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Esophago-gastro-duodenoscopy could be an important tool in the diagnostic dilemma inherent in perforated peptic ulcer: A case report. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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A Fast and Reliable Method to Interpret Short-Term Mortality in Perforated Peptic Ulcer: Red Cell Distribution Width is Sensitive and Specific. Surg Res Pract 2021; 2021:5542619. [PMID: 34056058 PMCID: PMC8149252 DOI: 10.1155/2021/5542619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Peptic ulcer is an important health problem worldwide with a prevalence of around 5%. Peptic ulcer perforation is a potentially mortal complication of peptic ulcer disease. We aimed to investigate the potential use of red cell distribution width as a prognostic marker in peptic ulcer perforation. Methods The files, operation notes, biochemical and hematological parameters, and prognosis of patients who were operated for a peptic ulcer perforation were reviewed in a retrospective cohort study. The relation of red cell distribution width (RDW) to main outcome in-hospital mortality was assessed. Results The mean age of the 172 patients was 40 ± 17.89. There were 158 (92%) males and 14 (8%) females. The in-hospital mortality was 8.7% (15/172). The median RDW in the group with mortality was 15.00 (interquartile range (IQR): 14.30–17.20) compared with the median RDW in the group with no mortality as 13.2 (IQR: 12.80–14.00, p ≤ 0.001). Receiver operator characteristic curves were plotted for RDW to identify nonsurvivors and yielded a significant area under the curve as 0.812 (95% confidence interval: 0.682–0.942). The sensitivity and specificity of RDW at a cutoff value of 14.25% were calculated with an accuracy of 81.98 (95% confidence interval: 75.40–87.41) as 80.00 (51.91–95.67) and 82.17 (75.27–87.81), respectively. Conclusion Increased RDW may be of use to interpret mortality in patients with peptic ulcer perforation.
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Wu H, Gu L, Ma X, Tian X, Fan S, Qin M, Lu J, Lyu M, Wang S. Rapid Detection of Helicobacter pylori by the Naked Eye Using DNA Aptamers. ACS OMEGA 2021; 6:3771-3779. [PMID: 33585756 PMCID: PMC7876845 DOI: 10.1021/acsomega.0c05374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/12/2021] [Indexed: 05/02/2023]
Abstract
Helicobacter pylori was first isolated from gastritis patients by Barry J. Marshall and J. Robin Warren in 1982, and more than 90% of duodenal ulcers and about 80% of gastric ulcers are caused by H. pylori infection. Most detection methods require sophisticated instruments and professional operators, making detection slow and expensive. Therefore, it is critical to develop a simple, fast, highly specific, and practical strategy for the detection of H. pylori. In this study, we used H. pylori as a target to select unique aptamers that can be used for the detection of H. pylori. In our study, we used random ssDNA as an initial library to screen nucleic acid aptamers for H. pylori. We used binding rate and the fluorescence intensity to identify candidate aptamers. One DNA aptamer, named HPA-2, was discovered through six rounds of positive selection and three rounds of negative selection, and it had the highest affinity constant of all aptamers tested (K d = 19.3 ± 3.2 nM). This aptamer could be used to detect H. pylori and showed no specificity for other bacteria. Moreover, we developed a new sensor to detect H. pylori with the naked eye for 5 min using illumination from a hand-held flashlight. Our study provides a framework for the development of other aptamer-based methods for the rapid detection of pathogenic bacteria.
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Affiliation(s)
- Hangjie Wu
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Lide Gu
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Xiaoyi Ma
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Xueqing Tian
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Shihui Fan
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Mingcan Qin
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Jing Lu
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Mingsheng Lyu
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
| | - Shujun Wang
- Jiangsu Key Laboratory
of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine
Biotechnology, Jiangsu Ocean University, Lianyungang 222005, PR China
- Co-Innovation Center of Jiangsu Marine
Bio-industry Technology, Jiangsu Ocean University, Lianyungang 222005, PR China
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Kim DW, Song S, Jee YS. Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:311. [PMID: 33708938 PMCID: PMC7944262 DOI: 10.21037/atm-20-3496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Perforated peptic ulcer (PPU) is a fatal complication of peptic ulcer disease, which requires emergency surgery. Laparoscopic repair is the widely accepted and effective method for the treatment of PPU. The aim of this study was to evaluate the safety and efficacy of duet laparoscopic repair of PPU with knotless barbed sutures. Methods From January 2013 to May 2019, 40 patients with PPU underwent laparoscopic primary repair and omentopexy at the Dankook University Hospital. The operative outcomes and complications of patients undergoing surgery using continuous suturing with absorbable knotless barbed sutures (group A, n=15) were compared with those undergoing surgery with conventional interrupted sutures (group B, n=25). Results The mean operative time was significantly shorter in group A than group B (84.4±39.8 vs. 104.2±49.4 min, P<0.001). There were no differences in other operative outcomes or postoperative complications (group A vs. group B, 20.0% vs. 24.0%, respectively; P=0.249) between the two groups. The mean operation time spent for laparoscopic sutures and omentopexy was 22.7 minutes. Conclusions The findings of the current study, albeit performed retrospectively at a single institution, suggested that duet laparoscopic repair of PPU with knotless barbed sutures might be considered as an alternative option, especially in hospitals lacking manpower.
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Affiliation(s)
- Dong-Wook Kim
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
| | - Sanghyun Song
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
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Laparoscopic Single Figure of Eight Suturing Omentopexy for the Treatment of a Perforated Duodenal Ulcer. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:23-28. [PMID: 35601707 PMCID: PMC8979847 DOI: 10.7602/jmis.2019.22.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022]
Abstract
Purpose Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. Methods Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. Results The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). Conclusion Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.
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Vakayil V, Bauman B, Joppru K, Mallick R, Tignanelli C, Connett J, Ikramuddin S, Harmon JV. Surgical repair of perforated peptic ulcers: laparoscopic versus open approach. Surg Endosc 2019; 33:281-292. [PMID: 30043169 DOI: 10.1007/s00464-018-6366-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/20/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Perforated peptic ulcers are a surgical emergency that can be repaired using either laparoscopic surgery (LS) or open surgery (OS). No consensus has been reached on the comparative outcomes and safety of each approach. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, we conducted a 12-year retrospective review (2005-2016) and identified 6260 adult patients who underwent either LS (n = 616) or OS (n = 5644) to repair perforated peptic ulcers. To mitigate selection bias and adjust for the inherent heterogeneity between groups, we used propensity-score matching with a case (LS):control (OS) ratio of 1:3. We then compared intraoperative outcomes such as operative time, and 30-day postoperative outcomes including infectious and non-infectious complications, and mortality. RESULTS Propensity-score matching created a total of 2462 matched pairs (616 in the LS group, 1846 in the OS group). Univariate analysis demonstrated successful matching of patient characteristics and baseline clinical variables. We found that OS was associated with a shorter operative time (67.0 ± 28.6 min, OS versus 86.9 ± 57.5 min, LS; P < 0.001) but a longer hospital stay (8.6 ± 6.2 days, OS versus 7.8 ± 5.9 days, LS; P = 0.001). LS was associated with a lower rate of superficial surgical site infections (1.5%, LS versus 4.2%, OS; P = 0.032), wound dehiscence (0.3%, LS versus 1.6%, OS; P = 0.030), and mortality (3.2%, LS versus 5.4%, OS; P = 0.009). CONCLUSION Fewer than 10% of patients with perforated peptic ulcers underwent LS, which was associated with reduced length of stay, lower rate of superficial surgical site infections, wound dehiscence, and mortality. Given our results, a greater emphasis should be provided to a minimally invasive approach for the surgical repair of perforated peptic ulcers.
