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The Korean Journal of Gastroenterology... Jun 2016Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H.... (Review)
Review
Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen.
Topics: Aging; DNA Virus Infections; Diphosphonates; Helicobacter Infections; Humans; Peptic Ulcer; Stress, Psychological; Substance-Related Disorders; Tuberculosis
PubMed: 27312831
DOI: 10.4166/kjg.2016.67.6.313 -
Medical Science Monitor : International... 2000During the last twenty years we have witnessed a revolutionary change in treatment and diagnosis of peptic ulcer disease (PUD). It was introduction of flexible... (Comparative Study)
Comparative Study
During the last twenty years we have witnessed a revolutionary change in treatment and diagnosis of peptic ulcer disease (PUD). It was introduction of flexible fiberoptic instruments and new drugs: H-2 blockers, proton pump inhibitors (PPI) and treatment against Helicobacter pylori which affected most significantly the course of this illness. Although indications for surgical intervention have not been changed, practice of surgery in this regard has changed a lot. In this report two periods of time were analyzed and compared: years 1977-81 and 1992-96. Operation reports from the above defined periods were reviewed and all surgeries performed for PUD and its complications have been noted along with data regarding patients and indications for surgery as reported by operating surgeons. There were 360 surgeries for PUD performed in the 1977-1981 period, and 246 in the years 1992-1996. Patients were divided into groups depending on indications for surgery. A significant reduction in the general number of operations performed was noted. The percentage of women operated upon increased. The mean age of patients in all indication groups was higher in the latter period. Patients operated for bleeding tended to be older than those in perforation and intractable disease groups. This was true in both periods of time. The number and percentage of patients operated for perforation increased. The natural course of PUD is changing; intractable disease as an indication for surgery is disappearing, the number of pyloric obstruction patients is diminishing, the incidence of bleeding and perforation remains constant. The mean age of patients and percentage of women is increasing.
Topics: Adult; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Peptic Ulcer; Poland; Time Factors
PubMed: 11208339
DOI: No ID Found -
Journal of General Internal Medicine Oct 2008No study has explored the volume-outcome relationship for peptic ulcer treatment. (Comparative Study)
Comparative Study
BACKGROUND
No study has explored the volume-outcome relationship for peptic ulcer treatment.
OBJECTIVE
To investigate the association between peptic ulcer case volume per hospital, on the one hand, and in-hospital mortality and 14-day readmission rates, on the other, using a nationwide population-based dataset.
DESIGN
A retrospective cross-sectional study, set in Taiwan.
PARTICIPANTS
There were 48,250 peptic ulcer patients included. Each patient was assigned to one of three hospital volume groups: low-volume (< or = 189 case), medium volume (190-410 cases), and high volume (> or = 411 cases).
MEASUREMENTS
Logistic regression analysis employing generalized estimating equations was used to examine the adjusted relationship of hospital volume with in-hospital mortality and 14-day readmission.
MAIN RESULTS
After adjusting for other factors, results showed that the likelihood of in-hospital mortality for peptic ulcer patients treated by low-volume hospitals (mortality rate = 0.68%) was 1.6 times (p < 0.05) that of those treated in high-volume hospitals (mortality rate = 0.72%) and 1.4 times (p < 0.05) that of those treated in medium-volume hospitals (mortality rate = 0.73%). The adjusted odds ratio of 14-day readmission likewise declined with increasing hospital volume, with the odds of 14-day readmission for those patients treated by low-volume hospitals being 1.5 times (p < 0.001) greater than for high-volume hospitals and 1.3 times (p < 0.01) greater than for medium-volume hospitals.
CONCLUSIONS
We found that, after adjusting for other factors, peptic ulcer patients treated in the low-volume hospitals had inferior clinical outcomes compared to those treated in medium-volume or high-volume ones.
Topics: Aged; Cross-Sectional Studies; Databases, Factual; Female; Hospital Mortality; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Outcome and Process Assessment, Health Care; Peptic Ulcer; Retrospective Studies; Treatment Outcome
PubMed: 18648892
DOI: 10.1007/s11606-008-0721-y -
Journal of Psychosomatic Research Aug 2013Recent research demonstrating concurrent associations between mental disorders and peptic ulcers has renewed interest in links between psychological factors and ulcers....
OBJECTIVE
Recent research demonstrating concurrent associations between mental disorders and peptic ulcers has renewed interest in links between psychological factors and ulcers. However, little is known about associations between temporally prior mental disorders and subsequent ulcer onset. Nor has the potentially confounding role of childhood adversities been explored. The objective of this study was to examine associations between a wide range of temporally prior DSM-IV mental disorders and subsequent onset of ulcer, without and with adjustment for mental disorder comorbidity and childhood adversities.
METHODS
Face-to-face household surveys conducted in 19 countries (n=52,095; person years=2,096,486). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Peptic ulcer onset was assessed in the same interview by self-report of physician's diagnosis and year of diagnosis. Survival analyses estimated associations between first onset of mental disorders and subsequent ulcer onset.
RESULTS
After comorbidity and sociodemographic adjustment, depression, social phobia, specific phobia, post-traumatic stress disorder, intermittent explosive disorder, alcohol and drug abuse disorders were significantly associated with ulcer onset (ORs 1.3-1.6). Increasing number of lifetime mental disorders was associated with ulcer onset in a dose-response fashion. These associations were only slightly attenuated by adjustment for childhood adversities.
