Is Helicobacter pylori eradication indicated in cirrhotic patients with peptic ulcer disease?

INTRODUCTION: The association between H. pylori infection and peptic ulcer disease (PUD) and the efficacy of eradication of H. pylori in treating ulcer disease in cirrhotic patients remains controversial. This study was carried out to ascertain the prevalence and significance of H. pylori in cirrhotic patients with PUD and to assess the need for anti H. pylori thrapy METHODS: Three groups of patients were studied . These were patients with (A) cirrhosis and PUD, (B) uncomplicated PUD and (C) cirrhosis without PUD. H. pylori status was determined by endoscopic urease test . Eradication therapy was given with a four drug regimen and repeat endoscopy was done three months later to detect ulcer healing as well as H. pylori status with PUD in groups A and B. RESULTS: Cirrhotic patients with PUD had a significantly lesser prevalence of H. pylori compared to uncomplicated ulcer patients (46.9 % vs 80 %; p = 0.04). While H. pylori eradication rates were similar between cirrhotic and non cirrhotic patients, ulcer healing rate was significantly lesser in cirrhotic patients ( 48 % vs 80.9 %) . Majority of residual ulcers in cirrhotic patients were negative for H. pylori. CONCLUSION: Eradication of H. pylori does not reduce the residual ulcer rate indicating that H. pylori infection might not be a significant risk factor for PUD in cirrhotic patients. Hence, routine H. pylori eradication might not be warranted in patients with cirrhosis and peptic ulcer disease.

Improvement in dysphagia and quality of life with self-expanding metallic stents in malignant esophageal strictures.

BACKGROUND: Carcinoma of the esophagus often presents at an advanced stage, with absolute dysphagia or aspiration. Palliative procedures have an important role in improving the quality of life (QOL) of patients who are not candidates for curative therapy. We report on the efficacy and complications of self-expanding metallic stents (SEMS) in such patients. METHODS: Ultraflex nitinol SEMS were placed under endoscopic guidance in patients with malignant esophageal strictures. Dysphagia, pain and QOL were assessed before and after SEMS placement. RESULTS: Thirty patients were treated with SEMS. QOL score improved significantly from 62-94 before stenting to 80-133 after the procedure. There was improvement in dysphagia grades. Pain was the most common complaint noted on follow up. There was no major morbidity or mortality related to the procedure. CONCLUSIONS: SEMS placement is a safe and effective treatment modality for palliation of dysphagia due to malignant esophageal strictures. It provides lasting relief in dysphagia and improvement in QOL, without major complications.

Postoperative intussusception in the adult: a case report.

We report the case of a 40-year-old man who presented with a history of sudden onset abdominal pain and obstipation of 1 day's duration. During laparatomy, a 5mm perforation was seen in the anterior wall of the first part of the duodenum, which was closed by a Graham patch and the abdomen was closed after peritoneal lavage. Postoperatively, the patient's condition worsened and he was posted for a laparatomy with a diagnosis of postoperative obstruction. During the laparatomy, an ileocolic was seen which could be easily reduced. After the second surgery, the patient made an uneventful recover.