Upper-gastrointestinal bleeding secondary to peptic ulcer disease:Incidence and outcomes

AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).

Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding

AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.

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).

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.

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.

Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease

AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.

Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

AIM： TO establish the prevalence of He/icobacterpy/on （H. pylori） infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs （NSAIDs）.METHODS： A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease （CLO） test, his- tological examination, and bacterial culture. TgG anti- CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.RESULTS： Eighty patients, 61 males （76.3%）, mean age 61.2 ~ 15.9 years, were consecutively enrolled. Forty-seven （58.8%） patients occasionally consumed NSAIDs, while 33 （41.3%） were on chronic treatment with low-dose aspirin （LD ASA）. Forty-four （55.0%） patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The high- est accuracy （92.5%） was obtained with the culture of biopsy specimens.CONCLUSION： Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child

Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.

Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia?A pilot study

AIM:Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron,but patients usually face a two-month recovery period from post- haemorrhage anaemia.This prospective,randomised,open, pilot study was designed to investigate whether recombinant human erythropoietin(Epoetin)therapy accelerate haematocrit increase in the post-bleeding recovery period. METHODS:We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis, who had a haematocrit of 27-33% and did not receive blood transfusions.One day after the endoscopic confirmation of cessation of bleeding,they were randomised either to erythropoietin(20 000 IU Epoetin alfa subcutaneously,on days 0,4 and 6)plus iron(100 mg im,on days 1-6,(G_1)or iron only(G_2).Haematocdt was measured on days 0,6,14, 30,45,and 60,respectively. RESULTS:One patient from G_1 and two from G_2 were lost to follow-up.Therefore,14 and 13 patients from G_1 and G_2 respectively were analysed.Demographic characteristics,serum iron,ferritin,total iron binding capacity,reticulocytes,and haernatoait were not significantly different at entry to the study. Median reticulocyte counts were significantly different between groups on day six(G_1:4.0,3.0-6.4 vs G_2:3.5,2.1-4.4%, P=0.03)and median haematocrit on day fourteen [G_1:35.9, 30.7-41.0 vs G_2:32.5,29.5-37.0%(median,range),P=0.04]. CONCLUSION:Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding. The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.

不同幽门螺杆菌感染状态消化性溃疡出血的临床特点及危险因素研究

目的分析消化性溃疡伴出血患者幽门螺杆菌(Helicobacter Pylori,HP)感染的情况,探索其临床特点和危险因素。方法回顾性分析2017年1月至2020年6月莆田学院附属医院消化内科256例消化性溃疡伴出血患者的临床资料。分为HP阴性(42例)、HPI型(98例)、HPII型(116例)三组,比较三组患者的临床资料,血清中胃蛋白酶原(Pepsinogen,PG)、血清CD40、DEFA、IL-10、IL-17、TNF-α水平。结果HPI型、HPII型患者PGI、PGII、CD40水平均显著高于HP阴性患者(P<0.05),而DEFA水平显著低于HP阴性患者(P<0.05);HPI型患者PGI、PGII、CD40水平均显著高于HPII型患者(P<0.05),而DEFA水平显著低于HPII型患者(P<0.05)。HPI型、HPII型患者IL-10、IL-17、TNF-α水平均显著高于HP阴性患者(P<0.05);HPI型患者IL-10、IL-17、TNF-α水平均显著高于HPII型患者(P<0.05)。结论PGI、PGII、CD40、IL-10、IL-17、TNF-α可能是消化性溃疡出血的危险因素,DEFA可能是消化性溃疡出血的保护因素。

