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Surgical Endoscopy Apr 2022Gastroduodenal perforation is potentially life threatening and requires early diagnosis and treatment. Urgent endoscopy facilitates detecting bleeding sites and...
BACKGROUND
Gastroduodenal perforation is potentially life threatening and requires early diagnosis and treatment. Urgent endoscopy facilitates detecting bleeding sites and achieving hemostasis. However, there is no consensus on urgent endoscopy for gastroduodenal perforation in Japan.
METHODS
We evaluated the effectiveness and safety of urgent endoscopy for gastroduodenal perforation. We compared clinical characteristics between 140 patients who underwent urgent endoscopy (urgent endoscopy group) and 16 patients did not (no urgent endoscopy group) at Hiroshima City Asa Citizens Hospital between December 2005 and December 2018.
RESULTS
Endoscopic diagnosis was possible in all urgent endoscopy group. In contrast, correct diagnosis of the perforation site was made on CT in 99 cases (63%). Furthermore, the proportion of cases with correct diagnosis of the perforation site by CT findings differed significantly between the urgent endoscopy group and the no urgent endoscopy group (66% vs. 38%, p < 0.05). No complications of urgent endoscopy were observed. Primary perforation site was gastric in 42 cases and duodenal in 114. In the 42 gastric perforation cases, 12 gastric perforation cases (29%) were managed conservatively, successfully in 9 (75%); 2 cases (17%) required delayed emergency surgery for worsening peritonitis. In the 114 duodenal perforation cases (duodenal ulcer in all cases), 52 cases (46%) were managed conservatively, successfully in 48 (92%); 3 cases (6%) required delayed emergency surgery for worsening peritonitis. A significantly higher proportion of gastric perforation cases than duodenal perforation cases required surgical treatment (76% vs. 57%, p < 0.05). Multivariate analysis revealed localized abdominal pain (no peritonism) (OR 0.25; 95% CI 0.08-0.75; p < 0.01) and perforation diameter ≤ 5 mm (OR 0.13; 95% CI 0.04-0.36; p < 0.01) as significant independent clinical factors for successful conservative management of duodenal ulcer perforation.
CONCLUSIONS
Urgent endoscopy in gastroduodenal perforation enabled primary diagnosis and perforation site identification, and facilitated deciding the management strategy.
Topics: Duodenal Ulcer; Endoscopy; Endoscopy, Gastrointestinal; Humans; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Peritonitis; Pilot Projects; Stomach Ulcer; Vascular System Injuries
PubMed: 34009476
DOI: 10.1007/s00464-021-08555-2 -
Alimentary Pharmacology & Therapeutics Jul 2022Low-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...
BACKGROUND
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.
AIM
To assess the associations of low-dose aspirin with gastric and duodenal ulcer incidence in prevalent- and new-user design.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer; Risk Factors; Stomach Ulcer
PubMed: 35621052
DOI: 10.1111/apt.17050 -
World Journal of Gastroenterology Apr 2017To elucidate the epidemiological characteristics and associated risk factors of perforated peptic ulcer (PPU).
AIM
To elucidate the epidemiological characteristics and associated risk factors of perforated peptic ulcer (PPU).
METHODS
We retrospectively reviewed medical records of patients who were diagnosed with benign PPU from 2010 through 2015 at 6 Hallym university-affiliated hospitals.
RESULTS
A total of 396 patients were identified with postoperative complication rate of 9.1% and mortality rate of 0.8%. Among 174 (43.9%) patients who were examined for () infection, 78 (44.8%) patients were positive for infection, 21 (12.1%) were on non-steroidal anti-inflammatory drugs (NSAIDs) therapy, and 80 (46%) patients were neither infected of nor treated by any kinds of NSAIDs. Multivariate analysis indicated that older age (OR = 1.09, 95%CI: 1.04-1.16) and comorbidity (OR = 4.11, 95%CI: 1.03-16.48) were risk factors for NSAID-associated PPU compared with non-, non-NSAID associated PPU and older age (OR = 1.04, 95%CI: 1.02-1.07) and alcohol consumption (OR = 2.08, 95%CI: 1.05-4.13) were risk factors for non-, non-NSAID associated PPU compared with solely positive PPU.
