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Alimentary Pharmacology & Therapeutics Mar 2008In clinical trials of peptic ulcer prevention, the most appropriate definition of an ulcer remains challenging. (Review)
Review
BACKGROUND
In clinical trials of peptic ulcer prevention, the most appropriate definition of an ulcer remains challenging.
AIMS
To evaluate the ulcer definitions used in clinical trials of ulcer prevention among non-steroidal anti-inflammatory drug users and to determine whether any specific definition is preferred.
METHODS
A systematic literature search of the PubMed, Medline and EMBASE databases was conducted. Results were limited to full papers published in English from June 1987 to June 2007 that met the following criteria: randomized, controlled non-steroidal anti-inflammatory drug trials of > or =8 weeks' duration, with a primary end point of ulcer upon endoscopy.
RESULTS
Forty five publications met the inclusion criteria and were reviewed. Overall, an ulcer diameter of > or =3 mm was used in 25 publications and most included a description of ulcer depth. Of the remainder, ulcer was defined as any lesion with unequivocal/observable depth (with no lower limit for ulcer diameter; five publications) or an excavated mucosal break >3 mm (one publication), whereas nine defined a minimum ulcer size of > or =5 or >5 mm. Ulcer definition was unclear in the remaining five publications.
CONCLUSION
In clinical trials of ulcer prevention among non-steroidal anti-inflammatory drug users, a gastric or duodenal lesion > or =3 mm in diameter with significant depth is the preferred definition.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Humans; Peptic Ulcer; Terminology as Topic
PubMed: 18194499
DOI: 10.1111/j.1365-2036.2008.03610.x -
Analytical Cellular Pathology... 2015Background. Helicobacter pylori (HP) infection and nonsteroidal anti-inflammatory drugs (NSAID) use are considered the main risk to develop peptic ulcer disease (PUD)....
Background. Helicobacter pylori (HP) infection and nonsteroidal anti-inflammatory drugs (NSAID) use are considered the main risk to develop peptic ulcer disease (PUD). However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV) reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129), and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers). Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5), while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1). Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD.
Topics: Adult; Antibodies, Viral; Duodenal Ulcer; Epstein-Barr Virus Infections; Female; Helicobacter Infections; Herpesvirus 4, Human; Humans; Immunoglobulin G; Male; Middle Aged; Odds Ratio; Peptic Ulcer; Risk Factors; Stomach Ulcer
PubMed: 26199856
DOI: 10.1155/2015/164840 -
Pharmacotherapy 1993The pathophysiology of peptic ulcer disease (PUD) is often described as an imbalance between aggressive factors such as acid and pepsin and alterations in the mucosal... (Review)
Review
The pathophysiology of peptic ulcer disease (PUD) is often described as an imbalance between aggressive factors such as acid and pepsin and alterations in the mucosal protective mechanisms. Helicobacter pylori is a gram-negative organism that has been identified as a potential causative agent in the pathogenesis of PUD. The exact mechanism by which it contributes to mucosal damage is unknown. It is thought that the organism may disrupt the protective mucous layer, allowing the underlying epithelium to be injured by gastric acid. Significant evidence indicates that H. pylori is a major etiologic factor in type B gastritis. Data confirming its etiologic role in duodenal ulcer (DU) disease is not conclusive; however, eradication of the organism is associated with a reduction in the recurrence of DU. Optimum therapy to eradicate H. pylori has not been established, although several multidrug regimens have been evaluated. Treatment of H. pylori infection should be reserved for individuals in whom conventional therapy for DU is unsuccessful and those whose ulcers relapse during maintenance therapy.
