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Nakajima N, Takeuchi T, Hokari R, Narimatsu K, Iijima K, Koizumi S, Kasugai K, Ebi M, Nagahara A, Takeda T, Tomita T, Shinzaki S, Mizukami K, Murakami K, Yagi N, Mukai R, Okumura T, Tanabe H, Tanaka K, Iwamoto J, Irisawa A, Fukushi K, Kataoka H, Nishie H, Fujiwara Y, Otani K, Handa O, Maruyama Y, Uraoka T, Hosaka H, Furuta T, Takagi T, Nakamura M, Nyumura Y, Hakoda A, Sugawara N, Iwatubo T, Ota K, Kawaguchi S, Higuchi K, Nishikawa H. Background factors of idiopathic peptic ulcers and optimal treatment methods: a multicenter retrospective Japanese study. J Clin Biochem Nutr 2024; 74:82-89. [PMID: 38292123 PMCID: PMC10822756 DOI: 10.3164/jcbn.23-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 02/01/2024] Open
Abstract
This study investigated the trends in idiopathic peptic ulcers, examined the characteristics of refractory idiopathic peptic ulcer, and identified the optimal treatment. The characteristics of 309 patients with idiopathic peptic ulcer were examined. We allocated idiopathic peptic ulcers that did not heal after 8 weeks' treatment (6 weeks for duodenal ulcers) to the refractory group and those that healed within this period to the healed group. The typical risk factors for idiopathic peptic ulcer (atherosclerosis-related underlying disease or liver cirrhosis complications) were absent in 46.6% of patients. Absence of gastric mucosal atrophy (refractory group: 51.4%, healed group: 28.4%; p = 0.016), and gastric fundic gland polyps (refractory group: 17.6%, healed group: 5.9%; p = 0.045) were significantly more common in the refractory group compared to the healed group. A history of H. pylori eradication (refractory group: 85.3%, healed group: 66.0%; p = 0.016), previous H. pylori infection (i.e., gastric mucosal atrophy or history of H. pylori eradication) (refractory group: 48.5%, healed group: 80.0%; p = 0.001), and potassium-competitive acid blocker treatment (refractory group: 28.6%, healed group, 64.1%; p = 0.001) were significantly more frequent in the healed group compared to the refractory group. Thus, acid hypersecretion may be a major factor underlying the refractoriness of idiopathic peptic ulcer.
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Affiliation(s)
- Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Toshihisa Takeuchi
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama 359-0042, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama 359-0042, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Shigeto Koizumi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
| | - Masahide Ebi
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Toshihiko Tomita
- Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo 663-8501, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo 663-8501, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5503, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5503, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu 500-8523, Japan
| | - Rieko Mukai
- Department of Gastroenterology, Asahi University Hospital, Gifu 500-8523, Japan
| | - Toshikatsu Okumura
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Hiroki Tanabe
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa-Kosei General Hospital, Hokkaido 078-8211, Japan
| | - Junichi Iwamoto
- Department of Gastroenterology, Endoscopy Center, Tokyo Medical University Ibaraki Medical Center, Tokyo 300-0395, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0207, Japan
| | - Koh Fukushi
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0207, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi 467-8602, Japan
| | - Hirotada Nishie
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi 467-8602, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Osamu Handa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Yasuhiko Maruyama
- Division of Gastroenterology, Fujieda Municlpal General Hospital, Shizuoka 426-8677, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University, Gunma 371-0034, Japan
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology, Gunma University, Gunma 371-0034, Japan
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University Hospital, Shizuoka 431-3192, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masakatsu Nakamura
- Department of Gastroenterology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Yuya Nyumura
- Department of Surgery, Fuji City General Hospital, Shizuoka 417-8567, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Taro Iwatubo
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Kazuhiro Ota
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Shinpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
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Yang TJ, Dhanasekar K, Bhandari R, Muraleedharan D, Chirindoth SS, Kaur H, Goswami R, Maiyani P, Desai M, Moradiya DV, Devani H, Patel AA. Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study. Cureus 2021; 13:e19315. [PMID: 34900489 PMCID: PMC8650630 DOI: 10.7759/cureus.19315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database. METHODS We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients. RESULTS Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2). CONCLUSION H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.
