Helicobacter Pylori Infections in Peptic Ulcer Perforations: A Retrospective Analysis in Two Referral Hospitals in Douala, Cameroon

Background: Perforations are major complications of peptic ulcer disease and surgical emergencies with important mortality and morbidity. Helicobacter pylori (H. pylori) has been identified as one of the commonest factors associated with peptic ulcer disease. However, little is known about its implication in cases of perforations in Cameroon. We aimed to determine the frequency of Helicobacter pylori infections in cases of perforated peptic ulcers, describe clinical features and outcomes of these cases in Cameroon. Method: A hospital-based retrospective cross-sectional study was conducted through the review of patients’ records admitted for peptic ulcer perforations in Laquintinie and Douala General Hospitals over a period of 5 years (January 2014 - December 2018). We defined H. pylori infection as;positive result on tissue biopsy at time of surgery. We used SPSS version 23.0 to analyse data and set an alpha value at P = 0.05. Results: We reviewed 115 cases of peptic ulcer perforation, with a mean age of 40 years and sex ratio (M:F) of 5:1. All patients underwent emergency laparotomy, 48 (41%) cases had a biopsy report and the prevalence of H. pylori infection in these cases was 47.9 %. Smoking, alcohol consumption and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) use, were not associated with peptic ulcer perforation. The morbidity was at 43.7% and mortality at 14%. Mortality was increasing with a higher Mannheim Peritonitis Index score (OR: 23.51, 95% CI: 4.197 - 143.003, P-value: 0.000). Conclusion: We observed a high prevalence of H. pylori infection in patients with peptic ulcer perforations. We recommend systematic H. pylori screening in cases of perforations and that larger studies should be carried out to evaluate the association of H. pylori infection with peptic ulcer perforation in Sub-Saharan Africa.

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.

Peptic Ulcer Disease in CHUYO

Background: Prevalence of Peptic Ulcer Disease (PUD) is decreasing in developed countries since the use of the treatments for eradication of Helicobacter pylori. Objectives: To revalue the sociodemographic, clinical and evolutionary aspects of the PUD among hospitalized patients in CHUYO. Methodology: This prospective study is related to 65 files of patients hospitalized in hepato-gastroenterology and general surgical services of the CHUYO between March 1st and August 31st, 2015. Results: Hospital utilization rate was 6.59%. The average age of patients was 40.6 years with extremes of 17 and 80 years. The sex ratio was 9.8. The location of the ulcer was 69.23% in stomach. A notion of taking aggressive gastrointestinal products was found in 62 patients (95.4%). The clinical picture was represented by diffuse abdominal pain (76.92%), peritoneal irritation syndrome (64.61%) and epigastric pain (56.92%), anemia (23.07%). Gastric perforations (64.61%) and gastrointestinal bleeding (12.30%) were the main complications. Consumption of non-steroidal anti-inflammatory drugs (NSAIDs) was found in 81.5% of cases. The management was medical and/or surgical with an overall mortality rate of 7.7%. Conclusion: The PUD rate decreased from 10.12% to 6.59% in 5 years. The complications are dominated by stomach perforations. They are relative increase and seem related to NSAIDs. Better management of this disease requires awareness of the population to self-medication.

Geographic differences in low-dose aspirin-associated gastroduodenal mucosal injury

Aspirin, even at low doses, has been known to cause upper gastro-intestinal complications, such as gastroduodenal ulcers, despite the definite benefits from its antithrombotic effects. Helicobacter pylori(H. pylori) is major pathogen responsible for gastroduodenal ulcerformation. There have been conflicting results about the potential interaction between these two ulcerogenic factors and the geographic areas involved. In Western countries, the prevalence of gastroduodenal ulcers is consistently higher in H. pylori-positive low-dose aspirin(LDA) users than in H. pylori-negative ones, suggesting that H. pylori infection exacerbates LDA-induced gastroduodenal mucosal injury in these geographic areas. Meanwhile, previous studies from Japan have generally reported a similar prevalence of LDA-induced gastroduodenal mucosal injury regardless of the presence of H. pylori infection, indicating that the infection is not an overall exacerbating factor for drug-induced injury. H. pylori infection could have a synergistic or antagonistic interaction with LDA use in adverse gastroduodenal events depending on gastric acid secretion. It is wellrecognized that the net effect of H. pylori infection on gastric acid secretion shows considerable geographic variation at the population level. While gastric acid secretion levels were not decreased and were wellpreserved in most patients with H. pylori infection from Western countries, the majority of Japanese patients with H. pylori infection exhibited decreased gastric acid secretion. Such large geographic differences in the net effect of H. pylori infection on gastric acid secretion could be at least partly responsible for the geographically distinct interaction between LDA use and H. pylori infection on adverse gastroduodenal lesions.

