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A 36-year-old man with peptic ulcer disease presented to the emergency department with a 2-day history of haemoptysis and cough. Though he had no prior pulmonary symptoms, he noted progressive chest tightness and shortness of breath. He had no fever or night sweats. Vital signs were afebrile and

Although the mucosal barrier serves as a primary interface between the environment and host, little is understood about the repair of acute, superficial lesions or deeper, persistent lesions that if not healed, can be the site of increased permeability to luminal antigens, inflammation and/or neoplasia development.Recent studies have focused on focal adhesion kinase, which regulates controlled matrix adhesion during restitution after superficial injury. Actin polymerization regulates cell migration and the importance of actin-related proteins was also highlighted. Work on SARS-CoV-2 infection lent important new insights on gastroduodenal mucosal injury in patients with Covid-19 infection and work done with organoids and intestine-on-a-chip contributed new understanding about how coronaviruses infect gastrointestinal tissues and its resulting barrier dysfunction. A novel risk stratification paradigm was proposed to assist with decision making about repeat endoscopy for patients with gastric or duodenal ulcers and new therapeutic options were studied for ulcer disease. Lastly, work to support the mechanism of metaplasia development after deep injury and parietal cell loss was provided using novel transgenic mouse models.Recent studies highlight novel molecular targets to promote mucosal healing after injury of the gastroduodenal mucosa.

Contains fulltext : 287492.pdf (Publisher’s version ) (Open Access) INTRODUCTION: Unplanned hospital admissions associated with Parkinson's disease could be partly attributable to comorbidities. METHODS: We studied nationwide claims databases and registries. Persons with newly diagnosed Parkinson's disease were identified based on the first Parkinson's disease-related reimbursement claim by a medical specialist. Comorbidities were classified based on the Charlson Comorbidity Index. We studied hospitalization admissions because of falls, psychiatric diseases, pneumonia and urinary tract infections, PD-related hospitalizations-not otherwise specified. The association between comorbidities and time-to-hospitalization was estimated using Cox proportional hazard modelling. To better understand pathways leading to hospitalizations, we performed multiple analyses on causes for hospitalizations. RESULTS: We identified 18 586 people with newly diagnosed Parkinson's disease. The hazard of hospitalization was increased in persons with peptic ulcer disease (HR 2.20, p = 0.009), chronic obstructive pulmonary disease (HR 1.61, p

Anti-Saccharomyces cerevisiaeantibodies (ASCA) is related to the pathogenesis of Crohn’s disease as digestive tract inflammation. But the relationship between ASCA and peptic ulcer as upper digestive tract inflammation is unknown. The aim of this study was to determine the prevalence of ASCA positivity in patients with peptic ulcer and the relationship between ASCA andHelicobacter pylori. Total 128 patients with peptic ulcer were enrolled at Nagoya university hospital from 1999 to 2005. Serum samples obtained from with all peptic ulcer patients were examined. Determination of ASCA was performed by ELISA method. All patients were confirmedH. pyloriinfection. 10 patients withH. pyloriinfection were treated with eradication therapy. Fifty-five patients of 128 were suffered from active peptic ulcer. Of 128, 38 patients were ASCA-positive. 34 patients of 38 ASCA positive patients were active ulcer and other 4 patients were ulcer-scar. ASCA positivity in active ulcer patients was more significant than that in ulcer-scar. TheH. pylori–positive patients were 78. Thirty patients were ASCA positive in 78H. pyloripositive. Eight patients was ASCA positive in 50H. pylorinegative patients. ASCA inH. pyloripositive was increasing more than that inH. pylorinegative patients significantly. ASCA positivity was found to be correlated with eradication. All successful eradication patients were ASCA negative after treatment even if 3 patients were ASCA positive before eradication therapy. Our results show that ASCA is associated with both peptic ulcer andH. pyloriinfection.

Weight reduction decreases gastroesophageal reflux disease (GERD), but laparoscopic sleeve gastrectomy (LSG) that damages the structure of the stomach may worsen GERD. We aimed to elucidate the factors associated with increased severity of erosive esophagitis (EE) at 1 year after LSG.Data on patients who underwent LSG between February 2007 and March 2016 were reviewed. Endoscopic findings and anthropometric data before and after surgery were recorded. The severity of EE was assessed according to the Los Angeles classification; severe EE was defined as grade C or D esophagitis.Totally, 316 patients were enrolled. Before LSG, 96 patients (30.4%) had grade A or B EE. One year after LSG, 215 patients (68%) had EE, including 136 (43%) with grade A, 62 (19.6%) with grade B, and 17 (5.4%) with grade C or D EE. One-hundred and twenty-seven of 220 patients (57.7%) without EE before LSG developed de novo EE following LSG. The incidence of severe EE after LSG in patients without pre-operative EE, grade A EE, or grade B EE at baseline was 3.2%, 6.8%, and 50%, respectively. Independent factors for an increased severity of EE after LSG were male gender (OR = 2.55, 95% CI = 1.52-4.28) and post-operative hiatal hernia (OR = 3.17, 95% CI = 1.66-6.06).The prevalence and severity of EE increased after LSG. Male gender and post-operative hiatal hernia are independent factors for an increased severity of EE after LSG. The incidence of severe EE after LSG is low for patients without pre-operative EE or grade A EE at baseline.

Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m

The widespread Helicobacter pylori infection is a substantial global health problem affecting approximately 50% of the worldwide population, with 50% infection rates in developed countries and 80% in developing countries, mainly concentrating in resource-limited settings. The mode of transmission is through the faecal-oral route, contamination of food and water, where inadequate sanitation practices, low socioeconomic status and overcrowdedness seem to relate to the high prevalence of H. pylori infections. This study sought to serologically determine the prevalence of H. pylori and the disease-associated burden in patients accessing care in a Tertiary Hospital. This hospital-based cross-sectional study was conducted at the Bingham University Teaching Hospital, North-Central Nigeria, for four months (September to December 2022). There, 551 blood specimens were collected from the patients into plain tubes and spun to obtain serum for the serological qualitative analysis. Out of the 551 screened specimens for H. pylori, 79% (n=437) were 58.4% reactive female and 41.6% male. Ages 15-49 had 62%, 50-70 yrs had 26.5%, and less than 14 yrs had 11.4% respectively. Furthermore, 64.3% of female patients presented with burning pains, nausea/vomiting, and trouble breathing.In comparison, 35.5% of the male counterparts presented symptoms of dyspepsia, and 32.1% had either taken one of the Nonsteroidal-inflammatory drugs. 86.7% of the suspected patients were hand washed after using the toilet, 83.3% had a loss of appetite, 55.4% reported alcohol intake and 35.9% smoked instead. 47.7% ate from mama-put, 30.1% from street-vended foods and 22.2% from classified restaurants, while 94.7% got their drinking water from sachet, bottled, borehole or tap, and well water, respectively.Serum antibody detection of H. pylori infection was higher in female than male patients accessing care at the Bingham University Teaching Hospital, Jos. This revealed that gender could be considered a potential risk factor. Thus, early risk identification factors, such as other transmission routes, are urgently needed in defining clinical and epidemiological characteristics to facilitate appropriate supportive care and prompt treatment.