艾司奥美拉唑钠持续泵入与静脉滴注给药方式在消化性溃疡合并出血患者中的应用效果

目的 比较艾司奥美拉唑钠持续泵入与静脉滴注给药方式在消化性溃疡合并出血患者中的应用效果。方法 选择2018年4月至2021年4月收治的90例消化性溃疡合并出血患者作为研究对象,按红绿双色球法将其分为对照组和研究组,各45例。对照组给予艾司奥美拉唑钠静脉滴注治疗,研究组给予艾司奥美拉唑钠持续泵入治疗。比较两组的治疗效果。结果 研究组的出血、呕血、黑便停止时间和腹痛缓解时间短于对照组(P<0.05)。研究组的治疗总有效率为95.56%,显著高于对照组的80.00%(P<0.05)。治疗后,研究组的纤维蛋白原、D-二聚体水平低于对照组,血小板计数(PLT)、红细胞比容(HCT)高于对照组(P<0.05)。治疗后,研究组的表皮生长因子(EGF)、前列腺素E2(PGE2)水平高于对照组,基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-3(MMP-3)水平低于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 相比于艾司奥美拉唑钠静脉滴注给药,持续泵入效果会更好,能够缩短消化性溃疡合并出血患者临床症状消失时间,提高治疗效果,改善凝血功能及血清指标。

消化性溃疡患者并发上消化道出血的危险因素分析

目的分析探讨消化性溃疡(PU)患者并发上消化道出血(UGH)的危险因素。方法选取2021年4月至2022年4月郑州市第九人民医院收治的90例PU患者作为研究对象,收集患者性别、年龄、溃疡长径、溃疡病程、溃疡部位、职业、有无吸烟史、有无饮酒史、是否合并幽门螺杆菌感染、入院时血清单核细胞趋化蛋白-1(MCP-1)水平、入院时CD4+水平、入院时CD8+水平、有无高血压病史、有无糖尿病病史、是否长时间应用非甾体抗炎药、是否合并UGH等资料,并根据患者是否合并UGH将其分为并发UGH组和未并发UGH组,多因素Logistic回归分析PU患者并发UGH的危险因素。结果90例PU患者中22例(24.44%)患者合并UGH,设为并发UGH组;68例(75.56%)患者未合并UGH,设为未并发UGH组。单因素分析结果显示,并发UGH组有饮酒史、长时间应用非甾体抗炎药患者比例明显高于未并发UGH组(χ^(2)=17.113、10.399,P<0.001、P=0.001),血清MCP-1水平、CD4+水平明显高于未并发UGH组(t=18.595、4.757,P均<0.001);多因素Logistic回归分析结果显示,有饮酒史、长时间应用非甾体抗炎药、血清MCP-1高水平、CD4+高水平是PU患者并发UGH的独立危险因素(95%CI为3.386~30.422、1.805~14.281、1.047~1.131、1.098~1.349,P<0.001、P=0.002、P<0.001、P<0.001)。结论PU患者并发UGH与饮酒史、非甾体抗炎药应用史以及MCP-1与CD4+水平密切相关,临床应予以重点关注,及时根据患者具体情况采取针对性干预措施,以预防UGH的发生。

奥美拉唑联合白眉蛇毒血凝酶对消化性溃疡并出血患者凝血指标及血小板参数变化的影响

目的探讨奥美拉唑联合白眉蛇毒血凝酶的治疗消化性溃疡并出血患者的临床疗效。方法选取2020年4月至2022年3月瑞金市总医院/瑞金市人民医院收治的80例消化性溃疡并出血患者作为研究对象,采用单双号法分为对照组与研究组,每组40例。对照组采用奥美拉唑治疗,研究组采用奥美拉唑联合白眉蛇毒血凝酶治疗,比较两组凝血功能指标、血小板参数、临床疗效、临床指标及不良反应发生情况。结果治疗后,两组凝血酶时间(TT)、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均短于治疗前,且研究组短于对照组,差异有统计学意义(P<0.05)。治疗后,两组血小板计数(PLT)均高于治疗前,血小板比容(PCT)均大于治疗前,血小板体积(MPV)均小于治疗前,且研究组PLT高于对照组,PCT大于对照组,MPV小于对照组,差异有统计学意义(P<0.05)。研究组治疗总有效率为97.50%,高于对照组的77.50%,差异有统计学意义(P<0.05)。研究组止血时间、住院时间均短于对照组,复发率低于对照组,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。结论奥美拉唑联合白眉蛇毒血凝酶治疗消化性溃疡并出血疗效更佳,可有效改善患者凝血指标及血小板参数,缩短止血时间、住院时间,降低复发率,且安全性较高。

