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.

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.

Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?

AIM:To investigate the effects of Helicobacter pylori (H pylori)eradication therapy for treatment of peptic ulcer on the incidence of gastric cancer. METHODS:A multicenter prospective cohort study was conducted between November 2000 and December 2007 in Yamagata Prefecture,Japan.The study included patients with H pylori-positive peptic ulcer who decided themselves whether to receive H pylori eradication(eradication group)or conventional antacid therapy(non-eradication group).Incidence of gastric cancer in the two groups was determined based on the results of annual endoscopy and questionnaire surveys,as well as Yamagata Prefectural Cancer Registry data,and was compared between the two groups and by results of H pylori therapy.RESULTS:A total of 4133 patients aged between 13 and 91 years(mean 52.9 years)were registered,and 56 cases of gastric cancer were identified over a mean follow-up of 5.6 years.The sex-and age-adjusted incidence ratio of gastric cancer in the eradication group, as compared with the non-eradication group,was 0.58 (95%CI:0.28-1.19)and ratios by follow-up period(<1 year,1-3 years,>3 years)were 1.16(0.27-5.00),0.50 (0.17-1.49),and 0.34(0.09-1.28),respectively.Longer follow-up tended to be associated with better prevention of gastric cancer,although not to a significant extent.No significant difference in incidence of gastric cancer was observed between patients with successful eradication therapy(32/2451 patients,1.31%)and those with treatment failure(11/639 patients,1.72%).Among patients with duodenal ulcer,which is known to be more prevalent in younger individuals,the incidence of gastric cancer was significantly less in those with successful eradication therapy(2/845 patients,0.24%)than in those with treatment failure(3/216 patients,1.39%). CONCLUSION:H pylori eradication therapy for peptic ulcer patients with a mean age of 52.9 years at registration did not significantly decrease the incidence of gastric cancer.

Effects of killing Helicobacter pylori quadruple therapy on peptic ulcer: A randomized double-blind clinical trial

AIM: To study the therapeutic efficacy of a Chinese and Western integrated regimen, killing Helicobacter pylori quadruple therapy on H pylori-associated peptic ulcers(PU).METHODS: With prospective and double-blind controlled method, seventy-five active PU patients with H pylori infection were randomized to receive one of the following three regimens: (1) new triple therapy (group A:lansoprazole 30 mg qd, plus clarithromycin 250 mg bid,plus amoxycillin 500 mg tid, each for 10 d); (2) killing Hp quadruple therapy(group B: the three above drugs plus killing H pylori capsule 6 capsules bid for 4 wk) and (3)placebo(group C: gastropine 3 tablets bid for 4 wk).H pylori eradication and ulcer healing quality were evaluated under an endoscope 4 wk after treatment. The patients were followed up for 5 years.RESULTS: Both the healing rate of PU and H pylori eradication rate in group B were significantly higher than those in group C (100% and 96.4% vs 20% and 0%,respectively, P＜0.005), but there was no significant difference compared to those in group A (88% and92%, P＞0.05). The healing quality of ulcer in group B was superior to that in groups C and A (P＜0.05). The recurrence rate of PU in group B (4%) was lower than that in group A (10%) and group C (100%, P＜0.01).CONCLUSION: Killing Helicobacter pylori quadruple therapy can not only promote the eradication of H pylori and healing quality of ulcer but also reduce recurrence rate of ulcer.

Risk factors and therapeutic response in Chinese patients with peptic ulcer disease

AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retrospectively collected between January 2008 and December 2008.The differences were compared.RESULTS:Among all 448 cases,254(56.6%) and 194(43.4%) patients had gastric ulcers and duodenal ulcers respectively.Patients with gastric ulcers were younger than those with duodenal ulcers.Although more men existed,there was a female predominance in middle-aged cases.Patients with duodenal ulcers had a higher rate of Helicobacter pylori(H.pylori) infection(62.4% vs 43.3%,P = 0.001),and those with gastric ulcers owned a significantly higher amount of aspirin and nonsteroidal anti-inflammatory drug(NSAID) use(7.5% vs 1.5%,6.7% vs 2.1%,P = 0.001).Tobacco smoking and alcohol drinking had no different impact between these two groups.Proton-pump inhibitors and H2-receptor antagonists(H2RA) were effective,but significantly less so in cases with duodenal ulcers receiving H2RAs,or in those with H.pylori infection and a history of NSAID use.CONCLUSION:Patients with gastric ulcers had lower H.pylori infection but more aspirin or NSAID use.Antisecretory therapy was ineffective in gastric ulcers underwent H2RA treatment,and cases combined H.pylori infection and NSAID use.

Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

Endoscopic hemoclip treatment for bleeding peptic ulcer

AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.

Distinctive aspects of peptic ulcer disease,Dieulafoy'slesion,and Mallory-Weiss syndrome in patients withadvanced alcoholic liver disease or cirrhosis

AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS.

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.