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Affiliation(s)
- Victor Vakayil
- Department of Surgery, University of Minnesota, Minneapolis, USA. .,School of Public Health, University of Minnesota, Minneapolis, USA. .,Critical Care and Acute Care Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - Brent Bauman
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Keaton Joppru
- University of Minnesota Medical School, Minneapolis, USA
| | - Reema Mallick
- Department of Surgery, University of Alabama-Birmingham, Birmingham, USA
| | | | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | | | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, USA
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Abstract
Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.
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Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg 2017; 44:251-257. [PMID: 28258286 DOI: 10.1007/s00068-017-0777-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/21/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. METHODS This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed. RESULTS Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay. CONCLUSIONS An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.
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Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg 2017; 9:1-12. [PMID: 28138363 PMCID: PMC5237817 DOI: 10.4240/wjgs.v9.i1.1] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.
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Teymournejad O, Shokoohizadeh L, Mohabati Mobarez A, Amini M. Helicobacter Pylori and CagA: Relationships With Esophageal and Gastroduodenal Disorders in Iranian Patients. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2015. [DOI: 10.17795/ijep25022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Lee TH, Lin CC, Chung CS, Lin CK, Liang CC, Tsai KC. Increasing biopsy number and sampling from gastric body improve the sensitivity of rapid urease test in patients with peptic ulcer bleeding. Dig Dis Sci 2015; 60:454-7. [PMID: 25213078 DOI: 10.1007/s10620-014-3351-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/01/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies demonstrated that the sensitivity of rapid urease test (RUT) for diagnosis of Helicobacter pylori infection decreased during peptic ulcer bleeding. AIM We designed this study and tried to find a better method to improve the detection rate of H. pylori infection at the same session of endoscopic diagnosis of peptic ulcer bleeding. METHODS We prospectively enrolled 116 patients with peptic ulcer bleeding. These patients received intravenous proton pump inhibitor and then received upper gastrointestinal endoscopy within 24 h after arrival. We took one piece of biopsy from gastric antrum (Group 1), four pieces from gastric antrum (Group 2), and one piece from the gastric body (Group 3) for three separate RUTs, respectively. (13)C-urease breath test was used as gold standard for diagnosis of H. pylori infection. RESULTS There were 74 patients (64 %) with positive (13)C-urease breath test. Among these 74 patients, 45 patients had positive RUT (sensitivity: 61 %) in Group 1; 55 patients had positive RUT (sensitivity: 74 %) in Group 2; 54 patients had positive RUT (sensitivity: 73 %) in Group 3. There were significant differences between Group 1 and Group 2 (p = 0.02) and between Group 1 and Group 3 (p = 0.022). CONCLUSIONS The sensitivity of RUT was 61 % during peptic ulcer bleeding. The sensitivity of RUT can be increased significantly by increased biopsy number from gastric antrum or biopsy from gastric body.
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Affiliation(s)
- Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, 21, Sec. 2, Nan-Ya South Road, Banciao District, New Taipei City, 22060, Taiwan,
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Taş İ, Ülger BV, Önder A, Kapan M, Bozdağ Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. ULUSAL CERRAHI DERGISI 2014; 31:20-5. [PMID: 25931940 DOI: 10.5152/ucd.2014.2705] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. MATERIAL AND METHODS Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. RESULTS The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. CONCLUSION Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.
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Affiliation(s)
- İlhan Taş
- Clinic of General Surgery, Ministry of Health Cizre State Hospital, Şırnak, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Akın Önder
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Murat Kapan
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Zübeyir Bozdağ
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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Møller MH, Vester-Andersen M, Thomsen RW. Long-term mortality following peptic ulcer perforation in the PULP trial. A nationwide follow-up study. Scand J Gastroenterol 2013; 48:168-75. [PMID: 23215900 DOI: 10.3109/00365521.2012.746393] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. In the recently published PULP trial, 30-day mortality in patients surgically treated for PPU decreased from 27% to 17% following the implementation of a perioperative care protocol based on The Surviving Sepsis Guidelines. The objective of the present study was to evaluate long-term mortality in the PULP trial intervention and control cohort. DESIGN nationwide follow-up study of a multicenter, non-randomized, clinical trial with external controls. SETTING Danish patients surgically treated for PPU between 1 January 2008 and 31 December 2009. PATIENTS 117 patients in the intervention group and 512 in the control group. INTERVENTION a perioperative care protocol based on The Surviving Sepsis Guidelines. OUTCOME MEASURES 60-day, 90-day, 180-day, 1-year, and 2-year mortality rates. STATISTICAL ANALYSIS survival statistics. RESULTS Baseline characteristics, clinical, and perioperative data were in general, similar in the intervention and control group. Sixty days postoperatively, the originally observed difference in 30-day mortality had diminished (25% vs. 30%, p = 0.268). After 180 days, the mortality difference was reduced additionally (31% vs. 33%, p = 0.645), and one year postoperatively, a mortality difference was no longer present (36% in both groups, p = 0.993). Two years postoperatively, the mortality rate in the intervention group was 44%, as compared to 40% in the control group (p = 0.472). CONCLUSIONS The survival benefit associated with a perioperative care protocol in patients treated for PPU decreases progressively after 30 days and is no longer present after one year. REGISTRATION NUMBER NCT00624169 ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Morten Hylander Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Velayos B, Fernández-Salazar L, Pons-Renedo F, Muñoz MF, Almaraz A, Aller R, Ruíz L, Del Olmo L, Gisbert JP, González-Hernández JM. Accuracy of urea breath test performed immediately after emergency endoscopy in peptic ulcer bleeding. Dig Dis Sci 2012; 57:1880-6. [PMID: 22453995 DOI: 10.1007/s10620-012-2096-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/10/2012] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this work is to investigate the accuracy of the urea breath test (UBT) performed immediately after emergency endoscopy in peptic ulcer bleeding (PUB). METHODS Urea breath test was carried out right after emergency endoscopy in patients with PUB. The accuracy of this early UBT was compared to a delayed one after hospital discharge that was considered the gold standard. Clinical and epidemiological factors were analyzed in order to study their influence on the accuracy of the early UBT. RESULTS Early UBT was collected without any complication and good acceptance from all the 74 patients included. In 53 of the patients (71.6%), a delayed UBT was obtained. Comparing concordance between the two tests we have calculated an accuracy of 83% for the early UBT. Sensibility and specificity were 86.36 and 66%, respectively, with a positive predictive value of 92.68% and negative predictive value of 50% (Kappa index = 0.468; p = 0.0005; CI: 95%). We found no influence of epidemiological factors, clinical presentation, drugs, times to gastroscopy, Forrest classification, endoscopic therapy, hemoglobin, and urea levels over the accuracy of early UBT. CONCLUSIONS Urea breath test carried out right after emergency endoscopy in PUB is an effective, safe, and easy-to-perform procedure. The accuracy of the test is not modified by clinical or epidemiological factors, ulcer stage, or by the type of therapy applied. However, we have found a low negative predictive value for early UBT, so a delayed test is mandatory for all negative cases.