艾司奥美拉唑治疗消化性溃疡出血的临床效果

目的研究艾司奥美拉唑治疗消化性溃疡出血的疗效。方法回顾性选取永春县蓬壶中心卫生院消化内科2023年1月至2024年1月收治的60例消化性溃疡出血患者,按照治疗方法不同分为对照组与观察组,每组各30例。对照组采取常规补液、止血等治疗,观察组在常规治疗基础上加用艾司奥美拉唑治疗,比较两组临床治疗效果。结果观察组治疗效果、临床症状恢复情况、血常规、炎症因子均显著优于对照组(P<0.05)。两组不良反应对比无差异(P>0.05)。结论在常规治疗基础上加用艾司奥美拉唑治疗消化性溃疡出血临床效果佳。

学龄期儿童消化性溃疡并发出血的危险因素分析

目的探讨分析学龄期儿童消化性溃疡并发出血的相关危险因素。方法选取2020年3月至2023年3月南阳市中心医院收治的213例学龄期消化性溃疡患儿作为研究对象,收集患儿性别、有无家族史、年龄、溃疡类型、溃疡病程、是否喜好酸辣、有无幽门螺杆菌(Hp)感染、有无心理障碍、有无可加重消化性溃疡病情药物(抗生素、激素、非甾体类抗炎药等)应用史、临床症状(有无呕血、柏油样便或血便等)、是否并发出血等相关资料,并根据患儿并发出血情况将其分为出血组和非出血组,Logistic回归分析并发出血的相关危险因素。结果213例消化性溃疡患儿并发出血60例(28.17%),临床表现为呕血25例(41.67%)、柏油样便35例(58.33%)、嗳气反酸22例(36.67%)、腹痛不适20例(33.33%)、恶心呕吐21例(35.00%),设为出血组;其余153例(71.83%)未并发出血,设为非出血组。单因素分析结果显示,出血组中性别为男性、有家族史、年龄为11~13岁、溃疡病程≥1年、喜好酸辣、有Hp感染、有心理障碍、有可加重消化性溃疡病情药物应用史的患儿明显多于非出血组(χ^(2)=7.502、50.233、8.851、6.927、7.148、8.759、4.719、7.392,P=0.006、P<0.001、P=0.003、P=0.008、P=0.008、P=0.003、P=0.030、P=0.007)。Logistic回归分析结果显示,性别为男性、有家族史、年龄为11~13岁、溃疡病程≥1年、喜好酸辣、有Hp感染、有心理障碍、有可加重消化性溃疡病情药物应用史是学龄期儿童消化性溃疡并发出血的独立危险因素(95%CI为1.329~4.516、1.318~11.888、1.848~32.710、1.188~6.046、1.133~5.763、1.937~7.914、1.182~11.257、1.155~1.771,P=0.004、0.014、0.005、0.017、0.023、0.001、0.024、0.001)。结论学龄期儿童消化性溃疡并发出血以呕血和柏油样便为主要临床表现,且其发生与性别、有无家族史、年龄、溃疡病程、是否喜好酸辣、有无Hp感染、有无心理障碍、有无可加重消化性溃疡病情药物应用史密切相关。

艾普拉唑钠与艾司奥美拉唑钠治疗消化性溃疡出血患者的效果比较

目的:比较艾普拉唑钠与艾司奥美拉唑钠治疗消化性溃疡出血患者的效果。方法:选取2021年6月至2023年6月该院收治的100例消化性溃疡出血患者进行前瞻性研究,按随机数字表法将其分为研究组与对照组各50例。对照组采用注射用艾司奥美拉唑钠治疗,研究组采用注射用艾普拉唑钠治疗。比较两组止血成功率、再出血率,治疗前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]水平和不良反应发生率。结果:研究组止血成功率高于对照组,再出血率低于对照组,差异均有统计学意义(P<0.05);治疗后,两组PT、APTT均短于治疗前,且研究组短于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:艾普拉唑钠治疗消化溃疡出血患者可提高止血成功率,改善凝血功能指标水平,以及降低再出血率、不良反应发生率的效果优于艾司奥美拉唑钠治疗。