CONCLUSIONS
A wide range of mental disorders were linked with the self-report of subsequent peptic ulcer onset. These associations require confirmation in prospective designs, but are suggestive of a role for mental disorders in contributing to ulcer vulnerability, possibly through abnormalities in the physiological stress response associated with mental disorders.
Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Female; Health Surveys; Humans; Life Change Events; Male; Mental Disorders; Middle Aged; Peptic Ulcer; Prevalence; Prospective Studies
PubMed: 23915767
DOI: 10.1016/j.jpsychores.2013.04.007 -
World Journal of Surgery Apr 2011Throughout recent decades there has been noticeable change in the incidence of peptic ulcer disease and its complications. The aim of the present study was to determine... (Comparative Study)
Comparative Study
BACKGROUND
Throughout recent decades there has been noticeable change in the incidence of peptic ulcer disease and its complications. The aim of the present study was to determine the character of changes over the last 45 years in the localization of perforation, in patient age, and in patient gender.
METHODS
A group of 881 patients admitted to the Second Department of General Surgery in Krakow, Poland, from 1962 to 2006 were included in the study and constituted the material for the analysis. The study was divided into three time periods (1962-1976, 1977-1991, and 1992-2006) to allow statistical analysis of trends.
RESULTS
The general incidence of perforations of peptic ulcer did not show changes; however, the percentage of women with perforated duodenal ulcer markedly increased. Patients with perforated stomach ulcer--regardless of gender--and females suffering from perforated duodenal ulcer were, on the average, about 10 years older than males with perforated duodenal ulcers. The mean age of male and female patients with perforated duodenal ulcer over the last 45 years showed an insignificant upward trend.
CONCLUSIONS
(1) The percentage of women with perforated duodenal ulcer continuously and statistically significantly rose. (2) Men with perforated duodenal ulcer were significantly younger than other patients. (3) The mean ages of male and female patients with perforated duodenal ulcer over the last 45 years showed an insignificant upward trend.
Topics: Adult; Age Distribution; Aged; Cohort Studies; Duodenal Ulcer; Female; Humans; Incidence; Male; Middle Aged; Peptic Ulcer Perforation; Poland; Prognosis; Registries; Retrospective Studies; Severity of Illness Index; Sex Distribution; Stomach Ulcer
PubMed: 21267567
DOI: 10.1007/s00268-010-0917-2 -
British Medical Journal Aug 1969
Topics: Female; Humans; Male; Peptic Ulcer; Personality Disorders; Postoperative Complications
PubMed: 5797775
DOI: No ID Found -
British Medical Journal (Clinical... Apr 1982
Topics: Age Factors; Aged; Duodenal Ulcer; Dyspepsia; Female; Humans; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Perforation; United Kingdom
PubMed: 6802407
DOI: 10.1136/bmj.284.6322.1063 -
British Medical Journal Mar 1968
Topics: Diagnosis, Differential; Drainage; Gastrectomy; Gastroenterostomy; Humans; Peptic Ulcer Perforation; Postoperative Care; Vagotomy
PubMed: 5637575
DOI: 10.1136/bmj.1.5592.625 -
Canadian Journal of Surgery. Journal... Oct 2000Since the causative role of Helicobacter pylori in peptic ulcer and gastritis was established, a number of advances have been made. Helicobacter virulence factors have... (Review)
Review
Since the causative role of Helicobacter pylori in peptic ulcer and gastritis was established, a number of advances have been made. Helicobacter virulence factors have been identified, the changes it causes in gastric acid secretion has been elucidated, and the entire genome of H. pylori has been mapped. Multiple lines of evidence indicate a strong link between the bacterium and noncardia gastric cancer. The infection can be confidently diagnosed by noninvasive serologic tests and the urea breath test. Triple therapy is almost always curative, and the infection almost never recurs in Canadian adults, but eradicating the bacteria in the absence of peptic ulcer only rarely leads to resolution of dyspepsia. New studies suggest that treating Helicobacter may increase the risk of peptic esophagitis and adenocarcinoma of the esophagus and cardia.
Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer; Precancerous Conditions; Risk Factors; Stomach Neoplasms; Virulence
PubMed: 11045091
DOI: No ID Found -
California Medicine Sep 1955Peptic ulcers of the stomach and duodenum look much alike and the reaction around them is nonspecific, yet other evidence indicates that ulcers in the two locations do...
Peptic ulcers of the stomach and duodenum look much alike and the reaction around them is nonspecific, yet other evidence indicates that ulcers in the two locations do not represent the same disease. It is suggested that a common causal factor is the digestive effect of gastric juice, and that hypersecretion may produce duodenal ulcer without any predisposing change in the relatively susceptible duodenum. The development of a gastric ulcer, which may occur without hypersecretion, presumably requires some previous alteration of the normally resistant gastric mucosa. Focal metaplasia of the gastric mucosa to tissue resembling the lining of the small intestine, which is observed frequently in association with gastric ulcer, may be a factor in providing decreased resistance to peptic injury.
Topics: Digestion; Duodenal Ulcer; Duodenum; Gastric Juice; Gastric Mucosa; Metaplasia; Peptic Ulcer; Stomach Ulcer
PubMed: 13250420
DOI: No ID Found