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Affiliation(s)
- Benito Velayos
- Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain.
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Kang JM, Kim N, Lee BH, Park HK, Jo HJ, Shin CM, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Lee DH, Jung HC, Song IS. Risk factors for peptic ulcer bleeding in terms of Helicobacter pylori, NSAIDs, and antiplatelet agents. Scand J Gastroenterol 2011; 46:1295-301. [PMID: 21815866 DOI: 10.3109/00365521.2011.605468] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The role of the Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiplatelet agents in the risk of peptic ulcer bleeding has not yet been established. This study was performed to identify the risk factors for peptic ulcer bleeding compared with non-bleeding peptic ulcer disease (PUD). MATERIAL AND METHODS A total of 475 patients, 265 with bleeding PUD and 210 with non-bleeding PUD were consecutively recruited. H. pylori status was determined by histology, rapid urease test, and culture. Exposure to NSAIDs, aspirin, and antiplatelet agents (clopidogrel and ticlopidine) within 4 weeks was obtained. RESULTS Compared with non-bleeding PUD, bleeding PUD had a higher proportion of male gender and current smoking, alcohol drinking, history of aspirin/antiplatelet use, and history of PUD. Whereas the proportion of H. pylori infection and history of H. pylori eradication in bleeding PUD were significantly lower than that in non-bleeding PUD. In multivariate analysis, male gender (OR 1.78, 95% CI 1.10-2.89), drinking alcohol (OR 2.08, 95% CI 1.29-3.14), aspirin/antiplatelet use (OR 2.35, 95% CI 1.45-3.82), and history of PUD (OR 2.46, 95% CI 1.36-4.46) remained independent risk factors for bleeding PUD. When H. pylori status and aspirin/antiplatelet agent use were combined, highest risk of bleeding peptic ulcers was found among H. pylori-negative patients with a history of aspirin/antiplatelet agent use (OR 3.03 95% CI 1.48-6.18) compared with H. pylori-positive patients with no history of aspirin/antiplatelet agent use. CONCLUSIONS Patients with H. pylori-negative peptic ulcers who continuously took aspirin or antiplatelet agents had the highest peptic ulcer bleeding risk.
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Affiliation(s)
- Jung Mook Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Møller MH, Adamsen S, Thomsen RW, Møller AM. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg 2011; 98:802-10. [PMID: 21442610 DOI: 10.1002/bjs.7429] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. METHODS This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. RESULTS The 30-day mortality rate following PPU was 17·1 per cent in the intervention group, compared with 27·0 per cent in the three control groups (P = 0·005). This corresponded to a relative risk of 0·63 (95 per cent confidence interval 0·41 to 0·97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). CONCLUSION The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment. REGISTRATION NUMBER NCT00624169 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M H Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark.
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18
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Has H. pylori prevalence in bleeding peptic ulcer been underestimated? A meta-regression. Am J Gastroenterol 2011; 106:398-405. [PMID: 21304499 DOI: 10.1038/ajg.2011.2] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It has been suggested that prevalence of Helicobacter pylori (Hp) in peptic ulcer bleeding (PUB) is lower than that in non-complicated ulcers. As Hp infection is elusive in PUB, we hypothesized that this low prevalence could be related to an insufficiently intensive search for the bacteria. The aim of the study was to evaluate whether the prevalence of Hp in PUB depends on the diagnostic methods used in a given study. METHODS A systematic review was performed of studies assessing the prevalence of Hp infection in patients with PUB. Data were extracted in duplicate. Univariate and multivariate random-effects meta-regression analyses were performed to determine the factors that explained the differences in Hp prevalence between studies. RESULTS The review retrieved 71 articles, including 8,496 patients. The mean prevalence of Hp infection in PUB was 72%. The meta-regression analysis showed that the most significant variables associated with a high prevalence of Hp infection were the use of a diagnostic test delayed until at least 4 weeks after the PUB episode-odds ratio: 2.08, 95% confidence interval: 1.10-3.93, P=0.024-and a lower mean age of patients-odds ratio: 0.95 per additional year, 95% confidence interval: 0.92-0.99, P=0.008. CONCLUSIONS Studies that performed a delayed test and those including younger patients found a higher prevalence of Hp, approaching that recorded in cases of non-bleeding ulcers. These results suggest that the low prevalence of Hp infection described in PUB may be related to the methodology of the studies and to patients' characteristics, and that the true prevalence of Hp in PUB is still to be determined. Our data also support the recent recommendations of the International Consensus on Non-Variceal Upper Gastrointestinal Bleeding regarding the performance of a delayed diagnostic test when Hp tests carried out during the acute PUB episode are negative.
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Abstract
BACKGROUND Helicobacter pylori infection rates in duodenal ulcer (DU) patients may be lower than previously estimated. AIM To review the real prevalence of H. pylori-negative DUs and its possible causes. METHODS Bibliographical searches in MEDLINE looking for the terms 'H. pylori' and 'duodenal ulcer'. RESULTS Mean prevalence of H. pylori infection in DU disease, calculated from studies published during the last 10 years including a total of 16 080 patients, was 81%, and this figure was lower (77%) when only the last 5 years were considered. Associations with H. pylori-negative DU were: (1) False negative results of diagnostic methods, (2) NSAID use (21% in studies with <90% infection rate), (3) Complicated DU (bleeding, obstruction, perforation), (4) Smoking, (5) Isolated H. pylori duodenal colonization, (6) Older age, (7) Gastric hypersecretion, (8) Diseases of the duodenal mucosa, (9) Helicobacter'heilmanii' infection and (10) Concomitant diseases. CONCLUSION In patients with H. pylori-negative DU disease, one should carefully confirm that the assessment of H. pylori status is reliable. In truly H. pylori-negative patients, the most common single cause of DU is, by far, the use of NSAIDs. Ulcers not associated with H. pylori, NSAIDs or other obvious causes should, for the present, be viewed as 'idiopathic'. True idiopathic DU disease only exceptionally exists.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)m, Madrid, Spain.
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20
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Abstract
Despite the introduction of histamine H2-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring. To improve the outcome of these patients, it is necessary to investigate the reasons behind this high mortality rate. In this review we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evident status. Only a few randomized, controlled trials have been published. The mortality rate and the extent of postoperative complications are fairly high but the reasons for this have not been thoroughly explained, even though a number of risk factors have been identified. Some of these risk factors can be explained by the septic state of the patient on admission. In order to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment.
