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Soldner T, Bakke K, Savage S. Surgical Management of Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2024; 34:301-316. [PMID: 38395485 DOI: 10.1016/j.giec.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
The use of surgery in managing upper gastrointestinal (GI) bleeding has rapidly diminished secondary to advances in our understanding of the pathologies that underlie upper GI bleeding, pharmaceutical treatments for peptic ulcer disease, and endoscopic procedures used to gain hemostasis. A surgeon must work collaboratively with gastroenterologist and interventional radiologist to determine when, and what kind of, surgery is appropriate for the patient with upper GI bleeding.
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Affiliation(s)
- Teresa Soldner
- Acute Care and Regional General Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Katherine Bakke
- Acute Care and Regional General Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Stephanie Savage
- Acute Care and Regional General Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Zhang S, Zhang J, Zhao Y. Effect of health nursing intervention on quality of life and complications of peptic ulcer patients on the basis of traditional Chinese medicine constitution identification. Minerva Med 2022; 113:899-901. [PMID: 32407053 DOI: 10.23736/s0026-4806.20.06620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Shanhong Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jianhua Zhang
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yongjuan Zhao
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, China -
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Lupeol Stearate Accelerates Healing and Prevents Recurrence of Gastric Ulcer in Rodents. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6134128. [PMID: 35463093 PMCID: PMC9020945 DOI: 10.1155/2022/6134128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/19/2022]
Abstract
Objective The focus of this study was to evaluate the gastric healing effect of lupeol stearate (LS) and its ability to minimize ulcer recurrence in rodents. Methods To evaluate the gastric healing properties of LS, rats were subjected to 80% acetic acid-induced ulcer model and treated with vehicle, LS (1 mg/kg, p.o.), or omeprazole (20 mg/kg, p.o.), twice daily by seven days. The gastric ulcers were evaluated macroscopically, histologically, and biochemically. To evaluate the effects of LS in gastric ulcer recurrence, mice were ulcerated with 10% acetic acid and treated with vehicle, LS (1 mg/kg, p.o.), or ranitidine (100 mg/kg, p.o.), twice a day for ten days. Then, ulcer recurrence in these animals was induced by IL-1β at five days after the treatment period. Results The oral treatment with LS accelerated gastric healing by 63% in rats compared to the vehicle group, evidenced by histological improvement and increased gastric mucin levels. Moreover, the gastric healing effects of LS in rats were accompanied by an elevation in glutathione S-transferase activity and a reduction in myeloperoxidase activity. Furthermore, the LS treatment reduced the recurred lesions in mice. Conclusions The oral treatment of LS accelerates gastric healing in rats by favoring mucus production and reducing neutrophil migration, and it also can reduce ulcer recurrence. These data highlighted this compound as promising for developing new pharmacological strategies for the management of gastric ulcer.
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Network Pharmacology and Molecular Docking Analysis on Pharmacological Mechanisms of Astragalus membranaceus in the Treatment of Gastric Ulcer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9007396. [PMID: 35140802 PMCID: PMC8820867 DOI: 10.1155/2022/9007396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Astragalus membranaceus (AM, family: Leguminosae) exerts significant therapeutic effect on gastric ulcer (GU); however, there are scarce studies on its molecular mechanism against GU. This study aims to explore the key ingredients, key targets, and potential mechanisms of AM in the treatment of GU by utilizing network pharmacology and molecular docking. METHODS Several public databases were used to predict the targets of AM and GU, respectively, and the drug and disease targets were intersected to obtain the common targets. Next, the key ingredients and key targets were identified by constructing ingredient-target network and protein-protein-interaction (PPI) network. Gene Ontology biological processes (GOBP) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out on the common targets in order to ascertain the biological processes and signaling pathways involved. Finally, molecular docking was conducted to verify the binding affinity between the key ingredients and key targets. RESULTS A total of 552 predicted targets were obtained from 23 screened active ingredients, of which 203 targets were the common targets with GU. Quercetin, kaempferol, and isorhamnetin were identified as the key ingredients by constructing ingredient-target network, and TP53, AKT1, VEGFA, IL6, TNF, CASP3, and EGFR were selected as the key targets by constructing PPI network. GOBP and KEGG pathway enrichment analysis suggested that the therapeutic effect of AM on GU involved multiple biological processes and signaling pathways related to inflammation, oxidative stress, apoptosis, cell proliferation, and angiogenesis. Molecular docking validation demonstrated that all key ingredients had good binding affinity with the key targets. CONCLUSION This study revealed the key ingredients, key targets, and potential mechanisms of AM against GU, and these data may provide some crucial references for subsequent research and development of drugs for treating GU.
