Observation on 105 Cases of Duodenal Bulbar Ulcer Treated by Combined Therapy of Catgut Embe0ding and Chinese Drugs

Duodenal bulbar ulcer is a frequently encountered disease. Clinically, it manifests itself by regular epigastric pain accompanied by belching and acid regurgitation, corresponding to epigastralgia and stomach distending pain in traditional Chinese medicine (TCM). Based on the TCM type-differentiation, the author has treated 105 cases of duodenal bulbar ulcer by the combined therapy of catgut embedding at point Zusanli (ST 36) and Chinese drugs with satisfactory results. A summary is as follows. Clinical Data1. Case selection: The cases selected all had the clinical symptoms and signs of duodenal bulbar ulcer, and had been diagnosed by GI examination at this or other hospitals with no obvious therapeutic effects obtained after relevant treatment, and still symptoms and signs and repeated attacks of pain.

Azithromycin in a triple therapy for H.pylori eradication in active duodenal ulcer

AIM:To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole, which is still widely used in Russia,and B)azithromycin, amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication. METHODS:100 patients with active duodenal ulcer were included in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A) metronidazole 500 mg bid,amoxicillin I g bid and omeprazole 20 mg bid(OAM,n=50)and B)azithromycin 1 god for the first 3 days(total dose 3 g),amoxicillin 1 g bid and omeprazole 20 mg bid(OAA,n=50).Omeprazole 20 mg od was given after the eradication course as a monotherapy for three weeks.The control endoscopy was performed 8 weeks after the entry.H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test. RESULTS:97 patients completed the study according to the protocol(1 patient of the OAM group did not come to the control endoscopy,2 patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in 48 patients of the OAM group(96 %, C190.5-100 %)and in 46 patients of the OAA group(92 %, CI 89.5-94.5 %)(p=ns).H.pyloHinfection was eradicated in 15 out of 50 patients with OAM(30 %,CI 17-43 %)and in 36 out of 50 patients treated with OAA(72 %;CI 59-85 %) (P<0.001)-ITT analysis.CONCLUSION: The triple therapy with omeprazole, amoxicillin and metronidazole failed to eradicate H.pylori'vc\ the majority of patients, which is an essential argument to withdraw this regimen out of the national recommendations. Macrolide with amoxicillin are preferable to achieve higher eradication rates. Azithromycin (1 g od for the first 3 days) can be considered as a successful component of the triple PPI-based regimen.

Observation of the Effect of Triple Therapy on Duodenal Ulcer with HP Posity

Thirty-foar cases of duodenal ulcer with Hp osity weve treated with Ompeperazole, Amoxi-cillin and Tindazole, which were compared with 34 cases of Hp positive duodenal ulcer treated with omeperazole only. The duration of treatment were both one week and all the patients were re-examed at one month after treatment. The result showed that the huring rate of ulcers (HRU) in triple therapy group was 88. 2%, uhile that of the contr group was 82. 3%. No significant difference was observed in the two groups (p>0.05). Hp eradication rate (HER) in triple therapy group was 91. 7%, while that of the control group was 41. 1 %. There was significant difference between the HERs of the two gronps (p<0.01 ). In the 45 cases with Hp eradication, ulcers in 44 cases hared, with huring rate of 97. 8%. In the 23cases without Hp eradication, ulcers in 14 cases hured, with huring rate of 60. 9%. There was significant difference between these two gronps (p<0.05), which suggested the significant improvement of HRU of-ter Hp eradication. The triple therapy has the advantages such as high HRU, high rate of tolerance and no severe side effects. The therapy deserve recomrnendation clinically.

Clinical effects of psychological intervention and drug therapy against peptic ulcer

Objective:To evaluate the clinical effects of psychological interventions and drug therapy against peptic ulcer.Methods:96 patients with peptic ulcer were divided into control group with Tagamet 800 mg per evening p.o.and trial group with psychological intervention on the basis of drug treatment.Results:There were significant differences between the two groups(P【0.05), the trial group showed that the anxiety and depression cases declined obviously and effective rate of ulcer therapy was much higlier than control group.Conclusions:In sum,psychological intervention combined with drug therapy provides an effective method for ulcer treatment.

