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Leng ZY, Wang JH, Gao L, Shi K, Hua HB. Efficacy of pantoprazole plus perforation repair for peptic ulcer and its effect on the stress response. World J Gastrointest Surg 2023; 15:2757-2764. [PMID: 38222001 PMCID: PMC10784820 DOI: 10.4240/wjgs.v15.i12.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Peptic ulcer (PU) is an abnormal phenomenon in which there is rupture of the mucosa of the digestive tract, which not only affects patients' normal life but also causes an economic burden due to its high medical costs. AIM To investigate the efficacy of pantoprazole (PPZ) plus perforation repair in patients with PU and its effect on the stress response. METHODS The study subjects were 108 PU patients admitted between July 2018 and July 2022, including 58 patients receiving PPZ plus perforation repair [research group (RG)] and 50 patients given simple perforation repair [control group (CG)]. The efficacy, somatostatin (SS) concentration, stress reaction [malondialdehyde (MDA), lipid peroxide (LPO)], inflammatory indices [tumor necrosis factor (TNF)-α, C-reactive protein (CRP), interleukin (IL)-1β], recurrence, and complications (perforation, hemorrhage, and pyloric obstruction) were compared. RESULTS The overall response rate was higher in the RG than in the CG. Patients in the RG had markedly elevated SS after treatment, which was higher than that of the CG, while MDA, LPO, TNF-, CRP, and IL-1β were significantly reduced to lower levels than those in the CG. Lower recurrence and complication rates were identified in the RG group. CONCLUSION Therefore, PPZ plus perforation repair is conducive to enhancing treatment outcomes in PU patients, reducing oxidative stress injury and excessive inflammatory reactions, and contributing to low recurrence and complication rates.
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Affiliation(s)
- Zi-Yan Leng
- The Second Hospital of Traditional Chinese Medicine of Jiangsu Province, Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jia-Hao Wang
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Lei Gao
- School of Chinese Medicine & School of Integrated, Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Ke Shi
- Department of Spleen and Gastroenterology, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin 214400, Jiangsu Province, China
| | - Hai-Bing Hua
- Department of Spleen and Gastroenterology, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin 214400, Jiangsu Province, China
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Zhang Z, Yan W, Zhang X, Wang J, Zhang Z, Lin Z, Wang L, Chen J, Liu D, Zhang W, Li Z. Peptic ulcer disease burden, trends, and inequalities in 204 countries and territories, 1990-2019: a population-based study. Therap Adv Gastroenterol 2023; 16:17562848231210375. [PMID: 38026102 PMCID: PMC10647969 DOI: 10.1177/17562848231210375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Peptic ulcer disease has been a major threat to the world's population, which remains a significant cause of hospitalization worldwide and healthcare resource utilization. Objectives We aimed to describe the global burden, trends, and inequalities of peptic ulcer disease. Design An observational study was conducted. Methods In this secondary analysis of the Global Burden of Disease, Injuries, and Risk Factors Study 2019, we extracted data for age-standardized incidence rates (ASIRs), disability-adjusted life year rates (ASDRs), and mortality rates (ASMRs); then, we stratified by age, level of regionals, and country; subsequently, we calculated estimated annual percentage changes (EAPC) of ASIR, ASDR, ASMR, and quantified cross-country inequalities in peptic ulcer disease mortality. Results Globally, ASIR showed a continuous downward trend, from 63.84 in 1990 to 44.26 per 100,000 population in 2019, with an annual decrease of 1.42% [EAPC = -1.42 (95% CI: -1.55 to -1.29)]. ASDR showed a continuing downward trend, and the EAPC was -3.47% (-3.58 to -3.37). ASMR showed a persistent decline, declining by nearly half in 2019 compared to 1990 (3.0 versus 7.39 per 100,000 population), with an annual decrease of 2.55% [EAPC = -3.36 (95% CI: -3.47 to -3.25)]. A significant reduction in sociodemographic index (SDI)-related inequality, from an excess of 190.43 disability-adjusted life years (DALY) per 100,000 (95% CI: -190.83 to -190.02) between the poorest and richest countries in 1990 to 62.85 DALY per 100,000 (95% CI -62.81 to -62.35) in 2019. Conclusion Global peptic ulcer disease morbidity and mortality rates decreased significantly from 1990 to 2019. These health gains were in accordance with a substantial reduction in the magnitude of SDI-related inequalities across countries, which is paired with overall socioeconomic and health improvements observed in the region.
