Evaluation of peptic ulcer healing with a highly magnifying endoscope: potential prognostic and therapeutic implications

The Value of Confocal Laser Endoscopy in Assessing the Quality of Duodenal Ulcer Healing

BACKGROUND AND OBJECTIVE

Confocal laser endomicroscopy (CLE) is a novel endoscopic technique that can image cells and subcellular layers of the gastric mucosa in vivo. We aimed to investigate the value of CLE in assessing the quality of ulcer healing (QOUH) and preliminarily establish evaluation criteria.

MATERIALS AND METHODS

Patients with duodenal ulcers were enrolled. After duodenal ulcer healing, we compared the value of CLE and white light endoscopy (WLE) in assessing the QOUH by using the histopathological diagnosis as the gold standard. At the same time, immunohistochemistry was performed to examine the expressions of transforming growth factor β1 (TGF-β1) and fibroblast growth factor 2 (FGF-2) in normal and scar tissues.

RESULTS

In assessing the QOUH classified as poor, good, and excellent by the pathological classification, the sensitivity of WLE was 57.14%, 50%, and 47.06%, the specificity was 87.80%, 52.38%, and 81.58%, and the accuracy was 80.00%, 50.91%, and 70.91%, respectively. Meanwhile, the sensitivity of CLE was 73.33%, 85.19%, and 92.31%, the specificity was 95%, 85.71%, and 92.86%, and the accuracy was 89.09%, 85.45%, and 92.73%, respectively. The κ value for the correlation with pathological diagnosis grade was 0.38 for WLE vs. 0.74 for CLE. The assessment of the QOUH in the CLE image classification showed great improvement compared with that in the WLE image classification. The image classification of CLE was not associated with the immunohistochemical expression of TGF-β1 or FGF-2 according the Spearman rank correlation (P > 0.05).

CONCLUSION

Compared with WLE, CLE has a higher value in assessing the QOUH. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Progress in understanding effects of positive acceleration on quality of ulcer healing in rats with experimental gastric ulcer

Injuries associated with high-performance fighter aircrafts and spacecrafts are bringing serious challenges to pilots. Exposure to positive acceleration (+Gz) can increase the incidence and recurrence of peptic ulcer. Recurrence of ulcer is closely related to quality of ulcer healing (QOUH), and improving QOUH is considered to be the third leap of understanding of peptic ulcer and has become a hotspot of aerospace medicine research. In this paper, we review the recent advances in understanding the effects of +Gz exposure on QOUH in rats with experimental gastric ulcer in terms of animal model development, QOUH assessment, and influencing factors for QOUH, with an aim to improve the protection against injuries caused by +Gz exposure, strengthen the pilot's overall ability to resist +Gz, and enhance the safety of flight.

Quality of gastric ulcer healing evaluated by endoscopic ultrasonography

AIM: To evaluate the quality of gastric ulcer healing after different antiulcer treatment by endoscopic ultrasonography (EUS).

METHODS: The patients were divided into three groups, and received lansoprazole, amoxicillin and clarithromycin for 1 wk. Then group A took lansoprazole combined with tepreton for 5 wk, group B took lansoprazole and group C took tepreton for 5 wk. Endoscopy and EUS were performed before and 6 wk after medication.

RESULTS: There was no significant difference in cumulative healing rate to S stage between the groups (89%, 82% vs 83%, P>0.05). The rate of white scar formation was significantly higher in group A than in groups B and C (67%, 36%, 50%, P<0.05). The average contraction rates of the width of ulcer crater, length of disrupted muscularis propria layer and hypoechoic area were higher in group A than in groups B and C (0.792±0.090, 0.660±0.105 vs 0.668±0.143, P<0.05). The hypoechoic area disappeared in four cases of group A, one of group B and two of group C. The percentage of hypoechoic area disappearance was higher in group A than in the other two groups (44%, 9% vs 17%, P<0.05). Gastric ulcer healing was better in group A.

CONCLUSION: The combined administration of proton-pump inhibitors and mucosal protective agent can improve gastric ulcer healing.

Preliminary study on a novel quadruple eradication therapy with a mucoprotective drug, sofalcone, for Helicobacter pylori infection

To assess the effects of the mucoprotective drug sofalcone, which has direct and indirect effects on Helicobacter pylori in vitro, the eradication rate, adverse effects, and the quality of healing peptic ulcers were evaluated. Each study patient was given 500 mg t.i.d. amoxicillin and 200 mg t.i.d. clarithromycin. In addition, three different treatment regimens were compared: a standard dose (20 mg q.d.) of the proton pump inhibitor omeprazole (OAC), a double dose (20 mg b.i.d.) of omeprazole (Ox2AC), and a standard dose of omeprazole and a standard dose (100 mg t.i.d.) of sofalcone (OACS). Thirty-one H. pylori-positive patients were treated with OAC, 37 with Ox2AC, and 41 with OACS therapy. With an intention-to-treat analysis, the eradication rates were 74.2% for OAC, 86.2% for Ox2AC, and 85.0% for OACS therapy. The incidence of side effects was 9.6% for patients given OAC therapy, 86.5% for Ox2AC, and only 7.5% for OACS-treated patients, which was significantly lower than the incidence in the Ox2AC group. High-quality peptic ulcer scars were observed after eradication therapy which included solfacone. Although it is necessary to conduct a randomized double-blind study to obtain definitive conclusions, our results indicate that this novel quadruple eradication therapy with solfacone is an efficacious regimen with a high eradication rate and positive effects on ulcer healing, combined with a low incidence of adverse events.