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Affiliation(s)
- Tsu Jung Yang
- Hospital Medicine, MultiCare Good Samaritan Hospital, Puyallup, USA
| | | | - Renu Bhandari
- Medicine, Manipal College of Medical Sciences, Kaski, NPL
| | | | | | - Harpreet Kaur
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Ruchir Goswami
- Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | - Maheshkumar Desai
- Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Augusta, USA
| | | | - Hiteshkumar Devani
- Dental Medicine, University of Pittsburgh School of Dental Medicine, Pittsburgh, USA
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Chen Y, Guo J, Chen C, Shi D, Fang D, Ji F, Li L. Characterization of the Gastric Mucosal Microbiota in Patients with Liver Cirrhosis and Its Associations with Gastrointestinal Symptoms. ENGINEERING 2021; 7:507-514. [DOI: 10.1016/j.eng.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Shah H, Yang TJ, Wudexi I, Solanki S, Patel S, Rajan D, Rodas A, Dajjani M, Chakinala RC, Shah P, Sarker K, Patel A, Aronow W. Trends and outcomes of peptic ulcer disease in patients with cirrhosis. Postgrad Med 2020; 132:773-780. [PMID: 32654578 DOI: 10.1080/00325481.2020.1795485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. METHODS We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002-2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes. RESULTS Between the years 2002-2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63-1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 - 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis. CONCLUSION Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes.
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Affiliation(s)
- Harshil Shah
- Internal Medicine, Guthrie Robert Packer Hospital , Sayre, Pennsylvania, United States
| | - Tsu Jung Yang
- MultiCare Good Samaritan Hospital , Puyallup, Washington, United States
| | - Ivan Wudexi
- Internal Medicine, University at Buffalo/Catholic Health System , Buffalo, New York, United States
| | - Shantanu Solanki
- Internal Medicine, Guthrie Robert Packer Hospital , Sayre, Pennsylvania, United States
| | - Shakumar Patel
- Internal Medicine, Ocean Medical Center , Brick, New Jersey, United States
| | - Don Rajan
- Internal Medicine, UTRGV Doctors' Hospital at Renaissance , Edinburg, Texas, United States
| | - Aaron Rodas
- Internal Medicine, Pontiac General Hospital , Pontiac, Michigan, United States
| | - Mousa Dajjani
- Internal Medicine, Pontiac General Hospital , Pontiac, Michigan, United States
| | | | - Priyal Shah
- Internal Medicine, Medical Center Navicent Health , Macon, Georgia, United States
| | - Khadiza Sarker
- Internal Medicine, Carle Foundation Hospital , Urbana, Illinois, United States
| | | | - Wilbert Aronow
- New York Medical College, Cardiology Division, New York Medical College Macy Pavilion , Valhalla, New York, United States
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Voulgaris T, Karagiannakis D, Siakavellas S, Kalogera D, Angelopoulos T, Chloupi E, Karamanolis G, Papatheodoridis G, Vlachogiannakos J. High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis. Ann Gastroenterol 2019; 32:451-456. [PMID: 31474790 PMCID: PMC6686096 DOI: 10.20524/aog.2019.0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH). Methods: We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data. Results: One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection. Conclusions: A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation.
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Affiliation(s)
- Theodoros Voulgaris
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Spyridon Siakavellas
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Despina Kalogera
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Theodoros Angelopoulos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Elissavet Chloupi
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Karamanolis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Papatheodoridis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - John Vlachogiannakos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
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Zeng HJ. Efficacy of pantoprazole and omeprazole in treatment of peptic ulcer bleeding. Shijie Huaren Xiaohua Zazhi 2017; 25:1894-1898. [DOI: 10.11569/wcjd.v25.i20.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of pantoprazole and omeprazole in the treatment of peptic ulcer bleeding.
METHODS Eighty hospitalized patients with peptic ulcer bleeding treated at Department of Gastroenterology, Qianjiang Central Hospital from March 2016 to December 2016 were included and divided into either an omeprazole group (n = 40) or a pantoprazole group (n = 40) according to the drug used. The curative effect, bleeding, hematemesis and melena were compared between the two groups.
RESULTS There was no significant difference in the total effective rate between the pantoprazole group and omeprazole group [95% (38/40) vs 95% (38/40), P > 0.05]. The amount of bleeding (153.2 mL + 15.6 mL on day 1 and 12.1 mL + 2.5 mL on day 3) was significantly lower, and the time to hemostasis (1.3 d + 0.4 d) was significantly shorter in the pantoprazole group than in the omeprazole group (P < 0.05). The average duration of hematemesis (0.2 + 0.1) and the average number of episodes of melena (0.9 + 0.2) in the pantoprazole group were significantly lower than those of the omeprazole group (P < 0.05). The average intragastric pH value within 24 h was 6.7 ± 0.2 in the pantoprazole group, which was significantly higher than that in the omeprazole group. The mean duration of intragastric pH > 4.0 (18.1 min ± 2.5 min) min and > 6.0 (31.5 min ± 1.2 min) in the pantoprazole group was significantly shorter than that of the omeprazole group (P < 0.05).
