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Revista Espanola de Enfermedades... Dec 2021We present the case of a 72-year-old male with upper gastrointestinal bleeding. He had been discharged from hospital two weeks before after severe COVID-19 infection,...
We present the case of a 72-year-old male with upper gastrointestinal bleeding. He had been discharged from hospital two weeks before after severe COVID-19 infection, treated with lopinavir-ritonavir (L-R), hydroxychloroquine, tocilizumab, and methylprednisolone. On presentation, he was in hypovolemic shock. Esophagogastroduodenoscopy showed an ulcer in the third duodenal portion, which was sclerosed and hemodynamic stability was recovered. A scan was performed as it was in an atypical location for ulcers, showing an aortic aneurysm in close relationship to the duodenum, suggesting a primary aortoenteric fistula (PAEF).
Topics: Aged; Aortic Diseases; COVID-19; Duodenal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; SARS-CoV-2; Vascular Fistula
PubMed: 34488422
DOI: 10.17235/reed.2021.8272/2021 -
Scientific Reports Feb 2021Although the type 4 secretion system of the integrating and conjugative elements (tfs ICE) is common in Helicobacter pylori, its clinical association with the cag...
Although the type 4 secretion system of the integrating and conjugative elements (tfs ICE) is common in Helicobacter pylori, its clinical association with the cag pathogenicity island (cagPAI) have not yet been well-investigated. In this study, Vietnamese patient H. pylori samples (46 duodenal ulcer (DU), 51 non-cardia gastric cancer (NCGC), 39 chronic gastritis (CG)) were fully sequenced using next-generation sequencing and assembled into contigs. tfs3, tfs4, and cagPAI genes were compared with the public database. Most (94%) H. pylori strains possessed a complete cagPAI, which was the greatest risk factor for clinical outcomes, while the prevalences of tfs3 and tfs4 were 45% and 77%, respectively. Complete tfs3 and tfs4 were found in 18.3% and 17.6% of strains, respectively. The prevalence of H. pylori strains with complete tfs3 ICE in DU patients was significantly higher than that in NCGC patients (30.4% vs 11.7%, P < 0.05). In addition, the prevalence of strains with complete tfs3 ICE and cagPAI was significantly higher in DU patients than that in NCGC (28.4% vs 9.8%, P = 0.038) and CG patients (28.2% vs 7.7%, P = 0.024). cagPAI and complete tfs3 increased the risk of DU compared to NCGC (OR = 3.56, 95%CI: 1.1-14.1, P = 0.038) and CG (OR = 4.64, 95%CI: 1.1-27.6, P = 0.024). A complete cluster of tfs3 ICE was associated with gastroduodenal diseases in Vietnam. However, there was a low prevalence of the dupA/complete dupA cluster (15.4%) in the Vietnam strains. The prevalence of cagPAI in Vietnam strains was significantly higher than in US (P = 0.01) and Indonesia (P < 0.0001); the prevalence of the dupA cluster was also higher in the Vietnam strains than in the Indonesian strains (P < 0.05). In addition, the prevalence of ctkA, an accessory gene of tfs3, was significantly different between Vietnam and US strains (28% vs 2%, P = 0.0002). In summary, the acquisition of tfs3/4 ICE was common in H. pylori strains in patients with gastroduodenal disease in Vietnam, and the complete cluster of tfs3 ICE was a reliable marker for the severity of disease in the H. pylori infected population.
Topics: Biomarkers; Duodenal Diseases; Genes, Bacterial; Helicobacter Infections; Helicobacter pylori; Humans; Severity of Illness Index; Stomach Diseases; Type IV Secretion Systems; Vietnam
PubMed: 33633144
DOI: 10.1038/s41598-021-83862-1 -
Frontiers in Microbiology 2023Recent an observational study has suggested a potential connection between gut microbiota (GM) and peptic ulcer diseases (PUDs), particularly gastric ulcer (GU) and...
BACKGROUND
Recent an observational study has suggested a potential connection between gut microbiota (GM) and peptic ulcer diseases (PUDs), particularly gastric ulcer (GU) and duodenal ulcer (DU). However, the causal connection remains unsure.