A study of the changes in the cause of peptic ulcer bleeding

AIM: To clarify the frequency of and changes in the cause of peptic ulcer bleeding. METHODS: This study retrospectively evaluated the out- and inpatients who underwent endoscopy between 2002 to 2008. The subjects were patients presenting with peptic ulcer bleeding. The details of these patients were obtained from their endoscopic reports and medical records. RESULTS: The rates of Helicobacter pylori (H. pylori ) infection were significantly low (P = 0.039), while the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) users and vascular disease significantly increased over the period studied (P = 0.034 and P = 0.04, respectively). However, there was no significant difference in the proportion of low-dose aspirin users (P = 0.832).CONCLUSION: It's found that the primary cause of peptic ulcer bleeding changed from H. pylori infection to use of NSAIDs over the 7-year period of study. It seems that the number of low-dose aspirin users has increased with the increase in the proportion of vascular disease. It is necessary to take measures to prevent peptic ulcer bleeding among NSAIDs and low dose aspirin users.

研究埃索美拉唑治疗胃十二指肠溃疡的效果

目的探讨对胃十二指肠溃疡患者采用埃索美拉唑药物治疗后的临床效果。方法选取2020年2月—2023年5月枣庄市皮肤病性病防治院收治的46例胃十二指肠溃疡患者为研究对象,依据投掷硬币法分为参照组和研究组。参照组(23例)采用常规疗法;研究组(23例)在参照组基础上加用埃索美拉唑。比较两组的治疗总有效率、不良反应(头晕、恶心、食欲不佳以及嗜睡)发生率、生活质量评分(病情控制、正常工作、心理状态良好以及发作次数较少)、幽门螺旋杆菌(Helicobacter Pylori,Hp)清除率。结果研究组治疗有效率(95.65%)高于参照组(65.22%),差异有统计学意义(χ^(2)=4.973,P<0.05);研究组不良反应发生率低于参照组,差异有统计学意义(P<0.05);研究组生活质量评分高于参照组,差异有统计学意义(P<0.05);研究组Hp清除率高于参照组,差异有统计学意义(P<0.05)。结论临床采用埃索美拉唑治疗胃十二指肠溃疡患者,可以提升患者的疗效、减少不良反应以及提高Hp清除率,进而提升患者的生活质量,促进患者的恢复。

瑞巴派特联合三联疗法在幽门螺杆菌阳性胃十二指肠溃疡急性穿孔保守治疗中的应用研究

目的:探讨瑞巴派特联合三联疗法在幽门螺杆菌(Helicobacter pylori,Hp)阳性胃十二指肠溃疡急性穿孔保守治疗中的应用。方法:选取2015年10月至2019年12月德阳市人民医院收治住院的Hp阳性胃十二指肠溃疡急性穿孔患者105例,采用随机数字表法将患者分为研究组(n=55)和对照组(n=50)。两组患者均进行保守治疗,对照组患者在此基础上采用三联疗法,研究组患者在对照组的基础上给予瑞巴派特治疗。观察两组患者的临床疗效、住院情况、Hp根除情况及溃疡愈合情况,治疗前后血清炎症因子[肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)]和胃肠激素[胃泌素(Gas)、胃蛋白酶原Ⅰ(PGⅠ)和胃蛋白酶原Ⅱ(PGⅡ)]水平,记录并比较研究期间两组患者不良反应发生情况的差异。结果:研究组患者的总有效率为94.55%(52/55),明显高于对照组的82.00%(41/50),差异有统计学意义(P<0.05)。研究组患者临床症状缓解时间、胃肠减压时间和住院时间明显短于对照组,差异均有统计学意义(P<0.05)。研究组患者的Hp根除率为90.91%(50/55),明显高于对照组的76.00%(38/50);研究组患者溃疡愈合率为87.27%(48/55),明显高于对照组的68.00%(34/50),差异均有统计学意义(P<0.05)。治疗后,两组患者血清TNF-α和IL-6水平明显低于治疗前,且研究组患者明显低于对照组;治疗后,两组患者Gas、PGⅠ和PGⅡ水平明显高于治疗前,且研究组患者明显高于对照组,差异均有统计学意义(P<0.05)。研究组、对照组患者不良反应发生率分别为9.09%(5/55)、12.00%(6/50),差异无统计学意义(P>0.05)。结论:瑞巴派特联合三联疗法可有效减轻进行保守治疗的Hp阳性胃十二指肠溃疡急性穿孔患者的炎症反应,改善胃肠功能,促进溃疡面愈合,提高Hp根除率,缩短临床症状缓解时间、胃肠减压时间和住院时间,疗效确切,具有一定的临床应用价值。