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Affiliation(s)
- Zhongmian Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Weitian Yan
- Department of Rheumatology, Yunnan Provincial Hospital of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Xiyan Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaqi Wang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhonghan Zhang
- College of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Zili Lin
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lan Wang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaqin Chen
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Daming Liu
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Hutong, Dongcheng District, Beijing 100700, China
| | - Wen Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Hutong, Dongcheng District, Beijing 100700, China
| | - Zhihong Li
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Hutong, Dongcheng District, Beijing 100700, China
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Risk factors for leak after omentopexy for duodenal ulcer perforations. Eur J Trauma Emerg Surg 2022; 49:1163-1167. [PMID: 35870005 DOI: 10.1007/s00068-022-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS Duodenal ulcer perforations are frequently encountered but there is limited literature regarding risk factors for leak after omentopexy. METHODOLOGY The record of 100 patients of duodenal ulcer perforation undergoing omentopexy by open approach was prospectively maintained to identify any significant factors contributing towards leak. RESULTS Out of 100 patients undergoing omentopexy, 9 (9%) developed leak; when leak occurred, the mortality was very high (44.4%). Patients who developed leak (09) were compared against those who did not (91), and it was seen that seen that duration of symptoms before surgery (> 3 days), amount of intra-abdominal contamination (> 2 L), low body mass index (BMI < 19.35 kg/m2), serum creatinine (> 1.5 mg/dl), and deranged International Normalized Ratio (INR) were found to be significant on univariate analysis; however, multivariate analysis revealed only low BMI and high creatinine to be contributory towards leak. CONCLUSION Leak after omentopexy carries a high morbidity and mortality. Identification of risk factors may help in optimizing patients at risk and reduce the incidence of leak and its sequelae. TRIAL REGISTRATION NUMBER CTRI/2020/03/023798.
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Koranne A, Byakodi KG, Teggimani V, Kamat VV, Hiregoudar A. A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers. Surg J (N Y) 2022; 8:e162-e168. [PMID: 35928546 PMCID: PMC9345676 DOI: 10.1055/s-0042-1743526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction
Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases.
Materials and Methods
This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period.
Observation
A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a
p
-value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had
p
-value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a
p
-value of 0.047.
Conclusion
Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.
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Affiliation(s)
- Aboli Koranne
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - K G. Byakodi
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Vasant Teggimani
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Vijay V. Kamat
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Abhijith Hiregoudar
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Singh PK, Easwari TS. Emerging Trends and their Impacts on Peptic Ulcer Diseases: Treatments and Techniques. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220307115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background:
Peptic ulcer disease (PUD) is prevalent in almost all parts of the world. PUD complications are creating a major source of preventable health care expenses. The major factors responsible for the incidence of PUD and its complication have changed over the past few decades after the identification of non-steroidal inflammatory drugs (NSAIDs) and Helicobacter pylori bacterial infection along with a marked increase in the use of proton-pump inhibitors (PPIs) as drug therapy. The management of PUD has become more complex and challenging due to antimicrobial resistance.
Objective:
The objective of the study was to highlight current therapy and novel techniques used in the treatment of peptic ulcer diseases.
Methods:
An exhaustive literature search has been conducted across PubMed, Google, Scopus and Web of Science as an electronic database to add the crucial information from the relevant literature.
Results:
In the present review, we have discussed PUD and its pathophysiology. The recent trends in PUD and possible treatments with novel techniques have also been discussed. The type and presence of ulcers cannot be predicted accurately based on symptoms. The available treatment approaches for peptic ulcers based on their clinical presentation and etiology are anti-secretary therapy, endoscopy to reveal ulcers followed by drug therapy, and triple therapy for H pylori infection.
Conclusion:
Thus, the popular and effective methods are very beneficial in controlling PUD. The treatment based on diagnosis is the foremost requirement for ameliorating any disorder. In this article, the emerging techniques and development in the treatment and diagnosis of PUD have been reviewed.
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Affiliation(s)
- Pranjal Kumar Singh
- Department of Pharmaceutics, IIMT College of Medical Sciences, IIMT University, Meerut, Uttar Pradesh, India
| | - T. S. Easwari
- Department of Pharmaceutics, IIMT College of Medical Sciences, IIMT University, Meerut, Uttar Pradesh, India
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Focus on emergency general surgery. Eur J Trauma Emerg Surg 2022; 48:1-3. [PMID: 35137280 DOI: 10.1007/s00068-022-01877-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang YL, Chan XW, Chan KS, Shelat VG. Omental patch repair of large perforated peptic ulcers ≥25 mm is associated with higher leak rate. J Clin Transl Res 2021; 7:759-766. [PMID: 34988327 PMCID: PMC8710357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIM Omental patch repair is the present gold-standard technique for patients with perforated peptic ulcers (PPUs). Data are lacking regarding the safe ulcer size for omental patch repair leak (OPL). We analyze our experience in managing PPU to identify an ulcer size cut-off for predicting OPL. METHODS Patients who had undergone omental patch repair for PPU between Jan 2004 and Apr 2016 were included. Demographic data, the American Society of Anesthesiologists score, ulcer size, operative approach, post-operative complications, and length of stay were recorded. OPL, intra-abdominal collection, repeat surgery, and 30-day mortality were recorded. The relationship between ulcer size, pre-operative characteristics, and OPL were investigated with univariate and multivariate logistic regression. Receiver operating characteristic curve analysis derived the ulcer size cut-off to predict OPL. In addition, we analyzed if ulcer size predicted mortality or malignancy. RESULTS Six hundred and ninety patients with a mean age of 55.1 years (range 16-94) were managed for PPU during the study period. Free air on X-ray was evident in 417 (60.4%) patients. Mean ulcer size was 7.8 mm (range 1-50). OPL occurred in 15 patients (2.2%) and 30-day mortality was 7.4% (n=51). Multivariate analysis found ulcer size increase of 10 mm (OR 3.30, 95% CI 1.81-6.02, P<0.001) predicted increased risk of OPL. At 25 mm cut-off, sensitivity was 26.7%, specificity was 97.2%, positive likelihood ratio was 9.47, and negative likelihood ratio was 0.76 for OPL. CONCLUSION Ulcer size increase in 10 mm increases leak rate by 3.3 times. Ulcer size ≥25 mm predicts OPL. RELEVANCE FOR PATIENTS Increased risk of OPL for ≥25 mm warrants need for close post-operative monitoring and lowers threshold for investigations in event of clinical deterioration. Decision for omental patch repair versus gastrectomy however should not be based on ulcer size alone.