Introduction: Emergency Department (ED) overcrowding is a health, political, and economic problem of concern worldwide. The causes of overcrowding are an aging population, an increase in chronic diseases, a lack of access to primary care, and a lack of resources in communities. Overcrowding has been associated with an increased risk of mortality. The establishment of a Short Stay Unit (SSU) for conditions that cannot be treated at home but require treatment and hospitalization for up to 72 h may be a solution. SSU can significantly reduce hospital length of stay (LOS) for certain conditions but does not appear to be useful for other diseases. Currently, there are no studies addressing the efficacy of SSU in the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB). Our study aims to evaluate the efficacy of SSU in reducing the need for hospitalization, LOS, hospital readmission, and mortality in patients with NVUGIB compared with admission to the regular ward. Materials and Methods: This was a retrospective, single-center observational study. Medical records of patients presenting with NVUGIB to ED between 1 April 2021, and 30 September 2022, were analyzed. We included patients aged >18 years who presented to ED with acute upper gastrointestinal tract blood loss. The test population was divided into two groups: Patients admitted to a normal inpatient ward (control) and patients treated at SSU (intervention). Clinical and medical history data were collected for both groups. The hospital LOS was the primary outcome. Secondary outcomes were time to endoscopy, number of blood units transfused, readmission to the hospital at 30 days, and in-hospital mortality. Results: The analysis included 120 patients with a mean age of 70 years, 54% of whom were men. Sixty patients were admitted to SSU. Patients admitted to the medical ward had a higher mean age. The Glasgow-Blatchford score, used to assess bleeding risk, mortality, and hospital readmission were similar in the study groups. Multivariate analysis after adjustment for confounders found that the only factor independently associated with shorter LOS was admission to SSU (p < 0.0001). Admission to SSU was also independently and significantly associated with a shorter time to endoscopy (p < 0.001). The only other factor associated with a shorter time to EGDS was creatinine level (p = 0.05), while home treatment with PPI was associated with a longer time to endoscopy. LOS, time to endoscopy, number of patients requiring transfusion, and number of units of blood transfused were significantly lower in patients admitted to SSU than in the control group. Conclusions: The results of the study show that treatment of NVUGIB in SSU can significantly reduce the time required for endoscopy, the hospital LOS, and the number of transfused blood units without increasing mortality and hospital readmission. Treatment of NVUGIB at SSU may therefore help to reduce ED overcrowding but multicenter randomized controlled trials are needed to confirm these data

To report the outcomes of dogs that underwent primary repair of gastroduodenal perforations associated with the administration of nonsteroidal anti-inflammatory drugs (NSAID). A secondary objective was to identify clinicopathological findings that predisposed dogs to postoperative death.Retrospective study.Eleven dogs with complete gastric or duodenal perforation related to administration of an NSAID that underwent primary surgical repair.Medical records were reviewed for dogs that presented with peritonitis due to a complete gastroduodenal perforation while receiving NSAIDs between November, 2011 and January, 2021. Data collected included patient characteristics, clinical signs, clinicopathological results, surgical details, and postoperative management and outcome.All dogs were large breeds (mean weight 42 kg; range 22-75 kg), with a mean age of 7.35 years. Nine dogs from a total of 11 (82 %) received a concurrent corticosteroid and NSAID, or a higher dose/frequency/length of NSAID administration than recommended by the manufacturer. All gastroduodenal perforations were found in the upper gastrointestinal tract. Eight of 11 (73%) dogs survived to discharge. The median postoperative duration of follow up was 444 days (range 2-1460 days). No association was detected between ulcer size or location and mortality.Most dogs who underwent primary repair of complete gastroduodenal ulcers survived. Gastroduodenal perforations were generally due to the administration of higher or longer doses of NSAIDs, or concurrent administration of another NSAID or corticosteroid.Primary closure may be associated with a high success rate in dogs with full thickness gastroduodenal ulcers.

Gastrinoma may cause refractory esophageal stricture due to gastro-esophageal reflux disease (GERD), but imaging technologies have limited power in its diagnosis. A 74-year-old female with a history of peptic ulcers suffered from repeated epigastralgia, and she visited a local hospital. An esophago-gastro-duodenoscopy (EGD) demonstrated severe reflux esophagitis and multiple peptic ulcers. Blood examination revealed a high value of fasting serum gastrin. Multi-detector computed tomography showed a hypervascular and tiny nodule in duodenal bulb, although other imaging technologies did not. Short-term medication with a proton pump inhibitor or potassium-competitive acid blocker was intermittently provided, but dysphagia was repeatedly worsened, and she was referred to our division. Serum hypergastrinemia was retained, and EGD reexamination depicted esophageal stricture, treated by multiple sessions of endoscopic balloon dilatation. Primary tumor was not identified by the morphological imaging technologies, but a selective arterial secretagogue injection test suggested its existence in the duodenum or pancreatic head. Pancreaticoduodenectomy was performed, and histological study identified 2 mm-sized microgastrinoma buried in Brunner`s glands on the posterior wall of the duodenum bulb. We reported a case with difficulty in diagnosis of the smallest sporadic gastrinoma of the duodenum, which might cause refractory GERD-associated stricture.

The incidence rate of peptic ulcer is increasing gradually. Medical images can meet the needs of patients as an auxiliary diagnosis and treatment method for peptic ulcer. However, in the long-term treatment, the actual effect is average, and the diagnosis effect of gastrointestinal diseases will gradually deteriorate. In this paper, we use an image enhancement algorithm to study the mechanism of peptic ulcer from the perspective of a medical image. In this paper, 56 images of children with peptic ulcer were selected, and the gastroscopy based on the image enhancement algorithm provided technical support for the rapid diagnosis of patients with peptic ulcer. Experimental results show that the clinical features of peptic ulcer have different characteristics according to the age difference of patients, which can play a positive role in promoting the treatment of patients of different ages.

Background: Worldwide, Helicobacter pylori (HP) infection in children with peptic ulcer and/or gastritis (PUG) is increasingly common. In Vietnam, clinical symptoms of HP infection in PUG children are often non-specific, and treatment regimens currently have a low success rate. Objective: This study determined the HP infection prevalence, its clinical and endoscopic findings, and its associated factors. Additionally, the efficiencies of HP treatment regimens in PUG children were also evaluated. Design and setting: A cross-sectional descriptive study was conducted on 140 pediatric patients diagnosed with PUG at Can Tho Children’s Hospital from 2017–2019. Results: The prevalence of HP infection in PUG children was 46.4%. A significant association was found between HP infection and patient possessing a family history of HP infection (aOR: 2.35 (1.1–4.76). Symptoms of abdominal pain accounted for the highest rate of 88.6%, followed by vomiting, heartburn, epigastric burning, and gastric bleeding (57.9%, 36.4%, 22.9%, and 13.6%, respectively). Endoscopic findings denoted that inflammatory lesions accounted for 85% and ulcers accounted for 15%. The successful HP eradication rate using the PAM regimen (Proton pump inhibitor/amoxicillin/metronidazole) was 51.8%, with 13.6% of PUG children encountering side effects. Conclusion: PUG children have a high rate of HP infection. Clinical symptoms are often non-specific, in which abdominal pain is the most common symptom. The success of HP eradication by the standard guideline of the Vietnam Ministry of Health is quite low. Thus, critical adjustments in the regimens are necessary.

Peptic ulcer disease (PUD) is a common cause of hospitalization worldwide. We assessed temporal trends in hospitalization for PUD in 36 Organisation for Economic Co-operation and Development (OECD) countries since the turn of the 21st century.The OECD database contains data on PUD-related hospital discharges and mortality for 36 countries between 2000 and 2019. Hospitalization rates for PUD were expressed as annual rates per 100,000 persons. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs) for each country, which were pooled using meta-analyses. The incidence of PUD was forecasted to 2021 using autoregressive integrated moving average and Poisson regression models.The overall median hospitalization rate was 42.4 with an interquartile range of 29.7-60.6 per 100,000 person-years. On average, hospitalization rates (AAPC = -3.9%; 95% CI: -4.4, -3.3) and morality rates (AAPC = -4.7%; 95% CI: -5.6, -3.8) for PUD have decreased from 2000 to 2019 globally. The forecasted incidence of PUD hospitalizations in 2021 ranged from 3.5 per 100,000 in Mexico to 92.1 per 100,000 in Lithuania. Across 36 countries in the OECD, 329,000 people are estimated to be hospitalized for PUD in 2021.PUD remains an important cause of hospitalization worldwide. Reassuringly, hospitalizations and mortality for PUD have consistently been falling in OECD countries in North America, Latin America, Europe, Asia, and Oceania. Identifying underlying factors driving these trends is essential to sustaining this downward momentum.

