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Proton pump inhibitors are widely prescribed, notably for the over 65s, despite there being significant side effects in the geriatric population. It is therefore important that doctors, caregivers and patients are fully aware of the recognised indications of PPIs and on the less well-known problems inherent to their prescription., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background/aims: The aim was to determine the sociodemographic and etiologic factors, endoscopic accuracy, treatment efficiency and clinical outcome of patients with nonvariceal upper gastrointestinal system bleeding in Kosova., Materials and Methods: We retrospectively evaluated patients who had applied to our Gastroenterology Department between January 2006 and December 2010., Results: There were 460 eligible cases with mean age 56.85+16.18 years, while male /female ratio was 2.71/1. The greatest occurrence was at age group of 60-69 years (27.1 %). The most common clinical symptom was melena (62.6%). Comorbid diseases were present in 57, 6% of the patients. The percentage of patients using acetylsalicylic acid and /or other non-steroidal anti-inflammatory drugs was 43.7%. Five point two percent were using anticoagulants. Peptic ulcer was the main cause of bleeding (82.2%) and most of them were Forrest III (41.6%). Endoscopic treatment was performed in 90 patients, primary hemostasis was achieved in 96.7% while rebleeding developed in 10% of these patients. The average length of hospital stay was 9.29+5.58 (1-35) days. Rebleeding was reported in 4.1% of all patients while the overall mortality rate was 5.7%., Conclusion: Age over 60 years, previous history of gastrointestinal bleeding, treatment with anticoagulants, low hemoglobin values at presentation (<7 g/dL), hematemesis, Forrest class, localization of lesion of bleeding, comorbidities, tachycardia, transfusion requirement>2 unit, type of treatment and time of endoscopy were predictors of poor outcome in study present.

Acute upper gastrointestinal bleeding (UGIB) is a common gastroenterological emergency. A vast majority of these bleeds have nonvariceal causes, in particular gastroduodenal peptic ulcers. Nonsteroidal antiinflammatory drugs, low-dose aspirin use, and Helicobacter pylori infection are the main risk factors for UGIB. Current epidemiologic data suggest that patients most affected are older with medical comorbidit. Widespread use of potentially gastroerosive medications underscores the importance of adopting gastroprotective pharamacologic strategies. Endoscopy is the mainstay for diagnosis and treatment of acute UGIB. It should be performed within 24 hours of presentation by skilled operators in adequately equipped settings, using a multidisciplinary team approach., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Heterotopic gastric mucosa (HGM) may be located at sites throughout the gastrointestinal (GI) tract. Clinical characteristics of HGM, role of Helicobacter pylori infection, natural history, and relationship to neoplastic transformation have not sufficiently been explored., Aim: To retrospectively study the prevalence, histological features, and clinical characteristics of HGM among Chinese patients who underwent upper GI endoscopy., Methods: Endoscopic, histological, and clinical records of patients, who underwent upper GI endoscopy (n = 6802) and colonoscopy (n = 3504), respectively, between May 2011 and May 2012, were collected and retrospectively analyzed. A total of 6716 sex- and age-matched patients without HGM were enrolled as controls., Results: HGM was diagnosed in 86 cases (51 esophageal, 0.75%; 35 duodenal, 0.51%). Male:female ratio was 1.4:1 (30/21) for esophageal HGM, 1.7:1 (22/13) for duodenal HGM, and 1.1:1 (3557/3159) for controls. Two histopathological types of HGM were identified: foveolar epithelium alone and foveoloar epithelium together with gastric glands. Helicobacter pylori were present in 19.6% of cases with esophageal HGM and 20.0% of cases with duodenal HGM. Esophageal HGM was significantly associated with dysphagia and globus; duodenal HGM was not significantly associated with GI symptoms. Intestinal metaplasia was present in two and three patients in both groups, respectively, with no dysplasia or carcinoma., Conclusion: HGM was present in fewer patients undergoing upper GI endoscopy, and it was more often present in men. A careful endoscopic examination is required to diagnose HGM, and it should be supported with a biopsy when indicated.

In a process of medical care and supervision on staff and military personnel, eliminating the chemical weapons, it was revealed that they are more susceptible to esophagogastroduodenal pathology in comparison with the control group. Moreover, the given pathology has an asymptomatic disease course but associated with high contamination of Helicobacter pylori. Marked inflammation changes, atrophic and fibrosis manifestation and microcirculation dysfunction have been confirmed by histological analysis of gastric mucosa. We supposed that the complex of occupational health risk factors, including possible subliminal toxic influence of eliminated CW components determines this pathological dysfunction. Negative influence of shift work and irregular nutrition rhythm are not excluded. The findings of this research are dictating the necessary of revision of military medical expertise principles and the development of the more effective treatment and prophylactic methods.

Background: There are no prior studies that have estimated the risk of upper gastrointestinal bleeding (UGIB) among the dialysis population relative to the general population. The aim of this study was to examine the risk of UGIB among end-stage renal disease (ESRD) patients during a 6-year period following their initiation of hemodialysis (HD) therapy in Taiwan- a country with the highest incidence of ESRD in the world, using general population as an external comparison group., Methods: Data were obtained from the Taiwan National health Insurance Research Database. In total, 796 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3,184 patients matched for age and sex were included as comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 6-year UGIB-free survival rate between these two cohorts., Results: The incidence rate of UGIB (42.01 per 1000 person-year) was significantly higher in the HD cohort than in the control cohort (27.39 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios for UGIB during the 6-year follow-up periods for HD patients was 1.27 (95% CI=1.03-1.57) compared to patients in the comparison cohort., Conclusions: We conclude that HD patients were at an increased risk for UGIB compared with the general population.