半夏泻心汤联合穴位贴敷治疗肝胃不和型消化性溃疡出血临床观察

目的 探究半夏泻心汤加减联合穴位贴敷治疗肝胃不和型消化性溃疡出血的疗效。方法 选取玉山县中医院2022年7月—2023年9月收治的60例肝胃不和型消化性溃疡出血患者,随机数字表法将其设为对照组与研究组,各30例。对照组予西医常规治疗,研究组在此基础上予半夏泻心汤加减联合穴位贴敷治疗。分析2组疗效、腹痛缓解时间、止血时间、住院时间、不良反应、中医证候积分及贫血指标。结果 治疗后,研究组疗效比对照组高(P<0.05);治疗后,研究组中医证候积分低于对照组(P<0.05);研究组腹痛缓解时间、止血时间及住院时间均短于对照组(P<0.05);研究组血红蛋白、血细胞比容和红细胞计数高于对照组(P<0.05);2组不良反应总发生率对比,差异无统计学意义(P>0.05)。结论 半夏泻心汤加减联合穴位贴敷治疗肝胃不和型消化性溃疡出血疗效确切,可明显改善患者临床症状及贫血指标,且安全性较高。

小儿消化道出血的临床特点分析

目的分析小儿消化道出血的临床特征,为儿童消化道出血规范诊治提供理论依据。方法临床纳入2021年9月—2023年3月在泉州市儿童医院收治的小儿消化道出血109例,对全部小儿消化道出血的临床资料进行回顾性分析,总结小儿消化道出血的临床特征。结果嗜酸性粒细胞胃肠炎1例,急性胃肠炎1例,15例感染幽门螺杆菌,11例为十二指肠溃疡;糜烂性胃炎7例,结肠炎9例;直肠溃疡1例,直肠息肉22例,炎症性肠病8例;十二指肠炎5例,结肠息肉10例,咽下综合征1例,急性出血性胃炎1例,贲门炎7例,肛裂10例。结论小儿消化道出血需要结合其出血原因予以针对性地诊治。

消化性溃疡患者外周血细胞免疫及体液免疫功能变化分析

目的探讨消化性溃疡患者外周血细胞免疫及体液免疫功能的变化及临床意义。方法选择2014年1月—2015年1月杭州师范大学附属医院门诊及住院的连续经胃镜确诊的消化性溃疡患者122例为溃疡组,另选择同期体检中心体检健康者70例为对照组,溃疡组患者根据是否感染幽门螺杆菌分为幽门螺杆菌阳性亚组(Hp+亚组)85例和幽门螺杆菌阴性亚组(Hp-亚组)37例,根据是否出血分为出血亚组58例和未出血亚组64例。检测外周血细胞免疫指标(包括CD_3、CD_4、CD_8、CD_4/CD_8、CD_(19)、CD_(56))及体液免疫指标(IgG、IgA、IgM、IgE、C_3、C_4)水平,出血亚组中30例大便隐血试验阳性患者大便隐血试验转阴后复查外周血细胞免疫指标及体液免疫指标。结果溃疡组患者外周血CD_3、CD_4、CD_4/CD_8、CD_(19)、CD_(56)、C_3、C_4水平较对照组降低,IgG水平较对照组升高(P<0.05);Hp+亚组患者外周血CD_3、CD_4、CD_8、CD_(19)、IgM、IgE水平较Hp-亚组升高,CD_4/CD_8较Hp-亚组降低(P<0.05);出血亚组患者外周血CD_3、CD_4水平、CD_4/CD_8较未出血亚组降低(P<0.05)。大便隐血试验阳性患者转阴后外周血CD_3、CD_4、CD_8、CD_(19)、CD_(56)、C_3、C_4水平较治疗前升高,IgG、IgM水平较治疗前降低(P<0.05)。结论消化性溃疡患者存在免疫功能调节紊乱,幽门螺杆菌感染可促使机体产生强烈的免疫反应,急性出血后免疫功能处于抑制状态,止血后免疫功能有所恢复。