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Hong CW, Tsai HY, Chung CH, Wang JC, Hsu YJ, Lin CY, Hsu CW, Chien WC, Tsai SH. The associations among peptic ulcer disease, Helicobacter pylori infection, and abdominal aortic aneurysms: A nationwide population-based cohort study. J Cardiol 2024; 84:180-188. [PMID: 38382580 DOI: 10.1016/j.jjcc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND There are overlapping risk factors and underlying molecular mechanisms for both peptic ulcer disease (PUD) and abdominal aortic aneurysm (AAA). Despite improvements in the early diagnosis and treatment of AAA, ruptured AAAs continue to cause a substantial number of deaths. Helicobacter pylori are Gram-negative, microaerophilic bacteria that are now recognized as the main cause of PUD. H. pylori infection (HPI) is associated with an increased risk of certain cardiovascular diseases. HPIs can be treated with at least two different antibiotics to prevent bacteria from developing resistance to one particular antibiotic. METHODS We conducted a population-based cohort study using the National Health Insurance Research Database to evaluate whether associations exist among PUD, HPI, and eradication therapy for HPI and AAA. The primary outcome of this study was the cumulative incidence of AAA among patients with or without PUD and HPI during the 14-year follow-up period. RESULTS Our analysis included 7003 patients with PUD/HPI, 7003 patients with only PUD, and another 7003 age-, sex-, and comorbidity-matched controls from the database. We found that patients with PUD/HPI had a significantly increased risk of AAA compared to those with PUD alone and matched controls. The patients who had PUD/HPI had a significantly higher cumulative risk of developing AAA than those with PUD and the comparison group (2.67 % vs. 1.41 % vs. 0.73 %, respectively, p < 0.001). Among those patients with PUD/HPI, patients who had eradication therapy had a lower incidence of AAA than those without eradication therapy (2.46 % vs. 3.88 %, p = 0.012). CONCLUSIONS We revealed an association among PUD, HPI, and AAA, even after adjusting for age, sex, comorbidities, and annual medical follow-up visits. Notably, we found that HPI eradication therapy reduced the incidence of AAA among patients with PUD.
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Affiliation(s)
- Chia-Wei Hong
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ya Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Yuan Lin
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan; Taichung Armed Forces General Hospital, Taichung, Taiwan.
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Chen CC, Geng JH, Wu PY, Huang JC, Hu HM, Chen SC, Kuo CH. High Obesity Indices Are Associated with Gastroesophageal Reflux Disease, but Low Obesity Indices Are Associated with Peptic Ulcer Disease in a Large Taiwanese Population Study. Obes Facts 2024; 17:491-501. [PMID: 39008955 PMCID: PMC11458163 DOI: 10.1159/000540281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/06/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are prevalent in Taiwan. Few studies have investigated the associations between obesity indices with GERD and PUD simultaneously. This study aimed to investigate the correlations among obesity indices with GERD and PUD in a large cohort of participants, around 120,000, in the Taiwan Biobank (TWB). METHODS A total of 121,583 participants (male: 43,698; female: 77,885; mean age 49.9 ± 11.0 years) were included to analyze the associations among obesity indices, including body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), abdominal volume index (AVI), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose index (TyG index), with GERD and PUD. Self-reported GERD and PUD were obtained by questionnaires. Multivariate logistic regression analysis was employed to analyze the relationship between obesity indices with GERD and PUD. RESULTS The prevalence of GERD and PUD was 13.7% and 14.6%, respectively. After multivariable analysis, high WHR (odds ratio [OR] = 1.009, p < 0.001), WHtR (OR = 1.005, p = 0.003), BRI (OR = 1.022, p = 0.005), AVI (OR = 1.013, p < 0.001), LAP (OR = 1.001, p < 0.001), TyG index (OR = 1.068, p < 0.001), and VAI (OR = 1.013, p = 0.002) were significantly associated with GERD, except BMI (p = 0.384). On the other hand, low BMI (OR = 0.984; p < 0.001) and AVI (OR = 0.994; p = 0.036) were significantly associated with PUD. However, the values of WHR (p = 0.151), WHtR (p = 0.304), BRI (p = 0.452), LAP (p = 0.799), VAI (p = 0.347), and TyG index (p = 0.642) were not. CONCLUSION This study found that high obesity indices are associated with GERD, but low obesity indices are associated with PUD in a large Taiwanese population study. Our findings may alert physicians to notice that different obesity index may be associated with different gastrointestinal disorder.
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Affiliation(s)
- Chien-Cheng Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abushamma S, Chen LS, Chen J, Smock N, Pham G, Chen CH. Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model. BMC Health Serv Res 2024; 24:752. [PMID: 38902682 PMCID: PMC11188289 DOI: 10.1186/s12913-024-11092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND & AIM Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.
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Affiliation(s)
- Suha Abushamma
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA.
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chien-Huan Chen
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA
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Zhou J, Song W, Liu Y, Yuan X. An efficient computational framework for gastrointestinal disorder prediction using attention-based transfer learning. PeerJ Comput Sci 2024; 10:e2059. [PMID: 38855223 PMCID: PMC11157572 DOI: 10.7717/peerj-cs.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024]
Abstract
Diagnosing gastrointestinal (GI) disorders, which affect parts of the digestive system such as the stomach and intestines, can be difficult even for experienced gastroenterologists due to the variety of ways these conditions present. Early diagnosis is critical for successful treatment, but the review process is time-consuming and labor-intensive. Computer-aided diagnostic (CAD) methods provide a solution by automating diagnosis, saving time, reducing workload, and lowering the likelihood of missing critical signs. In recent years, machine learning and deep learning approaches have been used to develop many CAD systems to address this issue. However, existing systems need to be improved for better safety and reliability on larger datasets before they can be used in medical diagnostics. In our study, we developed an effective CAD system for classifying eight types of GI images by combining transfer learning with an attention mechanism. Our experimental results show that ConvNeXt is an effective pre-trained network for feature extraction, and ConvNeXt+Attention (our proposed method) is a robust CAD system that outperforms other cutting-edge approaches. Our proposed method had an area under the receiver operating characteristic curve of 0.9997 and an area under the precision-recall curve of 0.9973, indicating excellent performance. The conclusion regarding the effectiveness of the system was also supported by the values of other evaluation metrics.
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Affiliation(s)
- Jiajie Zhou
- Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu, China
| | - Wei Song
- Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu, China
| | - Yeliu Liu
- Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiaoming Yuan
- Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu, China
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Tuerk E, Doss S, Polsley K. Peptic Ulcer Disease. Prim Care 2023; 50:351-362. [PMID: 37516507 DOI: 10.1016/j.pop.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Peptic ulcer disease is a common cause of epigastric pain typically related to Helicobacter pylori infection or NSAID use that can lead to serious consequences including upper GI bleed or perforation if undiagnosed. Diagnostic strategies vary depending on age and treatment is dependent on etiology.
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Affiliation(s)
- Emily Tuerk
- Loyola University Chicago Stritch School of Medicine, Primary Care, 2160 South First Avenue, Mulcahy 2525, Maywood, IL 60153, USA.
| | - Sara Doss
- Loyola University Chicago Stritch School of Medicine, Primary Care, 2160 South First Avenue, Mulcahy 2525, Maywood, IL 60153, USA
| | - Kevin Polsley
- Loyola University Chicago Stritch School of Medicine, Primary Care, 2160 South First Avenue, Mulcahy 2525, Maywood, IL 60153, USA
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Negaresh M, Safarzadeh E, Fouladi N, Matin S, Pourfarzi S. The evaluation of the MMP-2/TIMP-1 ratio in peptic ulcer and its association with refractory helicobacter pylori infection. BMC Gastroenterol 2023; 23:287. [PMID: 37605137 PMCID: PMC10440920 DOI: 10.1186/s12876-023-02923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) is one of the leading causes of peptic ulcers, and its treatment is a worldwide challenge. Matrix metalloproteinases and their inhibitors influence the development and healing of peptic ulcers. This study aimed to evaluate the ratios of matrix metalloproteinase-2 (MMP-2) to tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with peptic ulcers that are sensitive or resistant to H. pylori treatment and compare them with healthy individuals. METHODS In this study, 95 patients were included and divided into two groups sensitive (41 patients) and resistant to treatment (54 patients). The results were compared with a control group of 20 participants with normal endoscopy and H. pylori-negative. After obtaining written informed consent, five ml of venous blood was taken to determine their serum MMP-2 and TIMP-1 levels using an enzyme-linked immunosorbent assay. RESULTS In patients with H. pylori-induced peptic ulcers, the MMP-2/TIMP-1 ratio was significantly higher than the healthy controls (P < 0.05). MMP-2 level was associated with patients' response to treatment (P < 0.05). The MMP-2/TIMP-1 ratio was higher in patients with simultaneous gastric and duodenal ulcers (P < 0.05). CONCLUSION It seems that peptic ulcer disease caused by infection with H. pylori increases the MMP-2/TIMP-1 ratio in patients with peptic ulcers. However, it might not be a good predictor of refractory H. pylori-induced peptic ulcer disease.
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Affiliation(s)
- Mohammad Negaresh
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Safarzadeh
- School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Fouladi
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Somaieh Matin
- Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Sanaz Pourfarzi
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Xu A, Duan K, Yang W, Feng G, Wu Z, Jiang X, Li M, Liu P, Chen J. The toxic effects of electronic cigarette aerosol and cigarette smoke on cardiovascular, gastrointestinal and renal systems in mice. Sci Rep 2023; 13:12366. [PMID: 37524767 PMCID: PMC10390502 DOI: 10.1038/s41598-023-39201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
Electronic cigarette (EC) has been suggested to be less harmful than cigarette smoking, but the research on the full extent of their harm reduction potential is still lacking. This study aimed to evaluate the influence of EC aerosol and cigarette smoke (CS) on cardiovascular, gastrointestinal, and renal functions in mice after prolonged exposure. Forty-eight C57BL/6J male mice were randomly grouped and then exposed to fresh air (control), mung bean-flavored EC aerosol with low and high dose (EC1L, 6 mg/kg; EC1H, 12 mg/kg), watermelon-flavored EC aerosol with low and high dose (EC2L, 6 mg/kg; EC2H, 12 mg/kg), and finally a cigarette smoke (CS, 6 mg/kg), respectively. After 10 weeks of exposure, the heart rate increased for both the EC and CS groups, and the effect of CS on blood oxygen saturation was significantly higher than that of the EC group (P < 0.01). Proteomic analysis of the heart tissue showed that the overlapped differential expression protein from the EC and CS exposures was Crip2. For the gastrointestinal system, oral mucosa was significantly damaged in CS group. Compare with CS, EC had significantly fewer negative effects on most of the indictors which focused on in this study.