Objective: Helicobacter pylori (Hp) and Epstein-Barr virus (EBV) are involved in gastric cancer (GC) etiology. EBV/Hp co- infection was thought synergistically increase gastroduodenal disease occurence. We aimed to determine the presence of EBV/Hp co-infection in gastroduodenal diseases. Methods: The study group had 68 Hp (+) cases [25 GC, 13 IM (intestinal metaplasia), 30 PU (peptic ulcer)], and the control group had 40 NUD (non-ulcer dyspepsia) cases [20 Hp+, 20 Hp-]. EBV-DNA was detected by non-polymorphic EBNA-1 gene-based qPCR. EBV/EBNA-1 IgG levels were determined by quantitative and qualitative ELISA methods, respectively. Results: EBV-DNA positivity was 32% (8/25), 6.6% (2/30) and 5% (1/20) in GC, PU and NUD Hp (+) cases, respectively. There was a significant difference (p = 0.001) between GC (32%) and NUD Hp (+) (5%) cases in terms of EBV-DNA positivity. Mean EBV-DNA copy numbers were 6568.54 ± 20351, 30.60 ± 159.88 and 13.85 ± 61.93 for GC, PU, and NUD, respectively. In terms of the mean EBV-DNA copy number, a significant difference was found between the groups (p = 0.005). In terms of EBV/EBNA-1 IgG antibody positivity, no significant difference was found between GC and NUD cases (p = 0.248). EBV DNA positivity was found to be significant (odds ration [OR] = 26.71 (p=0.009, %95CI 2.286- 312.041) in multivariate logistic regression. Conclusioin: Although we had a small number of GC cases, it can be suggested that the estimated risk created by the synergistic effect based on the addition of EBV increased 26 times in the presence of Hp in GC.

Background There are different methods to repair a perforated peptic ulcer, the two most frequently used are the Graham patch omentopexy and the primary closure. Currently there is no high-level evidence to provide guidance of the optimal method of repair. The aim of this study is to compare the outcomes of the two methods so as to provide improved guidance for surgeons undertaking this repair. Methods A systematic review and meta-analysis was conducted including any study that compared Graham patch omentopexy with primary closure in adults. Embase, Medline, Cochrane and Google's search engine were searched. The primary outcome was breakdown of the repair resulting in bile leak and the secondary outcomes were mortality, operation time, wound infection and time to start oral intake. The meta-analysis was conducted using Review Manager Software version 5:4. Outcome data were reported as odd ratios and weighted mean differences with their 95% confidence intervals. Results Of the 229 studies identified, 6 were suitable for analysis, 4 were retrospective, one was a prospective cohort study and one was a randomized controlled trial. Meta-analysis showed no difference in occurrence of bile leak or mortality between primary closure and Graham patch omentopexy (OR 0.64; 95% (0.26–1.54) & 0.66; 95% (0.25–1.76) respectively). There was no difference in the rates of wound infection OR 0.65; 95% (0.4–1.05). The duration of the operation was shorter in the primary closure group by 5.6 min; 95% (−21 + 10.4). Conclusion There was no difference in the clinical outcomes between the two modes of repair.

Resumen Objetivo El consenso de Baveno VI para el cribado endoscopico de varices esofagogastricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrian pasar desapercibidas lesiones no relacionadas con hipertension portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clinicos asociados a las mismas. Pacientes y metodos Estudio transversal unicentrico sobre una cohorte consecutiva de pacientes cirroticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogastricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertension portal mediante regresion logistica uni y multivariante. Resultados Se incluyo a 379 pacientes. La etiologia mayoritaria de la cirrosis fue etilica (n = 229; 60,4%). La prevalencia de lesiones endoscopicas no relacionadas con hipertension portal fue del 39,6% (n = 150). Entre los 96 pacientes con enfermedad peptica (25,3%) se tomo test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscopicas no relacionadas con hipertension portal no estuvo influida por la edad (p = 1), el genero (p = 0,28), la funcion hepatica (MELD p = 0,20, Child-Pugh p = 0,77) o la presencia de datos ecograficos de hipertension portal (p = 0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscopicas no relacionadas con la hipertension portal (43,2% vs. 34,6%; p = 0,09), particularmente ulcera peptica (6,4% vs. 0,6%; p = 0,05) y duodenitis peptica (17,3% vs. 6,3%; p = 0,002). El tabaquismo activo fue el unico factor predictivo independiente de ulcus o duodenitis peptica (odds ratio = 2,56; intervalo de confianza del 95%: 1,18-5,56; p = 0,017). Conclusiones El tabaquismo activo aumenta el riesgo de lesiones endoscopicas no relacionadas con hipertension portal, lo cual deberia ser investigado en profundidad para redefinir el cribado endoscopico en pacientes fumadores con cirrosis hepatica.

To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis.Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression.A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017).Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.

Low-dose aspirin is a risk factor for peptic ulcer disease but previous, population-based cohort studies may have underestimated the low-dose aspirin risk because they did not use a new-user design. Gastrointestinal bleeding occurs more frequently early after initiation of low-dose aspirin therapy than in later years.To assess the associations of low-dose aspirin with gastric and duodenal ulcer incidence in prevalent- and new-user design.Multivariate Cox regression models in the German ESTHER study (N = 7737) and the UK Biobank (N = 213,598) with more than 10 years of follow-up.In the prevalent-user design, there was no significant association between low-dose aspirin and gastric ulcer observed in both cohorts. Furthermore, low-dose aspirin was weakly, statistically significantly associated with prevalent duodenal ulcer in the UK Biobank (hazard ratio [95% confidence interval]: 1.27 [1.07-1.51]) but not in the ESTHER study (1.33 [0.54-3.29]). When restricting the exposure to only new users, the hazard ratios for incident gastric and duodenal ulcer disease were 1.82 [1.58-2.11] and 1.66 [1.36-2.04] in the UK Biobank, respectively, and 2.83 [1.40-5.71] and 3.89 [1.46-10.42] in the ESTHER study, respectively.This study shows that low-dose aspirin is an independent risk factor for both gastric and duodenal ulcers. The associations were not significant or weak in the prevalent-user design and strong and statistically significant in the new-user design in both cohorts. Thus, it is important to weigh risks against benefits when low-dose aspirin treatment shall be initiated and to monitor adverse gastrointestinal symptoms after the start of low-dose aspirin therapy.

The purpose of this meta-analysis was to evaluate the efficacy and safety of proton pump inhibitors (PPIs) plus antithrombotic strategy in patients with coronary artery diseases compared with antithrombotic strategy alone. We searched PubMed, EMBASE, Cochrane Library, and Chinese Biomedical Medical Literature databases to retrieve randomized controlled trials investigating PPIs combined with antithrombotic strategy in coronary artery diseases. The primary efficacy outcome was major adverse cardiovascular and cerebrovascular events (MACCE). The primary safety outcome was gastrointestinal events. Secondary outcomes included all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, significant bleeding from gastroduodenal lesions, and gastroduodenal ulcer. Overall, 43,943 patients were enrolled from 19 trials. The incidence of MACCE [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96-1.15], all-cause death (RR 0.84; 95% CI 0.69-1.01), cardiovascular death (RR 0.88; 95% CI 0.69-1.12), myocardial infarction (RR 0.98; 95% CI 0.88-1.09), stent thrombosis (RR 1.01; 95% CI 0.76-1.34), and gastroduodenal ulcer (RR 0.40; 95% CI 0.13-1.29) did not increase significantly in patients receiving PPIs compared with patients without those. There were significant differences in the risk of gastrointestinal events (RR 0.34; 95% CI 0.21-0.54) and significant bleeding from gastroduodenal lesions (RR 0.09; 95% CI 0.03-0.28) between the 2 groups. In patients with coronary artery diseases, PPIs plus antithrombotic strategy could reduce the risk of gastrointestinal events and significant bleeding from gastroduodenal lesions but may not affect the incidence of MACCE, all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, and gastroduodenal ulcer (PROSPERO: CRD42021277899, date of registration October 10, 2021).