METHODS
A two-sample Mendelian randomization (MR) is carried out to explore the connection between the GM and DU or GU. Data on the GM comes from the MiBioGend database, and GU or DU data are based on the FinnGen database. One group of single nucleotide polymorphisms (SNPs) ( < 5 × 10) are served as instrumental variables (IVs). To obtain a more comprehensive conclusion, the other SNPs ( < 1 × 10) are selected as IVs. Inverse variance weighting (IVW) is used to determine the causal relationship.
RESULTS
At the level of < 1 × 10, the IVW analysis suggests that Clostridiaceae1, Butyriccoccus, and Peptcoccus have harmful effects on GU, while LachnospiraceaeUCG004 and MollicutesRF9 have beneficial effects on GU. Then, in the case of DU, the IVW analysis suggested that Lentisphaeria, Negativicutes, Clostridiaceae1, ClostridiumseMnsustricto1, ErysipelotrichaceaeUCG003, LachnospiraceaeNC2004group, Selenomonadale, Victivallales, and Lentisphaerae have harmful effects, while Catenibacterium, Escherichia.Shigella, LachnospiraceaeUCG008, and Sutterella have beneficial effects. When < 5 × 10, IVW analysis suggests that GM has no significant influence on GU or DU.
CONCLUSION
This two-sample MR indicates a causal relationship between GM and GU or DU.
PubMed: 38274744
DOI: 10.3389/fmicb.2023.1277300 -
SAGE Open Medicine 2023infection is very common worldwide, and about 10%-16% of these patients develop peptic ulcer disease. However, there is limited research on the impact of eradication...
BACKGROUND
infection is very common worldwide, and about 10%-16% of these patients develop peptic ulcer disease. However, there is limited research on the impact of eradication and peptic ulcer disease treatment sequencing.
METHODS
We conducted a retrospective study of adult patients diagnosed with infection and peptic ulcer disease between October 2020 and April 2021 at our center. Data on primary treatment outcomes, including eradication and peptic ulcer disease healing, were collected, and factors that may influence treatment outcomes were analyzed.
RESULTS
A total of 306 patients were included in this study. The sequence of eradication and peptic ulcer disease treatment did not significantly affect the outcomes of eradication and peptic ulcer disease healing. In addition, patient age, peptic ulcer disease type, clinic type and treatment regimen (including choice of proton pump inhibitor) had no significant impact on eradication. However, patient gender and the choice of antibiotic combination proved to be key factors, as eradication rates were lower in female patients compared to males, and the combination of levofloxacin and clarithromycin was the least effective in eradicating . Regarding peptic ulcer disease healing, the peptic ulcer disease type was an important influencing factor, since gastric ulcers being more likely to get cured completely compared to duodenal ulcers.
CONCLUSIONS
The sequence of eradication and peptic ulcer disease treatment does not significantly affect the primary outcomes. Patient gender and the choice of antibiotic combination are important factors in eradication, whereas peptic ulcer disease type plays a key role in ulcer healing.
PubMed: 38144880
DOI: 10.1177/20503121231220809 -
Experimental and Therapeutic Medicine Jun 2023The present network meta-analysis aimed to enhance the corresponding evidence with respect to the efficacy and safety of pharmaceuticals treatments. Frequentist network...
The present network meta-analysis aimed to enhance the corresponding evidence with respect to the efficacy and safety of pharmaceuticals treatments. Frequentist network meta-analysis was used. Medical literature up to November 2022 was searched for randomized clinical trials assessing the efficacy and safety of these pharmaceuticals, either compared with each other or compared with placebo. With the exception of ranitidine (300 mg four times daily) and vonoprazan (20 mg once daily) having lower safety than placebo, the efficacy and safety of the remaining treatments were superior to placebo. Cimetidine (400 mg four times daily) and pantoprazole (40 mg once daily) were ranked first in terms of efficacy. The frequentist network meta-analysis shows that for cimetidine (except 400 mg once daily), famotidine, rabeprazole, ilaprazole, lansoprazole (except 7.5 mg once daily) and omeprazole (except 10 mg once daily or 30 mg once daily), the efficacy comparison between the different doses of each of the aforementioned pharmaceuticals did not indicate statistically significant differences. In conclusion, pantoprazole (40 mg once daily) was the best choice for the initial non-eradication treatment of patients with duodenal ulcer, and cimetidine (400 mg twice daily), omeprazole (20 mg once daily), lansoprazole (15 mg once daily), ilaprazole (5 mg once daily) and rabeprazole (10 mg once daily) could be used as the first choice. If the aforementioned pharmaceuticals cannot be prescribed, famotidine (40 mg twice daily) is recommended.