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Affiliation(s)
- Morten Hylander Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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21
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Gisbert JP, Esteban C, Jimenez I, Moreno-Otero R. 13C-urea breath test during hospitalization for the diagnosis of Helicobacter pylori infection in peptic ulcer bleeding. Helicobacter 2007; 12:231-7. [PMID: 17493003 DOI: 10.1111/j.1523-5378.2007.00492.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the accuracy of (13)C-urea breath test (UBT) to detect Helicobacter pylori infection in patients hospitalized with peptic ulcer bleeding and treated with proton pump inhibitors (PPIs). METHODS Patients hospitalized with peptic ulcer bleeding, and treated with omeprazole, had a first UBT performed the day after resuming oral feeding. Patients with a negative UBT during hospitalization underwent a repeated UBT 15 days after stopping PPIs. RESULTS The first UBT during hospitalization was positive in 86% of 131 patients. Time between admission and performance of the test was longer in patients with negative versus positive UBT (5.2 +/- 0.7 versus 4.3 +/- 0.5 days; p < .001). The repeated UBT became positive in 15 of 18 (83%) patients with a negative first UBT. In the multivariate analysis, the only variable associated with a negative first UBT was the time elapsed between admission and performance of the test (odds ratio = 6.6; 95%CI = 2.9-15.1). CONCLUSION Most H. pylori-positive patients with ulcer bleeding have a positive UBT (performed just after resuming oral feeding) despite previous treatment with high-dose PPIs. Nevertheless, to preclude false-negative results due to PPI therapy, the UBT should be performed as early as possible. If the infection cannot be demonstrated with this first UBT, H. pylori still needs to be definitively excluded with a second UBT performed after stopping PPIs.
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Affiliation(s)
- Javier P Gisbert
- Service of Gastroenterology and Hepatology, La Princesa University Hospital, Universidad Autónoma, Madrid, Spain.
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22
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Affiliation(s)
- Riza Tady Conroy
- Department of Family Medicine, The Ohio State University, OSU Family Practice-Gahanna, 504 Havens Corners Road, Gahanna, OH 43230, USA
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Lipof T, Shapiro D, Kozol RA. Surgical perspectives in peptic ulcer disease and gastritis. World J Gastroenterol 2006; 12:3248-52. [PMID: 16718847 PMCID: PMC4087970 DOI: 10.3748/wjg.v12.i20.3248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 04/06/2006] [Accepted: 04/16/2006] [Indexed: 02/06/2023] Open
Abstract
For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
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Affiliation(s)
- Tamar Lipof
- Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, MC 3955 Farmington, CT 06030-3955, USA
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Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol 2006; 101:848-63. [PMID: 16494583 DOI: 10.1111/j.1572-0241.2006.00528.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To perform a systematic review and a meta-analysis of diagnostic accuracy of the different tests aimed to detect Helicobacter pylori infection in patients with upper gastrointestinal bleeding (UGIB). SELECTION OF STUDIES assessing the accuracy of H. pylori diagnostic methods in patients with UGIB. SEARCH STRATEGY electronic bibliographical searches. DATA EXTRACTION independently done by two reviewers. DATA SYNTHESIS meta-analyses of the different tests were performed combining the sensitivities, specificities, and likelihood ratios (LRs) of the individual studies. RESULTS Studies showed a high degree of heterogeneity. Pooled sensitivity, specificity, LR+ and LR- (95% confidence interval (CI)) for the different methods were: Rapid urease test (16 studies/1,417 patients): 0.67 (0.64-0.70), 0.93 (0.90-0.96), 9.6 (5.1-18.1), and 0.31 (0.22-0.44). Histology (10 studies/827 patients): 0.70 (0.66-0.74), 0.90 (0.85-0.94), 6.7 (2.5-18.4), and 0.23 (0.12-0.46). Culture (3 studies/314 patients): 0.45 (0.39-0.51), 0.98 (0.92-1.00), 19.6 (4-96), and 0.31 (0.05-1.9). Urea breath test (8 studies/520 patients): 0.93 (0.90-0.95), 0.92 (0.87-0.96), 9.5 (3.9-23.3), and 0.11 (0.07-0.16). Stool antigen test (6 studies/377 patients): 0.87 (0.82-0.91), 0.70 (0.62-0.78), 2.3 (1.4-4), and 0.2 (0.13-0.3). Serology (9 studies/803 patients): 0.88 (0.85-0.90), 0.69 (0.62-0.75), 2.5 (1.6-4.1), and 0.25 (0.19-0.33). CONCLUSION Biopsy-based methods, such as rapid urease test, histology, and culture, have a low sensitivity, but a high specificity, in patients with UGIB. The accuracy of 13C-urea breath test remains very high in these patients. Stool antigen test is less accurate in UGIB. Although serology seems not to be influenced by UGIB, it cannot be recommended as the first diagnostic test for H. pylori infection in this setting.
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Affiliation(s)
- Javier P Gisbert
- Department of Gastroenterology, La Princesa University Hospital, Universidad Autónoma, Madrid, Spain
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25
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Abstract
The urea breath test is a noninvasive and very accurate test for the diagnosis of Helicobacter pylori infection. However, false negative urea breath test results have been reported to occur in a considerable percentage of the individuals taking proton pump inhibitors; the interval needed to be completely confident that false negative tests had been excluded has varied among the different studies between 6 and 14 days. The impact of H(2)-receptor antagonists on the accuracy of urea breath test remains controversial, although, in contrast with proton pump inhibitors, the data suggest that H(2)-receptor antagonists, for the most part, have little effect on the result of the urea breath test. The urea breath test does not represent a suitable tool for estimating the density of H. pylori colonization. The only quantitative information to be obtained from the urea breath test is that the higher the delta value, the lower the probability of a false-positive urea breath test result. Although some authors have demonstrated a correlation between urea breath test values and histological lesions of the gastric mucosa, the practical utility of this relationship remains unclear. It has been suggested that the pretreatment urea breath test has the potential to identify patients who require modification of the standard therapeutic regimen (for example, prolonging the duration of treatment or increasing the pharmacological dose when bacterial density is high), but other studies could not confirm this relationship. Some studies have shown that the urea breath test is less accurate in patients who have undergone partial gastrectomy. Finally, in contrast with biopsy-based methods, which are responsible for a high number of false-negative results when used to diagnose H. pylori infection in patients with upper gastrointestinal bleeding, urea breath test seems not to be negatively influenced by the presence of this complication.
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Affiliation(s)
- J P Gisbert
- Department of Gastroenterology, University Hospital of La Princesa, Playa de Mojácar 29, Urb. Bonanza, Boadilla del Monte, Madrid 28669, Spain.
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26
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Affiliation(s)
- Sean P Harbison
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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Lo CC, Lai KH, Peng NJ, Lo GH, Tseng HH, Lin CK, Shie CB, Wu CM, Chen YS, Huang WK, Chen A, Hsu PI. Polymerase chain reaction: A sensitive method for detecting Helicobacter pylori infection in bleeding peptic ulcers. World J Gastroenterol 2005; 11:3909-14. [PMID: 15991292 PMCID: PMC4504895 DOI: 10.3748/wjg.v11.i25.3909] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the sensitivity and specificity of polymerase chain reaction (PCR) in detecting Helicobacter pylori (H pylori) infection in patients with bleeding peptic ulcers, and to compare its diagnostic efficacy with other invasive and non-invasive tests.
METHODS: From April to September 2002, H pylori status in 60 patients who consecutively presented with gastroduodenal ulcer bleeding was examined by rapid urease tests (RUT), histology, culture, PCR, serology and urea breath tests (UBT).