CONCLUSION The clinical curative effect of omeprazole and pantoprazole in the treatment of peptic ulcer bleeding is comparable, but pantoprazole is superior in controlling hemorrhage, shortening the bleeding time, and alleviating melena symptoms.
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Williams MJ, Hayes P. Improving the management of gastrointestinal bleeding in patients with cirrhosis. Expert Rev Gastroenterol Hepatol 2016; 10:505-15. [PMID: 26581713 DOI: 10.1586/17474124.2016.1122523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gastrointestinal bleeding remains a major cause of mortality in patients with cirrhosis. The most common source of bleeding is from gastroesophageal varices but non-variceal bleeding from peptic ulcer disease also carries a significant risk in patients with liver disease. The prognosis is related to the severity of the underlying liver disease, and deaths often occur due to liver failure, infection or renal failure. Optimal management should therefore not only achieve haemostasis but address these complications as well. The management of gastrointestinal bleeding in patients with cirrhosis includes a range of medical, endoscopic and radiological interventions. This article updates the recent developments in this area and highlights topics where further research is still required.
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Affiliation(s)
- Michael J Williams
- a Centre for Liver and Digestive Diseases , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Peter Hayes
- a Centre for Liver and Digestive Diseases , Royal Infirmary of Edinburgh , Edinburgh , UK
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Chang SS, Hu HY. Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients. Gut Liver 2016; 9:346-52. [PMID: 25167793 PMCID: PMC4413968 DOI: 10.5009/gnl13451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background/Aims The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.
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Affiliation(s)
- Shen Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.,Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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Chang SS, Hu HY. Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens. World J Gastrointest Pharmacol Ther 2015; 6:127-136. [PMID: 26558147 PMCID: PMC4635153 DOI: 10.4292/wjgpt.v6.i4.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/10/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
The presence of concomitant diseases is an independent predictive factor for non-Helicobacter pylori (H. pylori) peptic ulcers. Patients contracting concomitant diseases have an increased risk of developing ulcer disease through pathogenic mechanisms distinct from those of H. pylori infections. Factors other than H. pylori seem critical in peptic ulcer recurrence in end stage renal disease (ESRD) and cirrhotic patients. However, early H. pylori eradication is associated with a reduced risk of recurrent complicated peptic ulcers in patients with ESRD and liver cirrhosis. Resistances to triple therapy are currently detected using culture-based and molecular methods. Culture susceptibility testing before first- or second-line therapy is unadvisable. Using highly effective empiric first-line and rescue regimens can yield acceptable results. Sequential therapy has been included in a recent consensus report as a valid first-line option for eradicating H. pylori in geographic regions with high clarithromycin resistance. Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual- (clarithromycin- and metronidazole-) resistant H. pylori strains. We aim to review the prevalence of and eradication therapy for H. pylori infection in patients with ESRD and cirrhosis. Moreover, we summarized the updated H. pylori eradication regimens.
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Chang SS, Hu HY. Association between early Helicobacter pylori eradication and a lower risk of recurrent complicated peptic ulcers in end-stage renal disease patients. Medicine (Baltimore) 2015; 94:e370. [PMID: 25569660 PMCID: PMC4602848 DOI: 10.1097/md.0000000000000370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
End-stage renal disease (ESRD) patients exhibit an increased incidence of peptic ulcer disease. Helicobacter pylori plays a central role in the development of peptic ulcers. The effect of early H pylori eradication on the recurrence of complicated peptic ulcer disease in ESRD patients remains unclear. The aim of the present study was to explore whether early H pylori eradication therapy in ESRD patients can reduce the risk of recurrent complicated peptic ulcers.We conducted a population-based cohort study and recruited patients with ESRD who had developed peptic ulcers. We categorized patients into early (time lag ≦120 days after peptic ulcer diagnosis) and late H pylori eradication therapy groups. The Cox proportional hazards model was used. The endpoint was based on hospitalization for complicated recurrent peptic ulcers.The early and late H pylori eradication therapy groups consisted of 2406 and 1356 ESRD patients, respectively, in a time lag of 120 days. After adjusting for possible confounders, the early eradication group exhibited a lower rate of complicated recurrent peptic ulcer disease (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.64-0.91, P = 0.003) in a time lag of ≦120 days, but a similar rate of complicated recurrent peptic ulcer disease in time lags of ≦1 year (HR = 0.97, 95% CI 0.79-1.19, P = 0.758) and 2 years (HR = 1.11, 95% CI 0.86-1.44, P = 0.433) compared with the late eradication group.We recommend administering H pylori eradication within 120 days after peptic ulcer diagnosis to H pylori infected ESRD patients who have developed peptic ulcers.