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Liu A, Kuang Y, Huang R, Ge Q. Application Value of Information-Based Health Education and Continuity of Care in Patients With Peptic Ulcer. Front Public Health 2021; 9:694128. [PMID: 34540784 PMCID: PMC8440824 DOI: 10.3389/fpubh.2021.694128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study is to assess the application value of information-based health education and continuity of care in patients with PU (peptic ulcer). Methods: Patients (116) with PU who have been treated in the hospital between January 2019 and October 2020 were taken as research objects and equally assigned to a control group and an observation group in a random manner. In contrast to the routine care applied to the control group, the observation group received information-based health education and continuity of care intervention. The clinical efficacy, the mastery of health knowledge, self-care ability, medication compliance, quality of life, mental state, and nursing satisfaction of the two groups were compared. Results: After the intervention, the total effective rate, health knowledge adequate rate, Exercise of Self-Care Agency (ESCA) scores of all dimensions, the MOS 36-item short-form health survey (SF-36) scores of all dimensions, medication compliance rate, and total nursing satisfaction of the observation group all notably exceeded those of the control group, with a p < 0.05. Patients of the group with continuity of care intervention showed lower Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, as compared to the group with conventional care (p < 0.05). Conclusion: Information-based health education and continuity of care elevates the medication adherence and nursing satisfaction of patients with PU, enhances disease-related knowledge of patients and their self-care ability, and eventually ameliorates the quality of life and psychological state. It is worthy of clinical application.
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Affiliation(s)
- Aihong Liu
- Department of Endoscopy, Jiaozhou Central Hospital of Qingdao, Qingdao, China
| | - Yuhua Kuang
- Department of General Medicine, Qingdao Jimo People's Hospital, Qingdao, China
| | - Ruiping Huang
- Department of Infection Control, Qingdao Jimo People's Hospital, Qingdao, China
| | - Qunying Ge
- Hemodialysis Department, Jiaozhou People's Hospital, Qingdao, China
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Xiao Chai Hu Tang for Peptic Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6693677. [PMID: 34012475 PMCID: PMC8105105 DOI: 10.1155/2021/6693677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
A peptic ulcer (PU) is a digestive disorder most commonly found in clinical practice. An oriental herbal formula, Xiao Chai Hu Tang (XCHT), has been used to treat PU for an extended period in China. The effectiveness and safety of XCHT in treating peptic ulcers was evaluated using a systematic review of randomized controlled trials (RCTs). Studies were systematically retrieved from CNKI, Embase, Medline, PubMed, SinoMed, VIP, Wanfang, and Web of Science. The following information was extracted from the relevant RCTs: the clinical efficacy rate, recurrence rate, clinical efficacy of traditional Chinese medicine, and the adverse effects. 13 RCTs, including 1334 patients, were included in this review. The meta-analysis showed that treatment with XCHT was superior to conventional pharmacotherapy (CPT) in improving the clinical efficacy rate (RR: 1.20, 95% confidence intervals (CIs): 1.08–1.34, P=0.0007), poor appetite (RR: 0.30, 95% CI: 0.15–0.61, P=0.0009), abdominal distension (RR: 0.61, 95% CI: 0.39–0.96, P=0.03), vomiting (RR: 0.33, 95% CI: 0.19–0.55, P < 0.0001), and stomach pain (RR: 0.36, 95% CI: 0.19–0.68, P=0.002) and reducing adverse events (RR: 0.23, 95% CI: 0.07–0.69, P=0.009). XCHT considerably increased the total clinical efficacy rate (RR: 1.22, 95% CI: 1.15–1.30, P < 0.00001) as both monotherapy and adjunctive therapy. The recurrence rate (RR = 0.29; 95% CI: 0.16–0.52, P < 0.0001) was remarkably decreased in the XCHT plus CPT group. The meta-analysis did not show a significant beneficial effect of XCHT compared with CPT in reducing the recurrence rate (RR = 0.45; 95% CI: 0.07–3.10, P=0.42) and acid reflux (RR: 0.76, 95% CI: 0.47–1.23, P=0.26). Our findings show that XCHT can treat peptic ulcers as part of an alternative medicine approach.