RESULTS: The sensitivity of PCR was significantly higher than that of RUT, histology and culture (91% vs 66%, 43% and 37%, respectively; P = 0.01, < 0.001, < 0.001, respectively), but similar to that of serology (94%) and UBT (94%). Additionally, PCR exhibited a greater specificity than serology (100% vs 65%, P < 0.01). However, the specificity of PCR did not differ from that of other tests. Further analysis revealed significant differences in the sensitivities of RUT, culture, histology and PCR between the patients with and those without blood in the stomach (P < 0.01, P = 0.09, P < 0.05, and P < 0.05, respectively).
CONCLUSION: PCR is the most accurate method among the biopsy-based tests to detect H pylori infection in patients with bleeding peptic ulcers. Blood may reduce the sensitivities of all biopsy-based tests.
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Affiliation(s)
- Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, China
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Lin HJ, Lo WC, Perng CL, Tseng GY, Li AFY, Ou YH. Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers. World J Gastroenterol 2005; 11:382-5. [PMID: 15637749 PMCID: PMC4205342 DOI: 10.3748/wjg.v11.i3.382] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Helicobacter pylori (H pylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma. Conventional invasive tests are less sensitive than non-invasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers.
METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test, histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of H pylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2), iceA1, iceA2 and cag A.
RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%) and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity, positive predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79% and 81%) than in patients with non-bleeding peptic ulcers (99%, 99% and 98%) (P<0.001, P<0.01 and P<0.001 respectively). The sensitivity, negative predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori were significantly lower in patients with bleeding peptic ulcers (84%, 83% and 81%) than in patients with chronic gastritis (100%, 100% and 100%) (P = 0.02, P = 0.02 and P = 0.001).
CONCLUSION: Mucosal polymerase chain reaction for detecting H pylori infection is not reliable in patients with bleeding peptic ulcers.
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Affiliation(s)
- Hwai-Jeng Lin
- Division of Gastroenterology, Department of Medicine, VGH-Taipei, Taiwan, China.
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Lin HJ, Lo WC, Perng CL, Li AFY, Tseng GY, Sun IC, Ou YH. Helicobacter pylori stool antigen test in patients with bleeding peptic ulcers. Helicobacter 2004; 9:663-8. [PMID: 15610081 DOI: 10.1111/j.1083-4389.2004.00276.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Helicobacter pylori has been linked to chronic gastritis, peptic ulcers, gastric cancer and mucosa-associated lymphoid tissue lymphoma. Invasive tests are less sensitive than noninvasive tests in diagnosing H. pylori infection in patients with bleeding peptic ulcers. The H. pylori stool antigen test has been useful in diagnosing H. pylori in patients with peptic ulcers before and after eradication of H. pylori. The aim of this study was to evaluate the H. pylori stool antigen test in patients with bleeding peptic ulcers. METHODS Patients with bleeding and nonbleeding peptic ulcers underwent a rapid urease test, histology, bacterial culture and H. pylori stool antigen test. Positive H. pylori infection was defined as a positive culture or both a positive histology and a positive rapid urease test. Helicobacter pylori stool antigen was assessed with a commercial kit (Diagnostec H. pylori antigen EIA Kit, Hong Kong). RESULTS Between October 2000 and April 2002, 93 patients with bleeding peptic ulcers (men/women: 78/15, gastric ulcer/duodenal ulcer: 58/35) and 59 patients with nonbleeding peptic ulcers (men/women: 47/12, gastric ulcer/duodenal ulcer: 30/29) were enrolled in this study. Forty-seven (50.5%) patients with bleeding peptic ulcers and 30 (50.8%) patients with nonbleeding peptic ulcers, were found to be infected with H. pylori (p > .1). Helicobacter pylori stool antigen tests were positive in 54 (58.1%) and 30 (50.8%) patients with bleeding peptic ulcers and nonbleeding peptic ulcers, respectively (p > .1). The sensitivity (82% vs. 93%), specificity (68% vs. 93%), positive predictive value (74% vs. 93%), negative predictive value (77% vs. 93%) and diagnostic accuracy (75% vs. 93%) were all lower in patients with bleeding vs. nonbleeding peptic ulcers. The specificity, positive predictive value, and diagnostic accuracy of the H. pylori stool antigen test in patients with bleeding peptic ulcers were significantly lower than those in patients with nonbleeding peptic ulcers (p = .01, p = .02 and p = .003, respectively). CONCLUSION The H. pylori stool antigen test is not reliable for diagnosing H. pylori infection in patients with bleeding peptic ulcers.
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Affiliation(s)
- Hwai-Jeng Lin
- Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Taipei, Taiwan.
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Abstract
Our aim was to review systematically the diagnostic accuracy of the Helicobacter pylori stool antigen test. Bibliographical searches were performed in several electronic databases and abstracts from congresses up to May 2003. Eighty-nine studies (10,858 patients) evaluated the stool antigen test in untreated patients. Mean sensitivity, specificity, positive predictive value and negative predictive value were 91%, 93%, 92% and 87%, respectively. Analysis of the eight studies (1399 patients) in which pretreatment evaluation of the monoclonal stool antigen test was performed showed better (p < .001) results (96%, 97%, 96% and 97%, respectively), with a clearer distinction between positive and negative results. Thirty-nine studies (3147 patients) evaluated the stool antigen test for the confirmation of H. pylori eradication 4-8 weeks after therapy, with accuracies of 86%, 92%, 76% and 93% for mean sensitivity, specificity, positive predictive value and negative predictive value, respectively. Results were similar when a gold standard based on at least two methods was used. Relatively low accuracy was reported in some posttreatment studies with the polyclonal stool antigen test. However, excellent results (p < .001) were achieved in all the six studies evaluating the monoclonal stool antigen test 4-8 weeks posttreatment. Results evaluating the stool antigen test < 4 weeks posttreatment are contradictory. Proton-pump inhibitors seem to affect the accuracy of the stool antigen test. Sensitivity and/or specificity in patients with gastrointestinal bleeding may be suboptimal. The stool antigen test performs well in children. Finally, the stool antigen test seems to be a cost-effective method.
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Affiliation(s)
- Javier P Gisbert
- Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain.
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31
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Gisbert JP, Trapero M, Calvet X, Mendoza J, Quesada M, Güell M, Pajares JM. Evaluation of three different tests for the detection of stool antigens to diagnose Helicobacter pylori infection in patients with upper gastrointestinal bleeding. Aliment Pharmacol Ther 2004; 19:923-9. [PMID: 15080854 DOI: 10.1111/j.1365-2036.2004.01932.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To evaluate the accuracy of several methods aimed to detect Helicobacter pylori stool antigens in patients with upper gastrointestinal bleeding. METHODS Thirty-four patients with upper gastrointestinal bleeding because of peptic ulcer were included. The first stool sample during hospitalization was collected, and stool antigens were determined with: polyclonal enzyme-linked immunosorbent assay (Premier-Platinum-HpSA); monoclonal enzyme-linked immunosorbent assay (Amplified-IDEIA-HpStAR); and rapid monoclonal immunochromatographic test (ImmunoCard-STAT HpSA). A patient was considered infected when H. pylori was diagnosed with invasive tests (rapid urease test or histology) or with (13)C-urea breath test. When all tests were negative, a new breath test was repeated after stopping proton pump inhibitors. RESULTS All patients were infected and, therefore, only sensitivity of the tests could be calculated: polyclonal enzyme-linked immunosorbent assay (74%), monoclonal enzyme-linked immunosorbent assay (94%), and rapid monoclonal immunochromatographic test (60%; concordance between the two observers was high, kappa = 0.9). Neither the presence of maelena nor the delay in obtaining stool samples explained false negatives. CONCLUSIONS Neither the polyclonal enzyme-linked immunosorbent assay stool antigen test nor the rapid immunochromatographic stool antigen test can be recommended to diagnose H. pylori infection in patients with upper gastrointestinal bleeding. However, the monoclonal enzyme-linked immunosorbent assay stool antigen test is highly sensitive for detecting the infection in patients with this complication, although more studies are necessary to evaluate the specificity of the method.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain.
