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European Journal of Trauma and... Apr 2023Duodenal ulcer perforations are frequently encountered but there is limited literature regarding risk factors for leak after omentopexy.
AIMS
Duodenal ulcer perforations are frequently encountered but there is limited literature regarding risk factors for leak after omentopexy.
METHODOLOGY
The record of 100 patients of duodenal ulcer perforation undergoing omentopexy by open approach was prospectively maintained to identify any significant factors contributing towards leak.
RESULTS
Out of 100 patients undergoing omentopexy, 9 (9%) developed leak; when leak occurred, the mortality was very high (44.4%). Patients who developed leak (09) were compared against those who did not (91), and it was seen that seen that duration of symptoms before surgery (> 3 days), amount of intra-abdominal contamination (> 2 L), low body mass index (BMI < 19.35 kg/m), serum creatinine (> 1.5 mg/dl), and deranged International Normalized Ratio (INR) were found to be significant on univariate analysis; however, multivariate analysis revealed only low BMI and high creatinine to be contributory towards leak.
CONCLUSION
Leak after omentopexy carries a high morbidity and mortality. Identification of risk factors may help in optimizing patients at risk and reduce the incidence of leak and its sequelae.
TRIAL REGISTRATION NUMBER
CTRI/2020/03/023798.
Topics: Humans; Duodenal Ulcer; Peptic Ulcer Perforation; Incidence; Omentum; Risk Factors
PubMed: 35870005
DOI: 10.1007/s00068-022-02058-y -
JPMA. the Journal of the Pakistan... Apr 2022A 57 years old male presented in the emergency department of EAST Surgical Ward, MAYO Hospital Lahore in February 2021 with complaints of abdominal distension, pain and...
A 57 years old male presented in the emergency department of EAST Surgical Ward, MAYO Hospital Lahore in February 2021 with complaints of abdominal distension, pain and vomiting. He was a chronic smoker and diagnosed hypertensive for the last 14 years but was non-compliant with oral antihypertensive medications. He was a factory worker and took NSAIDs off and on for pain in the knee joint for the last five years. On examination, his abdomen was tense and tender with resonant percussion notes in the right hypogastrium and epigastrium. His chest x-ray showed free gas under the right diaphragm. Diagnosis of a perforated duodenal ulcer was made and exploratory laparotomy was done. Examination revealed a perforated ulcer in the first part of the duodenum with greenish gangrenous patches on the next 3 feet of the small gut. Graham's patch repair and resection of the diseased small gut was done and a jejuno ileostomy was performed. Unfortunately, the patient expired on 2nd postoperative day due to sudden cardiopulmonary arrest.
Topics: Abdominal Pain; Duodenal Ulcer; Humans; Male; Mesenteric Ischemia; Middle Aged; Peptic Ulcer Perforation; Tertiary Care Centers
PubMed: 35614616
DOI: 10.47391/JPMA.3716 -
Irish Journal of Medical Science Feb 2024Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk...
BACKGROUND
Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers.
AIMS
The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding.
METHODS
We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods.
RESULTS
Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870).
CONCLUSIONS
Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.
Topics: Humans; Duodenal Ulcer; Peptic Ulcer Hemorrhage; Retrospective Studies; Peptic Ulcer; Risk Factors; Recurrence; Albumins
PubMed: 37432526
DOI: 10.1007/s11845-023-03450-2 -
Revista Espanola de Enfermedades... Jun 2021Gastric mucosa has been widely studied during the pre/post-Helicobacter pylori (Hp) era. Excluding peptic ulcer disease (PUD), the duodenal mucosa has not been...
Gastric mucosa has been widely studied during the pre/post-Helicobacter pylori (Hp) era. Excluding peptic ulcer disease (PUD), the duodenal mucosa has not been thoroughly analyzed, even less so in functional dyspepsia (FD). We would like to make some comments after studying 161 dyspeptic patients with samples taken from the gastric body, antrum, proximal and distal duodenum.
Topics: Duodenal Ulcer; Duodenum; Dyspepsia; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 33393335
DOI: 10.17235/reed.2020.7673/2020 -
Microbial Pathogenesis Mar 2019Costa Rica is one of the countries with the highest incidence and mortality rates for gastric cancer. Helicobacter pylori infection rates are high in the whole country....
BACKGROUND AND AIMS
Costa Rica is one of the countries with the highest incidence and mortality rates for gastric cancer. Helicobacter pylori infection rates are high in the whole country. We have previously shown that H. pylori CagA+ is significantly associated with atrophic gastritis (AG) of the antrum in a dyspeptic population. The aim of this work is to determine if other H. pylori virulence factors (vacA, dupA, oipA, iceA and babA2) are associated with atrophic gastritis (AG) or duodenal ulcer (DU).
METHODS
The presence of virulence genes in Costa Rican H. pylori isolates was analyzed by PCR in 151 cultured strains from patients with dyspeptic symptoms. Endoscopic and histopathological diagnoses were available. Odds-ratio and 95% confidence intervals for AG patients vs. non-atrophic gastritis (NAG) or DU patients vs. no duodenal ulcer (NDU) patients were calculated.
