kim, S. W.; Lim, J. S.; Kim, Y. J.

1981-01-01

This study was carried out to analyze the distribution of age, sex, chief complaint, physical examination and findings of chest x-ray films before operation in 59 cases of peptic ulcer perforation. The ratio of male to female was 1.7 : 1 and incidence of the ulcer perforation was most common in 5th decades. Thirty five among 59 cases showed pleural effusion, segmental atelectasis and pneumonic infiltration on chest x-ray film. Twenty nine among 50 cases of duodenal ulcer perforation and 6 of 9 cases of stomach ulcer perforation showed positive chest x-ray findings. No relationship was found between fever and preoperative chest x-ray findings

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

International Nuclear Information System (INIS)

Grassi, Roberto; Romano, Stefania; Pinto, Antonio; Romano, Luigia

2004-01-01

Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

Energy Technology Data Exchange (ETDEWEB)

Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; Pinto, Antonio; Romano, Luigia

2004-04-01

Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24

Fecal Calprotectin is an Accurate Tool and Correlated to Seo Index in Prediction of Relapse in Iranian Patients With Ulcerative Colitis.

Science.gov (United States)

Hosseini, Seyed Vahid; Jafari, Peyman; Taghavi, Seyed Alireza; Safarpour, Ali Reza; Rezaianzadeh, Abbas; Moini, Maryam; Mehrabi, Manoosh

2015-02-01

The natural clinical course of Ulcerative Colitis (UC) is characterized by episodes of relapse and remission. Fecal Calprotectin (FC) is a relatively new marker of intestinal inflammation and is an available, non-expensive tool for predicting relapse of quiescent UC. The Seo colitis activity index is a clinical index for assessment of the severity of UC. The present study aimed to evaluate the accuracy of FC and the Seo colitis activity index and their correlation in prediction of UC exacerbation. In this prospective cohort study, 157 patients with clinical and endoscopic diagnosis of UC selected randomly from 1273 registered patients in Fars province's IBD registry center in Shiraz, Iran, were followed from October 2012 to October 2013 for 12 months or shorter, if they had a relapse. Two patients left the study before completion and one patient had relapse because of discontinuation of drugs. The participants' clinical and serum factors were evaluated every three months. Furthermore, stool samples were collected at the beginning of study and every three months and FC concentration (commercially available enzyme linked immunoassay) and the Seo Index were assessed. Then univariate analysis, multiple variable logistic regression, Receiver Operating Characteristics (ROC) curve analysis, and Pearson's correlation test (r) were used for statistical analysis of data. According to the results, 74 patients (48.1%) relapsed during the follow-up (33 men and 41 women). Mean ± SD of FC was 862.82 ± 655.97 μg/g and 163.19 ± 215.85 μg/g in relapsing and non-relapsing patients, respectively (P Seo index were significant predictors of relapse. ROC curve analysis of FC level and Seo activity index for prediction of relapse demonstrated area under the curve of 0.882 (P Seo index was significant in prediction of relapse (r = 0.63, P Seo activity index in prediction of relapse in the course of quiescent UC in Iranian patients.

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

Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease--Results of a Double Institution Study of 35 Patients.

Science.gov (United States)

Chereau, Nathalie; Chandeze, Marie-Maëlle; Tantardini, Camille; Trésallet, Christophe; Lefevre, Jérémie H; Parc, Yann; Menegaux, Fabrice

2016-03-01

Endoscopic and interventional techniques are currently the mainstay of management of bleeding duodenal ulcer. As well, for patients with perforated duodenal ulcer, laparoscopic simple closure is nowadays usually performed. Although indications for emergency antroduodenectomy have declined, this procedure is still necessary as a salvage option when conservative management has failed or is not practicable. Our study aimed to evaluate indications and results of antroduodenectomy with gastroduodenal anastomosis in current practice and to examine the factors that predict operative outcomes. All patients who underwent emergency antroduodenectomy with gastroduodenal anastomosis in two surgical care departments specialized in emergency digestive surgery were studied from 2000 to 2015. Thirty-five patients (27 males, 77 %) with a median age of 68 years (20-90) underwent emergency antroduodenectomy with gastroduodenal anastomosis. Indications were bleeding and perforated duodenal ulcer in 24 and 11 patients, respectively. The overall complication rate was 69 %, especially because of a high rate of medical complications (57 %). Only two patients (6 %) required reoperation for anastomotic leakage. The overall mortality rate was 40 % (n = 14). According to the univariate analysis, age >70, >3 comorbidities, ASA score >2, and postoperative medical complications were associated with an increased risk of in-hospital mortality. In the multivariate analysis, age and ASA score remained independent risk factors. No recurrence of complicated duodenal disease was observed. Antroduodenectomy with gastroduodenal anastomosis is a safe and effective long-term strategy, with a low and acceptable rate of surgical complications, for complicated duodenal ulcer not responding to conservative measures.

Measures of Adiposity Are Associated with Increased Risk of Peptic Ulcer

Science.gov (United States)

Boylan, Matthew R.; Khalili, Hamed; Huang, Edward S.; Chan, Andrew T.

2014-01-01

Background & Aims Obesity is associated with systemic inflammation, alterations in the intestinal microbiome, and decreased epithelial integrity. The association between obesity and peptic ulcer has not been thoroughly investigated. Methods We conducted a prospective cohort study of 47,120 men enrolled in the Health Professionals Follow-up Study (mean age of 54 years at baseline). Biennially, we updated information on body mass index (BMI), physical activity, smoking, and use of non-steroidal anti-inflammatory drugs (NSAID) or aspirin. Self-reported waist and hip measurements were validated among a subsample of participants. Self-reported cases of gastric and duodenal ulcers were confirmed by medical record review. Helicobacter pylori status was determined from endoscopic biopsies, serum antibody measurements, and/or stool antigen assays documented in the medical record. We used Cox proportional hazards modeling to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results We documented 272 gastric and 320 duodenal ulcers over 24 years of follow up. The multivariate-adjusted HR for gastric ulcer was 1.83 (95% CI, 1.20–2.78; Ptrendulcer was not associated with BMI (Ptrend=.24) or WHR (Ptrend=.68). In secondary analyses, increased BMI and WHR were each associated with increased risk of H pylori-negative, but not H pylori-positive, ulcers. The effect of BMI on ulcer risk did not change with use of aspirin or NSAID, alcohol consumption, physical activity, or smoking. Conclusions In a large prospective cohort of male health professionals, central and total obesity were associated with increased risk of peptic ulcer—particularly gastric and H pylori-negative ulcers. PMID:24681076

Оцінка лікування виразки дванадцятипалої кишки у дітей з точки зору відновлення репаративної функції = The estimation of treatment in children with duodenal ulcer from the perspective of reparative function recovery

Directory of Open Access Journals (Sweden)

V. M. Dudnyk

2016-07-01

Department of Pediatrics No 2, National Pirogov Memorial Medical University Vinnitsya, Ukraine   Abstract Background .Diseases of the upper gastrointestinal tract in children occupy a leading place in the structure of gastroenterological diseases, including the  duodenal ulcer, which is the actual problem of modern medicine throughout the world, characterized by  the progressive growth. Establishing the role of H. pylori in the mechanisms of a number of diseases of the upper gastrointestinal tract changed the approach to the problem of this disease. An important role in the development of infectious-inflammatory process induced by H. pylori play TLR4, having reactivity to lipopolysaccharide of Gram-negative bacteria. Much attention is being paid to determine the effect of H. pylori in the regeneration  damaged of duodenal mucosa, which by means of growth factors, such as epidermal growth factor(EGF. EGF - a universal endogenous regulator of cell renewal, which accelerates migration and proliferation of the epithelium, enhances angiogenesis. The aim of our study was to evaluate the results of complex treatment in children with duodenal ulcer according to the dynamics of TLR4 and EGF in  blood serum. Materials and methods. The overall clinical group consisted of 54 children with duodenal ulcer aged 7-18 years. The control group consisted of 25 healthy children of similar age. The average age of patients was 13,3 ± 0,2 years.  The study used clinical, laboratory and instrumental  methods of  examination   used.  The content of  TLR 4 and EGF in serum were determined by ELISA. Results and discussion. Children who were under supervision, were allocated based on the severity of the disease and the presence of H. pylori infection. Among the patients  H. pylori (+ duodenal ulcer had 40 (74.07% children - 14 (25.93% patients had no H. pylori infection. Severe degree of disease was observed in 16 (29.63% children, 38 (70.37% of the children had moderate course

Increased short- and long-term mortality in 8146 hospitalised peptic ulcer patients.

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Malmi, H; Kautiainen, H; Virta, L J; Färkkilä, M A

2016-08-01

Incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity. © 2016 John Wiley & Sons Ltd.

[Antiulcer activity of dibunol in experimental stomach and duodenal ulcers].

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Shatalov, V N; Korman, D B; Krutova, T V; Sokolov, L K; Andrianova, O P

1988-01-01

The antiulcer effect of two medicinal forms (oil solution, liniment) of dibunol in rats with different models of the stomach and duodenum ulcers was studied. The therapeutic activity of dibunol was evaluated by determining the index of ulcer formation as well as during the morphological and histochemical studies. The two medicinal forms of dibunol possessed equal antiulcer activity by all studied criteria. One should note a characteristic property of dibunol--its ability to produce pronounced epithelialization of ulceroerosive and ulceronecrotic lesions of the mucosa without rough scarring.

Gastric ulcer treatment: cure of Helicobacter pylori infection without subsequent acid-suppressive therapy: is it effective?

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van Zanten, Sander Veldhuyzen; van der Knoop, Bloeme

2008-06-01

Whether it is a requirement to continue with anti-secretory therapy following anti-Helicobacter therapy in H. pylori positive gastric ulcers is an important question. As gastric ulcers tend to heal more slowly than duodenal ulcers, may be asymptomatic or only causing mild symptoms and success at curing H. pylori with current fist line therapies is 80% at best, clinicians will likely err on the side of caution and continue acid suppressive therapy to ensure healing of gastric ulcers. This is certainly recommended when dealing with bleeding ulcers.

Penyakit Peptik dan Misoprostol

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Mariana Raini

2012-10-01

Full Text Available Peptic mucus synthesize especially prostaglandine E2 and I2. Prostaglandine E2 and I2 can impede acid secrete and stimulate mucus and bicarbonate secretion. Misoprostof, a synthetic methyl ester analogue of prostaglandin is both a powerful inhibitor of gastric secretion and is able to protect the gastroduodenal mucosa from damage. Misoprostol and other prostaglandine derivatives can be alternative drug of peptic ulcer relapse because the metyl ester of prostaglandin exert an antisecretion and protective effects on peptic mucus. The clinical effectiveness of misoprostol is comparable to cimethidin in short term treatment of peptic and duodenum ulcer as well as reducing duodenal ulcer relapse. Misoprostol may prevent gastrointestinal and peptic ulcer in long term treatment of Non Steroid Anti Jnflamation Drug. The side effect of misoprostol is cervix maturation and uterotonic. This article describe misoprostol effictiveness on peptic and duodenum ulcer treatment.   Key Words: Misoprostol, Peptik ulcer, Sitoproteksi

Prevalence and incidence of peptic ulcer disease in a Danish County--a prospective cohort study.

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Rosenstock, S J; Jørgensen, T

1995-01-01

Peptic ulcer prevalence and five year incidence were assessed in a sex and age stratified population sample of 3608 Danish subjects aged 30-60 years. Statements of peptic ulcer disease obtained from questionnaires were scrutinised by reviewing medical records. Life time ulcer prevalence (95% confidence intervals) was 5.6 (4.9-6.4) per cent. Male to female prevalence ratio was 2.2:1, and duodenal to gastric ulcer prevalence ratio was 3.8:1. Thirty two participants with no previous history of p...

Features of Clinical Course of Perforated Ulcers of Stomach and Duodenum in Children

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A.G. Zaporozhchenko

2013-11-01

Full Text Available We examined 52 patients aged from 14 to 17 years with perforated ulcer of stomach and the duodenum, operated using laparoscopic and open ways. It is established, that perforated ulcer of stomach and the duodenum in children onset suddenly, the are characterized by absence of «ulcer anamnesis» and clinical picture of acute peritonitis in 77 % of children. Maximum efficiency of diagnosis of perforated gastric and duodenal ulcers is achieved by using a comprehensive diagnostic program that includes the use of phased diagnostic measures in accordance with their resolution in each case.

Double Pylorus After a Peptic Ulcer in the Gastric Antrum: A Case Report

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Song, Jang hyeon; Shin, Sang Soo; Heo, Young Hoe; Kim, Jin Woong; Jeong, Yong Yeon; Heo, Suk Hee; Kang, Heoung Keun

2010-01-01

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 complication after a previous peptic ulcer in the gastric antrum

Double Pylorus After a Peptic Ulcer in the Gastric Antrum: A Case Report

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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 complication after a previous peptic ulcer in the gastric antrum

Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer.

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Lunevicius, Raimundas; Morkevicius, Matas

2005-10-01

The primary goal of this study was to describe epidemiology and management strategies of the perforated duodenal ulcer, as well as the most common methods of laparoscopic perforated duodenal ulcer repair. The secondary goal was to demonstrate the value of prospective and retrospective studies regarding the early results of surgery and the risk factors. The tertiary goal was to emphasize the benefits of this operation, and the fourth goal was to clarify the possible risk factors associated with laparoscopic repair of the duodenal ulcer. The Medline/Pubmed database was used. Review was done after evaluation of 96 retrieved full-text articles. Thirteen prospective and twelve retrospective studies were selected, grouped, and summarized. The spectrum of the retrospective studies' results are as follows: median overall morbidity rate 10.5 %, median conversion rate 7%, median hospital stay 7 days, and median postoperative mortality rate 0%. The following is the spectrum of results of the prospective studies: median overall morbidity rate was slightly less (6%); the median conversion rate was higher (15%); the median hospital stay was shorter (5 days) and the postoperative mortality was higher (3%). The risk factors identified were the same. Shock, delayed presentation (> 24 hours), confounding medical condition, age > 70 years, poor laparoscopic expertise, ASA III-IV, and Boey score should be considered preoperative laparoscopic repair risk factors. Each of these factors independently should qualify as a criterion for open repair due to higher intraoperative risks as well as postoperative morbidity. Inadequate ulcer localization, large perforation size (defined by some as > 6 mm diameter, and by others as > 10 mm), and ulcers with friable edges are also considered as conversion risk factors.

Evaluation of Helicobacter pylori infection and other risk factors in patients with benign peptic ulcer disease

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Depender Kumar Timshina

2011-03-01

Full Text Available Objective: To assess and compare the risk factors in patients with benign gastric and duodenal ulcers and to correlate the prevalence of Helicobacter pylori (H. pylori infection in benign peptic ulcer disease. Methods: A total of 30 consecutive patients with peptic ulcer disease were included in this study after upper gastrointestinal endoscopy. Their clinical profile and endoscopic findings were noted. Antral biopsies were subjected to histopathological examination and urease test for detection of H. pylori. Results were correlated. The study was cleared by the Institute Research Council and the Ethics committee. Results: The male: female ratio was 11:4. Overall, H. pylori infection was prevalent in 93.3% of the patients. Patients who took spicy food had a significantly higher rate of H. pylori positivity (P=0.04. Smoking, alcohol intake and NSAIDs did not affect H. pylori status in patients. There was no significant association between the site of the ulcer and H. pylori infection. Conclusions: Based on our observations we conclude that prevalence of H. pylori infection is similar in duodenal and gastric ulcers and intake of spicy food is a significant risk factor.

Epithelial Regeneration After Gastric Ulceration Causes Prolonged Cell-Type AlterationsSummary

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Eitaro Aihara

2016-09-01

Full Text Available Background & Aims: The peptic ulcer heals through a complex process, although the ulcer relapse often occurs several years later after healing. Our hypothesis is that even after visual evidence of healing of gastric ulceration, the regenerated epithelium is aberrant for an extended interval, increasing susceptibility of the regenerated epithelium to damage and further diseases. Methods: Gastric ulcers were induced in mice by serosal topical application of acetic acid. Results: Gastric ulcers induced by acetic acid visually healed within 30 days. However, regenerated epithelial architecture was poor. The gene profile of regenerated tissue was abnormal, indicating increased stem/progenitor cells, deficient differentiated gastric cell types, and deranged cell homeostasis. Despite up-regulation of PDX1 in the regenerated epithelium, no mature antral cell type was observed. Four months after healing, the regenerated epithelium lacks parietal cells, trefoil factor 2 (TFF2 and (sex-determining region Y-box 9 (SOX9 remain up-regulated deep in the gastric gland, and the Na/H exchanger 2 (a TFF2 effector in gastric healing remains down-regulated. Gastric ulcer healing was strongly delayed in TFF2 knockout mice, and re-epithelialization was accompanied with mucous metaplasia. After Helicobacter pylori inoculum 30 days after ulceration, we observed that the gastric ulcer selectively relapses at the same site where it originally was induced. Follow-up evaluation at 8 months showed that the relapsed ulcer was not healed in H pylori–infected tissues. Conclusions: These findings show that this macroscopically regenerated epithelium has prolonged abnormal cell distribution and is differentially susceptible to subsequent damage by H pylori. Keywords: Gastric Ulcer Healing, Metaplasia, H pylori, SOX9, TFF2, NHE2

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

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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

An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults.

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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 discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer.

Gastrointestinal morbidity of adjuvant radiotherapy in stage I malignant teratoma of the testis

International Nuclear Information System (INIS)

Hamilton, C.R.; Horwich, A.; Peckham, M.J.; Bliss, J.M.

1987-01-01

Between January 1963 and December 1983, 248 patients with stage I teratoma were managed by the Testicular Tumour Unit of the Royal Marsden Hospital (RMH). Before 1979, these patients were treated with adjuvant irradiation to the abdominal and pelvic lymph nodes (142 patients) to a mid-plane dose of 40 Gy in 20 fractions over 4 weeks. In 1979, a surveillance policy was adopted (106 patients) and relapsing patients treated with chemotherapy. By 2 years post-orchidectomy, seven patients (4.9%) in the irradiated group developed duodenal ulceration compared to none in the surveillance group (p = 0.05). A past medical history of duodenal ulcer was a significant risk factor for ulceration after radiotherapy (p = 0.04) whereas a past history of abdominal surgery was not (p = 0.8). It is concluded that adjuvant radiotherapy for stage I teratoma may increase the risk of peptic ulceration. 14 refs.; 1 figure; 4 tabs

Life-event stress induced by the Great East Japan Earthquake was associated with relapse in ulcerative colitis but not Crohn's disease: a retrospective cohort study

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Shiga, Hisashi; Miyazawa, Teruko; Kinouchi, Yoshitaka; Takahashi, Seiichi; Tominaga, Gen; Takahashi, Hiroki; Takagi, Sho; Obana, Nobuya; Kikuchi, Tatsuya; Oomori, Shinya; Nomura, Eiki; Shiraki, Manabu; Sato, Yuichirou; Takahashi, Shuichiro; Umemura, Ken; Yokoyama, Hiroshi; Endo, Katsuya; Kakuta, Yoichi; Aizawa, Hiroki; Matsuura, Masaki; Kimura, Tomoya; Kuroha, Masatake; Shimosegawa, Tooru

2013-01-01

Objective Stress is thought to be one of the triggers of relapses in patients with inflammatory bowel disease (IBD). We examined the rate of relapse in IBD patients before and after the Great East Japan Earthquake. Design A retrospective cohort study. Settings 13 hospitals in Japan. Participants 546 ulcerative colitis (UC) and 357 Crohn's disease (CD) patients who received outpatient and inpatient care at 13 hospitals located in the area that were seriously damaged by the earthquake. Data on patient's clinical characteristics, disease activity and deleterious effects of the earthquake were obtained from questionnaires and hospital records. Primary outcome We evaluated the relapse rate (from inactive to active) across two consecutive months before and two consecutive months after the earthquake. In this study, we defined ‘active’ as conditions with a partial Mayo score=2 or more (UC) or a Harvey-Bradshaw index=6 or more (CD). Results Among the UC patients, disease was active in 167 patients and inactive in 379 patients before the earthquake. After the earthquake, the activity scores increased significantly (p<0.0001). A total of 86 patients relapsed (relapse rate=15.8%). The relapse rate was about twice that of the corresponding period in the previous year. Among the CD patients, 86 patients had active disease and 271 had inactive disease before the earthquake. After the earthquake, the activity indices changed little. A total of 25 patients experienced a relapse (relapse rate=7%). The relapse rate did not differ from that of the corresponding period in the previous year. Multivariate analyses revealed that UC, changes in dietary oral intake and anxiety about family finances were associated with the relapse. Conclusions Life-event stress induced by the Great East Japan Earthquake was associated with relapse in UC but not CD. PMID:23396562

Profile of peptic ulcer disease and its risk factors in Arar, Northern Saudi Arabia.