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Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. To evaluate the effectiveness of X-ray interventions in arosive bleeding in patients with complicated duodenal ulcer.
Materials and methods. X-ray endovascular interventions were used in 8 patients who developed arosive bleeding as a complication of duodenal ulcer. All patients with signs of gastrointestinal bleeding were examined according to clinical protocols. Hemodynamically stable patients underwent X-ray endovascular interventions.
Results and discussion. In the near future, bleeding stopped in all 8 (100 %, OR–0.04 [0.005–0.29], p=0.03) patients. On day 2, two patients who underwent embolization of their own hepatic artery had a recurrence of bleeding (0.56 [0.065–4.76], p=0.29). Repeated angiography and embolization attempts were ineffective, and both patients died. In patients who underwent gastroduodenal and pancreatouodenal artery embolization, bleeding did not resume. Thus, we obtained good results as 6 out of 8 patients recovered (75 %), despite the severity of their condition and a disappointing prognosis (OR–9.0 [1.0–46.7], p <0.05).
Conclusions. Adherence to the tactics mentioned above in the treatment of bleeding in duodenal ulcer was highly effective, especially in superselective embolization with the detection of bleeding gel. If the presence of arosive bleeding is confirmed, emergency surgical treatment with suturing of the damaged vessel is shown in hemodynamically unstable patients, and endovascular intervention is possible in hemodynamically stable patients. Further studies are needed to determine the criteria for a high risk of arosive bleeding developing in patients with complicated duodenal ulcer as well as to prevent its occurrence through the use of X-ray endovascular interventions.
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Ivashkin VT, Maev IV, Tsar’kov PV, Korolev MP, Andreev DN, Baranskaya EK, Burkov SG, Derinov AA, Efetov SK, Lapina TL, Pavlov PV, Pirogov SS, Tkachev AV, Trukhmanov AS, Fedorov ED, Sheptulin AA. Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society). ACTA ACUST UNITED AC 2020. [DOI: 10.22416/1382-4376-2020-30-1-49-70] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - I. V. Maev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | - D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - S. G. Burkov
- Polyclinic No. 3 of the Administrative Department of the President of the Russian Federation
| | | | - S. K. Efetov
- I.M. Sechenov First Moscow State Medical University
| | - T. L. Lapina
- I.M. Sechenov First Moscow State Medical University
| | - P. V. Pavlov
- I.M. Sechenov First Moscow State Medical University
| | - S. S. Pirogov
- P.A. Gertsen National Medical Research Centre for Radiology, branch of the Moscow Research Institute of Oncology
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Beburishvili AG, Fedorov AV, Sazhin VP, Panin SI, Zyubina EN. [Surgical treatment of ulcerative pyloroduodenal stenosis]. Khirurgiia (Mosk) 2019:94-99. [PMID: 31120455 DOI: 10.17116/hirurgia201904194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. MATERIAL AND METHODS Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. RESULTS Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. CONCLUSION Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.