非甾体抗炎药相关性胃十二指肠溃疡并出血的临床特点及幽门螺杆菌对溃疡特点的影响

目的 研究非甾体抗炎药 (NSAIDs)所致胃十二指肠溃疡并出血的临床特点及幽门螺杆菌对溃疡特点的影响。方法 调查我院 1997年 1月至 2 0 0 1年 12月间因胃十二指肠球部溃疡并出血收住院治疗患者的临床资料 ,根据入院前 1周内有无服用NSAIDs史将患者分为两组 ,对两组患者的临床资料进行分析比较。结果 服药组 86例 ,未服药组 36 0例。服药组患者的年龄更高 ,血红蛋白下降更明显 (P =0 .0 0 4 ) ,胃溃疡和复合溃疡、多发溃疡及大溃疡在服药组更多见 (P <0 .0 0 1)。未服药组幽门螺杆菌 (Hp)的感染率为72 .5 % ,服药组为 5 3.4 % (P =0 .0 0 1)。进一步的研究发现 ,Hp感染状态对NSAIDs相关溃疡并出血的临床特点无明显影响 ,但胃黏膜糜烂更常见 (P <0 .0 5 )。结论 应加强对NSAIDs相关性胃十二指肠溃疡并出血临床特点的认识 。

幽门螺杆菌阳性的消化性溃疡患者中胃、十二指肠上皮细胞及幽门螺杆菌的超微结构特点

目的研究幽门螺杆菌(Helicobacter pylori,H.pylori)阳性的消化性溃疡患者胃、十二指肠上皮细胞及H.pylori的超微结构特点。方法经尿素酶实验和14C-尿素呼气实验证实为H.pylori阳性的消化性溃疡30例(胃溃疡和十二指肠球部溃疡各15例)作为观察组,以无H.pylori感染的健康成年人的胃和十二指肠黏膜组织作为对照,通过透射电镜技术观察上皮细胞及H.pylori的超微结构变化。结果透射电镜观察结果显示,H.pylori阳性的胃黏膜上皮细胞多数肿大,排列紊乱,部分发生肠腺化生,肠腺化生标本中发现上皮内瘤细胞。细胞内线粒体肿胀,粗面内质网扩张。H.pylori感染引起胃上皮内淋巴细胞浸润。H.pylori阳性的十二指肠黏膜上皮细胞明显肿胀,出现空泡变性,细胞游离面微绒毛减少或消失,排列稀疏。部分细胞间连接复合体消失,间隙加大。局部浆细胞增生,毛细血管结构不完整,血浆及红细胞渗出。胃、十二指肠黏膜组织中H.pylori呈杆状或球状,黏附于细胞表面或进入细胞内。结论H.pylori以不同形态、不同的寄生及黏附方式感染黏膜,引起消化性溃疡患者胃、十二指肠上皮细胞及细胞内结构发生多种炎性改变,甚至引起胃上皮细胞内瘤细胞形成。

胃十二指肠疾病与幽门螺杆菌感染关系的研究

目的 :探讨胃十二指肠疾病与幽门螺杆菌感染的关系。方法 :对 5 73例患有不同胃十二指肠疾病的患者施行胃镜检查及胃粘膜碱性粉红试验。结果 :5 73例胃十二指肠不同疾病幽门螺杆菌检出率各异 ,其中消化性溃疡阳性率高。结论 :Hp是慢性胃炎、尤其是慢性活动性胃炎、消化性溃疡的重要致病原因之一 。

胃十二指肠溃疡穿孔手术治疗的术式选择

目的:观察穿孔修补,术后抗菌、抑酸和保护胃肠黏膜等综合治疗胃十二指肠溃疡穿孔的临床疗效,重新评价胃大部切除术在胃十二指肠溃疡穿孔中的临床应用.方法:选择61例胃十二指肠溃疡穿孔且溃疡直径＜2 cm的患者行单纯修补术,术后胃肠减压、输液,并应用抗生素和抑酸剂.出院后给予抑酸剂、抗幽门螺杆菌药物和黏膜保护药物治疗,并随访其康复情况.结果:本组61例患者均顺利出院,服药痊愈后随访2～5年,胃十二指肠黏膜幽门螺杆菌检测均为阴性,无复发病例.结论:胃大部切除术在胃十二指肠溃疡穿孔中的临床应用应重新评价.术中穿孔修补,术后抗菌、抑酸和保护胃肠黏膜等应成为首选的治疗方案.

