Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study

PURPOSE

To investigate the outcomes of transcatheter arterial embolization (TAE) for the treatment of peptic ulcer bleeding (PUB).

MATERIALS AND METHODS

This is a retrospective, multicenter study, which investigated all patients who underwent TAE for the treatment of severe upper gastrointestinal hemorrhage from peptic ulcers in five European centers, between January 1, 2012 and May 1, 2017. All patients had undergone failed endoscopic hemostasis. Forty-four patients (male; mean age 74.0 ± 11.1 years, range 49-94), with bleeding from duodenum (36/44; 81.8%) or gastric ulcer (8/44; 18.2%) were followed up to 3.5 years (range 2-1354 days). In 42/44 cases, bleeding was confirmed by pre-procedural CT angiography. In 50% of the cases, coils were deployed, while in the remaining glue, microparticles, gel foam and combinations of the above were used. The study's outcome measures were 30-day survival technical success (occlusion of feeding vessel and/or no extravasation at completion DSA), overall survival, bleeding relapse and complication rates.

RESULTS

The technical success was 100%. The 30-day survival rate was 79.5% (35/44 cases). No patients died due to ongoing or recurrent hemorrhage. Re-bleeding occurred in 2/44 cases (4.5%) and was successfully managed with repeat TAE (one) or surgery (one). The rate of major complications was 4.5% (2/44; one acute pancreatitis and one partial pancreatic ischemia), successfully managed conservatively. According to Kaplan-Meier analysis survival was 71.9% at 3.5 years.

CONCLUSIONS

TAE for the treatment of PUB was technically successful in all cases and resulted in high clinical success rate. Minimal re-bleeding rates further highlight the utility of TAE as the second line treatment of choice, after failed endoscopy.

Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy

BACKGROUND

Proton pump inhibitors (PPIs) are now widely prescribed for the management of patients with acute upper gastrointestinal bleeding; although its optimal dose and route of administration has remained a controversial issue. The aim of this study was to assess the clinical effectiveness of high dose oral versus intravenous (IV) PPI after successful endoscopic therapy in patients with bleeding peptic ulcer disease.

METHODS

178 patients with active upper gastrointestinal bleeding due to a peptic ulcer with stigmata of high risk for re-bleeding entered the study. After successful endoscopic hemostasis, they were randomized to receive either high dose oral pantoprazole (80 mg stat and 80 mg twice daily for 3 days) or high dose intravenous pantoprazole (80 mg IV infusion within 30 minutes and 8 mg per hour for 3 days). After the 3rd day, the patients in both groups received oral pantoprazole 40 mg twice daily for one month. The end points were comparing the rate of re-bleeding or mortality, and the need for blood transfusion or surgery during the first month between the two groups.

RESULTS

There were not significant statistical differences between the two groups in the volume of blood transfusion, mean duration of hospital stay, need to surgery, or mortality rates. However, the rates of re-bleeding were 2.3% (2:88) in the IV group and 3.3% (3:90) in the oral group (p = 0.6).

CONCLUSION

According to our findings, it seems that high dose oral PPI can be a good alternative to high dose IV PPI in patients with bleeding peptic ulcer who are at high risk of re-bleeding. Due to the lower cost and the availability of oral PPIs, their use can be economically much more affordable.

Endotherapy of Peptic Ulcer Bleeding

Peptic ulcer bleeding is common and associated with significant morbidity and mortality. We discuss the endoscopic assessment of peptic ulcers and the rationale for treatment. We also review the evidence for the available endoscopic therapies, both individually and in combination, to draw conclusions on the optimum endoscopic management of peptic ulcer bleeding.

Effect of Banxia Xiexin decoction on Helicobacter pylori-related peptic ulcers and its possible mechanism via the TGF-β/Smad signaling pathway

OBJECTIVE

To investigate the effect of Banxia Xiexin decoction (BXD) on Helicobacter pylori (Hp)-related peptic ulcers (PUs) and the possible mechanism underlying BXD actions via the transforming growth factor-¦Â/small mothers against decapentaplegic (TGF-β/Smad) signaling pathway.