How evidence-based are current guidelines for managing patients with peptic ulcer bleeding?

Current guidelines for managing ulcer bleeding state that patients with major stigmata should be managed by dual endoscopic therapy(injection with epinephrine plus a thermal or mechanical modality) followed by a high dose intravenous infusion of proton pump inhibitors(PPIs).This paper aims to review and critically evaluate evidence supporting the purported superiority of a continuous infusion over less intensive regimens of PPIs administration and the need for adding a second hemostatic endoscopic procedure to epinephrine injection.Systematic searches of PubMed,EMBASE and the Cochrane library were performed.There is strong evidence for an incremental benefit of PPIs over H2receptor antagonists or placebo for the outcome of patients with peptic ulcer bleeding following endoscopic hemostasis.However,the benefit of PPIs is unrelated to either the dosage(intensive vs standard regimen) or the route of administration(intravenous vs oral).There is significant heterogeneity among the 15 studies that compared epinephrine with epinephrine plus a second modality,which might preclude the validity of reported summary estimates.Studies without second look endoscopy plus re-treatment of re-bleeding lesions showed a signif icant benef it of adding a second endoscopic modality for hemostasis,while studies with second-look and re-treatment showed equal efficacy between endoscopic mono and dual therapy.Inconclusive experimental evidence supports the current recommendation of the use of dual endoscopic hemostatic means and infusion of high-dose PPIs as standard therapy for patients with bleeding peptic ulcers.Presently,the combination of epinephrine monotherapy with standard doses of PPIs constitutes an appropriate treatment for the majority of patients.

OBSERVATION ON CURATIVE EFFECTS OF 245 CASES WITH PEPTIC ULCER TREATED BY CATGUT IMPLANTATION AT THE ACUPOINT

It is reported that 245 cases of peptic ulcer were treated with catgut implantationat Pishu（BL 20）-through-Weishu（BL 21）,Shangwan（CV 13）-through-Xiawan（CV 10）and Zusanli（ST 36）points.Catgut was embedded subcutaneously and left for 15 days as a course.As a resuit,121 cases（49.39％）were cured and 124（50.61％）improved.The total effective was 100％.

Optimal treatment of peptic－ulcer：per?

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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。

荆花胃康胶丸联合雷贝拉唑四联疗法治疗Hp感染性消化性溃疡的效果及对溃疡愈合情况的影响

目的探讨荆花胃康胶丸联合雷贝拉唑四联疗法治疗幽门螺杆菌(Hp)感染性消化性溃疡的效果及对溃疡愈合情况的影响。方法选取2021年3月至2023年3月收治的76例Hp感染性消化性溃疡患者为研究对象,将其随机分为对照组与观察组,各38例。对照组采用雷贝拉唑四联疗法,观察组在对照组基础上加荆花胃康胶丸治疗。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,观察组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)及降钙素原(PCT)水平均低于对照组(P<0.05)。治疗后,观察组的溃疡愈合情况优于对照组(P<0.05)。治疗后,观察组的世界卫生组织生存质量测定量表简表(WHOQOL-BREF)各维度评分均高于对照组(P<0.05)。结论荆花胃康胶丸联合雷贝拉唑四联疗法治疗Hp感染性消化性溃疡的效果显著,不仅能抑制炎性浸润,还能促进溃疡愈合,改善患者生活质量。

热敏灸联合耳穴埋豆对消化性溃疡的效果观察

目的:探究热敏灸联合耳穴埋豆对消化性溃疡的效果观察。方法:选取100例消化性溃疡患者均分为两组,观察前后指标变化。结果:治疗前,两组患者PG-I、PG-II、GAS血清指标无显著差异(P>0.05)。治疗后,观察组PG-I、PG-II、GAS血清指标水平降低。观察组总有效率、Hp根除率略高,正常进食恢复时间和上腹胀症状消失时间均较低(P<0.05),不良反应发生率和复发率略低。结论:热敏灸联合耳穴埋豆能有效改善消化性溃疡患者相关血清指标,减少不良反应发生率,降低疾病复发率。

消化性溃疡应用半夏泻心汤联合标准化三联疗法效果研究

目的:分析对消化性溃疡患者实施半夏泻心汤辨证加减联合标准化三联疗法的效果。方法:对甘肃省礼县第一人民医院2020年7月至2023年7月收治的80例消化性溃疡患者进行观察,并将其随机分为两组,每组40例。其中对照组进行半夏泻心汤治疗,观察组进行半夏泻心汤联合标准化三联疗法,对比治疗有效率、不良反应发生情况、疼痛程度。结果:观察组各指标优于对照组,差异有统计学意义(P<0.05)。结论:对消化道溃疡患者应用半夏泻心汤联合标准化三联疗法,可以使患者的疼痛程度降低,减少不良反应的发生率,提升整体治疗效果。

