-
Clinical Gastroenterology and... Feb 2006The aim was to systematically review the interactions between Helicobacter pylori (HP) infection and NSAID use on the risk of uncomplicated or bleeding peptic ulcer. (Review)
Review
BACKGROUND & AIMS
The aim was to systematically review the interactions between Helicobacter pylori (HP) infection and NSAID use on the risk of uncomplicated or bleeding peptic ulcer.
METHODS
All relevant full articles published in MEDLINE from January 1989-June 2004 were included. Sensitivity analyses for type of controls or use of aspirin or non-aspirin NSAIDs were performed.
RESULTS
In 21 studies involving 10,146 patients, uncomplicated peptic ulcer was more common in HP-positive than HP-negative patients (pooled odds ratio [OR], 2.17) or in HP-positive than HP-negative NSAID users (OR, 1.81). In 6 age-matched controlled studies, ulcer was more common in HP-positive than HP-negative patients (OR, 4.03), irrespective of NSAID use, and in NSAID users than non-users (OR, 3.10), irrespective of HP status; the risk of ulcer was 17.54-fold higher in HP-positive NSAID users than HP-negative non-users. The use of aspirin or non-aspirin NSAIDs did not affect the results. Ulcer bleeding was evaluated in 17 studies involving 4084 patients. NSAID use was more frequent in bleeding patients than control subjects (OR, 5.13), irrespective of HP status and type of controls. In contrast, HP infection in bleeding patients compared with control subjects was less frequent in the 8 studies with ulcer cases as control subjects (OR, 0.40) and more frequent in the 9 studies with uninvestigated subjects as controls (OR, 2.56). In the latter studies, presence compared with the absence of both HP and NSAIDs increased the risk of bleeding 20.83-fold.
CONCLUSION
HP infection and NSAID use represent independent and synergistic risk factors for uncomplicated and bleeding peptic ulcer.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer; Peptic Ulcer Hemorrhage
PubMed: 16469671
DOI: 10.1016/j.cgh.2005.10.006 -
The American Journal of Medicine Apr 2010Management of peptic ulcer disease has improved over the past few decades. However, the widespread use of nonsteroidal anti-inflammatory drugs and low-dose... (Review)
Review
BACKGROUND
Management of peptic ulcer disease has improved over the past few decades. However, the widespread use of nonsteroidal anti-inflammatory drugs and low-dose acetylsalicylic acid means that the burden of peptic ulcer disease remains a relevant issue.
METHODS
We systematically searched PubMed and EMBASE for articles published 1966-2007 that reported symptoms, impairment of well-being or health-related quality of life, and costs associated with peptic ulcer disease.
RESULTS
Thirty studies reported the prevalence of patient-reported gastrointestinal symptoms in individuals with endoscopically diagnosed symptomatic peptic ulcer disease. Average prevalence estimates, weighted by sample size, were 81% (95% confidence interval [CI], 77%-85%) for abdominal pain (11 studies), 81% (95% CI, 76%-85%) for pain specifically of epigastric origin (14 studies), and 46% (95% CI, 42%-50%) for heartburn or acid regurgitation (11 studies). On average, 29% (95% CI, 25%-34%) of patients with peptic ulcer disease presented with bleeding, often as the initial symptom (11 studies). Patients with peptic ulcer disease had significantly lower health-related quality of life than the general population, as measured by the Psychological General Well-Being index (P <.05; 7 studies) and the Short-Form-36 questionnaire (P <.05; 2 studies). Direct medical costs of peptic ulcer disease based on national estimates from several countries were USD163-866 per patient. The most costly aspects of peptic ulcer disease management were hospitalization and medication. Complicated peptic ulcer disease is particularly costly, estimated to be USD1883-25,444 per patient.
CONCLUSION
Peptic ulcer disease significantly impairs well-being and aspects of health-related quality of life, and is associated with high costs for employers and health care systems.
