Intravenous proton pump inhibitors for peptic ulcer bleeding:Clinical benefits and limits

Peptic ulcer bleeding is a common disease and recurrent bleeding is an independent risk factor of mortality.Infusion with proton pump inhibitors(PPIs) prevents recurrent bleeding after successful endoscopic therapy.A gastric acidic environment of less than pH 5.4 alters coagulation function and activates pepsin to disaggregate platelet plugs.Gastric acid is secreted by H+,K+-ATPase,naming the proton pump.This update review focuses on the mechanism and the role of PPIs in the clinical management of patients with peptic ulcer bleeding.An intravenous omeprazole bolus followed by high-dose continuous infusion for 72 h after successful endoscopic therapy can prevent the recurrent bleeding.In the Asian,however,the infusion dosage can possibly be diminished whilst preserving favorable control of the intragastric pH and thereby still decreasing rates of recurrent bleeding.Irrespective of the infusion dosage of PPIs,rates of recurrent bleeding remain high in patients with co-morbidities.Because recurrent peptic ulcer bleeding may be prolonged in those with co-morbidities,a lowdose infusion of IV PPIs for up to 7-day may result in better control of recurrent bleeding of peptic ulcers.Due to the inter-patient variability in CYP2C19 genotypes,the infusion form of new generation PPIs,such as esomeprazole,should be promising for the prevention of recurrent bleeding.This article offers a comprehensive review of clinical practice,highlighting the indication,the optimal dosage,the duration,and the potential limitation of PPIs infusion for peptic ulcer bleeding.

Epidemiology of perforating peptic ulcer:A population-based retrospective study over 40 years

BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.

Role of proton pump inhibitors in the management of peptic ulcer bleeding

Peptic ulcer bleeding is a serious medical problem with significant morbidity and mortality.Endoscopic therapy significantly reduces further bleeding,surgery and mortality in patients with bleeding peptic ulcers and is now recommended as the first hemostatic modality for these patients.The efficacy of large-dose proton pump inhibitor(PPI) therapy in reducing re-bleeding after endoscopic therapy has been supported by evidence derived from randomized controlled trials.It may be premature to recommend small-dose intravenous injection PPI after endoscopic hemostasis in patients with bleeding ulcers.An updated systematic review shows that PPI therapy before endoscopy significantly reduces the proportion with major stigmata and requirement for endoscopic therapy at index endoscopy.Some studies show that there is no significant difference between oral and intravenous PPIs in raising intragastric pH.However,clinical data is lacking in patients with peptic ulcer bleeding to date.

Accuracy of Helicobacter pylori serology in two peptic ulcer populations and in healthy controls

AIM： To estimate the test characteristics of Heli- cobacter pylori （H pylori） serology and of C14-urea breath test （C14-UBT） in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of Hpylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS： Vagotomized （n = 83）, medically treated peptic ulcer patients （n = 73） and one reference group of community controls （n = 88） were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS： The prevalence of Hpylori infection varied from 70% to 79%. The C14-UBT had high accuracy compared to the serology test. The sensitivity of the serology test was good, but the specificity was low （41%-71%）. The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION： The accuracy of CI4-UBT to diagnose Hpylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.

Weekly pattern of emergency room admissions for peptic ulcers:A population-based study

AIM:To investigate variations in the incidence of peptic ulcers(PUs) in Taiwan by day of the week within age subgroups.METHODS:Ambulatory care data were retrieved from the Longitudinal Health Insurance Database 2000.There were 7204 subjects≥18 years-old with an emergency room admission claim for the treatment of PUs,resulting in a total of 9234 emergency room visits for PUs between 2009 and 2011.Data was divided into the seven days of the week and an additional variable for holidays.One-way analysis of variance was used to examine associations among the daily mean number of PU emergency room admissions and holidays/weekends/weekdays.RESULTS:One-way analysis of variance showed that there was a significant difference in emergency room admissions for PUs by the day of the week(P<0.001),with admission more likely to occur on Sundays or holidays than weekdays within the total and working populations.The weekday patterns of admission were similar for the patients aged 18-64 years and≥65years of age.Holidays,followed by Sundays,had higher PU admissions than the mean daily PU emergency room admissions.Furthermore,inclusion of only those treated for PUs with hemorrhage or perforation,Sundays and holidays had higher mean emergency room admissions than other days.Inclusion of patients who diagnosed with Helicobacter pylori infection,only holidays had higher mean emergency room admissions than other days.Inclusion of patients who had been prescribed non-steroidal anti-inflammatory drugs(NSAIDs)for over30 d,Sundays and holidays had higher mean PU ER admissions than other non-holiday weekdays.CONCLUSION:There is a higher incidence of emergency room admission for PUs on weekends than on weekdays for the total and working populations.

Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.

Effect of psychological nursing intervention on anxiety level and quality of life in patients with gastrointestinal peptic ulcer

BACKGROUND Peptic ulcer is a common gastrointestinal disease,and psychological intervention has an important influence on its occurrence and development.AIM To investigate the effect of psychological nursing intervention on the anxiety level and quality of life of patients with gastrointestinal peptic ulcers.METHODS Two groups of patients with peptic ulcer were selected from January to December 2012,with 60 cases in each group,and psychological nursing intervention and routine treatment were respectively performed.Psychological nursing interven-tions include cognitive behavioral therapy,psychological support and relaxation training.Self-rating anxiety scale(SAS)and quality of life questionnaire were used to evaluate the anxiety level and quality of life of patients before,during and after treatment.RESULTS The SAS scores of the experimental group significantly decreased over the course of treatment,from 52.3 before treatment to 30.5 after treatment,while SAS scores of the control group did not change significantly.Meanwhile,the experimental group's quality of life score(SF-36)significantly improved over the course of treatment,from 65.2 to 85.2,while the control group remained stable.Further analysis showed that sex and age had no significant influence on the effect of psychotherapy.Both men and women,young and old,showed similar trends in anxiety relief and improved quality of life after treatment.CONCLUSION Psychological nursing-based intervention program has a positive effect on the anxiety level and quality of life of patients with gastrointestinal peptic ulcer.

Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding:Meta-analysis of randomized controlled trials

BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Causal associations between intermediate very-low-density lipoprotein cholesterol-to-total lipids ratio and peptic ulcer:A bidirectional Mendelian randomization study

BACKGROUND Previous epidemiologic investigations have consistently demonstrated a strong association between the ratio of cholesterol to total lipids in medium very-lowdensity lipoprotein(VLDL)and the occurrence of peptic ulcers(PU).However,the precise causal relationship between these factors remains ambiguous.Consequently,this study aims to elucidate the potential correlation between the ratio of cholesterol to total lipids in medium VLDL and the incidence of peptic ulcer.AIM To investigate the ratio of cholesterol to total lipids in medium very-low-density lipoprotein(VLDL)association with PU via genetic methods,guiding future clinical research.METHODS Genome-wide association study(GWAS)datasets for the ratio of cholesterol to total lipids in intermediate VLDL and peptic ulcer were retrieved from the IEU OpenGWAS project(https://gwas.mrcieu.ac.uk).For the forward Mendelian randomization(MR)analysis,72 single nucleotide polymorphisms(SNPs)were identified as instrumental variables.These SNPs were selected based on their association with the ratio of cholesterol to total lipids in intermediate VLDL,with peptic ulcer as the outcome variable.Conversely,for the inverse MR analysis,no SNPs were identified with peptic ulcer as the exposure variable and the ratio of cholesterol to total lipids in intermediate VLDL as the outcome.All MR analyses utilized inverse variance weighted(IVW)as the primary analytical method.Additionally,weighted median and MR-Egger methods were employed as supplementary analytical approaches to assess causal effects.Egger regression was used as a supplementary method to evaluate potential directional pleiotropy.Heterogeneity and multiplicity tests were conducted using the leave-one-out method to evaluate result stability and mitigate biases associated with multiple testing.RESULTS The genetically predicted ratio of cholesterol to total lipids in medium VLDL was significantly associated with an elevated risk of peptic ulcer(IVW:OR=2.557,95%CI=1.274-5.132,P=0.008).However,no causal association of peptic ulcer with the ratio of cholesterol to total lipids in medium VLDL was observed in the inverse Mendelian randomization analysis.CONCLUSION In conclusion,our study reveals a significant association between the ratio of cholesterol to total lipids in medium VLDL and an elevated risk of peptic ulcers.However,further validation through laboratory investigations and larger-scale studies is warranted to strengthen the evidence and confirm the causal relationship between these factors.