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Albaqawi, Afaf Shuaib Badi; El-Fetoh, Nagah Mohamed Abo; Alanazi, Reem Faleh Abdullah; Alanazi, Najah Salah Farhan; Alrayya, Sara Emad; Alanazi, Arwa Nughaymish Mulfi; Alenezi, Shoug Zeid Trad; Alanazi, Rehab Abdallah Alrkowi; Alshalan, Anfal Muaddi; Alenezi, Omar Tabaan; Ali, Wafaa Mohamed Bakr

2017-11-01

Peptic ulcer disease is a multifactorial health problem, and its prevalence and risk factors have changed considerably within the past century. To determine the prevalence of peptic ulcer among the population of Arar city and to identify risk factors for peptic ulcer and to estimate their relative impact on ulcer incidence. A cross-sectional study was carried out on the population of Arar city, Northern Saudi Arabia from November 01, 2016 to April 30, 2017. Data were analyzed by SPSS version 16, using descriptive statistics, prevalence, and Chi-square test. Total prevalence of peptic ulcer among the studied respondents was thus: 21.9% had peptic ulcer; 16.2% gastric ulcer and 5.6% duodenal ulcer. In 19.7% of the cases, the pain was severe, 92.4% reported that pain was precipitated by certain food. In addition to heartburn, 78.8% reported loss of appetite, 71.2% indigestion, 66.7% regurgitation, 59.1% nausea and vomiting and 42.4% with chest pain. Regarding the risk factors, coffee drinking came in first place (81.8%) followed by physical stress in 77.3%, spicy food in 57.6%, prolonged use of Non-steroidal anti-inflammatory drugs (NSAIDs) in 33.3% and Helicobacter pylori (H. pylori) infection in 24.2%. A further 22.7% reported melena as a complication while only 10.6% reported hematemesis. This is the first population-based study in Arar, Northern Saudi Arabia reporting point prevalence of peptic ulcer disease. The rate of 16.2% for gastric ulcer and 5.6% for duodenal ulcers are substantially high. Coffee drinking, physical stress, spicy food, prolonged use of NSAID and H. pylori infection were the reported risk factors. Population-based endoscopic studies are recommended.

[Interrelation between trophological status and the course of stomach and duodenal ulcer diseases].

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Butov, M A; Zhestkova, T V

2014-01-01

There was installed a significant positive relationship between body mass index (BMI) and the velocity of cicatrization of ulcer in patients with ulcer disease (PUD) with trophological violations. Change in the index ratio of lymphocytes and ESR in patients with PUD trophological violations can be used to predict the velocity of cicatrization of ulcer. The general maladjustment more often observed in patients (PUD) underweight.

Tobacco use as contributory factor in peptic ulcer disease

International Nuclear Information System (INIS)

Afridi, M.A.R.

2003-01-01

Objective: To find out the association of tobacco as a contributory factor in patients presenting with peptic ulcer disease (PUD). Results: Fifty-six percent of all the patients with PUD used tobacco, 33% as cigarette, 18% took it as 'naswar' and 5% of patients used it in both the forms. Of these, 85.7% (48/56) patients had duodenal ulcer and 14.3% (8/56) patients had gastric ulcer. All these patients were male none of the female patients used tobacco in any form. Moreover, 40% of PUD patients reported long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusion: This study supports the view that use of tobacco is associated with PUD in men. (author)

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation.

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Bruner, David I; Gustafson, Corey

2011-06-22

Dyspnea and chest pain are common presenting complaints to the ED, and coupled together can present a challenging diagnostic dilemma in patients in extremis. A thoughtful evaluation is required, giving due diligence to the immediate life threats as well as multiple etiologies which can cause serious morbidity. A perforated peptic ulcer is one such possibility and requires rapid diagnosis and prompt intervention to avoid the associated high risk of morbidity and mortality. We present a case report of a 54 year old man with respiratory distress and chest pain as the initial Emergency Department presentation of a perforated duodenal ulcer. We discuss an unusual presentation of a perforated duodenal ulcer that was recognized in the emergency department and treated promptly. The patient was surgically treated immediately, had a prolonged and complicated post-operative course, but is ultimately doing well. We also provide a brief literature review of the risk factors, imaging choices, and management decision required to treat a perforated ulcer. Perforated ulcers can have highly varied presentations and are occasionally difficult to diagnose in a complicated patient. Knowledge of the risk factors and a thorough history and physical can point to the diagnosis, but timely and appropriate imaging is often required because delays in diagnosis and treatment lead to poor outcomes. Early administration of antibiotics and immediate surgical repair are necessary to limit morbidity and mortality.

TREATMENT OF ULCER GASTRODUODENAL BLEEDINGS: CURRENT STATE OF THE PROBLEM (A LITERATURE REVIEW

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O. N. Antonov

2014-01-01

Full Text Available ABSTRACT. The problem of ulcer gastro-duodenal bleeding therapy is one of the most essential in urgent surgery. The bleeding is the most serious complication of peptic ulcer desease. It is observed in 15– 20% cases when patients have peptic ulcer diagnosis determined. In general the issues of bleeding therapy in gastroduodenal sphere are surveyed imperfectly. Some patulous endoscopic hemostasis methods don’t fully meet safety and confidence reqirements that preserves high level of general and post-operational lethality in our country and in the rest of the world. 

Exeretic surgery in complicated peptic ulcer: An inopportune procedure?

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Armas Perez, Barbaro; Reyes Balseiro, Evelio; Garcia Rodriguez, Miguel; Armas Moredo, Karina

2010-01-01

INTRODUCTION: The aim of present study was to analyze the surgical treatment results in the complicated duodenal or gastric chronic peptic ulcer over 15 years. METHODS: A retrospective and descriptive study was conducted in patients presenting with complicated peptic ulcer by exeresis. Patients (n=45) were seen by some of us in the ''Amalia Simoni'' Clinical Surgical of Camaguey province from January, 1989 to December, 2004. RESULTS: Disease was more frequent in male sex (82,22%) and in ages from 36 to 50 years (46,67%). The 95,56% of patients treated suffered from duodenal ulcer and the main criterion for surgery was its unmanageable condition (62,22%). Endoscopy was very useful for diagnosis of this entity. All operated on underwent vagotomy with antrectomy; in the 68,89% we performed a Billroth's II anastomosis and in remainder (31,11% it was of Billroth I type. There was a similar figure of early complications related to techniques used and among them prevails the anastomosis bleeding and delay evacuation. There were more late complications in type Billroth II anastomosis than in the Billroth I. Surgical results were excellent and very good in the 89% of cases. The enterocolitis variant has the great percentage of non-satisfactory results (9,09%). Only two patients had poor results, although there wasn't operative mortality. CONCLUSIONS: This kind of surgery is indicated only in cases of complicated peptic ulcer. It is not the choice method in ulcer patients, but in its use it is necessary to know about different techniques and its use. Thus, we must to know a lot about this procedure. (author)

Biphasic effect of duodenal ulcerogens cysteamine (C), mepirizole (M) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropryridine (MPTP) on gastric emptying in the rat

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Pihan, G.; Kline, T.J.; Szabo, S.

1986-03-01

The effect of acute or chronic administration of duodenal ulcerogens on gastric emptying (GE) of a liquid meal was investigated. In Sprague-Dawley rats (150-200g) 2 ml of /sup 51/Cr in 2% dextrose (5000 CPM) was given intragastrically and the GE half life was established as 7.6 min (controls). In acute experiments, C (30mg/100g), M (40mg/100g) or MPTP (4mg/100g) injected subcutaneously all delayed GE at 1, 2, 4, 8 and 24 hr by 15-77%. Maximal GE delay (p<0.05) by 77, 48 or 71% was found 1, 1 or 2 hr after C, M or MPTP, respectively. In chronic experiments, C (22mg/100g) was given x3 on the first day and once daily (25mg/100g) for 3 or 10 additional days. M (20mg/100g) once daily and MPTP (4mg/100g) x3 daily were given for 4 or 11 days. GE was measured on the 5th and 12th day. Chronically, MPTP accelerated GE by 63 and 31% at 5 and 12 days (p<0.05) and C and M did not change GE. The severity of duodenal ulcers correlated (p<0.05) with the amount of /sup 51/Cr remaining in the stomach: r=-0.68, -0.74 and -0.70 after C, M and MPTP, respectively. Acute administration of duodenal ulcerogens delay GE in rats. Chronic treatment with duodenal ulcerogens either accelerates or does not change GE. The most severe chronic ulcers exhibit the most rapid emptying. The authors data suggest that rapid GE might be a secondary rather than a primary alteration in duodenal ulceration.

Peptic ulcer among urban bus drivers in Denmark

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Netterstrøm, Bo; Juel, K

1990-01-01

As part of a survey on the work environment of bus drivers, 2045 (83%) of 2465 male bus drivers in the three major cities in Denmark in 1978 answered a postal questionnaire on health and working conditions. In order to evaluate the relative occurrence of peptic ulcer among the bus drivers, a follow......-up study was also conducted. All hospital discharges with a peptic ulcer diagnosis among the bus drivers were registered from the Danish National Patient Register. All Danish men were used as reference group. On the basis of the 1978-questionnaire association between occupational and psychosocial factors...... and subsequent hospital discharge with a peptic ulcer diagnosis was studied. The prevalence of abdominal pain alleviated by food intake was 12% among bus drivers and 6% in the reference group. The incidence of hospital discharge with duodenal ulcer among younger bus drivers was twice the incidence among Danish...

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

International Nuclear Information System (INIS)

Shin, Tae Beom; Kim, Young Hwan; Seong, Chang Kyu

2004-01-01

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

Perforated peptic ulcer in Tikur Anbessa Hospital: a review of 74 cases.

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Ersumo, Tessema; W/Meskel, Yidnekachew; Kotisso, Berhanu

2005-01-01

Little is known on the pattern of perforated peptic ulcer in Ethiopia. To evaluate the early, outcome of management, a five-year retrospective analysis of 74 operated cases of perforated peptic ulcer was undertaken. Perforated peptic ulcer accounted for 3.4% of the adult emergency surgical procedures. The mean age was 32.6 years, with a male to female ratio of 7.2 to 1.0. Fifty-six percent of the cases were unmarried. In nearly 22.0% of the patients, no previous history of peptic ulcer disease was documented. Delay in diagnosis was noted in 95% of the cases. Most patients had duodenal ulcer perforation, and about 78% had purulent peritonitis at laparotomy. Fourteen died in hospital. Early presentation of patients to surgical care facilities may reduce morbidity and mortality in cases of peptic ulcer perforation.

Some peculiarities of lipides peroxide oxidation and anti oxidation therapy of duodenal peptic ulcer in the persons who stayed in the zone of the Chernobyl accident

International Nuclear Information System (INIS)

Babak, O.Ya.; Chernyak, A.M.; Goncharova, L.Yi.; Pasyijeshvyilyi, L.M.

1994-01-01

The authors have studied the links of lipides peroxide oxidation (LPO) in the blood plasma, i.e. the level of antioxidant protection at duodenal peptic ulcer (DPU) in the persons who stayed in the zone of the accident at Chernobyl Atomic Power Station. LPO intensification takes place at the expense of the primary stages (spontaneous and hydrogen peroxide induced chemo luminescence) in the liquidators with DPU, when compared with the patients having DPU who did not stay in the zone of the accident. It suggests of exhaustion of cell membranes anti-oxidate protection level which provides atypical course of inflammatory processes in the gastrointestinal tract mucous membrane. The peculiarities of blood plasma LPO changes suggest that it would be reasonable to include antioxidants (Unithiolum) to the complex treatment of the liquidators

[Peritonitis following gastroduodenal ulcer perforation disease in children: report of 4 cases].

Science.gov (United States)

Ndour, O; Bansouda, J; Fall, A F; Alumeti, D M; Diouf, C; Ngom, G; Ndoye, M

2012-10-01

Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this

Clinical relevance of radioimmunologic gastrin determination for peptic ulcer

International Nuclear Information System (INIS)

Boesl, F.

1980-01-01

The clinical validity of the specific and sensitive radioimmunoassay was proved by the verification of the gastrin concentrations (given in the special literature) in the fasting serum of healthy control persons and of defined patient groups: duodenal ulcer, gastric ulcer, peptico-jejunal ulcer, chronically atrophic gastritis with and without pernicious anaemia, pyloric stenosis, gastric carcinoma and renal insufficiency. The result of the examinations carried out with a standardised beverage test was that the serum gastric release, which was basally and postprandially increased with respect to healthy control persons, is significantly increased by selective and proximal vagotomy in patients with chronically recurrent duodenal ulcer. Pyloroplasty has no significant influence on the serum gastrin reaction after selective proximal vagotomy. Contrary to that the reduced basal serum gastrin values of patients with Billroth II gastrectomy could not be stimulated by the beverage test. The basal and postprandial hypergastrinaemia existing after selective proximal vagotomy does not change significantly during the first postoperative year. In order to statistically compare such studies the authos suggests the 'integrated overall gastrin release'. Synchronous measurements of insulin and blood-sugar reactions do not give any indication that hypergastrinaemia, induced by selective proximal vagotomy, causes any change of the endocrine pancreatic function. Several own examples illustrate the higher diagnostic value of the secretin provocative and calcium infusion test in cases of the Zollinger-Ellison syndrome and that of the standardised beverage test in antral G-cell hyperplasia. In most cases the glucagon test is not required. (orig./MG) [de

Perforated Duodenal Ulcer; Management in a Resource Poor, Semi ...

African Journals Online (AJOL)

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 pre.operative risk factors. Keywords: More wide spread use of definitive ...

Management of duodenal trauma

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CHEN Guo-qing

2011-02-01

Full Text Available 【Abstract】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. Key words: Duodenum; Wounds and injuries; Diagnosis; Therapeutics

Association of Helicobacter pylori infection with peptic ulcer disease ...

African Journals Online (AJOL)

Background: Helicobacter pylori infection has been identified as an important risk factor for the development of peptic ulcer disease and is probably the most important cause of relapse in those previously treated for peptic ulcer disease. The aim of this study was to determine the association of Helicobacter pylori infection as ...

Candida-associated gastric ulcer relapsing in a different position with a different appearance.

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Sasaki, Kenji

2012-08-28

An 87-year-old, Japanese woman was shown to have a submucosal tumor-like lesion with a deep, central ulceration covered with thick, whitish exudate in the stomach. Biopsy showed Candida tropicalis but not Helicobacter pylori (H. pylori). She had no predisposing factors or history of peptic ulcers nor had taken non-steroidal anti-inflammatory drugs (NSAIDs), diagnosed with Candida-associated gastric ulcer. Though cured of the lesion, she developed another ulcer in a different position, in which Candida was demonstrated but H. pylori was undetectable. This is the first case of recurrent Candida-associated gastric ulcer in the world. Detected in both the original and recurrent lesions in an H. pylori-negative patient with no antecedent ulcers who had not taken NSAIDs, Candida is considered, contrary to the prevailing opinion, to play an etiologic role in ulcer formation.

Management of duodenal trauma

OpenAIRE

CHEN Guo-qing; YANG Hua

2011-01-01

【Abstract】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...

Helicobacter Pylori Associated Antral Gastritis in Peptic Ulcer Disease Patients and Normal Healthy Population of Kashmir, India

Science.gov (United States)

Malik, G. M.; Bhat, M. Youssuf; rather, Ab. Rashid; Basu, Javaid Ahmad; Qureshi, Khursheed Ahmad

1998-01-01

Aim: To study the association of Helicobacter pylori infection with chronic antral gastritis in peptic ulcer disease patients and healthy population of Kashmir. Methods: 50 peptic ulcer patients (duodenal ulcer = 46, gastric ulcer = 2 and combined duodenal and gastric ulcer = 2) and 30 asymptomatic healthy volunteers were included in this study. Peptic ulcer was diagnosed on endoscopic examination. 4–6 punch biopsies were taken from gastric antrum in all the individuals and in case of gastric ulcer an additional biopsy was taken from the edge of the ulcer to exclude its malignant nature. Helicobacter pylori (H. pylori) organism was diagnosed using three different test methods, viz. Histology (using Giemsa Stain), Microbiology (Gram Stain) and Biochemistry (using one minute Endoscopy Room Test). Histological diagnosis of H. pylori was taken as the “gold standard” for the presence of H. pylori organism. Histological diagnosis of gastritis was made using Hematoxylin and Eosin Stain and the gastritis was classified as active chronic gastritis and superficial chronic gastritis. Results: Out of 30 peptic ulcer disease patients with associated antral gastritis, 27 (90%) were positive for H. pylori on histological examination (13 superficial chronic gastritis and 14 active chronic gastritis) whereas out of 8 healthy volunteers with histological evidence of chronic antral gastritis, H. pylori was observed in 7 individuals (87.50%) (4 active chronic gastritis and 3 superficial chronic gastritis). Conclusion: A highly significant association between H. pylori infection with chronic antral gastritis both in peptic ulcer disease patients and healthy volunteers of Kashmir was found in this study. Association between H. pylori infection and chronic gastritis was 90% in peptic ulcer group and 87.50% in healthy population (P<0.005). PMID:18493464

Current guidelines for the eradication of Helicobacter pylori in peptic ulcer disease

NARCIS (Netherlands)

Rauws, E. A.; van der Hulst, R. W.

1995-01-01

Pharmacological suppression of gastric acid secretion has traditionally been the most rational approach to healing ulcers successfully. However, ulcers initially healed using antisecretory therapy have a tendency to relapse after treatment is withdrawn. This tendency is altered definitively by

Frequency of peptic ulcer disease in patients of dyspepsia an analysis of upper gastrointestinal endoscopy

International Nuclear Information System (INIS)

Anwar, S.O.; Ambreen, S.; Ashraf, H.M.

2010-01-01

To evaluate the frequency of peptic ulcer disease in patients of dyspepsia on upper gastrointestinal endoscopy. A convenient non probability sampling was done and one hundred patients were selected from out patient department presenting within six months of dyspeptic symptoms. They were all subjected to upper gastrointestinal endoscopy Of all patients 61% (n=61) were males and 39% (n=39) were females with age ranging between 20 - 45 years. Study revealed functional dyspepsia (76%), duodenal ulcer (11%), gastric ulcer (4%) and esophagitis including gastoesophageal reflux disease (9%). This showed an overall frequency of peptic ulcer disease to be 15% in the studied population.Conclusion: Peptic ulcer disease is a common structural cause of dyspepsia and was responsible for 15% of dyspepsia. (author)

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

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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.

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

2015-07-01

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.

Short-term stress, but not mucosal healing nor depression was predictive for the risk of relapse in patients with ulcerative colitis: a prospective 12-month follow-up study.

Science.gov (United States)

Langhorst, Jost; Hofstetter, Anna; Wolfe, Fred; Häuser, Winfried

2013-10-01

Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. Psychological factors such as depression and stress are under debate to contribute to the risk of relapse. The impact of mucosal healing to reduce the risk of relapse had not been studied prospectively. The aim of this study was to identify whether depression and stress increase and mucosal healing reduces the risk of clinical relapse in patients with UC in clinical remission. Patients in clinical remission were followed prospectively for 1 year, or less if they relapsed. Endoscopy and histology score and long-term perceived stress (Perceived Stress Questionnaire) were measured at baseline. Mucosal healing was defined by a Mayo Endoscopy score of 0-1. Depression (Hospital Anxiety and Depression Scale) and acute perceived stress (Cohen Perceived Stress Scale) were measured at baseline and after 1, 3, 6, 9, and 12 months. A time-dependent multivariate Cox regression model determined the predictors of time to relapse. Seventy-five patients were included into final analysis, of which 28 (37.3%) relapsed. Short-term stress at the last visit before relapse (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.01-1.10) and male gender (HR = 2.38, 95% CI = 1.01-5.61), but not baseline mucosal healing (HR = 0.86, 95% CI = 0.35-2.11), baseline long-term stress (HR = 0.20, 95% CI = 0.01-3.31), and depression at the last visit before relapse (HR = 1.08, 95% CI = 0.95-1.22) were predictive for a relapse. Short-term stress but not depression nor mucosal healing was predictive for the risk of relapse in patients with UC in clinical remission. Larger multicentre studies are necessary to confirm our findings.

Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation

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Edouard Matevossian

2008-03-01

Full Text Available Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.

[Neurosis and genetic theory of etiology and pathogenesis of ulcer disease].

Science.gov (United States)

Kolotilova, M L; Ivanov, L N

2014-01-01

Based on the analysis of literature data and our own research, we have developed the original concept of etiology and pathogenesis of peptic ulcer disease. An analysis of the literature shows that none of the theories of pathogenesis of peptic ulcer disease does not cover the full diversity of the involved functions and their shifts, which lead to the development of ulcers in the stomach and the duodenum. Our neurogenic-genetic theory of etiology and pathogenesis of gastric ulcer and duodenal ulcer very best explains the cause-and-effect relationships in the patient peptic ulcer, allowing options for predominance in one or the other case factors of neurosis or genetic factors. However, it is clear that the only other: combination of neurogenic factor with genetically modified reactivity of gastroduodenal system (the presence of the target organ) cause the chronicity of the sores. The theory of peptic ulcer disease related to psychosomatic pathologies allows us to develop effective schema therapy, including drugs with psychocorrective action. On the basis of our theory of the role of Helicobacter pylori infection is treated as a pathogenetic factor in the development of peptic ulcer disease.

Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

Science.gov (United States)

Wang, Fu-Wei; Tu, Ming-Shium; Mar, Guang-Yuan; Chuang, Hung-Yi; Yu, Hsien-Chung; Cheng, Lung-Chih; Hsu, Ping-I

2011-01-01

AIM: To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease (PUD) in a general Taiwanese population. METHODS: From January to August 2008, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy. Gastroduodenal mucosal breaks were carefully assessed, and a complete medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to identify independent risk factors for asymptomatic PUD. RESULTS: Of the 572 asymptomatic subjects, 54 (9.4%) were diagnosed as having PUD. The prevalence of gastric ulcer, duodenal ulcer and both gastric and duodenal ulcers were 4.7%, 3.9%, and 0.9%, respectively. Multivariate analysis revealed that prior history of PUD [odds ratio (OR), 2.0, 95% CI: 1.3-2.9], high body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m2: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) were independent predictors of asymptomatic PUD. In contrast, high education level was a negative predictor of PUD (years of education 10-12: OR, 0.5, 95% CI: 0.3-0.8; years of education > 12: OR, 0.6, 95% CI: 0.3-0.9). CONCLUSION: The prevalence of PUD in asymptomatic subjects is 9.4% in Taiwan. Prior history of PUD, low education level, a high BMI and current smoker are independent risk factors for developing asymptomatic PUD. PMID:21448426

Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study.