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Perng CL, Lin HJ, Lo WC, Tseng GY, Sun IC, Ou YH. Genotypes of Helicobacter pylori in patients with peptic ulcer bleeding. World J Gastroenterol 2004; 10:602-5. [PMID: 14966926 PMCID: PMC4716989 DOI: 10.3748/wjg.v10.i4.602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Helicobacter pylori causes chronic gastritis, peptic ulcer, gastric cancer and MALT-lymphoma. Different genotypes of Helicobacter pylori are confirmed from diverse geographic areas. Its association with bleeding peptic ulcer remains controversial. The aim of this study was to investigate the Helicobacter pylori vacA alleles, cagA and iceA in patients with bleeding peptic ulcer.
METHODS: We enrolled patients with bleeding, non-bleeding peptic ulcers and chronic gastritis. Biopsy specimens were obtained from the antrum of the stomach for rapid urease test, bacterial culture and PCR assay. DNA extraction and polymerase chain reaction were used to detect the presence or absence of cagA and to assess the polymorphism of vacA and iceA.
RESULTS: A total of 168 patients (60.4%) (25 patients with chronic gastritis, 26 patients with bleeding gastric ulcer, 51 patients with non-bleeding gastric ulcer, 26 patients with bleeding duodenal ulcer, and 40 patients with non-bleeding duodenal ulcer) were found to have positive PCR results between January 2001 and December 2002. Concerning genotypes, we found cagA (139/278, 50%), vacA s1a (127/278, 45.7%), and ice A1 (125/278, 45%) predominated in all studied patients. In patients with bleeding peptic ulcers, vacA s1a and m1T were fewer than those in patients with non-bleeding peptic ulcers (37/106 vs 69/135, P = 0.017, and 4/106 vs 21/135, P = 0.002).
CONCLUSION: In patients with peptic ulcers, H pylori vacA s1a and m1T prevent bleeding complication.
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Affiliation(s)
- Chin-Lin Perng
- Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Shih-Pai Rd, Sec 2, Taipei, Taiwan, 11217, China
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Winiarski M, Bielanski W, Plonka M, Dobrzanska M, Kaminska A, Bobrzynski A, Ronturek PC, Konturek SJ. The usefulness of capsulated 13C-urea breath test in diagnosis of Helicobacter pylori infection in patients with upper gastrointestinal bleeding. J Clin Gastroenterol 2003; 37:34-8. [PMID: 12811206 DOI: 10.1097/00004836-200307000-00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND H. pylori infection and peptic ulcerations and their complications such as bleeding are causally related, but the available methods used in bleeding to confirm active H. pylori lack accuracy. AIM To evaluate the usefulness of 13C-urea breath test (UBT) in diagnosing of H. pylori infection in bleeding patients. PATIENTS AND METHODS Eighty-one patients with upper gastrointestinal bleeding and 258 matched controls without bleeding were enrolled to the study. UBT was performed using low-dose capsulated 13C-urea and IgG antibodies to H. pylori were determined by ELISA. RESULTS UBT performed in bleeding patients was positive in 77.7%. In this group anti Hp IgG was positive in 79% of cases and among them gastroscopy showed 40.7% of bleeding duodenal ulcer, 38% bleeding gastric ulcer, and 86% hemorrhagic gastritis. UBT was positive in 90.9%, 77.4%, and in 52.97% cases, respectively, and it was not statistically different from that in non-bleeding controls, duodenal and gastric ulcers and gastritis. All patients with blood or "coffee grounds" in the stomach had both UBT and serology positive. CONCLUSION The UBT is simple and non-invasive method, which can be successively applied also in patients with upper gastrointestinal bleeding to detect active H. pylori infection prior to emergency endoscopy.
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Affiliation(s)
- Marek Winiarski
- Department of General Surgery, Jagiellonian University College of Medicine, Krakow, Poland
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Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter 2003; 8:159-67. [PMID: 12752726 DOI: 10.1046/j.1523-5378.2003.00139.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.
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Affiliation(s)
- Javier P Gisbert
- Department of Gastroenterology. University Hospital of 'La Princesa', Madrid, Spain
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Sharma VK, Sahai AV, Corder FA, Howden CW. Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage. Aliment Pharmacol Ther 2001; 15:1939-47. [PMID: 11736725 DOI: 10.1046/j.1365-2036.2001.01134.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Helicobacter pylori eradication decreases ulcer recurrence and should prevent recurrent ulcer haemorrhage. AIM By meta-analysis, to compare treatment of H. pylori infection with other approaches to prevent recurrent ulcer haemorrhage and, by cost minimization analysis, to determine the least costly strategy. METHODS We searched for randomized, controlled trials comparing treatment of H. pylori infection with ulcer healing alone or with maintenance therapy in preventing recurrent ulcer haemorrhage. We calculated the relative and absolute risk reductions and numbers needed to treat. RESULTS Treatment of H. pylori infection decreased recurrent bleeding by 17% (numbers needed to treat=6) compared with ulcer healing treatment alone. Compared with ulcer healing treatment followed by maintenance therapy, recurrent bleeding was decreased by 4% (numbers needed to treat=25). Decision model-based cost minimization analysis demonstrated that treatment of H. pylori infection was the least costly strategy unless the incidence of complicated recurrences after treatment was over 6%, or the cost of confirming eradication was over $741. CONCLUSIONS Treatment of H. pylori infection is superior to ulcer healing treatment with or without maintenance therapy in preventing recurrent ulcer haemorrhage. All patients with ulcer bleeding should be tested for H. pylori infection and appropriately treated if positive.
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Affiliation(s)
- V K Sharma
- Division of Digestive Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Gisbert JP, Pajares JM. Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review. Am J Gastroenterol 2001; 96:2829-38. [PMID: 11693315 DOI: 10.1111/j.1572-0241.2001.04235.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recently a new, noninvasive diagnostic test based on the detection of Helicobacter pylori stool antigen (SA) has been developed. The aim of this study was to systematically review the experience on H. pylori SA test for the diagnosis of H. pylori infection. Bibliographic searches were performed in the PubMed database and abstracts from several congresses. A total of 43 studies fulfilled the inclusion criteria and evaluated H. pylori SA test accuracy for the diagnosis of H. pylori infection in nontreated patients. Overall, 4769 patients were included. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) (weighted mean) were, respectively: 92.4% (95% CI = 91-93%), 91.9% (91-92%), 92.1% (91-93%), and 90.5% (90-91%). Therefore the SA test can definitively be considered an accurate noninvasive method for the diagnosis of H. pylori infection in untreated patients. A total of 25 studies including 2078 patients evaluated H. pylori SA test for the confirmation of H. pylori eradication > or = 4 wk after completion of therapy. Sensitivity, specificity, PPV and NPV (weighted mean) were: 88.3% (87-90%), 92% (91-93%), 75.1% (73-77%), and 94.8% (94-96%). Although most studies showed that SA test is an accurate method to confirm H. pylori eradication > or = 4 wk after treatment, these favorable results were not confirmed in other studies. Further investigation is necessary to explain these discrepancies, as well as to clarify the precise time for confirmation of eradication after therapy, the appropriate cutoff point for the SA test, and which factors influence it. Proton pump inhibitors seem to affect the accuracy of SA test, but the negative effect disappears 1-2 wk after stopping treatment. The SA test is technically feasible in patients with upper GI bleeding. although the true diagnostic accuracy in this group of patients remains to be more fully assessed. Finally, the SA test seems to be a highly cost-effective method for the diagnosis of H. pylori infection.