CONCLUSION
Elderly patients with comorbidities are associated with NSAIDs-associated PPU. Non-, non-NSAID peptic ulcer is important etiology of PPU and alcohol consumption is associated risk factor.
Topics: Adult; Age Factors; Aged; Alcohol Drinking; Anti-Inflammatory Agents, Non-Steroidal; Comorbidity; Duodenal Ulcer; Female; Helicobacter Infections; Helicobacter pylori; Hospitals, University; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Republic of Korea; Retrospective Studies; Risk Factors; Stomach Ulcer; Time Factors; Treatment Outcome
PubMed: 28465641
DOI: 10.3748/wjg.v23.i14.2566 -
Eksperimental'naia I Klinicheskaia... 2016Helicobocterpylori (HP) - the human infection that persists for a long time in the stomach and can cause chronic gastritis, gastric and duodenal ulcer, MALT-lymphoma,... (Review)
Review
Helicobocterpylori (HP) - the human infection that persists for a long time in the stomach and can cause chronic gastritis, gastric and duodenal ulcer, MALT-lymphoma, gastric adenocarcinoma. There is a well-adapted niche-specific microbial community in the stomach represented by Lactobocillus, Streptococcus ahd other bacteria. Use of probiotics is considered to be an alternative or supplement to eradication therapy Among the Lactobacillus the most promising is Loctobocillus reutert who are able to have the anti-HP activity L. reureri produces powerful antimicrobial compounds such as reuterin, reuteritsin 6, reutetsiklin and metabolites that inhibit the growth of I-/P (volatile fatty acids, lactic acid, hydrogen peroxide, etc.). These compounds could reduce the adhesion of HP to gastric epithelial cells, inhibit growth HP, which leads to a significant reduction in the degree of contamination of HP and the severity of gastric mucosal inflammation. The data on the effectiveness of L. re uteri as monotherapy in patients with HP without absolute indications for eradication, and as an additional component, which increase the effectiveness of eradication are presented.
Topics: Adenocarcinoma; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Limosilactobacillus reuteri; Lymphoma, B-Cell, Marginal Zone; Stomach Neoplasms
PubMed: 29874441
DOI: No ID Found -
Asian Journal of Surgery Feb 2023
Topics: Humans; Duodenal Ulcer; Peptic Ulcer Perforation
PubMed: 36055888
DOI: 10.1016/j.asjsur.2022.08.001 -
Clinica Chimica Acta; International... Jul 2020A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal...
A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal ulcer with duodenal perforation. When investigating the culprit of this case, the pain medications prescribed two weeks prior by a traditional Chinese medicine doctor raised attention. The patient's admission serum sample and the pain medications from unknown sources were analyzed using a clinically validated liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method. The NSAIDs diclofenac, piroxicam, and indomethacin were identified, as well as some other synthetic drugs and natural products. The patient's concurrent exposure to multiple NSAIDs significantly increased the risk of upper GI complications. It is reasonable to argue that the high-dose use of the NSAIDs was a major cause of the duodenal ulcer and GI bleed. In addition, the identified natural products such as atropine and ephedrine have well-documented toxicities. It is important to increase the visibility of unregulated medications, and the capability to perform untargeted mass spectrometry analysis provides a unique diagnostic advantage in cases where exposure to toxic substances is possible.
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Chromatography, Liquid; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Mass Spectrometry
PubMed: 32234495
DOI: 10.1016/j.cca.2020.03.037 -
Current Opinion in Gastroenterology Nov 2019This review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors (PPIs). (Review)
Review
PURPOSE OF REVIEW
This review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors (PPIs).
RECENT FINDINGS
PPIs are amongst the most widely prescribed and over-prescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies that mine large databases have reported a panoply of putative adverse effects associated with PPIs. It should be emphasized that the quality of the evidence underlying most of these associations is very low and the studies, by design, cannot ascribe cause and effect. These associations continue to be sensationalized in the media and misinterpreted by providers and patients. The unintended consequences are that patients who require PPIs, such as those taking dual antiplatelet agents, are not being prescribed or taking these necessary medications. In addition, physicians are spending an inordinate amount of additional time placing these findings into proper perspective for their patients and reassuring them upon initiating PPI treatment as well as at every follow-up visit.