Neurofibromatosis type (NF-1) is an autosomal dominant disorder characterized predominantly by neurocutaneous manifestations. Involvement of the gastrointestinal tract is uncommon but is associated with a significant risk of malignancy. There are a handful of case reports linking NF-1 with pancreatic neuroendocrine tumors; these include gastrin-secreting variants with the attendant Zollinger-Ellison syndrome. We present the case of a 52-year-old lady who presented with recurrent peptic ulceration and diarrhea. Serum gastrin levels were elevated and magnetic resonance imaging demonstrated the presence of a pancreatic lesion with multiple liver metastases. The lesion was moderately fludeoxyglucose avid on positron emission tomography-computed tomography. Endoscopic ultrasonography-guided sampling revealed the presence of synaptophysin positive neuroendocrine cells with positive gastrin immunostaining. A conservative approach was adopted, and the patient's symptoms improved on proton pump inhibitors. Zollinger-Ellison syndrome is an important condition, which should be kept in mind in the patient with NF-1 who presents with recurrent peptic ulceration and diarrhea. The emerging association between these 2 conditions is being examined on a cellular and immunohistochemical level.

Peptic ulcer is a common gastrointestinal disease seen among many peoples. It may be caused by irregular food habits, spicy foods, either an infection or long-time use of medications, drugs and stress. An ulcer depends upon the presence of acid and peptic activity in gastric juice plus a breakdown in mucosal defences. A number of anti-ulcer drug are available for curing ulcer disease. Standard treatment is including antibiotics and proton pump inhibitors. But the same time these drugs are expensive and there are many side effects caused by these drugs comparing to other herbal medicines. Pantoprazole is an irreversible proton pump inhibitor (PPI) that reduces gastric acid secretion. It is used to treat stomach ulcers, gastro-oesophageal reflux disease (GORD), acid reflux, and heartburn. Zollinger-Ellison syndrome is a rare disorder brought on by a pancreatic or intestinal tumour that is treated with pantoprazole. Both a generic and a brand-name version of the oral tablet medication pantoprazole are offered. A stomach H+/K+-ATPase (hydrogen-potassium adenosine triphosphatase) inhibitor is pantoprazole. Although oral dose forms are the most common drug, they nevertheless have significant drawbacks compared to other delivery systems, such as the possibility of medication absorption that is too sluggish and complicated by gastric residence time. It can be treated by using a lesser dosage of the medication instead of taking it in liquid form. Another technique is the effervescent technique, which can be used to create a dosage form that can speed up the time the drug dissolves and combines with the body. This technique is typically employed with preparations for rapid release. Effervescent tablets are being used more frequently and widely to modify the behaviour of drug release, such as in sustained and controlled release preparations, pulsatilla drug delivery systems, and so forth, along with the development of novel pharmaceutical techniques. The present review illustrated about the etiology of peptic ulcer, its complications, pharmacological property of pantoprazole antiulcer drug and the new effervescent tablet methodology. Keywords: Peptic ulcer; Pantoprazole; Proton pump inhibitor; Floating Delivery System; Effervescent Tablet.

Earlier the treatment for peptic ulcer was surgery such as truncal vagotomy and drainage procedure. Recurrence after surgery and complications were common. It was because of our lack of knowledge abouthelicobacter pyloribacteria we used to blame factors such as lifestyle, other than infections causing peptic ulcer. It was due to two genius Australian doctors who identified the bacteria and the scenario was changed. Surgery for peptic ulcer gradually diminished dramatically after the development of H2 receptor antagonists and proton pump inhibitors. The surgery for complications of peptic ulcer such as perforations remain same but elective surgery for peptic ulcer drastically reduced. There was a time when after failed medical treatment for peptic ulcer patients were advised surgery or remain on cold milk and bread. These researches in medicine have alleviated human suffering from peptic ulcer disease. Patients of deep penetrating peptic ulcer used to weep with pain and treating clinicians also used to get frustrated for not getting ways to make patients painfree.

Ischaemia and reperfusion (I/R)-induced gastrointestinal disorders are caused by free radicals, resulting in organ damage and functional disarrangement. This study aimed to investigate the healing effects of hydroalcoholic extracts from the leaves of Eugenia punicifolia (Kunth) DC. (HEEP) in male and female Wistar rats with I/R-induced peptic injuries, and the role of antioxidants in improving this response. After I/R-induced gastric and duodenal injuries, male and female [intact (INT) and ovariectomized (OVZ)] rats were orally treated with HEEP for 6 days. Biochemical analysis was used to determine the catalase (CAT), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities, as well as malondialdehyde and reduced glutathione levels, to measure the gastric and duodenal healing process. Six days of HEEP treatment significantly decreased the I/R-induced gastric [male (73.68%), INT (52.83%), and OVZ (43.13%)] and duodenal damage [male (57.03%), INT (56.04%), and OVZ (54.83%)] in all groups. In OVZ rats, the healing effect of HEEP occurred because of the increased activity of SOD (2x) and CAT (1.16x) in the gastric mucosa. In the duodenal mucosa of INT rats, the extract reduced MPO (20.83%) activity. The 6-day HEEP treatment improved the healing of I/R-induced peptic ulcer injury, with the system acting differently in males and females. The antioxidant system is an important component of the HEEP activity during post-I/R mucosal recovery. This result revealed the importance of antioxidant compounds in minimizing the severity of I/R-related events.

BACKGROUND: Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques paper demonstrates these infrequently encountered, but critical operations. CONTENT (VIDEO DESCRIPTION): A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown and includes Roux-en-Y gastrojejunostomy. CONCLUSIONS: Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation as well as gastric resection, vagotomy and reconstruction. STUDY TYPE: Video Procedure and Technique LEVEL OF EVIDENCE: Not applicable

Background Peptic ulcer disease is one of the most common diseases in gastroenterology clinics. However, reported data about the global burden of peptic ulcer disease are still scarce. Methods This was a secondary data analysis on the prevalence, mortality and disability-adjusted life years (DALYs) due to peptic ulcer disease by sex, age group and socio-demographic index (SDI) at the global level in 21 regions and 204 countries and territories between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Results Globally, the prevalence cases of peptic ulcer disease increased from 6 434 103 (95% uncertainty interval 5 405 963 to 7 627 971) in 1990 to 8 090 476 (6 794 576 to 9 584 000) in 2019. However, the age-standardized prevalence rate decreased from 143.4 (120.5 to 170.2) per 100 000 population in 1990 to 99.4 (83.9 to 117.5) per 100 000 population in 2019. Moreover, the age-standardized mortality rate decreased by 59.4% (55.3 to 63.1) and the DALYs rate fell by 60.6% (56.8 to 63.9) from 1990 to 2019. Across SDI quintiles, low-middle and low SDI quintiles had the highest age-standardized prevalence, mortality and DALYs rates from 1990 to 2019. Conclusion The age-standardized prevalence, mortality and DALYs estimates of peptic ulcer disease decreased from 1990 to 2019 globally, but more efforts are needed for the prevention, early diagnosis and treatment of peptic ulcer disease in low SDI and low-middle SDI groups of countries.

Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.

Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.

