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World Journal of Gastroenterology May 2014Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and... (Review)
Review
Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.
Topics: Animals; Duodenal Ulcer; Helicobacter Infections; Helicobacter pylori; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Prevalence; Risk Factors; Stomach; Stomach Neoplasms; Stomach Ulcer; Time Factors
PubMed: 24833849
DOI: 10.3748/wjg.v20.i18.5191 -
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 -
BMJ Case Reports Jan 2017We describe a rare case of a 60-year-old man with known history of peptic ulcer disease who presented with melena and epigastric pain secondary to coil migration into...
We describe a rare case of a 60-year-old man with known history of peptic ulcer disease who presented with melena and epigastric pain secondary to coil migration into duodenal mucosa 4 years after the initial therapeutic embolisation of the gastroduodenal artery. Upper endoscopy revealed oozing duodenal ulcer at the same site of the previously located duodenal ulcer 4 years ago and metal coil impacted at the duodenal mucosa. It is unclear if the coil migration is the effect or the cause of the bleeding duodenal ulcer. Our patient was treated by surgical intervention due to failed endoscopic haemostasis and medical management.
Topics: Angiography; Duodenal Diseases; Duodenal Ulcer; Duodenum; Embolization, Therapeutic; Endoscopy, Digestive System; Foreign-Body Migration; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 28130285
DOI: 10.1136/bcr-2016-218207 -
BMC Pediatrics Mar 2023This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health.
BACKGROUND
This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health.
METHODS
Fifty-two children with duodenal perforation hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery.
RESULTS
A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3-15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery.
CONCLUSION
Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.
Topics: Male; Female; Adolescent; Humans; Child; Duodenal Ulcer; Retrospective Studies; Helicobacter Infections; Laparoscopy; Peptic Ulcer Perforation
PubMed: 36997985
DOI: 10.1186/s12887-023-03957-8 -
Archives of Disease in Childhood Jun 1989A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of...
A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers.
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Duodenal Ulcer; Duodenoscopy; Duodenum; Female; Follow-Up Studies; Gastrins; Humans; Infant; Male
PubMed: 2774612
DOI: 10.1136/adc.64.6.774 -
Gut Jul 1984A refractory duodenal ulcer was arbitrarily defined as one that had failed to heal completely after treatment with cimetidine 1 g daily for three months. Of 66 patients...
A refractory duodenal ulcer was arbitrarily defined as one that had failed to heal completely after treatment with cimetidine 1 g daily for three months. Of 66 patients with refractory duodenal ulcer, healing eventually occurred in 37 patients, after treatment for an average of 7.4 months. But 28 patients did not heal despite treatment for an average of 9.4 months; and one patient defaulted. In 41 patients the daily dose of cimetidine was increased to 2 g: the ulcers in 31 patients healed. In eight patients the daily dose was increased to 3 g and healing occurred in four patients. Eighteen patients required admission on 22 occasions because of severe symptoms despite treatment. Nine patients underwent surgery but in five the results were poor. Differences in clinical and endoscopic features between refractory and non-refractory ulcer patients were small. Acid and pepsin secretion were similar and gastrin concentrations normal. Blood levels of the drug and suppression of acid secretion were both satisfactory. Identification of refractory ulcer patients at the start of treatment was therefore not possible. Refractoriness could occur at any time during the course of the disease, previous treatment with cimetidine often having resulted in rapid healing, but subsequent relapses were also usually refractory. The cause of refractoriness remains unknown and the rather poor results of surgery in this series suggests that optimal management of these patients remains to be determined. Refractoriness probably indicates a changed natural history of the disease and in some patients a more poor prognosis.
