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Edyedu I, Okedi FX, Muhumuza J, Asiimwe D, Laker G, Lule H. Factors associated with peptic ulcer perforations in Uganda: a multi-hospital cross-sectional study. BMC Gastroenterol 2024; 24:199. [PMID: 38886654 PMCID: PMC11181620 DOI: 10.1186/s12876-024-03285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. However, there is paucity of published data on the patterns of perforated peptic ulcer in the region. The aim of this study was to determine the factors associated with anatomical patterns of peptic ulcer perforation, as well as the clinical, socio-demographic, and anatomical patterns among patients in Uganda. METHODS This was a cross sectional study that enrolled 81 consecutive patients with perforated peptic ulcers. Using a structured pretested questionnaire the social demographic and clinical characteristics were obtained. At surgery, the patterns of the perforations were determined. Logistic regression was done in SPSS version 22 to determine the factors associated with the anatomical patterns. RESULTS Perforated peptic ulcer disease was more prevalent among males (79.5%), peasants (56.8%) and those from rural areas (65.4%). Majority of study participants were of blood group O (43.2%). Gastric perforations were more common (74.1%). Majority of the perforations were found anteriorly (81.5%). Being a casual laborer was independently associated with lower odds of having a gastric perforation compared to being a peasant farmer (P < 0.05). CONCLUSION Public health campaigns aimed at prevention of peptic ulcer perforations should prioritize the males, peasants and those living in rural areas. When a patient in our setting is suspected to have a peptic ulcer perforation, the anterior part of the stomach should be considered as the most likely site involved more so in peasant farmers.
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Affiliation(s)
- Isaac Edyedu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Francis Xaviour Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Goretty Laker
- Faculty of Clinical Medicine and Dentistry, Department of pediatrics and child health, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Herman Lule
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neuroscience, University of Turku, Turku, Finland
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Ogbuanya AUO, Eni UE, Umezurike DA, Obasi AA, Ikpeze S. Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e18. [PMID: 38371449 PMCID: PMC10871054 DOI: 10.22037/aaem.v12i1.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Introduction Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. Methods This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Results Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Conclusion Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Southeast Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Southeast Nigeria
- Department of Surgery, District Hospital, Nsukka, Enugu State, Southeast Nigeria
- Department of surgery, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
| | - Uche Emmanuel Eni
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
- Department of surgery, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
| | - Daniel A Umezurike
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
| | - Akputa A Obasi
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
| | - Somadina Ikpeze
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Anatomy, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
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Ogbuanya AUO, Ugwu NB, Enemuo VC, Nnadozie UU, Eni UE, Ewah RL, Ajuluchuku UE, Umezurike DA, Onah LN. Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa. Afr J Emerg Med 2023; 13:265-273. [PMID: 37790994 PMCID: PMC10542594 DOI: 10.1016/j.afjem.2023.08.005] [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: 02/26/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment. Aim To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly. Methods This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria. Results Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65-74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (p = 0.036), late presentation (p = 0.004), district location of hospital (p = 0.011) and intestinal resection (p = 0.003). Conclusion Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Surgery, District Hospital, Nsukka, Enugu State, Nigeria
| | - Nonyelum Benedett Ugwu
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Anaesthesia, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Vincent C Enemuo
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of surgery, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Ugochukwu U Nnadozie
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Uche Emmanuel Eni
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Richard L Ewah
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
| | - Uzoamaka E Ajuluchuku
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Daniel A Umezurike
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Livinus N Onah