幽门螺杆菌对消化性溃疡穿孔修补后的影响

目的 :了解幽门螺杆菌对十二指肠溃疡穿孔单纯修补后溃疡愈合的影响。 方法 :收集 12 0例穿孔性胃十二指肠溃疡 ,其中 99例 (82 5 % )为幽门螺杆菌阳性 ,其中 5 1例为抗HP治疗组 ,用次橼酸铋 12 0mg、阿莫西林 5 0 0mg和甲硝唑 30 0mg治疗。 4 8例为单用雷尼替丁治疗组。 结果 :胃十二指肠穿孔单纯修补后只要消除感染 ,溃疡复发率就降低。 结论

单纯修补或加PCV后清除Hp治疗十二指肠溃疡穿孔

目的：评估十二指肠溃疡穿孔行单纯修补或加行壁细胞迷切（ＰＣＶ）术后常规清除幽门螺杆菌（Ｈｐ）的疗效。方法：１９９４年来，我院收治十二指肠溃疡穿孔５１例，其中单纯修补４１例，修补加ＰＣＶ１０例。术后均常规予清除Ｈｐ治疗，并对术后恢复及溃疡复发情况作一回顾性分析。结果：经２年以上随访，单纯修补或加ＰＣＶ术后再常规清除Ｈｐ，溃疡复发率和再手术率均明显降低。修补加ＰＣＶ组疗效显著优于单纯修补组（Ｐ＜０．０５）；单纯修补组中，急性溃疡穿孔病例的疗效显著优于慢性溃疡穿孔（Ｐ＜０．０５）。结论：单纯修补术后再清除Ｈｐ可作为急性溃疡穿孔的理想治疗方案；修补加ＰＣＶ术后再清除Ｈｐ治疗慢性溃疡穿孔可获良好根治溃疡效果。

幽门螺杆菌与消化性溃疡穿孔、出血、幽门狭窄关系的研究

目的探讨幽门螺杆菌(Hp)与消化性溃疡穿孔、出血、幽门狭窄的关系,为临床治疗提供依据。方法随机选择96例因胃十二指肠溃疡穿孔、出血、幽门狭窄而急诊手术的病人,于胃穿部手术标本或活检标本,作免疫组化染色,在高倍镜下行Hp计数,对Hp感染的密度进行分析,按Rauws标准评估胃炎的严重度。结果消化性溃疡穿孔、出血、幽门狭窄的Hp感染阳性率分别为90%、58%、50%;Hp感染分级分别为3郾4±0郾19、2郾2±0郾17、2郾6±0郾20;Rauws分数分别为8郾0±0郾31、5郾1±0郾29、5郾8±0郾42。Hp感染和胃炎改变在消化性溃疡穿孔较出血,狭窄更为明显,前者的P值分别为<0郾01和<0郾05。结论消化性溃疡穿孔与Hp感染密切相关,根治Hp能有效防止溃疡穿孔。

胃十二指肠溃疡急性穿孔42例联合治疗体会

目的探讨采用单纯缝合修补术或溃疡病灶切除加缝合术与抗溃疡药物联合治疗胃十二指肠溃疡急性穿孔的效果。方法回顾性分析、总结本院2000年2月～2008年6月42例我院住院治疗的胃十二指肠溃疡急性穿孔的患者采用单纯缝合修补术或溃疡病灶切除加缝合术及抗溃疡三联药物治疗的资料。结果单纯缝合修补39例,病灶局部切除缝合3例,(1)手术时间为(38±3.6)分钟,术中无1例患者输血;(2)术后无并发症发生;(3)术后1月治愈率为100%;(4)术后1年,经复查胃镜,只有1例有溃疡复发。结论单纯缝合修补术或溃疡病灶切除加缝合术后辅以抗溃疡三联药物治疗对胃十二指肠溃疡急性穿孔疗效确切,适合在基层医院推广。

