Long term Low-Dose Aspirin Therapy: Is Gastric Protection Necessary?

Aspirin is commonly used in primary and secondary prevention of cardiovascular events. However, its long-term use leads to gastrointestinal compromise, such as gastric mucosal erosions, peptic ulcer, and GI bleeding. These complications are common in our daily clinical practice, as illustrated in the case of a 67-year-old male who has ischaemic heart disease and was on long-term aspirin without any gastric protection for 9 years. He was subsequently admitted for bleeding from gastric ulcers and diagnosed to be positive for H. pylori infection. The risk factors for GI damage and bleeding, and the evidence for gastric protection in long-term aspirin users are reviewed here. High-risk patients, such as those with a history of ulcer disease or gastrointestinal bleeding, should undergo screening and treatment of H. pylori infection. Concomitant use of proton-pump inhibitors is recommended as they are superior to histamine-2 receptor antagonists in prevention of GI bleeding. PPI use should also be encouraged if patients have two or more of the following risk factors: over 60 years old, corticosteroid use, dyspepsia, or gastroesophageal reflux disease symptoms. Further research is needed to determine if H. pylori screening is required prior to commencement of long-term aspirin in the general population.

Effect of cognitive behavior intervention combined with drug therapy on quality of life in patients with gastric duodenal ulcer / 中国生化药物杂志

Objective To investigate the effect of combination therapy with cognitive behavior on the quality of life of patients with gastroduodenal ulcer.Methods The patients with gastroduodenal ulcer treated in our hospital from April 2015 to April 2017 were randomly divided into intervention group and control group according to the order of treatment.Both groups were treated with bismuth-containing quadruple therapy and routine nursing was performed.The intervention group received cognitive behavior on this basis.SF-36 scale was used to evaluate the quality of life of the two groups of patients, and the prognosis of the patients was evaluated.The patient satisfaction was investigated by the self-designed questionnaire of patient satisfaction questionnaire.The clinical efficacy, treatment compliance, quality of life improvement, prognosis and satisfaction were compared between the two groups.Results The total effective rate was 96.67%(58/60) in the intervention group and 81.67%(49/60) in the control group.The total effective rate of the intervention group was significantly higher than that of the control group(P<0.05).The scores of SF-36 scale in the intervention group were higher than those in the control group(P<0.05).The incidence of complications in the intervention group was lower than that in the control group, and the satisfaction rate was higher than that of the control group(P<0.05).Conclusion Cognitive behavioral intervention combined with bismuth quadruple therapy for gastroduodenal ulcer can improve the patient's compliance and efficacy, significantly improve the quality of life of patients, improve patient satisfaction, with clinical application value.

Effect of irrigation of peritoneal cavity with warm normal saline on expression of transforming growth factor beta-1 in the peritoneum during the laparoscopic operation / 国际外科学杂志

ObjectiveTo explore the effects of the temperature of saline for irrigation of peritoneal cavity on expression of transforming growth factor beta- 1 in the peritoneum.MethodsSixty patients scheduled for the laparoscopic repair of gastroduodenal benign ulcer perforation were randomized into two groups then surgically treated with various temperature saline.Peritoneal biopsies were taken at the beginning and end of surgery.Tissue concentrations of total and active were measured using enzymelinked immunosorbent assa technique.ResultsAt the start of surgery,there were no significant differences between groups in the total and active fractions of TGFβ1 (P ＞0.05).At the end of procedure,the peritoneal total( 135.8 ±52.8) pg/mL and active( 136.5 ± 33.0) pg/mL concentrations were significantly lower(P ＜ 0.05) in patients receiving warm normal saline.A light,nonsignificant increase in total(361.3 ± 178.9) pg/mL and active ( 198.3 ± 87.5) pg/mL TGFβ1 levels was observed in patients receiving cold saline(P ＞ 0.05).ConclusionsThe choice of warm normal saline used in irrigation of peritoneal cavity during the laparoscopic operation can decrease peritoneal transforming growth factor beta-1 concentrations.Because of the broad biological effects of TGF31,including regulation of peritoneal healing and oncological processes,this observation may have important clinical perspective.