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Affiliation(s)
- Aijing Xu
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China
| | - Kun Duan
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, 518101, China
| | - Wanchun Yang
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China
| | - Guodong Feng
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China
| | - Zehong Wu
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, 518101, China
| | - Xingtao Jiang
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, 518101, China
| | - Min Li
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China
- National and Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Engineering Laboratory of Druggability and New Drug Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Peiqing Liu
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China.
- National and Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Engineering Laboratory of Druggability and New Drug Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China.
| | - Jianwen Chen
- Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China.
- National and Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Engineering Laboratory of Druggability and New Drug Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China.
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Wang R, Li Z, Liu S, Zhang D. Global, regional, and national burden of 10 digestive diseases in 204 countries and territories from 1990 to 2019. Front Public Health 2023; 11:1061453. [PMID: 37056655 PMCID: PMC10088561 DOI: 10.3389/fpubh.2023.1061453] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundDigestive diseases are very common worldwide and account for considerable health care use and expenditures. However, there are no global population-based estimates of the disease burden and temporal trend of digestive diseases.MethodsAnnual case numbers, age-standardized rates of prevalence, incidence, death, and disability-adjusted life-years (DALYs), and their estimated annual percentage changes (EAPCs) for digestive diseases between 1990 and 2019 were derived from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019. The association between digestive disease burden and the sociodemographic index (SDI) was investigated. We also calculated DALYs attributable to risk factors that had evidence of causation with digestive diseases.ResultsGlobally, in 2019, there were 88.99 million DALYs due to digestive diseases (3.51% of global DALYs). Digestive diseases were the 13th leading cause of DALYs globally in 2019. Global digestive disease DALYs were highest in the middle SDI quintile and in South Asia and were higher in males than females in 2019. Cirrhosis and other chronic liver diseases constituted the highest proportion of categorized digestive disease DALY burdens globally. From 1990 to 2019, the global age-standardized DALY rate of digestive diseases decreased from 1570.35 in 1990 to 1096.99 in 2019 per 1,00,000 population, with the EAPC being −1.32 (95% confidence interval [CI] −1.36 to −1.27). In 2019, the largest contributor to digestive disease DALYs at the global level, for both sexes, was alcohol use.ConclusionThe results of this systematic analysis suggest that the global burden of digestive diseases is substantial and varies markedly according to age, sex, SDI, and geographical region. These results provide comprehensive and comparable estimates that can potentially inform efforts toward digestive disease control worldwide.
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Affiliation(s)
- Rui Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Changsha, Hunan, China
| | - Zhaoqi Li
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Changsha, Hunan, China
| | - Shaojun Liu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Changsha, Hunan, China
| | - Decai Zhang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Changsha, Hunan, China
- *Correspondence: Decai Zhang
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Liu Y, Xiao Z, Ye K, Xu L, Zhang Y. Smoking, alcohol consumption, diabetes, body mass index, and peptic ulcer risk: A two-sample Mendelian randomization study. Front Genet 2023; 13:992080. [PMID: 36685897 PMCID: PMC9852705 DOI: 10.3389/fgene.2022.992080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Observational evidence has shown that smoking, alcohol consumption, type 2 diabetes, and body mass index (BMI) are risk factors for peptic ulcer disease (PUD), including gastric ulcer (GU) and duodenal ulcer (DU). However, the observed associations may be confounding factors. Herein, we use Mendelian randomization (MR) to examine causal associations such as smoking, alcohol, type 2 diabetes, BMI, and risks of PUD. Methods: We used 8,17,41,325,82, 231, and 616 identified genetic variants as proxies for age of smoking initiation (AgeSmk), smoking cessation (SmkCes, current/former), number of cigarettes smoked per day (CigDay), smoking status (SmkIni, ever/never), alcohol consumption, type 2 diabetes, and BMI to obtain unconfounded effect estimates on the GU and DU levels among 452,264 participants from the Gene ATLAS. The causal relationship was estimated by using inverse-variance weighted (IVW) as the main method. Sensitivity analysis includes Cochran's Q test, the MR-Egger test, MR pleiotropy residual sum and outlier (MR-PRESSO), and MR-robust adjusted profile score (MR-RAPS). In addition, secondary MR analysis was conducted within summary data using genetic risk scores (GRSs) as instrumental variables (IVs). Results: In our two-sample MR analyses, genetic predisposition to smoking (SmkInit) and BMI were associated with an increased risk of GU. The beta values were 0.0035 (95% CI, 0.0021, 0.0049, p = 1.56E-06) for smoking (SmkInit) and 0.0021 (95% CI, 0.0009, 0.0033, p = 0.0008) for BMI. Genetic predisposition to smoking (SmkInit) and higher genetically predicted BMI were associated with an increased risk of DU. The beta values of DU were 0.0029 (95% CI, 0.0017, 0.0041, p = 2.43E-06) for smoking (SmkInit) and 0.0018 (95% CI, 0.0007, 0.0029, p = 0.001) for BMI. No other causal association between smoking (AgeSmk, CigDay, and SmkCes), alcohol consumption, type 2 diabetes, and GU or DU was observed. Consistent results were obtained in sensitivity analyses. Furthermore, the GRS approach showed similar results in the several MR methods. Conclusion: These findings do not support a causal role of AgeSmk, CigDay, SmkCes, alcohol consumption, and type 2 diabetes in the development of GU and DU. However, it is confirmed that SmkInit and BMI have a causal part in the development of GU and DU.
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Affiliation(s)
- Yi Liu
- Department of Digestive System, Anqing Municipal Hospital, Anqing, China,Department of Digestive System, Wannan Medical College, Wuhu, China
| | - Zhihan Xiao
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kun Ye
- Department of Digestive System, Anqing Municipal Hospital, Anqing, China,Department of Digestive System, Wannan Medical College, Wuhu, China
| | - Linlin Xu
- Department of Digestive System, Anqing Municipal Hospital, Anqing, China
| | - Yanping Zhang
- Department of Digestive System, Anqing Municipal Hospital, Anqing, China,*Correspondence: Yanping Zhang,
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Loke SS, Li WC. Peptic Ulcer Disease Associated with Central Obesity. J Pers Med 2022; 12:jpm12121968. [PMID: 36556189 PMCID: PMC9786886 DOI: 10.3390/jpm12121968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
This retrospective cross-sectional study aimed to evaluate associations between peptic ulcer disease (PUD), bone mineral density, and metabolic syndrome (MetS) and its components in healthy populations. Data were collected from the health examination database of a tertiary medical center in southern Taiwan from January 2015 to December 2016. Subjects who had undergone metabolic factors assessment, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scans were enrolled. In total, 5102 subjects were included, with mean age 52.4 ± 12.0 years. Among them, 1332 (26.1%) had PUD. Multivariate logistic regression analysis showed that age (OR 1.03, p < 0.001), male (OR 1.89, p < 0.001), diabetes (OR 1.23, p = 0.004), BMI (OR 1.03, p = 0.001), and GOT (OR 1, p = 0.003) are risk factors for PUD. Regarding MetS parameters, larger waist circumference (OR 1.26, p = 0.001) is associated with PUD, and high triglycerides (OR 1.20, 95% CI 1.01−1.43) is associated with gastric ulcer, while low HDL (OR 1.31, 95% CI 1.07−1.59) and osteoporosis (OR 1.44, 95% CI 1.08−1.91) are associated with duodenal ulcer. In conclusion, central obesity is associated with PUD in a middle-aged healthy population. Subjects with high triglycerides are prone to gastric ulcers, and those with osteoporosis and low HDL are prone to duodenal ulcers.
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Affiliation(s)
- Song-Seng Loke
- Division of Geriatric Medicine, Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 80708, Taiwan
- Correspondence:
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan 32023, Taiwan
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11
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Park SK, Kim MH, Jung JY, Oh CM, Ha E, Yang EH, Lee HC, Hwang WY, You AH, Ryoo JH. Change in smoking status and its relation to the risk of gastroduodenal ulcer in Korean men. J Gastroenterol Hepatol 2022; 37:2091-2097. [PMID: 35940868 DOI: 10.1111/jgh.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Smoking is associated with the increased risk of gastroduodenal ulcer. However, although smoking status can vary over time, most of studies have analyzed this association with smoking status at a single point of time. We analyzed the risk of gastroduodenal ulcer according to change in smoking status for more than 5 years. METHODS Study participants were 43 380 Korean adults free of gastroduodenal ulcer who received health check-up between 2002 and 2013. Through evaluating their smoking status (never, quitter, and current) at 2003-2004 and 2009, they were categorized them into seven groups (never-never, never-quitter, never-current, quitter-quitter, quitter-current, current-quitter, and current-current) and monitored until 2013 to identify incident gastroduodenal ulcer. Cox-proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% confidence interval (CI) for incident gastroduodenal ulcer according to changes in smoking status and smoking amount. RESULTS Compared with never-never group (reference), other groups had the significantly increased adjusted HRs and 95% CI for gastroduodenal ulcer. In particular, participants with current smoking (never-current, quitter-current, and current-current) had the relatively higher HRs than other groups (never-quitter: 1.200 [1.070-1.346], never-current: 1.375 [1.156-1.636], quitter-quitter: 1.149 [1.010-1.306], quitter-current: 1.325 [1.058-1.660], current-quitter: 1.344 [1.188-1.519], and current-current: 1.379 [1.256-1.513]). Heavy smoker had the highest risk for gastroduodenal ulcer, followed by moderate and light smoker. CONCLUSION People who ever experienced smoking had increased risk of gastroduodenal ulcer. Out of smoking status, current smoking is more associated with the increased risk of gastroduodenal ulcer than past smoking.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Min-Ho Kim
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ju Young Jung
- Total Healthcare Center, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Hye Yang
- Department of Occupational and Environmental Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Hyo Choon Lee
- Department of Occupational and Environmental Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital, Seoul, Korea
| | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jae-Hong Ryoo
- Department of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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12
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Ren J, Jin X, Li J, Li R, Gao Y, Zhang J, Wang X, Wang G. The global burden of peptic ulcer disease in 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Int J Epidemiol 2022; 51:1666-1676. [PMID: 35234893 DOI: 10.1093/ije/dyac033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/15/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Peptic ulcer disease is one of the most common diseases in gastroenterology clinics. However, reported data about the global burden of peptic ulcer disease are still scarce. METHODS This was a secondary data analysis on the prevalence, mortality and disability-adjusted life years (DALYs) due to peptic ulcer disease by sex, age group and socio-demographic index (SDI) at the global level in 21 regions and 204 countries and territories between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. RESULTS Globally, the prevalence cases of peptic ulcer disease increased from 6 434 103 (95% uncertainty interval 5 405 963 to 7 627 971) in 1990 to 8 090 476 (6 794 576 to 9 584 000) in 2019. However, the age-standardized prevalence rate decreased from 143.4 (120.5 to 170.2) per 100 000 population in 1990 to 99.4 (83.9 to 117.5) per 100 000 population in 2019. Moreover, the age-standardized mortality rate decreased by 59.4% (55.3 to 63.1) and the DALYs rate fell by 60.6% (56.8 to 63.9) from 1990 to 2019. Across SDI quintiles, low-middle and low SDI quintiles had the highest age-standardized prevalence, mortality and DALYs rates from 1990 to 2019. CONCLUSION The age-standardized prevalence, mortality and DALYs estimates of peptic ulcer disease decreased from 1990 to 2019 globally, but more efforts are needed for the prevention, early diagnosis and treatment of peptic ulcer disease in low SDI and low-middle SDI groups of countries.
