Perforated peptic ulcer disease in Zewditu Hospital

BACKGROUND

Peptic ulcer perforation is a serious complication of peptic ulcer disease with a significant morbidity and mortality.

OBJECTIVE

To evaluate 76 patients operated for peptic ulcer perforation and analyse the associated factors in Zewditu Memorial Hospital, Addis Ababa from September 2006 to August 2008.

PATIENTS AND METHODS

A retrospective analysis of medical records of 76 patients who were operated up on for perforated peptic ulcer over a two year period (2006-2008).

RESULTS

The male to female ratio was 6.6:1 with a mean age being 31.5 years. The most common presenting symptom was abdominal pain in 76 (100%) patients. History of smoking and khat chewing was documented in 53/64 (82.8%) and 48/64 (75%) of the patients respectively. Twenty five per cent of the patients gave no history of previous peptic ulcer disease. Seventy patients (92.1%) presented after 48 hours of their illness. The mean hospital stay was 14.5 days. Leucocytosis was found in 31.6% of the cases. Sixty five (85.5%) patients had duodenal ulcer perforation. Postoperative complications occurred in 24 (31.6%) patients. Twelve (15.8%) patients died in the hospital.

CONCLUSION

Early presentation of patients and change in life style may reduce morbidity and mortality in patients with peptic ulcer perforation.

[Use of the immunopotentiator N-acetyl-glucosamine-N-acetylmuramyl dipeptide during triple anti-Helicobacter pylori therapy]

AIM

To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosaminylmuramyldipeptide (Licopid JSC "Peptek", Russia).

SUBJECTS AND METHODS

Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1 +/- 13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (OCA7; n = 33); 2) the above drugs for 14 days (OCA14; n = 34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosaminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (OCA7L1; n = 34) and 4) the above drugs and L 0.01 g/day for 10 (OCA7L10; n = 27).

RESULTS

According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for OCA7; 82.4 and 93.3% for OCA14; 88.2 and 93.8% for OCA7L1; 88.9 and 96% for OCA7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for OCA7; 17.6% for OCA14 (5.9% stopped treatment); 5.9% for OCA7L1; 7.4% for OCA7L10. The cost of the treatment protocols was $ 32 for OCA7; $ 64 for OCA14; $ 40 for OCA7L1; $ 67 for OCA7L10. The intake of glucosaminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects.

CONCLUSION

H. pylori-positive patients with duodenal bulb ulcer should be given glucosaminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.

[Clinic pathogenetic features of gastroduodenal erosions and ulcers in patients with unstable stenocardia]

OBJECTIVE

To reveal the clinical, morphological and pathogenic features of gastroduodenal erosions and ulcers in unstable angina.

METHODS

135 patients with unstable angina were examined and divided into 2 groups, depending on the presence of a pathological process in the gastroduodenal zone. The state of microcirculation in the tissues of the gastroduodenal zone, secretory and motor function of the stomach were estimated by complex of techniques, adapted to the severity of the patients.

RESULTS

It is found that the pathological process in the gastroduodenal zone in patients with unstable angina was presented primarily by acute erosions, less - acute ulcers or recurrent peptic ulcer disease. In this case, the leading symptom of acute erosions was dyspepsia, that as a rule prevailed over the indistinct abdominal pain, and often disappeared in the first few days of treatment. Clinical picture of acute ulcers was determined by gastric dyspepsia and was often combined with abdominal pain and symptoms of gastrointestinal bleeding. The recurrence of peptic ulcer disease was characterized by the combination of moderate abdominal pain, often with migration in retrosternal and cardiac area and loss of circadian rhythm inherent in anthro-duodenal ulcer localization, and dyspeptic disorders. The severity of symptoms of ulcerous process was gradually decreased with time, but in most patients, they had remained by the end of the 2nd week of treatment. The basis of development of erosions and ulcers in unstable angina were the focal mainly thrombohaemorrhagic disorders of the terminal blood flow in the gastroduodenal mucosa. Its were combined with changes in the functional state of the stomach, manifested with an increase activity of acid-peptic factor, reduced production of gastromucoproteins, hypomotor dyskinesia and discoordination of anthro-duodenal propulsion on the hypotonic type.

CONCLUSION

Erosive and ulcerative lesions of gastroduodenal zone in unstable angina have a number of clinical and pathogenetic features that should be considered in the process of diagnosis and treatment.

Therapeutic attitude in perforated stress ulcer

There are medical conditions where the etiology is not at the level of digestive system, but as a result of a distant lesion, determined by head trauma. The latter is a severe impact on the whole body, not only locally; it produces damages in the gastro-duodenal area mainly as acute stress ulcer.

