-
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 -
Annals of African Medicine 2023Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been...
BACKGROUND
Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria.
AIM
This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world.
METHODS
Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North-West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed.
RESULTS
Over a 9-year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 14-85), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged <40 years were significantly more likely to be diagnosed with DU than GU (54.7% vs. 33.9%, P = 0.016) while those >40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU.
CONCLUSION
The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed - patients were predominantly male and older, and GU predominated.
Topics: Humans; Male; Middle Aged; Adolescent; Young Adult; Adult; Aged; Aged, 80 and over; Female; Prevalence; Nigeria; Peptic Ulcer; Stomach Ulcer; Duodenal Ulcer
PubMed: 38358140
DOI: 10.4103/aam.aam_144_22 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2018Introduction: High morbidity rate, frequent relapses, and significant economic losses give reasons for highlighting the peptic ulcer disease as the most topical...
OBJECTIVE
Introduction: High morbidity rate, frequent relapses, and significant economic losses give reasons for highlighting the peptic ulcer disease as the most topical medical-statistical problem. The aim of the study is to assess the influence of the main risk factors on the course of gastric and duodenal peptic ulcer.
PATIENTS AND METHODS
Materials and methods: We formed up the risk groups consisted of patients with 12 modified (4) and regular (8) factors, each characterized with its own signs and gradations. We performed the quantitative evaluation of the factors and scored the signs thereof, the results of which were used for determination of the most informative ones.
RESULTS
Results: Among the regular factors, we placed emphasis on gender, age, burdened heredity, and 0(I), Rh+ blood type. The risk of peptic ulcer in hereditary tainted young men of the working age with parental lineage (+2.3) and in males with 0(I) Rh+ blood type (+1.4) was proved. Helicobacter pylori (Hp) infection is a key contributor (a predictor of) to severity of the disease course (+9.7) among the modified risk factors. Negative effect of a concomitant pathology (+5.0), including hepatobiliary lesions (+3.8), hypertension (+4.0), and diabetes mellitus (+1.3) is also significant. Diet violation (+3.7), tobacco smoking (+3.2) and stress (+3.0) were ranked third.
CONCLUSION
Conclusions: The results of quantitative evaluation of the factors scoring suggest of the underlying H.pylori infection (the significance of which is growing along with the growth of the disease incidence) and irrational diet as the most informatively important ones. We have established the direct dependence between the most important peptic ulcer risk factors, severity of the disease, and duration and periodicity of treatment thereof.
Topics: Adult; Blood Group Antigens; Diabetes Mellitus; Duodenal Ulcer; Female; Helicobacter Infections; Helicobacter pylori; Humans; Hypertension; Male; Middle Aged; Risk Factors; Stomach Ulcer
PubMed: 29602925
DOI: No ID Found -
Medicine May 2023Gastric mucosal ulcer caused by drug overdose is very rare in clinical practice, and here is a case of gastric antral ulcer caused by drug overdose.
RATIONALE
Gastric mucosal ulcer caused by drug overdose is very rare in clinical practice, and here is a case of gastric antral ulcer caused by drug overdose.
PATIENT CONCERNS
A 35-year-old housewife from a mountainous region in China took 48 Ibuprofen Sustained-Release capsules (300 mg/capsule) orally at 1 time. Because of severe tingling in the upper abdomen accompanied by a sharp increase in blood pressure, she came to the doctor 48 hours later.
DIAGNOSES
Gastric antral ulcer (multiple stage A1), duodenococcitis, chronic nonatrophic gastritis, Helicobacter pylori infection, moderate depression, and cognitive impairment.
INTERVENTIONS
Acid suppression, antihypertensive and a series of symptomatic treatments.
OUTCOMES
All somatic symptoms disappeared after a follow-up visit 2 months later.
LESSONS
This case provides valuable information to the clinic, through the compilation of literature and case analysis, the author found that paying attention to mental health, to women in poor areas and to women from families of low education level are indispensable in medical diagnosis and treatment.