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Affiliation(s)
- Jiajia Ren
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuting Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiamei Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingjing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaochuang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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13
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Al-Zahrani MS, Alhassani AA, Zawawi KH. Clinical manifestations of gastrointestinal diseases in the oral cavity. Saudi Dent J 2021; 33:835-841. [PMID: 34938023 PMCID: PMC8665164 DOI: 10.1016/j.sdentj.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Aim In this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed. Materials and methods Using MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed. Results Many gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals. Conclusion Care must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized.
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Affiliation(s)
- Mohammad S Al-Zahrani
- Professor, Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Alhassani
- Assistant Professor, Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid H Zawawi
- Professor, Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabi
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14
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Ajuka Obasi N, Aloke C, Obasi SE, Ogbonnia Egwu C, Clement Famurewa A, Nkemjika Ogbu P. Protective effects of Dialium guineense pulp on aspirin-induced gastric mucosal injury in albino rats. J Appl Biomed 2021; 19:170-178. [PMID: 34907760 DOI: 10.32725/jab.2021.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/07/2021] [Indexed: 11/05/2022] Open
Abstract
The numerous challenges and detrimental effects connected with the treatment of peptic ulcers in the world today calls for alternative attention. Ethnomedicinally, Dialium guineense pulp (DAGP) has numerous pharmacological activities. This study investigated the anti-ulcer activities of Dialium guineense pulp on gastric mucosa injury induced with aspirin in albino Wistar rats. DAGP extract was orally administered at doses of 250, 500 and 1000 mg/kg bw (mg per kg of the body weight) per day for 3 or 7 days followed by 400 mg/kg bw oral aspirin administration. Ulcer indices were determined, followed by a biochemical estimation of antioxidant enzymes using gastric mucosal tissue from the stomach. Student's t-test was used to compare significant differences among groups of animals at P ≤ 0.05. The results showed that Dialium guineense pulp caused a significant decrease (P ≤ 0.05) in the ulcer index in aspirin induced rats. This decrease in ulcer index is dose dependent and 1000 mg/kg bw per day caused the highest decrease in 7 days. The results showed a significant increase (P ≤ 0.05) in lipid peroxidation and a decrease (P ≤ 0.05) in antioxidant enzymes activities in the aspirin-induced ulcerated rats. Oral administration of DAGP increased antioxidant enzymes activities and decreased injury in the gastric mucosa in ulcer induced rats. Therefore, this study showed that DAGP exhibited anti-ulcer potential and that the gastrointestinal protection may be through the scavenging action of free radicals by its constituent antioxidants. Thus, Dialium guineense pulp has ameliorative medicinal potential for the curing of gastric disorders.
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Affiliation(s)
- Nwogo Ajuka Obasi
- Alex Ekwueme Federal University Ndufu-Alike, Department of Medical Biochemistry, Ikwo, Nigeria
| | - Chinyere Aloke
- Alex Ekwueme Federal University Ndufu-Alike, Department of Medical Biochemistry, Ikwo, Nigeria
| | - Stella Eberechukwu Obasi
- Akanu Ibiam Federal Polytechnic Unwana, Department of Science Laboratory Technology, Unwana, Nigeria
| | - Chinedu Ogbonnia Egwu
- Alex Ekwueme Federal University Ndufu-Alike, Department of Medical Biochemistry, Ikwo, Nigeria.,Paul Sabatier University Toulouse III, Department of Biochemistry, Toulouse, France
| | | | - Patience Nkemjika Ogbu
- Alex Ekwueme Federal University Ndufu-Alike, Department of Medical Biochemistry, Ikwo, Nigeria
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15
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Wang Q, Gallardo-Macias R, Rashmi, Golovko MY, Elsayed AAR, More SK, Oncel S, Gurvich VJ, Basson MD. Discovery of Novel Small-Molecule FAK Activators Promoting Mucosal Healing. ACS Med Chem Lett 2021; 12:356-364. [PMID: 33738062 DOI: 10.1021/acsmedchemlett.0c00311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
Gastrointestinal mucosal wounds are common to patients injured by factors as diverse as drugs, inflammatory bowel disease, peptic ulcers, and necrotizing enterocolitis. However, although many drugs are used to ameliorate injurious factors, there is no drug available to actually stimulate mucosal wound healing. Focal adhesion kinase (FAK), a nonreceptor tyrosine kinase, induces epithelial sheet migration and wound healing, making FAK a potential pharmacological target in this regard. In our previous research, we found a lead compound with drug-like properties, ZINC40099027, which promotes FAK phosphorylation, inducing mucosal healing in murine models. Herein we describe the design and optimization of a small library of novel FAK activators based on ZINC40099027 and their applications toward human intestinal epithelial wound closure and mouse ulcer healing.
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Affiliation(s)
- Qinggang Wang
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Ricardo Gallardo-Macias
- Institute for Therapeutics Discovery and Development and Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414, United States
| | - Rashmi
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Mikhail Y. Golovko
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Ahmed Adham Raafat Elsayed
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Shyam K. More
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Sema Oncel
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
| | - Vadim J. Gurvich
- Institute for Therapeutics Discovery and Development and Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414, United States
| | - Marc D. Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Grand Forks, North Dakota 58201, United States
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16
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Kim B, Kim BJ, Yoon HJ, Lee H, Park JY, Choi CH, Kim JG. Atypical Scar Patterns after Gastric Endoscopic Submucosal Dissection. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) for gastric neoplasms is a widely performed procedure. Local recurrence is rare, but various post-ESD scars are encountered during follow-up endoscopy. Therefore, we investigated atypical scar patterns and evaluated the associated factors.Materials and Methods: Clinicopathologic and endoscopic reviews of gastric neoplasms treated with ESD from January 2009 to December 2015 were conducted. Atypical scar patterns were classified as irregular erythema, nodularity, or mucosal defect.Results: A total of 264 patients with 274 gastric neoplasms, including 201 adenomas and 73 early gastric cancers, were enrolled. The key endoscopic findings at the resection scar were defined on the basis of gross morphology as follows: irregular erythema, mucosal defect (erosion or ulcer), and nodularity. An irregular erythema scar pattern was associated with male sex, a nodularity scar pattern with smoking, and a mucosal defect scar pattern with infra-angle location (angle and antrum) and cancer. An irregular erythema with nodularity scar pattern was also associated with male sex. An irregular erythema with nodularity and mucosal defect scar pattern was associated with liver disease and chronic kidney disease.Conclusions: The atypical scar patterns after gastric ESD are associated with various clinicopathologic factors.
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17
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A retrospective observation on 105 patients with chronic cluster headache receiving indomethacin. Neurol Sci 2021; 42:4175-4182. [PMID: 33547540 DOI: 10.1007/s10072-021-05114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Indomethacin (IMC) as a prophylactic treatment is considered to be ineffective in cluster headache (CH). However, small series suggested the interest of IMC in CH. Some authors support that an IMC test is useful in all trigeminal autonomic cephalalgias. We described clinical features of IMC responders in a retrospective cohort of chronic cluster headache (CCH). METHODS This single-center and retrospective study was conducted in a tertiary care specialist headache center in France. Patients were selected between January 2007 and December 2008. We included all patients fulfilling CCH criteria (ICHD-3-beta). Data were collected from medical records. We recorded all the prescriptions of IMC as a prophylactic treatment. Responders were defined by 50% reduction in attack frequency; complete response was defined by disappearance of the attacks. The non-responders must have received at least 100 mg daily during 7 days. RESULTS The study consisted of 324 CCH, 121 female (37%) and 203 males (63%) with an average age at onset of 33.93 (± 14.71) years. Of the patients, 105 were treated with IMC. Thirty patients (29%) were responders. Thirty-four patients (32%) were non-responders. Responding status was undefined for 41 patients (39%). Twelve patients (11%) had a complete response. Responders were composed by 18 women (60%) and 12 men (40%) and had on average 44.89 (± 12.88) years. The minimal effective dose was 86.11 mg daily (± 48.72). DISCUSSION This study shows the interest of IMC in CCH patients. We recommend an IMC test as a third-line treatment in CCH.
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18
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Huang H, Rong Y, Wang M, Guo Z, Yu Y, Long Z, Chen X, Wang H, Ding J, Yan L, Peng J. Analysis of gastroscopy results among healthy people undergoing a medical checkup: a retrospective study. BMC Gastroenterol 2020; 20:412. [PMID: 33297981 PMCID: PMC7724807 DOI: 10.1186/s12876-020-01557-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background The association of upper gastrointestinal endoscopic findings with sex, age, and Helicobacter pylori infection in asymptomatic healthy people is unclear. The aim of this study was to retrospectively determine the associations of upper gastrointestinal endoscopic findings in asymptomatic healthy people with sex, age, and H. pylori infection.
Methods A retrospective study was conducted on 2923 patients from a health examination center in Xiangya Hospital between September 2015 and September 2019. Data on sex, age, H. pylori infection, and gastroscopy results were collected.
Results Among 2923 asymptomatic patients who underwent gastroscopy, 2911 (99.59%) had abnormal results. The top three results were chronic gastritis (95.11%), peptic ulcer (17.45%), and duodenitis (9.17%). Inflammation of the gastric mucosa in chronic gastritis was more severe in the H. pylori-positive group. The incidence of peptic ulcer decreased with increasing age and was higher in men, patients aged < 30 years, and H. pylori-positive patients. The incidence of polyps was higher in women (9.54%) than in men (5.94%), and the incidence in individuals aged ≥60 years (11.63%) was higher than that in those aged < 60 years (6.83%). The pathological results of gastric polyps depended on the location of the lesion. Conclusion The incidence of abnormal upper gastrointestinal endoscopic results is high in asymptomatic healthy people undergoing a check-up and is associated with sex, age, and H. pylori infection. Gastroscopy should be considered part of a routine health check.