The Evolutionary Profile of Patients Operated for Peptic Ulcer Perforation in Bujumbura

Background: The evolutionary profile of patients operated for peptic ulcer perforation in Bujumbura. Perforated peptic ulcer is a serious complication of peptic ulcer with potential risk of grave complications. Aim: To study the early morbidity and mortality of surgery for peptic ulcer perforation in Bujumbura City Hall hospitals: Kamenge University Hospital Center (CHUK), Kamenge Military Hospital (HMK) and Prince Louis Rwagasore Clinic (CPLR). Patients and methods: This is a retrospective, descriptive and analytical study carried out in the three hospitals of Bujumbura over a period of three years from January 1, 2020 to December 31, 2022. It involved 57 cases (n = 57) of peptic ulcer perforation. Results: The frequency of surgery for peptic ulcer perforation was 2.7% with a mean age of 43.6 years +/- 15.3 years and a male predominance with a sex ratio of 3.7. Eight percent of patients presented with shock, 24.5% were smokers, and 67.9% had taken non steroidal anti-inflammatory drugs. The mean hospital stay was 15.2 days with a standard deviation of 12.1. The morbidity rate was 30.2%, 32% were classified in grade IIIb of the Clavien-Dindo Surgical Complications Scale. There were 9 deaths (17%). Seven patients who underwent surgery and received late consultations died. Conclusion: Surgery for peptic ulcer perforation remains an intervention associated with a high rate of morbidity and mortality in Bujumbura. Surgery for peptic ulcer perforation remains a procedure associated with a high morbidity and mortality rate in Bujumbura. The time before consultation was the only factor associated with early morbidity and mortality of Surgery for peptic ulcer’s perforations.

Clinical Effect of Ilaprazole Enteric-Coated Tablets in Patients with Peptic Ulcer

Objective: To discuss the actual effect of ilaprazole enteric-coated tablets in the treatment of peptic ulcer patients. Methods: 200 peptic ulcer patients who received treatment from January to December 2023 were selected as the study sample, and all patients were randomly and evenly divided into the study group (n = 100) and the control group (n = 100), and the serum inflammatory factors and the disappearance time of symptoms were compared. Results: After treatment, the serum inflammatory factors in the observation group were better than those in the control group, and the time of belching and burning sensation in the observation group was shorter than that in the control group, all of which were statistically significant (P Conclusion: Ilaprazole enteric-coated tablets in the treatment of peptic ulcer have a good effect and can effectively improve the symptoms of patients with clinical signs, with reference significance.

Changing trends and characteristics of peptic ulcer disease:A multicenter study from 2010 to 2019 in Korea

BACKGROUND The clinical trend and characteristics of peptic ulcer disease(PUD)have not fully been investigated in the past decade.AIM To evaluate the changing trends and characteristics of PUD according to age and METHODS We analyzed seven hospital databases converted into the Observational Medical Outcomes Partnership-Common Data Model between 2010 and 2019.We classified patients with PUD who underwent rapid urease tests or Helicobacter pylori(H.pylori)serology into three groups:H.pylori-related,drug[nonsteroidal anti-inflammatory drugs(NSAIDs)or aspirin]-related,and idiopathic(H.pylori/NSAID/aspirin-negative)PUD and compared the yearly trends and characteristics among the three groups.RESULTS We included 26785 patients in 7 databases,and the proportion of old age(≥65 years)was 38.8%.The overall number of PUD exhibited no decrease,whereas PUD in old age revealed an increasing trend(P=0.01 for trend).Of the 19601 patients,41.8%had H.pylori-related,36.1%had drug-related,and 22.1%had idiopathic PUD.H.pylorirelated PUD exhibited a decreasing trend after 2014(P=0.01),drug-related PUD demonstrated an increasing trend(P=0.04),and idiopathic PUD showed an increasing trend in the old-age group(P=0.01)during 10 years.Patients with drug-related PUD had significantly more comorbidities and concomitant ulcerogenic drugs.The idiopathic PUD group had a significantly higher number of patients with chronic liver disease.CONCLUSION With the aging population increase,the effects of concomitant ulcerogenic drugs and preventive strategies should be investigated in drug-induced PUD.Further studies are required to clarify the relationship between idiopathic PUD and chronic liver disease.

Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

Peptic ulcer disease in non-alcoholic fatty liver disease hospitalizations:A new challenge on the horizon in the United States

BACKGROUND Peptic ulcer disease(PUD)is frequently seen in patients with liver cirrhosis.However,current literature lacks data on PUD in non-alcoholic fatty liver disease(NAFLD)hospitalizations.AIM To identify trends and clinical outcomes of PUD in NAFLD hospitalizations in the United States.METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)NAFLD hospitalizations with PUD in the United States from 2009-2019.Hospitalization trends and outcomes were highlighted.Furthermore,a control group of adult PUD hospitalizations without NAFLD was also identified for a comparative analysis to assess the influence of NAFLD on PUD.RESULTS The total number of NAFLD hospitalizations with PUD increased from 3745 in 2009 to 3805 in 2019.We noted an increase in the mean age for the study population from 56 years in 2009 to 63 years in 2019(P<0.001).Racial differences were also prevalent as NAFLD hospitalizations with PUD increased for Whites and Hispanics,while a decline was observed for Blacks and Asians.The all-cause inpatient mortality for NAFLD hospitalizations with PUD increased from 2%in 2009 to 5%in 2019(P<0.001).However,rates of Helicobacter pylori(H.pylori)infection and upper endoscopy decreased from 5%in 2009 to 1%in 2019(P<0.001)and from 60%in 2009 to 19%in 2019(P<0.001),respectively.Interestingly,despite a significantly higher comorbidity burden,we observed lower inpatient mortality(2%vs 3%,P=0.0004),mean length of stay(LOS)(11.6 vs 12.1 d,P<0.001),and mean total healthcare cost(THC)($178598 vs$184727,P<0.001)for NAFLD hospitalizations with PUD compared to non-NAFLD PUD hospitalizations.Perforation of the gastrointestinal tract,coagulopathy,alcohol abuse,malnutrition,and fluid and electrolyte disorders were identified to be independent predictors of inpatient mortality for NAFLD hospitalizations with PUD.CONCLUSION Inpatient mortality for NAFLD hospitalizations with PUD increased for the study period.However,there was a significant decline in the rates of H.pylori infection and upper endoscopy for NAFLD hospitalizations with PUD.After a comparative analysis,NAFLD hospitalizations with PUD had lower inpatient mortality,mean LOS,and mean THC compared to the non-NAFLD cohort.

Retrospective Study Efficacy of pantoprazole plus perforation repair for peptic ulcer and its effect on the stress response

BACKGROUND Peptic ulcer(PU)is an abnormal phenomenon in which there is rupture of the mucosa of the digestive tract,which not only affects patients'normal life but also causes an economic burden due to its high medical costs.AIM To investigate the efficacy of pantoprazole(PPZ)plus perforation repair in patients with PU and its effect on the stress response.METHODS The study subjects were 108 PU patients admitted between July 2018 and July 2022,including 58 patients receiving PPZ plus perforation repair[research group(RG)]and 50 patients given simple perforation repair[control group(CG)].The efficacy,somatostatin(SS)concentration,stress reaction[malondialdehyde(MDA),lipid peroxide(LPO)],inflammatory indices[tumor necrosis factor(TNF)-α,C-reactive protein(CRP),interleukin(IL)-1β],recurrence,and complications(perforation,hemorrhage,and pyloric obstruction)were compared.RESULTS The overall response rate was higher in the RG than in the CG.Patients in the RG and IL-1β were significantly reduced to lower levels than those in the CG.Lower recurrence and complication rates were identified in the RG group.CONCLUSION Therefore,PPZ plus perforation repair is conducive to enhancing treatment outcomes in PU patients,reducing oxidative stress injury and excessive inflammatory reactions,and contributing to low recurrence and complication rates.

A review on conventional and herbal drug approach to peptic ulcer

Peptic ulcer,a common digestive ailment,has been considered as an inflammatory response and necrotic lesions of the gastric mucosa.Peptic ulcer reaches intensely to the mucosal muscle layer in the stomach and duodenum.Various factors have been documented to be involved in the pathogenesis of peptic ulcers like Helicobacter pylori,nonsteroidal anti-inflammatory drugs(NSAIDs),acid and pepsin,genetics,and smoking.The conventional use of drugs like proton pump inhibitors(PPIs),histamine(H_(2))receptor antagonists,antacids,potassium competitive acid blockers,and antibiotics has shown antiulcer effects.However,various researches have shown that herbal drugs can successfully treat peptic ulcers in preclinical and clinical models by different mechanisms.Many herbal drugs and their extracts from different parts like root,stem,leaf,flower,and seed showed potent ulcerprotective effects in the experimental setup.This review critically discusses the factors involved in the pathogenesis of peptic ulcers.In addition,the potential of herbal drug extracts has been highlighted in the present review.