Science.gov (United States)

Tzathas, Charalambos; Triantafyllou, Konstantinos; Mallas, Elias; Triantafyllou, George; Ladas, Spiros D

2008-07-01

The role of Helicobacter pylori eradication to cure peptic ulcer disease in patients with cirrhosis is not clear. To investigate the course of peptic ulcer disease in cirrhotics, first after healing with either H. pylori eradication or omeprazole therapy and second while on omeprazole maintenance therapy after recurrence. Prospective cohort study in a tertiary-care hospital in Greece. Out of 365 consecutive cirrhotic patients who underwent endoscopy, 67 had peptic ulcer and 30 were enrolled. H. pylori positive patients received eradication therapy and H. pylori negative patients received omeprazole treatment. Follow-up endoscopies were performed at 12 and 24 months or when symptoms recurred. Patients with ulcer recurrence were treated with omeprazole maintenance therapy. The main outcome measurement of the study was peptic ulcer relapse rate during follow-up. Twenty-eight patients with healed ulcers were followed for up to 2 years. During follow-up, ulcer relapsed in 17 patients (8/18 H. pylori positive and 9/10 H. pylori negative at study entry, P=0.041), including 2 patients who died from ulcer bleeding. No further ulcer relapse was observed in the remaining 15 patients who received omeprazole maintenance therapy for the rest of follow-up. H. pylori negative status (P=0.002) and severity of cirrhosis (P=0.015) at study entry were independently related to shorter peptic ulcer relapse-free time. H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients. Therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status.

Association of mortality with out-of-hours admission in patients with perforated peptic ulcer

DEFF Research Database (Denmark)

Knudsen, N V; Møller, M H

2015-01-01

BACKGROUND: Perforated peptic ulcer is a serious emergency surgical condition. The aim of the present nationwide cohort study was to evaluate the association between mortality and out-of-hours admission in patients surgically treated for perforated peptic ulcer. METHODS: All Danish patients...... surgically treated for benign gastric or duodenal perforated peptic ulcer in Denmark between September 1, 2011 and August 31, 2013 were included. Patients were identified through The Danish Clinical Register of Emergency Surgery. The association between 90-day mortality and time and day of admission...... with the primary analysis. The overall 90-day mortality rate was 25.6% (186/726). CONCLUSION: No statistically significant adjusted association between 90-day mortality and out-of-hours admission was found in patients surgically treated for perforated peptic ulcer....

A multicenter, double-blind study on triple therapy with lansoprazole, amoxicillin and clarithromycin for eradication of Helicobacter pylori in Japanese peptic ulcer patients.

Science.gov (United States)

Asaka, M; Sugiyama, T; Kato, M; Satoh, K; Kuwayama, H; Fukuda, Y; Fujioka, T; Takemoto, T; Kimura, K; Shimoyama, T; Shimizu, K; Kobayashi, S

2001-09-01

Two triple therapies with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of Helicobacter pylori were studied in multicenter, double-blind fashion to evaluate the eradication rate of H. pylori and safety of eradiation treatment in Japanese patients with H. pylori-positive active gastric ulcers or duodenal ulcers. Patients were randomly chosen for the control treatment of LPZ 30 mg twice a day (b.i.d.; Group A-LPZ-only) or the test treatments of LPZ 30 mg plus AMPC 750 mg and CAM 200 mg b.i.d. (Group B-LAC200) and LPZ 30 mg, AMPC 750 mg and CAM 400 mg b.i.d. (Group C-LAC400). All eradication treatments lasted for a period of 7 days. Successful eradication was assessed by culture and gastric histology 1 month after completion of the ulcer treatment. The eradication rates of H. pylori in the full analysis set were 0% in Group A-LPZ-only, 87.5% in Group B-LAC200 and 89.2% in Group C-LAC400 for gastric ulcer and, 4.4% in Group A-LPZ-only, 91.1% in Group B-LAC200 and 83.7% in Group C-LAC400 for duodenal ulcer. The eradication rates of Group B-LAC200 and Group C-LAC400 were 89.2% (95% CI: 84.8-93.7%) and 86.4% (95%CI: 81.5-91.3%) in total in the full analysis set, 89% (95% CI: 84.3-93.7%) and 85.3% (95%CI: 80.1-90.5%) in the per protocol set. The eradication rates in Groups B-LAC200 and group C-LAC400 were statistically significantly higher than the rate in Group A-LPZ-only for both gastric ulcer and duodenal ulcer patients (p high H. pylori eradication rate was obtained in Japanese ulcer patients with the triple therapy regimen consisting of LPZ 30 mg, AMPC 750 mg, and CAM 200 mg b.i.d.

Helicobacter pylori virulence factors and their role in peptic ulcer diseases in Turkey.

Science.gov (United States)

Tuncel, I E; Hussein, N R; Bolek, B K; Arikan, S; Salih, B A

2010-01-01

The role of virulence factors present in Helicobacter pylori (H. pylori) strains and the characterization of such factors being predictive of specific disease is still not clear. In this study, the cagA, vacA alleles and the recently characterized vacA i-region and dupA and their association with the severity of the disease was determined. Antral biopsies from 91patients with peptic ulcer (PU) (n = 41), gastritis (n = 48) and gastric cancer (GC) (n = 2) were analyzed for the presence of H. pylori by the CLO-test and PCR. A 79/91 (86%) patients were positive for H. pylori by either PCR or by both PCR and CLO-test. PCR-based typing of H. pylori isolates was performed on DNA extracted directly from biopsy samples. The cagA+ strains were found more likely to be associated with vacA s1 than s2. The vacA i1 allele detected in 16/23 (70%) of samples had significant association with duodenal ulcers than those 16/37 (44%) of gastritis (P dupA and duodenal ulcer. This study provided more evidence that the vacA i1 allele is one of the virulence factors of H. pylori that had significant association with severe outcome.

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

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

Energy Technology Data Exchange (ETDEWEB)

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.

Influence of cure of Helicobacter pylori infection on gastric acidity and gastroesophageal reflux: study by 24-h pH monitoring in patients with gastric or duodenal ulcer.

Science.gov (United States)

Fukuchi, Takumi; Ashida, Kiyoshi; Yamashita, Hiroshi; Kiyota, Naomi; Tsukamoto, Reiko; Takahashi, Hajime; Ito, Dai; Nagamatsu, Ryousuke

2005-04-01

Whether or not the eradication of Helicobacter pylori is a risk factor for reflux esophagitis (RE) is a question at issue. To find an answer, it is necessary to clarify the influence of H. pylori eradication on the mechanism of RE. The authors investigated the influence of H. pylori eradication on gastric acidity and gastroesophageal reflux in ten gastric ulcer (GU) patients and ten duodenal ulcer (DU) patients by 24-h simultaneous determination of pH in the stomach and esophagus. Though the results indicated enhanced gastric acidity in GU patients at night after H. pylori eradication, no such influence was observed in DU patients. No significant changes in gastroesophageal reflux occurred in GU or DU patients before and after H. pylori eradication. RE after H. pylori eradication occurred in only one patient, with GU. This patient had several risk factors for RE, such as obesity, male sex, and dietary habits to add to the increase in gastric acidity at night that occurred after H. pylori eradication. No increase in gastroesophageal reflux occurred in any DU patients or in the other GU patients that demonstrated enhanced gastric acidity at night after H. pylori eradication. The cure of H. pylori infection does not, by itself, cause RE in patients who have few other risk factors for RE.

[Comparative assessment of the strength properties of the mucous membrane of the stomach in patients with peptic ulcer and the effect of quamatel on ulcer cicatrization in experiment].

Science.gov (United States)

Ias'kov, I M; Troshin, V P; Kirillov, S K; Korolev, A A; Martynovich, A I

2008-01-01

The article reviews the research work of the authors on the strength properties of the mucous membrane of the stomach in patients with peptic ulcer and in experiment with quamatel application. Experiments were performed in laboratory animals and resected stomachs of patients with duodenal or stomach ulcer and complications requiring scheduled surgical treatment. The results of the research into the maximum tension (durability) of the stomach mucous membrane, antrum, and the periulcer area are described. For both localizations of the ulcer, the mucous membrane of the antrum was found to exhibit the least durability, while the highest durability was exhibited by the mucous membrane of the periulcer area. In the case of bulbar ulcer, the durability of the mucous membrane was shown to decrease with an increase in the number of aggravations. An inverse relationship between the strength properties and the intensity of hydrochloric acid production was observed.

Phenotypic and genotypic characterization of Helicobacter pylori from patients with and without peptic ulcer disease

DEFF Research Database (Denmark)

Petersen, A M; Fussing, V; Colding, H

2000-01-01

) profile of H. pylori strains were recorded; randomly amplified polymorphic DNA (RAPD) and urease gene typing were performed and correlated with diagnostic groups. RESULTS: Electron micrographs showed that H. pylori strains from patients with gastric ulcers adhered more frequently through filamentous...... ulcers were more prone to autoagglutinate than were strains from the other diagnostic groups (P = 0.03). H. pylori strains from gastric ulcer patients were found to be more homogeneous, as determined by RAPD and urease gene typing, than strains from the other diagnostic groups (P ..., a positive correlation was found between a patient's age and the adhesion to AGS cells of the patient's H. pylori strain (P = 0.006). CONCLUSION: A combination of an H. pylori autoagglutination test, RAPD, and urease gene typing may be useful in separating gastric ulcer-related strains from duodenal ulcer...

X-ray examination of the stomach and duodenum in patients with ulcer disease after vagotomy

International Nuclear Information System (INIS)

Pavlovskij, M.P.; Vdovichenko, V.I.; Matlam, L.G.

1987-01-01

A roentgenological and endoscopical study is presented of the stomach and duodenum in 66 patients during remission and in 22 patients during exacerbation of ulcer disease from 6 months up to 5 years after organsaving operations using vagotomy. In the majority of patients the stomach was characterized by a large gas bubble, cascade-like torsion, deformation of the antral portion and duodenal bulb. In some patients thickenings of the gastric antral mucosa were noted. An endoscopically confirmed ulcer was revealed roentgenologically only in 50% of patients

X-ray diagnostic features of acute bleeding ulcers of the stomach and duodenum

International Nuclear Information System (INIS)

Shcherbatenko, M.K.; Selina, I.E.; Chekalina, M.I.

1996-01-01

The paper is based on the analysis of clinical, X-ray, and morphological studies in 74 patients with massive gastrointestinal hemorrhage. The paper presents the specific features of X-ray studies of patients with bleeding gastroduodenal ulcers. X-ray studies shout be twice performed in these patients. The first study is conducted if gastroscopic findings are unclear, the repeated one is carried out while assessing changes in disease regression. X-ray diagnosis of bleeding ulcers is determined by their sites and the nature of an ulcerous process. The X-ray diagnosis of chronic callous gastric ulcers accompanied by hemorrhage was based on the detection of two direct symptoms of a niche on the gastric outlines and configuration and an inflammatory mound on the gastric outline and configuration. That of chronic bleeding ulcers of the duodenal bulb is based not only on searches niche, but other signs of the disease - the deformed organ, and the magnitude of a periprocess. 10 refs., 5 figs

Duodenal neuroendocrine tumor and the onset of severe diabetes mellitus in a US veteran

Directory of Open Access Journals (Sweden)

Lauren Murray

2016-01-01

Full Text Available Objective: Neuroendocrine tumors are neoplasms derived from endocrine cells, most commonly occurring in the gastrointestinal tract. Duodenal neuroendocrine tumors are rare tumors averaging 1.2–1.5 cm, and most are asymptomatic. Common presentation is abdominal pain, upper gastrointestinal bleed, constipation, anemia, and jaundice. Methods: An adult, Black, male patient with newly diagnosed diabetes mellitus presented to the emergency department with elevated liver function test and fatigue. Results: Magnetic resonance cholangiopancreatography demonstrated a large obstructing mass (3.6 cm × 4.4 cm × 3 cm within the second and third portions of the duodenum at the ampulla. Esophagogastroduodenoscopy demonstrated an ulcerated duodenal mass that was biopsied. Immunohistochemical stains were positive for synaptophysin, chromogranin B, and CK7. Chromogranin A was in normal range. Post-Whipple procedure demonstrated a 5.5 cm × 4.1 cm × 2.9 cm duodenal mass with invasion of the subserosal tissue of the small intestine, a mitotic rate of 2 per high-power field, and antigen Ki-67 of 2%–5%. Conclusion: This case raises the question as to if the patient developed diabetes mellitus due to the tumor size and location or if the new onset of diabetes was coincidental. This case also demonstrates the importance of a proficient history and physical.

Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

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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.

Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction

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Ju Hyoung Lee

2016-11-01

Full Text Available Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Congenital duodenal diaphragm in eight children

International Nuclear Information System (INIS)

Nawaz, Akhtar; Matta, Hilal; Jacobsz, Alic; Al-Salem, Ahmad H.; Trad, Omar

2004-01-01

Congenital duodenal obstruction (CDO) is common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm. The medical record of 22 children with the diagnosis of congenital intrinsic duodenal were reviewed for age, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes. Eight of 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from the plain abdominal X-ray, which showed the classic double-bubble appearence, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition. The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition. (author)

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

Science.gov (United States)

Aydinli, Bulent; Yilmaz, Omer; Ozturk, Gurkan; Yildigan, M Ilhan; Gursan, Nesrin; Basoglu, Mahmut

2007-09-01

A marginal ulcer developing after an initial operation for gastroduodenal ulcer is a serious threat to the patient, and a challenge to surgeons. Helicobacter pylori is the primary cause of peptic ulcer disease. However, its role in ulcer recurrence, especially of marginal ulcer (MU), after peptic ulcer surgery is unclear. This study aimed to determine any association between H. pylori infection and perforated MU by comparing the prevalence of H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) use in patients with perforated (PMU) and in those with nonperforated MU (NPMU). The study retrospectively evaluated the records of 16 patients with PMU who underwent surgical treatment and 24 patients with NPMU who underwent medical treatment in Atatürk University, School of Medicine, Department of General Surgery and Gastroenterology, between January 1995 and December 2004. The rate of H. pylori in the PMU group was significantly higher than that of the NPMU group (P PMU compared with NPMU patients (P PMU (P PMU operation especially in cases with impaired hemodynamics, severe peritoneal contamination, and/or a diameter smaller than 1 cm and avoiding the use of NSAIDs will surely reduce the risk of relapsing ulcers.

A mutein of human basic fibroblast growth factor TGP-580 accelerates colonic ulcer healing by stimulating angiogenesis in the ulcer bed in rats.

Science.gov (United States)

Satoh, H; Szabo, S

2015-10-01

Previously, we reported that TGP-580, a mutein of human basic fibroblast growth factor (bFGF), accelerated the healing of gastric and duodenal ulcers in rats. In the present study, we examined the effect of TGP-580 on the healing of colonic ulcers. In male Sprague Dawley rats, ulcers were induced in the colon 6 cm from the anus by enema of 50 μl of 3% N-ethylmaleimide, a sulfhydryl alkylator. The lesions were examined under a dissecting microscope (x10). The concentration of bFGF in the ulcerated colon was measured by enzyme immunoassay, and both the distribution of bFGF and the density of microvessels in the ulcer bed were examined by immunohistochemical staining. The content of bFGF in the ulcerated colon was markedly increased associated with ulcer healing, and ulcer healing was significantly delayed by intravenous administration of a monoclonal antibody for bFGF (MAb 3H3) once daily for 10 days. In the ulcer bed, many cells such as fibroblasts, vascular endothelial cells and macrophages were positively stained with bFGF antiserum. TGP-580, human bFGF or dexamethasone was given intracolonally twice daily for 10 days, starting the day after ulcer induction. TGP-580 (0.2 - 20 μg/ml, 200 μl/rat) dose-dependently accelerated ulcer healing, and its effect was more than 10 times stronger than that of human bFGF. Density (μm/0.01 mm(2)) of microvessels in the ulcer bed was significantly increased by treatment with TGP-580, and there was a good correlation between the density of microvessels and the decrease of ulcerated area (R(2) = 0.633). On the other hand dexamethasone (20 μg/ml) inhibited angiogenesis in the ulcer bed and delayed ulcer healing. These results suggest that angiogenesis in the ulcer bed plays an important role in ulcer healing, and that bFGF mutein TGP-580 accelerated colonic ulcer healing, at least in part, by stimulating angiogenesis, whereas glucocorticoids may delay the healing by inhibiting angiogenesis.

Duodenal diverticulitis. computed tomography findings

International Nuclear Information System (INIS)

Sanchez, E.; Martin, S.; Garcia, J.; Dominguez, A.

2001-01-01

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,

Previous use of non-steroidal anti-inflammatory drugs and anticoagulants: the influence on clinical outcome of bleeding gastroduodenal ulcers

NARCIS (Netherlands)

Vreeburg, E. M.; de Bruijne, H. W.; Snel, P.; Bartelsman, J. W.; Rauws, E. A.; Tytgat, G. N.

1997-01-01

To evaluate the relationship between prior non-steroidal anti-inflammatory drug (NSAID) or anticoagulant use and clinical outcome in bleeding gastric and duodenal ulcer patients. Prospective cohort-study. All patients (n = 132) admitted because of upper gastrointestinal bleeding during 3 months in

FEATURES OF PEROXIDIZATION OF LIPIDS AND ITS CORRECTION AT THE PATIENTS OF DUODENAL ULCER

Directory of Open Access Journals (Sweden)

T. V. Тregub

2015-05-01

[2] Odessa National University named I.I. Mechnikov, Odessa, Ukraine   Summary Aim of work. To study influences of mineral concentrate "Vita" on peroxidization of lipids in red corpuscles and plasma of blood for patients by ulcerous  illness of duodenum. Researches passed on the base of different hospitals Odessa during 5. It was inspected 210 patients in age from 18 to 60  that men there was 75,2 %. Conclusions. Thus, application over of mineral concentrate "Vita" brings to the considerable improvement of clinical flow of duodenal ulser, to the improvement of quality of life and peroxidization of lipids reduces for certain, namely - diminishes maintenance of malonic dialdehyde and diene conugates of the nonsaturated fat acids in plasma and red corpuscles of blood for patients of duodenum ulcer on a background normalization of properties. Keywords: duodenal ulcer, peroxidization of lipids, "Vita".   Резюме Цель работы - исследовать влияние минерального концентрата «Вита» на перекисное окисление липидов в эритроцитах и плазме крови у больных язвенной болезнью двенадцатиперстной кишки. Исследования проходили на базе различных больниц г. Одессы в течение 5 лет. Было обследовано 210 больных в возрасте от 18 до 60 лет, из которых мужчин было 75,2 %. Исследовано, что применение минерального концентрата «Вита» приводит к значительному улучшению клинического течения язвенной болезни двенадцатиперстной кишки, улучшению качества жизни и достоверно снижает перекисное окисление липидов, а �

Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data.

Science.gov (United States)

Rickard, Jennifer

2016-04-01

Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these countries. This study describes surgical interventions for peptic ulcer disease in sub-Saharan Africa. A systematic review was performed using PubMed, EMBASE, and African Index Medicus for studies describing surgical management of peptic ulcer disease in sub-Saharan Africa. From 55 published reports, 6594 patients underwent surgery for peptic ulcer disease. Most ulcers (86%) were duodenal with the remainder gastric (14%). Thirty-five percent of operations were performed for perforation, 7% for bleeding, 30% for obstruction, and 28% for chronic disease. Common operations included vagotomy (60%) and primary repair (31%). The overall case fatality rate for peptic ulcer disease was 5.7% and varied with indication for operation: 13.6% for perforation, 11.5% for bleeding, 0.5% for obstruction, and 0.3% for chronic disease. Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.

[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.

Peptic Ulcer Disease Risk in Chronic Kidney Disease: Ten-Year Incidence, Ulcer Location, and Ulcerogenic Effect of Medications

Science.gov (United States)

Liang, Chih-Chia; Muo, Chih-Hsin; Wang, I-Kuan; Chang, Chiz-Tzung; Chou, Che-Yi; Liu, Jiung-Hsiun; Yen, Tzung-Hai; Huang, Chiu-Ching; Chung, Chi-Jung

2014-01-01

Objectives We aimed at determining peptic ulcer disease (PUD) incidence among chronic kidney disease (CKD) patients during 1998–2008, compared to patients without CKD, and at examining associations between CKD and PUD. Methods Data for 1998–2008 were extracted from the National Health Insurance Research Database in Taiwan. The annual PUD incidence (cases per thousand persons per year) was calculated separately for patients with and without CKD. Characteristics of patients with newly diagnosed PUD (n = 16322) were compared to those of a control group without PUD (n = 32644). The 2 groups were matched for age, sex, and index year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression. Results Over the 10-year period, the PUD incidence was ∼10–12 times higher in CKD patients than in those without CKD. Its incidence in elderly CKD patients increased rapidly over time. For CKD patients, most PUD events (>95%) were managed during hospitalization. Peptic ulcer risk, adjusted for all potential confounders, was much higher in CKD patients undergoing hemodialysis (adjusted OR, 9.74; 95% CI, 7.11–13.31). Maintenance hemodialysis patients were 2 times more likely to have gastric ulcers than duodenal ulcers, while CKD patients not on dialysis had similar risks for both. There were no significant interactions between medications and CKD status on the peptic ulcer risk. Unlike CKD patients on nonsteroidal anti-inflammatory drugs and clopidogrel, those on aspirin did not have a higher peptic ulcer risk (adjusted OR, 0.88; 95% CI, 0.44–1.77). Conclusions CKD patients have a substantially increased PUD risk, and the majority of CKD patients with PUD require hospital management. Further, peptic ulcer risk is affected by hemodialysis therapy, patient status (inpatient vs. outpatient), and ulcerogenic medications. PMID:24498412

Abnormal duodenal loop demonstrated by X-ray

International Nuclear Information System (INIS)

Thommesen, P.; Funch-Jensen, P.