The author retrieved and retrospectively investigated biopsy specimens of heterotopic gastric mucosa registered in our computer database. There were 1008 cases affecting the esophagus, 684 cases affecting the duodenum, and 1636 cases affecting the colorectum. A total of 158 cases of heterotopic gastric mucosa were identified (84 cases affecting the esophagus, 74 cases affecting the duodenum, and no case affecting the colorectum). The frequency amounted to 8% in the esophagus, 11% in the duodenum, and 0% in the colorectum. The male to female ratio was 112:46, and the mean age was 62.22±14.29 years. Pathologically, two types of heterotopic gastric mucosa were identified. The first type consisted of gastric glands and foveolar epithelium, and the second type was composed only of foveolar epithelium. The first type was recognized in 69 of 84 cases (82%) in the esophagus, and in 54 of 74 cases (73%) in the duodenum. The second type was encountered in 15 of 84 cases (18%) in the esophagus, and in 20 of 74 cases (27%) in the duodenum. The first type appeared to be of congenital origin, while the second type was reminiscent of foveolar metaplasia. Foveolar hyperplasia and mild lymphocytic infiltration were frequent in the heterotopic gastric mucosa. Goblet cell metaplasia was recognized in 11 cases. The most frequent clinical diagnosis of heterotopic gastric mucosa of the esophagus was heterotopic gastric mucosa, followed in order by iodine-unstained area, reflux disease, flat elevation, polyp, carcinoma, ulcer, erosion, redness, submucosal tumor, esophagitis, adenoma, and tumor. The most frequent clinical diagnosis of heterotopic gastric mucosa in the duodenum was polyp, followed in order by ulcer, tumor, submucosal tumor, carcinoma, and duodenitis. The data suggest that esophageal gastric mucosa and duodenal heterotopic gastric mucosa are common lesions, with a frequency of about 9% in biopsy specimens in Japan., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

Overall 92 patients with esophagogastroduodenal bleedings, portal hypertension and esophageal varicose veins dilatation were treated, gastric erosions and ulcers were diagnosed at 21 (22,8%) of them. Urgent esophagogastroduodenoscopy was 100% diagnostic value. Endoscopic hemostasis is the method of choice for the treatment of these patients. Five patients underwent urgent operation. Three (14,3%) patients died, all of them -- after urgent operations. Mass health examination and well-timed elective surgery are the main ways for reduction of complication and lethal outcomes rate.

Historically, Crohn's disease of the esophagus, stomach, and duodenum has been reported only rarely. With more frequent use of upper endoscopy, however, upper gastrointestinal involvement has been found to be more common than previously suspected. The surgeon with an interest in Crohn's disease needs to be familiar with all areas that are potentially affected in this perplexing and sometimes devastating disease. This article examines the literature on foregut Crohn's and discusses the incidence, clinical manifestations, diagnosis, medical management, surgical indications, and operative techniques.

Seven hundred and ninety patients had upper gastrointestinal endoscope in a fifteen-year review in the Ahmadu Bello University Hospital, Zaria. Dyspepsia was the commonest indication for the procedure. The male female ratio was 1.5:1 The mean age of the patients was 37.8 years and most patients presented in the 4th and 5th decade of life. Epigastric tenderness was the commonest physical finding and chronic liver disease was seen in only 4.3%. Gastritis and doudenitis were the commonest endoscopic findings. The duodenal and gastric ulcer ratio was 10:1. Gastric and oesophgeal malignancies were seen in the 6th and 7th decade of life. Non-ulcer dyspepsia was seen in 39% of the patients.

Objectives: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors., Design: Case ascertainment study., Setting: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland., Subjects: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period., Main Outcome Measures: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality., Results: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors., Conclusions: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.

Colon polyps are commonly detected in the workup of fecal occult blood (FOB). It is, however, unclear whether colon polyps can adequately explain FOB. Our aim was to determine the frequency of upper gastrointestinal (UGI) pathology in patients with and without UGI symptoms and with and without risk factors for UGI pathology (such as smoking, drinking alcohol, taking nonsteroidal anti-inflammatory medications, or the presence of associated chronic diseases) who have colon polyps and FOB. Among our 67 study patients with colon polyps and FOB, 79% had associated UGI lesions. Presence or absence of UGI symptoms, risk factors associated with UGI lesions, and polyp characteristics such as size, location, number, and histology, did not appreciably affect this high frequency. Ulcers were the most common lesions in both symptomatic and asymptomatic patients. We conclude that patients with colon polyps found in the evaluation of FOB are likely to have concomitant UGI pathology, and UGI workup should be considered in both symptomatic and asymptomatic patients.

The authors analyse the results of esophago-gastro-duodenal fibroscopy in 930 symptomatic patients. Ninety one per cent of them had lesions. Inflammatory pathology was predominant: esophagitis, gastritis and duodenitis were seen in 21.5%, 47% and 29.08% respectively of the patients investigated. Gastritis accompanied 75.13% of cases of esophagitis and 76.4% of duodenitis, and was associated with the demonstration of the presence of Helicobater pylori in gastric biopsies in 56.41% of patients with that lesion. The relatively high incidence of carcinoma of the esophagus (2.7%) is a particular feature of this study, while that of carcinoma of the stomach (1%) was in accordance with classical data. Duodenal ulcer was found in 18% of patients as compared with 5.16% for gastric ulcer. From a pathophysiological standpoint, mention is made of traditional diet (hot, highly spiced), self-medication and intestinal parasite infestation in causing inflammatory lesions. Finally, emphasis is placed upon the role of Helicobacter infection in the development of chronic gastritis. The high rate of infection with this organism and its involvement in the mechanisms of duodenal ulcerogenesis could explain the high incidence of duodenal ulcers in our group and in studies emanating from developing countries.