- Department of Obstetric and Gynaecology, Enugu State University Teaching Hospital Enugu, Nigeria
- Department of Obstetric and Gynaecology, Enugu State University of Science and Technology, Enugu, Nigeria
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Treatment outcome of perforated peptic ulcer disease among surgically treated patients: A cross-sectional study in Adama hospital medical college, Adama, Ethiopia. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gbenga OJ, Ayokunle DS, Ganiyu A, Adekoya I. Pattern of Presentation, Management and Early Outcome in Patients with Perforated Peptic Ulcer Disease in a Semi-urban Tertiary Hospital. Ethiop J Health Sci 2021; 31:975-984. [PMID: 35221614 PMCID: PMC8843151 DOI: 10.4314/ejhs.v31i5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation in peptic ulcer disease (PUD) patients. This study aimed to describe the pattern of presentation, management and early outcome in patients with perforated PUD. METHODS This was a prospective study of patients who had operation for perforated PUD at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Southwestern Nigeria from June 2015 to May 2020. RESULTS Forty-six patients were studied with their ages ranging from 21-85 years. Their mean age was 49.9±16.3 years while the median was 54 years. Males outnumbered females by a ratio of 5.5:1. Majority (56.5%) of the patients were farmers and artisans. Duration of symptoms was 6 hours to 9 days (mean 2.7±1.9 days). Non-steroidal anti-inflammatory drugs use, herbal concoction, alcohol and smoking was found in 54.3%, 52.2%, 30.4% and 21.7% respectively. More duodenal perforations (63.0%) were recorded. Graham's patch closure was done for 27 (58.7%) while the remaining (41.3%) had primary closure with omentoplasty. Sixteen (34.8%) had postoperative complications with wound infection predominating. Overall postoperative mortality was 17.4%. Age ≥ 60 years (p=0.04), premorbid illness (p=0.01), delayed presentation ≥ 48 hours (p=0.01), shock (p=0.01) and intraperitoneal effluent ≥ 2000ml (p=0.03) were associated with mortalities. CONCLUSION Perforated PUD accounts for high morbidities and mortalities in our setting. Abuse of NSAIDs and herbal concoction ranked highest among the risk factors. Efforts at curtailing indiscriminate sales of NSAIDs and herbal concoction will reduce the menace.
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Affiliation(s)
| | | | - Akanbi Ganiyu
- Department of Radiology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Inubile Adekoya
- Departtment of Statistics and Research, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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Abstract
Gastroduodenal perforation may be spontaneous or traumatic and the majority of spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The classic sub-diaphragmatic air on chest x-ray may be absent and computed tomography scan is a more sensitive investigation in the stable patient. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is asymptomatic or unfit for surgery. However, non-operative management has a significant incidence of intra-abdominal abscesses and sepsis. Primary closure is achievable in traumatic perforation, but the management follows the Advanced Trauma Life Support (ATLS) principles.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Teshome H, Birega M, Taddese M. Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study. Ethiop J Health Sci 2020; 30:363-370. [PMID: 32874079 PMCID: PMC7445938 DOI: 10.4314/ejhs.v30i3.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Peptic ulcer perforation is one of the two major acute complications of peptic ulcer disease with significant morbidity and mortality. Methods Institution based retrospective review was done to determine patient presentation, management and postoperative complications of perforated peptic ulcer disease (PPUD) at a tertiary hospital in Addis Ababa, Ethiopia. Patients operated on from January 2013 to December 2017 were included. Univalent analysis was used to determine the influence of patient and operative events on postoperative outcomes. Result Totally, 136 patients were studied. Males outnumbered females by a ratio of 5.5:1. The mean age of patients was 36.05±16.56 years. Seventy-one (52.2%) patients presented after twenty-four hours of onset of symptoms. Most perforations were located on the first part of the duodenum (117,86%). There were 73 postoperative complications recorded in 31(22.8%) patients. Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity (P<0.05). Nine (6.6%) patients died at the hospital. Mortality was significantly associated with old age, comorbid illness, tachycardia, and development of post-operative complications (P<0.05). The postoperative hospital stay of the patients with complications was 18.6 ± 14.7 days which was significantly higher than that of patients without complication 6.7±2.7days (P=0.001). Conclusion Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity. Old age, comorbid illness, tachycardia and development of post-operative complications were found to increase the risk of mortality.