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Affiliation(s)
- Haosu Huang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Yanting Rong
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Meng Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Zimeng Guo
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Yanghua Yu
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Zhenpu Long
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Xiaoxiao Chen
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Hanyue Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Junjie Ding
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Lu Yan
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Jie Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
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Mathews L, Ishigami J, Ding N, Hoogeveen RC, Kucharska-Newton A, Ballantyne CM, Gottesman R, Selvin E, Matsushita K. Cardiac Biomarkers and Subsequent Risk of Hospitalization With Bleeding in the Community: Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2020; 9:e013560. [PMID: 32114886 PMCID: PMC7335570 DOI: 10.1161/jaha.119.013560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background hs‐cTnT (high‐sensitivity cardiac troponin T), but not NT‐proBNP (N‐terminal pro–B natriuretic peptide), has been shown to predict bleeding in patients with atrial fibrillation. Whether these biomarkers are independently associated with bleeding in the general population is unknown. Methods and Results We used Cox proportional hazards models to examine the association of hs‐cTnT and NT‐proBNP with incident bleeding (defined by International Classification of Diseases, Ninth Revision [ICD‐9] codes) among 9550 middle‐aged men and women without a history of cardiovascular disease or bleeding. There were 847 hospitalizations with bleeding (92% from gastrointestinal bleeding) during a median follow‐up of 9.0 years. Serum levels of hs‐cTnT were associated with bleeding in a graded fashion, with a hazard ratio of 1.28 (95% CI, 1.06–1.59) for 6 to <9 ng/L, 1.52 (1.21–1.91) for 9 to <14, and 2.05 (1.56–2.69) for ≥14 versus <3 ng/L. For NT‐proBNP, the highest category (≥264 versus <42 pg/mL) showed a hazard ratio of 2.00 (1.59–2.61), and the remaining 3 categories had hazard ratios ranging from 1.2 to 1.3. Individuals in the highest category of both hs‐cTnT and NT‐proBNP had a hazard ratio of 3.03 (1.97–4.68) compared with those in the lowest categories. Conclusions In a community‐based population, elevated hs‐cTnT and NT‐proBNP were associated with bleeding‐related hospitalizations. These biomarkers may have a high utility in identifying people at high risk for bleeding. There is a need for research on the underlying mechanisms linking subclinical cardiac abnormalities and bleeding.
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Affiliation(s)
- Lena Mathews
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Johns Hopkins School of Medicine Baltimore MD
| | - Junichi Ishigami
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ning Ding
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ron C Hoogeveen
- Department of Medicine Baylor College of Medicine Houston TX
| | - Anna Kucharska-Newton
- Gillings School of Global Public Health University of North Carolina at Chapel Hill NC.,College of Public Health University of Kentucky Lexington KY
| | | | - Rebecca Gottesman
- Department of Neurology Johns Hopkins School of Medicine Baltimore MD
| | - Elizabeth Selvin
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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20
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Costa-Moreira P, Vilas-Boas F, Teixeira Fraga A, Macedo G. Particular aspects of gastroenterological disorders in chronic kidney disease and end-stage renal disease patients: a clinically focused review. Scand J Gastroenterol 2020; 55:129-138. [PMID: 32027522 DOI: 10.1080/00365521.2020.1722217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Besides renal disease, gastrointestinal (GI) disorders are frequently reported in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Related gastrointestinal symptoms tend to increase as the renal disease progresses. Also, in patients with ESRD, the modality of dialysis is related to particular forms of GI disorders.The kidney can interact with the digestive organs through functional endogenous systems such as the 'kidney-colon axis' and the 'kidney-liver axis'. Digestive diseases are one of the visible manifestations of the disturbance between hemostatic, hemodynamic and immunological balance in such patients.No clear management guidelines currently exist for many of the gastrointestinal problems that accompany renal failure. This review aims to describe the particular aspects of GI diseases present in CKD/ESRD. We focus our discussion in the specificities of epidemiology, diagnosis, and prognosis of such disorders between the different segments of the digestive system.
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Affiliation(s)
- Pedro Costa-Moreira
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Medicine Department, University of Porto, Portugal
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Medicine Department, University of Porto, Portugal
| | | | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Medicine Department, University of Porto, Portugal
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Helicobacter pylori Infection, Virulence Genes' Distribution and Accompanying Clinical Outcomes: The West Africa Situation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7312908. [PMID: 31886245 PMCID: PMC6925786 DOI: 10.1155/2019/7312908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
Data on Helicobacter pylori (H. pylori) infection and virulence factors in countries across West Africa are scattered. This systematic review seeks to present an update on the status of H. pylori infection focusing on prevalence rate, distribution of virulent genes, and their link to clinical outcomes across countries in the western part of Africa. This information is expected to broaden the knowledge base of clinicians and researchers regarding H. pylori infection and associated virulence factors in West African countries. Search Method. A comprehensive search of the scientific literature in PubMed and ScienceDirect was conducted using the search terms including “Helicobacter pylori infection in West Africa”. Databases were sourced from January 1988 to December 2018. Results. Data on the incidence of H. pylori infection and related pathological factors were found for some countries, whereas others had no information on it. Smoking, alcohol, exposure to high levels of carcinogens and diet were reported to be involved in the pathogenesis of gastroduodenal diseases and gastric cancer. Besides the environmental factors and genetic characteristics, there are important characteristics of H. pylori such as the ability to infect, replicate, and persist in a host that have been associated with the pathogenesis of various gastroduodenal diseases. Concluding Remarks. This systematic search has provided information so far available on H. pylori virulence factors and clinical outcomes in West Africa. Accordingly, this piece has identified gaps in the body of knowledge highlighting the need for more studies to clarify the role of H. pylori virulence factors and associated clinical outcomes in the burden of this bacterial infection in West Africa, as data from these countries do not give the needed direct relation.
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Obesity and Risk of Peptic Ulcer Disease: A Large-Scale Health Check-Up Cohort Study. Nutrients 2019; 11:nu11061288. [PMID: 31174419 PMCID: PMC6627340 DOI: 10.3390/nu11061288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023] Open
Abstract
The association between obesity and peptic ulcer disease (PUD) is inconclusive. To evaluate the association of obesity and metabolically healthy obesity (MHO) with PUD risk, we performed a retrospective cohort study of 32,472 subjects without PUD at baseline who underwent repeated health examinations. Participants were stratified by body mass index (BMI) and metabolically healthy state. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard modelling. During the follow-up period, 1940 PUD cases occurred. PUD, particularly gastric ulcer (GU), had significantly higher cumulative incidence in obese subjects compared to non-obese subjects (p value < 0.001). The HR for developing GU was 1.32 (95% CI, 1.16-1.49; p value <0.001); after adjusting for confounding factors (lifestyle, metabolic, and Helicobacter pylori status), the association was no more significant (p value = 0.789). For duodenal ulcer (DU), cumulative incidence between obese and non-obese groups was not significantly different (p value = 0.464). The risk of developing DU in the obese group was not significantly different from the non-obese group (HR 0.95; 95% CI, 0.83-1.09; p value = 0.469) and consistently showed no association after adjusting for metabolic parameters (p value = 0.199). Furthermore, MHO subjects had no increase in GU or DU risks. In this large cohort study, PUD risk was not associated with obesity or MHO.
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Chuang YS, Wu MC, Wang YK, Chen YH, Kuo CH, Wu DC, Wu MT, Wu IC. Risks of substance uses, alcohol flush response, Helicobacter pylori infection and upper digestive tract diseases-An endoscopy cross-sectional study. Kaohsiung J Med Sci 2019; 35:341-349. [PMID: 31001924 DOI: 10.1002/kjm2.12071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022] Open
Abstract
This study examines the effects of environmental hazards, including tobacco, alcohol/alcohol flush response, areca nut, and Helicobacter pylori (H pylori) infection on upper digestive diseases. This is a multi-hospital-based endoscopy-survey cross-sectional study. Subjects were received upper endoscopies in outpatient clinics at four hospitals in Taiwan between 2008 and 2013. Biopsy-based methods or urea breath test were used confirm the status of H pylori infection. In total, 8135 subjects were analyzed. Higher cumulative amounts of alcohol consumption were at higher risk of Barrett's esophagus and esophageal squamous cell carcinoma (ESCC), higher cumulative amounts of tobacco consumption were at higher risk of peptic ulcer, and higher cumulative amounts of areca nut consumption were at higher risk of duodenitis. Alcohol flush response was significant risk for reflux esophagitis and Barrett's esophagus (adjusted odds ratio [aOR] = 1.18 and 1.32, 95% confidence interval [CI] = 1.07-1.31 and 1.06-1.65, respectively). H pylori infection was inversely associated with ESCC risk (aOR = 0.20, 95% CI = 0.10-0.40). In addition, H pylori infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis (aOR = 5.51, 1.84, and 2.10, 95% CI = 4.85-6.26, 1.03-3.26, and 1.71-2.56, respectively). Besides the cumulative risk of alcohol, tobacco, and areca nut for Barrett's esophagus, ESCC, and peptic ulcer, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barrett's esophagus. H pylori infection was positively associated with peptic ulcer, gastric adenocarcinoma, and duodenitis, but inversely associated with ESCC.
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Affiliation(s)
- Yun-Shiuan Chuang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Hsun Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Tsang Wu
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Peptic ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have peptic ulcer disease are asymptomatic. In symptomatic patients, the most common presenting symptom of peptic ulcer disease is epigastric pain, which may be associated with dyspepsia, bloating, abdominal fullness, nausea, or early satiety. Most cases of peptic ulcer disease are associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), or both. In this review, we discuss the role of proton pump inhibitors in the management of peptic ulcer disease, highlight the latest guidelines about the diagnosis and management of H. pylori, and discuss the latest evidence in the management of complications related to peptic ulcer disease, including endoscopic intervention for peptic ulcer-related bleeding. Timely diagnosis and treatment of peptic ulcer disease and its sequelae are crucial in order to minimize associated morbidity and mortality, as is prevention of peptic ulcer disease among patients at high risk, including those infected with H. pylori and users of NSAIDs.
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25
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Lee BJ, Kim J, Kim KH. Association of gastric and duodenal ulcers with anthropometry and nutrients: Korean National Health and Nutrition Examination Survey (KNHANES II-IV) 2001-2009. PLoS One 2018; 13:e0207373. [PMID: 30440018 PMCID: PMC6237383 DOI: 10.1371/journal.pone.0207373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/30/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives The objective of this study was to examine the association of peptic ulcer disease (PUD), including gastric ulcer and duodenal ulcer, with obesity-related indices, nutrients, and blood parameters in Korean adults. Methods Data were obtained from the Second-Fourth Korean National Health and Nutrition Examination Survey (KNHANES II-IV). Binary logistic regression was carried out to analyze the association between PUD and all variables in the crude analysis; in a subsequent analysis, adjustments were made for age, region, house type, number of snacks per day, and number of household members. Results PUD exhibited the highest association with age in both men and women among all variables used in this study. In men, only body mass index was associated with PUD in both the crude and adjusted analyses. PUD was associated with weight, height, and fat in the crude analysis, but these associations disappeared after adjustment for confounders. Vitamin B2, hemoglobin, and glucose were related to PUD, but these associations became nonsignificant in the adjusted analysis. Water, vitamin C, and potassium were not associated with PUD in the crude analysis but were associated with PUD after adjustment for confounders. In women, systolic blood pressure and height were associated with PUD. PUD was also related to waist circumference, the waist-to-height ratio, fat, and cholesterol, but these associations became nonsignificant after adjustment for confounders. Vitamin C, protein, niacin, sodium, energy, vitamin B2, vitamin B1, and aspartate aminotransferases were associated with PUD in only the crude analysis. PUD was not associated with diastolic blood pressure, water, vitamin A, or glucose, but these factors were associated with the disease in the adjusted analysis. Conclusion Older age was a risk factor for PUD in Korean adults, and the association of PUD with most nutrients and anthropometric indices may differ according to gender.