METHODS

PU patients with cold-heat complex syndrome were randomly assigned to groups that received Chinese or Western medicines with 20 patients in each group. Serum was collected after 7 d of treatment. The healthy group included 20 individuals. Gastric mucosal epithelial cell line GES-1 was cultured in vitro and randomly divided into the following seven groups: control, model, healthy, Western Medicine, prior treatment, low dosage, and high dosage. After 72 h of treatment with the corresponding serum, the mRNA and protein expression levels of TGF-β1, Smad3, and Smad7 were measured by reverse transcription quantitative polymerase chain reaction and western blotting, respectively.

RESULTS

The mRNA expression levels of TGF-β1 and Smad3 in GES-1 cells were increased after Hp introduction, and these increased levels were reduced by the BXD-containing serum. The protein levels of p-Smad3, but not TGF-β1 or Smad3, were significantly increased in Hp-treated GES-1 cells, and treatment with the BXD-containing serum markedly decreased the protein levels. Smad7 expression was significantly enhanced following treatment with the BXD-containing serum at transcriptional and protein levels in a dose-dependent manner.

CONCLUSION

BXD regulates the TGF-β/Smad signaling pathway by inhibiting the expression of TGF-β1 and Smad3, and increasing the expression of Smad7.

Gastroprotective and antioxidant effects of fluvoxamine on stress-induced peptic ulcer in rats

Objectives

Stress-induced peptic ulcer disease (SPUD) refers to erosions in the mucosa of the upper gastrointestinal tract that are caused by stress. Some antidepressants are reported to have antioxidant and antiulcer effects. However, histopathological and biochemical evaluation of the anti-ulcer activity of a comparable antidepressant, fluvoxamine, has not been adequately investigated. This study aims to determine the anti-ulcer efficacy of fluvoxamine in reducing stress-induced histopathological and biochemical changes in the gastric mucosa.

Methods

Thirty adult male albino rats were divided into three groups of 10 rats each: the control groups, the SPUD group, and the fluvoxamine-pre-treated group, which received fluvoxamine for eight days before stress exposure. The cold-restraint stress method was used to induce stomach ulcers in the SPUD and fluvoxamine groups. Afterward, the stomachs of rats were removed, opened, and ulcer indices were calculated. Light microscopy was performed following haematoxylin and eosin staining, periodic acid Schiff's, Masson's trichrome staining, and proliferating cell nuclear antigen immunostaining. Gastric tissue levels of oxidative stress markers were measured and compared among groups.

Results

The stomachs of the fluvoxamine-treated rats showed a significantly lower number of ulcers with minimal mucosal injury compared with those of rats from the SPUD group. The oxidative stress marker levels and SPUD ulcer indices were significantly different among groups.

Conclusion

Fluvoxamine pre-treatment exerted a gastroprotective effect against ulcer development and promoted healing of the developed lesions.

The Effect of H2 Receptor Antagonist in Acid Inhibition and Its Clinical Efficacy

The first histamine H₂ receptor antagonists (H₂RAs) were developed in the early 1970s. They played a dominant role in treating peptic ulcer disease and gastroesophageal reflux disease (GERD). H₂RAs block the production of acid by H⁺, K⁺-ATPase at the parietal cells and produce gastric luminal anacidity for varying periods. H₂RAs are highly selective, and they do not affect H1 receptors. Moreover, they are not anticholinergic agents. Sequential development of H₂RAs, proton pump inhibitors (PPIs), and discovery of Helicobacter pylori infection changed the paradigm of peptic ulcer disease with marked decrease of morbidity and mortality. PPIs are known to be the most effective drugs that are currently available for suppressing gastric acid secretion. Many studies have shown its superiority over H₂RAs as a treatment for acid-related disorders, such as peptic ulcer disease, GERD, and Zollinger-Ellison syndrome. However, other studies have reported that PPIs may not be able to render stomach achlorhydric and have identified a phenomenon of increasing gastric acidity at night in individuals receiving a PPI twice daily. These nocturnal acid breakthrough episodes can be eliminated with an addition of H₂RAs at night. The effectiveness of nighttime dose of H₂RA suggests a major role of histamine in nocturnal acid secretion. H₂RAs reduce secretion of gastric acid, and each H₂RA also has specific effects. For instance, nizitidine alleviates not only symptoms of GERD, but also provokes gastric emptying, resulting in clinical symptom improvement of functional dyspepsia. The aim of this paper was to review the characteristics and role of H₂RAs and assess the future strategy and treatment of upper gastrointestinal disease, including acid related disorders.