1986-01-01

The occurrence of dyspeptic symptoms has previously been correlated with the shape of the duodenal loop in patients with X-ray-negative dyspepsia. An abnormal duodenal loop was associated with a significantly higher incidence of symtoms provoked by meals, vomiting, regurgitations, heartburn, and the irritable bowel syndrome. 89% of these patients (26 patients with a normal duodenal loop and 39 patients with abnormal duodenal loop) were available for a 5-year follow-up study of symptomatic outcome. The incidence of symptoms provoked by meals was still significantly higher in patients with an abnormal duodenal loop, and there was also a significant difference concerning symptomatic outcome. Approximately 75% of the patients with a normal duodenal loop had improved, and 25% had unchanged clinical conditions. Approximately 50% of the patients with an abnormal duodenal loop had improved, and 50% had an unchanged or even deteriorated clinical condition

[Effect of components and some protocols of anti-ulcer therapy on content and activity of monooxigenase system enzymes of the stomach mucosa in experimental stomach ulcer].

Science.gov (United States)

Iakubov, A V; Pattakhova, M Kh

2009-01-01

The influence of components and some schemata of antiulcerous therapy on content and activity of monooxigenase system's enzymes in mucous membrane of stomach are studied on the model of experimental stomach ulcer in rats. It is established, that among components of antiulcerous therapy such as omeprazole, clarithromycin and metronidazole inhibit content and activity of MOS enzymes. Tinidazol, amoxicillin and azithromycin do not affect the function of MOS. Rifampicin and pantoprazole induce enzyme system of monooxigenase. In triple therapy with omeprazole, clarithromycin and metronidazole the inhibit effect of preparations to system of MOS is exponentiated and it leads to suppression of mucous cytoprotaction of gastro duodenal zone. Triple therapy of ulcerous disease with pantoprazole, rifampicin and azithromycin is effective planning to stimulate defense mechanisms of the organism.

Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

DEFF Research Database (Denmark)

Hillingsø, J.G.; Kjeldsen, J.; Schmidt, P.T.

2002-01-01

reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis.Methods: In a randomized, double-blind, placebo-con trolled study, concentrations of leukotriene B-4...... rectal administration of a 200-mg dose of ropivacaine- or placebo-gel by use of radioimmunoassays. For comparison with normal conditions, concentrations of neuropeptides were measured in another 19 patients with relapsing ulcerative colitis and 14 controls with non-inflamed colon.Results: No significant...... changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon.Conclusions: These findings...

Rise and fall of peptic ulceration: A disease of civilization?

Science.gov (United States)

Roberts-Thomson, Ian C

2018-07-01

Humans and Helicobacter pylori have evolved and adapted over tens of thousands of years. Yet peptic ulcer disease appeared to be rare prior to the 19th century. The prevalence of peptic ulcer disease increased between 1850 and 1900 and culminated in a cohort at high risk that was born at the end of the 19th century. This coincided with the provision of safe water and improvements in sanitation and personal hygiene. One hypothesis for the emergence of peptic ulcer disease focuses on the rate of development of atrophic gastritis induced by H. pylori. The hypothesis developed in this article focuses on delay in the age of acquisition of H. pylori to a time when immune and inflammatory responses to the infection were more mature. Whereas the acquisition of H. pylori in infancy usually resulted in mild pangastritis, hypochlorhydria, and a low risk for peptic ulcer disease, delayed acquisition could cause either more severe pangastritis (predisposing to gastric ulceration) or gastritis largely restricted to the antrum of the stomach (predisposing to duodenal ulceration). The decline in the prevalence of peptic ulcer disease over the past 100 years parallels the decline in the prevalence of H. pylori. The epidemic of ulcer disease in the first half of the 20th century seems likely to be an adverse effect of important public health measures undertaken in the latter half of the 19th century. © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Current status of indications for surgery in peptic ulcer disease.

Science.gov (United States)

Jamieson, G G

2000-03-01

The eradication of Helicobacter pylori in patients with peptic ulcer disease has greatly diminished the need for antiulcer surgery. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out. If the required expertise is available, it can be undertaken laparoscopically. The advent of endoscopic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic ulcer disease. Once again, however, when such therapy fails surgery is still indicated. Even with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nonoperative management of perforation is indicated in fit patients if the diagnosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extremely ill either because of co-morbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is established to be unsealed, particularly after

The hemostatic effect of endoscopic sodium hyaluronate injection in peptic ulcer bleeding.

Science.gov (United States)

Cho, Yong Kyun; Kim, Chang Seop; Kim, Si Young; Park, Jung Ho; Kim, Hong Joo; Park, Dong Il; Sohn, Chong H; Jeon, Woo Kyu; Kim, Byung Ik; Shin, Jun Ho; Son, Byung Ho

2007-06-01

Endoscopic injection therapy is a well-established method of controlling peptic ulcer bleeding but it is not clear which agent would be the best choice for injection material. In this study, we evaluated the effect of Sodium Hyaluronate for control of ulcer bleeding. The subjects consisted of 26 patients with major peptic ulcer hemorrhage from June 2000 to August 2001. There were 17 gastric ulcers, 7 duodenal ulcers and 2 ulcers at anastomosis site. According to modified Forrest classifications, there were 7 active bleeding (spurting, 3; oozing, 4) and 19 stigmata of recent hemorrhage (visible vessel, 14; fresh blood clots, 5). Sodium Hyaluronate-saline solution was injected to control the bleeding. The initial and permanent hemostatic rate, rebleeding rate, and other complications were retrospectively evaluated. The initial hemostatic rate was 25/26 (96.2%) and re-bleeding rate 3/26 (11.5%). The success rate of the second trial of Sodium Hyaluronate injection was 3/3 (100%). Overall, the permanent hemostatic rate was 25/26 (96.2%) and there were no complications related to Sodium Hyaluronate injection. Sodium Hyaluronate is an excellent candidate agent for endoscopic injection therapy because of its convenience and safety. Further prospective randomized trials with other hemostatic methods are needed.

[Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications].

Science.gov (United States)

2017-01-01

Non-steroidal anti-inflammatory drugs (NSAIDs) are a broad class of non glucocorticoid drugs which are extensively used in anti-inflammatory, analgesic, and antipyretic therapies. However, NSAIDs may cause many side effects, most commonly in gastrointestinal(GI) tract. Cardiovascular system, kidney, liver, central nervous system and hematopoietic system are also involved. NSAID-induced GI side effects not only endanger the patients' health, increase mortality, but also greatly increase the cost of medical care. Therefore, how to reduce GI side effects is of particular concern to clinicians. The Chinese Rheumatism Data Center(CRDC) and Chinese Systemic Lupus Erythematosus Treatment and Research Group(CSTAR) compose a "Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications" , as following: (1) GI lesions are the most common side effects of NSAIDs. (2) NSAID-induced GI side effects include gastritis, esophagitis, gastric and duodenal ulcers, bleeding, perforation and obstruction. (3) With the application of capsule endoscopy and small intestinal endoscopy, growing attention is being paid to the NASID-induced small intestine mucosa damage, which is mainly erosion and ulcer. (4) Risk factors related to NSAID-induced GI ulcers include: Helicobacter pylori (Hp) infection, age> 65 years, past history of GI ulcers, high doses of NSAIDs, multiple-drug combination therapy, and comorbidities, such as cardiovascular disease and nephropathy.(5) GI and cardiovascular function should be evaluated before using NSAIDs and gastric mucosal protective agents. (6) The risk of GI ulcers and complications caused by selective cyclooxygenase-2 (COX-2) inhibitors is less than that of non-selective COX-2 inhibitors. (7)Hp eradication therapy helps to cure GI ulcers and prevent recurrence when Hp infection is positive in NSAID-induced ulcers. (8) Proton pump inhibitor (PPI) is the first choice for the

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

A roentgenological study of duodenal diverticular in Korean

Energy Technology Data Exchange (ETDEWEB)

Park, Choong Ki [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1979-06-15

Duodenal diverticulum is a pouch like protrusion of the mucous menibrane through a weak area or defect of the muscle layer of the duodenal wall. 206 cases of the duodenal diverticular out of the consecutive 4030 cases on upper G-I series during the period from Feb. 1977 to Aug. 1978 Department of Radiology, College of Medicine, Hanyang University were studied. The results were as follows; 1. Overall incidence of duodenal diverticular was 5.1 percent (5.0 percent in male, and 5.3 percent in female). 2. The incidence of duodenal diverticular were 1.4 percent in the age group below 19, 1.4 percent in the second decade, 0.8 percent in the third decade, 2.4 percent in the fourth decade, 5.3 percent in the fifth decade, 10.2 percent in the sixth decade, 9.2 percent in the seventh decade, and 17.0 percent in the age group over 70. Incidence of duodenal diverticular is higher in the older individuals. 3. Male was more frequently affected in the age group below 40, but more in females in the age group over 40. 4. 76.3 percent of duodenal diverticular were found in the concave side of the second portion of the duodenum. 5. Multiplicity of duodenal diverticular was 5.8 percent of cases. Triple duodenal diverticular were found in 1 case. 6. The size of duodenal diverticular was variable from 3 to 70 mm in diameter. More than half of duodenal diverticular were smaller than 9 mm in diameter. Large diverticular of more than 30 mm in diameter were 13.6 percent of cases. The size of the duodenal diverticular were relatively large in older age group.

Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes.

Science.gov (United States)

Quan, Samuel; Frolkis, Alexandra; Milne, Kaylee; Molodecky, Natalie; Yang, Hong; Dixon, Elijah; Ball, Chad G; Myers, Robert P; Ghosh, Subrata; Hilsden, Robert; van Zanten, Sander Veldhuyzen; Kaplan, Gilaad G

2014-12-14

To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI. The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95

Acquired Duodenal Obstruction in Children

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Jen-Hung Chien

2008-10-01

Full Text Available Traumatic intramural hematoma of the duodenum is a rare cause of acquired duodenal obstruction in children, and a high degree of suspicion is therefore required to make an early and accurate diagnosis. We report a 6-year-old boy whose epigastrium was impacted by the handlebar of his bicycle during a traffic accident. The boy then experienced epigastralgia. Six days later, progressive bilious vomiting suggestive of gastrointestinal obstruction was noted. Imaging studies revealed a large hematoma extending from the fourth portion of the duodenum to the jejunum. Conservative methods of treatment failed to manage his condition. He underwent laparoscopic surgery to evacuate the hematoma. We also report a case of duodenal obstruction in a previously healthy 2-year-old girl who presented for the first time with acute symptoms of proximal intestinal obstruction. Contrast examinations showed apparent barium retention over the stomach and proximal duodenum. She underwent surgery due to persistent obstruction, and a mushroom-like foreign body was detected embedded in the orifice of the windsock duodenal web. After duodenoduodenostomy and removal of the bezoar, she had a smooth recovery and tolerated feeding well. We conclude that blunt abdominal trauma and incomplete duodenal obstruction, such as that caused by duodenal web, should be considered as possible causes of acquired proximal gastrointestinal obstruction in previously healthy children, despite their rarity.

A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria.

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Dongo, A E; Uhunmwagho, O; Kesieme, E B; Eluehike, S U; Alufohai, E F

2017-01-01

Peptic ulcer perforation is a common cause of emergency admission and surgery. This is the first study that documents the presentation and outcome of management in Irrua, Nigeria. This is a prospective study of all patients operated on for perforated peptic ulcer between April 1, 2010, and March 31, 2015. A structured questionnaire containing patients' demographics, operation findings, and outcome was filled upon discharge or death. There were 104 patients. 81 males and 23 females (M : F = 3.5 : 1). The age range was between 17 years and 95 years. The mean age was 48.99 years ± SD 16.1 years. The ratio of gastric to duodenal perforation was 1.88 : 1. Perforation was the first sign of peptic ulcer disease in 62 (59.6%). Pneumoperitoneum was detectable with plain radiographs in 95 (91%) patients. 72 (69.2%) had Graham's Omentopexy. Death rate was 17.3%. We note that gastric perforation is a far commoner disease in our environment. Perforation is often the first sign of peptic ulcer disease. We identify fasting amongst Christians as a risk factor for perforation.

Peptic ulcer disease in endogenous hypercortisolism: myth or reality?

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Hatipoglu, Esra; Caglar, Asli Sezgin; Caglar, Erkan; Ugurlu, Serdal; Tuncer, Murat; Kadioglu, Pinar

2015-11-01

Many clinicians believe hypercortisolism is ulcerogenic. However, data from clinical studies show that prophylaxis for peptic ulcer disease is no longer recommended in patients receiving corticosteroid treatment. This has not yet been verified in endogenous hypercortisolism by controlled clinical studies. The purpose of the current study was to evaluate the relationship between endogenous Cushing's syndrome (CS) and peptic ulcer disease and Helicobacter pylori infection. The study group contained 20 cases with CS resulting from ACTH-dependent endogenous hypercortisolism. The control groups consisted of 14 age- and gender-matched cases receiving exogenous corticosteroid therapy and 100 cases of dyspepsia with non-cushingoid features. Upper gastrointestinal endoscopy was performed on all cases. Biopsies were taken from five different points: two samples from the antrum, two samples from the corpus, and one sample from the fundus. A histological diagnosis of Helicobacter pylori infection was also obtained from evaluation of biopsy specimens. The frequency of stomach and duodenal ulcers did not vary between the groups (p = 0.5 and p = 0.7). Antral gastritis was less frequent and pangastritis was more common in cases with CS compared to the healthy controls (p = 0.001 and p peptic ulcer or Helicobacter pylori infection. Prophylactic use of proton pump inhibitors is not compulsory for hypercortisolism of any type.

[Endoscopic diagnosis of local chemical burn of mucous membranes of the stomach, induced with the purpose of simulation of gastric ulcer].

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Byzov, N V; Plekhanov, V N

2013-01-01

With the purpose of improvement of diagnosis of induced gastric ulcer were examined 11 patients who took aggressive agents for simulation of gastric ulcer and 33 patients who took pseudo-aggressive agents. Observables, conduced diagnosis of local chemical burn of mucous coat of stomach during initial 6 days after taking aggressive agents. Stages of ulcerous process, resulting from local chemical burn of mucous coat of stomach, coressponds to real gactric ulcer. Gelatin capsule using as a container for delivery of aggressive agents, melts in stomach in 5-6 minutes after taking. Independent from body position, mucous coat of greater curvature of the stomach is damaged. It is impossible to simulate duodenal bulb ulcer using the gelatine capsule or ball made of breadcrumb. The last method of delivery of aggressive agent can damage the small intestine because of uncontrollability of the place of breaking the ball.

A rare association between dextrogastria, duodenal web, and ...

African Journals Online (AJOL)

... the radiologic investigation for bilious vomiting and feeding intolerance, revealing congenital duodenal stenosis and dextrogastria. During surgery, the association of the dextrogastria with the duodenal web situated in the second part of the duodenum was established. Keywords: dextrogastria, duodenal web, malrotation ...

Rapid urease test and endoscopic data in dynamic in case of peptic ulcers in former Chernobyl accident clean-up workers

International Nuclear Information System (INIS)

Orlikovs, G.; Seleznovs, J.; Farbtuha, T.; Straupeniece, I.; Kuzenko, A.; Pokrotnieks, J.

2002-01-01

111 peptic ulcer patients former Chernobyl accident clean-up workers were examined. The patients have been working in the damaged zone during 1986-87 years receiving small radiation dosages. Chronic peptic gastric and duodenal ulcers appeared in them later. The goal of the trial is to investigate the effectiveness of Helicobacter pylori eradication measures in triple-therapy course of medium duration (10 days) include ranitidine, amoxycillinum, and methronidazolum. Upper gastrointestinal endoscopy was accompanied by rapid urease test. The test was repeated after a 1-year period. Analysing the data results we ascertain that the prolonged success of triple-therapy is rather ineffective and have unclear correlation with endoscopic data. This is much evident in case of gastric ulcers. These results testify that clinical course of peptic ulcers in case of post-radiation syndrome differs from the same in population. (authors)

Study on the changes of serum levels of polypeptide growth factors (EGF, TGF-α) and related hormones (gastrin, somatostatin) in patients with peptic ulcer

International Nuclear Information System (INIS)

Cao Jianfan; Ma Yunbao; Zhang Xiaoyi

2005-01-01

Objective: To study the possible roles of EGF, TGF-α, gastrin and somatostatin in the pathogenesis of peptic ulcer by measuring the changes of serum levels of those four parameters in the patients with peptic ulcer. Methods: Serum levels of epidermal growth factor (EGF), transforming growth factor-α (TGF-α), gastrin (Gas) and somatostatin (SS) were measured with RIA in 30 patients with gastric ulcer, 32 patients with duodenal ulcer and 30 controls. Results: Serum levels of gastrin and EGF were significantly higher in the patients with peptic ulcer than those in the controls (both P 0.05). However, serum TGF-α levels were significantly lower in the ulcer patients than those in the controls (P<0.01). Conclusion: Changes of serum levels of gastrin, EGF and TGF-α were quite significant in the ulcer patients and determining of which might be of clinical meanings. Determination of somatostatin changes seemed to be of less importance. (authors)

Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

DEFF Research Database (Denmark)

Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle

2012-01-01

(interquartile range 9-17). The cumulative lifetime risk of duodenal adenomatosis was 88% (95% CI 84-93), and of Spigelman stage IV 35% (95% CI 25-45). The Spigelman stage improved in 32 (12%), remained unchanged in 88 (34%) and worsened in 116 (44%). Twenty patients (7%) had duodenal cancer at a median age...... of 56 years (range 44-82). The cumulative cancer incidence was 18% at age 75 (95% CI 8-28) and increased with increasing Spigelman stage at the index endoscopy to 33% in stage IV (p...

Randomised clinical trial: efficacy and safety of vonoprazan vs. lansoprazole in patients with gastric or duodenal ulcers - results from two phase 3, non-inferiority randomised controlled trials.

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Miwa, H; Uedo, N; Watari, J; Mori, Y; Sakurai, Y; Takanami, Y; Nishimura, A; Tatsumi, T; Sakaki, N

2017-01-01

Vonoprazan is a new potassium-competitive acid blocker for treatment of acid-related diseases. To conduct two randomised-controlled trials, to evaluate the non-inferiority of vonoprazan vs. lansoprazole, a proton pump inhibitor, for treatment of gastric ulcer (GU) or duodenal ulcer (DU). Patients aged ≥20 years with ≥1 endoscopically-confirmed GU or DU (≥5 mm white coating) were randomised 1:1 using double-dummy blinding to receive lansoprazole (30 mg) or vonoprazan (20 mg) for 8 (GU study) or 6 (DU study) weeks. The primary endpoint was the proportion of patients with endoscopically confirmed healed GU or DU. For GU, 93.5% (216/231) of vonoprazan-treated patients and 93.8% (211/225) of lansoprazole-treated patients achieved healed GU; non-inferiority of vonoprazan to lansoprazole was confirmed [difference = -0.3% (95% CI -4.750, 4.208); P = 0.0011]. For DU, 95.5% (170/178) of vonoprazan-treated patients and 98.3% (177/180) of lansoprazole-treated patients achieved healed DU; non-inferiority to lansoprazole was not confirmed [difference = -2.8% (95% CI -6.400, 0.745); P = 0.0654]. The incidences of treatment-emergent adverse events were slightly lower for GU and slightly higher for DU with vonoprazan than with lansoprazole. There was one death (subarachnoid haemorrhage) in the vonoprazan group (DU). The possibility of a relationship between this unexpected patient death and the study drug could not be ruled out. In both studies, increases in serum gastrin levels were greater in vonoprazan-treated vs. lansoprazole-treated patients; levels returned to baseline after treatment in both groups. Vonoprazan 20 mg has a similar tolerability profile to lansoprazole 30 mg and is non-inferior with respect to GU healing and has similar efficacy for DU healing. © 2016 Takeda Pharmaceutical Company, Ltd. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Fecal Calprotectin Predicts Relapse and Histological Mucosal Healing in Ulcerative Colitis

DEFF Research Database (Denmark)

Theede, Klaus; Holck, Susanne; Ibsen, Per

2016-01-01

. Fecal calprotectin (FC) was measured 2 to 3 days before the sigmoidoscopy. The tissue samples were evaluated for neutrophilic inflammation. We aimed at testing the predictive performance of FC and histological inflammatory activity on disease relapse. RESULTS: A baseline FC level of more than 321 mg...

Efficacy and safety of rabeprazole in non-steroidal anti-inflammatory drug-induced ulcer in Japan.

Science.gov (United States)

Mizokami, Yuji

2009-10-28

To investigate the efficacy and safety of rabeprazole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan. Subjects comprised patients undergoing NSAID treatment in whom upper gastrointestinal endoscopy revealed an ulcerous lesion (open ulcer) with diameter > or = 3 mm, who required continuous NSAID treatment. Endoscopies were performed at the start of treatment, during the treatment period, and at the conclusion (or discontinuation) of treatment. Findings were evaluated as size (maximum diameter) and stage based on the Sakita-Miwa classification. An ulcer was regarded as cured when the "white coating" was seen to have disappeared under endoscopy. As criteria for evaluating safety, all medically untoward symptoms and signs (adverse events, laboratory abnormalities, accidental symptoms, etc.) occurring after the start of rabeprazole treatment were handled as adverse events. Endoscopic cure rate in 38 patients in the efficacy analysis (endoscopic evaluation) was 71.1% (27/38). Among those 38 patients, 35 had gastric ulcer with a cure rate of 71.4% (25/35), and 3 had duodenal ulcer with a cure rate of 66.7% (2/3). Three adverse drug reactions were reported from 64 patients in the safety analysis (interstitial pneumonia, low white blood cell count and pruritus); thus, the incidence rate for adverse drug reactions was 4.7% (3/64). The treatment efficacy of rabeprazole for NSAID-induced ulcer under continuous NSAID administration was confirmed.