Topics: Humans; Female; Adult; Stomach Ulcer; Helicobacter Infections; Ibuprofen; Gastritis; Ulcer; Helicobacter pylori; Stomach; Gastric Mucosa; Duodenal Ulcer
PubMed: 37335722
DOI: 10.1097/MD.0000000000033812 -
Surgical Endoscopy Sep 2022Peptic ulcer perforation is a common surgical emergency and a major cause of death especially in elderly patients, despite the fact of the presence of effective drug...
BACKGROUND
Peptic ulcer perforation is a common surgical emergency and a major cause of death especially in elderly patients, despite the fact of the presence of effective drug treatments and an increased understanding of its etiology. Giant duodenal perforations, in particular, pose a significant challenge and there is scarce data regarding their optimal management. Laparoscopic surgery is advocated in the surgical treatment of perforated duodenal ulcer disease, in experienced hands.
METHODS
Herein we present an 84-year-old man with past medical history of type II diabetes mellitus and hypertension who was admitted to our Department due to epigastric pain and diffuse peritonitis. CT scan revealed the presence of a significant amount of free air and fluid in the upper abdomen secondary to a duodenal perforation.
RESULTS
The patient was taken immediately to the theater for an urgent laparoscopy. Methylene blue via the NG tube better defined the extent of the duodenal perforation which was not amenable to a primary repair. Consequently, a decision was made for a laparoscopic pancreas-sparing, ampulla preserving gastroduodenectomy with intracorporeal Billroth II gastrojejunal anastomosis. The postoperative period was uneventful and the patient was discharged on the 13th postoperative day. Histopathology revealed a large benign duodenal ulcer.
CONCLUSIONS
Although the incidence of peptic ulcer disease is decreasing, it appears that the incidence of complications is rising. Laparoscopic approach, especially when performed by laparoscopic surgery experts, could be a treatment option for difficult duodenal ulcer perforations with less pain, shorter hospital stay and reduced morbidity.
Topics: Aged; Aged, 80 and over; Ampulla of Vater; Anastomosis, Surgical; Diabetes Mellitus, Type 2; Duodenal Ulcer; Humans; Laparoscopy; Male; Pain; Peptic Ulcer Perforation
PubMed: 34997347
DOI: 10.1007/s00464-021-08955-4 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Apr 2021Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted...
Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.
Topics: Duodenal Ulcer; Embolization, Therapeutic; Endoscopy; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Recurrence; Retrospective Studies
PubMed: 33966702
DOI: 10.3881/j.issn.1000-503X.13045 -
Revista de La Facultad de Ciencias... Jun 2021Peptic ulcers are acid-induced lesions found in the stomach and duodenum. The prevalence of peptic ulcer disease in the United States is estimated to be 8.4%.
INTRODUCTION
Peptic ulcers are acid-induced lesions found in the stomach and duodenum. The prevalence of peptic ulcer disease in the United States is estimated to be 8.4%.
OBJECTIVE
Describe an atypical presentation of complicated duodenal ulcer that causes jaundice and review the literature.
CASE PRESENTATION
A 42-year-old male patient, who consulted for generalized jaundice and coluria, associated with low back pain treated with non-steroidal anti-inflammatory drugs. In the laboratory, total bilirubin increased to direct prevalence. A magnetic resonance cholangiography was performed that revealed duodenal thickening, with a decrease in its lumen; and a double contrast computed tomography, where thickening of the duodenal walls was observed, without oral contrast leakage. Subsequently, an upper digestive video-endoscopy was performed where a 30 mm duodenal bulb ulcer was observed. The patient presented good evolution with medical treatment, being discharged on the fifth day of hospitalization.
DISCUSSION
Jaundice can be caused by a duodenal ulcer that causes obstruction of the common bile duct. Medical treatment may specify in selected patients. In the present case, it was established to opt for medical treatment since the patient presented hemodynamic stability, without signs of generalized peritonitis, with complementary studies in favor of a contained duodenal ulcer without free air.
CONCLUSION
We are dealing with a case of duodenal ulcer complicated with jaundice that presented good evolution with medical treatment.
Topics: Duodenal Ulcer; Humans; Jaundice, Obstructive; Retrospective Studies
PubMed: 34181841
DOI: 10.31053/1853.0605.v78.n2.29786 -
Acta Gastro-enterologica Belgica 2020As a component of the cag T4SS, the cagL gene is involved in the translocation of CagA into host cells and is essential for the formation of cag PAI-associated pili...