The Impacts of Peptic Ulcer on Stroke Recurrence

BACKGROUND

Peptic ulcer has been associated with an increased risk of stroke. This study aimed to evaluate the impacts of peptic ulcer on stroke recurrence and mortality.

SUBJECTS AND METHODS

Patients with first-ever ischemic stroke were retrospectively confirmed with or without a history of peptic ulcer. The primary end point was defined as fatal and nonfatal stroke recurrence. Risks of 1-year fatal and nonfatal stroke recurrence were analyzed with the Kaplan-Meier method. Predictors of fatal and nonfatal stroke recurrence were evaluated with the Cox proportional hazards model.

RESULTS

Among the 2577 enrolled patients with ischemic stroke, 129 (5.0%) had a history of peptic ulcer. The fatal and nonfatal stroke recurrence within 1 year of the index stroke was higher in patients with peptic ulcer than in patients without peptic ulcer (12.4% versus 7.2%, P = .030). Cox proportional hazards model detected that age (hazard ratio [HR] = 1.018, 95% confidence interval [CI] 1.005-1.031, P = .008), hypertension (HR = 1.397, 95% CI 1.017-1.918, P = .039), and history of peptic ulcer (HR = 1.853, 95% CI 1.111-3.091, P = .018) were associated with stroke recurrence.

CONCLUSIONS

Ischemic stroke patients with peptic ulcer may have an increased risk of stroke recurrence. The results emphasize the importance of appropriate prevention and management of peptic ulcer for secondary stroke prevention.

Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation

BACKGROUND

Laparoscopic primary repair is one of the main procedures used for perforated gastric ulcers, and this technique requires reproducible and secure suturing. The aim of this study was to investigate the safety and efficacy of a novel continuous suture method with barbed sutures during laparoscopic repair for perforated peptic ulcers.

PATIENTS AND METHODS

Clinical data from 116 consecutive patients undergoing laparoscopic repair for perforated peptic ulcers were collected between November 2009 and October 2015. Continuous suturing with 15-cm-long unidirectional absorbable barbed sutures was used for laparoscopic repair in the study group, termed group V (n = 51). Patients who underwent laparoscopic repair with conventional interrupted sutures were defined as group C (n = 65). The complication and operative data were compared between groups.

RESULTS

Although there was no difference between group V and group C in the overall complication rate (15.7% vs. 24.6%; p = 0.259), the complication rate related to suturing was lower (3.9% vs. 15.4%; p = 0.04) in group V. Group V showed rates of 0% for leakage, 2% for intra-abdominal fluid collection, and 2% for stricture; the corresponding rates in group C were 3.1, 7.7, and 4.6%, respectively. Regarding operative data, the total operation time (V vs. C, 87.7 min vs. 131.2 min), total suture time (7.1 min vs. 25.3 min), and suture time per stitch (1.2 min vs. 6.2 min) were significantly shorter in group V than in group C (p < 0.001).

CONCLUSION

The use of a continuous suture technique with unidirectional barbed sutures is as safe as the conventional suture technique and allows easier and faster suturing in the repair of perforated peptic ulcers.

Clinical effects of evidence-based nursing care in elderly patients with type 2 diabetes and peptic ulcer

AIM

To evaluate the clinical effects of evidence-based nursing in elderly patients with type 2 diabetes and peptic ulcer and utilize evidence-based methods to improve their quality of life.

METHODS

One hundred and thirty elderly patients with type 2 diabetes with peptic ulcer treated from August 2014 to August 2016 were divided into either a control group (n = 65) or an observation group (n = 65). The control group was given traditional nursing, and the observation group was given evidence-based nursing care. The levels of blood sugar, therapeutic effect for peptic ulcer, quality of life, and nursing satisfaction were compared between the two groups.