MATERIAL AND METHODS

Our study includes 4 cases of patients with multiple trauma, admitted in the "St. Pantelimon" Emergency Hospital, where, despite medication, they subsequently developed stress ulcer (Cushing ulcer). Laboratory tests were followed in the development the level of leukocytes, ESR(erythrocyte sedimentation rate) and abdominal ultrasound. Around the fifth day it was observed that the level of the leukocytes were high (between 15000-20000/microl).

RESULTS

ESR between 40-70mm/hour and ultrasound showed fluid in peritoneal cavity, mainly in subhepatic space (Morison's pouch). A positive radiological result highlight the crescent transparency (mesogastric pneumoperitoneum) in dorsal decubitus position, lateral incidence (pacients that could not be mobilised and the radiologic exam was made in intensive care bed). On the group of four patients studied with multiple trauma and Cushing ulcer perforation, it was laparoscopically intervined in order to reduce the negativ effects of combined anesthesic and surgical trauma on an already fragile status.

CONCLUSIONS

The study showed that emergency laparoscopy in patients with multiple trauma is a successful approach in it's minimally invasivity, being a diagnosis and therapeutic first option in acute abdominal conditions in these patients.

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

OBJECTIVE

Risk factors for hemorrhage due to gastric and/or duodenal ulcer in patients diagnosed by upper gastrointestinal (GI) endoscopy were investigated in the present study.

METHODS

Medical records of 350 patients (226 males, 124 females) diagnosed as duodenal or gastric ulcers by GI endoscopy in the gastroenterology clinic were scanned retrospectively. Upper GI hemorrhage was detected in 92 patients by upper endoscopic examination. The medical history of non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) usage and the presence of coronary artery disease (CAD) were investigated in all patients with or without hemorrhage. Results were evaluated by Chi-square test and logistic regression analysis.

RESULTS

The mean age of the patients was 50.4 ± 15.7 years (range: 25 to 82 years). Hemorrhage due to gastric or duodenal ulcer was identified in 92 patients (26%). Mean age was 64.6 ± 11.4 years in patients with hemorrhage and 45.7 ± 13.9 years in patients without hemorrhage. ASA usage was more common than NSAID in patients with ulcer hemorrhage (NSAID usage n=35 (40%); ASA usage n=51 (60%); p=0.035). Hemorrhage was reported in 20% of the females and in 28% of the males who have ulcer (p=0.055). Risk factors for hemorrhage were CAD (OR:24.75, 95% CI=1.6-96.7, p=0.001), ASA usage (OR:9.76, 95% CI=2.1-37.5, p=0.021), NSAID usage (OR: 4.72, 95%CI=1.1-16.5, p=0.032), age (OR: 11.59, 95% CI= 2.7-12.1, p=0.001), and male gender (OR: 2.56, 95% CI= 0.8, 9.6, p=0.052).

CONCLUSION

Advanced age, atherosclerosis, male gender and NSAID administration (particularly aspirin) are the major risk factors of upper GI hemorrhage in patients with gastric and/or duodenal ulcer.

[The role of capsule endoscopy in diagnosis of duodenal ulcer in patients with asthenia]

INTRODUCTION

One of the mayor lesion type in the small bowel (SB) is excavated (aphthae, erosion, ulcer) (EL). AIM OFSTUDY: To evaluate a possible correlation between EL in the SB, which were established using capsule endoscopy (CE).

METHODS

All our CE cases for the last 5 years were consecutively analyzed. Using the MST 3.0 classification, aphthae and erosions were consolidated into one group.

RESULTS

174 patients were enrolled in the study. Out of these, 100 (73%) had complaints on weakness. EL in the SB were found in 137 (78.7%) patients. Statistically significant interconnection was found between patients complaints on weakness and presence of EL in the SB (X = 4.882, p = 0.027).

CONCLUSIONS

Presence of EL in the SB is interconnected with patients' complaints on weakness.

[The new algorithm of diagnostics, prevention and treatment of acute erosive and ulcerative lesions of the gastrointestinal tract]

The work presents an analysis of treatment 745 patients with gastrointestinal bleeding from acute ulcers. Algorithm diagnosis and treatment of acute ulcers by different groups of patients. Treatment depends on the nature of secretory activity stomach bleeding risk of relapse and localization ulcers.