SUMMARY
Most of the recent publicized putative serious adverse effects attributed to PPIs rely on observational data and have not been confirmed in prospective randomized trials. Nevertheless, PPIs should be prescribed for valid indications and when prescribed long-term, they should be used at the lowest effective dose and the need for their use periodically reassessed.
Topics: Drug Utilization; Drug-Related Side Effects and Adverse Reactions; Duodenal Ulcer; Female; Gastroesophageal Reflux; Humans; Male; Outcome Assessment, Health Care; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Risk Assessment; Stomach Ulcer
PubMed: 31433315
DOI: 10.1097/MOG.0000000000000580 -
Journal of Ultrasound in Medicine :... Feb 2022Direct ultrasound imaging findings alone have low sensitivity for diagnosing duodenal (65%) and gastric ulcers (40%). This retrospective study evaluated the efficiency...
OBJECTIVE
Direct ultrasound imaging findings alone have low sensitivity for diagnosing duodenal (65%) and gastric ulcers (40%). This retrospective study evaluated the efficiency of ultrasound in detecting gastric/duodenal ulcers in pediatric patients through direct and indirect findings.
METHODS
We evaluated 244 children who underwent ultrasound and subsequent endoscopy within 4 weeks for direct and indirect imaging findings indicative of gastric/duodenal ulcers. Positive direct imaging findings revealed gastric or duodenal wall thickness >8 or 5 mm, respectively, and indirect findings revealed inflammatory changes, hyperechogenicity, and presence of lymph node around ulcers. Correspondingly, we calculated the sensitivity and specificity for diagnosing gastric/duodenal ulcers and used the Fisher's exact and Mann-Whitney U tests to compare the frequency of findings and gastroduodenal wall thicknesses in pediatric patients with gastric/duodenal ulcers.
RESULTS
Overall, 6 and 24 were diagnosed with gastric and duodenal ulcers, respectively. The sensitivities of direct and indirect findings were 60.0% (18/30) and 80.0% (24/30), respectively; the corresponding specificities were 98.1% (210/214) and 97.2% (208/214). The frequency of direct and indirect sonographic findings differed significantly between patients with gastric or duodenal ulcers (18/30 versus 24/30, P = .002). Gastric and duodenal wall thicknesses were greater in patients with gastric (6.6 ± 2.6 mm versus 3.6 ± 1.4 mm; P = .003) or duodenal ulcer (5.0 ± 1.4 mm versus 2.2 ± 1.0 mm; P <.0001), respectively, than in those without.
CONCLUSIONS
The frequency of indirect finding was greater than that of direct finding in pediatric patients with gastric/duodenal ulcers. Therefore, sonographers should carefully evaluate indirect findings around the stomach or duodenum.
Topics: Child; Duodenal Ulcer; Endoscopy, Gastrointestinal; Humans; Retrospective Studies; Ultrasonography
PubMed: 33876858
DOI: 10.1002/jum.15727 -
Indian Journal of Gastroenterology :... Jan 2015
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Duodenal Ulcer; Endoscopy, Gastrointestinal; Humans; Male; Proton Pump Inhibitors; Pylorus
PubMed: 25586076
DOI: 10.1007/s12664-014-0533-4 -
Surgical Endoscopy Dec 2021Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial.
METHODS
All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2-3 weeks. Complications were recorded and classified according to Clavien-Dindo (C-D).
RESULTS
43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5 years (23-91) with no difference between groups. ASA score was unevenly distributed between the groups (p = 0.069). Operation time was significantly shorter in the stent group, 68 min (48-107) versus 92 min (68-154) (p = 0.001). Stents were removed after a median of 21 days (11-37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2-5) (n.s.).
CONCLUSIONS
Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment.
Topics: Aged; Duodenal Ulcer; Humans; Laparoscopy; Peptic Ulcer Perforation; Prospective Studies; Stents; Treatment Outcome
PubMed: 33258032
DOI: 10.1007/s00464-020-08158-3