RESULTS

The levels of fasting blood glucose, postprandial sugar, and glycosylated hemoglobin were significantly lower in the observation group than in the control group (6.15 mmol/L ± 0.92 mmol/L vs 6.92 mmol/L ± 1.07 mmol/L, 8.21 mmol/L ± 1.39 mmol/L vs 9.82 mmol/L ± 1.51 mmol/L, and 6.65% ± 1.01% vs 7.86% ± 1.16%, P < 0.05). The cure rate and improvement rate for peptic ulcer were significantly higher in the observation group than in the control group (58.46% vs 38.46%, P < 0.05). The length of hospitalization was significantly shorter in the observation group than in the control group (19.61 d ± 5.32 d vs 23.65 d ± 6.18 d, P < 0.05). The scores of daily activities, sleep quality, mental outlook, appetite, and disease cognition in the observation group were significantly higher than those in the control group (P < 0.05). The rate of satisfaction with nursing was significantly higher in the observation group than in the control group (93.85% vs 70.77%, P < 0.05).

CONCLUSION

Evidence-based nursing care has significant clinical effects in elderly patients with type 2 diabetes with peptic ulcer and is worthy of recommendation.

Amaranth oil reduces accumulation of 4-hydroxynonenal-histidine adducts in gastric mucosa and improves heart rate variability in duodenal peptic ulcer patients undergoing Helicobacter pylori eradication

Helicobacter pylori-induced oxidative stress in gastric mucosa (GM) is a milieu for the development of chronic gastritis, duodenal peptic ulcer (DPU), gastric cancer, and a number of extragastric diseases. Because our previous study revealed the accumulation of the protein adducts of lipid peroxidation product 4-hydroxynonenal (HNE) in GM, which persists after eradication of H. pylori, the aim of the study was to test whether Amaranth oil supplementation in addition to standard anti-Helicobacter treatment could prevent such accumulation of HNE in GM in H. pylori-positive DPU patients. Seventy-five patients were randomly split into two groups: group 1 - standard treatment (n = 39) and group 2 - standard treatment with additional supplementation of 1 ml of concentrated oil from amaranth seeds (Amaranthus cruenthus L., n = 36). Clinical analysis, including endoscopy with biopsies from antrum and corpus of the stomach were performed before and after the treatment, as was heart rate variability (HRV) recorded, as parameter of systemic, extragastric pathophysiological alterations in DPU patients. Improvement of clinical, endoscopic and histologic manifestations, and successful ulcer healing were observed in both the groups. Moreover, supplementation of amaranth oil in addition to standard anti-H. pylori treatment significantly reduced accumulation of HNE-histidine adducts in GM and increased HRV in DPU patients (p < .05). Therefore, standard treatments of DPU require additional therapeutic approaches, in accordance with integrative medicine principles, aiming to reduce persistence of oxidative stress, as was successfully done in our study by the use of amaranth oil.

Endoscopically guided titanium clip therapy and adrenaline injection for treatment of patients with peptic ulcer bleeding: Clinical efficacy and impact on serum inflammatory cytokines

AIM

To evaluate the clinical efficacy of endoscopically guided titanium clip therapy and adrenaline injection in the treatment of patients with peptic ulcer bleeding and the impact on serum inflammatory cytokines.

METHODS

One hundred and thirty-two patients with peptic ulcer bleeding treated from January 2015 to December 2016 were divided into either an observation group or a control group. The control group was given endoscopically guided titanium clip therapy, and the observation group was given endoscopically guided titanium clip therapy and adrenaline injection. Therapeutic indicators, serum inflammatory cytokines, adverse reactions, and clinical efficacy were compared between the two groups.

RESULTS

The effective rate was significantly higher in the observation group than in the control group (98.48% vs 89.39%, χ² = 4.790, P < 0.05). Time to achieve hemostasis, blood loss, amount of blood transfusion, and hospital stay were significantly lower in the observation group than in the control group (t = 6.842, 5.384, 6.772, and 9.407, respectively, P < 0.05 or 0.01). Serum levels of interleukin (IL)-6 and C-reaction protein were significantly lower and that of IL-10 was significantly higher in the observation group than in the control group (t = 7.545, 6.071, and 8.919, respectively, P < 0.05 or 0.01). The rates of perforation, infection, and rebleeding were significantly lower in the observation group than in the control group (3.03% vs 12.12%, 6.06% vs 18.18%, and 1.52% vs 10.61%; χ² = 3.895, 4.552, and 4.790, respectively; P < 0.05).