Topics: Drug Therapy, Combination; Gastric Acid; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Pepsin A; Peptic Ulcer; Tinidazole
PubMed: 8361859
DOI: No ID Found -
British Medical Journal Sep 1979
Topics: Animals; Burns; Gastric Juice; Humans; Peptic Ulcer; Rats; United Kingdom; United States
PubMed: 497665
DOI: 10.1136/bmj.2.6189.512 -
Gut Jun 1969
Topics: Adolescent; Adult; Age Factors; Aged; Aspirin; Australia; Child; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Peptic Ulcer; Retrospective Studies; Sex Factors; Stomach Ulcer
PubMed: 5786140
DOI: 10.1136/gut.10.6.443 -
Annals of the Royal College of Surgeons... Mar 1977The hypothesis that peptic ulcer is a manifestation of a generalized metabolic disorder caused by excess dietary fat intake is supported by the results in a series of...
The hypothesis that peptic ulcer is a manifestation of a generalized metabolic disorder caused by excess dietary fat intake is supported by the results in a series of 134 patients with proven gastric or duodenal ulcer treated with a simple 'fat-free' diet, together with pyloroplasty in 82 cases and simple suture of a perforated ulcer in 16. Relief of symptoms and healing of the ulcer resulted in the great majority of cases so long as the diet was strictly adhered to, and there have been no side effects or morbidity.
Topics: Diet; Dietary Fats; Duodenal Ulcer; England; Follow-Up Studies; Humans; Metabolic Diseases; Peptic Ulcer; Peptic Ulcer Perforation; Pylorus; Stomach Ulcer
PubMed: 843047
DOI: No ID Found -
Alimentary Pharmacology & Therapeutics Nov 2009Few studies have examined the incidence of uncomplicated peptic ulcer or the trends in factors affecting its incidence.
BACKGROUND
Few studies have examined the incidence of uncomplicated peptic ulcer or the trends in factors affecting its incidence.
AIM
To estimate the incidence rate of uncomplicated peptic ulcer in the UK from 1997 to 2005 and report temporal changes in the main known preventive and risk factors.
METHODS
Population-based cohort study of 1 049 689 patients enrolled in The Health Improvement Network in the UK. We estimated the incidence rate of uncomplicated peptic ulcer and evaluated temporal trends in demographic characteristics and prescription patterns for various anti-inflammatory and gastroprotective agents.
RESULTS
Overall uncomplicated peptic ulcer incidence was 0.75 cases per 1000 persons-years, declining from 1.1 to 0.52 cases per 1000 person-years between 1997 and 2005. Distributions of age, gender and alcohol habits were similar in 1997 and 2005. The proportion of documented Helicobacter pylori-negative cases increased from 5% to 12%. Monthly prevalence of subjects with prescriptions for traditional non-aspirin NSAIDs changed from 7.7% to 6.8%, Coxibs from 0% to 0.7%, and proton pump inhibitors (PPIs) from 2.4% to 7.4%. The proportion of subjects on prescription NSAIDs on PPIs increased continuously over time.