Comportamiento de la úlcera gastroduodenal perforada / Behavior of the perforated gastroduodenal ulcer

INTRODUCCIÓN: la úlcera gastroduodenal perforada continúa siendo un problema importante para el cirujano. OBJETIVO: caracterizar a los pacientes con úlceras gastroduodenales perforadas en un periodo de 4 años. MÉTODOS: se realizó un estudio descriptivo y retrospectivo en el Hospital Militar Central Dr. Carlos J. Finlay. Se seleccionaron 140 historias clínicas de pacientes a quienes se les efectuó intervención quirúrgica urgente por presentar úlcera gastroduodenal perforada, desde enero de 2004 a diciembre de 2008. Las variables recogidas fueron: edad, sexo, ocupación, localización de las perforaciones, hábitos tóxicos, procederes quirúrgicos empleados y complicaciones posoperatorias. RESULTADOS: predominó el grupo de edad de 51 a 60 años, la ocupación obrera y el sexo masculino. Las perforaciones duodenales fueron las más frecuentes. El tabaquismo, consumo de café y alcoholismo se consideraron los hábitos tóxicos predominantes en los pacientes. El proceder quirúrgico más empleado fue la sutura y epiploplastia. La sepsis de la herida quirúrgica y la peritonitis resultaron ser las complicaciones más frecuentes. CONCLUSIONES: Los pacientes atendidos por úlcera gastroduodenal perforada correspondieron fundamentalmente al sexo masculino, mayores de 50 años de edad con úlcera duodenal y consumidores de café, tabaco, alcohol, y fueron tratados con sutura y epiploplastia

INTRODUCTION: the perforated gastroduodenal ulcer remains as a significant problem for surgeon. OBJECTIVE: to characterize the patients presenting with perforated gastroduodenal ulcers over four years. METHODS: a retrospective and descriptive study was conducted in the Dr. Carlos J. Finlay Central Military Hospital. A total of 140 medical records were selected from patients underwent an urgent surgical intervention due to perforated gastroduodenal ulcer from January, 2004 to December, 2008. Variables included were: age, sex, occupation, perforations locations, toxic habits, surgical procedures used and postoperative complications. RESULTS: there was predominance of 51 to 60 age group, occupation and male sex. The more frequent were the duodenal perforations. Smoking, coffee habits and alcoholism were the predominant toxic habits in patients. The more used surgical procedure was the suture and epiploplasty. The surgical wound sepsis and the peritonitis were the more frequent complications

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica / Stress ulcer prophylaxis in pediatric intensive care units

OBJETIVO: Avaliar a utilização de profilaxia para úlcera de estresse (UE), em pacientes internados, de cinco unidades de terapia intensiva pediátrica (UTIP) de Porto Alegre (RS). MÉTODOS: Estudo multicêntrico, prospectivo, transversal, observacional. Foram avaliados os prontuários dos pacientes internados em dia definido para visitação, entre abril de 2006 e fevereiro de 2007, excluindo os avaliados em visitas anteriores e aqueles com hemorragia digestiva alta na admissão. Foram avaliados a idade, o gênero, o diagnóstico na admissão, a gravidade da doença, o uso de profilaxia para UE, a sua justificativa e o medicamento profilático utilizado como primeira escolha. As variáveis foram descritas como frequências absoluta e relativa, ou média e desvio padrão/mediana, e intervalo interquartil (IQ). Os testes qui-quadrado de Pearson, de tendência linear, ou exato de Fisher foram utilizados para avaliar as associações. O nível de significância adotado foi de 5 por cento, sendo estatisticamente significativo p < 0,05. RESULTADOS: Foram avaliados 398 pacientes, sendo 57 por cento do gênero masculino. A mediana de idade foi de 16 meses (IQ4-65) e mediana de permanência em UTIP foi de 4 dias (IQ1-9). O principal motivo de internação foi doença respiratória (32,7 por cento). Usaram profilaxia 77,5 por cento dos pacientes, variando de 66 a 91 por cento; a ventilação mecânica (22,3 por cento) foi a justificativa mais prevalente, seguida de rotina informal do serviço (21,4 por cento). Apenas uma das UTIP tinha protocolo assistencial para profilaxia de UE. A ranitidina foi o medicamento mais empregado (84,5 por cento). CONCLUSÕES: O uso de profilaxia para UE foi prática frequente nas UTIP avaliadas, sendo a ranitidina a droga de escolha. Entre as justificativas, a ventilação mecânica e o uso baseado em rotinas institucionais foram as mais prevalentes.