CONCLUSION

Endoscopically guided titanium clip therapy and adrenaline injection can improve the therapeutic effect in patients with peptic ulcer bleeding and reduce adverse reactions, which may be related to the alleviation of the inflammatory state.

Endoscopic injection of desmopressin combined with hemostatic titanium therapy for treatment of elderly patients with acute peptic ulcer bleeding

AIM

To evaluate the value of endoscopic injection of desmopressin combined with titanium clip therapy in the treatment of elderly patients with acute peptic ulcer bleeding.

METHODS

Two hundred and twenty elderly patients with acute peptic ulcer bleeding treated at our hospital from May 2012 to May 2017 were divided into either an observation group or a control group (n = 110 each). The observation group underwent endoscopic injection of desmopressin combined with titanium clip therapy, and the control group underwent endoscopic injection of epinephrine combined with titanium clip therapy. Clinical efficacy, cardiovascular adverse reactions, and other indicators were compared between the two groups.

RESULTS

There was no significant difference between the control group and the observation group in the time to achieve hemostasis (12.9 h ± 1.3 h vs 13.1 h ± 1.5 h), the amount of blood transfusion (1250 mL ± 210 mL vs 1190 mL ± 220), the percentage of cases undergoing transhepatic operation (2.72% vs 2.72%), or the percentage of cases developing rebleeding within 1 wk (3.63% vs 4.55%) (P > 0.05). The total effective rate was comparable between the observation group and the control group (94.55% vs 93.64%, P > 0.05). The incidence of cardiovascular adverse events was significantly lower in the observation group than in the control group (1.82% vs 14.55%, P < 0.05).

CONCLUSION

For elderly patients with acute peptic ulcer bleeding, endoscopic injection of desmopressin can reduce the incidence of cardiovascular adverse reactions.

Marzulene-S combined with standard triple therapy for treatment of children with Helicobacter pylori positive peptic ulcer: Efficacy and influence on serum pepsinogen and gastrointestinal hormones

AIM

To evaluate the efficacy of marzulene-S combined with standard triple therapy in the treatment of children with Helicobacter pylori (H. pylori) positive peptic ulcer (PU), and to observe the effect on serum pepsinogen (PG) and gastrointestinal hormones.

METHODS

A total of 144 children with H. pylori positive PU were randomly divided into either an observation group or a control group, with 72 cases in each group. Both groups were treated with standard triple therapy (omeprazole + clarithromycin + amoxicillin), and the observation group was additionally given marzulene-S. The clinical efficacy, eradication rate of H. pylori and adverse drug reaction rate were compared between the two groups. Serum levels of PG Ⅰ, PG Ⅱ, gastrin (GAS), and somatostatin (SS) were measured in all patients before and after treatment, and the results were compared with those of 30 healthy children who received physical examination at our hospital.

RESULTS

The total effective rate was significantly higher in the observation group than in the control group (97.22% vs 84.72%, P < 0.05). Compared with the healthy control group, serum levels of PG Ⅰ, PG Ⅱ, and SS were significantly higher, and that of SS was significantly lower in the two patient groups before treatment (P < 0.05). Serum levels of PG Ⅰ, PG Ⅱ, and SS significantly decreased, and that of SS significantly increased in the two patient groups after treatment compared with pretreatment levels (P < 0.05). Compared with the control group, serum levels of PG Ⅰ, PG Ⅱ, and SS were significantly lower, and that of SS was significantly higher in the observation group after treatment (P < 0.05). The incidence of adverse drug reactions was 4.17% in the observation group and 6.94% in the control group, which showed no statistical difference (P > 0.05).

CONCLUSION

Marzulene-S combined with standard triple therapy can regulate serum levels of PG and gastrointestinal hormones in children with H. pylori positive PU, improve the clinical curative effects, and has few adverse drug reactions.

Cost-effectiveness of omeprazole based triple therapy vs sequential therapy for elderly patients with Helicobacter pylori positive peptic ulcer

AIM

To compare the cost-effectiveness (C/E) of omeprazole based triple therapy vs sequential therapy for patients with Helicobacter pylori (H. pylori) positive peptic ulcer, in order to provide reference for clinical selection of effective, safe, and economical therapy regimen.