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Affiliation(s)
- A G Beburishvili
- Volgograd State Medical University, Ministry of Health of Russia, Volgograd, Russia
| | - A V Fedorov
- Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, Moscow, Russia
| | - V P Sazhin
- Pavlov Ryazan State Medical University, Ministry of Health of Russia, Ryazan, Russia
| | - S I Panin
- Volgograd State Medical University, Ministry of Health of Russia, Volgograd, Russia
| | - E N Zyubina
- Volgograd State Medical University, Ministry of Health of Russia, Volgograd, Russia
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Périco LL, Rodrigues VP, Ohara R, Bueno G, Nunes VVA, dos Santos RC, Camargo ACL, Júnior LAJ, de Andrade SF, Steimbach VMB, da Silva LM, da Rocha LRM, Vilegas W, dos Santos C, Hiruma-Lima CA. Sex-specific effects of Eugenia punicifolia extract on gastric ulcer healing in rats. World J Gastroenterol 2018; 24:4369-4383. [PMID: 30344421 PMCID: PMC6189849 DOI: 10.3748/wjg.v24.i38.4369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the sex-specific effects of a hydroalcoholic extract from Eugenia punicifolia (HEEP) leaves on gastric ulcer healing.
METHODS In this rat study involving males, intact (cycling) females, and ovariectomized females, gastric ulcers were induced using acetic acid. A vehicle, lansoprazole, or HEEP was administered for 14 d after ulcer induction. Body weight was monitored throughout the treatment period. At the end of treatment, the rats were euthanized and the following in vivo and in vitro investigations were performed: macroscopic examination of the lesion area and organ weights, biochemical analysis, zymography, and evaluation of protein expression levels. Additionally, the concentration-dependent effect of HEEP was evaluated in terms of subacute toxicity and cytotoxicity.
RESULTS Compared to the vehicle, HEEP demonstrated a great healing capacity by substantially reducing the ulcerative lesion area in males (52.44%), intact females (85.22%), and ovariectomized females (65.47%), confirming that HEEP accelerates the healing of acetic acid-induced gastric lesions and suggesting that this effect is modulated by female sex hormones. The antiulcer effect of HEEP was mediated by prostaglandin E2 only in male rats. Overall, the beneficial effect of HEEP was the highest in intact females. Notably, HEEP promoted the expression of vascular endothelial growth factor (intact vs ovariectomized females) and decreased the expression of Caspase-8 and Bcl-2 (intact female vs male or ovariectomized female). Additionally, HEEP enhanced fibroblast proliferation and migration into a wounded area in vitro, confirming its healing effect. Finally, no sign of subacute toxicity or cytotoxicity of HEEP was observed.
CONCLUSION In gastric ulcers, HEEP-induced healing (modulated by female sex hormones; in males, mediated by prostaglandin) involves extracellular matrix remodeling, with gastric mucosa cell proliferation and migration.
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Affiliation(s)
- Larissa Lucena Périco
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Vinícius Peixoto Rodrigues
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Rie Ohara
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Gabriela Bueno
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Vânia Vasti Alfieri Nunes
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Raquel Cássia dos Santos
- Laboratory of Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, São Paulo, Brazil
| | - Ana Carolina Lima Camargo
- Department of Morphology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Luis Antônio Justulin Júnior
- Department of Morphology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Sérgio Faloni de Andrade
- Programa de Pós-graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico-Farmacêuticas (NIQFAR), Universidade do Vale do Itajaí - UNIVALI, Itajaí 88302-901, Santa Catarina, Brazil
| | - Viviane Miranda Bispo Steimbach
- Programa de Pós-graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico-Farmacêuticas (NIQFAR), Universidade do Vale do Itajaí - UNIVALI, Itajaí 88302-901, Santa Catarina, Brazil
| | - Luísa Mota da Silva
- Programa de Pós-graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico-Farmacêuticas (NIQFAR), Universidade do Vale do Itajaí - UNIVALI, Itajaí 88302-901, Santa Catarina, Brazil
| | - Lúcia Regina Machado da Rocha
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
| | - Wagner Vilegas
- Coastal Campus of São Vicente, São Paulo State University (UNESP), São Vicente 11330-900, São Paulo, Brazil
| | - Catarina dos Santos
- Department of Biological Science, Faculty of Sciences and Languages, São Paulo State University (UNESP), Assis 19806-900, São Paulo, Brazil
| | - Clélia Akiko Hiruma-Lima
- Department of Physiology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-970, São Paulo, Brazil
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