Preliminary clinical study on gastric ulcer scars and ulcer relapses after Helicobacter pylori eradication therapy

To determine the effect of Helicobacter pylori eradication on the healing of gastric ulcers, endoscopic examinations of gastric ulcer scars and ulcer relapse after eradication therapies or antisecretory therapy were carried out in 24 H. pylori-positive patients with recurrent gastric ulcers located in the gastric angle. Sixteen patients were initially treated with 2-week triple eradication therapy. Subsequently, seven of eight noneradicated cases were retreated with triple therapy, which included metronidazole. Eight patients received antisecretory monotherapy. Endoscopic examinations were performed at 4 weeks and 6 months after the treatments. Gastric ulcer scars were classified endoscopically into three types: Sa, a central depression surrounded by a coarse pattern: Sb, a coarse regenerated pattern; and Sc, a fine pattern indicating matured scar of high quality. Transformations of the scar patterns and ulcer relapse were assessed in 19 patients who showed an ulcer scar at 4 weeks after initial therapy. Thirteen cases in which H. pylori was successfully eradicated, either after initial or re-eradication therapies, mainly showed Sc scars and had no ulcer relapse. Sa scar was mainly observed during H. pylori-positive conditions. Transformation from the Sa to the Sc was observed after successful re-eradication. Ulcer relapses occurred in three patients who showed Sa scar after antisecretory therapy. Although a random study would be needed to obtain a definite conclusion, we suspect that the H. pylori-negative condition after eradication therapies may result in good ulcer healing and may subsequently reduce ulcer relapse.

An endoscopic study on relationship between Helicobacter pylori infection and endoscopic gastric ulcer scars

A two-year endoscopic follow-up study of 45 gastric ulcer patients was conducted in order to ascertain the relationship between Helicobacter pylori infection, the transformation of ulcer scar patterns, and ulcer relapse during maintenance therapy. Endoscopic findings of gastric ulcer scar patterns, which established the quality of ulcer scars, were classified as follows: Sa, with a central depression, Sb, with a coarse regenerating mucosal pattern up to the center, and Sc, with a fine pattern. The proportion of ulcer relapses was 62% among 29 H. pylori-positive patients and 0% among 16 H. pylori-negative patients. In regard to the relationship between H. pylori infection and scar patterns, 94% of the H. pylori-negative patients displayed Sc scar patterns, while all the H. pylori-positive patients showed various scar patterns, ie, Sa in 38%, Sb in 28%, and Sc in 10%. Ulcer relapses in the H. pylori-positive cases were limited to the Sa and Sb groups (100% and 88%, respectively). In conclusion, our results indicate that H. pylori infection plays an important role in the transformation of the ulcer scar patterns which relate to ulcer relapse.

Sequential observation of gastric ulcer healing by endoscopic ultrasonography

BACKGROUND

The relationship between superficial findings and the inner structure of gastric ulcers is unclear. The present study was undertaken to clarify the relationship between them.

METHODS

In the first study, 43 patients with active gastric ulcers were examined by endoscopic ultrasonography (EUS) in each stage of Sakita's endoscopic classification. In the second study, 16 patients with gastric ulcer scars were examined by EUS in both S1 stage and S2 stage.

RESULTS

Ulcer area, ulcer length, thickness of the ulcer base, and diameter of the crater differed significantly in each endoscopic stage. Ulcer area, ulcer length, and thickness of the ulcer base differed significantly even between S1 stage and S2 stage. Mean ulcer area in S1 stage was 96.9 mm2; this shows that the ulcer scar in S1 stage is incomplete with regard to tissue contraction. Although ulcer area in S2 stage had shrunk significantly compared with that in S1 stage, it still remained 53.3 mm2. This implies that the risk of local recurrence remains even in S2 stage.

CONCLUSIONS

Sequential observation by EUS showed that the healing of the ulcer surface strongly reflected the healing within the ulcers.

Histologic patterns of omeprazole and nizatidine-healed duodenal ulcers:accuracy of endoscopic diagnosis

The mechanisms underlying duodenal ulcer (DU) recurrence after endoscopically confirmed healing are unclear. We sought to examine histologic differences in healing induced by omeprazole and nizatidine. This also entailed assessing interobserver variation in endoscopic diagnosis and the correlation between endoscopic and histomorphologic healing. We treated 31 DU patients for 4 weeks with either omeprazole (20 mg daily a.m.) or nizatidine (300 mg twice daily). The healing rates of both groups showed no significant differences (86.7% versus 81.2%; p = 0.5). Good mucosal repair rates did not differ significantly (38.5% versus 69.2% respectively; p = 0.5). Endoscopists' agreement over scar type was 0.80, with the chance of agreement 0.70 (k = 0.34 +/- -0.08). The correlation between macroscopic and histologic appearance of scars was fair, but fully significant (r = 0.48; p < 0.05). We conclude that the study was too small to detect significant differences in healing patterns between the two drugs. The wide variation in endoscopic diagnosis suggests that mucosal repair is best assessed by histologic examination of biopsy samples.