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

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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.

Duodenal epithelial transport in functional dyspepsia

DEFF Research Database (Denmark)

Witte, Anne-Barbara; D'Amato, Mauro; Poulsen, Steen Seier

2013-01-01

To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling.......To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling....

Duodenal Transection without Pancreatic Injury following Blunt ...

African Journals Online (AJOL)

following blunt abdominal trauma and its clinical picture is often ... Here we report a case of complete duodenal ... Key words: Duodenal injury, peritonitis, transection. Department of ... When our patient was brought to the emergency room, he.

Civilian duodenal gunshot wounds: surgical management made simpler.

Science.gov (United States)

Talving, Peep; Nicol, Andrew J; Navsaria, Pradeep H

2006-04-01

Low-velocity gunshot wounds cause most civilian duodenal injuries. The objective of this study was to describe a simplified surgical algorithm currently in use in a South African civilian trauma center and to verify its validity by measuring morbidity and mortality. A retrospective chart review of patients with duodenal gunshot injuries during the study period January 1999 to December 2003 was performed. Data points accrued included patient demographics, admission hemodynamic status and resuscitative measures, laparotomy damage control procedures, methods of surgical repair of the duodenal injury, associated injuries, length of intensive care and hospital stays, complications, and mortality. A total of 75 consecutive patients with gunshot injuries to the duodenum were reviewed. Primary repair was performed in 54 patients (87%), resection and reanastomosis in 7 (11%), and pancreatoduodenectomy in 1 (2%) during the initial phases. The overall morbidity and mortality were 58% and 28%, respectively. Duodenum-related complications were recorded in nine (15%) patients: two duodenal fistulas, one duodenal obstruction, and six cases of suture-line dehiscence. Overall and duodenum-related morbidity rates in patients with combined pancreatoduodenal injuries were 83% and 17%, respectively. Duodenum-related mortality occurred in three (4.8%) patients. Most civilian low-velocity duodenal gunshot injuries treated with simple primary repair result in overall morbidity, mortality, and duodenum-related complication rates comparable to those in reports where more complex surgical procedures were employed. Primary repair is also applicable for most combined pancreatic and duodenal gunshot injuries.

[Health education for varicose ulcer patients through group activities].

Science.gov (United States)

da Silva, Jodo Luis Almeida; Lopes, Marta Julia Marques

2006-06-01

It is a report on the group activities carried out with carriers of varicose ulcer in a health unit in Porto Alegre, Rio Grande do Sul, Brazil. The varicose ulcer presents factors, besides the biological ones, which interfere in the cicatrization, in the relapse cases and in its effective resolution. The proposed activities aimed at producing behavior changes with the intention of achieving self-care, providing information, socializing the participants, and stimulating cooperation, searching for joint solutions, aggregating interdisciplinary spirit and improving the care. Two groups have been formed and a thematic schedule established. The results have showed higher adhesion to the treatment, behavioral changes, and adapted and more effective attitudes of the health team.

Duodenal diverticular bleeding: an endoscopic challenge

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Eduardo Valdivielso-Cortázar

Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

Duodenal pathologies in children: a single‐center experience

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Ulas Emre Akbulut

2018-05-01

Full Text Available Objective: Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. Method: Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. Results: Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3% patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p = 0.002, OR: 3.91, 95% CI: 1.59–9.57. Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%. Conclusion: Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis. Resumo: Objetivo: Foram feitos vários estudos com relação a patologias do estômago e esôfago na faixa etária pediátrica. Contudo, poucos estudos das patologias duodenais em crianças. Visamos a examinar as características clínicas, endoscópicas e histopatológicas, juntamente com a etiologia, das patologias duodenais em crianças. Método: Foram investigados retrospectivamente pacientes entre 1 e 17 anos submetidos a

[STUDY OF THE VARIABILITY OF THE CARDIAC RHYTHM IN RAILROAD EMPLOYEES, WHO SUFFER BY STOMACH ULCER AND DUODENUM, ASSOCIATED AND NONASSOCIATED WITH THE INFECTION HELICOBACTER PYLORI].

Science.gov (United States)

Shelekhova, Yu V; Hramtsova, N A; Onuchina, E V; Kuklin, S G

2015-01-01

To estimate the Heart rate variability (HRV), by the method of daily kholterovskogo monitoring in the workers of rail transport (RT). A total of 93 persons working in the East Siberian Railway. The main group (CG) consisted of 27 patients with gastric ulcer (GU) and duodenal ulcer (DU) contamination without Helicobacter infection. The first group of clinical comparison (GCS 1) included 36 patients with gastric ulcer and duodenal with contamination of infection H. pylori. The second group of clinical comparison (GCS 2) consisted of 30 employees VT held preventive medical examination, without contamination of Helicobacter infection is not suffering from gastric ulcer and duodenum. With the analysis of spectral and time characteristics HRV in Haug is revealed the explicit displacement of vegetative homeostasis with the prevalence of the sympathetic component of regulation, which is restored against the background of treatment. Meanwhile in GKS1 the indices of vegetative regulation had parasympathetic directivity, they were more close to the standard and did not change after conducting of the eradikatsionnoy therapy. The greatest unbalance of sympathetic and parasympathetic nervous system is observed in patients, workers (RT), who suffer SU and UD in the absence of the contamination of H. pylori. The use of a method of study VCR in the conditions of the absence of H. pylori infection can make it possible to form the group of risk of development SU and UD in workers RT.

[An individual approach to the surgical treatment and medical rehabilitation of duodenal ulcer patients].

Science.gov (United States)

Kochetkov, A V; Barashkov, V G; Papazov, V I

1996-01-01

Since 1986 403 patients have been treated according to the following programme: successive preparation for surgery, the operative intervention chosen individually for each patient, the purposeful medical rehabilitation. Different types of vagotomy with draining operations were performed in 85.6% of the cases, stomach resection--in 14.4% of the patients. The mortality rate was 0%. The indications for various types of vagotomy, stomach resection and different types of draining operations were determined. Rehabilitation of 55% of the patients after the operative treatment took place at the gastroenterological department, the others--at an outpatient department. The indications for rehabilitation, its volume and time were established. The best remote results in the follow-up periods up to five years were obtained after truncal vagotomy and stomach resection. Ulcer recurrences were noted in 3.5% and 5.2% of the cases respectively. Recurrences of the disease were noted in 7.8% after combined vagotomy and in more than 20% after SPV. Nine patients out of 34 with recurrent ulcers were reoperated with good results, the others were successfully treated by conservative therapy.

Duodenal White Spots Mimicking Intestinal Candidiasis: Report of Case

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Ozgur Turk

2015-12-01

Full Text Available Duodenal white spots are mentioned in these nonspecific lesions until recently. Although there is not enough studies about duedonal white spots yet; these lesions described in a separate syndrome. Here now we reported a case that we diagnosed multiple Duodenal white spots mimicking intestinal candidiasis. Clinical manifestation and endoscopic appearance of lesions gave rise to thought intestinal candidiasis histopathological examination revealed us several duodenitis. There was no evidence of fungal infection in PAS staining. Early after endoscopy patient took treatment of Lansoprozole at the 30 mg dose and bismuth salicylate. Patients compliant declined and control endoscopy exposed white duodenal spots cleared away three months later. Duodenal white spots are becoming to be designated as a separate disease even a syndrome. Etiology of duodenal white spots must be determined carefully during endoscopy. Sometimes it is difficult to make the correct diagnosis by appearance of lesion; in such cases histopathological examination can be useful both differential diagnosis of disease and determination of etiological factor. [J Contemp Med 2015; 5(4.000: 249-252

Rapid duodenal and jejunal intubation

International Nuclear Information System (INIS)

Nolan, D.J.

1979-01-01

A size 12 French radiopaque catheter, 135 cm long, suitable for rapid duodenal and jejunal intubation, is described. Its size and flexibility enable it to be passed with ease through the nose, stomach and duodenum. A guide wire is used to act as a stiffener as the catheter is passed through the stomach. The catheter is suitable for infusing barium directly into the small intestine and for performing hypotonic duodenography. The technique for duodenal and jejunal intubation is discussed. (author)

Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

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Konstantinos Blouhos

2013-01-01

Full Text Available When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.

Management of pancreatic and duodenal injuries in pediatric patients.

Science.gov (United States)

Plancq, M C; Villamizar, J; Ricard, J; Canarelli, J P

2000-01-01

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.

Presentation and Surgical Management of Duodenal Duplication in Adults

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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.

Fatty acid composition and mechanisms of the protective effects of myrtle berry seed aqueous extract in alcohol-induced peptic ulcer in rat.

Science.gov (United States)

Jabri, Mohamed-Amine; Rtibi, Kais; Tounsi, Haifa; Hosni, Karim; Marzouki, Lamjed; Sakly, Mohsen; Sebai, Hichem

2017-05-01

This study aimed to investigate the antiulcer and antioxidant activities of myrtle berry seed aqueous extract (MBSAE) in a peptic ulcer model induced by ethanol in male Wistar rats. MBSAE is rich in total polyphenols, total flavonoids, and unsaturated fatty acids, particularly linoleic (18:2) and oleic (18:1) acids. MBSAE also exhibited in vitro antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) (IC 50 = 172.1 μg/mL) and superoxide anion (IC 50 = 200.24 μg/mL) scavenging activities. In vivo, MBSAE provided dose-dependent protection against ethanol-induced gastric and duodenal macroscopic and histological alterations. Also, it inhibited secretory profile disturbances and lipid peroxidation, and preserved normal antioxidant enzyme activities and nonenzymatic antioxidant levels. More importantly, we showed that acute alcohol intoxication increased gastric and duodenal calcium, hydrogen peroxide, and free iron levels, whereas MBSAE treatment protected against intracellular mediator deregulation. In conclusion, we suggest that MBSAE has potent protective effects against alcohol-induced peptic ulcer in rat. This protection might be related in part to its antioxidant properties as well as its opposite effects on some studied intracellular mediators.

Influence of prostate stem cell antigen gene polymorphisms on susceptibility to Helicobacter pylori-associated diseases: a case-control study.

Science.gov (United States)

Ichikawa, Hitomi; Sugimoto, Mitsushige; Uotani, Takahiro; Sahara, Shu; Yamade, Mihoko; Iwaizumi, Moriya; Yamada, Takanori; Osawa, Satoshi; Sugimoto, Ken; Miyajima, Hiroaki; Yamaoka, Yoshio; Furuta, Takahisa

2015-04-01

Patients with duodenal ulcer have a reduced risk of developing gastric cancer compared to those without. Recently, the prostate stem cell antigen (PSCA) rs2294008 C>T polymorphism was found to be associated with different pathogenesis of duodenal ulcer and gastric cancer developments. However, whether PSCA rs2294008 C>T polymorphism is associated with severity of gastric mucosal atrophy is unclear. We examined the influence of the PSCA rs2294008 C>T polymorphism on susceptibility to H. pylori-related diseases and the relationships between PSCA polymorphism and gastric mucosal atrophy. PSCA rs2294008 C>T polymorphism was assessed in H. pylori-positive Japanese patients (n = 488) with noncardia gastric cancer (n = 193), gastric ulcer (n = 84), duodenal ulcer (n = 61), and atrophic gastritis (n = 150), as well as in H. pylori-negatives (n = 266). Frequency of PSCA rs2294008 C/C genotype in duodenal ulcer was 36.1%, which was significantly higher than those with gastric cancer (12.4%), gastric ulcer (19.0%), gastritis (10.7%), and H. pylori-negatives (19.5%) (p T polymorphism is associated with differing susceptibilities to H. pylori-associated diseases. The PSCA rs2294008 C>T polymorphism may be acting through induction of gastric mucosal atrophy, finally leading to development of gastric ulcer and gastric cancer in PSCA rs2294008 T allele carriers, but not duodenal ulcer. © 2014 John Wiley & Sons Ltd.

Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease.

Science.gov (United States)

Lim, Joo Hyun; Kim, Sang Gyun; Song, Ji Hyun; Hwang, Jae Jin; Lee, Dong Ho; Han, Jae Pil; Hong, Su Jin; Kim, Ji Hyun; Jeon, Seong Woo; Kim, Gwang Ha; Shim, Ki-Nam; Shin, Woon Geon; Kim, Tae Ho; Kim, Sun Moon; Chung, Il-Kwon; Kim, Hyun-Soo; Kim, Heung Up; Lee, Joongyub; Kim, Jae Gyu

2017-03-15

The resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease. Between 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed. The overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655). Levofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies.

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

International Nuclear Information System (INIS)

Akinci, Devrim; Akhan, Okan; Ozkan, Fuat; Ciftci, Turkmen; Ozkan, Orhan S.; Karcaaltincaba, Musturay; Ozmen, Mustafa N.

2007-01-01

Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting

Management of perforated peptic ulcer in patients at a teaching hospital.

Science.gov (United States)

Bin-Taleb, Ali K; Razzaq, Riyadh A; Al-Kathiri, Zaki O

2008-02-01

To explore and analyze the current status in management of patients with perforated peptic ulcers (PPU). A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study. A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU was noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.38:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours), wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks. Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment, and equipment are needed to reduce the high rate of complications.

Acute Necrotizing Esophagitis Followed by Duodenal Necrosis

Science.gov (United States)

del Hierro, Piedad Magdalena

2011-01-01

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. PMID:27957030

NSAID is inversely associated with asymptomatic gastric ulcer: local health examination data from the Korean National Health Insurance Corporation.

Science.gov (United States)

Kim, Hee Man; Cho, Jae Hee; Choi, Jin Yi; Chun, Song Wook; Kim, Yu Jin; Cho, Hyeon Geun; Song, Si Young; Han, Ki Jun

2013-12-01

BACKGROUND. Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. AIM. We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. METHODS. The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. RESULTS. From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, p = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. CONCLUSION. NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.

Combined pancreatic and duodenal transection injury: A case report

OpenAIRE

Mungazi, Simbarashe Gift; Mbanje, Chenesa; Chihaka, Onesai; Madziva, Noah

2017-01-01

Introduction: Combined pancreatic-duodenal injuries in blunt abdominal trauma are rare. These injuries are associated with high morbidity and mortality, and their emergent management is a challenge. Case presentation: We report a case of combined complete pancreatic (through the neck) and duodenal (first part) transections in a 24-year-old male secondary to blunt abdominal trauma following a motor vehicle crash. The duodenal stumps were closed separately and a gastrojejunostomy performed f...

Prevalence of gastroduodenal lesions in chronic nonsteroidal anti ...

African Journals Online (AJOL)

At endoscopy, only 10 (13.9%) patients had normal gastroduodenal mucosa. Gastritis was the most prevalent lesion occurring in 50% of the patients. Peptic ulcer disease had a point prevalence of 30.5% (duodenal ulcers 22.2%, and gastric ulcers 8.3%). Other lesions at endoscopy were duodenitis 16.7%, gastric erosions ...

Association of specific haplotype of TNFα with Helicobacter pylori ...

Indian Academy of Sciences (India)

pylori-mediated duodenal ulcer in eastern Indian population. MEENAKSHI ... IL6 and IL8 revealed no association with H. pylori-mediated duodenal ulcer at the .... cation, belonging to the same caste/ethnic (Bengali–Hindu) background.

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....

Bowel habits after gastric bypass versus the duodenal switch operation.

Science.gov (United States)

Wasserberg, Nir; Hamoui, Nahid; Petrone, Patrizio; Crookes, Peter F; Kaufman, Howard S

2008-12-01

One of the perceived disadvantages of the biliopancreatic diversion with duodenal switch operation is diarrhea. The aim of this study was to compare the bowel habits of patients after duodenal switch operation or Roux-en-Y gastric bypass. A prospective comparative case series design was used. Forty-six patients who underwent duodenal switch (n=28) or gastric bypass (n=18) were asked to complete a daily diary for 14 days after losing least 50% of their excess body weight. Data were collected on number of bowel episodes, incontinence, urgency, stool consistency, and awakening from sleep to defecate. Background variables were recorded from the medical files. The duodenal switch group was heavier (body mass index 53.5 vs 47.0 kg/m(2), p=0.03) and older (47.5 vs 41.0 years, p=NS) than the gastric bypass group. Median time to 50% excess body weight loss was 22 months in the duodenal switch group compared to 10.0 months in the gastric bypass group (p=0.001). Patients after duodenal switch surgery reported a median of 23.5 bowel episodes over the 14-day study period compared to 16.5 in the gastric bypass group (p=NS). There was no between-group differences in any of the other bowel parameters studied. Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.

ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

Directory of Open Access Journals (Sweden)

Daniela Benedeto-Stojanov

2015-06-01

Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

Radionuclide imaging using Technetium-99m labelled Sucralfate and Potassium Sucrose Sulfate to detect gastric and duodenal ulcers

International Nuclear Information System (INIS)

Vasquez, T.E.; Evans, D.G.; Hartman, M.T.; Hagan, P.; Fardi, M.; Ashburn, W.L.

1986-01-01

The purpose of this paper is to report the results of the first 33 patients studied with Thechnetium-99m labelled Sucralfate for the detection of peptic ulcers and report preliminary results in 6 patients studied with a new analog of the original labelled compound: Potassium Sucrose Sulfate. Of 33 human studies utilizing 99m Tc-Sucralfate, 16 gave true-positive, 9 gave true-negative, 8 gave false-negative and 0 gave false-positive results. The sensitivity of the scan was 66%; the specificity was 100% for the detection of peptic ulcers

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.

N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

International Nuclear Information System (INIS)

Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung

2007-01-01

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

Duodenal mucosal protein kinase C-δ regulates glucose production in rats.

Science.gov (United States)

Kokorovic, Andrea; Cheung, Grace W C; Breen, Danna M; Chari, Madhu; Lam, Carol K L; Lam, Tony K T

2011-11-01

Activation of protein kinase C (PKC) enzymes in liver and brain alters hepatic glucose metabolism, but little is known about their role in glucose regulation in the gastrointestinal tract. We investigated whether activation of PKC-δ in the duodenum is sufficient and necessary for duodenal nutrient sensing and regulates hepatic glucose production through a neuronal network in rats. In rats, we inhibited duodenal PKC and evaluated whether nutrient-sensing mechanisms, activated by refeeding, have disruptions in glucose regulation. We then performed gain- and loss-of-function pharmacologic and molecular experiments to target duodenal PKC-δ; we evaluated the impact on glucose production regulation during the pancreatic clamping, while basal levels of insulin were maintained. PKC-δ was detected in the mucosal layer of the duodenum; intraduodenal infusion of PKC inhibitors disrupted glucose homeostasis during refeeding, indicating that duodenal activation of PKC-δ is necessary and sufficient to regulate glucose homeostasis. Intraduodenal infusion of the PKC activator 1-oleoyl-2-acetyl-sn-glycerol (OAG) specifically activated duodenal mucosal PKC-δ and a gut-brain-liver neuronal pathway to reduce glucose production. Molecular and pharmacologic inhibition of duodenal mucosal PKC-δ negated the ability of duodenal OAG and lipids to reduce glucose production. In the duodenal mucosa, PKC-δ regulates glucose homeostasis. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Abnormalities of intestinal rotation and congenital intrinsic duodenal ...

African Journals Online (AJOL)

ultrasound. Echocardiography was normal in one patient, and in the other, there were features of Fallot's tetralogy. Intraoperatively, one had duodenal atresia with a gap, whereas the other had a duodenal diaphragm (Fig. 2). In the remaining seven patients, the diagnosis of associated malrotation was made intraoperatively.

Duodenal diverticula demonstrated by barium examination

Energy Technology Data Exchange (ETDEWEB)

Christiansen, T.; Thommesen, P.

An investigation for biliary tract calculi and food-stimulated gastro-oesophageal reflux was carried out in 37 patients with duodenal diverticula demonstrated by barium examination. Sixty per cent of the diverticula were located in the descending part of the duodenum. Biliary tract calculi were demonstrated in 38 per cent and food-stimulated gastro-oesophageal reflux in 81 per cent of the patients. The detection of a duodenal diverticulum should result in a supplementary investigation for gallstones and gastrooesophageal reflux and its sequelae.

[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.

Lack of association between Helicobacter pylori infection with dupA-positive strains and gastroduodenal diseases in Brazilian patients.

Science.gov (United States)

Gomes, Luciana I; Rocha, Gifone A; Rocha, Andreia M C; Soares, Taciana F; Oliveira, Celso A; Bittencourt, Paulo F S; Queiroz, Dulciene M M

2008-04-01

Duodenal ulcer-promoting gene (dupA) was recently described as a new putative Helicobacter pylori virulence marker associated with an increased risk for duodenal ulcer and reduced risk for gastric carcinoma in Japan and Korea. Since differences regarding the association among H. pylori markers and H. pylori-associated diseases have been demonstrated around the world, we evaluated the presence of the gene in 482 strains from Brazilian children (34 with duodenal ulcer and 97 with gastritis) and adults (126 with duodenal ulcer, 144 with gastritis and 81 with gastric carcinoma) by PCR using the described primers and an additional set of primers based on Brazilian strain sequences. The results were confirmed by sequencing. The presence of cagA was investigated by PCR and also included in the analysis. dupA was present in 445 (92.32%) and absent in 29 (6.02%) strains. All samples from children with and without duodenal ulcer were dupA-positive (p=1.0). No association was observed among the strains from adults with gastritis (92.36%), duodenal ulcer (87.30%, p=0.30) and gastric carcinoma (87.65%, p=0.31). Conversely, cagA-positve status remained independently associated with duodenal ulcer (children: odds ratios (OR)=5.58, 95% confidence intervals (CI)=1.67-18.50; adults: OR=3.33, 95% CI=2.14-5.19) and gastric carcinoma (OR=6.58, 95% CI=3.51-12.30) in multivariate analyses. The presence of dupA was significantly higher in strains from children than in those from adults (p=0.01). In conclusion, dupA is highly frequent and not associated with H. pylori-associated diseases in both Brazilian adults and children, which points to regional differences in the distribution of the gene.