OBJECTIVE: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil. METHODS: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5 percent (p < 0.05). RESULTS: 398 patients (57 percent male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7 percent). Most patients received stress ulcer prophylaxis (77.5 percent; range, 66-91 percent). Mechanical ventilation (22.3 percent) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4 percent). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5 percent of cases). Evidence of minor gastrointestinal bleeding was found in 3 percent of patients; none had clinically significant bleeds. CONCLUSIONS: Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.

Treatment of Gastroduodenal Ulcer Perforation of 59 Cases with Acupuncture plus Sanbai Powder / 国际中医中药杂志

Objective To investigate an effective method to treat gastric ulcer perforation with integrated traditional Chinese and western medicine. Methods 117 patients were randomly divided into a treatment group and a control group.The treatment group was treated with acupuncture plus Sanbal Powder, and the control group was treated with conventional western medicine exclusively. Results The two groups showed significant difference in the cure rate, the total efficiency, the average inpatient free, and the relapse rate in three years with P＜0.01. Conclusion The therapy of integrated traditional Chinese and western medicine will shorten inpatient time, alleviate pain and increase recovery rate when treating gastroduodenal ulcer perforation.

H.pylori infection status in gastroduodenal ulcer patients and primary evaluations of bacterial antibiotic sensibility at Can Tho General Hospital

Study on 100 gastroduodenal ulcer patients treated at Can Tho General Hospital between March and December 2001. Results: the prevalence of gastric ulcer was high (58%), followed by duodenal ulcer (39%) and the prevalence of gastroduodenal ulcer was low (3%). The rate of H.pylori positive was 66.66% in duodenal ulcer patients, 55.17% in gastric ulcer patients. The rate of H.pylori infection was 33.33% in gastroduodenal ulcer patients. H.pylori was still sensitive with amoxicillin (97.29%), tetracycline (94.6%), clarythromycine and erythromycin (72.97%), but was highly resistant with metronidazole (91%).

The efficacy of the solution of 3.6% natri chloride - 1/10000 adrenaline in treatment of peptic ulcer bleeding due to gastroduodenal ulcer through endoscopy

From March 2001 to August 2001, at the Military Hospital N0 108, 185 cases of gastrointestinal hemorrbiage due to gastroduodenal ulcer were managed, among them 55 bleeding cases by HSE injection. The incidence of this hemorrhage was higher in male patients than in femal and a majority of patients was in productive age. HSE injections gave successful results on 100%. The rate of success in the 1st injection attained in 47 cases (81.2%), in 8 cases (18.2%) the bleeding recured or had got the risk of recurrent bleeding and an injection again to cease the hemorrhage was needed. There was 1 patient needed the third injection. The mean dose of efficacy for 1 bleeding ulcer attained 8.82.6ml with 4.01.2 injections. The time of injection was 17.35.1 minute. HSE were effective in stop bleeding, using HSE is simplicity, safety and low cost.

Management of perforated gastroduodenal ulceration

170 patients with perforated peptic ulcer (90% perforated duodenal ulcer and 10% perforated gastric ulcer) were included in the study from 8/1998 to 8/1999 at the Cho Ray hospital, Ho Chi Minh city. 165 patients (97.05%) were treated by simple surgical closure (including by one laparoscopic repair) with a postoperative mortality of 4.84%. 4 of them were treated by subtotal gastrectomy and one by vagotomy+ pyloroplasty without mortality. In summary, simple surgical closure is a satisfactory operation for most patients.