Proton pump inhibitors are widely used throughout the world for the treatment of gastrointestinal disorders that are related to acid secretion, such as peptic ulcer disease and dyspepsia. Another common indication for proton pump inhibitors is stress ulcer prophylaxis. Proton pump inhibitors have proven efficacy for the treatment of acid-related gastrointestinal disorders, but there is concern that their use may be associated with the development of significant complications, such as fractures, Clostridium difficile infection, acute kidney injury, chronic kidney disease, and hypomagnesemia. Proton pump inhibitors are overused in the hospital setting, both for stress ulcer prophylaxis and gastrointestinal bleeding, and then they are often inappropriately continued after discharge from the hospital. This narrative review article outlines the evidence surrounding appropriate proton pump inhibitor use for stress ulcer prophylaxis and peptic ulcer bleeding.

To assess of the ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease (PUD), chronic gastritis and chronic duodenitis relative to the total number of people treated in the gastroenterological departments of the hospital in 20102019.Data of the annual reports of the work of the hospital departments were studied retrospectively.The relative number of persons hospitalized for chronic duodenitis decreased 2.8 times (p0.001), but the proportion of patients with chronic gastritis did not tend to decrease. This is most likely due to diagnostic errors. The cases of hospitalization of persons with uncomplicated PUD decreased by 3.1 times (p0.001), the proportion of men with duodenal ulcer decreased by 6.3 times (p0.001), with gastric ulcer decreased 1.9 times (p0.01). The proportion of women hospitalized with duodenal ulcer decreased 2.3 times (p0.01). The number of hospitalized men with duodenal ulcer is 3.8 times more than females (p0.001). It can be explained by a decrease in social stressful influences and active anti-Helicobacter pylori therapy.Over the period of follow-up, the cases of hospitalization of patients with uncomplicated PUD decreased, primarily due to a decrease in the proportion of persons with ulcer of the duodenum and duodenitis, while the number of patients with chronic gastritis not undergoing modern examination did not have significant dynamics.Цель. Оценить10-летнюю динамику количества случаев госпитализации пациентов с язвенной болезнью (ЯБ), хроническим гастритом и хроническим дуоденитом относительно общего числа лиц, пролеченных в гастроэнтерологических отделениях больницы в 20102019 гг. Материалы и методы. Ретроспективно изучались данные годовых отчетов работы отделений больницы. Результаты. Относительное число лиц, госпитализированных по поводу хронического дуоденита, снизилось в 2,8 раза (p0,001), но доля пациентов с хроническим гастритом не имела тенденции к уменьшению. Вероятнее всего, это связано с ошибками диагностики. Количество случаев госпитализации лиц с неосложненной ЯБ уменьшилось в 3,1 раза (p0,001), доля мужчин с ЯБ двенадцатиперстной кишки (ДПК) уменьшилась в 6,3 раза (p0,001), с ЯБ желудка уменьшилась в 1,9 раза (p0,01). Доля госпитализированных женщин с ЯБ ДПК уменьшилась в 2,3 раза (p0,01). Число госпитализированных мужчин с ЯБ ДПК больше, чем женщин, в 3,8 раза (p0,001), что может объясняться уменьшением социальных стрессовых влияний и активной антихеликобактериальной терапией. Заключение. За период наблюдения количество случаев госпитализации пациентов с неосложненной ЯБ уменьшилось прежде всего за счет снижения доли лиц с ЯБ ДПК и дуоденитом, в то время как число пациентов с хроническим гастритом, не проходящих современного обследования, не имело достоверной динамики.

Helicobacter pylori is a spiral-shaped gram-negative bacterium that colonizes the stomach lining. The presence of a microorganism in humans was described more than a century ago, but from detection to recognition of its role in the etiology and pathogenesis of diseases of the stomach, researchers had to overcome a long path of criticism and mistrust. Coiled bacteria have been mentioned several times in the medical literature, but these bacteria were thought to be contaminants, and any evidence of the bacteria in the stomach was ignored by the medical community. The discovery of H. pylori led to a revolutionary rethinking of the mechanisms of development of a number of diseases: the role of bacteria in the development of chronic gastritis, peptic ulcer disease, stomach cancer and MALT lymphoma was proved. The principles of their prevention and treatment have changed. For this discovery in 2005, Barry Marshall and Robin Warren were awarded the Nobel Prize in Medicine and Physiology.Helicobacter pylori спиралевидная грамотрицательная бактерия, которая колонизирует слизистую оболочку желудка. Присутствие микроорганизма у человека было описано более века назад, но от момента обнаружения до признания ее роли в этиологии и патогенезе заболеваний желудка исследователям пришлось преодолеть долгий путь критики и недоверия. Спиралевидные бактерии неоднократно упоминались в медицинской литературе, однако считалось, что они являлись контаминантами, и любые свидетельства наличия бактерии в желудке игнорировались медицинским сообществом. Открытие Н. pylori привело к революционному переосмыслению механизмов развития ряда заболеваний: была доказана роль бактерии в развитии хронического гастрита, язвенной болезни, рака желудка и MALT-лимфомы. Изменились принципы их профилактики и лечения. За это открытие Барри Маршалл и Робин Уоррен были удостоены Нобелевской премии в области медицины и физиологии в 2005 г.

Background Peptic ulcer disease (PUD) is a common digestive disorder, of which the prevalence decreased in the past few decades. However, the decreasing tendency has plateaued in recent years due to changes in risk factors associated with the etiology of PUD, such as non-steroidal anti-inflammatory drug use. In this study, we investigated the epidemiological and the sociodemographic characteristics of PUD in 204 countries and territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study. Methods Demographic characteristics and annual prevalence, incidence, mortality, disability-adjusted life years (DALYs) and age-standardized death rate (ASR) data associated with PUD were obtained and analyzed. According to the sociodemographic index (SDI), the numbers of patients, ASRs, estimated annual percentage changes and geographical distributions were assessed with a generalized linear model and presented in world maps. All evaluations of numbers and rates were calculated per 100,000 population with 95% uncertainty intervals (UIs). Results In 2019, the global prevalence of PUD was approximately 8.09 [95% UI 6.79–9.58] million, representing a 25.82% increase from 1990. The age-standardized prevalence rate was 99.40 (83.86–117.55) per 100,000 population in 2019, representing a decrease of 143.37 (120.54–170.25) per 100,000 population from 1990. The age-standardized DALY rate in 2019 was decreased by 60.64% [74.40 (68.96–81.95) per 100,000 population] compared to that in 1990. In both sexes, the numbers and ASRs of the prevalence, incidence, deaths and DALYs were higher in males than in females over 29 years. Regionally, South Asia had the highest age-standardized prevalence rate [156.62 (130.58–187.05) per 100,000 population] in 2019. A low age-standardized death rate was found in the high-income super-region. Among nations, Kiribati had the highest age-standardized prevalence rate [330.32 (286.98–379.81) per 100,000 population]. Regarding socioeconomic status, positive associations between the age-standardized prevalence, incidence, death rate, DALYs and SDI were observed globally in 2019. Conclusions Morbidity and mortality due to PUD decreased significantly from 1990 to 2019, while a gradual upward inclination has been observed in recent 15 years, which might be associated with changes in risk factors for PUD. Attention and efforts by healthcare administrators and society are needed for PUD prevention and control.