CONCLUSION
A reduction in H. pylori-related peptic ulcers, changing patterns in NSAID use and increasing PPI use may have contributed to a decline in uncomplicated peptic ulcer incidence in the UK.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Drug Prescriptions; Female; Humans; Incidence; Male; Middle Aged; Overweight; Peptic Ulcer; Risk Factors; Sex Factors; Smoking; United Kingdom
PubMed: 19709097
DOI: 10.1111/j.1365-2036.2009.04131.x -
Alimentary Pharmacology & Therapeutics Oct 2000Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori are well-recognized causes of gastroduodenal mucosal damage. This damage is mediated through the... (Review)
Review
Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori are well-recognized causes of gastroduodenal mucosal damage. This damage is mediated through the effects of both agents on acid secretion, neutrophil activity and function, and prosta- glandin metabolism. Clinical trials on the interrelation- ship between H. pylori, NSAIDs and gastroduodenal mucosal injury have yielded conflicting results. No consensus has been reached on what recommenda- tions should be implemented with regard to H. pylori eradication in patients on long-term NSAID therapy. At present, the presence of H. pylori is identified at endoscopy and eradication is carried out in symptomatic patients. Asymptomatic patients remain a dilemma that requires further investigation. Clinical practice will continue to be tailored to a patient's individual requirements. Therefore, in patients at risk of gastrointestinal haemorrhage, and on NSAID therapy, acid suppression therapy should be prescribed.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 11050486
DOI: 10.1046/j.1365-2036.2000.00399.x -
Annals of Surgery Feb 1989Proximal gastric vagotomy is nearing its twentieth year in clinical use as an operation for peptic ulcer disease. No other acid-reducing operation has undergone as much... (Review)
Review
Proximal gastric vagotomy is nearing its twentieth year in clinical use as an operation for peptic ulcer disease. No other acid-reducing operation has undergone as much scrutiny or study. At this time, the evidence of such studies and long-term follow-up strongly supports the use of proximal gastric vagotomy as the treatment of choice for chronic duodenal ulcer in patients who have failed medical therapy. Its application in treating the complications of peptic ulcer disease, which recently have come to represent an increasingly greater percentage of all operations done for peptic ulcer disease, is well-tested. However, initial series suggest that it should probably occupy a prominent role in treating some of these complications, particularly in selected patients, in the future. The operation has the well-documented ability to reduce gastric acid production, not inhibit gastric bicarbonate production, and also minimally inhibit gastric motility. The combination of these physiologic results after proximal gastric vagotomy, along with preservation of the normal antropyloroduodenal mechanism of gastrointestinal control, serve to allow patients with proximal gastric vagotomy the improved benefits of significantly fewer severe gastrointestinal side effects than are seen after other operations for peptic ulcer disease.
Topics: Cimetidine; Combined Modality Therapy; Duodenal Ulcer; Emergencies; Gastric Acid; Humans; Peptic Ulcer; Pylorus; Recurrence; Stomach Ulcer; Vagotomy, Proximal Gastric
PubMed: 2644897
DOI: 10.1097/00000658-198902000-00001 -
Alimentary Pharmacology & Therapeutics Jul 2001One-week triple regimens have been shown to be effective for the treatment of Helicobacter pylori-related peptic ulcer disease. (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
One-week triple regimens have been shown to be effective for the treatment of Helicobacter pylori-related peptic ulcer disease.
AIM
To conduct an economic analysis of four triple regimens for the treatment of H. pylori-related peptic ulcer disease from the perspective of a public health organization in Hong Kong.
METHODS
Records of 200 patients with H. pylori-related peptic ulcer disease, who had previously participated in a randomized comparison of ranitidine bismuth citrate (RBC) with amoxicillin and clarithromycin (RAC), omeprazole with amoxicillin and clarithromycin (OAC), RBC with metronidazole and tetracycline (RMT), or, colloidal bismuth subcitrate with metronidazole and tetracycline (BMT) in either in-patient or out-patient setting were reviewed.
RESULTS
Fifty patients were excluded because of incomplete documentation or lack of peptic ulcer. In the out-patient group (n=72), the median direct costs of the RAC group (HK $ 5094) were lower those of the BMT (HK $ 5400), RMT (HK $ 5394), or OAC (HK $ 5440) groups, but the difference was significant only between the RAC and BMT groups (P < 0.05). In the in-patient group (n=78), the median direct costs of the RMT group (HK $ 8524) were significantly lower than those of the OAC (HK $ 13 871) and RAC (HK $ 12 092) groups (P < 0.05), but were similar to those of the BMT group (HK $ 8758).
CONCLUSIONS
RAC and RMT are the least costly regimens for out-patient and in-patient treatment, respectively, of H. pylori-related peptic ulcer disease in Hong Kong.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Female; Health Care Costs; Helicobacter Infections; Hong Kong; Humans; Inpatients; Male; Middle Aged; Outpatients; Peptic Ulcer
PubMed: 11421876
DOI: 10.1046/j.1365-2036.2001.01000.x