Topics: Adult; Cimetidine; Dose-Response Relationship, Drug; Drug Resistance; Duodenal Ulcer; Female; Gastric Acid; Humans; Male; Middle Aged; Pepsin A
PubMed: 6428982
DOI: 10.1136/gut.25.7.711 -
The Yale Journal of Biology and Medicine 1996Acid-peptic disease is widely considered conquered or controlled, future advances being refinements of existing treatments rather than radical new developments. Yet... (Review)
Review
Acid-peptic disease is widely considered conquered or controlled, future advances being refinements of existing treatments rather than radical new developments. Yet controversies remain and developments have yet to be made. DUODENAL ULCER: Daily maintenance treatment with the anti-secretory drugs, histamine H2 receptor antagonists and proton pump blockers, controls duodenal ulcer effectively, markedly reducing relapse rate at one year after treatment from about 75 percent to 15 to 20 percent (and to about 10 percent on proton pump blockers). In contrast, Helicobacter pylori eradication with a one to two week course of treatment yields prolonged remission or cure. The consequent reduction in drug costs in individual patients, however, has been exceeded by increasing community use on the more expensive proton pump blockers for the treatment of gastroesophageal reflux disease. The marked decline in elective surgery since the introduction of histamine H2 receptor antagonists is commonly attributed to the power of these drugs. The fall, however, had started much earlier, indicating that the decline is due to changing natural history. In contrast, complication rates remain unaltered. An increasing proportion of newly diagnosed duodenal ulcer patients are elderly, and more of them now present for the first time with complications (in this center, about 40 percent), which consequently cannot be forestalled. Thus, duodenal ulcer disease is likely to remain a problem and in many will be a serious illness. GASTROESOPHAGEAL REFLUX DISEASE: The proton pump blockers have revolutionized the treatment of gastroesophageal reflux disease. In clinical trials they have proven markedly superior to the histamine H2 receptor antagonists in healing (at eight weeks, 80 to 90 percent vs. 50 to 60 percent), symptom relief, prevention of relapse on maintenance therapy and cost-effectiveness. However, several issues remain. The prevalence of gastroesophageal reflux disease seems to be rising and is now probably the commonest acid-peptic disease encountered in the West. Most clinical trials comparing proton pump blockers vs. histamine H2 receptor antagonists have been done in patients with erosive esophagitis, whereas the majority (50 to 60 percent) of patients with gastroesophageal reflux disease have milder, generally non-erosive, disease. The therapeutic gain of proton pump blockers diminishes in mild disease so may not be worth the higher drug costs. This is an important area for investigation. The majority of patients with erosive esophagitis relapse when treatment is stopped (about 75 percent at one year). Relapse is markedly reduced (to 20 to 25 percent) by daily maintenance treatment with proton pump blockers. Mild disease relapses less often, so longterm therapy by intermittent treatment may prove acceptable and more cost-effective than maintenance treatment. This strategy remains unexplored in trials. The ideal profile of an anti-secretory drug for intermittent treatment would combine rapid onset of action (similar to histamine H2 receptor antagonists) with powerful effect (as with proton pump blockers). The new class of drug, the reversible proton pump blocker (e.g., BY841) approaches this requirement.
Topics: Duodenal Ulcer; Endoscopy; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Proton Pump Inhibitors; Proton Pumps; Time Factors
PubMed: 9165690
DOI: No ID Found -
World Journal of Gastroenterology Aug 2008Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently, few cases... (Review)
Review
Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently, few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy, the introduction of H-2 receptor blockers and proton pump inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis, treatment and outcome of this condition. Nevertheless, GDUs are still associated with high rates of morbidity, mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.
Topics: Diagnosis, Differential; Duodenal Ulcer; Duodenum; Endoscopy, Digestive System; Humans
PubMed: 18763280
DOI: 10.3748/wjg.14.4995 -
World Journal of Gastroenterology Jun 2015Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its... (Review)
Review
Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.
Topics: Diet; Dietary Supplements; Duodenal Ulcer; Humans; Polyphenols; Risk Factors; Stomach Ulcer; Treatment Outcome
PubMed: 26074689
DOI: 10.3748/wjg.v21.i21.6499 -
World Journal of Gastroenterology May 2014To compare the efficacy and tolerance of ilaprazole compared with other proton pump inhibitors (PPIs) in the treatment of duodenal ulcer. (Meta-Analysis)
Meta-Analysis Review
AIM
To compare the efficacy and tolerance of ilaprazole compared with other proton pump inhibitors (PPIs) in the treatment of duodenal ulcer.
METHODS
An electronic database search of Medline, Embase, the Cochrane controlled trials register, Web of Science, PubMed, and the Chinese Biomedical Literature Database (updated to July 2013), and manual searches were conducted. A meta-analysis of randomized controlled trials comparing the efficacy and tolerance of ilaprazole and other PPIs in the treatment of duodenal ulcers was performed.
RESULTS
Five articles involving 1481 patients were included. The meta-analysis showed no difference in the 4-wk healing rate between ilaprazole and other PPIs [89.7% vs 87.0%; relative risk (RR) = 1.02; 95%CI: 0.98-1.06; Z = 1.00; P = 0.32]. The results did not change in the sensitivity analyses. The meta-analysis indicated that the adverse effect rate in the ilaprazole group was lower than that in the control group, but the difference was not significant (9.7% vs 13.0%; RR = 0.81; 95%CI: 0.60-1.07; Z = 1.47; P = 0.14).
CONCLUSION
Ilaprazole is a highly effective and safe PPI in the treatment of duodenal ulcers. Ilaprazole can be recommended as a therapy for acid-related disorders, especially in Asian populations.
Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Asian People; Chi-Square Distribution; Duodenal Ulcer; Humans; Odds Ratio; Proton Pump Inhibitors; Risk Factors; Treatment Outcome
PubMed: 24803828
DOI: 10.3748/wjg.v20.i17.5119