PubMed: 37206569
DOI: 10.3892/etm.2023.11971 -
Scientific Reports Mar 2022Chronic gastrointestinal (GI) diseases are the most common diseases in captive common marmosets (Callithrix jacchus). Despite standardized housing, diet and husbandry, a...
Chronic gastrointestinal (GI) diseases are the most common diseases in captive common marmosets (Callithrix jacchus). Despite standardized housing, diet and husbandry, a recently described gastrointestinal syndrome characterized by duodenal ulcers and strictures was observed in a subset of marmosets sourced from the New England Primate Research Center. As changes in the gut microbiome have been associated with GI diseases, the gut microbiome of 52 healthy, non-stricture marmosets (153 samples) were compared to the gut microbiome of 21 captive marmosets diagnosed with a duodenal ulcer/stricture (57 samples). No significant changes were observed using alpha diversity metrics, and while the community structure was significantly different when comparing beta diversity between healthy and stricture cases, the results were inconclusive due to differences observed in the dispersion of both datasets. Differences in the abundance of individual taxa using ANCOM, as stricture-associated dysbiosis was characterized by Anaerobiospirillum loss and Clostridium perfringens increases. To identify microbial and serum biomarkers that could help classify stricture cases, we developed models using machine learning algorithms (random forest, classification and regression trees, support vector machines and k-nearest neighbors) to classify microbiome, serum chemistry or complete blood count (CBC) data. Random forest (RF) models were the most accurate models and correctly classified strictures using either 9 ASVs (amplicon sequence variants), 4 serum chemistry tests or 6 CBC tests. Based on the RF model and ANCOM results, C. perfringens was identified as a potential causative agent associated with the development of strictures. Clostridium perfringens was also isolated by microbiological culture in 4 of 9 duodenum samples from marmosets with histologically confirmed strictures. Due to the enrichment of C. perfringens in situ, we analyzed frozen duodenal tissues using both 16S microbiome profiling and RNAseq. Microbiome analysis of the duodenal tissues of 29 marmosets from the MIT colony confirmed an increased abundance of Clostridium in stricture cases. Comparison of the duodenal gene expression from stricture and non-stricture marmosets found enrichment of genes associated with intestinal absorption, and lipid metabolism, localization, and transport in stricture cases. Using machine learning, we identified increased abundance of C. perfringens, as a potential causative agent of GI disease and intestinal strictures in marmosets.
Topics: Animals; Callithrix; Constriction, Pathologic; Dysbiosis; Gastrointestinal Microbiome; Gastrointestinal Tract
PubMed: 35347206
DOI: 10.1038/s41598-022-09268-9 -
World Journal of Gastroenterology Sep 2020There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic.
BACKGROUND
There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic.
AIM
To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events.
METHODS
Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.
RESULTS
Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations ( = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use ( = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy dual antiplatelet agents.
CONCLUSION
We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%).
Topics: Adult; Anticoagulants; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer; Platelet Aggregation Inhibitors
PubMed: 33024397
DOI: 10.3748/wjg.v26.i36.5463 -
Journal of Epidemiology Jan 2021While duodenal ulcer (DU) and gastric cancer (GC) are both H. pylori infection-related diseases, individuals with DU are known to have lower risk for GC. Many...
BACKGROUND
While duodenal ulcer (DU) and gastric cancer (GC) are both H. pylori infection-related diseases, individuals with DU are known to have lower risk for GC. Many epidemiological studies have identified the PSCA rs2294008 T-allele as a risk factor of GC, while others have found an association between the rs2294008 C-allele and risk of DU and gastric ulcer (GU). Following these initial reports, however, few studies have since validated these associations. Here, we aimed to validate the association between variations in PSCA and the risk of DU/GU and evaluate its interaction with environmental factors in a Japanese population.