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Affiliation(s)
- Bum Ju Lee
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- * E-mail:
| | - Jihye Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Keun Ho Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Zuo Y, Wang S, Cui X, Lv H. Therapeutic Endoscopy in Combination with Quadruple Therapy in Treating Bleeding Caused by Gastric Ulcer. Pak J Med Sci 2018; 34:10-14. [PMID: 29643870 PMCID: PMC5856990 DOI: 10.12669/pjms.341.13418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To analyze the efficacy of therapeutic endoscopy in combination with quadruple therapy in treating bleeding caused by gastric ulcer and investigate the factors inducing rebleeding. Methods: Two hundred and twelve patients with bleeding caused by gastric ulcer who were admitted to Binzhou People's Hospital, Shandong, China between April 2015 and April 2016 were selected as research subjects. The patients were randomly divided into a control group and an experimental group. Patients in the control group were treated by quadruple therapy, while patients in the observation group received therapeutic endoscopy treatment in addition to the same treatment as the control group. The treatment efficacy, adverse reaction, H pylori (Hp) clearance rate and rebleeding were compared between the two groups. Results: The effective rate of the observation group was 98.1%, which was significantly higher than that of the control group (80.2%), and the difference had statistical significance (P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group. The Hp clearance rate of the observation group was higher than that of the control group, and the difference had statistical significance (P<0.05). The multi-factor analysis on rebleeding suggested that whether therapeutic endoscopy was performed or not, hemoglobin level and presence of peptic ulcer stage A1 were independent risk factors. Conclusion: Endoscopic treatment in combination with quadruple therapy is better in the treatment of bleeding caused by gastric ulcer as compared to medical treatment alone. Patients with high-risk factors such as low content of hemoglobin and ulcer at stage A1 should be monitored more carefully to prevent the occurrence of rebleeding.
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Affiliation(s)
- Yuqin Zuo
- Yuqin Zuo, Department of Gastroenterology, Binzhou People's Hospital, Shandong, 256600, China
| | - Shuhui Wang
- Shuhui Wang, Department of Ophthalmology, Binzhou People's Hospital, Shandong, 256600, China
| | - Xiujuan Cui
- Xiujuan Cui, Department of Neurosurgery, Binzhou People's Hospital, Shandong, 256600, China
| | - Hongna Lv
- Hongna Lv, Department of Gastroenterology, Binzhou People's Hospital, Shandong, 256600, China
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27
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First-Line Helicobacter pylori Eradication in Patients with Chronic Kidney Diseases in Taiwan. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3762194. [PMID: 29376072 PMCID: PMC5742431 DOI: 10.1155/2017/3762194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 12/24/2022]
Abstract
Aims Patients with chronic kidney disease (CKD) and Helicobacter pylori (H. pylori) infection have a higher incidence of gastroduodenal diseases and therefore are recommended to receive eradication therapies. This study aimed to assess the efficacy of a 7-day standard triple therapy in patients with CKD (eGFR < 60 ml/min/1.73 m2) and to investigate the clinical factors influencing the success of eradication. Methods A total of 758 patients with H. pylori infection receiving a 7-day standard first-line triple therapy between January 1, 2013, and December 31, 2014, were recruited. Patients were divided into two groups: CKD group (N = 130) and non-CKD group (N = 628). Results The eradication rates attained by the CKD and non-CKD groups were 85.4% and 85.7%, respectively, in the per-protocol analysis (p = 0.933). The eradication rate in CKD stage 3 was 84.5% (82/97), in stage 4 was 88.2% (15/17), and in those who received hemodialysis was 87.5% (14/16). There were no significant differences in the various stages of CKD (p = 0.982). The adverse events were similar between the two groups (3.1% versus 4.6%, p = 0.433). Compliance between the two groups was good (100.0% versus 99.8%, p = 0.649). There was no significant clinical factor influencing the H. pylori eradication rate in the non-CKD and CKD groups. Conclusions This study suggests that the H. pylori eradication rate and adverse rate in patients with CKD are comparable to those of non-CKD patients.
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Zvolensky MJ, Bakhshaie J, Norton PJ, Smits JA, Buckner JD, Garey L, Manning K. Visceral sensitivity, anxiety, and smoking among treatment-seeking smokers. Addict Behav 2017; 75:1-6. [PMID: 28654824 PMCID: PMC10062190 DOI: 10.1016/j.addbeh.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 01/22/2023]
Abstract
It is widely recognized that smoking is related to abdominal pain and discomfort, as well as gastrointestinal disorders. Research has shown that visceral sensitivity, experiencing anxiety around gastrointestinal sensations, is associated with poorer gastrointestinal health and related health outcomes. Visceral sensitivity also increases anxiety symptoms and mediates the relation with other risk factors, including gastrointestinal distress. No work to date, however, has evaluated visceral sensitivity in the context of smoking despite the strong association between smoking and poor physical and mental health. The current study sought to examine visceral sensitivity as a unique predictor of cigarette dependence, threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), and perceived barriers for cessation via anxiety symptoms. Eighty-four treatment seeking adult daily smokers (Mage=45.1years [SD=10.4]; 71.6% male) participated in this study. There was a statistically significant indirect effect of visceral sensitivity via general anxiety symptoms on cigarette dependence (b=0.02, SE=0.01, Bootstrapped 95% CI [0.006, 0.05]), smoking abstinence somatic expectancies (b=0.10, SE=0.03, Bootstrapped 95% CI [0.03, 0.19]), smoking abstinence harmful experiences (b=0.13, SE=0.05, Bootstrapped 95% CI [0.03, 0.25]), and barriers to cessation (b=0.05, SE=0.06, Bootstrapped 95% CI [0.01, 0.13]). Overall, the present study serves as an initial investigation into the nature of the associations between visceral sensitivity, anxiety symptoms, and clinically significant smoking processes among treatment-seeking smokers. Future work is needed to explore the extent to which anxiety accounts for relations between visceral sensitivity and other smoking processes (e.g., withdrawal, cessation outcome).
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29
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Mearin F, Lanas Á, Bujanda L, Canelles P, Cotter J, Hervás A, Martín de Argila C, Montoro M, Gisbert JP. Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:63-76. [PMID: 29107389 DOI: 10.1016/j.gastrohep.2017.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.
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Affiliation(s)
- Fermín Mearin
- Servicio de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - Ángel Lanas
- Servicio de Enfermedades Digestivas, Hospital Universitario, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínico Universitario, Zaragoza, España
| | - Luis Bujanda
- Departamento de Gastroenterología, Hospital Donostia/Instituto Biodonostia; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Pilar Canelles
- Servicio de Patología Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - José Cotter
- Departamento de Gastroenterología, Hospital da Senhora da Oliveira, Guimarães, Portugal; Instituto de Investigación en Ciencias de la Vida y la Salud (ICVS), Escuela de Ciencias de la Salud, Universidad de Minho, Portugal; ICVS/3B's, Laboratorio Asociado al Gobierno de Portugal, Braga/Guimarães, Portugal
| | - Antonio Hervás
- Servicio de Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Carlos Martín de Argila
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Miguel Montoro
- Departamento de Gastroenterología, Hospital General San Jorge, Huesca, España
| | - Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
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30
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Lee YB, Yu J, Choi HH, Jeon BS, Kim HK, Kim SW, Kim SS, Park YG, Chae HS. The association between peptic ulcer diseases and mental health problems: A population-based study: a STROBE compliant article. Medicine (Baltimore) 2017; 96:e7828. [PMID: 28834889 PMCID: PMC5572011 DOI: 10.1097/md.0000000000007828] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aimed to investigate the association between the prevalence of peptic ulcer disease (PUD) and mental health problems, such as severe stress, depressive mood, and suicidal ideation.The population-based cross-sectional study was comprised of 14,266 subjects participating in the fourth annual Korea National Health and Nutrition Examination survey from 2007 to 2009. The participants were divided into 2 groups according to the self-reported questionnaires: the PUD group and the non-PUD group. The association between PUD and mental health problems, such as severe stress, depressed mood, suicidal ideation, and psychological counseling history, were evaluated by using multivariate analysis and logistic regression.Among the 14,266 participants over 19-years old, 813 participants (5.6%) had PUD. Compared to the non-PUD group (n = 13,453), the PUD group had a significantly higher percentage of males, current smokers, and heavy drinkers, lower education status, lower income, and greater presence of diabetes mellitus, hypertension, metabolic syndrome and mental health problems, including severe stress, depressed mood, suicidal ideation, and psychological counseling history. After adjustment for lifestyle and medical and environmental factors, mental health problems were found to be associated with a significantly higher risk for PUD.Psychological problems, such as severe stress, depressed mood, suicidal ideation, and psychological counseling, were associated with PUD prevalence.
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Affiliation(s)
- Young Bok Lee
- Department of Dermatology, The Catholic University of Korea
| | - Jihan Yu
- Department of Internal Medicine, HeeMyoung General Hospital
| | | | | | | | | | | | - Yong Gyu Park
- Department of Medical Statistics, The Catholic University of Korea, Seoul, South Korea
| | - Hiun Suk Chae
- Department of Internal Medicine, HeeMyoung General Hospital
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31
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Huang KW, Kuan YC, Chi NF, Huang YH, Luo JC, Chien LN. Chronic obstructive pulmonary disease is associated with increased recurrent peptic ulcer bleeding risk. Eur J Intern Med 2017; 37:75-82. [PMID: 27727075 DOI: 10.1016/j.ejim.2016.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/06/2016] [Accepted: 09/25/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The association between chronic obstructive pulmonary disease (COPD) and the risk of recurrent peptic ulcer bleeding (PUB) remains unclear. In this study, we compared the risk of recurrent PUB between patients with and those without COPD. METHODS Using the Taiwan National Health Insurance Research Database, we first selected patients newly diagnosed with PUB in 2002-2009. Two groups comprising 13,732 COPD cases and 13,732 non-COPD matched controls were created using propensity score matching, thereby making the differences in basic demographics, medication use, and disease conditions between the two groups negligible. Cox proportional hazard regression was used to evaluate the risk of recurrent PUB during the follow-up period. RESULTS The cumulative recurrence rate of PUB was significantly higher in the patients with COPD than in the non-COPD matched controls (2years: 10.8% vs 9.3%; 6years: 18.3% vs 15.7%, P all <0.05), with an adjusted hazard ratio (HR) of 1.17 (95% confidence interval [CI], 1.08-1.26, P<0.001) and 1.19 (95% CI, 1.12-1.26, P<0.001) within 2-year and 6-year follow-ups, respectively. Patients with COPD using steroids were at a marginally higher risk of recurrent PUB than those who did not use steroids. Multivariate stratified analysis revealed similar results in many subgroups. CONCLUSIONS The risk of recurrent PUB is higher in patients with COPD than in patients without COPD.