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Affiliation(s)
- J P Gisbert
- Department of Gastroenterology University Hospital of La Princesa, Madrid, Spain
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Capurso G, Annibale B, Osborn J, D'Ambra G, Martino G, Lahner E, Delle Fave G. Occurrence and relapse of bleeding from duodenal ulcer: respective roles of acid secretion and Helicobacter pylori infection. Aliment Pharmacol Ther 2001; 15:821-9. [PMID: 11380320 DOI: 10.1046/j.1365-2036.2001.00992.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Helicobacter pylori infection, gastric acid hypersecretion and NSAID consumption may cause peptic ulcer. AIM To investigate the respective roles of H. pylori and acid secretion in bleeding duodenal ulcer. PATIENTS AND METHODS A total of 99 duodenal ulcer patients were referred for evaluation of acid secretion: seven with Zollinger-Ellison Syndrome; 14 with hypersecretory duodenal ulcer, defined by the coexistence of elevated basal acid output and pentagastrin acid output; and 78 duodenal ulcer patients with normal acid output. All non-Zollinger-Ellison Syndrome patients were H. pylori-positive and cured of infection. All patients were followed-up for a 36-month period, to assess the occurrence of bleeding episodes. RESULTS Twenty-nine patients had at least one bleeding episode in the 4 years before the study. Bleeding was more frequent in males and in patients on NSAIDs. The mean basal acid output was not higher among bleeders. In the 21 patients (14 hypersecretory duodenal ulcer, seven Zollinger-Ellison Syndrome) with basal acid output > 10 meg/h and pentagastrin acid output > 44.5 meg/h, the risk of bleeding was higher (OR 6.5; 95% CI: 2-21). In the follow-up period, three out of 83 (3.3%) non-Zollinger-Ellison Syndrome patients had a H. pylori-negative duodenal ulcer with bleeding. The risk of bleeding after H. pylori cure was not higher in hypersecretory duodenal ulcer patients (P > 0.3), nor among patients with previous bleeding episodes (P > 0.2). CONCLUSIONS In H. pylori-positive duodenal ulcer patients, the coexistence of elevated basal acid output and pentagastrin acid output leads to a sixfold increase in the risk of bleeding. After H. pylori cure, gastric acid hypersecretion is not a risk factor for bleeding. However, duodenal ulcer recurrence with bleeding may occasionally occur in patients cured of H. pylori, even if acid output is normal.
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Affiliation(s)
- G Capurso
- Digestive and Liver Diseases Unit, II Medical School, Rome, Italy Istituto di Igiene G Sanarelli, University La Sapienza, Rome, Italy
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Duff M, Scheepers M, Cooper M, Hoghton M, Baddeley P. Helicobacter pylori: has the killer escaped from the institution? A possible cause of increased stomach cancer in a population with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2001; 45:219-225. [PMID: 11422646 DOI: 10.1046/j.1365-2788.2001.00302.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher-than-expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between 1946 and 1996. A 50-year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to 48% of all cancer deaths. A further 25 residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored.
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Affiliation(s)
- M Duff
- Bath and West Community Care Trust, Brentry Hospital, Bristol, UK.
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39
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40
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Surgical Management of Peptic Ulcer Disease in the Helicobacter Era—Management of Bleeding Peptic Ulcer. Surg Laparosc Endosc Percutan Tech 2001. [DOI: 10.1097/00129689-200102000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Lai KC, Hui WM, Wong BC, Hu WH, Lam SK. Ulcer-healing drugs are required after eradication of Helicobacter pylori in patients with gastric ulcer but not duodenal ulcer haemorrhage. Aliment Pharmacol Ther 2000; 14:1071-6. [PMID: 10930902 DOI: 10.1046/j.1365-2036.2000.00803.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM To study the efficacy of a 2-week anti-Helicobacter therapy in the healing of H. pylori-associated bleeding peptic ulcers. METHODS Omeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g, twice daily, were given for 2 weeks to 180 patients with H. pylori-associated bleeding peptic ulcers. Endoscopy was repeated 4 weeks after the eradication therapy to assess healing of the peptic ulcers. RESULTS Repeat endoscopies were performed in 168 patients (42 gastric ulcer and 126 duodenal ulcer) who followed the protocol. Thirty-eight patients with bleeding gastric ulcers and 124 patients with bleeding duodenal ulcers healed 4 weeks after treatment (per protocol analysis; gastric ulcer: 91% vs. duodenal ulcer: 98%; P=0. 035). No patients who were compliant to the study medications suffered from re-bleeding. Stepwise discriminant analysis demonstrated that small ulcers (< 15 mm) and the presence of duodenal ulcers best predicted healing of the peptic ulcers. CONCLUSIONS Ulcer-healing drugs should be continued after a 2-week course of omeprazole-containing anti-Helicobacter therapy for gastric ulcers and large peptic ulcers that have bled, but can be omitted in most patients with a bleeding duodenal ulcer.
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Affiliation(s)
- K C Lai
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China.
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42
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Lee JM, Breslin NP, Fallon C, O'Morain CA. Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding. Am J Gastroenterol 2000; 95:1166-70. [PMID: 10811322 DOI: 10.1111/j.1572-0241.2000.02004.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The eradication of Helicobacter pylori (H. pylori) in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer rebleeding. Although all methods for H. pylori diagnosis have been extensively evaluated in uncomplicated PUD the efficacy of the commonly used rapid urease test (RUT) has not been established in patients with bleeding peptic ulcer disease. The aim of this study was to evaluate the efficacy of the RUT (CLOtest) in patients with bleeding duodenal ulcers (DUs). METHODS Consecutive patients with symptoms of upper GI tract hemorrhage and a DU at the time of endoscopy were evaluated. The presence of H. pylori infection was determined by RUT, microbiology, and histology. Consecutive patients with uncomplicated DUs were similarly evaluated. The prevalence of H. pylori as determined by the RUT alone was compared to that determined by a combination of all tests in both patient groups. RESULTS Fifty-five patients with bleeding DUs and 69 with nonbleeding DUs were evaluated. The prevalence of H. pylori in patients presenting with bleeding was 72.7% (95% confidence interval [CI] 61.0-84.5%) and lower than the prevalence rate of 92.8% (95% CI 86.6-98.8%) in patients with uncomplicated PUD (p < 0.05). The prevalence of H. pylori in the bleeding DU group as determined by RUT alone (54.5%) was less than that determined by a combination of all tests (73%) with a false-negative rate of 10 of 40 (25%; 95% CI 11.6-38.4%) (p < 0.05). This false-negative rate was significantly greater than that observed in the group presenting with dyspepsia (1 of 64 [1.6%; 95% CI 0-4.6%]) (p < 0.01). CONCLUSIONS The prevalence of H. pylori is lower in patients with bleeding DUs when compared to patients with uncomplicated DUs. In addition, the sensitivity and negative predictive value of the RUT is lower in patients presenting with bleeding, and other methods of H. pylori diagnosis should be used in this patient group.