INTRODUCTION
As a component of the cag T4SS, the cagL gene is involved in the translocation of CagA into host cells and is essential for the formation of cag PAI-associated pili between H. pylori and gastric epithelial cells.
AIM
We aimed to investigate the clinical association of the cagL gene with other virulence factors (VacA, CagA, EPIYA-C, and BabA protein) of H. pylori strains isolated from GC, duodenal ulcer (DU), and non-ulcer dyspepsia (NUD) cases.
METHODS
The patient group (PG), including 47 patients (22 GC and 25 DU) and a 25 control group (CG= NUD) were included. Amplification of the H. pylori cagL, cagA, vacA, and babA2 genes and typing of EPIYA motifs were performed by PCR methods.
RESULTS
Sixty-one (84.7%) H. pylori strains were detected with cagL (93.6% in SG, 68% in CG). We detected a significant difference between SG and CG for the presence of cagL (p=0.012) but no statistical comparison was done for (≥2) EPIYA-C repeats In the comparison of H. pylori strains with cagA/vacAs1m1 and cagA/ vacAs1m2 and babA2 for the presence of cagL, we could not detect a significant difference (p=1).
CONCLUSION
We detected a significant difference between groups for the presence of cagL genotype (p=0.012). The vacAs1m1 (OR: 2.829), genotypes increased the GC and DU risk by 2.8 times, while multiple (≥2) EPIYA-C repeats incresed the GC and DU risk by 3.524 times. Gender (to be female) (OR: 0.454) decreased the GC and DU risk by inversly decreased in the multivariate analysis.
Topics: Antigens, Bacterial; Bacterial Proteins; Duodenal Neoplasms; Duodenal Ulcer; Dyspepsia; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Ulcer
PubMed: 33094584
DOI: No ID Found -
World Journal of Gastroenterology Sep 2020The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating...
BACKGROUND
The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease.
AIM
To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years.
METHODS
This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades.
RESULTS
Two hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades.
CONCLUSION
Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.
Topics: Aged; Cohort Studies; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Norway; Peptic Ulcer Perforation; Retrospective Studies; Stomach Ulcer
PubMed: 32994689
DOI: 10.3748/wjg.v26.i35.5302 -
Annals of Diagnostic Pathology Jun 2019To assess the prevalence of the lesions in duodenal bulb mucosa and the relationship between duodenal lesions and upper gastrointestinal diseases, including helicobacter...
AIM
To assess the prevalence of the lesions in duodenal bulb mucosa and the relationship between duodenal lesions and upper gastrointestinal diseases, including helicobacter pylori infection.
METHODS
Clinical, endoscopic and pathological data of the cases with duodenal bulb and gastric mucosal biopsy from January 2005 to May 2017 were analyzed retrospectively.
RESULTS
A total of 3540 patients were enrolled. The biopsy from protuberant lesions with endoscopic morphology are mostly duodenal gastric heterotopia or adenoma. The biopsy from duodenal ulcers are often observed in inflammatory changes and gastric metaplasia. Patients with gastric heterotopia had a significantly lower prevalence of chronic atrophic gastritis, intestinal metaplasia, and gastric ulcer; and much higher prevalence of gastroesophageal reflux disease and gastric fundic polyps. Patients with gastric metaplasia had been positively associated with gastroesophageal reflux disease, and negatively associated with gastric fundic polyps. There were positive correlation between helicobacter pylori infection and duodenal active inflammation, Brunner gland hyperplasia, gastric metaplasia and duodenal ulcer. However, Patients with gastric heterotopia in bulb had been negatively associated with helicobacter pylori infection.
CONCLUSIONS
The mucosa lesions in duodenal bulb were associated with concurrent gastric fundic gland polyps, gastroesophageal reflux disease, duodenal ulcer, and helicobacter pylori infection.
Topics: Biopsy; Duodenal Ulcer; Duodenum; Gastrointestinal Diseases; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Mucosa; Metaplasia; Retrospective Studies; Stomach; Stomach Ulcer
PubMed: 30921623
DOI: 10.1016/j.anndiagpath.2019.02.006