Topics: Humans; Peptic Ulcer; Quality of Life
PubMed: 20362756
DOI: 10.1016/j.amjmed.2009.09.031 -
Therapeutic Advances in Gastroenterology 2020Some studies suggest that the accuracy of diagnostic tests is decreased in peptic ulcer bleeding (PUB). We aimed to assess the accuracy of diagnostic tests for in... (Review)
Review
INTRODUCTION
Some studies suggest that the accuracy of diagnostic tests is decreased in peptic ulcer bleeding (PUB). We aimed to assess the accuracy of diagnostic tests for in patients with PUB in a diagnostic test accuracy (DTA) network meta-analysis.
METHODS
A systematic search was carried out in seven databases until November 2019. We collected or calculated true and false positive and negative values, and constructed 2×2 diagnostic contingency tables with reference standards including histology, rapid urease test, urea breath test, serology, stool antigen test, culture, and polymerase chain reaction. We ranked the index tests by the superiority indices (SI) and calculated pooled sensitivity and specificity of each test.
DISCUSSION
Our search yielded 40 eligible studies with 27 different diagnostic strategies for . In 32 articles, the reference standard was a combination of multiple tests. In 12 studies, the index tests were compared with a single testing method. We analyzed seven networks with the reference standards against a single or a combination of diagnostic index tests. None of the index tests had better diagnostic accuracy (SI between 9.94 and 2.17) compared with the individual index tests as all the confidence intervals included 1. Combined testing strategies had higher sensitivities (0.92-0.62) and lower specificities (0.85-0.46) while single tests proved to have higher specificities (0.83-0.77) and lower sensitivities (0.73-0.42).
CONCLUSION
Use of combined tests may have a rationale in clinical practice due to their higher sensitivities. The differences between the included DTA studies limited the comparison of the testing strategies.
PubMed: 33403002
DOI: 10.1177/1756284820965324 -
BMC Gastroenterology Aug 2020Helicobacter pylori is accounted as the most etiologic agent for digestive disorders, in particular, the most important of them i.e. peptic ulcer and gastric cancer. In... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Helicobacter pylori is accounted as the most etiologic agent for digestive disorders, in particular, the most important of them i.e. peptic ulcer and gastric cancer. In the recent years, association of vacA genotypes and gastrointestinal disorders has attracted a lot of attention. In present study, we assessed the correlation between vacA genotypes (s1, s2, m1, m2, s1m1, s1m2, s2m1 and s2m2) and development to peptic ulcer in Iranian population.
METHODS
In our study, first, 24 original articles containing of information of 3328 patients were evaluated. Statistical analysis was done by Comprehensive Meta-Analysis version 2.0 software (Biostat, Englewood, NJ, USA). In this regards, we used from fixed-effects model for analysis of data with low heterogeneity, while for analysis of data with high heterogeneity (I statistic index > 25%, Cochrane Q statistic p value < 0.05), random-effects model was used.
RESULTS
Abundance of each of s1, s2, m1, m2, s1m1, s1m2, s2m1, and s2m2 was estimated 36.24, 28.32, 42.90 29.86, 27.88, 32.34, 15.70, and 25.94%, respectively. According to the results, the m1, s1, and s1m2 genotypes were among the most prevalent genotypes among the Iranian patients, whereas, s2m1 genotype had the lowest frequency.
CONCLUSIONS
Overall, 24 articles (total participants = 3328) were included in this comprehensive analysis. H. pylori infection rate were 90.26% in these cases, so that 33.65% of whom had peptic ulcer. Moreover, the abundance of each vacA genotypes including s1, s2, m1, m2, s1m1, s1m2, s2m1, and s2m2 was estimated as 36.24, 28.32, 42.90 29.86, 27.88, 32.34, 15.70, and 25.94% respectively. We demonstrated that there is a significant relationship between infection of stomach with m1, s1m1, and s2m1 genotypes and development to peptic ulcer disease.
Topics: Antigens, Bacterial; Bacterial Proteins; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Iran; Peptic Ulcer
PubMed: 32795257
DOI: 10.1186/s12876-020-01406-9 -
Pharmacoepidemiology and Drug Safety Jul 2011Incidence rate (IR) estimates for peptic ulcer disease (PUD) vary widely among studies. We conducted a systematic review to quantify and examine the discrepancies. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Incidence rate (IR) estimates for peptic ulcer disease (PUD) vary widely among studies. We conducted a systematic review to quantify and examine the discrepancies.