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Affiliation(s)
- Kuang-Wei Huang
- Division of Gastroenterology, Department of Internal Medicine, Taipei Beitou Health Management Hospital, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Nai-Fang Chi
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Hsien Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiing-Chyuan Luo
- Division of Gastroenterology, Department of Internal Medicine, Taipei, Veterans General Hospital, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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32
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Ko SH, Baeg MK, Ko SY, Han KD. Women Who Sleep More Have Reduced Risk of Peptic Ulcer Disease; Korean National Health and Nutrition Examination Survey (2008-2009). Sci Rep 2016; 6:36925. [PMID: 27830741 PMCID: PMC5103261 DOI: 10.1038/srep36925] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/21/2016] [Indexed: 12/17/2022] Open
Abstract
Sleep is integral to life and sleep duration is important in sleep quality, physical, and psychological health. Disturbances in sleep duration have been associated with increased risk of metabolic disorders, hypertension, and overall mortality. Sleep disturbance has also been linked with various gastrointestinal disorders. However, the association between sleep and peptic ulcer disease (PUD) has not been evaluated. We investigated the association between sleep duration and PUD. Subjects were included from the fifth Korean National Health and Nutrition Examination Survey conducted from 2008-2009. Individuals with PUD were defined as those with a physician diagnosis of PUD. Daily sleep duration was established by asking participants the amount of time that they slept per day. Multiple logistic regression models were used to evaluate the association of PUD and sleep duration. This study included 14,290 participants (8,209 women). The prevalence of PUD was 5.7% and was higher in men (6.8%) than in women (4.9%). Women who slept ≥9 hours were significantly less likely to have PUD compared to women who slept 7 hours. In men, longer sleep duration (≥9 hours) had a tendency toward PUD prevention. Our results suggest that longer sleep duration may play a protective role for PUD development.
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Affiliation(s)
- Sun-Hye Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myong Ki Baeg
- Department of Internal Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, South Korea.,Institute for Translational and Clinical Research, Catholic Kwandong University, Incheon, South Korea
| | - Seung Yeon Ko
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Kyung-Do Han
- Department of Preventive Medicine, The Catholic University of Korea, Seoul, South Korea
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Liang CM, Hsu CN, Tai WC, Yang SC, Wu CK, Shih CW, Ku MK, Yuan LT, Wang JW, Tseng KL, Sun WC, Hung TH, Nguang SH, Hsu PI, Wu DC, Chuah SK. Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis: A nationwide cohort study. Medicine (Baltimore) 2016; 95:e4795. [PMID: 27603387 PMCID: PMC5023910 DOI: 10.1097/md.0000000000004795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45-0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.
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Affiliation(s)
- Chih-Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Gang Gung Memorial Hospital, Kaohsiung
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine
- Chang Gung University, College of Medicine, Kaohsiung
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Chih-Wei Shih
- Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Ming-Kun Ku
- Division of Gastroenterology, Fu-Ying University Hospital, Pin-Tung
| | - Lan-Ting Yuan
- Divisions of Gastroenterology, Yuan General Hospital, Kaohsiung
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Kuo-Lun Tseng
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Wei-Chih Sun
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung
| | - Tsung-Hsing Hung
- Division of Gastroenterology; Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Seng-Howe Nguang
- Division of Gastroenterology; Pin-Tung Christian Hospital, Pin-Tung, Taiwan
| | - Pin-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Correspondence: Seng-Kee Chuah and Deng-Chyang Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan (e-mails: and )
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine
- Chang Gung University, College of Medicine, Kaohsiung
- Correspondence: Seng-Kee Chuah and Deng-Chyang Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan (e-mails: and )
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Knightly R, Tadros G, Sharma J, Duffield P, Carnall E, Fisher J, Salman S. Alcohol screening for older adults in an acute general hospital: FAST v. MAST-G assessments. BJPsych Bull 2016; 40:72-6. [PMID: 27087989 PMCID: PMC4817649 DOI: 10.1192/pb.bp.114.049734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method Documented prevalence of alcohol misuse among older adult patients at Birmingham Heartlands Hospital is significantly lower than the national prevalence. We aimed to evaluate our alcohol misuse screening protocol for older adults to identify possible shortcomings. Hospital protocol is to screen all adults for alcohol misuse in the accident and emergency (A&E) department using the Fast Alcohol Screening Test (FAST). One hundred consecutive consenting in-patients aged 65-94 admitted via A&E subsequently undertook an additional alcohol screening test (Michigan Alcoholism Screening Test-Geriatric version; MAST-G). Results of the two tests were compared. Results FAST screening was completed for 71 patients and none were FAST-positive for alcohol misuse, yet using MAST-G, 18 patients scored positively for alcohol misuse. FAST screening failed to identify 8 patients with a documented history of alcohol misuse. Clinical implications Older adult alcohol misuse prevalence is significantly underreported using FAST. Screening older adults for alcohol problems requires a different approach to screening the general population.
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Affiliation(s)
- Rachel Knightly
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham
| | - George Tadros
- Birmingham and Solihull Mental Health Foundation Trust, City Hospital, Birmingham
| | - Juhi Sharma
- Birmingham and Solihull Mental Health Foundation Trust, City Hospital, Birmingham
| | - Peter Duffield
- Birmingham and Solihull Mental Health Foundation Trust, City Hospital, Birmingham
| | | | | | - Shaza Salman
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham
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Zhao Y, Guo J, You B, Hou S, Hu B, Li H. The dynamic of nasogastric decompression after esophagectomy and its predictive value of postoperative complications. J Thorac Dis 2016; 8:S99-S106. [PMID: 26941977 DOI: 10.3978/j.issn.2072-1439.2015.10.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To investigate the regularity and the influence factors of nasogastric decompression volume after esophagectomy, and explore whether the volume of nasogastric decompression can be employed as a predictor for postoperative complications of esophageal carcinoma. METHODS Consecutive 247 patients with esophageal cancer who underwent esophagectomy were retrospectively evaluated. The volume of postoperative nasogastric decompression was recorded and the regularity based on it was described. The single and multiple factors regression analysis were used to find out relative factors of the nasogastric decompression volume among the patients without postoperative complication. Gender, age, height, weight, tobacco or alcohol exposure, location of the tumor, histological type, pathological staging, operation time, surgical procedures, anastomotic position and gastric conduit reconstruction were considered as the independent variable. Then, verify the former regression models using the data of patients with postoperative complications. RESULTS In trend analysis, the curve estimation revealed a quadratic trend in the relationship between nasogastric decompression volume and postoperative days (R(2) =0.890, P=0.004). The volume of postoperative nasogastric decompression was described by daily drainage (mL) =82.215 + 69.620 × days - 6.604 × days(2). The results of multiple linear stepwise regression analysis showed that gastric conduit reconstruction (β=0.410, P=0.000), smoking (β=-0.231, P=0.000), age (β=-0.193, P=0.001) and histological type of the tumor (β=-0.169, P=0.006) were significantly related to the volume of nasogastric decompression. The average drainage in 5 days after surgery =262.287 + 132.873 × X1 - 72.160 × X2 - 27.904 × X3 - 36.368 × X4 (X1, gastric conduit reconstruction; X2, smoking; X3, histological type; X4, age). The nasogastric decompression of the patients with delayed gastric emptying, and lung infection statistically differ from their predictive values respectively according to the former equation (P<0.01), but the data of anastomotic leakage cases had no significance difference (P=0.344). CONCLUSIONS It is found that the volume of postoperative nasogastric decompression presents a quadratic trend based on the days after esophagectomy. Gastric conduit reconstruction, smoking history, age and histological type were independent factors affecting on the volume of postoperative nasogastric decompression. Also, the volume of nasogastric decompression has validity and application value for predicting postoperative complications.
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Affiliation(s)
- Yan Zhao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jie Guo
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin You
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shengcai Hou
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Kim MK, Ko BJ, Kim EY, Han BD, Cho KH. Fast Eating Speed Increases the Risk of Endoscopic Erosive Gastritis in Korean Adults. Korean J Fam Med 2015; 36:300-4. [PMID: 26634096 PMCID: PMC4666865 DOI: 10.4082/kjfm.2015.36.6.300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fast eating or overeating can induce gastrointestinal diseases such as gastritis. However, the association between gastritis and speed of eating is unclear. The aim of this study was to determine whether eating speed is associated with increased risk of endoscopic erosive gastritis (EEG). METHODS We carried out a cross-sectional study involving 10,893 adults who underwent a general health checkup between 2007 and 2009. Two groups, EEG patients and EEG-free patients, were compared by using the t-test and the chi-square test. Multiple logistic regression analyses were performed to investigate the association between eating speed and EEG. RESULTS The group with EEG had a higher proportion of males, average age, body mass index, and percentages of current smokers and risky drinkers than those without EEG. After adjusting for anthropometric, social, and endoscopic parameters, the group with the highest eating speed (<5 min/meal) had 1.7 times higher risk for EEG than the group with the lowest eating speed (≥15 min/meal) (odds ratio, 1.71; 95% confidence interval, 1.20-2.45). CONCLUSION High eating speed is an independent risk factor for EEG. Our results indicate the need for further studies to clarify the role of eating speed in gastritis.
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Affiliation(s)
- Min-Kyung Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Joon Ko
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - E-Yeon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byoung-Duck Han
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Kao LT, Tsai MC, Lin HC, Pai F, Lee CZ. Weekly pattern of emergency room admissions for peptic ulcers: A population-based study. World J Gastroenterol 2015; 21:3344-3350. [PMID: 25805943 PMCID: PMC4363766 DOI: 10.3748/wjg.v21.i11.3344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/09/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate variations in the incidence of peptic ulcers (PUs) in Taiwan by day of the week within age subgroups.
METHODS: Ambulatory care data were retrieved from the Longitudinal Health Insurance Database 2000. There were 7204 subjects ≥ 18 years-old with an emergency room admission claim for the treatment of PUs, resulting in a total of 9234 emergency room visits for PUs between 2009 and 2011. Data was divided into the seven days of the week and an additional variable for holidays. One-way analysis of variance was used to examine associations among the daily mean number of PU emergency room admissions and holidays/weekends/weekdays.