Giant duodenal ulcers

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 p^Jmp 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.

Current medical therapy for ulcerative colitis

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黄连素+四联疗法治疗幽门螺杆菌阳性消化性溃疡的临床效果分析

目的探究黄连素(别称:盐酸小檗碱)与四联疗法联合用药方案治疗幽门螺杆菌(Hp)阳性消化性溃疡的临床效果,为临床医师选择合理用药方案提供参考。方法204例Hp阳性消化性溃疡患者为研究对象,采用随机数字表法分为对照组和观察组,每组102例。对照组患者接受常规四联疗法治疗,观察组采用黄连素与四联疗法联合治疗。比较两组患者症状改善时间、Hp清除率及复发率、临床治疗效果、不良反应发生率。结果观察组患者反酸、嗳气、腹痛消失时间与溃疡愈合时间分别为(2.95±0.51)、(3.85±0.44)、(5.65±0.88)、(8.74±0.85)d,较对照组的(4.35±0.85)、(6.85±0.61)、(7.51±1.38)、(12.45±1.28)d短(P<0.05)。观察组患者Hp清除率及复发率分别为96.1%、3.9%,对照组患者分别为80.4%、17.6%,两组比较,观察组患者Hp清除率高,复发率低(P<0.05)。观察组患者治疗总有效率为98.0%,对照组为90.2%,两组比较,观察组较高(P<0.05)。观察组患者不良反应发生率为2.0%(2/102),与对照组的3.9%(4/102)比较无差异(P>0.05)。结论对Hp阳性消化性溃疡患者实施四联疗法治疗时联合黄连素可以快速改善临床症状,提升治疗效果,同时还能提高Hp清除率,降低复发率,值得推广。

Strategies and opportunities of micro/nano delivery systems for targeted therapy of ulcerative colitis:Focus on underlying mechanisms and future perspectives

Ulcerative colitis(UC)is a common progressive inflammatory disease whose incidence has increased rapidly in recent years,and can develop into colorectal cancer in severe cases.There are currently no adequate or effective treatments for UC due to the fact that some patients have found suboptimal results after repeated administration,while others have experienced adverse effects.With the rapid development of nanotechnology,developing innovative colon-targeting platforms is essential to improving efficacy,reducing side effects,and improving patient compliance.In this review,we summarize the pathophysiological characteristics of UC and the most recent status of numerous nanodrug delivery systems based on different targeting mechanisms in treating UC.Oral,intravenous,and rectal drug delivery nanoparticles targeting the colon are discussed,which can provide ideas for the design of colon-targeting nanoparticles for the treatment of colon diseases,especially for the treatment of UC.Last but not least,we provide a glimpse into the future of colon-targeted delivery systems,as well as future advancements in the field.

消化内科胃及十二指肠溃疡药物治疗的临床疗效分析

目的 探究消化内科胃及十二指肠溃疡药物治疗的临床效果。方法 80例胃及十二指肠溃疡患者,随机分为对照组和观察组,每组40例。对照组接受三联疗法进行治疗,观察组在对照组用药基础上加用枸橼酸铋钾治疗。对比两组患者临床疗效、幽门螺杆菌(Hp)清除率、不良反应发生率、满意度及生活质量评分。结果 观察组临床总有效率95.00%高于对照组的70.00%(P<0.05)。观察组患者Hp清除率97.50%高于对照组的72.50%,不良反应发生率15.00%低于对照组的37.50%(P<0.05)。治疗后,观察组患者躯体功能、社会功能、角色功能、认知功能评分分别为(77.88±6.96)、(79.81±7.85)、(86.94±6.88)、(86.58±6.77)分,均高于对照组的(64.14±6.19)、(65.18±7.22)、(73.19±5.33)、(75.20±6.41)分(P<0.05)。观察组患者总满意率为97.50%,高于对照组的72.50%(P<0.05)。结论 针对胃及十二指肠溃疡患者,在三联疗法基础上加用枸橼酸铋钾可显著提升患者临床疗效,提高Hp清除率,降低不良反应发生率,并且可以有效改善患者生活质量,增强患者满意度,值得临床推广应用。