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

. After 4 h this pool of undiluted gastric secretions gradually is emptied into the duodenum, where the mucosal resistance is reduced by inhibition of the secretory activity of Brunner's glands, and ulceration rapidly develops. The time relationship is supported by histopathologic findings...

Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

LENUS (Irish Health Repository)

2012-01-31

BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

Duodenal adenocarcinoma in a 10-year-old boy.

Science.gov (United States)

Mohamed, Zouari; Habib, Bouthour; Rabia, Ben Abdallah; Youssef, Hlel; Riath, Ben Malek; Youssef, Gharbi; Nejib, Kaabar

2014-01-01

Gastrointestinal malignancies are extremely rare in the paediatric population and duodenal cancers represent an even more unusual entity. It represents 0.3-1% of all gastrointestinal tumours. A case report of a 10-year-old boy with duodenal adenocarcinoma is reported and the difficulties of diagnosing and treating this rare tumour are discussed.

Management of perforated peptic ulcer in patients at a teaching hospital

International Nuclear Information System (INIS)

Bin-Taleb, Ali K.; Razzaq, Riyadh A.; Al-Kathiri, Zaki O.

2008-01-01

Objective was to explore and analyze the current status in management of patients with perforated peptic ulcers (PPU). A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study. A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU were noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.8:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours) wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks. Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment and the equipments are needed to reduce the high rate of complications. (author)

Myeloid Sarcoma Developing in Prexisting Hydroxyurea-Induced Leg Ulcer in a Polycythemia Vera Patient

Directory of Open Access Journals (Sweden)

Hatim Nafil

2013-01-01

Full Text Available Myeloid sarcoma (MS is an extramedullary tumour consisting of myeloblasts or immature myeloid cells located in an extramedullary site. It may occur at presentation of AML, at relapse, or prior to the onset of frank leukemia. We report a rare case of MS developing in prexisting Hydroxyurea-induced leg Ulcer in a 70-year-old woman.

Duodenal adenocarcinoma in a 10-year-old boy

Directory of Open Access Journals (Sweden)

Zouari Mohamed

2014-01-01

Full Text Available Gastrointestinal malignancies are extremely rare in the paediatric population and duodenal cancers represent an even more unusual entity. It represents 0.3-1% of all gastrointestinal tumours. A case report of a 10-year-old boy with duodenal adenocarcinoma is reported and the difficulties of diagnosing and treating this rare tumour are discussed.

Pyloro-duodenal hernia with formation of enterocutaneous fistula in ...

African Journals Online (AJOL)

A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy. Keywords: Abomaso-epiplocele, Buffalo calf, Duodenal fistula, Herniorrhaphy.

Gastric potential difference and pH in ulcer patients and normal volunteers during Stroop's colour word conflict test

DEFF Research Database (Denmark)

Højgaard, L; Bendtsen, Flemming

1989-01-01

Whether mental stress is important in the pathogenesis of gastric mucosal disorders is not clearly established. This study investigated the relationship between sympathetic activation caused by the Stroop's colour word conflict test and gastric mucosal function, monitored by measuring the gastric...... mucosal electrical potential difference (PD). In 13 healthy volunteers and 12 duodenal ulcer patients gastric PD, pH, and heart rate were measured continuously during basal conditions, during mental stress evoked by the Stroop's colour word conflict test, and after return to basal conditions...

Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

DEFF Research Database (Denmark)

Munkholm, P.; Michetti, P.; Probert, C.S.

2010-01-01

Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can...... improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine...

Anomalous pancreatic ductal system allowing distal bowel gas with duodenal atresia

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Shruti Sevak

2017-11-01

Bypass of the atretic duodenal segment through an anomalous pancreatic ductal system is a rare anomaly described in the literature in only a handful of cases. This case report highlights the importance of considering duodenal atresia and pancreaticobiliary enteric bypass in the differential diagnosis of neonates presenting with partial duodenal obstruction. On ultrasound, the presence of gas in the biliary tree or pancreatic duct should alert the physician to the possibility of duodenal atresia with congenital pancreaticobiliary duct anomalies that allow for bypass of enteric contents, including air, into more distal bowel, thereby creating a gas pattern aptly described as double bubble with distal gas.

Gastric diverticulum causing gastric outlet obstruction in the setting of duodenal atresia

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Devashis Mukherjee

2018-04-01

Full Text Available Duodenal obstruction due to duodenal atresia occurs in 1 in 10,000 live births and is the most common type of intestinal obstruction in neonates [1–3]. Gastric outlet obstruction in the newborn period from causes other than hypertrophic pyloric stenosis is very uncommon [3]. Potential etiologies include gastric volvulus, antral web, and duplication cysts. Gastric diverticula in the infant is even more rare, with only a few case reports published, and only one describes a gastric diverticulum in the presence of a duodenal atresia [4–8]. In this report, we describe the first case of a gastric outlet obstruction due to a gastric diverticulum in the presence of duodenal atresia. Keywords: Duodenal atresia, Gastric diverticulum, Gastric outlet obstruction

Solitary rectal ulcer syndrome in children and adolescents.

Science.gov (United States)

Perito, Emily R; Mileti, Elizabeth; Dalal, Deepal H; Cho, Soo-Jin; Ferrell, Linda D; McCracken, Marjorie; Heyman, Melvin B

2012-02-01

The aim of this study was to describe the presenting symptoms, endoscopic and histologic findings, and clinical courses of pediatric patients diagnosed with solitary rectal ulcer syndrome (SRUS). We describe 15 cases of SRUS diagnosed at our institution during a 13-year period. Cases were identified by review of a pathology database and chart review and confirmed by review of biopsies. Data were collected by retrospective chart review. Presenting symptoms were consistent but nonspecific, most commonly including blood in stools, diarrhea alternating with constipation, and abdominal/perianal pain. Fourteen of 15 patients had normal hemoglobin/hematocrit, erythrocyte sedimentation rate, and albumin at diagnosis. Endoscopic findings, all limited to the distal rectum, ranged from erythema to ulceration and polypoid lesions. Histology revealed characteristic findings. Stool softeners and mesalamine suppositories improved symptoms, but relapse was common. SRUS in children presents with nonspecific symptoms and endoscopic findings. Clinical suspicion is required, and diagnosis requires histologic confirmation. Response to present treatments is variable.

A 12 years audit of upper gastrointestinal endoscopic procedures

International Nuclear Information System (INIS)

Khurram, M.; Khaar, H.B.; Hasan, Z.; Umar, M.; Javed, S.; Asghar, T.; Minhas, Z.; Akbar, A.; Atta, N.; Nassar, F.; Sultana, Q.; Pervaiz, A.; Masoom, A.

2003-01-01

Objective: Evaluation of upper gastrointestinal (GI) endoscopy in terms of indications, diagnostic efficacy, and diseases diagnosed. Results: Of the 8481 patients, 4935 (58.2%) were female and 3546 (41.8%) male. Mean patient age was 40.5 years. Dyspepsia (42.6%), upper GI bleed (32.8%), and evaluation of chronic liver disease (10.2%) were common indications of the procedure. An endoscopic diagnosis was possible in 82.6% patients. Varices, gastritis, duodenitis, and combined lesions were common endoscopic diagnosis. Gastritis and duodenitis were most frequent causes of upper GI bleed. We noted more gastric ulcers compared to duodenal ulcers. Females had significantly more normal endoscopies, p-value = 0.02. Conclusion: Upper GI endoscopy is an effective procedure. Dyspepsia evaluation is commonest indication for upper GI endoscopy in our patients. Etiology of upper GI bleed, and incidence of duodenal ulcer compared to gastric ulcer in our patients are different than described in literature. Females have significantly more normal endoscopies. (author)

Duodenal adenocarcinoma in a 10-year-old boy | Mohamed ...

African Journals Online (AJOL)

Gastrointestinal malignancies are extremely rare in the paediatric population and duodenal cancers represent an even more unusual entity. It represents 0.3-1% of all gastrointestinal tumours. A case report of a 10-year-old boy with duodenal adenocarcinoma is reported and the diffi culties of diagnosing and treating this ...

Gastroprotective effects of several H2RAs on ibuprofen-induced gastric ulcer in rats.

Science.gov (United States)

Liu, Jing; Sun, Dan; He, Jinfeng; Yang, Chengli; Hu, Tingting; Zhang, Lijing; Cao, Hua; Tong, Ai-Ping; Song, Xiangrong; Xie, Yongmei; He, Gu; Guo, Gang; Luo, Youfu; Cheng, Ping; Zheng, Yu

2016-03-15

Ibuprofen is the first line of treatment for osteoarthritis and arthritis. The main side effects of ibuprofen especially in long-term treatment include gastric ulcer, duodenal ulcer and indigestion etc. Therefore, screening drugs with effective gastric protective effects and low toxicity for combination therapy with ibuprofen is necessary. The mechanism of gastric damage induced by ibuprofen is still unclear, however, cell damage caused by reactive oxygen species (ROS) is considered as the main reason. Preliminary screening of literature with the criteria of low toxicity led to four histamine-2 receptor antagonists (H2RAs): nizatidine, famotidine, lafutidine, and roxatidine acetate, which were selected for further investigation. These drugs were evaluated systemically by examining the gastric ulcer index, lipid peroxidation (LPO), membrane permeability, toxicity to main organs, and the influence on the activity of antioxidant enzymes, and myeloperoxidase (MPO). Nizatidine was found to be the best gastric protective agent. It exhibited excellent protective effect by increasing antioxidant enzyme activity, decreasing MPO activity, reducing LPO, and membrane permeability. Combination treatment with nizatidine and ibuprofen did not show any significant toxicity. Nizatidine was considered as a good option for combination therapy with ibuprofen especially for diseases that require long-term treatment such as arthritis and osteoarthritis. Copyright © 2016 Elsevier Inc. All rights reserved.

Pancreatic and duodenal injuries: keep it simple.

Science.gov (United States)

Rickard, Matthew J F X; Brohi, Karim; Bautz, Peter C

2005-07-01

The management of pancreatic and duodenal trauma has moved away from complex reconstructive procedures to simpler methods in keeping with the trend towards organ-specific, damage control surgery. A retrospective case note review was undertaken over a 30-month period to evaluate a simplified protocol for the management of these injuries. Of 100 consecutive patients there were 51 with pancreatic injury, 30 with a duodenal injury and 19 with combined pancreaticoduodenal trauma. Overall mortality was 18.0%, with a late mortality (after 24 h) of 9.9%. This is comparable to previous studies. Morbidity from abscesses, fistulas and anastomotic breakdown was acceptably low. The concept of staged laparotomy can be successfully applied to wounds of the pancreas and duodenum. Debridement of devitalized tissue and drainage can be employed for most cases of pancreatic trauma. Most duodenal injuries can be managed with debridement and primary repair. Temporary exclusion and reoperation should be employed for unstable patients.

Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002

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Ranstam Jonas

2009-04-01

Full Text Available Abstract Background Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID and acetylsalicylic acid (ASA. Methods All cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey. Results When comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p Conclusion When comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.

The influence of duodeno-gastric reflux on frequency of Helicobacter pylori infection at patients with ulcer gastric

International Nuclear Information System (INIS)

Kopanski, Z.; Niziol, J.; Micherdzinski, J.; Wasilewska-Radwanska, M.; Cienciala, A.; Lasa, J.

1996-01-01

To estimate the correlation between frequency of Helicobacter pylori (H. pylori) infection and intensity of duodeno-gastric reflux it was analysed 61 species with ulcer gastric. Bacterial infection was diagnosed by the breath test with 14 C-labelled urea, whereas presence and intensity of the reflux was found with dynamic scintigraphy with 99 Tm MBrIDA support. The H. pylori infection was present at 42 (68.9%) patients. The presence of throwing back the duodenal liquid was found at 32 (52.5%) diagnosed patients. At 19 (31.2%) of them the reflux has intensity of 1%, at 11 (18%)-2 o and 2 (3.3%)-3 o .The investigations which were carried out, showed that at patients with ulcer gastric disease, duodeno-gastric reflux is an agent which slows down H. pylori infection, however it is easily seen not earlier than at 2 o of its intensity. (author)

Abnormal duodenal loop demonstrated by X-ray. Correlation to symptoms and prognosis of dyspepsia

Energy Technology Data Exchange (ETDEWEB)

Thommesen, P.; Funch-Jensen, P.

1986-01-01

The occurrence of dyspeptic symptoms has previously been correlated with the shape of the duodenal loop in patients with X-ray-negative dyspepsia. An abnormal duodenal loop was associated with a significantly higher incidence of symtoms provoked by meals, vomiting, regurgitations, heartburn, and the irritable bowel syndrome. 89% of these patients (26 patients with a normal duodenal loop and 39 patients with abnormal duodenal loop) were available for a 5-year follow-up study of symptomatic outcome. The incidence of symptoms provoked by meals was still significantly higher in patients with an abnormal duodenal loop, and there was also a significant difference concerning symptomatic outcome. Approximately 75% of the patients with a normal duodenal loop had improved, and 25% had unchanged clinical conditions. Approximately 50% of the patients with an abnormal duodenal loop had improved, and 50% had an unchanged or even deteriorated clinical condition.

Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology.

Science.gov (United States)

Linsenmaier, Ulrich; Wirth, Stefan; Reiser, Maximilian; Körner, Markus

2008-10-01

Pancreatic and duodenal injuries after blunt abdominal trauma are rare; however, delays in diagnosis and treatment can significantly increase morbidity and mortality. Multidetector computed tomography (CT) has a major role in early diagnosis of pancreatic and duodenal injuries. Detecting the often subtle signs of injury with whole-body CT can be difficult because this technique usually does not include a dedicated protocol for scanning the pancreas. Specific injury patterns in the pancreas and duodenum often have variable expression at early posttraumatic multidetector CT: They may be hardly visible, or there may be considerable exudate, hematomas, organ ruptures, or active bleeding. An accurate multidetector CT technique allows optimized detection of subtle abnormalities. In duodenal injuries, differentiation between a contusion of the duodenal wall or mural hematoma and a duodenal perforation is vital. In pancreatic injuries, determination of involvement of the pancreatic duct is essential. The latter conditions require immediate surgical intervention. Use of organ injury scales and a surgical classification adapted for multidetector CT enables classification of organ injuries for trauma scoring, treatment planning, and outcome control. In addition, multidetector CT reliably demonstrates potential complications of duodenal and pancreatic injuries, such as posttraumatic pancreatitis, pseudocysts, fistulas, exudates, and abscesses. (c) RSNA, 2008.

Prevalence of Helicobacter pylori among patients with dyspepsia and correlation between endoscopic and histological diagnosis

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Shiva Raj K.C.

2016-03-01

Full Text Available Background: Dyspepsia is a prevalent complaint in general practice and gastrointestinal clinics. Helicobacter pylori have major causal relationship with gastro duodenal disease. The following study seeks to identify the prevalence of H. pylori based on histology and to correlate endoscopic findings with histopathology.Materials and Methods: This was a cross-sectional observational study conducted in GRP Polyclinic and Om Hospital and research centre from April 2015-September 2015. The upper gastrointestinal endoscopic findings were recorded and were correlated with histopathological findings. All the relevant data were collected and analysed using Statistical Package of Social Sciences version 16 for windows.  Results: Endoscopy finding was divided into reflux esophagitis, antral gastritis, duodenitis, duodenal ulcer, gastric ulcer, and gastric cancer. Duodenal ulcer and gastric ulcer was noted more frequently in males than in females (55.0% vs. 45.0% and 58.2% vs. 41.8%, respectively, P < 0.001.Chronic follicular gastritis was the most common in gastric ulcer (41.7%, whereas chronic persistent gastritis was common in non-ulcerative disease. Chronic active gastritis and chronic follicular gastritis were more common in ulcerative diseases, whereas chronic persistent gastritis was more common in gastritis and duodenitis (P < 0.001. The overall prevalence of H. pylori infection was 68.1% with male preponderance. Chronic active gastritis had highest prevalence of H. pylori (84.8%, followed by chronic follicular gastritis (84.1% and chronic persistent gastritis (p value < 0.001.Conclusion: Rate of H. pylori infected patients with dyspepsia was high. Ulcerative lesions were more common in males than in females with higher rate of infection with H. Pylori.  Histological diagnosis of chronic active gastritis and chronic follicular gastritis was the most common pathologies in ulcerative lesions. 

Safety of repair for severe duodenal injuries.

Science.gov (United States)

Velmahos, George C; Constantinou, Constantinos; Kasotakis, George

2008-01-01

There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs. The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR--simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared. PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups. Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.

Proximal duodenal perforation in three dogs following deracoxib administration.

Science.gov (United States)

Case, J Brad; Fick, Jennifer L; Rooney, Matthew B

2010-01-01

The purpose of this study was to describe the clinical and gross pathological findings, treatment, and outcome in three dogs receiving deracoxib that developed proximal duodenal perforation and subsequent septic peritonitis. Clinical findings were acute vomiting and anorexia following initiation of deracoxib therapy. Deracoxib dosages ranged from 2 to 3 mg/kg per os q 24 hours. In each dog, exploratory laparotomy revealed duodenal perforations approximately 1 cm orad to the major duodenal papilla. Two out of three dogs survived following exploratory laparotomy. Two of three dogs in the present case series received the approved deracoxib dosage. Dogs receiving deracoxib, even at labeled dosages, should be monitored judiciously for signs of gastrointestinal disease.

Endoscopy and biopsy findings in the esophageal, gastric and duodenal mucosa before and after radiotherapy for Hodgkin's disease

Energy Technology Data Exchange (ETDEWEB)

Slanina, J.; Neidl, K.; Wannenmacher, M.; Froehlich, J.; Hoppe-Seyler, P.; Oehlert, W.

1985-04-01

Esophago-gastro-duodenoscopies with multiple mucosa biopsies were performed before and after irradiation of the mantle field or the spleen pedicle in 13 patients with Hodgkin's disease in stage I and II. For the irradiation the photons of a 4 MeV linear accelerator were applied with focal doses of 40 to 44 Gy. Contrast simulator radiographs were made in order to verify the position within the irradiation field of the organs from which biopsies were taken. In 0/10 patients examined before the irradiation, 0/5 patients examined less than 15 weeks after the irradiation, and 0/12 patients examined 15 weeks or later after the irradiation, histomorphologic investigation of the mucosa of the esophagus showed no pathologic findings. With the same intervals of examination related to irradiation, the gastric mucosa showed a pathologic histomorphology in 1/13, 7/9, and 5/9 patients, respectively, and the duodenal mucosa in 0/13, 5/9, and 2/9 patients, respectively. With the exception of one ulcer in the duodenal bulb, the histopathologic findings as well as the macroscopic findings were neither significant nor characteristic, i.e. not radiospecific. Most of these findings were inflammatory alterations of the mucosa, erosions, and capillarectasies.

Infectious complications following duodenal and/or pancreatic trauma.

Science.gov (United States)

Tyburski, J G; Dente, C J; Wilson, R F; Shanti, C; Steffes, C P; Carlin, A

2001-03-01

Patients with pancreatic and/or duodenal trauma often have a high incidence of infectious complications. In this study we attempted to find the most important risk factors for these infections. A retrospective review of the records of 167 patients seen over 7 years (1989 through 1996) at an urban Level I trauma center for injury to the duodenum and/or pancreas was performed. Fifty-nine patients (35%) had isolated injury to the duodenum (13 blunt, 46 penetrating), 81 (49%) had isolated pancreatic trauma (18 blunt, 63 penetrating), and 27 (16%) had combined injuries (two blunt, 25 penetrating). The overall mortality rate was 21 per cent and the infectious morbidity rate was 40 per cent. The majority of patients had primary repair and/or drainage as treatment of their injuries. Patients with pancreatic injuries (alone or combined with a duodenal injury) had a much higher infection rate than duodenal injuries. The patients with duodenal injuries had significantly lower penetrating abdominal trauma indices, number of intra-abdominal organ injuries, and incidence of hypothermia. On multivariate analysis independent factors associated with infections included hypothermia and the presence of a pancreatic injury. Although injuries to the pancreas and duodenum often coexist it is the pancreatic injury that contributes most to the infectious morbidity.

Duodenal Hematoma after upper Gastrointestinal Endoscopy: Case Report and Literature Review

OpenAIRE

Sousa, Marta Reis; Vieira, Ana Catarina; Rio, Gisela; Moreira, Angela; Noruegas, Maria José; Sanches, Conceição

2018-01-01

Duodenal hematoma is a rare complication of endoscopic duodenal biopsy, with just a few cases reported in children in the literature available.The authors present a case of a 13 year-old girl, with a history of Noonan Syndrome and neurofibromatosis type 1, who presented abdominal pain and vomiting after an endoscopic duodenal biopsy.In this article, we describe the clinical case, imaging findings, evolution and therapeutic approach.We briefly discuss the hematologic complications in patients ...