RESULTS: One-way analysis of variance showed that there was a significant difference in emergency room admissions for PUs by the day of the week (P < 0.001), with admission more likely to occur on Sundays or holidays than weekdays within the total and working populations. The weekday patterns of admission were similar for the patients aged 18-64 years and ≥ 65 years of age. Holidays, followed by Sundays, had higher PU admissions than the mean daily PU emergency room admissions. Furthermore, inclusion of only those treated for PUs with hemorrhage or perforation, Sundays and holidays had higher mean emergency room admissions than other days. Inclusion of patients who diagnosed with Helicobacter pylori infection, only holidays had higher mean emergency room admissions than other days. Inclusion of patients who had been prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for over 30 d, Sundays and holidays had higher mean PU ER admissions than other non-holiday weekdays.
CONCLUSION: There is a higher incidence of emergency room admission for PUs on weekends than on weekdays for the total and working populations.
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Wu JG, Lai JY. Clinical effects of Jiedu Xiaoyong granules in treatment of active gastric ulcer. Shijie Huaren Xiaohua Zazhi 2014; 22:3968-3971. [DOI: 10.11569/wcjd.v22.i26.3968] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effects of Jiedu Xiaoyong granules in the treatment of active gastric ulcer (GU).
METHODS: Ninety-eight patients with active GU were randomly divided into either an experiment group or a control group. The experiment group was treated with Jiedu Xiaoyong granules, and the control group was treated with Anweiyang capsules. The traditional Chinese medicine symptom scores, the disappearance rates of yellow tongue coating and white greasy moss, the eradication rate of Helicobacter pylori (H. pylori), clinical effect and adverse reactions were compared between the two groups.
RESULTS: The scores of traditional Chinese medicine symptoms in both groups were significantly lower after treatment than before treatment (1.31 ± 1.22 vs 4.11 ± 1.42, 0.91 ± 1.19 vs 3.02 ± 1.11, 0.92 ± 1.29 vs 3.13 ± 1.06, 0.50 ± 0.71 vs 1.98 ± 0.91, 0.42 ± 0.39 vs 1.84 ± 0.69, 0.62 ± 0.60 vs 1.61 ± 0.80, 2.33 ± 1.30 vs 4.12 ± 1.40, 1.52 ± 1.38 vs 2.98 ± 1.10, 1.60 ± 0.88 vs 3.12 ± 1.08, 1.01 ± 0.69 vs 2.00 ± 0.88, 0.79 ± 0.80 vs 1.82 ± 0.80, 0.91 ± 0.79 vs 1.62 ± 0.79; P < 0.05); the decreases in the scores of traditional Chinese medicine symptoms in the experiment group were significantly higher than those in the control group (1.31 ± 1.22 vs 2.33 ± 1.30, 0.91 ± 1.19 vs 1.52 ± 1.38, 0.92 ± 1.29 vs 1.60 ± 0.88, 0.50 ± 0.71 vs 1.01 ± 0.69, 0.42 ± 0.39 vs 0.79 ± 0.80, 0.62 ± 0.60 vs 0.91 ± 0.79; P < 0.05). The disappearance rates of yellow tongue coating and white greasy moss as well as the eradication rate of H. pylori in the experiment group were significantly higher than those in the control group (77.55% vs 42.86%, 65.31% vs 38.78%; P < 0.05). The recovery rate and total effective rate in the experiment group were also significantly higher than those in the control group (67.35% vs 34.69%, 97.96% vs 75.51%; P < 0.05).
CONCLUSION: Jiedu Xiaoyong granules can improve Chinese medicine symptoms and tongue image in patients with active GU, and is associated with a high eradication rate of H. pylori, distinct clinical effects, and very few adverse reactions.
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Hou YL, Liu Q. Clinical effects of rabeprazole, omeprazole or ranitidine combined with amoxicillin and clarithromycin in treatment of peptic ulcer. Shijie Huaren Xiaohua Zazhi 2014; 22:3208-3213. [DOI: 10.11569/wcjd.v22.i22.3208] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the clinical effects of rabeprazole, omeprazole or ranitidine combined with amoxicillin and clarithromycin in treatment of peptic ulcer.
METHODS: One hundred and eighty-six patients with peptic ulcer were divided into a rabeprazole group (n = 65), an omeprazole group (n = 62) or a ranitidine group (n = 59). They were treated with rabeprazole-amoxicillin-clarithromycin, omeprazole-amoxicillin-clarithromycin and ranitidine-amoxicillin-clarithromycin, respectively. The main symptoms, ulcer pain, rate of Helicobacter pylori (H. pylori) eradication, clinical effects and adverse reactions were compared.
RESULTS: The remission rates of main symptoms on day 3 and at weeks 1 and 2 post-treatment in the rabeprazole group and omeprazole group were significantly higher than those in the ranitidine group (P < 0.05). There was no significant difference in the remission rate of main symptoms at week 4 among the three groups (P > 0.05). The rates of ulcer pain disappearance on day 3 and at week 1 in the rabeprazole group were significantly higher than those in the omeprazole group (81.54% vs 58.06%, 90.77% vs 77.42%, P < 0.05). The rates of ulcer pain disappearance on day 3 and at weeks 1, 2, and 4 in the rabeprazole group were significantly higher than those in the ranitidine group (81.54% vs 35.59%, 90.77% vs 62.71%, 100.00% vs 71.19%, 100.00% vs 93.22%, P < 0.05). The rates of ulcer pain disappearance on day 3 and at weeks 2 and 4 in the omeprazole group were significantly higher than those in the ranitidine group (77.42% vs 62.71%, 98.39% vs 71.19%, 100.00% vs 93.22%, P < 0.05). There was no significant difference in the rate of H. pylori eradication between the rabeprazole group and omeprazole group (95.38% vs 93.55%, P > 0.05), while the rates of H. pylori eradication in the rabeprazole group and omeprazole group were significantly higher than that in the ranitidine group (95.38%, 93.55% vs 79.66%, P < 0.05). There was no significant difference in the clinical effects between the rabeprazole group and omeprazole group (98.46% vs 91.94%, 100.00% vs 100.00%, P > 0.05). The healing rates and total effective rates were significantly higher in the rabeprazole group and omeprazole group than in the ranitidine group (98.46% vs 69.49%, 100.00% vs 88.14%, 91.94% vs 69.49%, 100.00% vs 88.14%, P < 0.05). There was no significant difference in the rate of adverse reactions among the three groups (1.54% vs 1.61% vs 3.39%, 0.00% vs 3.23% vs 0.00%, 0.00% vs 0.00% vs 1.69%, P > 0.05).
CONCLUSION: Rabeprazole containing regimen can result in a rapid response in patients with peptic ulcer and improve the clinical symptoms in a short time, but has few adverse reactions, representing the drug of first choice for patients with peptic ulcer.
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Li LF, Chan RLY, Lu L, Shen J, Zhang L, Wu WKK, Wang L, Hu T, Li MX, Cho CH. Cigarette smoking and gastrointestinal diseases: the causal relationship and underlying molecular mechanisms (review). Int J Mol Med 2014; 34:372-80. [PMID: 24859303 DOI: 10.3892/ijmm.2014.1786] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/20/2014] [Indexed: 12/16/2022] Open
Abstract
Cigarette smoking is an important risk factor for gastrointestinal (GI) disorders, including peptic ulcers, inflammatory bowel diseases, such as Crohn's disease and cancer. In this review, the relationship between smoking and GI disorders and the underlying mechanisms are discussed. It has been demonstrated that cigarette smoking is positively associated with the pathogenesis of peptic ulcers and the delay of ulcer healing. Mechanistic studies have shown that cigarette smoke and its active ingredients can cause mucosal cell death, inhibit cell renewal, decrease blood flow in the GI mucosa and interfere with the mucosal immune system. Cigarette smoking is also an independent risk factor for various types of cancer of the GI tract. In this review, we also summarize the mechanisms through which cigarette smoking induces tumorigenesis and promotes the development of cancer in various sections of the GI tract. These mechanisms include the activation of nicotinic acetylcholine receptors, the formation of DNA adducts, the stimulation of tumor angiogenesis and the modulation of immune responses in the GI mucosa. A full understanding of these pathogenic mechanisms may help us to develop more effective therapies for GI disorders in the future.
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Affiliation(s)
- L F Li
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - R L Y Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - L Lu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - J Shen
- Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - L Zhang
- Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - W K K Wu
- Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - L Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - T Hu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - M X Li
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - C H Cho
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
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Yang YB, Li L, Chen JC, Xiong WW, Chen X. Efficacy of somatostatin in treatment of massive peptic ulcer bleeding. Shijie Huaren Xiaohua Zazhi 2014; 22:2977-2980. [DOI: 10.11569/wcjd.v22.i20.2977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effects of sandostatin in treating massive peptic ulcer bleeding (PUB).
METHODS: Eighty-six patients with PUB were randomly divided into either an experiment group or a control group. Both the control and treatment groups underwent fasting, routine nursing and therapeutic intervention, and the experiment group was additionally given somatostatin. The bleeding status at 6, 12, 24 and 48 h, the re-bleeding rate after 72 h and adverse reactions were compared between the two groups.
RESULTS: The bleeding rates at 6, 12, 24 and 24 h were significantly higher in the experiment group than in the control group (51.16% vs 27.91%, 76.74% vs 53.49%, 86.05% vs 65.12%, 97.67% vs 79.07%; P < 0.05). There was no significant difference in the re-bleeding rate or the rate of adverse reactions between the two groups (2.33% vs 6.98%, 4.65% vs 11.63%, P > 0.05).
CONCLUSION: Somatostatin can shorten the time of hemostasis and improve the bleeding rate in patients with massive peptic ulcer bleeding.
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Abstract
The stomach has a range of functions, including chemical digestion and mechanical breakdown of food, temporary storage of bulk intake, and regulation of the passage of nutrients into the duodenum. Further gastric functions are the nonspecific defense against microbes entering the gastrointestinal tract, preparation of ions as well as liberation of protein-bound cobalamin and production of intrinsic factor for uptake further along the tract, and finally limited absorption of water, alcohol, and some fat-soluble food components including some drugs. These functions are influenced by various lifestyle factors, such as smoking and alcohol intake with interference by Helicobacter pylori colonization. This paper focuses on the interaction between lifestyle and gastric function.