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Affiliation(s)
- Shen-Shong Chang
- From the Division of Gastroenterology (S-SC), Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch; School of Medicine (S-SC); Institute of Public Health & Department of Public Health (H-YH), National Yang-Ming University; and Department of Education and Research (H-YH), Taipei City Hospital, Taipei, Taiwan
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Kalaitzakis E. Gastrointestinal dysfunction in liver cirrhosis. World J Gastroenterol 2014; 20:14686-14695. [PMID: 25356031 PMCID: PMC4209534 DOI: 10.3748/wjg.v20.i40.14686] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/27/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023] Open
Abstract
Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life. Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity, psychological distress, and gut dysfunction (e.g., increased gastric sensitivity to distension and delayed gut transit). They may lead to reduced food intake and, thus, may contribute to the nutritional status deterioration in cirrhotic patients. Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach, published data on gastric accommodation in cirrhotics without significant ascites are not unanimous. Gastric emptying and small bowel transit have generally been shown to be prolonged. This may be related to disturbances in postprandial glucose, insulin, and ghrelin levels, which, in turn, appear to be associated to insulin resistance, a common finding in cirrhosis. Furthermore, small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth. Finally, several studies have reported intestinal barrier dysfunction in patients with cirrhosis (especially those with portal hypertension), which is related to bacterial translocation and permeation of intestinal bacterial products, e.g., endotoxin and bacterial DNA, thus potentially being involved in the pathogenesis of complications of liver cirrhosis.
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Abstract
OBIECTIVE The study aimed to investigate whether early Helicobacter pylori (H. pylori) eradication therapy in cirrhotic patients caused a dramatic reduction of recurrent peptic ulcers compared with those treated with a late eradication. METHODS We identified cirrhotic patients using the International Classifications of Diseases, Revision 9 (ICD-9-CM). Decompensated cirrhotic patients can apply for a catastrophic illness card and were identified via the ICD-9-CM codes 571.2, 571.5 and 571.6. Compensated cirrhotic patients were identified via the ICD-9-CM codes 571.2, 571.5 and 571.6, after excluded decompensated cirrhotic patients. We categorized patients into early (time lag ≤365 days after peptic ulcer diagnosis) and late (time lag >365 days) H. pylori eradication therapy groups. The end-point was the occurrence of recurrent peptic ulcers. Cox proportional hazards model was used to calculate the hazard ratios (HRs). RESULTS Altogether, 154 cirrhotic patients were included in the early H. pylori eradication group and 103 in the late H. pylori eradication group. Cirrhotic patients had a higher risk of recurrent peptic ulcers in the late H. pylori eradication group (HR 1.58, 95% CI 1.09-2.28, P = 0.015). However, the risk of recurrent peptic ulcers in alcoholic cirrhotic patients in both groups (HR 1.47, 95% CI 0.77-2.83, P = 0.247) was similar. CONCLUSIONS Early H. pylori eradication is associated with a lower risk of recurrent peptic ulcers in cirrhotic patients. H. pylori eradication is the mainstay for treating cirrhotic patients who have contracted peptic ulcers.
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Affiliation(s)
- Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan, China; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan, China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, China
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Iijima K, Kanno T, Koike T, Shimosegawa T. Helicobacter pylori-negative, non-steroidal anti-inflammatory drug: Negative idiopathic ulcers in Asia. World J Gastroenterol 2014; 20:706-713. [PMID: 24574744 PMCID: PMC3921480 DOI: 10.3748/wjg.v20.i3.706] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/07/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
Since the discovery of Helicobacter pylori (H. pylori) infection in the stomach, the bacteria infection and non-steroidal anti-inflammatory drugs (NSAIDs) use had been considered to be the 2 main causes of peptic ulcers. However, there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors; these are termed idiopathic peptic ulcers. Such trend was firstly indicated in 1990s from some reports in North America. In Asia, numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s, but in the 2000s, multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%, indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years. While a decline in H. pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers, it is also possible that the absolute number of idiopathic ulcer cases has increased. Advanced age, serious systemic complication, and psychological stress are considered to be the potential risk factors for idiopathic ulcers. Management of idiopathic ulcers is challenging, at present, because there is no effective preventative measure against recurrence in contrast with cases of H. pylori-positive ulcers and NSAIDs-induced ulcers. As it is expected that H. pylori infection rates in Asia will decline further in the future, measures to treat idiopathic ulcers will also likely become more important.
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