One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable

AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).

Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin

AIM： To investigate the usefulness of anti-ulcer drugs for the prevention and treatment of low-dose aspirin-induced peptic ulcer.METHODS： Upper gastrointestinal endoscopy was performed in 68 patients receiving daily low-dose aspirin （81 or 100 rag/day）. The endoscopic findings were classified according to the Lanza score, and the scores were compared between groups categorized according to the concomitant use of anti-ulcer drugs and the types of drugs used. In another study, 31 hemorrhagic peptic ulcer patients who had been receiving low-dose aspirin were enrolled. The patients were randomly classified into the proton pump inhibitor （PPI）-treated group and the H2 receptor antagonist （H2RA）-treated group. The administration of low-dose aspirin was continued concomitantly, and endoscopic examinations were performed 8 wk later.RESULTS： The Lanza scores （mean ± SD） of the gastro-mucosal lesions were 1.0 ± 1.9 and 1.9 ± 2.3 in 8 and 16 patients receiving prevention therapy with a PPI and an H2RA, respectively. Both scores were significantly smaller than the scores in 34 patients who were not receiving prevention therapy （4.7 ± 1.0） and in 10 patients receiving cytoprotective anti-ulcer drugs （4.3± 1.6）. In the prospective study, 18 and 13 patients received a PPI and an H2RA, respectively. Endoscopic examinations revealed that the tissue in the region of the gastro-mucosal lesions had reverted to normal in all patients in the PPI-treated group and in 12 patients （92%） in the H2RA-treated group; no significant differences were observed between the groups.CONCLUSION： H2RA therapy was effective for both the prevention and treatment of low-dose aspirin-induced peptic ulcer, similar to the effects of PPIs, while cytoprotective anti-ulcer drugs were ineffective in preventing ulceration.

Low serum albumin may predict poor efficacy in patients with perforated peptic ulcer treated nonoperatively

BACKGROUND Nonoperative management(NOM)is a promising therapeutic modality for patients with perforated peptic ulcer(PPU).However,the risk factors for poor efficacy and adverse events of NOM are a concern.AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM.METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018.Of these 272 patients,50 converted to emergency surgery due to a lack of improvement(surgical group)and 222 patients were included in the NOM group.The clinical data of these patients were collected.Baseline patient characteristics and adverse outcomes were compared between the two groups.Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU.RESULTS Adverse outcomes were observed in 71 patients(32.0%).Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU.CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes,and can be used for risk stratification in patients with PPU.

Ultrastructural observation on the relation of H.pylori to the gastric epithelia in chronic gastrictis and in peptic ulcer

AIMS The relationship between Helicobacter pylori (Hp) and gastric epithelia in chronic gastritis and in petic ulcer was studied by transmission electron mi- croscopy (TEM). METHODS Seventy-five gastric antral biopsy speci- mens from the patients examined by six other methods for Hp were fixed in glutaraldehyde and treated with tanin acid before OsO_4 staining than routinely prooessed for TEM studies (at least 4 semi- thin sections oriented for ultrathin sections in each sample). RESULTS The bacilli were detected by TEM within gastric mucosa in 53 of 55 patients infected with Hp. Ultrathin sections especially stained with tanin acid re- vealed clearly glycocalyx by which the bacillus was connected with the epithelium. As the bacilli grouped as colony and breed,the adjacent mucous cells degerated and characterized by erosion of the juxtalu- minal cytoplasm,vacuolation or blebs,even desqua- mation of cell. Evidence was accumulated to show that the baoilli were located in the lumen attracted neu- trophils which intended to migrate into intercellular space of epithelia or into the lumen to exert the effect of Hp phagocytosis. CONCLUSIONS The sensitivity and specificity of Hp diagnosis by TEM is respectively 96% and 95%. Tanin acid is suitable for the preservation of glycocalyx of cell. The colonized bacilli,usually with the wide periplasmic pools,contributed to the spectrum degen- eration of epithelia,including mucous neck cells. If Hp infection persists,the degeneration and regeneration of mucous neck cells alternatively carried on and ultimate- ly the generative stem cells were damaged,as the result,the chronic atrophy gastritis could occure.