Objective. Periodontitis is a highly prevalent oral infectious disease and has been increasingly associated with H. pylori infection, gastric inflammation, and gastric cancer but little is known about epigenetic machinery underlying this potentially bidirectional association. The present study is aimed at identifying key deregulated miRNA, their associated genes, signaling pathways, and compounds linking periodontitis with H. pylori-associated peptic ulcer disease. Methods. miRNA expression datasets for periodontitis-affected and H. pylori-associated peptic ulcer disease-affected tissues were sought from the GEO database. Differentially expressed miRNA (DEmiRNAs) were identified and the overlapping, shared-DEmiRNA between both datasets were determined. Shared-DEmiRNA-target networks construction and functional analyses were constructed using miRNet 2.0, including shared-DEmiRNA-gene, shared-DEmiRNA-transcription factor (TF), and shared-DEmiRNA-compound networks. Functional enrichment analysis for shared DEmiRNA-gene and shared DEmiRNA-TF networks was performed using the KEGG, Reactome, and Geno Ontology (GO) pathways. Results. 11 shared-DEmiRNAs were identified, among which 9 showed similar expression patterns in both diseases, and 7 were overexpressed. miRNA hsa-hsa-mir-155-5p and hsa-mir-29a-3p were top miRNA nodes in both gene and TF networks. The topmost candidate miRNA-deregulated genes were PTEN, CCND1, MDM2, TNRC6A, and SCD while topmost deregulated TFs included STAT3, HIF1A, EZH2, CEBPA, and RUNX1. Curcumin, 5-fluorouracil, and the gallotanin 1,2,6-Tri-O-galloyl-beta-D-glucopyranose emerged as the most relevant linkage compound targets. Functional analyses revealed multiple cancer-associated pathways, PI3K pathways, kinase binding, and transcription factor binding among as enriched by the network-associated genes and TFs. Conclusion. Integrative analysis of deregulated miRNAs revealed candidate molecular mechanisms comprising of top miRNA, their gene, and TF targets linking H. pylori-infected peptic ulcer disease with periodontitis and highlighted compounds targeting both diseases. These findings provide basis for directing future experimental research.

Upper gastrointestinal (GI) bleeding is a common presentation in emergency departments (EDs). This medical emergency has a mortality rate of up to 14%, particularly in men and older people. The most frequent cause of upper GI bleeding is peptic ulcer disease. Management has not changed significantly in the past 50 years and there is ongoing debate in the literature about the most effective treatment protocols. This article uses a case study of a patient who presented to an ED with upper GI bleeding caused by peptic ulcer disease to examine the evidence on treatment and management. The article also discusses a care bundle that has been developed for rapid assessment and management of patients with acute upper GI bleeding.

З метою встановлення особливостей розподілу антигенів HLA-системи, їх внутрішньолокусних і міжлокусних комбінацій при виразковій хворобі дванадцятипалої кишки в дітей всім обстежуваним пацієнтам (n = 120) та особам контрольної групи (n = 100) було проведено HLA-типування генів DRB1, DQA1 і DQB1 методом сиквенс-специфічного зонда, ампліфікації з послідовність-специфічними праймерами (SSP). Виразкова хвороба асоційована зі специфічностями DRB1*11, DRB1*13, алельним варіантом DQB1*0401/02, генотипом DQB1*0301,0302 і гаплотипами DRB1*07/DQA1*0301, DRB1*13/DQA1*0501, DRB1*11/DQB1*0501, DQA1*0102/DQB1*0401/02. Специфічність DRB1*15, алельний варіант DQB1*0201, генотип DQB1*0301,0301 і гаплотипи DRB1*15/DQA1*0101, DRB1*15/DQA1*0102, DRB1*01/DQB1*0201, DRB1*15/DQB1*0301, DQA1*0101/DQB1*0201, DQA1*0201/DQB1*0201 визначають резистентність до виникнення виразкової хвороби.

У роботі проведено ретроспективний аналіз ефективності лікування хворих на пептичну виразку дванадцятипалої кишки (ПВДПК) за 10 років, з моменту початку впровадження у клінічну практику положень Маастрихтських консенсусів. Виявлено, що частота звернень пацієнтів з приводу ПВДПК не зменшилась. Відмічено вірогідне збільшення частоти повторних звернень через невдалу ерадикацію з приводу даної патології (20,7 % в 1996 році проти 38,8 % у 2006 році, р < 0,01) і зростання відсотка реінфікованих пацієнтів з 5,8 % в 1996 році до 24,7 % у 2006 році. Не зафіксовано різниці в гендерному складі серед реінфікованих хворих та тих, які звернулися повторно. Серед найбільш працездатної частини населення віком від 20 до 50 років Львівського регіону кожен третій пацієнт з ПВДПК звертався для повторного лікування протягом року.

BACKGROUND Helicobacter pylori (H. pylori) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens. AIM To investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy. METHODS Ninety-two patients with dyspepsia symptoms and positive 13C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated 13C-urea breath test was done 4 wk after the completion of the eradication therapy. RESULTS Among the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group (P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups. CONCLUSION Ten days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.

Helicobacter pylori is an organism associated with ulcer disease and gastric cancer. The latter is one of the most prevalent malignancies and currently the fourth major cause of cancer-related deaths globally. The pathogen infects about 50% of the world population, and currently, no treatment ensures its total elimination. There has been an increase in our understanding of the pathophysiology and pathogenesis mechanisms of H. pylori over the years. H. pylori can induce several genetic alterations, express numerous virulence factors, and trigger diverse adaptive mechanisms during its adherence and colonization. For successful colonization and infection establishment, several effector proteins/toxins are released by the organism. Evidence is also available reporting spiral to coccoid transition as a unique tactic H. pylori uses to survive in the host’s gastrointestinal tract (GIT). Thus, the virulence and pathogenicity of H. pylori are under the control of complex interplay between the virulence factors, host, and environmental factors. Expounding the role of the various virulence factors in H. pylori pathogenesis and clinical outcomes is crucial for vaccine development and in providing and developing a more effective therapeutic intervention. Here we critically reflect on H. pylori infection and delineate what is currently known about the virulence and pathogenesis mechanisms of H. pylori.