METHODS
Six PSCA SNPs were genotyped in 584 DU cases, 925 GU cases, and 8,105 controls from the Japan Multi-Institutional Collaborative Cohort (J-MICC). Unconditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the SNPs and risk of DU/GU.
RESULTS
PSCA rs2294008 C-allele was associated with per allele OR of 1.34 (95% CI, 1.18-1.51; P = 2.28 × 10) for the risk of DU. This association was independent of age, sex, study site, smoking habit, drinking habit, and H. pylori status. On the other hand, we did not observe an association between the risk of GU and PSCA SNPs.
CONCLUSIONS
Our study confirms an association between the PSCA rs2294008 C-allele and the risk of DU in a Japanese population.
Topics: Adult; Antigens, Neoplasm; Cohort Studies; Cross-Sectional Studies; DNA, Neoplasm; Duodenal Ulcer; Female; GPI-Linked Proteins; Gene Expression Regulation, Neoplastic; Genetic Markers; Genetic Predisposition to Disease; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Immunoglobulin G; Japan; Male; Middle Aged; Neoplasm Proteins; Polymorphism, Single Nucleotide; Risk Factors
PubMed: 31839644
DOI: 10.2188/jea.JE20190184 -
The Eurasian Journal of Medicine Feb 2023Blood groups are associated with duodenal ulcer, diabetes mellitus, and urinary tract infection. In some studies, a relationship was detected between hematologic and...
OBJECTIVE
Blood groups are associated with duodenal ulcer, diabetes mellitus, and urinary tract infection. In some studies, a relationship was detected between hematologic and solid organ malignancies and blood groups. In this study, we investigated the frequency and phenotypes of blood groups (ABO, Kell, Duffy, Rh) in patients with hematologic malignancies.
MATERIALS AND METHODS
One hundred sixty-one patients with hematologic malignancy (multiple myeloma, chronic lymphocytic leukemia, and chronic myelocytic leukemia) and 41 healthy people were evaluated prospectively. We determined phenotypes and distribution of ABO, Rh, Kell, and Duffy blood groups in all cases. Chi-square test and 1-way variance analysis were used for statistical analysis. P < .05 value was considered statistically significant.
RESULTS
In patients with multiple myeloma, the A blood group was statistically significantly more frequent than in the control group (P = .021). Rh negativity was found more frequent in patients with hematologic malignancy than the control group (P = .009). Kpa and Kpb antigen positivity were found statistically significantly less frequent in patients with hematologic malignancy (P = .013, P = .007; respectively). Fy (a-b-) and K-k+ phenotypes were higher in patients with hematologic cancer than in the control group (P = .045).
CONCLUSION
We determined a significant relationship between hematologic malignancies and blood group systems. In our study, due to the low number of cases and few hematological malignancy types, extensive studies with more cases and more hematologic cancer types are needed.
PubMed: 36861861
DOI: 10.5152/eurasianjmed.2023.21124 -
Frontiers in Surgery 2023Peptic ulcer disease (PUD) is a very common condition, with an annual incidence ranging from 0.1% to 0.3% and a lifetime prevalence ranging from 5% to 10%. If not... (Review)
Review
Peptic ulcer disease (PUD) is a very common condition, with an annual incidence ranging from 0.1% to 0.3% and a lifetime prevalence ranging from 5% to 10%. If not treated, it can lead to severe complications such as gastro-intestinal bleeding, perforation, or entero-biliary fistula. Entero-biliary fistulas and especially choledocho-duodenal fistula (CDF) are a rare, but relevant and important diagnosis, which can lead to several complications such as gastric outlet obstruction, bleeding, perforation, or recurrent cholangitis. In this article, we present the case of an 85-year-old woman with PUD complicated with gastro-intestinal bleeding and a CDF. We also performed a review of the literature to search for pre-existing cases with this atypical clinical presentation. The aim was to raise awareness among surgeons and clinicians by offering a summary of different types of entero-biliary and especially CDF, existing diagnostic investigations, and management.
PubMed: 37409067
DOI: 10.3389/fsurg.2023.1206828