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Current Problems in Surgery Feb 2020
Review
Topics: Humans; Incidence; Peptic Ulcer; Peptic Ulcer Perforation; Prevalence
PubMed: 32138833
DOI: 10.1016/j.cpsurg.2019.100728 -
Digestive Diseases and Sciences Jul 2020As one of the most prevalent infections globally, Helicobacter pylori (H. pylori) continues to present diagnostic and therapeutic challenges for clinicians worldwide.... (Review)
Review
As one of the most prevalent infections globally, Helicobacter pylori (H. pylori) continues to present diagnostic and therapeutic challenges for clinicians worldwide. Diagnostically, the "test-and-treat" strategy is the recommended approach for healthcare practitioners when managing this potentially curable disease. The choice of testing method should be based on several factors including patient age, presenting symptoms, and medication use, as well as test reliability, availability, and cost. With rising antibiotic resistance, particularly of macrolides, care must be taken to ensure that therapy is selected based on regional resistance patterns and prior antibiotic exposure. In the USA, macrolide antibiotic resistance rates in some areas have reached or exceeded a generally accepted threshold, such that clarithromycin triple therapy may no longer be an appropriate first-line empiric treatment. Instead, bismuth quadruple therapy should be considered, while levofloxacin-based or alternative macrolide-containing therapies are also options. Once treated, it is essential to test for eradication as untreated H. pylori is associated with serious complications including peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. This review article aims to consolidate current knowledge of H. pylori infection with a particular emphasis on diagnostic and treatment strategies.
Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Antigens, Bacterial; Biopsy; Bismuth; Breath Tests; Clarithromycin; Culture Techniques; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Dyspepsia; Feces; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Nitro Compounds; Organometallic Compounds; Peptic Ulcer; Polymerase Chain Reaction; Proton Pump Inhibitors; Rifabutin; Salicylates; Salvage Therapy; Serologic Tests; Stomach Neoplasms; Tetracycline; Thiazoles; Treatment Outcome; Urea
PubMed: 32170476
DOI: 10.1007/s10620-020-06193-7 -
The Surgical Clinics of North America Dec 2023Gastric and small bowel emergencies are often seen in the emergency department and require rapid assessment and intervention as patients can deteriorate quickly. Some of... (Review)
Review
Gastric and small bowel emergencies are often seen in the emergency department and require rapid assessment and intervention as patients can deteriorate quickly. Some of the more frequently seen gastric emergencies include gastric volvulus and peptic ulcer disease, which can present with ischemia, strangulation, perforation, or severe bleeding. Swift diagnosis is crucial to ensuring the proper management whether that is endoscopic or with surgical exploration. Perforated peptic ulcers that are not contained will require surgical intervention, whereas bleeding ulcers can often be controlled with endoscopic interventions.
Topics: Humans; Duodenal Ulcer; Emergencies; Peptic Ulcer Perforation; Intestine, Small
PubMed: 37838458
DOI: 10.1016/j.suc.2023.05.012 -
The Journal of Trauma and Acute Care... Oct 2021There is no consensus on optimal surgical treatment of large duodenal defects arising from perforated ulcers, even though such defects are challenging to repair and...
BACKGROUND
There is no consensus on optimal surgical treatment of large duodenal defects arising from perforated ulcers, even though such defects are challenging to repair and inadequate repair is associated with high morbidity and mortality. The aim of this study was to carry out a systematic literature review of different surgical techniques used to treat large duodenal perforations, provide a narrative description of these techniques, and propose a framework for approaching this pathology.
METHODS
PubMed/MEDLINE database was searched for articles published in English between January 1, 1970, and December 1, 2020. Studies describing surgical techniques used to treat giant duodenal ulcer perforation and their outcomes in adult patients were included. No quantitative analysis was planned because of the heterogeneity across studies.
RESULTS
Out of 960 identified records, 25 studies were eligible for inclusion. Two randomized controlled trials, one case-control trial, three cohort studies, 14 case series, and 5 case reports were included. Eight main surgical approaches are described, ranging from simple damage-control operations, such as the omental plug and triple-tube techniques, all the way to complex resections, such as gastrectomy.
CONCLUSION
Evidence on surgical treatment of large duodenal defects is of poor quality, with the majority of studies corresponding to Oxford levels 3b-4. Current evidence does not support any single surgical technique as superior in terms of morbidity or mortality, but choice of technique should be guided by several factors including location of the perforation, degree of duodenal tissue loss, hemodynamic stability of the patient, as well as expertise of the operating surgeon.
LEVEL OF EVIDENCE
SR with more than two negative criteria, Level IV.
Topics: Duodenal Ulcer; Duodenum; Humans; Peptic Ulcer Perforation; Risk Factors
PubMed: 34254960
DOI: 10.1097/TA.0000000000003357 -
JPMA. the Journal of the Pakistan... Jul 2023Duodenal ulcer perforation, a frequent surgical emergency, needs simple closure with indirect Graham's Omentopexy which is effective with excellent results in majority...