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Affiliation(s)
- Yi Liang Wang
- 1Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Xue Wei Chan
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Kai Siang Chan
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Corresponding author Kai Siang Chan Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore. E-mail:
| | - Vishal G. Shelat
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
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8
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Reinke CE, Lim RB. Minimally Invasive Acute Care Surgery. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Reinke CE, Lim RB. Minimally invasive acute care surgery. Curr Probl Surg 2021; 59:101031. [DOI: 10.1016/j.cpsurg.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/16/2021] [Indexed: 12/07/2022]
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Chia ML, Chan SWY, Shelat VG. Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:236-242. [PMID: 34386552 PMCID: PMC8314773 DOI: 10.1159/000511822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/20/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. METHODS The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. RESULTS The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. CONCLUSION DDA is a distinct clinical pathology associated with complicated appendicitis.
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Affiliation(s)
- Ming Li Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- *Ming Li Chia, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (Singapore),
| | | | - Vishal G. Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Jayaraman SS, Kulkarni SS, Eaton B, Sides J, Gergen AK, Harmon L, Weinberger JM, Bruns BR, Neal MD, Turcotte J, Feather C, Klune JR. Does routine postoperative contrast radiography improve outcomes for patients with perforated peptic ulcer? A multicenter retrospective cohort study. Surgery 2021; 170:1554-1560. [PMID: 34175115 DOI: 10.1016/j.surg.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/05/2021] [Accepted: 05/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perforated peptic ulcer is a morbid emergency general surgery condition. Best practices for postoperative care remain undefined. Surgical dogma preaches practices such as peritoneal drain placement, prolonged nil per os, and routine postoperative enteral contrast imaging despite a lack of evidence. We aimed to evaluate the role of postoperative enteral contrast imaging in postoperative perforated peptic ulcer care. Our primary objective was to assess effects of routine postoperative enteral contrast imaging on early detection of clinically significant leaks. METHODS We conducted a multicenter retrospective cohort study of patients who underwent repair of perforated peptic ulcer between July 2016 and June 2018. We compared outcomes between those who underwent routine postoperative enteral contrast imaging and those who did not. RESULTS Our analysis included 95 patients who underwent primary/omental patch repair. The mean age was 60 years, and 54% were male. Thirteen (14%) had a leak. Eighty percent of patients had a drain placed. Nine patients had leaks diagnosed based on bilious drain output without routine postoperative enteral contrast imaging. Use of routine postoperative enteral contrast imaging varied significantly between institutions (30%-87%). Two late leaks after initial normal postoperative enteral contrast imaging were confirmed by imaging after a clinical change triggered the second study. Two patients had contained leaks identified by routine postoperative enteral contrast imaging but remained clinically well. Duration of hospital stay was longer in those who received routine postoperative enteral contrast imaging (12 vs 6 days, median; P = .000). CONCLUSION Routine postoperative enteral contrast imaging after perforated peptic ulcer repair likely does not improve the detection of clinically significant leaks and is associated with increased duration of hospital stay.
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Affiliation(s)
| | | | - Barbara Eaton
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Jake Sides
- Department of Surgery, Christiana Care Health System, Wilmington, DE
| | - Anna K Gergen
- Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Laura Harmon
- Department of Surgery, University of Colorado Hospital, Aurora, CO. https://twitter.com/lauraharmonmd
| | | | - Brandon R Bruns
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD. https://twitter.com/BrandonRBruns1
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh Medical Center, PA. https://twitter.com/macky_neal
| | - Justin Turcotte
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Cristina Feather
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - John R Klune
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD.
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