METHODS

One hundred and twenty-eight elderly patients with H. pylori positive peptic ulcer treated from July 2015 to December 2016 at Zhoushan Hospital were divided into an observation group and a control group. The control group was given 10 d omeprazole based triple therapy, and the observation group was given 10 d omeprazole based sequential therapy. Clinical efficacy, adverse reactions, and C/E were compared between the two groups.

RESULTS

The ulcer healing rate and H. pylori eradication rate were significantly higher in the observation group than in the control group (96.88% vs 78.13%, χ² = 10.286, P < 0.05; 92.19% vs 75.00%, χ² = 6.893, P < 0.01). The rate of adverse reactions was significantly lower in the observation group than in the control group (7.81% vs 20.31%, χ² = 4.137, P < 0.05). The C/E of ulcer healing rate and H. pylori eradication rate was significantly lower in the observation group than in the control group (2.27 vs 5.03, 2.39 vs 5.24). For every one percentage point increase in the ulcer healing rate and H. pylori eradication rate, the observation group would save 9.23 yuan and 10.07 yuan, respectively, compared with the control group.

CONCLUSION

Omeprazole based triple sequential therapy can eradicate H. pylori infection, promote ulcer healing, and reduce adverse reactions, and has better C/E.

Influence of working in auto factory on gastroesophageal reflux disease

AIM

Present study aimed to evaluate association between job -related factors and gastroesophageal reflux disease (GERD) among Iranian auto factory's workers.

BACKGROUND

Many of the gastrointestinal disorders may be caused as the result of stress-related occupations and biorhythm disruption.

METHODS

We performed a cross-sectional study on 3590 Iranian Auto factory employees. GERD symptoms, demographic information, work shift, work section and history of some gastrointestinal disease were asked from all employees by physician. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for GERD symptoms according to the potential risk factors.

RESULTS

The prevalence of GERD was 25.57%, which was higher in rotatory shift (91.6%) than the fixed shift (8.4%) (P-value = 0.009). Smoking (OR: 1.31; 95% CI: (1.09, 1.57)), working in official section (P-value < 0.001), history of GERD (OR: 8.63; 95 % CI (6.53, 11.40)), history of peptic ulcer (OR: 2.96; 95 % CI (2.08, 4.20)), family history of gastrointestinal cancers (OR: 1.47; 95 % CI (1.19, 1.81)) were the factors associated with GERD symptoms.

CONCLUSION

The prevalence of GERD in the rotatory shift was more than the fixed shift. Smoking, family history of gastrointestinal cancers and peptic ulcer could be associated with GERD symptoms. Working in the special job with high activity, may probably lead to decrease in the risk of reflux.

TLR2 Arg677Trp but not TLR2 -196 to -174 ins/del and Arg753Gln polymorphism alter the risk of peptic ulcer in north of Iran

BACKGROUND

Most polymorphisms that occur in TLR-2 are associated with gastrointestinal disorders such as peptic ulcer disease (PUD). Hence, in current study, association between TLR2-196 to -174 ins/del, Arg753Gln and Arg677Trp polymorphisms and risk of PUD development in north of Iran was evaluated.

METHODS

This case-control study included 50 patients with PUD as cases and 50 people without peptic ulcer as control group. Blood and endoscopic biopsies were collected. Helicobacter pylori infection was screened by rapid urease test, specific IgG measurement and specific PCR for glmM gene. Then, TLR2-196 to -174 ins/del polymorphism was assessed by using allele-specific PCR. The Arg753Gln and Arg677Trp polymorphism in TLR2 gene were analyzed by the PCR-restriction fragment length polymorphism (RFLP).

RESULTS

There was no significant difference in the allele and genotype frequencies of polymorphisms in the TLR2-196 to -174 ins/ins and Arg753Gln genes between controls and patients, respectively. However, an association with increased risk for PUD was observed for polymorphism TLR-2 Arg677Trp (odds ratio [OR] = 7.9; 95% confidence interval [CI] = 0.94-67.5). Further analysis showed that H. pylori infection was associated with a significant difference in genotype and allele frequencies of TLR2-196 to -174 ins/ins and Arg753Gln polymorphism, respectively. Furthermore, there was no association between variant haplotypes and PUD development in H. pylori infected subjects. However, no association was detected between gender and genotypic frequencies of all polymorphisms in TLR2.