Цель исследования – оценка эффективности различных комбинаций противоязвенных препаратов в эрадикационной терапии язвенной болезни желудка ассоциированной (позитивной) с H. pylori. Материалы и методы исследования. Эрадикационная терапия различными комбинациями противоязвенных препаратов была проведена 310 больным с позитивной формой язвенной болезнью желудка, в стадии обострения. Возраст пациентов составил 25-65 лет (в среднем 41,6±4,3 года). Все пациенты были разделены на 8 групп в зависимости от применяемой схемы эрадикационной терапии. Для определения локализации, размера и стадии язвы всем пациентам выполнялась эзофагогастродуоденоскопия. В процессе эзофагогастродуоденоскопии выполнялось взятие биоптатов из тела и пилорического отдела желудка для морфологического окрашивания на хеликобактерную инфекцию по методу Романовского-Гимзе без дифференцировки и проведением быстрого уреазного теста. Оценивалась степень обсемененности H. pylori. Эффективность лечения оценивалась по срокам рубцевания язвы, эффективности эрадикации H. pylori, активности воспалительного процесса в слизистой оболочки, срокам купирования язвенного симптомокомплекса. Переносимость лечения и его безопасность оценивались по проявлению и динамике побочных эффектов. Результаты и их обсуждение. В экспериментальных группах, где в схемах эрадикационной терапии метронидазол был заменен на амоксицилин, фуразолидон или тинидазол уровень успешности эрадикации H. pylori превышал 80%. При замене метронидазола амоксициллином успешность эрадикации составила 95,2%, фуразолидоном – 92,1%, тинидазолом – 86%. В случаях высокого уровня резистентности H. pylori к метронидазолу в схеме эрадикации первой линии показана замена метронидазола на амоксициллин, фуразолидон или тинидазол. Эффективность лечения для комбинации препаратов: омепразол + амоксициллин + вильпрафен составила 84%, комбинации омепразол + левофлоксацин + амоксициллин – 88%. В случае проявления резистентности К кларитромицину, допустима его замена на вильпрафен или левофлоксацин. При неосложненном и редко рецидивирующим течении. ЯБЖ ассоциированной с H. pylori прием ингибиторов протонного насоса рекомендуется ограничить периодом эрадикационной терапии, при осложненном течении необходимо продлевать до полного рубцевания язв. У больных ЯБЖ пожилого и старческого возраста схема эрадикационной терапии омепразол + кларитромицин + амоксициллин – половинные дозы антибиотиков, обеспечила успешность эрадикации H. pylori у 86% больных и рубцевание язвенного дефекта желудка у 100% пациентов через 4 недели. Назначение антибиотиков в половинных дозах в терапии первой линии у больных язвенная болезнь желудка пожилого и старческого возраста обеспечивает хорошую частоту эрадикации H. pylori и рубцевание язв в установленные сроки. Заключение. Больные язвенной болезнью в обязательном порядке должны проверяться на хеликобактерную инфекцию, а при положительном результате им должна проводится эрадикационная терапия. При выборе комбинации препаратов, их доз, а также определения длительности лечения необходимо учитывать уровень резистентности к антибиотикам, степень обсемененности H. pylori, характер течения заболевания, возраст больных., Aim of the research: The study evaluates the effect of different eradication therapies on patients with H. pylori peptic ulcer. Materials and methods. The study included 310 peptic ulcer patients with acute Helicobacter pylori infection stage. The mean age of patients was 41.6±4.3 years (range, 25 to 65 years). All patients were divided into 8 groups and each group was treated with a different eradication therapy. The patients underwent esophagogastroduodenoscopy (EGD) to determine the localization, size and stage of the ulcer. Stomach biopsies were performed. Biopsy specimens were taken from the stomach, its pyloric part, and the duo-denum. H. pylori infection was diagnosed by the Giemsa staining method and the rapid urease test (RUT). The degree of H. pylori infection was assessed. Treatment effectiveness was assessed based on the following indicators: ulcer healing rate, success rate of H. pylori eradication, severity of inflammation of the mucous membrane, and relief duration of the peptic ulcer symptoms. The safety and tolerability of treatment was assessed by evaluating the dynamics of side effects. Results and discussion. The combination of omeprazole, clarithromycin and metronidazole had an eradicating efficiency of 65%, suggesting the increased resistance to metronidazole. Other combinations had considerable higher eradicating efficiencies: omeprazole + clarithromycin + amoxicillin, 95.2%; omeprazole + clarithromycin + furazolidone, 92.1%; omeprazole + clarithromycin + tinidazole, 86%. In cases of high H. pylori resistance to metronidazole, metronidazole in the first-line eradication therapy was replaced with amoxicillin, furazolidone, or tinidazole. The combination of omeprazole, amoxicillin and vilprafen was effective in 84% patients. The association of omeprazole, levofloxacin and amoxicillin was effective in 88% of patients. In case of H. pylori resistance to clarithromycin, it can be replaced with vilprafen or levofloxacin. Patients with non-complicated H. pylori peptic ulcer received omeprazole as eradication treatment, whilst those with complicated peptic ulcer were instructed to take omeprazole until the ulcer is completely scarred. In elderly and old patients with H. pylori peptic ulcer, first-line eradication was effective with half doses of omeprazole-clarithromycin-amoxicillin. Conclusion. Patients with peptic ulcers localized in different regions were diagnosed for H. pylori. If positive, patients were assigned to receive eradication therapy. The combination and doses of antibiotics and treatment duration depend on the level of antibiotic resistance, infection severity, the clinical course of the disease, and the patient’s age.

Background: Histamine-2-receptor antagonists (H2RAs) have been largely replaced by proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) despite the inconclusive evidence concerning comparative effectiveness. Objective: To compare the effectiveness of PPIs and H2RAs on SUP in real-world setting. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to September 19, 2021. We included cohort studies comparing PPIs with H2RAs in critically ill adult patients and explicitly reporting the outcome of gastrointestinal (GI) bleeding or mortality. Newcastle-Ottawa Scale was used to assess potential risk of bias. We conducted a random-effects meta-analysis and only the studies with adjusted effect estimates were pooled. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the overall quality of the evidence. Results: Thirteen cohort studies (N = 145 149) were eligible and 11 of them available for full texts were of low to moderate risk of bias. Meta-analysis of adjusted effect estimates indicated that PPIs were associated with a significantly higher risk of GI bleeding, compared with H2RAs (8 studies, odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.30-3.01, low certainty). Post hoc pooling analysis also suggested that PPIs were associated with a slightly higher risk of mortality in comparison with H2RAs (7 studies, OR = 1.27, 95% CI = 1.13-1.42, low certainty). Conclusion and Relevance: The systematic review of cohort studies showed that PPIs were associated with higher risks of GI bleeding and mortality, although the certainty of evidence was low. Overall, we suggest not excluding H2RAs for SUP, while further studies are essential for elucidating the risk stratification, optimal regimen, and specific duration.

Peptic ulcer is a chronic disease that affects up to 10% of the world's population. The appearance of peptic ulcer is dependent on the presence of gastric juice and its pH and the decrease of the mucosal defense. Two major factors recognized as disruptors of mucosal resistance are nonsteroidal antiinflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection. The main conventional treatments for peptic ulcer, such as proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists, are associated with side effects, recurrences and various drug interactions. On the other hand, medicinal plants and their chemical compounds are useful in the prevention and treatment of many diseases. Therefore, this article presents some medicinal herbs that can be used for the treatment or prevention of peptic ulcers.

Objective: The objective of the present study was to evaluate the effects of Rhodiola rosea in the indomethacin-induced ulcer model in rats and to clarify the underlying mechanisms of action. Methods: Rats in treatment groups were treated with Rhodiola rosea (RR) 14 days. Peptic ulcer was induced by indomethacin (IND) injection (100 mg/kg, p.o.). The groups (n = 6) were designed as; Group I (control); Group II (IND): After 24h of food starvation, rats were given only 100 mg/kg IND by oral gavage to induce gastric mucosal injury. Group III (ESO): Rats were pretreated with 20 mg/kg of ESO for 14 consecutive days by oral gavage. Group IV (RR): Rats were pretreated with 500 mg/kg RR for 14 consecutive days with oral gavage. Results: Rhodiola rosea effectively alleviated indomethacin-induced ulcer via reduction in oxidative stress (decreased MDA and increased SOD, and GSH). Moreover, Rhodiola rosea alleviated indomethacin-induced damage by regulating expressions of COX enzymes, prostaglandin E2, proliferating cell nuclear antigen (PCNA), cell proliferation, apoptosis and regulated the NF-κB signaling pathway. Rhodiola rosea also attenuated inflammatory injury by suppressing TNF-𝛼𝛼, IL-1β, and NF-κB. The caspase-3 expression was also down-regulated in stomach tissues. Conclusions: In conclusion, Rhodiola rosea protected the gastric mucosa from harmful effects of indomethacin and as a natural medicinal herb, Rhodiola rosea might be a potential therapeutic agent for preventing and treating indomethacin-induced gastric damage.

Aim. A comparative review of the rabeprazole properties vs. other PPIs, its efficacy and safety in treatment for aciddependent diseases.Key points. Rabeprazole provides a rapid proton pump blockade in parietal cells due to its high dissociation constant (pKa). A lower rabeprazole metabolic dependence on cytochrome P-450 enzyme system renders its antisecretory effect predictable and reduces the risk of interactions with other drugs metabolised through this system. A faster antisecretory effect and higher acid-suppressive activity of rabeprazole determine its better clinical efficacy in treatment for such acid-dependent diseases as gastroesophageal reflux disease and peptic ulcer. This makes rabeprazole (Pariet) a preferred drug in course and maintenance therapies for acid-dependent diseases, as well as in H. pylori eradication.Conclusion. The rabeprazole properties of high acid suppression potential, persistent antisecretory effect from first day of therapy, non-enzymatic metabolism and pleiotropic action determine its high efficacy in treatment for a wide range of acid-dependent diseases at a minimal risk of drug interaction.