中医辨证治疗法治疗胃溃疡的临床效果

目的:分析中医辨证治疗法治疗胃溃疡的临床效果。方法:选择2018年1-11月笔者所在医院收治的60例胃溃疡患者作为研究对象,根据治疗方式的不同将其分为两组,每组30例。对照组接受阿司匹林、奥美拉唑、克拉霉素等常规西医治疗,观察组在对照组基础上进行中医辨证治疗。比较两组治疗效果、中医症状积分。结果:观察组治疗总有效率为93.33%,高于对照组的73.33%,差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后中医症状积分均明显降低(P<0.05),且观察组低于对照组,差异有统计学意义(P<0.05)。结论:中医辨证治疗方案在胃溃疡治疗中应用效果良好,能有效提高整体疗效,改善临床症状,值得推广使用。

慢性牙周炎与胃十二指肠溃疡关系的研究

目的观察慢性牙周炎与胃十二指肠溃疡的关系。方法从本院口腔科2013年3月~2014年10月收治的213例慢性牙周炎患者中,选择50例慢性牙周炎伴胃十二指肠溃疡的患者（观察组）,50例不伴有胃十二指溃疡的慢性牙周炎患者（阳性对照组）。另外在健康体检者中选择30例作为阴性对照组。检测3组受试者的血清胰岛素样生长因子-Ⅱ（IGF-Ⅱ）、白介素6（IL-6）、白介素8（IL-8）、生长抑素（SS）、胃泌素（Gas）以及幽门螺杆菌。比较观察组与阳性对照组的上述指标水平。结果观察组与阳性对照组的血清IGF-Ⅱ、IL-6、IL-8、SS、Gas比较,差异无统计学意义（P〉0.05）。观察组与阳性对照组的幽门螺杆菌阳性率比较,差异无统计学意义（P〉0.05）。结论慢性牙周炎伴胃十二指肠溃疡患者的IGF-Ⅱ、IL-6、IL-8、Gas、SS、幽门螺杆菌等异常指标,在单纯慢性牙周炎患者中也是异常的,说明慢性牙周炎与胃十二指肠溃疡有一定的相关性。

十二指肠溃疡穿孔修补术后根治幽门螺旋杆菌的远期疗效

目的:观察十二指肠溃疡穿孔修补术后患者,根治幽门螺旋杆菌的远期疗效。方法:回顾性分析收治的81例十二指肠溃疡穿孔患者,根据术后HP检测结果采用不同的药物治疗,疗程结束后随访1年胃镜复查溃疡复发率。结果:正规内科治疗患者中:HP阳性率88.4%(38/43);非正规内科治疗患者中:HP阳性率84.2%(32/38),两组对比差异无统计学意义(χ2=0.298,P=0.585)。1年后复查胃镜,HP阳性患者溃疡复发率:正规内科治疗组复发率为5.3%(2/38);对照组复发率59.4%(19/32),两组对比差异有统计学意义(χ2=21.713,P=0.000)。结论:十二指肠溃疡穿孔修补术后患者根治幽门螺旋杆菌治疗远期效果好,溃疡复发率低。

四联疗法中国产与进口雷贝拉唑治疗Hp阳性胃十二指肠溃疡的效果及费用比较

目的比较四联疗法中国产与进口雷贝拉唑治疗幽门螺杆菌(Hp)阳性胃十二指肠溃疡的效果及费用。方法将我院收治的94例Hp阳性胃十二指肠溃疡患者随机分为A组(国产雷贝拉唑四联疗法)和B组(进口雷贝拉唑四联疗法),每组47例。比较两组治疗前、后的症状积分、治疗效果、Hp清除率和药物费用。结果治疗前、后,两组症状积分无显著差异(P>0.05);治疗后,两组症状积分均显著降低(P<0.05)。两组的治疗总有效率和Hp清除率比较,差异不显著(P>0.05)。A组的药物费用低于B组。结论四联疗法中国产雷贝拉唑与进口雷贝拉唑治疗Hp阳性胃十二指肠溃疡对于症状改善、治疗效果、Hp清除效果的作用相当,而国产雷贝拉唑的药物费用更低。

保守治疗胃十二指肠溃疡并发出血止血效果临床分析

目的:探讨保守治疗胃十二指肠溃疡并发出血止血的临床效果。方法:收治胃十二指肠溃疡并发出血患者40例,随机分成观察组和对照组,各20例,对照组给予枸橼酸铋钾及法莫替丁片治疗,观察组在对照组的基础上加用兰索拉唑静脉注射治疗。结果:观察组总有效率95.0%明显高于对照组的75.0%(P<0.05)。1、2、3个月随访复查幽门螺杆菌阴转情况,观察组明显优于对照组(P<0.05)。结论:保守治疗胃十二指肠溃疡并发出血止血效果显著。