CONCLUSION

Our findings showed that TLR2 Arg677Trp polymorphism and H. pylori infection may play crucial roles in peptic ulcer development respectively in north of Iran.

Clinical application of dynamic electrocardiogram in patients with peptic ulcer: Impact of systematic nursing intervention

AIM

To explore the clinical significance of dynamic electrocardiogram (ECG) heart rate variability in patients with peptic ulcer (PU) and the effect of systematic nursing intervention on dynamic ECG.

METHODS

One hundred and twenty-eight subjects were enrolled at the Second Hospital of Tianjin Medical University from July 2016 to July 2017, including 64 patients with PU (experimental group) and 64 healthy volunteers (control group). The control group was given conventional nursing, and the experimental group was given systematic nursing intervention. All subjects underwent dynamic ECG monitoring. The time domain index and frequency index of heart rate variability were statistically analyzed. The incidence of ECG artefacts and patient satisfaction were also analyzed.

RESULTS

The standard deviation of NN intervals, standard deviation of average NN intervals, and low frequency (LF) were lower in the experimental group than in the control group (124.5 ms ± 8.3 ms vs 130.3 ms ± 7.2 ms, 109.2 ms ± 7.4 ms vs 128.4 ms ± 8.9 ms, 122.4 ms/Hz ± 9.5 ms/Hz vs 136.3 ms ± 10.6 ms), but the differences were not significant (P > 0.05). The root mean square of successive differences, the proportion derived by dividing NN50 by the total number of NN intervals, high frequency (HF), and LF/HF, which reflect changes in parasympathetic tone, differed significantly between the experimental group and the control group (45.8 ms ± 8.7 ms vs 25.8 ms ± 12.3 ms, 13.5 ± 4.9 vs 10.9 ± 4.3, 93.5 ms/Hz ± 8.3 ms/Hz vs 71.3 ms/Hz ± 9.5 ms/Hz, 0.7 ± 1.4 vs 1.6 ± 3.1, P < 0.05). The incidence of ECG artefacts was significantly lower in the experimental group than in the control group (P < 0.05), while the rate of satisfaction to nursing was significantly higher in the experimental group (90.6% vs 60.9%, P < 0.05).

CONCLUSION

Systematic care intervention can reduce the incidence of ECG artefacts, improve patient satisfaction, and ensure the accuracy and effectiveness of dynamic ECG monitoring.

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

Background

Peptic ulcer disease is a multifactorial health problem, and its prevalence and risk factors have changed considerably within the past century.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Critical Evaluation of Animal Models of Gastrointestinal Disorders

Preclinical research remains an important tool for discovery and validation of novel therapeutics for gastrointestinal disorders. While in vitro assays can be used to verify receptor-ligand interactions and test for structural activity of new compounds, only whole-animal studies can demonstrate drug efficacy within the gastrointestinal system. Most major gastrointestinal disorders have been modeled in animals; however the translational relevance of each model is not equal. The purpose of this chapter is to provide a critical evaluation of common animal models that are being used to develop pharmaceuticals for gastrointestinal disorders. For brevity, the models are presented for upper gastrointestinal disorders involving the esophagus, stomach, and small intestine and lower gastrointestinal disorders that focus on the colon. Particular emphasis is used to explain the face and construct validity of each model, and the limitations of each model, including data interpretation, are highlighted. This chapter does not evaluate models that rely on surgical or other non-pharmacological interventions for treatment.

Gastric perforation into the pericardium

Gastric perforation into the pericardium is an extremely rare but lethal condition. Only a few case reports have been described in the literature. It is difficult to diagnose these patients with clinical evaluation. Accurate and immediate diagnosis of the intestinal perforation is vital. Herein, we present a 56-year old female patient with gastric perforation into the pericardium due to benign gastric ulcer diagnosed with computed tomography (CT). We also emphasized the imaging findings in the diagnosis of intestinal perforation into the pericardium.

Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort

OBJECTIVE

To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades.

MATERIALS AND METHODS

A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry.

RESULTS

Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers.