四联疗法配合消化内镜治疗消化性溃疡出血的效果及对凝血指标的影响

目的:探讨四联疗法配合消化内镜治疗消化性溃疡出血(PUB)的效果及对凝血指标的影响。方法:选取2022年6月—2023年5月岑溪市人民医院收治的76例PUB患者,根据不同治疗方案分为联合组与常规组,各38例。常规组予以四联疗法治疗,联合组在四联疗法基础上予以消化内镜治疗,比较两组治疗效果。结果:联合组出血量少于常规组,止血时间、溃疡愈合时间早于常规组,差异有统计学意义(P<0.05)。治疗后,两组凝血酶时间(TT)、凝血酶原时间(PT)、D-二聚体(D-D)、国际标准化比值(INR)均低于治疗前,且联合组均低于常规组,差异有统计学意义(P<0.05)。治疗前,两组胃泌素-17水平比较,差异无统计学意义(P>0.05);治疗后,两组胃泌素-17水平均高于治疗前,且联合组明显高于常规组,差异有统计学意义(P<0.05)。联合组不良反应总发生率低于常规组,差异有统计学意义(P<0.05)。结论:四联疗法联合消化内镜治疗PUB的效果确切,可有效改善机体凝血功能,快速止血以减少出血量,不良反应发生率低,安全性较高。

双歧杆菌四联活菌片联合标准四联疗法治疗Hp感染消化性溃疡的效果及安全性

目的:观察幽门螺杆菌(Hp)感染消化性溃疡患者在标准四联疗法基础上加用双歧杆菌四联活菌片的治疗效果与安全性。方法:选择2021年6月—2023年5月北京市仁和医院消化内科接收的180例Hp感染消化性溃疡患者,按随机数字表法分为对照组(n=90,给予标准四联疗法)、观察组(n=90,给予标准四联疗法联合双歧杆菌四联活菌片)。比较两组溃疡愈合优良率、Hp清除率、胃肠功能[胃动素(MTL)、D-乳酸(D-LA)、生长抑素(SS)]、炎症因子[白介素-10(IL-10)、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)]、不良反应、复发率。结果:观察组溃疡愈合优良率、Hp清除率均较对照组高,差异均有统计学意义(P<0.05)。治疗前,两组胃肠功能、炎症因子比较,差异均无统计学意义(P>0.05);治疗后,两组MTL、D-LA、MMP-9、TNF-α均降低,IL-10、SS均升高,且观察组MTL、D-LA、MMP-9、TNF-α均较对照组低,IL-10、SS均较对照组高,差异均有统计学意义(P<0.05)。观察组不良反应与对照组比较,差异无统计学意义(P>0.05)。观察组复发率较对照组低,差异有统计学意义(P<0.05)。结论:Hp感染消化性溃疡给予标准四联疗法联合双歧杆菌四联活菌片治疗,能够提高Hp清除率,加快溃疡愈合进程,改善胃肠功能,减轻炎症反应,降低远期复发风险,且安全性高。

针灸为主治疗消化性溃疡研究进展

消化性溃疡是临床常见的消化系统疾病,目前多数患者体内均有幽门螺杆菌感染,以铋剂四联[质子泵抑制剂(PPI)+铋剂+2种抗生素]作为主要治疗方式,虽有效果,但仍存在病情容易复发、溃疡面愈合差或者出现耐药性等问题。针灸能有效缓解消化性溃疡的临床症状,促进溃疡愈合,减少复发率,取得较好的临床疗效。文章主要对近5年针灸为主治疗消化性溃疡的研究进行综述。

磷酸铝凝胶联合奥美拉唑三联疗法在小儿消化性溃疡临床治疗中的应用价值

目的:探究磷酸铝凝胶联合奥美拉唑三联疗法在小儿消化性溃疡临床治疗中的应用价值。方法:选取2021年1月—2022年6月洛阳市妇幼保健院收治的86例小儿消化性溃疡患儿作为研究对象。以随机数表法将其分为研究组和常规组,每组各43例,常规组患儿予以奥美拉唑三联疗法治疗,研究组患儿予以磷酸铝凝胶联合奥美拉唑三联疗法治疗。比较两组患儿治疗4周后的临床疗效、胃泌素(GAS)、血清降钙素原(PCT)以及不良反应发生情况。结果:两组患儿的临床疗效比较,差异有统计学意义(χ^(2)=5.460,P<0.05);治疗后,两组患儿血清PCT、GAS水平低于治疗前,研究组患儿血清PCT、GAS水平均低于常规组患儿,差异有统计学意义(t=4.031、10.296,P<0.05),两组患儿均未出现严重不良反应,研究组患儿头晕、恶心各1例,常规组头晕、恶心各2例,两组患儿不良反应发生率比较,差异无统计学意义(χ^(2)=0.717,P>0.05)。结论:在小儿消化性溃疡临床治疗中,通过采用磷酸铝凝胶联合奥美拉唑三联疗法,可有效改善治疗效果,降低血清PCT、GAS水平,且安全性良好。