Treatment of Duodenal Duplication by Trans-umbilical Exploratory Minimal Laparotomy

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Li-Lan Chiang

2009-08-01

Full Text Available Duodenal duplication cysts are rare congenital lesions. Their presentation is often non-specific and physical examination and laboratory studies usually reveal no abnormal findings. The diagnosis of duodenal duplication cysts can thus be challenging and relies on ultrasonography, barium swallow, contrast enhanced computed tomography (CT, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography (MRCP. The management of duodenal duplication cyst is surgical. Laparotomy is usually necessary, and complete resection is the management goal. Subtotal excision with stripping of the mucosa due to close involvement of the pancreatobiliary tree, and endoscopic resection have Duodenal duplication cysts are rare congenital lesions usually diagnosed in infancy, although they may present in adulthood. Prenatal diagnosis is difficult, and postnatal diagnosis relies on ultrasonography, barium swallow, contrast-enhanced computerized tomography, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography. A female newborn was diagnosed with an abdominal cyst (size around 6 ×; 5 × 4 cm at gestational age (GA 24 weeks, by regular prenatal examination. After her birth at GA 37 weeks, we performed abdominal ultrasonography and MRI, but there was no definite diagnosis. The usual management of an abdominal cyst involves resection by laparotomy (requiring a large incision or laparoscopy (requiring several small incisions. We performed an exploratory trans-umbilical minimal laparotomy excision for surgery, and the pathology revealed duodenal duplication. In our case, there was no recurrence of the cyst after 18 months follow-up, and the operation scar was almost undetectable. Trans-umbilical minimal laparotomy excision may be considered as an alternative choice for the management of abdominal and duodenal duplication cysts.

Duodenal ileus caused by a calf feeding nipple in a cow

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Gerspach Christian

2011-01-01

Full Text Available Abstract Background The aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow. Case Presentation The clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum. A diagnosis of duodenal ileus was made and the cow underwent right-flank laparotomy, which revealed a dilation of the cranial part of the duodenum because of obstruction by a pliable foreign body. This was identified via enterotomy as a calf feeding nipple. The cow was healthy at the time of discharge four days after surgery and went on to complete a successful lactation. Conclusions To our knowledge, this is the first description of duodenal obstruction by a calf feeding nipple. This is an interesting case, which broadens the spectrum of the causes of duodenal ileus, which is usually caused by obstruction of the duodenum by a phytobezoar.

Duodenal diverticulum and obstructive jaundice: two case reports

International Nuclear Information System (INIS)

Lopez, J.A.; Larena, J.A.; Larrea, L.M.; Pena, J.M.

1996-01-01

Duodenal diverticulum is a common, and usually asymptomatic, pathology. The associated complications are rare, but have an elevated degree of morbidity and mortality. We present two cases of obstructive jaundice due to duodenal diverticulum. this is an unusual complication, very few cases of which have been reported in the medical literature. We describes the ultrasound (US) and abdominal computerized tomography (CT) findings. The latter led to the diagnosis in both patients. (Author) 25 refs

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

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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.

Proximal gastric vagotomy: does it have a place in the future management of peptic ulcer?

Science.gov (United States)

Johnson, A G

2000-03-01

Proximal gastric vagotomy (PGV) is a modification of truncal vagotomy, which was introduced by Dragstedt for the treatment of duodenal ulcer (DU) in 1943. It is a technically demanding operation; but when performed by an experienced surgeon, it is safe and gives a cure rate for DU of more than 90%, with minimal side effects. The operation permanently alters the natural history of the disease and may be used for gastric ulcer (GU), with ulcer excision; but it is not as effective. Further adaptations, such as posterior truncal vagotomy with anterior seromyotomy, were introduced to simplify and shorten the operation, but they did not receive wide acceptance. Recently, with the identification of Helicobacter, it was found that DU can also be cured by eliminating the infection. PGV is therefore used electively in patients with persistent DU that is not Helicobacter-positive or in the few in whom Helicobacter cannot be eliminated. In patients with bleeding or perforated DUs, PGV may be used in conjunction with underrunning the vessel or patching the perforation. However, few surgeons doing emergency peptic ulcer surgery have experience with PGV, so simple suture followed by medical treatment is the safest option. Because elective PGV is now a rare procedure, patients should be referred to a center with special expertise. If Helicobacter becomes resistant to antibiotics in the future, surgery may be needed regularly again, but the technical nuances would have to be learned.

Assistance protocol for venous ulcers patients: validation of contents

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Daniele Vieira Dantas

2013-07-01

Full Text Available Venous ulcers require complex treatment and are responsible for significant morbidity and mortality rates. This study aims at identifying aspects validated by the jury for the preparation of an assistance protocol for venous ulcer sufferers. It is a descriptive and quantitative research, with 39 professionals (30 nurses, 7 doctors and two physiotherapists, held at the Onofre Lopes University Hospital, between April and July/2010. Data collection began through a questionnaire checklist. Analysis was performed through Statistical Package for Social Science 15.0, assessing compliance with guidelines. Results were the compositional aspects of the protocol: assessment of patient and lesion history/documentation, wound care/perilesional skin, dressing suggestion, use of antibiotics and pain treatment, surgical treatment/medication, improving venous return and relapse prevention, patient referral, professional training and referral/counter-referral. It was concluded that to compose the protocol, aspects related to diagnosis, treatment and injury prevention must be considered.

A newborn with duodenal atresia and a gastric perforation

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Akcora Bulent

2010-01-01

Full Text Available Congenital duodenal atresia complicated by gastric perforation (GP is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

Clinical impact of duodenal pancreatic heterotopia - Is there a need for surgical treatment?

Science.gov (United States)

Betzler, Alexander; Mees, Soeren T; Pump, Josefine; Schölch, Sebastian; Zimmermann, Carolin; Aust, Daniela E; Weitz, Jürgen; Welsch, Thilo; Distler, Marius

2017-05-08

Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation. A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich's classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%. PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.

Duodenal atresia with 'apple-peel configuration' of the ileum and ...

African Journals Online (AJOL)

According to the current understanding, duodenal atresia is considered to be a primary malformation resulting from the errors in recanalisation in early gestation. We report a rare case of duodenal atresia with apple-peel configuration of remaining small bowel with absent superior mesenteric artery in a preterm child, which ...

Epithelial cell proliferation in human fundic and antral mucosae. Influence of superselective vagotomy and relationship with gastritis

International Nuclear Information System (INIS)

Gutierrez, O.; Lehy, T.; Rene, E.; Gres, L.; Bonfils, S.

1985-01-01

Epithelial cell proliferation in the fundic and antral mucosae was studied in 19 duodenal ulcer patients, 11 patients having undergone fundic superselective vagotomy for duodenal ulcer, and 10 controls. This was achieved through in vitro incorporation of tritiated thymidine in mucosal biopsies and radioautography. Except for increased fundic mucosal height, duodenal ulcer patients did not differ from controls for all parameters studied. In vagotomized patients, as compared to the other two groups, the labeling index was significantly enhanced in the innervated antral mucosa where atrophic gastritis developed, but there was no change in the labeling index and no worsening of mucosal inflammation in the denervated fundic mucosa. The only abnormality in the latter was a striking expansion, towards the surface, of the proliferative area within the fundic pit. The labeling indices and the degree of gastritis in gastric mucosae are significantly correlated in control and duodenal ulcer patients. If findings in antral mucosa, after superselective vagotomy, seemed related to gastritis lesions, those in fundic mucosa were not and may indicate an alteration due to the vagotomy per se

Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

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Psaila Josephine

2009-10-01

Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

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Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

2013-01-01

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites

Clinical significance of the measurement of the gastric emptying time using sup(99m)Tc-DTPA (technetium-99m diethylene-triamine-pentaacetic acid)

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Imagawa, Masaru

1985-01-01

The gastric emptying time (GET) was measured by the radioisotopic method (sup(99m)Tc-DTPA) in healthy volunteers, normal controls and patients with various gastroduodenal diseases. The gastric juice after tetragastrin-stimulation was also analyzed in all patients, and in some patients to determine the serum gastrin levels (gastrin response) to test meal. The results are summarized as follows: 1) The present method provided excellent reproducibility and safety without absorption of the radiochemical, and demonstrated an exponentially linear pattern of GET. 2) GET was delayed in patients with atrophic gasritis, gastric ulcer and gastric cancer but was shortened significantly in patients with duodenal ulcer compared to normal controls. 3) GET was significantly correlated to aging and gastric acid secretion in non-ulcer subjects (normal controls and atrophic gastritis) but not in gastric ulcer patients. GET was delayed markedly in gastric ulcer patients with hypersecretion. 4) GET was shortened in duodenal ulcer patients, especially those with normosecretion, but was within a normal range in those with hypersecretion. Both the gastric emptying time and acid output in gastroduodenal ulcer patients were similar to those in duodenal ulcer patients with hypersecretion, suggesting the similarity of pathophysiology between them. 5) GET was delayed in gastric cancer patients, especially in advanced patients, suggesting impairment of the gastric motility due to cancer invasion into the muscular layer. 6) The gastrin response after test meal rapidly descended in duodenal ulcer patients but conversely continued to be high in gastric ulcer patients. This difference might have resulted from prolonged stimulation caused by gastric stasis. There may also be other factors, i.e., severity of atrophic gastritis. (J.P.N.)

Clinical significance of the measurement of the gastric emptying time using /sup 99m/Tc-DTPA (technetium-99m diethylene-triamine-pentaacetic acid)

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Imagawa, Masaru

1985-02-01

The gastric emptying time (GET) was measured by the radioisotopic method (/sup 99m/Tc-DTPA) in healthy volunteers, normal controls and patients with various gastroduodenal diseases. The gastric juice after tetragastrin-stimulation was also analyzed in all patients, and in some patients to determine the serum gastrin levels (gastrin response) to test meal. The results are summarized as follows: 1) The present method provided excellent reproducibility and safety without absorption of the radiochemical, and demonstrated an exponentially linear pattern of GET. 2) GET was delayed in patients with atrophic gastritis, gastric ulcer and gastric cancer but was shortened significantly in patients with duodenal ulcer compared to normal controls. 3) GET was significantly correlated to aging and gastric acid secretion in non-ulcer subjects (normal controls and atrophic gastritis) but not in gastric ulcer patients. GET was delayed markedly in gastric ulcer patients with hypersecretion. 4) GET was shortened in duodenal ulcer patients, especially those with normosecretion, but was within a normal range in those with hypersecretion. Both the gastric emptying time and acid output in gastroduodenal ulcer patients were similar to those in duodenal ulcer patients with hypersecretion, suggesting the similarity of pathophysiology between them. 5) GET was delayed in gastric cancer patients, especially in advanced patients, suggesting impairment of the gastric motility due to cancer invasion into the muscular layer. 6) The gastrin response after test meal rapidly descended in duodenal ulcer patients but conversely continued to be high in gastric ulcer patients. This difference might have resulted from prolonged stimulation caused by gastric stasis. There may also be other factors, i.e., severity of atrophic gastritis.

Duodenal nodularity in children: A clinical and pathologic study of 17 cases

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Çaltepe Dinler Gönül

2011-01-01

Full Text Available Aims: Duodenal nodularity is an uncommon endoscopic appearance of numerous visible mucosal nodules in the proximal duodenum. In this retrospective study we aimed to determine the clinical significance and histopathologic features of duodenal nodularity in children. Materials and Methods: The medical records of the patients who were defined to have duodenal nodularity by endoscopy were reviewed. Statistical Analysis Used: The data were expressed as mean ± SD and percentages (%. Results: Seventeen patients with endoscopically defined duodenal nodularity were chosen. The mean age at diagnosis was 12.1 years (range: 6-17 years, 9 males. Abdominal pain (47% was the most common clinical symptom and antral nodularity (41% was the most common endoscopic finding in children with duodenal nodularity. Histopathologic evaluation of duodenal nodules revealed chronic inflammation in all patients, increased intercryptal and intraepithelial numbers of eosinophils in 70.5%, and villous atrophy in 47% of patients. Giardia infestation was demonstrated in 6 patients by histologic examination and/or Giardia lamblia-specific antigen positivity in stools. The clinical diagnoses of the patients have shown variations, such as celiac disease, giardiasis, secretory IgA deficiency, and Helicobacter pylori gastritis, and some of them were associated with the others. Conclusions: Although the endoscopic appearance is similar, clinical spectrum and pathologic features are not so similar and there are no specific histomorphologic findings for nodularity. The most demonstrative findings we observed in children were increased lymphocyte and/or eosinophil infiltration in the duodenal mucosa. We suggested that care should be taken in the evaluation of microbiological and immunologic etiologies causing this prominent inflammatory reaction.

Sinonasal Lymphoma Presenting as a Probable Sanctuary Site for Relapsed B Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature

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W. Y. Lim

2015-01-01

Full Text Available Sinonasal lymphoma is a non-Hodgkin lymphoma (NHL representing 1.5% of all lymphomas. It presents as an unremitting ulceration with progressive destruction of midline sinonasal and surrounding structures. Poor prognosis warrants early treatment although diagnosis is challenging and frequently delayed. It is usually primary in origin and to our knowledge the sinonasal region has never been reported as a sanctuary site in leukaemia/lymphoma relapse. We present a unique case of B-cell ALL (acute lymphoblastic leukaemia with late relapse to the nasal septum as a sinonasal lymphoblastic lymphoma and with genetic support for this as a sanctuary site.

Sinonasal Lymphoma Presenting as a Probable Sanctuary Site for Relapsed B Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature.

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Lim, W Y; Care, R; Lau, M; Chiruka, S; Dawes, P J D

2015-01-01

Sinonasal lymphoma is a non-Hodgkin lymphoma (NHL) representing 1.5% of all lymphomas. It presents as an unremitting ulceration with progressive destruction of midline sinonasal and surrounding structures. Poor prognosis warrants early treatment although diagnosis is challenging and frequently delayed. It is usually primary in origin and to our knowledge the sinonasal region has never been reported as a sanctuary site in leukaemia/lymphoma relapse. We present a unique case of B-cell ALL (acute lymphoblastic leukaemia) with late relapse to the nasal septum as a sinonasal lymphoblastic lymphoma and with genetic support for this as a sanctuary site.

Upper gastrointestinal endoscopy at the korle bu teaching hospital, accra, ghana.

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Aduful, Hk; Naaeder, Sb; Darko, R; Baako, Bn; Clegg-Lamptey, Jna; Nkrumah, Kn; Adu-Aryee, Na; Kyere, M

2007-03-01

To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 +/- 0.5 and females 43.7 +/- 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.

Clinical and endoscopic aspects in the evolution of patients with bleeding peptic ulcer: a cohort study

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SEGAL Fábio

2000-01-01

Full Text Available Background - Bleeding ulcers are a major problem in public health and represent approximately half of all the cases of upper gastrointestinal hemorrhage in the United States. This study aims to determine the prognostic value of factors such as clinical history, laboratory and endoscopic findings in the occurrence of new episodes of bleeding in patients who have upper gastrointestinal hemorrhage caused by gastric or duodenal peptic ulcer. Methods - A cohort study with 94 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. Results - From the 94 patients studied, 88 did not present a new bleeding episode in the 7 days following hospital admission. The incidence of rebleeding was significantly higher in those patients with hemoglobin <6 g/dL at the admission (P = 0.03, RR = 6.2. The localization of the ulcers in bulb was positively associated to rebleeding (P = 0.003.The rebleeding group needed a greater number of units transfunded (P = 0.03 and the time of hospitalization was longer than the time of the hemostasia group (P = 0.0349. Conclusions - The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality.

Ulceration and stage are predictive of interferon efficacy in melanoma: results of the phase III adjuvant trials EORTC 18952 and EORTC 18991

NARCIS (Netherlands)

Eggermont, Alexander M. M.; Suciu, Stefan; Testori, Alessandro; Kruit, Wim H.; Marsden, Jeremy; Punt, Cornelis J.; Santinami, Mario; Salès, François; Schadendorf, Dirk; Patel, Poulam; Dummer, Reinhard; Robert, Caroline; Keilholz, Ulrich; Yver, Antoine; Spatz, Alan

2012-01-01

Adjuvant interferon has modest activity in melanoma patients at high risk for relapse. Patient selection is important; stage and ulceration of the primary tumour are key prognostic factors. In this post hoc meta-analysis of European Organisation for Research and Treatment of Cancer (EORTC) trials

Ulceration and stage are predictive of interferon efficacy in melanoma: results of the phase III adjuvant trials EORTC 18952 and EORTC 18991.

NARCIS (Netherlands)

Eggermont, A.M.M.; Suciu, S.; Testori, A.; Kruit, W.H.; Marsden, J.; Punt, C.J.A.; Santinami, M.; Sales, F.; Schadendorf, D.; Patel, P.; Dummer, R.; Robert, C.; Keilholz, U.; Yver, A.; Spatz, A.

2012-01-01

Adjuvant interferon has modest activity in melanoma patients at high risk for relapse. Patient selection is important; stage and ulceration of the primary tumour are key prognostic factors. METHODS: In this post hoc meta-analysis of European Organisation for Research and Treatment of Cancer (EORTC)

Duodenal endoscopic full-thickness resection (with video).

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Schmidt, Arthur; Meier, Benjamin; Cahyadi, Oscar; Caca, Karel

2015-10-01

Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device. Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD). Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed. EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Perforated peptic ulcer in an adolescent boy with acute appendicitis: a case report

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Aazam Khorassani

2013-06-01

Full Text Available Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma.

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Polistina, Francesco A; Costantin, Giorgio; Settin, Alessandro; Lumachi, Franco; Ambrosino, Giovanni

2010-10-23

Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

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Francesco A. Polistina

2010-10-01

Full Text Available Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

Dopamine enhances duodenal epithelial permeability via the dopamine D5 receptor in rodent.

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Feng, X-Y; Zhang, D-N; Wang, Y-A; Fan, R-F; Hong, F; Zhang, Y; Li, Y; Zhu, J-X

2017-05-01

The intestinal barrier is made up of epithelial cells and intercellular junctional complexes to regulate epithelial ion transport and permeability. Dopamine (DA) is able to promote duodenal epithelial ion transport through D1-like receptors, which includes subtypes of D 1 (D 1 R) and D 5 (D 5 R), but whether D1-like receptors influence the duodenal permeability is unclear. FITC-dextran permeability, short-circuit current (I SC ), Western blot, immunohistochemistry and ELISA were used in human D 5 R transgenic mice and hyperendogenous enteric DA (HEnD) rats in this study. Dopamine induced a downward deflection in I SC and an increase in FITC-dextran permeability of control rat duodenum, which were inhibited by the D1-like receptor antagonist, SCH-23390. However, DA decreased duodenal transepithelial resistance (TER), an effect also reversed by SCH-23390. A strong immunofluorescence signal for D 5 R, but not D 1 R, was observed in the duodenum of control rat. In human D 5 R knock-in transgenic mice, duodenal mucosa displayed an increased basal I SC with high FITC-dextran permeability and decreased TER with a lowered expression of tight junction proteins, suggesting attenuated duodenal barrier function in these transgenic mice. D 5 R knock-down transgenic mice manifested a decreased basal I SC with lowered FITC-dextran permeability. Moreover, an increased FITC-dextran permeability combined with decreased TER and tight junction protein expression in duodenal mucosa were also observed in HEnD rats. This study demonstrates, for the first time, that DA enhances duodenal permeability of control rat via D 5 R, which provides new experimental and theoretical evidence for the influence of DA on duodenal epithelial barrier function. © 2016 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

Surgical management of acute perforation of peptic ulcers. A single centre experience.

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Lemaitre, J; El Founas, W; Simoens, Chr; Ngongang, Chr; Smets, D; Mendes da Costa, P

2005-01-01

Acute perforation may occur in gastric and duodenal ulcers. During the past decade, the need for elective operation for peptic ulceration has decreased as medical treatment has improved. However, emergency operations for acute complications such as perforation or bleeding remain constant. Actually, the treatment of choice is simple suture-closure, with or without omentoplasty, and peritoneal lavage or even omentoplasty alone, associated with a high intravenous dose of inhibitors of the proton pump and Helicobacter pylori eradication, if needed. The standard treatment in our team is to perform a peritoneal lavage and drainage and a simple closure of the ulcer with an omentoplasty. A first retrospective analysis was made on data collected from 1996 to 2001 and we completed a prospective study from 2001 to 2003 to compare our results with our old data and with data collected from other teams. The mean age and the mean ASA score were similar in the two groups. For the majority of the patients, the diagnosis was made from symptoms and the presence of free abdominal air. The delay between arrival in the emergency room and the operating room was significantly shorter in the second group, but operating time was longer in this group. Morbidity was more frequent in the first group but mortality remained quite similar. Our results indicate that in a trained team the morbidity has decreased as the delay in surgery decreased and that the rate of diagnosis on plain abdominal film has increased. Laparoscopic suture of a perforated peptic ulcer is as safe as the open procedure but allows the surgeon to search for another cause of free air and offers the possibility, if conversion is needed, to perform a shorter laparotomy.

Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans

DEFF Research Database (Denmark)

Mertz-Nielsen, Anette; Hillingsø, J; Bukhave, Klaus

1996-01-01

this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n=17) and after pretreatment with high......H 6.9 v 6.8; p>0.05). Omeprazole caused higher rates of basal (mean (SEM)) (597 (48) v 351 (39) mu mol/h; pstimulated (834 (72) v 474 (66) mu mol/h; pstimulated (3351 (678) v 2550 (456) mu mol/h; p>0.05) duodenal bicarbonate secretion compared with control...... experiments. Also the combination of omeprazole and ranitidine increased (p=0.05) duodenal bicarbonate secretion, while ranitidine alone caused no change in either basal or stimulated secretion. In the stomach basal as well as vagally stimulated bicarbonate secretion was independent of the means of acid...

Efficacy of Bifidobacterium breve Fermented Milk in Maintaining Remission of Ulcerative Colitis.