[Minimal resections in surgical treatment of perforative duodenal ulcers]

289 patients were operated on the reason of perforative duodenal ulcer. Omental tamponade of the ulcer after Oppel-Policarpov was performed in 260 (90%) cases; traditional ulcer closure with omental support - in 13 (4,5%); excision of the ulcer - in 4 (1,4%); truncal vagotomy and pyloroplasty - in 9 (3,1%) and gastric resection was performed in 3 (1%) patients. After 277 operations "of minimal volume" major complications were registered in 21 (7,6%) patients with lethal outcomes in 9 cases. All patients received adequate antiulcer drug treatment. Follow-up results, obtained in 153 patients, demonstrated good results of the operation and nonrecurrent course in 133 (86,9%) cases. The omental tamponade of the ulcer after Oppel-Policarpov proved to be the method of choice in treatment of the perforative duodenal ulcer. Early beginning of antiulcer conservative treatment after the operation provide excellent results and stable recovery.

[Duodenal involvement in Henoch-Schonlein purpura. Report of a case]

Henoch-Schonlein purpura (HSP) is a systemic vasculitis of the small vessels of the skin, joints, gastrointestinal tract and kidneys. It is the most common cause of nonthrombocytopenic purpura in children, but may also occur in adults. Gastrointestinal symptoms and disease occurs in up to 85% of patients and can be of varying intensity. We report a 12 year old boy with gastrointestinal bleeding due to duodenal involvement associated with this condition evidenced by endoscopy.

[Iron metabolism in elderly patients with ulcer disease]

We examined 72 elderly patients with ulcer disease at the age from 55 till 79 years. We studied an iron metabolism (haemoglobin, serum iron, serum ferritin) and its correlation with a clinical current of ulcer disease. It is established that the anemic syndrome is the frequent companion of ulcer disease in elderly and old patients. Deficiency of iron negatively influences on dynamic abdominal painful and dyspepsia syndromes, considerably aggravates clinical display of a cardiovascular pathology.

[Surgical treatment of post bulbar stenotic ulcers]

Treatment results of 214 patients with post bulbar duodenal stenosis were analyzed. Penetrative ulcer was diagnosed in 85.9%. Surgical treatment, and notably, selective proximal vagotomy with duodenoplasty and Roux-en-Y gastric resection are considered to be methods of choice. Selective proximal vagotomy with duodenoplasty provides the best long-term results and quality of life restoration.

[Experience in using immunal in the complex treatment of patients with torpid peptic ulcer]

AIM

to provide a rationale for the use of immunal in intractable gastroduodenal peptic ulcers (PU), by studying Helicobacter pylori genotypes and immunological parameters.

SUBJECTS AND METHODS

Sixty-eight patients (37 men and 31 women) with torpid PU were examined. A study group comprised 35 patients who took immunal as a component of complex eradication therapy; a control group included 33 patients who received complex eradication therapy only. In addition to clinical and endoscopic data, the values of H. pylori genotypes were used to evaluate therapeutic efficiency.

RESULTS

The inclusion of immunal into the complex therapy in patients with torpid PU exerts a significant clinical effect in relieving the pain syndrome and dyspeptic symptoms and in accelerating ulcer cicatrization. The disappearance of virulent H. pylori strains was noted during treatment. Recovery of phagocytic, cellular, and humoral immunities is an important result of therapy.

CONCLUSION

The use of immunal as a component of complex therapy for torpid PU is pathogenetically founded and clinically effective.

[Objective system of evaluating severity of illness in the choice of therapeutic strategy in aged and elderly patients]

Use of mark systems estimation MODS and APACHE II at patients of elderly and senile age with the complicated forms of a stomach ulcer allows objectively to judge weight of a condition of the patient risk of operative treatment and to estimate the probable forecast of disease and mortality.

[What duodenal ulcer bleeding should be considered recurrent? (with commentary)]

Treatment tactics of patients with duodenal ulcer bleeding were analyzed. Criteria of recurrent ulcer bleeding were defined. The importance of consideration of thrombocyte hemostasis component in treatment of such conditions was studied.

[Stubborn nausea and not ease vomiting as a manifestation of glycoside toxicity in a patient with duodenal ulcer and gastric erosions in the background of Ebstein's anomaly]

In this article is presented the case of development of glycoside intoxication at patient of 26 years old, who has congenital heart disease (Ebstein's anomaly). He also has duodenal ulcer and gastric erosions, associated with Helicobacter Pylori, that were diagnosed for the first time. The clinical observation reflects the necessity of differential diagnostics between glycoside intoxication and manifestation of duodenal ulcer.