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The American Journal of Medicine Apr 2019Peptic ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have peptic ulcer disease... (Review)
Review
Peptic ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have peptic ulcer disease are asymptomatic. In symptomatic patients, the most common presenting symptom of peptic ulcer disease is epigastric pain, which may be associated with dyspepsia, bloating, abdominal fullness, nausea, or early satiety. Most cases of peptic ulcer disease are associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), or both. In this review, we discuss the role of proton pump inhibitors in the management of peptic ulcer disease, highlight the latest guidelines about the diagnosis and management of H. pylori, and discuss the latest evidence in the management of complications related to peptic ulcer disease, including endoscopic intervention for peptic ulcer-related bleeding. Timely diagnosis and treatment of peptic ulcer disease and its sequelae are crucial in order to minimize associated morbidity and mortality, as is prevention of peptic ulcer disease among patients at high risk, including those infected with H. pylori and users of NSAIDs.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer; Proton Pump Inhibitors
PubMed: 30611829
DOI: 10.1016/j.amjmed.2018.12.009 -
Lancet (London, England) Aug 2017The rapidly declining prevalence of Helicobacter pylori infection and widespread use of potent anti-secretory drugs means peptic ulcer disease has become substantially... (Review)
Review
The rapidly declining prevalence of Helicobacter pylori infection and widespread use of potent anti-secretory drugs means peptic ulcer disease has become substantially less prevalent than it was two decades ago. Management has, however, become more challenging than ever because of the threat of increasing antimicrobial resistance worldwide and widespread use of complex anti-thrombotic therapy in the ageing population. Peptic ulcers not associated with H pylori infection or the use of non-steroidal anti-inflammatory drugs are now also imposing substantial diagnostic and therapeutic challenges. This Seminar aims to provide a balanced overview of the latest advances in the pathogenetic mechanisms of peptic ulcers, guidelines on therapies targeting H pylori infection, approaches to treatment of peptic ulcer complications associated with anti-inflammatory analgesics and anti-thrombotic agents, and the unmet needs in terms of our knowledge and management of this increasingly challenging condition.
Topics: Algorithms; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Gastrointestinal Hemorrhage; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 28242110
DOI: 10.1016/S0140-6736(16)32404-7 -
Journal of Gastroenterology Apr 2021The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an...
The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcers, non-H. pylori, and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for H. pylori eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are H. pylori negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
Topics: Humans; Anti-Bacterial Agents; Evidence-Based Practice; Japan; Peptic Ulcer; Proton Pump Inhibitors
PubMed: 33620586
DOI: 10.1007/s00535-021-01769-0 -
Medicina Clinica Sep 2023Peptic ulcer disease is a frequent pathology; although the incidence has decreased in recent years, it continues to be an important cause of morbidity and mortality... (Review)
Review
Peptic ulcer disease is a frequent pathology; although the incidence has decreased in recent years, it continues to be an important cause of morbidity and mortality associated with high healthcare costs. The most important risk factors are Helicobacter pylori(H. pylori) infection and the use of non-steroidal anti-inflammatory drugs. Most patients with peptic ulcer disease remain asymptomatic, with dyspepsia being the most frequent and often characteristic symptom. It can also debut with complications such as upper gastrointestinal bleeding, perforation or stenosis. The diagnostic technique of choice is upper gastrointestinal endoscopy. Treatment with proton pump inhibitors, eradication of H. pylori and avoiding the use of non-steroidal anti-inflammatory drugs are the basis of treatment. However, prevention is the best strategy, it includes an adequate indication of proton pump inhibitors, investigation and treatment of H. pylori, avoiding non-steroidal anti-inflammatory drugs or using those that are less gastrolesive.