富马酸伏诺拉生片联合三联疗法治疗幽门螺杆菌感染合并十二指肠溃疡的有效性及安全性

目的:分析富马酸伏诺拉生片联合三联疗法治疗幽门螺杆菌(Hp)感染合并十二指肠溃疡的有效性及安全性。方法:选择2023年1—12月福清市妇幼保健院收治的118例Hp感染合并十二指肠溃疡患者作为研究对象,按简单随机法分为联合组与三联组,各59例。两组均给予阿莫西林、克拉霉素、枸橼酸铋钾三联治疗,联合组另给予富马酸伏诺拉生片治疗,两组均连续治疗14 d。比较两组临床疗效、Hp根除情况、溃疡愈合情况、胃肠激素、炎症因子及不良反应。结果:联合组总有效率、Hp根除率及溃疡愈合率分别为94.92%、88.14%、93.22%,明显高于三联组的81.36%、72.88%及72.88%,差异有统计学意义(P<0.05);治疗后,两组胃泌素、黏膜组织胃泌素-17(Gas-17)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平较治疗前降低,且联合组低于三联组,差异有统计学意义(P<0.05);联合组不良反应总发生率为18.64%,与三联组的16.95%比较,差异无统计学意义(P>0.05)。结论:富马酸伏诺拉生片联合三联疗法能有效缓解Hp感染合并十二指肠溃疡患者的临床症状,根除Hp,还能修复黏膜组织,有助于十二指肠溃疡愈合,减轻炎症反应,该治疗方案效果好且安全性高。

铝碳酸镁联合四联疗法治疗幽门螺杆菌感染十二指肠溃疡患者的效果

目的:观察铝碳酸镁联合四联疗法治疗幽门螺杆菌(Hp)感染十二指肠溃疡(DU)患者的效果。方法:选取2020年1月至2021年2月该院收治的80例Hp感染DU患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各40例。对照组采用四联疗法治疗,观察组在对照组基础上联合铝碳酸镁治疗,两组均连续治疗4周。比较两组临床疗效,治疗前后胃肠激素指标[胃泌素(GAS)、肾上腺髓质素(AM)、胃动素(MTL)、生长抑素(SS)、降钙素基因相关肽(CGRP)]水平、炎性因子[白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)]水平,Hp根除率和不良反应发生率。结果:观察组治疗总有效率为95.00%(38/40),高于对照组的80.00%(32/40),差异有统计学意义(P<0.05);治疗后,观察组GAS、AM、MTL水平均低于对照组,SS、CGRP水平均高于对照组,差异有统计学意义(P<0.05);治疗后,观察组IL-1β、IL-18水平均低于对照组,差异有统计学意义(P<0.05);观察组Hp根除率为92.50%(37/40),高于对照组的72.50%(29/40),差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:铝碳酸镁联合四联疗法治疗Hp感染DU患者可提高治疗总有效率和Hp根除率,改善胃肠激素指标水平,降低炎性因子水平,效果优于单纯四联疗法治疗。