Duodenal ulcer perforation, a frequent surgical emergency, needs simple closure with indirect Graham's Omentopexy which is effective with excellent results in majority of cases despite patients' late presentation. The objective of the study was to determine the frequency of postoperative complications of perforated duodenal ulcer, conducted in the Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, from March 20, 2018 to September 20, 2018. The study was a descriptive case series of 108 patients of both genders with perforated duodenal ulcer > 1 week old with ASA score I & II. Patients with trauma and comorbidities were excluded. The patients underwent laparotomy and peritoneal toilet, and after noting the site of perforation indirect Graham's Omentopexy was performed. Complications like duodenal fistula, peritonitis, and paralytic ileus, and patient's death within 10 days of surgery were noted. Age ranged from 18 to 50 years with mean age of 35.027±5.13 years, mean weight 71.120±12.77 kg, mean height 1.541 ±0.09 metres, mean BMI 29.975±4.99 kg/m2, and the mean duration of complaint was 4.194±1.30 weeks. Male predominance in 75 (69.4%) patients. Duodenal fistula was seen in 10 (9.3%) patients, peritonitis 12 (11.1%), paralytic ileus 14 (13%) and mortality was in 11 (10.2%) patients.
Topics: Humans; Male; Female; Adult; Infant; Duodenal Ulcer; Risk Factors; Peptic Ulcer Perforation; Peritonitis; Fistula
PubMed: 37469068
DOI: 10.47391/JPMA.4768 -
Surgery Jul 2020Marginal ulcer is a well-known complication after pancreatoduodenectomy. In light of increasing long-term survival after pancreatoduodenectomy, the identification of...
BACKGROUND
Marginal ulcer is a well-known complication after pancreatoduodenectomy. In light of increasing long-term survival after pancreatoduodenectomy, the identification of risk factors and preventive strategies are of utmost importance. We assessed the incidence, clinical impact, and potential risk factors of marginal ulcer after pancreatoduodenectomy.
METHODS
A prospectively maintained database of patients undergoing pancreatoduodenectomy was analyzed retrospectively. Univariate and bivariate competing-risk Cox regression analyses were performed to identify risk factors for marginal ulcer.
RESULTS
Two hundred and fifty-five consecutive patients underwent pancreatoduodenectomy. The median follow-up was 35.7 months. Marginal ulcer was diagnosed in 19 patients (7.5%), and the median time from pancreatoduodenectomy to marginal ulcer diagnosis was 450 days. Thirteen of these 19 patients presented with abdominal pain, melena, or anemia. In all these 13 patients, marginal ulcer resolved with proton pump inhibitor therapy and endoscopic surveillance. Six patients with marginal ulcer presented with an acute abdomen and underwent emergency laparotomy for marginal ulcer perforation and peritonitis. There was no marginal ulcer-related mortality. Univariate and bivariate competing-risk analyses showed an increased risk for marginal ulcer with discontinuation of proton pump inhibitor therapy, smoking, alcohol intake, and the use of non-steroidal anti-inflammatory drugs. Discontinuation of proton pump inhibitor therapy was an independent risk factor for marginal ulcer development.
CONCLUSION
Marginal ulcer is a relevant long-term complication after pancreatoduodenectomy that occurs more frequently after proton pump inhibitor therapy is discontinued. Based on our data, permanent use of proton pump inhibitor after pancreatoduodenectomy is strongly recommended especially for those patients who smoke, consume alcohol, or use non-steroidal anti-inflammatory drugs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Germany; Humans; Male; Middle Aged; Pancreaticoduodenectomy; Peptic Ulcer; Postoperative Complications; Proton Pump Inhibitors; Retrospective Studies; Young Adult
PubMed: 32276736
DOI: 10.1016/j.surg.2020.02.012 -
Zhongguo Ying Yong Sheng Li Xue Za Zhi... Dec 2023A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a... (Review)
Review
A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a significant source of worldwide morbidity and mortality. The Gastrointestinal ulcers and duodenal ulcers are considered the two most extreme types of peptic ulcers. Peptic ulcers are found to be caused by an excess of violent factors including Hydrochloric acid (HCL) pepsin, refluxed bile leukotrienes (LT), reactive oxygen species (ROS) and protective factors, these include mucus-bicarbonate barrier functions, prostaglandins (PGs), mucosal blood flow, cell regeneration and migration, non-enzymatic and enzymatic and certain growth factors. The primary cause of peptic ulcer disease is pylori infection and the use of NSAIDs. This review article underscores the importance of a multidisciplinary approach in the management of ulcers to improve patient outcomes and quality of life.
Topics: Humans; Peptic Ulcer
PubMed: 38755116
DOI: 10.62958/j.cjap.2023.006 -
Pediatrics in Review Aug 2020
Review
Topics: Abdominal Pain; Adolescent; Child; Child, Preschool; Diabetic Ketoacidosis; Diagnosis, Differential; Female; Humans; Migraine Disorders; Pain, Referred; Pediatrics; Pelvic Inflammatory Disease; Peptic Ulcer
PubMed: 32737258
DOI: 10.1542/pir.2019-0221 -
BMJ (Clinical Research Ed.) Oct 2019
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Gastroenterology Nursing : the Official... 2019
Review
Topics: Adult; Anti-Ulcer Agents; Education, Medical, Graduate; Female; Helicobacter Infections; Humans; Male; Middle Aged; Peptic Ulcer; Prognosis; Proton Pump Inhibitors; Severity of Illness Index; Stomach Ulcer; Treatment Outcome
PubMed: 31574076
DOI: 10.1097/SGA.0000000000000496