METHODS
Of 4780 articles identified from PubMed and EMBASE databases, 31 published in the last three decades that had reported IRs of PUD in the general population were included. Random effects meta-analysis and meta-regression were performed to calculate pooled estimates and to identify sources of heterogeneity.
RESULTS
The pooled IR estimate per 1000 person-years was 0.90 (95% confidence interval: 0.78-1.04) for uncomplicated PUD, 0.57 (0.49-0.65) for peptic ulcer bleeding, 0.10 (0.08-0.13) for gastrointestinal perforations, and 3.18 (2.05-4.92) for nonspecific PUD. Within specific outcomes definitions, IR estimates were significantly lower in studies with restriction to hospitalized cases, case validation, and case ascertainment directly from hospital or clinical sources versus computerized health care databases. Younger age, female sex, and later calendar time were also associated with lower PUD incidence.
CONCLUSIONS
We found that the IR of uncomplicated PUD was in the order of one case per 1000 person-years in the general population, and that the IR of peptic ulcer complications was around 0.7 cases per 1000 person-years. Comparisons of IR estimates among studies need to take into account disease definition and other study characteristics, particularly whether outcome validation was performed in computerized claims. The use of claims to identify PUD cases might overestimate the IR by around 45%.
Topics: Adult; Age Factors; Aged; Databases, Factual; Epidemiologic Methods; Female; Humans; Incidence; Male; Middle Aged; Outcome Assessment, Health Care; Peptic Ulcer; Regression Analysis; Risk Factors; Sex Factors; Validation Studies as Topic
PubMed: 21626606
DOI: 10.1002/pds.2153 -
Critical Care Medicine Nov 2010Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 hrs of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection.
OBJECTIVE
A systematic review of the literature to determine the benefit and risks of stress ulcer prophylaxis and the moderating effect of enteral nutrition.
DATA SOURCES
MEDLINE, Embase, Cochrane Register of Controlled Trials, and citation review of relevant primary and review articles.
STUDY SELECTION
Randomized, controlled studies that evaluated the association between stress ulcer prophylaxis and gastrointestinal bleeding. We included only those studies that compared a histamine-2 receptor blocker with a placebo.
DATA EXTRACTION
Data were abstracted on study design, study size, study setting, patient population, the histamine-2 receptor blocker and dosage used, the incidence of clinically significant gastrointestinal bleeding, hospital-acquired pneumonia, mortality, and the use of enteral nutrition.
DATA SYNTHESIS
Seventeen studies (which enrolled 1836 patients) met the inclusion criteria. Patients received adequate enteral nutrition in three of the studies. Overall, stress ulcer prophylaxis with a histamine-2 receptor blocker reduced the risk of gastrointestinal bleeding (odds ratio 0.47; 95% confidence interval, 0.29-0.76; p < .002; I = 44%); however, the treatment effect was noted only in the subgroup of patients who did not receive enteral nutrition. In those patients who were fed enterally, stress ulcer prophylaxis did not alter the risk of gastrointestinal bleeding (odds ratio 1.26; 95% confidence interval, 0.43-3.7). Overall histamine-2 receptor blockers did not increase the risk of hospital-acquired pneumonia (odds ratio 1.53; 95% confidence interval, 0.89-2.61; p = .12; I = 41%); however, this complication was increased in the subgroup of patients who were fed enterally (odds ratio 2.81; 95% confidence interval, 1.20-6.56; p = .02; I = 0%). Overall, stress ulcer prophylaxis had no effect on hospital mortality (odds ratio 1.03; 95% confidence interval, 0.78-1.37; p = .82). The hospital mortality was, however, higher in those studies (n = 2) in which patients were fed enterally and received a histamine-2 receptor blocker (odds ratio 1.89; 95% confidence interval, 1.04-3.44; p = .04, I = 0%). Sensitivity analysis and meta-regression demonstrated no relationship between the treatment effect (risk of gastrointestinal bleeding) and the classification used to define gastrointestinal bleeding, the Jadad quality score nor the year the study was reported.