芩连愈疡汤联合NSAIDs对十二指肠溃疡的治疗效果分析

目的探讨芩连愈疡汤联合非甾体类抗炎药物(NSAIDs)对十二指肠溃疡的治疗效果及对胃蛋白酶Ⅰ(PGⅠ)、人β2防御素2(HBD-2)的影响。方法选取2020年8月—2023年5月甘肃省白银市中心医院收治的80例十二指肠溃疡患者作为研究对象,应用随机数表法将其分为观察组与对照组,每组40例。对照组采取常规四联疗法进行治疗,并应用布洛芬进行镇痛治疗,观察组在对照组基础上增加芩连愈疡汤治疗。比较两组患者临床疗效、治疗前后中医证候积分变化,并比较PGⅠ、HBD-2表达水平。结果观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者腕腹疼痛或痞满、恶心、纳呆、小便短黄、口干不欲饮、口苦相关中医证候积分比较,差异无统计学意义(P>0.05);治疗后;两组患者腕腹疼痛或痞满、恶心、纳呆、小便短黄、口干不欲饮、口苦相关中医证候积分均降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者PGⅠ、HBD-2水平比较,差异无统计学意义(P>0.05);治疗后,两组患者PGⅠ、HBD-2水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论芩连愈疡汤联合NSAIDs对十二指肠溃疡治疗效果显著,可减轻患者临床症状,降低炎症反应,改善肠胃功能。

Comparison of sequential and 7-,10-,14-d triple therapy for Helicobacter pylori infection

AIM:To compare the effectiveness of sequential therapy for Helicobacter pylori(H.pylori) infection with that of triple therapy of varying durations.METHODS:The 460 patients enrolled in this study had H.pylori-associated gastritis or a gastric or duodenal ulcer.After screening,H.pylori-infected patients were randomly assigned to receive either conventional triple therapy for 7,10 or 14 d,or a new 10-d sequential therapy.Each of the 4 treatment groups included 115 patients.The outcomes of eradication therapy were assessed 4 wk after treatment by the urea breath test and histology.RESULTS:The overall eradication rate was 81.0%,and eradication rates were 75.7% for 7-d conventional triple therapy,81.9% for 10-d conventional triple therapy,84.4% for 14-d conventional triple therapy,and 82.0% for 10-d sequential therapy.Neither intention-to-treat analysis nor per protocol analysis showed significant differences in eradication rates using sequential therapy or the standard triple therapy(P = 0.416 and P = 0.405,respectively).CONCLUSION:There are no significant differences between 10-d sequential eradication therapy for H.pylori and any duration of standard triple treatment in Korean patients.

Clinical characteristics of peptic ulcer perforation in Korea

AIM To elucidate the epidemiological characteristics and associated risk factors of perforated peptic ulcer(PPU).METHODS We retrospectively reviewed medical records of patients who were diagnosed with benign PPU from 2010 through 2015 at 6 Hallym university-affiliated hospitals.RESULTS A total of 396 patients were identified with postoperative complication rate of 9.1% and mortality rate of 0.8%. Among 174(43.9%) patients who were examined for Helicobacter pylori(H. pylori) infection, 78(44.8%) patients were positive for H. pylori infection, 21(12.1%) were on non-steroidal anti-inflammatory drugs(NSAIDs) therapy, and 80(46%) patients were neither infected of H. pylori nor treated by any kinds of NSAIDs. Multivariate analysis indicated that older age(OR = 1.09, 95%CI: 1.04-1.16) and comorbidity(OR = 4.11, 95%CI: 1.03-16.48) were risk factors for NSAID-associated PPU compared with non-H. pylori, non-NSAID associated PPU and older age(OR = 1.04, 95%CI: 1.02-1.07) and alcohol consumption(OR = 2.08, 95%CI: 1.05-4.13) were risk factors for non-H. pylori, non-NSAID associated PPU compared with solely H. pylori positive PPU.CONCLUSION Elderly patients with comorbidities are associated with NSAIDs-associated PPU. Non-H. pylori, non-NSAID peptic ulcer is important etiology of PPU and alcohol consumption is associated risk factor.

Characteristics of gastric cancer in peptic ulcer patients with Helicobacter pylori infection