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Affiliation(s)
- Henok Teshome
- Assistant Professor of Surgery, St. Paul's Hospital Millennium Medical College (SPHMMC)
| | - Mekbib Birega
- Assistant Professor of Surgery, Arbaminch University
| | - Mekdim Taddese
- Assistant Professor of Surgery, St. Paul's Hospital Millennium Medical College (SPHMMC)
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Bupicha JA, Gebresellassie HW, Alemayehu A. Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa, Ethiopia: a prospective cohort multicenter study. BMC Surg 2020; 20:135. [PMID: 32539756 PMCID: PMC7296920 DOI: 10.1186/s12893-020-00796-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perforated peptic ulcer disease is a surgical emergency with a high morbidity and mortality. The socio-demographic characteristic and the factors associated with morbidity and mortality seems to differ between the developed and developing world. This is the first a prospective cohort study in Ethiopia designed to analyze pattern and outcome of patients with perforated peptic ulcer disease in four teaching hospitals affiliated with SOM, CHS of Addis Ababa University. METHOD This is a prospective cohort study of patients operated for perforated peptic ulcer disease from June 1, 2018 to May 31, 2019 in four teaching hospital affiliated to department of surgery of SOM, CHS of Addis Ababa university. RESULT A total of 97 patients were operated in a year. 86.6% were males with a male to female ratio of 6.5:1. The age group 21-30 were most affected constituting 42.3% of all patients. Mean age is 31.9, Median of 27, age ranges from 16 to 76. Alcohol use (45.4%) and previous history of ulcer disease (75.3%) were the most prevalent risk factors.33% were smokers. Abdominal was present in all and most presented within 48 h (79.4%). 85.6% had pneumo = peritoneum in an x-ray at presentation. Size of the perforation is 10 mm or less in 81.3%. 91(93.8%) had anterior first part duodenum perforation. Repair with pedicled omental patch was done in 65 (67.1%) patients. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Major morbidities were observed in 16 (16.5%) and mortality occurred in 3 (3.1%) patients. CONCLUSION Perforation of peptic ulcer disease here occurs in the young. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Morbidity and mortality rate of 16.5 and 3.1% observed here are quite acceptable.
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Jahagirdaar D, Bomanwar N, Joshi S. A Prospective Clinicoendoscopic Follow-up Study in Young Patients with Peptic Ulcer Perforation at a Tertiary Institute in Central India. Euroasian J Hepatogastroenterol 2019; 9:91-95. [PMID: 32117697 PMCID: PMC7047314 DOI: 10.5005/jp-journals-10018-1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perforation peritonitis is one of the commonest encountered emergencies in the surgery casualty. This study was conducted with the aim of identifying risk factors in peptic ulcer disease (PUD) in young patients. MATERIALS AND METHODS Seventy patients were evaluated in this study and were followed up with clinical examination and endoscopy at 8 weeks and 6 months. RESULTS Out of the total 70 patients, there was a mortality of 5 patients and 7 patients were lost to follow-up. Out of the remaining 57 patients, 56 were men and 1 was a woman. Maximum patients were from the age group of 35-40 years. The patients were categorized on the basis of their clinical symptoms and endoscopy results at the follow-up of 6 months in 4 categories-21 patients having an active ulcer and symptomatic, 15 patients having active ulcer but no symptoms, 16 patients who were asymptomatic and without an active ulcer and 5 patients nonulcer dyspepsia. CONCLUSION Postoperative treatment with H2 blockers or proton pump inhibiters along with anti-Helicobacter pylori regimen should be prescribed for all patients with peptic ulcer perforation. Routine endoscopic examination of such patients should also form a part of the follow-up to look for ulcer healing postoperatively. HOW TO CITE THIS ARTICLE Jahagirdaar D, Bomanwar N, Joshi S. A Prospective Clinicoendoscopic Follow-up Study in Young Patients with Peptic Ulcer Perforation at a Tertiary Institute in Central India. Euroasian J Hepato-Gastroenterol 2019;9(2):91-95.