CONCLUSIONS
The results of this meta-analysis suggest that, in those patients receiving enteral nutrition, stress ulcer prophylaxis may not be required and, indeed, such therapy may increase the risk of pneumonia and death. However, because no clinical study has prospectively tested the influence of enteral nutrition on the risk of stress ulcer prophylaxis, our findings should be considered exploratory and interpreted with some caution.
Topics: Enteral Nutrition; Histamine H2 Antagonists; Humans; Peptic Ulcer; Peptic Ulcer Hemorrhage; Risk Factors; Stress, Psychological
PubMed: 20711074
DOI: 10.1097/CCM.0b013e3181f17adf -
World Journal of Surgery Jun 2024Postoperative management after surgery for perforated peptic ulcer is still burdened by old traditions. All available data for fast-track recovery in this setting are...
Fast-track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta-analysis of six randomized controlled trials and 356 patients.
BACKGROUND
Postoperative management after surgery for perforated peptic ulcer is still burdened by old traditions. All available data for fast-track recovery in this setting are either very unspecific or underpowered. The aim of this study was to evaluate fast-track recovery in this diagnosis-specific context in a larger sample.
METHODS
Electronic data sources were searched. Eligible studies were randomized controlled trials (RCTs) comparing fast-track recovery and traditional management after surgery for perforated peptic ulcer in adults. A systematic review and meta-analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines regulated the process. Quality and risk of bias assessments of individual RCTs were performed by means of the Let Evidence Guide Every New Decision criteria and the Cochrane risk-of-bias tool. Primary endpoints were length of hospital stay and risk of complications. Random or fixed effects modeling were applied as indicated. Outcomes were measured by mean difference and risk difference.
RESULTS
Six RCTs with a total cohort of 356 patients were included. Results of our meta-analysis showed significantly shortened length of hospital stay (mean difference -3.50 days [95% CI -4.51 to -2.49], p ≤ 0.00001), significantly less superficial and deep surgical-site infections (risk differences -0.12 [95% CI -0.20, -0.05], p = 0.002 and -0.03 [95% CI -0.09, 0.03], and p = 0.032, respectively), and significantly fewer pulmonary complications (risk difference -0.10 [95% CI -0.17, -0.03], p = 0.004) in the fast-track group.
CONCLUSION
This systematic review and meta-analysis shows that fast-track recovery after surgery for perforated peptic ulcer significantly shortened hospital stay in the studied cohort without increasing the risk of postoperative complications.
PubMed: 38838070
DOI: 10.1002/wjs.12234 -
European Journal of Trauma and... Oct 2020The objective of this study was to compare the results of transcatheter arterial embolization (TAE) with surgery in terms of efficacy in the context of bleeding duodenal... (Comparative Study)
Comparative Study
Management of bleeding peptic duodenal ulcer refractory to endoscopic treatment: surgery or transcatheter arterial embolization as first-line therapy? A retrospective single-center study and systematic review.
BACKGROUND
The objective of this study was to compare the results of transcatheter arterial embolization (TAE) with surgery in terms of efficacy in the context of bleeding duodenal ulcer (BDU) refractory to endoscopic treatment.
MATERIALS AND METHODS
From January 2006 to December 2016, all patients treated for a BDU refractory to endoscopic treatment were included in this observational, comparative, retrospective, single-center study. Primary endpoint was the overall success of treatment of BDU requiring surgical and/or TAE. The secondary endpoints were pre-interventional data, recurrence rates, feasibility of secondary treatment, morbidity and mortality of surgical and radiological treatment, intensive care unit and length of stay. A systematic review of the literature was performed to compare results of surgery and TAE.
RESULTS
59 out of 396 patients (14.9%) treated for BDU required embolization and/or surgery: 15 patients underwent surgery (group S) including 7 patients after embolization failure and 44 patients underwent TAE (group TAE). The overall treatment success in intention to treat (85.7% vs 67.3%), per protocol (80% vs 79.5%) and bleeding recurrence rates (20% vs 15.9%) were also identical. Mortality (14.2% vs 15.3%) was similar between the two groups. Our study data were pooled with data from eight published studies and suggest that surgery have significant increased overall success (68.3% vs. 55.4%, p < 0.005).