Topics: Humans; Proton Pump Inhibitors; Helicobacter Infections; Peptic Ulcer; Anti-Inflammatory Agents, Non-Steroidal; Endoscopy, Digestive System; Helicobacter pylori
PubMed: 37365037
DOI: 10.1016/j.medcli.2023.05.008 -
Current Pharmaceutical Design 2018The risk of developing Peptic Ulcer Disease (PUD) was shown to be associated with genetic inheritance, lifestyle and social status of the patients. Unhealthy lifestyle... (Review)
Review
The risk of developing Peptic Ulcer Disease (PUD) was shown to be associated with genetic inheritance, lifestyle and social status of the patients. Unhealthy lifestyle habits and failure in coping with stress have been closely associated with the occurrence of PUD. In contrary, limiting the use of analgesic drugs and glucocorticoids, controlling environmental and socioeconomic factors that predispose to H. Pylori infection, having a balanced diet, exercising regularly, coping successfully with stress, avoiding smoking, limiting alcohol intake and getting sufficient night sleep are essential in prevention and healing of PUD.
Topics: Analgesics; Animals; Glucocorticoids; Helicobacter Infections; Humans; Life Style; Peptic Ulcer
PubMed: 29745325
DOI: 10.2174/1381612824666180510092303 -
The Surgical Clinics of North America Oct 2018The management of peptic ulcer disease has radically changed over the last 40 years from primarily surgical treatment to medical therapy nearly eliminating the need for... (Review)
Review
The management of peptic ulcer disease has radically changed over the last 40 years from primarily surgical treatment to medical therapy nearly eliminating the need for elective surgery in these patients. Although there has been a decline in patients requiring acute surgical intervention for complications of peptic ulcer disease (perforation, bleeding, and obstruction), these patients still make up a significant proportion of hospital admissions every year. The modern acute care surgeon must have significant knowledge of the multiple treatment modalities used to appropriately care for these patients.
Topics: Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 30243454
DOI: 10.1016/j.suc.2018.06.003 -
Primary Care Sep 2023Peptic ulcer disease is a common cause of epigastric pain typically related to Helicobacter pylori infection or NSAID use that can lead to serious consequences including... (Review)
Review
Peptic ulcer disease is a common cause of epigastric pain typically related to Helicobacter pylori infection or NSAID use that can lead to serious consequences including upper GI bleed or perforation if undiagnosed. Diagnostic strategies vary depending on age and treatment is dependent on etiology.
Topics: Humans; Helicobacter Infections; Helicobacter pylori; Peptic Ulcer; Anti-Inflammatory Agents, Non-Steroidal; Gastrointestinal Hemorrhage
PubMed: 37516507
DOI: 10.1016/j.pop.2023.03.003 -
Lancet (London, England) Sep 2015Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition... (Review)
Review
Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can be managed non-operatively or with novel endoscopic approaches, but validation of such methods in trials is needed. Quality of care, sepsis care bundles, and postoperative monitoring need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research.
Topics: Humans; Peptic Ulcer Perforation; Postoperative Care; Prognosis
PubMed: 26460663
DOI: 10.1016/S0140-6736(15)00276-7 -
The American Journal of Medicine Mar 2022Proton pump inhibitors are widely used throughout the world for the treatment of gastrointestinal disorders that are related to acid secretion, such as peptic ulcer... (Review)
Review
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.
Topics: Acute Disease; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer; Proton Pump Inhibitors; Stomach Ulcer; Ulcer
PubMed: 34655535
DOI: 10.1016/j.amjmed.2021.09.010 -
Gastroenterology Nursing : the Official... 2019
Review
Topics: Adult; Aged; Biopsy, Needle; Diet; Duodenal Ulcer; Duodenoscopy; Education, Medical, Continuing; Female; Gastroscopy; Healthy Lifestyle; Humans; Immunohistochemistry; Male; Middle Aged; Peptic Ulcer; Prevalence; Prognosis; Proton Pump Inhibitors; Risk Assessment; Severity of Illness Index; Stomach Ulcer
PubMed: 31574075
DOI: 10.1097/SGA.0000000000000478