AIM:To evaluate the incidence and clinical characteristics of gastric cancer(GC) in peptic ulcer patients with Helicobacter pylori(H.pylori) infection.METHODS:Between January 2003 and December 2013, the medical records of patients diagnosed with GC were retrospectively reviewed.Those with previous gastric ulcer(GU) and H.pylori infection were assigned to the Hp GU-GC group(n = 86) and those with previous duodenal ulcer(DU) disease and H.pylori infection were assigned to the Hp DUGC group(n = 35).The incidence rates of GC in the Hp GU-GC and Hp DU-GC groups were analyzed.Data on demographics(age, gender, peptic ulcer complications and cancer treatment), GC clinical characteristics [location, pathological diagnosis, differentiation, T stage, Lauren's classification, atrophy of surrounding mucosa and intestinal metaplasia(IM)], outcome of eradication therapy for H.pylori infection, esophagogastroduodenoscopy number and the duration until GC onset were reviewed.Univariate and multivariate analyses were performed to identify factors influencing GC development.The relative risk of GC was evaluated using a Cox proportional hazards model.RESULTS:The incidence rates of GC were 3.60%(86/2387) in the Hp GU-GC group and 1.66%(35/2098) in the Hp DU-GC group.The annual incidence was 0.41% in the Hp GU-GC group and 0.11% in the Hp DUGC group.The rates of moderate-to-severe atrophy of the surrounding mucosa and IM were higher in the Hp GU-GC group than in the Hp DU-GC group(86% vs 34.3%, respectively, and 61.6% vs 14.3%, respectively, P < 0.05).In the univariate analysis, atrophy of surrounding mucosa, IM and eradication therapy for H.pylori infection were significantly associated with the development of GC(P < 0.05).There was no significant difference in the prognosis of GC patients between the Hp GU-GC and Hp DU-GC groups(P = 0.347).The relative risk of GC development in the Hp GUGC group compared to that of the Hp DU-GC group,after correction for age and gender,was 1.71(95%CI:1.09-2.70;P=0.02).CONCLUSION:GU patients with H.pylori infection had higher GC incidence rates and relative risks.Atrophy of surrounding mucosa,IM and eradication therapy were associated with GC.

Functional dyspepsia of ulcer-dysmotility type:clinical incidence and therapeutic strategy

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Low eradication rate of Helicobacterpyloriwith triple 7-14 days and quadriple therapy in Turkey

AIM:The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS:One hundred and sixty-four H pylori positive patients (68 males,96 females;mean age:48±12 years) with duodenal or gastric ulcer without a smoking history were included in the study.The patients were divided into three groups according to the treatment regimens.Omeprazole 20mg,clarithromycin 500mg,amoxicillin 1g were given twice daily for 1 week (Group Ⅰ) and 2 weeks (Group Ⅱ). Patients in Group Ⅲ received bismuth subsitrate 300mg, tetracyline 500mg and metronidazole 500mg four times daily in addition to Omeprazole 20mg twice daily.Two biopsies each before and after treatment were obtained from antrum and corpus,and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment.The effects of factors like age,sex,H pylori density on antrum and corpus before treatment,the total H pylori density,and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS:The overall eradication rate was 42%.The rates in groups Ⅱ and Ⅲ were statistically higher than that in group Ⅰ (P<0.05).The rates of eradication were 24.5%, 40.7% and 61.5% in groups Ⅰ,Ⅱ and Ⅲ,respectively.The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05).The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr,P<0.001).No correlation between sex and H pylori eradication was found. CONCLUSION:Our rates of eradication were significantly lower when compared to those reported in literature.We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.

CLINICAL STUDY ON 118 CASES OF ULCERATIVE COLITIS TREATED BY INTEGRATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE

118 cases of ulcerative colitis were treated by integration of traditional Chinese and Western medicine. Another 86 cases of ulcerative colitis were treated by simple western drugs as controls. The therapeutic effects for both groups were observed and compared after two therapeutic courses of 40 consecutive days. As a result, 39 cases were cured, 60 cases improved and 19 cases failed, with a total effective rate of 84% in the treatment group; in the control group, 15 cases were cured, 37 cases improved and 34 cases failed, with a total effective rate of 60.5%. Statistically, the difference was very significant (P

Treatment of Peptic Ulcer with Xiao Jianzhong Tang—A Report of 80 Cases

With Xiao Jianzhong Tang (小建中汤), the author has successfully treated 80 cases of peptic ulcer. The therapeutic effects obtained were compared with that of the Western medicine. A report follows.