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Affiliation(s)
- Ernst J Kuipers
- Departments of Gastroenterology and Hepatology, and Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Huang KW, Leu HB, Luo JC, Chan WL, Hou MC, Lin HC, Lee FY, Kuan YC. Different peptic ulcer bleeding risk in chronic kidney disease and end-stage renal disease patients receiving different dialysis. Dig Dis Sci 2014; 59:807-13. [PMID: 24318806 DOI: 10.1007/s10620-013-2973-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/19/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) patients receiving hemodialysis (HD) have a higher risk of peptic ulcer bleeding (PUB). AIMS Whether ESRD patients receiving peritoneal dialysis (PD) also carries a higher risk of PUB has not been studied. METHODS This was a cohort study using Taiwan's National Health Insurance research database, whereby 11,408 patients, including 2,239 PD, 2,328 HD, 2,267 chronic kidney disease (CKD) and 4,574 controls with age-sex matching were recruited. The log-rank test was used to analyze differences in accumulated PUB-free survival rates between groups. Cox proportional hazard regression was performed to evaluate independent risk factors for PUB in all the enrollees. RESULTS During the 7-year follow-up, PD and CKD patients had a significantly higher rate of PUB than matched controls. The risk of PUB between PD and CKD was not significantly different. Moreover, patients receiving HD carried a higher risk of PUB than those receiving PD, with CKD and controls (p all <0.05, by log-rank test). Cox proportional hazard regression analysis showed that CKD (HR 3.99, 95 % CI 2.24-7.13), PD (HR 3.71, 95 % CI 2.00-6.87) and HD (HR 11.96, 95 % CI 7.04-20.31) were independently associated with an increased risk of PUB. Being elderly, male, having hypertension, diabetes, cirrhosis, and nonsteroidal anti-inflammatory drugs and steroid use were other independent risk factors of PUB in all enrollees. CONCLUSIONS Patients with CKD and ESRD receiving PD or HD carried a higher risk for PUB. They should be screened for risk factors for PUB and receive some protective measures to prevent PUB.
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Affiliation(s)
- Kuang-Wei Huang
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Liang CC, Muo CH, Wang IK, Chang CT, Chou CY, Liu JH, Yen TH, Huang CC, Chung CJ. Peptic ulcer disease risk in chronic kidney disease: ten-year incidence, ulcer location, and ulcerogenic effect of medications. PLoS One 2014; 9:e87952. [PMID: 24498412 PMCID: PMC3912161 DOI: 10.1371/journal.pone.0087952] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 01/03/2014] [Indexed: 12/30/2022] Open
Abstract
Objectives We aimed at determining peptic ulcer disease (PUD) incidence among chronic kidney disease (CKD) patients during 1998–2008, compared to patients without CKD, and at examining associations between CKD and PUD. Methods Data for 1998–2008 were extracted from the National Health Insurance Research Database in Taiwan. The annual PUD incidence (cases per thousand persons per year) was calculated separately for patients with and without CKD. Characteristics of patients with newly diagnosed PUD (n = 16322) were compared to those of a control group without PUD (n = 32644). The 2 groups were matched for age, sex, and index year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression. Results Over the 10-year period, the PUD incidence was ∼10–12 times higher in CKD patients than in those without CKD. Its incidence in elderly CKD patients increased rapidly over time. For CKD patients, most PUD events (>95%) were managed during hospitalization. Peptic ulcer risk, adjusted for all potential confounders, was much higher in CKD patients undergoing hemodialysis (adjusted OR, 9.74; 95% CI, 7.11–13.31). Maintenance hemodialysis patients were 2 times more likely to have gastric ulcers than duodenal ulcers, while CKD patients not on dialysis had similar risks for both. There were no significant interactions between medications and CKD status on the peptic ulcer risk. Unlike CKD patients on nonsteroidal anti-inflammatory drugs and clopidogrel, those on aspirin did not have a higher peptic ulcer risk (adjusted OR, 0.88; 95% CI, 0.44–1.77). Conclusions CKD patients have a substantially increased PUD risk, and the majority of CKD patients with PUD require hospital management. Further, peptic ulcer risk is affected by hemodialysis therapy, patient status (inpatient vs. outpatient), and ulcerogenic medications.
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Affiliation(s)
- Chih-Chia Liang
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jiung-Hsiun Liu
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiu-Ching Huang
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
- * E-mail:
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Stahre MA, Toomey TL, Erickson DJ, Forster JL, Okuyemi KS, Ahluwalia JS. The Effects of a Tobacco Intervention on Binge Drinking Among African American Light Smokers. J Addict Dis 2013; 32:377-86. [DOI: 10.1080/10550887.2013.849972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Luo JC, Leu HB, Hou MC, Huang KW, Lin HC, Lee FY, Chan WL, Lin SJ, Chen JW. Nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients. Am J Med 2013; 126:264.e25-32. [PMID: 23410569 DOI: 10.1016/j.amjmed.2012.09.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation. METHODS Using Taiwan's National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis. RESULTS A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients. CONCLUSIONS There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.
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Affiliation(s)
- Jiing-Chyuan Luo
- Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan.
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Tuo B, Ju Z, Riederer B, Engelhardt R, Manns MP, Rudolph KL, Seidler U. Telomere shortening is associated with reduced duodenal HCOFormula secretory but normal gastric acid secretory capacity in aging mice. Am J Physiol Gastrointest Liver Physiol 2012; 303:G1312-21. [PMID: 23019197 DOI: 10.1152/ajpgi.00035.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of duodenal ulcer, especially Helicobacter pylori-negative duodenal ulcer, strongly increases with age. In humans, telomere length shortening is considered to be one critical factor in cellular senescence and organ survival. In this study, we compared basal and stimulated gastric acid and duodenal HCO(3)(-) secretory rates in aged late-generation (G(3)) telomerase-deficient (mTERC(-/-)) mice, which are characterized by severe telomere dysfunction due to the inability to elongate telomeres during cell division. We found that basal and forskolin-stimulated HCO(3)(-) secretion and short-circuit current (I(sc)) in isolated duodenal mucosa of G(3) mTERC(-/-) mice were markedly reduced compared with age-matched wild-type mice. In contrast, basal and forskolin-stimulated acid secretory rates in isolated G(3) mTERC(-/-) gastric mucosa were not significantly altered. Correspondingly, duodenal mucosa of G(3) mTERC(-/-) mice showed slimming and shortening of villi, whereas gastric mucosal histology was not significantly altered. However, the ratios of cystic fibrosis transmembrane conductance regulator (CFTR) and solute-linked carrier 26 gene family (Slc26a6) mRNA expression in relation to cytokeratin-18 were not altered in duodenal mucosa. The further knockout of p21, which is a downstream effector of telomere shortening-induced senescence, rescued villus atrophy of duodenal mucosa, and basal and forskolin-stimulated duodenal HCO(3)(-) secretion and I(sc) in mTERC(-/-) p21(-/-) double-knockout mice were not different from wild-type controls. In conclusion, genetic ablation of telomerase resulted in p21-dependent duodenal mucosal atrophy and reduced duodenal HCO(3)(-) secretory capacity, whereas gastric morphology and acid secretory function were preserved. This suggests that telomere shortening during aging may result in an imbalance between aggressive and protective secretions against duodenal mucosa and thus predispose to ulcer formation.
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Affiliation(s)
- Biguang Tuo
- Dept. of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Dalian Rd. 149, Zunyi 563003, China.
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Yamamoto S, Watabe K, Araki H, Kamada Y, Kato M, Kizu T, Kiso S, Tsutsui S, Tsujii M, Kihara S, Funahashi T, Shimomura I, Hayashi N, Takehara T. Protective role of adiponectin against ethanol-induced gastric injury in mice. Am J Physiol Gastrointest Liver Physiol 2012; 302:G773-80. [PMID: 22323129 DOI: 10.1152/ajpgi.00324.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Adiponectin is an anti-inflammatory molecule released from adipocytes, and serum adiponectin concentrations are reduced in obesity. We previously reported that gastric erosion occurs in association with obesity and low serum adiponectin levels. In the present study, we examined adiponectin-knockout (APN-KO) mice to elucidate the role of adiponectin in gastric mucosal injury. Gastric injury was induced by oral administration of ethanol in wild-type (WT) and APN-KO mice. Ethanol treatment induced severe gastric injury in APN-KO mice compared with WT mice. In APN-KO mice, increased apoptotic cells and decreased expression of prostaglandin E(2) (PGE(2)) were detected in the injured stomach. We next assessed the effect of adiponectin on the cellular response to ethanol treatment and wound repair in rat gastric mucosal cells (RGM1). Adiponectin induced the expression of PGE(2) and cyclooxygenase 2 (COX-2) in ethanol-treated RGM1 cells. RGM1 cells exhibited efficient wound repair accompanied by increased PGE(2) expression in the presence of adiponectin. Coadministration of adiponectin with celecoxib, a COX-2 inhibitor, inhibited efficient wound repair. These findings indicate that adiponectin has a protective role against ethanol-induced gastric mucosal injury in mice. This effect may be partially mediated by the efficient wound repair of epithelial cells via increased PGE(2) expression.
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Affiliation(s)
- Shunsuke Yamamoto
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Huang KW, Luo JC, Leu HB, Lin HC, Lee FY, Chan WL, Lin SJ, Chen JW, Chang FY. Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study. Aliment Pharmacol Ther 2012; 35:796-802. [PMID: 22348540 DOI: 10.1111/j.1365-2036.2012.05028.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 01/18/2012] [Accepted: 01/26/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Peptic ulcer bleeding remains a major healthcare problem despite decreasing prevalence of peptic ulcer disease. The role of chronic obstructive pulmonary disease (COPD) in the risk of peptic ulcer bleeding has not yet been established. AIM To determine if COPD patients have a higher risk of peptic ulcer bleeding than the general population and to identify the risk factors of peptic ulcer bleeding in COPD patients. METHODS From Taiwan's National Health Insurance research database, 62,876 patients, including 32,682 COPD and 30,194 age-gender-matched non-COPD controls, were recruited. Cox proportional hazard regression was performed to evaluate independent risk factors for ulcer bleeding in all patients and to identify risk factors in COPD patients. RESULTS During the 8-year follow-up, COPD patients had a significant higher rate of peptic ulcer bleeding than the control group (P < 0.001, by log-rank test). By Cox proportional hazard regression analysis, COPD [hazard ratio (HR) 1.93, 95% CI 1.73-2.17] was an independent risk factor after adjusting for age, gender, underlying comorbidities and ulcerogenic medication. Age > 65 years, male, comorbidities of hypertension, diabetes, heart failure, history of peptic ulcer disease, and chronic renal disease and use of nonsteroidal anti-inflammatory drugs were risk factors of ulcer bleeding in COPD patients. CONCLUSION Patients with chronic obstructive pulmonary disease have a higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like underlying comorbidities and ulcerogenic medication.
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Affiliation(s)
- K-W Huang
- Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan
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Abstract
Peptic ulcer disease (PUD) is due mostly to the widespread use of low-dose aspirin and nonsteroidal anti-inflammator drugs. It occurs mostly in older patients and those with comorbidities. Pain awakening the patient from sleep between 12 and 3 a.m. affects two-thirds of duodenal ulcer patients and one-third of gastric ulcer patients. Older adults (>80 years old) with PUD often do not present with abdominal pain; instead, epigastric pain, nausea and vomiting are among their most common presenting symptoms.
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Affiliation(s)
- Wadie I Najm
- Department of Family Medicine & Geriatrics, Susan Samueli Center of Integrative Medicine, University of California, Irvine, 101 The City Drive, Building 200, #512, Orange, CA 92868, USA.
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