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Matsuoka, Katsuyoshi; Uemura, Yukari; Kanai, Takanori; Kunisaki, Reiko; Suzuki, Yasuo; Yokoyama, Kaoru; Yoshimura, Naoki; Hibi, Toshifumi

2018-02-15

Fermented milk products containing Bifidobacterium breve strain Yakult (BFM) may improve clinical status in ulcerative colitis (UC) patients. To assess efficacy of BFM in maintaining remission in Japanese patients with quiescent UC. This double-blind study (B-FLORA) enrolled 195 patients with quiescent UC, randomized to receive one pack of BFM fermented milk per day [Bifidobacterium breve strain Yakult (10 billion bacteria) and Lactobacillus acidophilus (1 billion bacteria)] (n = 98) or matching placebo (n = 97) for 48 weeks. The primary efficacy endpoint was relapse-free survival (relapse: rectal bleeding score ≥ 2 on Sutherland disease activity index scale for 3 consecutive days and/or initiation of remission induction therapy for worsening of UC). An interim analysis was conducted after inclusion and follow-up of one-third of patients for the first phase of the study (n = 195). Relapse-free survival was not significantly different between the BFM and placebo groups (P = 0.643; hazard ratio 1.16; 95% CI 0.63-2.14, log-rank test), nor was the incidence of relapse. Therefore, the study was discontinued for lack of efficacy. An exploratory analysis of fecal samples from a subgroup of patients revealed no effects of either study beverage on intestinal microbiota, but there was a significant decrease in Bifidobacterium species before relapse, regardless of treatment group. Three mild adverse events occurred for which a causal relationship with the study beverage could not be ruled out (placebo: abdominal bloating and stress in one patient; BFM: body odor in one patient). BFM had no effect on time to relapse in UC patients compared with placebo. UMIN000007593.

An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy

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MA Modi

2014-01-01

Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

Estenosis duodenal por páncreas anular. Presentación de un caso esporádico Duodenal stenosis for annular páncreas. A sporadic case presentation

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Sergio Piloña Ruíz

2006-04-01

Full Text Available La obstrucción intestinal duodenal es frecuente en el recién nacido como causa de oclusión, puede ser completa (atresia duodenal secundaria a un trastorno de revacuolización de la luz intestinal o por una rotación irregular del páncreas hacia la derecha del duodeno. Presentamos a un recién nacido con edad gestacional de 35.4 semanas, conteo de Apgar de 8-8 puntos, que nace con signos de shock hipovolémico secundario a una anemia aguda por desgarro del corión, con una Encefalopatía Hipóxica Isquémica(EHI. Desarrolló posteriormente una intolerancia digestiva con abundante residuo gástrico, valorándose una oclusión intestinal incompleta alta, posiblemente por una estenosis duodenal. Se le realizan radiografías de abdomen simple de pie apoyándose la sospecha clínica por la presencia de imagen típica "en doble burbuja", se realizó laparotomía exploradora encontrando en el acto quirúrgico una Estenosis Duodenal secundaria a un Páncreas Anular. Es egresado a los 45 días de vida con buen peso corporal y reflujo gastroesofágico grado III como complicación. Actualmente se encuentra bajo seguimiento ambulatorio multidisciplinario y en franca evolución satisfactoria.Duodenal intestinal obstruction is frequent in newborn as a cause of occlusion, it can be complete (duodenal atresia, secondary to a disorder of revacuolization of the intestinal lumen, or due to an irregular rotation of pancreas towards theright of duodenum. A newborn with a gestational age of 35.4 weeks, apgar score of 8.8 who was born with signs of hypovolemic shock secondary to an acute anemia caused by chorion tear with an Ischemic Hypoxic Encephalopathy, who subsequently deveoped a digestive intolerance with abundant gastric residue. An incomplete intestinal occluson was assessed - possibly as a result of a duodenal stenosis - simple abdominal X - rays was performed, supporting clinical suspicion because of the presence of a typical image in "double bubble". An

Histologic Normalization Occurs in Ulcerative Colitis and Is Associated With Improved Clinical Outcomes.

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Christensen, Britt; Hanauer, Stephen B; Erlich, Jonathan; Kassim, Olufemi; Gibson, Peter R; Turner, Jerrold R; Hart, John; Rubin, David T

2017-10-01

Mucosal healing, determined by histologic analysis, is a potential therapeutic target for patients with ulcerative colitis (UC). However, the histologic features of tissue normalization, as an outcome of treatment, have not been well described. We examined the prevalence and predictive values of normalization of the colonic mucosa, based on histologic analysis (histologic normalization) in patients with UC, and determined its association with risk of clinical relapse, compared with histologic disease quiescence and endoscopic mucosal healing. We performed a retrospective study of 646 patients with confirmed UC who underwent colonoscopy at a tertiary medical center from August 2005 through October 2013. We reviewed reports from pathology analyses of random mucosal biopsies from each colon segment, and categorized them into 3 groups based on histology findings: (1) normalization (completely normal mucosa with no features of chronicity present), (2) quiescence (crypt atrophy or branching without signs of active inflammation including erosions, abscesses, or focal neutrophil infiltration), or (3) active disease (epithelial infiltration by neutrophils, crypt abscesses, erosions, or ulceration). Histology findings were compared with clinical and endoscopic findings. We assessed variables associated with histology findings and, in patients in clinical remission (Simple Clinical Colitis Activity Index score ≤2 and subscore of ≤1 for stool frequency or rectal bleeding), predictive values for clinical relapse at follow-up evaluations 6 months later or more were calculated. Of the 646 patients included in the study, 60% had endoscopic mucosal healing, 40% had histologic quiescence, and 10% had histologic normalization. The level of agreement between mucosal and histologic activity was moderate (agreement for 68% of samples; κ = 0.50; P normalization (P = .002). Of 310 patients in clinical remission at initial review, 25% had a clinical relapse, after a median time

CpG island methylator phenotype and its association with malignancy in sporadic duodenal adenomas.

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Sun, Lifeng; Guzzetta, Angela A; Fu, Tao; Chen, Jinming; Jeschke, Jana; Kwak, Ruby; Vatapalli, Rajita; Baylin, Stephen B; Iacobuzio-Donahue, Christine A; Wolfgang, Christopher L; Ahuja, Nita

2014-05-01

CpG island methylator phenotype (CIMP) has been found in multiple precancerous and cancerous lesions, including colorectal adenomas, colorectal cancers, and duodenal adenocarcinomas. There are no reports in the literature of a relationship between CIMP status and clinicopathologic features of sporadic duodenal adenomas. This study sought to elucidate the role of methylation in duodenal adenomas and correlate it with KRAS and BRAF mutations. CIMP+ (with more than 2 markers methylated) was seen in 33.3% of duodenal adenomas; 61% of these CIMP+ adenomas were CIMP-high (with more than 3 markers methylated). Furthermore, CIMP+ status significantly correlated with older age of patients, larger size and villous type of tumor, coexistent dysplasia and periampullary location. MLH1 methylation was seen in 11.1% of duodenal adenomas and was significantly associated with CIMP+ tumors, while p16 methylation was an infrequent event. KRAS mutations were frequent and seen in 26.3% of adenomas; however, no BRAF mutations were detected. Furthermore, CIMP-high status was associated with larger size and villous type of tumor and race (non-white). These results suggest that CIMP+ duodenal adenomas may have a higher risk for developing malignancy and may require more aggressive management and surveillance.

[Aseptic cutaneous breast abscesses associated with ulcerative colitis].

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Sallé de Chou, C; Ortonne, N; Hivelin, M; Wolkenstein, P; Chosidow, O; Valeyrie-Allanore, L

2016-02-01

Inflammatory bowel diseases are associated with a broad range of cutaneous lesions. Herein we report the first case of aseptic skin abscesses associated with ulcerative colitis. Since March 2008, a 40-year-old woman presented with bilateral mammary abscesses, relapsing despite repeated antibiotic treatment. She was followed for ulcerative colitis diagnosed in 2011 by means of a rectal biopsy. Despite four surgical procedures, there was no improvement in her mammary abscesses and bilateral mastectomy was then proposed because of the persistent symptoms. Her general state of health remained stable. Clinically, there were bilateral inflammatory nodes with fistulae and pus. These lesions were extremely painful. Mild inflammatory syndrome was noted, but the immunological tests revealed nothing of note. Bacteriological, parasitological and mycological tests on biopsy specimens were negative. Histological examination of a surgical biopsy revealed lymphoplasmacytic infiltration of the dermis and subcutis with altered polymorphonuclear cells and epithelioid granuloma. The CT-scan showed no other remote lesions. The final diagnosis was cutaneous aseptic abscess syndrome associated with ulcerative colitis. Colchicine 1mg/day was initiated and resulted in regression of the skin lesions, with complete remission at one year of follow-up. Aseptic abscess syndrome must be considered in the event of recurrent aseptic cutaneous abscesses which may be associated with inflammatory bowel disease. Surgery should be avoided and treatment should be based on suitable drug therapy. Copyright © 2016. Published by Elsevier Masson SAS.

Co-infection with Helicobacter pylori and Epstein-Barr virus in benign upper digestive diseases: An endoscopic and serologic pilot study.

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Buzás, György M; Konderák, Judith

2016-06-01

Some gastric cancers are Epstein-Barr virus associated. To assess the prevalence of Helicobacter pylori and viral co-infection in benign upper digestive diseases. One hundred and four outpatients were included in a prospective endoscopic-serologic study. Epstein-Barr virus immunoglobulin G (IgG), immunoglobulin M and viral capsid antigen titres were assayed with an ELISA test. Helicobacter pylori was determined by the modified Giemsa stain and by IgG-chemiluminescence. The overall prevalence of Helicobacter pylori was 56.7%. Duodenal ulcer patients were infected in 72.5 % of the cases, with the prevalence being 33.3% in functional dyspepsia (p = 0.0008) and 25.8% in reflux patients (p = 0.0001). Epstein-Barr virus IgG was detected in 70.1% of the whole group, 75% of duodenal ulcer patients, 51.2% of functional dyspepsia patients (p = 0.04) and 51.6% of the reflux disease cases (p = 0.04). Co-infection with both agents was detected in 60% of duodenal ulcer patients, 18.1% of functional dyspepsia (p = 0.00014) and 12.9% of reflux disease patients (p = 0.00012). Anti-viral IgG titre displayed a 31.7 ± 3.0 cut-off index in duodenal ulcer, 20.5 ± 3.5 in functional dyspepsia (p = 0.01) and 21.4 ± 3.6 in reflux cases (p = 0.03). Both Helicobacter pylori and Epstein-Barr virus, and co-infection with these agents, were significantly more prevalent in duodenal ulcer patients than in dyspeptic/reflux patients.

Single nucleotide polymorphisms of Helicobacter pylori dupA that lead to premature stop codons.

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Moura, Sílvia B; Costa, Rafaella F A; Anacleto, Charles; Rocha, Gifone A; Rocha, Andreia M C; Queiroz, Dulciene M M

2012-06-01

 The detection of the putative disease-specific Helicobacter pylori marker duodenal ulcer promoting gene A (dupA) is currently based on PCR detection of jhp0917 and jhp0918 that form the gene. However, mutations that lead to premature stop codons that split off the dupA leading to truncated products cannot be evaluated by PCR. We directly sequence the complete dupA of 75 dupA-positive strains of H. pylori isolated from patients with gastritis (n = 26), duodenal ulcer (n = 29), and gastric carcinoma (n = 20), to search for frame-shifting mutations that lead to stop codon. Thirty-four strains had single nucleotide mutations in dupA that lead to premature stop codon creating smaller products than the predicted 1839 bp product and, for this reason, were considered as dupA-negative. Intact dupA was more frequently observed in strains isolated from duodenal ulcer patients (65.5%) than in patients with gastritis only (46.2%) or with gastric carcinoma (50%). In logistic analysis, the presence of the intact dupA independently associated with duodenal ulcer (OR = 5.06; 95% CI = 1.22-20.96, p = .02).  We propose the primer walking methodology as a simple technique to sequence the gene. When we considered as dupA-positive only those strains that carry dupA gene without premature stop codons, the gene was associated with duodenal ulcer and, therefore, can be used as a marker for this disease in our population. © 2012 Blackwell Publishing Ltd.

Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice

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Marta Gravito-Soares

2016-05-01

Discussion: Groove pancreatitis is a benign cause of obstructive jaundice, whose main differential diagnosis is duodenal or pancreatic neoplasia. When this condition causes duodenal or biliary stricture, surgical treatment can be necessary.

Duodenal activation of cAMP-dependent protein kinase induces vagal afferent firing and lowers glucose production in rats.

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Rasmussen, Brittany A; Breen, Danna M; Luo, Ping; Cheung, Grace W C; Yang, Clair S; Sun, Biying; Kokorovic, Andrea; Rong, Weifang; Lam, Tony K T

2012-04-01

The duodenum senses nutrients to maintain energy and glucose homeostasis, but little is known about the signaling and neuronal mechanisms involved. We tested whether duodenal activation of adenosine 3',5'-cyclic monophosphate (cAMP)-dependent protein kinase A (PKA) is sufficient and necessary for cholecystokinin (CCK) signaling to trigger vagal afferent firing and regulate glucose production. In rats, we selectively activated duodenal PKA and evaluated changes in glucose kinetics during the pancreatic (basal insulin) pancreatic clamps and vagal afferent firing. The requirement of duodenal PKA signaling in glucose regulation was evaluated by inhibiting duodenal activation of PKA in the presence of infusion of the intraduodenal PKA agonist (Sp-cAMPS) or CCK1 receptor agonist (CCK-8). We also assessed the involvement of a neuronal network and the metabolic impact of duodenal PKA activation in rats placed on high-fat diets. Intraduodenal infusion of Sp-cAMPS activated duodenal PKA and lowered glucose production, in association with increased vagal afferent firing in control rats. The metabolic and neuronal effects of duodenal Sp-cAMPS were negated by coinfusion with either the PKA inhibitor H89 or Rp-CAMPS. The metabolic effect was also negated by coinfusion with tetracaine, molecular and pharmacologic inhibition of NR1-containing N-methyl-d-aspartate (NMDA) receptors within the dorsal vagal complex, or hepatic vagotomy in rats. Inhibition of duodenal PKA blocked the ability of duodenal CCK-8 to reduce glucose production in control rats, whereas duodenal Sp-cAMPS bypassed duodenal CCK resistance and activated duodenal PKA and lowered glucose production in rats on high-fat diets. We identified a neural glucoregulatory function of duodenal PKA signaling. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Upper gastrointestinal tract injuries by intraoperative radiotherapy for pancreatic cancer

Energy Technology Data Exchange (ETDEWEB)

Tabata, I; Isawa, T; Satomi, T; Tazima, T [Tokyo Metropolitan Komagome Hospital (Japan)

1981-08-01

Twenty-one patients with unresectable carcinoma of the pancreas were treated by intraoperative irradiation with a large electron dose of 1500 - 3000 rads and upper gastrointestinal complications were encountered in five cases. All of those five cases were for carcinoma of the pancreatic head, and were seen for gastrointestinal tract injuries of the duodenum as follows, gastric ulcer in 2 cases, ulcer of the 1st duodenal portion in one case and ulcer with severe stenosis of the 2nd or 3rd duodenal portion in one case, respectively. Endoscopic features of these postirradiation gastrointestinal ulcers were characterized by deep, punched-out ulcers with grayish bases and sharp margins. Clinically these ulcers and stenosis were very difficult to treat, so by-pass operations were performed in two cases, resulting in prolonged survival.

Duodenal endoscopic findings and histopathologic confirmation of intestinal lymphangiectasia in dogs.

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Larson, R N; Ginn, J A; Bell, C M; Davis, M J; Foy, D S

2012-01-01

The diagnosis of intestinal lymphangiectasia (IL) has been associated with characteristic duodenal mucosal changes. However, the sensitivity and specificity of the endoscopic duodenal mucosal appearance for the diagnosis of IL are not reported. To evaluate the utility of endoscopic images of the duodenum for diagnosis of IL. Endoscopic appearance of the duodenal mucosal might predict histopathologic diagnosis of IL with a high degree of sensitivity and specificity. 51 dogs that underwent upper gastrointestinal (GI) endoscopy and endoscopic biopsies. Retrospective review of images acquired during endoscopy. Dogs were included if adequate biopsies were obtained during upper GI endoscopy and digital images were saved during the procedure. Images were assessed for the presence and severity of IL. Using histopathology as the gold standard, the sensitivity and specificity of endoscopy for diagnosing IL were calculated. Intestinal lymphangiectasia (IL) was diagnosed in 25/51 dogs. Gross endoscopic appearance of the duodenal mucosa had a sensitivity and specificity (95% confidence interval) of 68% (46%, 84%) and 42% (24%, 63%), respectively for diagnosis of IL. Endoscopic images in cases with lymphopenia, hypocholesterolemia, and hypoalbuminemia had a sensitivity of 80%. Endoscopic duodenal mucosa appearance alone lacks specificity and has only a moderate sensitivity for diagnosis of IL. Evaluation of biomarkers associated with PLE improved the sensitivity; however, poor specificity for diagnosis of IL supports the need for histopathologic confirmation. Copyright © 2012 by the American College of Veterinary Internal Medicine.

Domperidone prolongs oral to duodenal transit time in video capsule endoscopy.

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Mcfarlane, Michael; Liu, B; Nwokolo, C

2018-04-01

Domperidone is thought to accelerate gastric emptying via D2 receptor antagonism at the gastro-oesophageal and gastro-duodenal junctions. Listed in the BNF as a prokinetic anti-emetic, it has been used in video capsule endoscopy (VCE) to accelerate capsule delivery to the small intestine. We audited VCEs performed at UHCW from 2011, when as standard practice, domperidone was given pre-VCE, to 2012, after its discontinuation due to doubts about its effectiveness. Thirty-one patients received oral domperidone 20 mg pre-VCE. Thirty-three patients underwent VCE without domperidone pre-treatment. After 2 h, if the capsule remained intra-gastric, gastroscopy-assisted duodenal delivery was performed. Data was analysed using Mann-Whitney testing. Median oro-duodenal transit was 13 and 30 min in the untreated and domperidone groups, respectively (p = 0.01). Median oro-caecal transit was 242 and 267 min in the untreated and domperidone groups, respectively (p = 0.02). No difference in duodenal-caecal transit was seen (p = 0.60). Six percent of untreated and 13% of domperidone VCEs required gastroscopy-assisted duodenal capsule delivery (p = 0.65). Unexpectedly domperidone delayed VCE gastric transit. Most studies on domperidone prokinetic effects have been in diabetic gastroparesis, demonstrating that domperidone can achieve good symptomatic relief, but with mixed results for gastric emptying. Our study suggests that any antiemetic effects of domperidone are not mediated through accelerated gastric transit.

Diabetic foot disease: impact of ulcer location on ulcer healing

DEFF Research Database (Denmark)

Pickwell, KM; Siersma, Volkert Dirk; Kars, M

2013-01-01

Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.......Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing....

Peptic Ulcers

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... people of any age — even kids — can develop ulcers. About Peptic Ulcers An ulcer is a sore, which means it's ... that most people can be cured. Causes of Peptic Ulcers in Kids Although stress and certain foods may ...

Systematic review and meta-analysis: the relationship between the Helicobacter pylori dupA gene and clinical outcomes

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Shiota Seiji

2010-10-01

Full Text Available Abstract Background In 2005, the first disease-specific Helicobacter pylori virulence factor that induced duodenal ulcer and had a suppressive action on gastric cancer has been identified, and was named duodenal ulcer promoting gene (dupA. However, the importance of the dupA gene on clinical outcomes is conflicting in subsequent studies. The aim of this study was to estimate the magnitude of the risk for clinical outcomes associated with dupA gene. Methods A meta-analysis of case-control studies which provided raw data on the infection rates with the dupA-positive H. pylori detected by polymerase chain reaction was performed. Results Seventeen studies with a total of 2,466 patients were identified in the search. Infection with the dupA-positive H. pylori increased the risk for duodenal ulcer by 1.41-fold (95% confidence interval [CI], 1.12-1.76 overall. Subgroup analysis showed that the summary odds ratio (OR was 1.57 (95% CI, 1.19-2.06 in Asian countries and 1.09 (95% CI, 0.73-1.62 in Western countries. There was no association between the presence of the dupA gene and gastric cancer and gastric ulcer. Publication bias did not exist. Conclusion Our meta-analysis confirmed the importance of the presence of the dupA gene for duodenal ulcer, especially in Asian countries.

Systematic review and meta-analysis: the relationship between the Helicobacter pylori dupA gene and clinical outcomes.

Science.gov (United States)

Shiota, Seiji; Matsunari, Osamu; Watada, Masahide; Hanada, Katsuhiro; Yamaoka, Yoshio

2010-10-31

In 2005, the first disease-specific Helicobacter pylori virulence factor that induced duodenal ulcer and had a suppressive action on gastric cancer has been identified, and was named duodenal ulcer promoting gene (dupA). However, the importance of the dupA gene on clinical outcomes is conflicting in subsequent studies. The aim of this study was to estimate the magnitude of the risk for clinical outcomes associated with dupA gene. A meta-analysis of case-control studies which provided raw data on the infection rates with the dupA-positive H. pylori detected by polymerase chain reaction was performed. Seventeen studies with a total of 2,466 patients were identified in the search. Infection with the dupA-positive H. pylori increased the risk for duodenal ulcer by 1.41-fold (95% confidence interval [CI], 1.12-1.76) overall. Subgroup analysis showed that the summary odds ratio (OR) was 1.57 (95% CI, 1.19-2.06) in Asian countries and 1.09 (95% CI, 0.73-1.62) in Western countries. There was no association between the presence of the dupA gene and gastric cancer and gastric ulcer. Publication bias did not exist. Our meta-analysis confirmed the importance of the presence of the dupA gene for duodenal ulcer, especially in Asian countries.

Involvement of the Helicobacter pylori plasticity region and cag pathogenicity island genes in the development of gastroduodenal diseases.