CONCLUSIONS

A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.

Gastrocolic Fistula Presented as an Early Complication of Gastric Surgery in a 42-year-old Man

Currently, surgery is less needed for the treatment of refractory peptic ulcer disease (PUD) or its complications. So, the complications of PUD surgery have been clearly declined. Here in, we present a 42-year-old man with chronic watery diarrhea and significant weight loss during 2 years after gastrojejunostomy for the treatment of obstructive PUD. Small bowel gastrointestinal series showed rapid transit without passage of contrast in the parts of small bowel. The patient was scheduled for exploratory laparotomy. During the surgery a large fistula was detected between the stomach and transverse colon, which was repaired. At the follow-up 6 months after the surgery, the patient did not have any history of recurrence of diarrhea and had 10 kg weight gain. Gastrocolic fistula is a very rare complication of surgical management of PUD. Barium enema is the most helpful imaging procedure for the diagnosis of gastrocolic fistula and surgery after correction of nutritional status is suggested especially for malnourished patients.

Effect of evidence-based nursing care on treatment compliance and quality of life in elderly patients with peptic ulcer

AIM

To observe the effect of evidence-based nursing care on treatment compliance and quality of life in elderly patients with peptic ulcer.

METHODS

Two hundred and twenty-eight elderly patients with peptic ulcer admitted from February 2015 to July 2016 were randomly divided into a control group (n = 114) and an observation group (n = 114). Both groups were given conventional nursing care. The observation group was additionally given evidence-based nursing care. Treatment compliance was assessed with regard to behavior, exercise, diet and medication. The World Health Organization quality of life questionnaire was used to assess the patient's quality of life. The nursing effect, treatment compliance, and quality of life were compared between the two groups.

RESULTS

There were no statistically significant differences in treatment compliance in both groups between before and after nursing (P > 0.05). However, the compliance with regard to behavior, exercise, diet, and medication in the observation group was better than that in the control group (P < 0.05). The scores of quality of life in the observation group were higher than those in the control group (P < 0.05).

CONCLUSION

Evidence-based nursing care combined with conventional nursing can improve treatment compliance and quality of life in elderly patients with peptic ulcer.

Gastrointestinal Bleeding and Management

There is a broad clinical spectrum of gastrointestinal bleeding in children, ranging from subtle laboratory findings to dramatic clinical presentations. This review provides a framework for the evaluation and management of gastrointestinal hemorrhage for pediatricians. It outlines strategies for obtaining a tailored patient history and conducting a thorough physical examination that can shed light on the location, severity, and likely etiology of bleeding. It appraises blood tests, radiologic tools, and endoscopic modalities frequently used to identify and control a source of bleeding.

Diagnostic value of serum pepsinogen and anti-Helicobacter pylori IgG levels in patients with peptic ulcer

AIM

To evaluate the diagnostic value of serum pepsinogen (PG) and anti-Helicobacter pylori (H. pylori) immunoglobulin G (IgG) levels in patients with peptic ulcer.

METHODS

Two hundred and fifty patients with peptic ulcer treated at Baodi Clinical College of Medical University of Tianjin from January 2015 to July 2016 were included as an observation group, and 250 healthy volunteers were used as controls. Serum PG levels were determined by chemiluminescence microparticle immuno assay, and anti-H. pylori IgG levels were detected by enzyme linked immunosorbent assay. The diagnostic value of PG and anti-H. pylori levels in peptic ulcer were then analyzed.

RESULTS

Serum pepsinogen Ⅰ(PGⅠ) and pepsinogen Ⅱ (PGⅡ) levels and PGⅠ/ PGⅡ ratio (PGR) were significantly higher in the observation group than in the control group (P < 0.05). Of 50 patients in the observation group, 31 were H. pylori positive and 19 were H. pylori negative. Serum PGⅠ and PGⅡ levels and PGR were significantly higher in H. pylori positive patients than in H. pylori negative ones (P < 0.05). Combined detection of PGⅠ, PGⅡ and PGR had a higher sensitivity and specificity in diagnosing peptic ulcer than in detection any one of the three indexes alone (P < 0.05).

CONCLUSION

Serum PG and anti-H. pylori IgG levels can be used for early screening of peptic ulcer.