CONCLUSION
The overall success rate was in favour of surgery according our meta-analysis. Our single-center study highlights the fact that predictive factors for recurrent bleeding after TAE must be identified to select good candidates for TAE and/or surgery.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Angiography; Critical Care; Embolization, Therapeutic; Endoscopy, Gastrointestinal; Length of Stay; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Risk Factors
PubMed: 32246169
DOI: 10.1007/s00068-020-01356-7 -
Clinical and Translational... Apr 2021Current guidelines recommend intravenous (IV) proton pump inhibitor (PPI) therapy in peptic ulcer bleeding (PUB). We aimed to compare the efficacy of oral and IV... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Current guidelines recommend intravenous (IV) proton pump inhibitor (PPI) therapy in peptic ulcer bleeding (PUB). We aimed to compare the efficacy of oral and IV administration of PPIs in PUB.
METHODS
We performed a systematic search in 4 databases for randomized controlled trials, which compared the outcomes of oral PPI therapy with IV PPI therapy for PUB. The primary outcomes were 30-day recurrent bleeding and 30-day mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, while weighted mean differences (WMDs) with CI were calculated for continuous outcomes in meta-analysis. The protocol was registered a priori onto PROSPERO (CRD42020155852).
RESULTS
A total of 14 randomized controlled trials reported 1,951 peptic ulcer patients, 977 and 974 of which were in the control and intervention groups, respectively. There were no statistically significant differences between oral and IV administration regarding 30-day rebleeding rate (OR = 0.96, CI: 0.65-1.44); 30-day mortality (OR = 0.70, CI: 0.35-1.40); length of hospital stay (WMD = -0.25, CI: -0.93 to -0.42); transfusion requirements (WMD = -0.09, CI: -0.07 to 0.24); need for surgery (OR = 0.91, CI: 0.40-2.07); further endoscopic therapy (OR = 1.04, CI: 0.56-1.93); and need for re-endoscopy (OR = 0.81, CI: 0.52-1.28). Heterogeneity was negligible in all analysis, except for the analysis on the length of hospitalization (I2 = 82.3%, P = 0.001).
DISCUSSION
Recent evidence suggests that the oral administration of PPI is not inferior to the IV PPI treatment in PUB after endoscopic management, but further studies are warranted.
Topics: Administration, Intravenous; Administration, Oral; Blood Transfusion; Endoscopy, Gastrointestinal; Equivalence Trials as Topic; Humans; Length of Stay; Peptic Ulcer Hemorrhage; Proton Pump Inhibitors; Secondary Prevention; Treatment Outcome
PubMed: 33988530
DOI: 10.14309/ctg.0000000000000341 -
Helicobacter Apr 2012The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and Helicobacter pylori eradication.
AIM
To perform a systematic review and meta-analysis to ask whether this change in practice is in fact justified.
MATERIALS AND METHODS
A search on the Cochrane Controlled Trials Register, Medline, and Embase was made for controlled trials of duodenal ulcer perforation patients using simple closure method plus postoperative H. pylori eradication therapy versus simple closure plus antisecretory non-eradication therapy. The long-term results for prevention of ulcer recurrence were compared.
RESULTS
The pooled incidence of 1-year ulcer recurrence in H. pylori eradication group was 5.2% [95% confidence interval (CI) of 0.7 and 9.7], which is significantly lower than that of the control group (35.2%) with 95% CI of 0.25 and 0.45. The pooled relative risk was 0.15 with 95% CI of 0.06 and 0.37.
CONCLUSIONS
Helicobacter pylori eradication after simple closure of duodenal ulcer perforation gives better result than the operation plus antisecretory non-eradication therapy for prevention of ulcer recurrence. All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients.
Topics: Anti-Bacterial Agents; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer Perforation; Randomized Controlled Trials as Topic
PubMed: 22404446
DOI: 10.1111/j.1523-5378.2011.00928.x