Gastric and duodenal peptic ulcer disease is a multifactorial pathology, in the etiopathogenesis of which the general and local reactions of the body to external and internal risk factors play a role. Psychoemotional stress is the main cause of the pathology of nervous and humoral regulation (general reaction), and the local reaction is expressed in a violation of the ratio between the factors of aggression and protection factors in the mucous membrane of the stomach and / or duodenum. The combined action of these components leads to the formation of an ulcerative defect.

– At the of Electric Paton Welding Institute PWI on the basis of previous experience, created an electrosurgical instrument designed to solve the urgent problem of modern abdominal surgery - to stop bleeding in emergencies in the treatment of gastrointestinal ulcers. Known traditional methods of stopping bleeding: mechanical (thread, bracket), electrical, chemical, thermal, etc. have a number of shortcomings that prevent their widespread introduction into surgical practice. The main disadvantages are postoperative complications, tissue re-coagulation, high cost of equipment. The created electrosurgical instrument is developed taking into account the phenomenon of “skin effect". The working surfaces of the tool electrodes have an enlarged perimeter, compared to the traditional shape. This allows to evenly distribute the current density on the surfaces of the electrodes, and free up the central area of the working surfaces of the electrodes for the location of the tube of supply or removal of saline. This tool allows you to perform a quick emergency stop bleeding in the treatment of peptic ulcer disease. It eliminates the existing shortcomings of traditional technologies and can be used to treat patients with an artificial heart rate driver, which significantly expands the range of patients who can be cured. Developed equipment is much cheaper than traditional.Keywordselectrosurgical instrument, abdominal surgery, minimally invasiv e interventions, emergency cessation of bleeding, treatment of ulcers, skin effect.

During the last decades, Chinese medicine has been widely used for curing various diseases in the healthcare domain. Based on the databases of medicine wisdom and modern application of prescriptions, we have explored the medication pattern of ancient and modern prescriptions for the treatment of peptic ulcer in various patients. In this paper, we have proposed a neural network model which is based on the time series decomposition and is able to mine and predict the medication pattern of peptic ulcer treatment in Chinese medicine. For this purpose, cumulative distance level method, Mann–Kendall trend analysis, Hurst exponent, and characteristic point methods are used for the trend analysis. Likewise in the proposed model, the wavelet analysis method is used for the periodicity analysis and Mann–Kendall mutation test method along with Pettitt methods is used for mutability analysis. In addition, autocorrelation and unit root methods are utilized to test the random terms. The Chinese herbal formulas (where the main diseases are peptic ulcer, peptic ulcer, cerebral leakage, and cerebral abscess) are collected from the databases of medicine wisdom and modern application of prescriptions. Furthermore, methods of frequency analysis, association rule analysis, and factor analysis are used to evaluate the grouping pattern of prescriptions for peptic ulcer treatment. The error in the proposed scheme between the predicted and the measured values of 87 prescriptions, which involve five Chinese medicines for peptic ulcer and 160 Chinese medicines, obtained from the neural network was 16.79%.

Background There are limited studies regarding the impact of post-operative leak on perforated peptic ulcer disease (PPUD) and conflicting results regarding routine drain placement in operative repair of PPUD. This study aims to identify risk factors for gastrointestinal leak after operative repair of PPUD to better guide intra-operative decisions about drain placement. Methods We performed a retrospective cohort study at a tertiary care center from 2008 to 2019, identifying 175 patients who underwent operative repair of PPUD. Results Patients who developed a leak (17%) were compared to patients who did not. Both hypoalbuminemia (albumin < 3.5 g/dL) ( P = .03) and duodenal ulcers ( P < .01) were identified as significant risk factors for leak. No significant difference was found between leak and no leak groups for AAST disease severity grade, repair technique, or pre-operative use of tobacco, alcohol, or steroids. Post-operative leaks were associated with prolonged hospital stay (29 days compared to 10, P < .01), increased complication rates (77% compared to 48%, P < .01), and increased re-operation rates (73% compared to 26%, Discussion Leak after operative PPUD repair is associated with significant post-operative morbidity. Hypoalbuminemia and duodenal perforations are significant risk factors for post-operative leaks.

Introduction: Cirrhosis of liver and peptic ulcer disease (PUD) are very common in Bangladesh. PUD may coexist with cirrhosis and portal hypertension. Haematemesis and melaena in cirrhosis of liver are not always from ruptured oesophageal varices; rather it may be due to bleeding peptic ulcer disease. Objective: To find the prevalence of PUD among patients with liver cirrhosis and portal hypertension. Materials and Methods: This cross sectional, descriptive study was conducted on 96 patients of cirrhosis of liver diagnosed with oesophageal varices at endoscopy unit of Kurmitola general hospital, during endoscopic evaluations in 4 months period from september 2017 to december 2017. Results: Total cirrhotic patients enrolled were 96 (M=61, F=35), mean age was 51.8 ± 14.2 yrs (18-86years). Hepatitis B virus (HBV) was the leading cause of cirrhosis in 54.1%, Hepatitis C virus (HCV) 5.2 %, proven non-alcoholic steatohepatitis (NASH) were 11.5% and rest were from unknown aetiology. Their average Child-Turcotte-Pugh (CTP) score were 8.6 (12-5), 37.6% associated with portal hypertensive gastropathy. Grade-III oesophageal varices found in 52 patients, whereas grade-II in 25 patients. Among this 96 patients 39 (40.6%) revealed peptic ulcer disease more in the form of gastric ulcer (n=23) than duodenal ulcer (n=10) and both (n=6). Most of the ulcers belonged to Forrest class III (76.9%). Conclusions: Variceal bleeding and portal hypertensive gastropathy are the common causes of bleeding and anaemia in patients with cirrhosis of liver. Peptic ulcer disease has been found to be one of the potential causes of haematemesis, melaena, and anaemia among these patients in Bangladesh. Large multicenter controlled studies are needed to confirm the reports. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 68-71

Chengguo Zhang,1 Yinbin Wei2 1Department of Dermatology, Hanchuan People’s Hospital, Hanchuan, 431600, People’s Republic of China; 2Department of Infectious Diseases, Hanchuan People’s Hospital, Hanchuan, 431600, People’s Republic of ChinaCorrespondence: Yinbin WeiDepartment of Infectious Diseases, Hanchuan People’s Hospital, No. 1 Renmin Avenue, Hanchuan, 431600, People’s Republic of ChinaEmail weiyinbin1183840@163.comObjective: The association between peptic ulcer disease (PUD) and chronic urticaria (CU) is rarely examined in individuals without Helicobacter pylori infection. The study aimed to investigate the association between Helicobacter pylori-negative PUD and CU.Methods: Patients without Helicobacter pylori infection were retrospectively enrolled from those who visited the clinic or were admitted to the ward of the dermatological department with recent gastroscopy and Helicobacter pylori testing in a tertiary hospital between 2015 and 2019. After categorizing them as patients with and without PUD, we used propensity score matching to identify a cohort of PUD and a control cohort at a ratio of 1:2. CU was determined by examining medical records of the two cohorts, and logistic regression analyses were used to evaluate the association between PUD and CU with or without adjusting for covariates.Results: We included 40 patients with PUD as the PUD cohort and 80 patients without PUD as the control cohort, between which there were no significant differences in patient characteristics, including age, sex, and several comorbidities (P all > 0.05). Among the PUD cohort, 25.00% (10/40) of them were with CU, which was significantly higher than that in the control cohort 8.75% (7/80, P = 0.016). Results of logistic regression analyses showed PUD was significantly associated with increased risk of CU (odds ratio (OR) 3.48, 95% confidence interval (CI) 1.21– 9.99, P = 0.021), which was consistent with that after adjusted for potential confounding factors (OR 3.77, 95% CI 1.24– 11.45, P = 0.019).Conclusion: Helicobacter pylori-negative PUD is associated with increased risk of CU.Keywords: chronic urticaria, peptic ulcer, risk factors, Helicobacter pylori