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Affiliation(s)
- Deepa Jahagirdaar
- Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Nitin Bomanwar
- Department of Surgical Oncology, Kingsway Hospitals, Nagpur, Maharashtra, India
| | - Sneha Joshi
- Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Eleje GU, Ogbunugafor HA, Emegoakor CD, Okoye EI, Ezejiofor OI, Chukwurah SN, Ikechebelu JI, Nchinda GW, Ugochukwu CG, Nnaji-Ihedinmah LI, Okoye FBC, Eneh FU, Onwukamuche ME, Esimone CO. Efficacy and safety of Syferol-IHP for the treatment of peptic ulcer disease: a pilot, double-blind randomized trial. Clin Exp Gastroenterol 2019; 12:21-30. [PMID: 30679917 PMCID: PMC6338118 DOI: 10.2147/ceg.s178179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To our knowledge, there is no prior randomized study on the utility of Syferol-IHP (blend of virgin coconut oil and Ocimum sanctum oil) when coadministered with a triple therapy schedule. Aim This study determined the efficacy and safety of Syferol-IHP as adjunct to conventional triple therapy for the treatment of peptic ulcer disease (PUD). Methods A pilot double-blind randomized trial was conducted in patients with confirmed diagnosis (endoscopy-guided biopsy) of PUD. Eligible patients were randomized to Pylorest (a three-in-one tablet containing rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg) and Syferol-IHP for 2 weeks, followed by rabeprazole and Syferol-IHP for 2 weeks or Pylorest and placebo for 2 weeks, followed by rabeprazole and placebo for 2 weeks. Repeat endoscopy-guided biopsy and histology were done 4 weeks posttherapy. Primary outcome measures were the healing of ulcer and eradication of Helicobacter pylori. Secondary outcome measures were the disappearance of epigastric pain, gastritis, and duodenitis. Analysis was by intention-to-treat. Results Of the 63 patients enrolled, 60 patients had complete evaluation, with 37 patients receiving Pylorest and Syferol-IHP and 23 patients receiving Pylorest and Placebo. Healing of the PUD in favor of Pylorest and Syferol-IHP was significantly higher for gastric ulcer (RR=0.000, 95% CI=undefined, P=0.048) but not for duodenal ulcer (RR=0.400, 95% CI=0.07–2.37, P=0.241). H. pylori eradication was 100% with Syferol-IHP vs 50% with placebo (P=0.066). Epigastric pain (reduction to 16.2% vs 43.5%; P=0.021), gastritis (reduction to 13.5% vs 39.1%; P = 0.024), and duodenitis (reduction to 0% vs 8.7%; P=0.327) were observed in the Syferol-IHP and Pylorest vs placebo and Pylorest groups, respectively. Adverse events (RR=0.971, 95% CI=0.46–2.04, P=0.937) and laboratory parameters were not significantly different pre- and posttherapies (P>0.05, for both groups). Conclusion Although both treatment arms were equally safe, co-administration of Syferol-IHP and triple therapy is more efficacious than triple therapy alone for treating PUD. Pan African Clinical trial registry identifier number is PACTR201606001665364.
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Affiliation(s)
- George Uchenna Eleje
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Effective Care Research Unit, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria,
| | - Henrietta Aritetsoma Ogbunugafor
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Department of Applied Biochemistry, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chiemelu Dickson Emegoakor
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Department of General Surgery, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ebere Innocent Okoye
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Department of Pharmaceutics and Pharmaceutical Technology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Shirley Nneka Chukwurah
- Gastroenterology Unit, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Effective Care Research Unit, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria,
| | - Godwin W Nchinda
- Laboratory of Vaccinology/Biobanking, CIRCB BP 3077, Messa Yaounde, Cameroon
| | | | | | - Festus Basden C Okoye
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Department of Pharmaceutical and Medicinal Chemistry, Nnamdi Azikiwe University, Awka, Nigeria
| | - Frank Uchenna Eneh
- Department of Applied Biochemistry, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Charles Okechukwu Esimone
- Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria, .,Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
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