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Affiliation(s)
- J M Lee
- Department of Gastroenterology, Meath Hospital, Trinity College, Dublin, Ireland
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43
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Abstract
Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. Twenty years ago, most ulcers were considered idiopathic; but a revolution in knowledge has occurred, so that it is now understood that the great majority of ulcers results from infection with Helicobacter pylori (HP) or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Before this revolution, peptic ulcer disease was a common public health problem, responsible for considerable morbidity, some mortality, and high economic cost. Today, the overall prevalence of ulcers is falling, but complication rates remain relatively stable. These complex trends primarily reflect 3 factors: the rapid decline in the prevalence of HP in the population of developed countries, an increase in consumption of NSAIDs, and change in rates of smoking. Peptic ulcer prevalence is falling in younger individuals because of decreased prevalence of HP, whereas complications are rising in older subjects, largely as the result of increased NSAID use.
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Affiliation(s)
- A H Soll
- CURE-UCLA Digestive Disease Center, USA
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44
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Lee JM, Breslin NP, Gopaul M, Koh CW, Kong TY, Soong MM, O'Morain CA. The effects of blood on rapid urease testing for Helicobacter pylori in mucosal biopsies from the gastric antrum. Ir J Med Sci 2000; 169:60-2. [PMID: 10846863 DOI: 10.1007/bf03170489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND While the eradication of Helicobacter pylori in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer re-bleeding, the sensitivity of the rapid urease test (RUT) for H. pylori diagnosis is lower in this setting. The aim of this study was therefore to determine if exposing a gastric biopsy specimen to blood before its use in the RUT (CLOtest) could account for these findings. METHODS In patients undergoing endoscopy for the evaluation of dyspepsia gastric mucosal biopsies were obtained for H. pylori diagnosis (RUT, microbiology, and histology). Mucosal biopsies from each patient were also exposed to blood for 15, 30 and 45 minutes before use in the RUT. RESULTS Using a combination of diagnostic tests (histology, microbiology and routine CLOtest) as the 'gold standard', the sensitivity, specificity, positive predictive value and negative predictive value of the CLOtest remained above 90% despite prior exposure of the gastric biopsy specimen to blood, and these values were not significantly different from the performance characteristics of the CLOtest processed in a routine manner. CONCLUSION The exposure of gastric mucosal biopsy specimens to blood alone is not the explanation for the reduced sensitivity of the RUT in patients with bleeding peptic ulcers.
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Affiliation(s)
- J M Lee
- Department of Gastroenterology, Meath Hospital, Trinity College, Dublin
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Martino G, Paoletti M, Marcheggiano A, D'Ambra G, Delle Fave G, Annibale B. Duodenal ulcer relapse is not always associated with recurrence of H. pylori infection: a prospective three-year follow-up study. Helicobacter 1999; 4:213-7. [PMID: 10597388 DOI: 10.1046/j.1523-5378.1999.99285.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Long-term data concerning the reappearance of Helicobacter pylori infection and duodenal ulcer (DU) recurrence after successful eradication are still few and conflicting. Inadequate histological assessment or use of indirect tests for the determination of H. pylori and bias in the selection of patients to be controlled can influence reported results. The aim of this study was to determine the rate of recurrence of H. pylori infection and ulcer relapse in a population of cured DU patients followed up for 3 years irrespective of their symptomatology. METHODS Between 1992 and 1994, 126 patients with DU disease were treated with double or triple therapy. Patients using nonsteroidal antiinflammatory drugs or aspirin or receiving maintenance antisecretory therapy were excluded. H. pylori infection was assessed by three bioptic tests from both the antrum and the body (culture, urease, histopathological examination). After 2 months from cessation of treatment, DU had healed and H. pylori infection was cured in 102 of 126 patients (81%). These patients were endoscopically followed up after 1 and 3 years, respectively, and were advised to contact us at symptom recurrence. At 1 and 3 years, we studied 95 (93.2%) and 79 (77.4%) patients, respectively, of the 102 who were cured. The other patients were untraceable or refused endoscopy because they were asymptomatic. RESULTS After 1 year, no patient had H. pylori recurrence, whereas three patients had a relapse of DU without evidence of infection. After 3 years, recurrence of H. pylori occurred in six patients (annual rate, 2.5%), DU relapsed in five H. pylori-positive patients (6.3%) and in two H. pylori-negative patients (annual rate, 1.9%). Fasting gastrin and acid secretion values studied in all relapsed patients were within the normal range except for one H. pylori-positive patient. CONCLUSIONS Recurrence of H. pylori infection is very low where treatment is effective, but a DU relapse, not related to acid hypersecretion, can occur in a small percentage of cured patients.
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Affiliation(s)
- G Martino
- Cattedra di Gastroenterologia II Clinica Medica, Universita La Sapienza, Roma, Italy
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Humphries TJ, Merritt GJ. Review article: drug interactions with agents used to treat acid-related diseases. Aliment Pharmacol Ther 1999; 13 Suppl 3:18-26. [PMID: 10491725 DOI: 10.1046/j.1365-2036.1999.00021.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patients with acid-related diseases often need to take multiple medications. Treatment of Helicobacter pylori infection often includes either a histamine type 2 (H2)-receptor antagonist or a proton pump (H+,K(+)-ATPase) inhibitor (proton pump inhibitor), administered in conjunction with one or more antimicrobials. Also, treatment for acid-related diseases often requires extended therapy during which many concomitant medications may be administered for concurrent disease states. Polypharmacy may be the result, particularly in elderly patients, who are at increased risk for both acid-related and many other diseases. Thus, it is important to understand the potential for clinically significant drug-drug interactions in this setting. H2-receptor antagonists and proton pump inhibitors can influence the pharmacokinetic profiles of other commonly administered medications by elevating intragastric pH, which can alter drug absorption, and by interacting with the cytochrome P (CYP) 450 enzyme system, which can affect drug metabolism and clearance. Such interactions are particularly important when they affect the pharmacokinetics of drugs with narrow therapeutic ranges (e.g. warfarin, digoxin). In these cases, drug-drug interactions can result in significant toxicity and even death. There are marked differences among H2-receptor antagonists and proton pump inhibitors in their potential for such interactions. The oldest drugs in each class, cimetidine and omeprazole, respectively, have the greatest potential to alter CYP activity and change the pharmacokinetics of other drugs. The most recently developed H2-receptor antagonist, famotidine, and the newer proton pump inhibitors, rabeprazole and pantoprazole, are much less likely to induce or inhibit CYP and thereby change the metabolism of other medications. These differences are important when choosing medications for the safe treatment of patients with acid-related diseases.
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