RESULTS
Amongst the studied isolates, 82% had the cagA, 76.2% had the vacA s1m1, 97.0% had the oipA, 21.0% had the icea1, 79.0% had the iceA2, 44.0% had the babA2 and 76.0% the dupA genotypes. Infection with H pylori cagA, dupA, oipA, iceA, babA2, and vacA s1m1 genotypes was not associated with AG risk. The frequency of the dupA gene was 78.7 and 60.9% in isolates from patients with NDU and DU, respectively, and its presence was significantly associated with decreased risk of duodenal ulcer [odds-ratio: 0.33, p = 0.024, confidence interval 95% (0.11-0.85)].
CONCLUSION
H. pylori dupA genotype is inversely associated with DU risk in this population.
Topics: Adhesins, Bacterial; Antigens, Bacterial; Bacterial Outer Membrane Proteins; Bacterial Proteins; Costa Rica; Duodenal Ulcer; Female; Gastritis, Atrophic; Gene Frequency; Genes, Bacterial; Genetic Association Studies; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Molecular Epidemiology; Virulence; Virulence Factors
PubMed: 30654009
DOI: 10.1016/j.micpath.2019.01.018 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2023Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the...
BACKGROUND
Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model.
METHODS
Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-β1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically.
RESULTS
There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-β1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05).
CONCLUSION
We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.
Topics: Rats; Animals; Duodenal Ulcer; Transforming Growth Factor beta1; Peptic Ulcer Perforation; Duodenum; Drainage
PubMed: 37278083
DOI: 10.14744/tjtes.2023.92324 -
Georgian Medical News Jun 2019The purpose of the study was to identify the pathogenesis features of prepiloric and pyloric ulcers and to establish the cause of resistance to conservative therapy and...
The purpose of the study was to identify the pathogenesis features of prepiloric and pyloric ulcers and to establish the cause of resistance to conservative therapy and the tendency to complicated course of type III ulcers according to H.D. Johnson. A comparative analysis of acid production was carried out in 150 patents with duodenal ulcer (n-80) and peptic ulcer of type III according to H.D. Johnson classification (n-70). We revealed a definite individual rhythm of daily intragastric acidity with a maximum rise at night in patients with duodenal ulcer. The paper explores the peculiarities of digestive juice secretion depending on ulcerative substratum localization. The pathogenetic validity of the use of antisecretory drugs for duodenal ulcer treatment and the need to further improve the algorithm for pyloric and prepyloric ulcer therapy are shown. For pyloric and prepiloric ulcers characteristic specific morphological changes in the muscle layer of the wall of the antrum, leading to the motor-evacuation disorders and promoting duodenogastric reflux - dystrophy myocytes circular muscle layer vacuolation of the cytoplasm, edema and hypertrophy ganglia intermuscular plexus, hemorrhages in the muscle sheath, violation of muscle bundles.
Topics: Duodenal Ulcer; Gastric Acid; Humans; Pylorus; Stomach Ulcer
PubMed: 31418722
DOI: No ID Found -
Clinical Gastroenterology and... Oct 2022
Topics: Duodenal Ulcer; Duodenum; Dyspepsia; Humans; Inflammation
PubMed: 34785357
DOI: 10.1016/j.cgh.2021.11.005 -
Digestion 2015Small intestinal mucosal injuries have been recently recognized as common complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) because video... (Review)
Review
Small intestinal mucosal injuries have been recently recognized as common complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) because video capsule endoscopy and balloon enteroscopy are now available for the detection of small intestinal lesions. Small intestinal injury occurs not in an acid-dependent mechanism but by various factors such as enteric bacteria, bile acids, prostaglandin (PG) deficiency and topical factors (abnormal intestinal mucosal permeability, mitochondrial dysfunction, reactive oxygen species, endoplasmic reticulum stress and so on), and there is no well-established prophylactic approach. Several experimental and clinical studies found the effectiveness of some of the mucoprotective drugs, PG analogs, but not that of acid suppressants. Considering the effect of proton pump inhibitors (PPIs) for upper gastrointestinal (GI) disease and in the small intestine, the following 2 kinds of strategies against NSAID-induced GI injuries may be recommended. In patients with a high risk of upper GI disease (peptic ulcer etc.), simultaneous administration of a PPI (for upper GI disease) and a mucoprotective drug (for small intestine) is needed to prevent NSAID-induced GI injury. In other cases, an effective mucoprotective drug is enough for the protection of the entire digestive tract, that is, starting from the esophagus to the small intestine. These strategies may fulfill both economical and curative effects.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Capsule Endoscopy; Disease Models, Animal; Duodenal Ulcer; Humans; Intestinal Mucosa; Intestine, Small; Prostaglandins; Proton Pump Inhibitors; Rats
PubMed: 26279152
DOI: 10.1159/000437395 -
Digestive Diseases and Sciences Jun 2024Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different...
BACKGROUND AND GOALS
Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting.
METHODS
Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis.
RESULTS
A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs.
CONCLUSIONS
The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.
Topics: Humans; Male; Female; Aged; Retrospective Studies; United States; Middle Aged; Peptic Ulcer Hemorrhage; Hospital Mortality; Hemostasis, Endoscopic; Treatment Outcome; Duodenal Ulcer; Health Resources; Stomach Ulcer; Aged, 80 and over; Adult; Length of Stay
PubMed: 38446313
DOI: 10.1007/s10620-024-08322-y