The results after more than 1 year of the histopathology of the gastric mucosa before and after eradication of H. pylori in patient with the gastro-duodenal perforation and ulceration

The Aims of this study were to investigate to the role of Helicobacter pylori (H. pylori) eradication in cases of perforated peptic ulcer treated by simple surgical closure. In a large prospective study, these patients with H. pylori positive were evaluated before and after H. pylori eradication (>2 months and >1 year). Changes of gastric mocosal histopathology were assessed. Results: Improvement or resolution on the outcome of gastritis and atrophy (P<0.001) demonstrated the efficacy of eradication therapy but intestinal metaplasia did not change. Conclusions: After successful eradication of H. pylori, these lesions were restored significantly, but intestinal metaplasia is questionable

Relation between H.pylory infection and intestinal dysplasia and heteroplasia in patients with gastroduodenal ulceration

2,282 patients with gastric syndrome indicated the gastric endoscopy and histopathological test in the poste-telecommunication hospital during 1996-1998 have shown that the rate of heteroplasia among patients with gastritis, pepsic ulceration, duodenal ulceration, gastro-duodenal ulceration and anastomosis stoma were 18%; 34.3%, 25%; 25%, 27.2%, respectively. The rate of dysplasia among patients with gastritis, pepsic ulceration, duodenal ulceration, gastro-duodenal ulceration and connective stoma were 3.31%; 15.09%; 8.63%; 8.33%; 22%, respectively. It is not found that there was a relation betwween age with heteroplasia and dysplasia but dysplasia and heteroplasia ococcurredn the most of patients with possitive H.pylori.

Evaluation the stop-bleeding effect of Sandostanin in gastroduodenal ulcer-caused hemorrhage

The study involved 30 patients (21 males, 9 females, aged from 18 to 77) who had gastroduodenal ulcer-caused bleeding at the Hospital 103 between October 1999 to July 2000. Common symptoms included dizziness, tar-like stool, fatigue and fast pulse. The patients received Sandostanin 0.1 mg two ampoule mixed in 500 ml isotonic glucose or saline solution intravenous for 4 - 5 hours in consecutive 3 days. Results: Sandostanin (octreotid) is effective for gastroduodenal ulcer-caused bleeding, stops bleeding rapidly even in first day (93.4%), reduce the amount of transfused blood, shorten the stay duration, reduce the relapse, rate of induced sclerotization and operation is lowered. Sandostanin is safe, almost free of adverse effects and should be indicated early.

Laparoscopic evaluation of gastroduodenal ulceration before and after treatment with omeprazole or famotidin

86 patients (male: 56) with gastroduodenal ulceration divided into 2 groups: group A - patients treated by omeprazole and group B- patients treated by famotidine. The results of laparoscopic examination have shown that the gastroduodenal ulceration can be radically treated by omeprazole or famotidine in combination with antibiotics in case of gastroduodenal ulceration with H. pylori: 85.1-92.3% of patients had no pain after 4 weeks of the treatment and 100% of patients in group A and 93.61% of patients in group B had scar healing.

Gram stain and determining enzyme urease to diagnosis rapidly with Helicobacter pylori infection in the patients with gastroduodenal ulcer

Investigating the biopsed gastroduodenal specimens collected from patients with gastroduodenal ulcer showed that: the gastroduodenal conditions can occur in all age groups, but they are most likely to be seen in the middle and old people. Gram stain and urease test from biopsed specimens gives result rapidly, especially with Gram stain. Rate of positive result is high (90.6% and 89.5%, respectively). Therefore, it can be based on the result of two these techniques to make diagnosis earlier

Histopathological features of gastric mucosa before and after eradication of H.pylori in patients with operated perforated gastroduodenal ulceration

98 patients with perforated peptic ulcer were treated by simple surgical closure followed by H.pylori eradication. Effect of H.pylori eradication was demonstrated by improvement or resolution of histopathological lesions of chronic gastritis 97.95% compared with 60.2% in pre and postreatment lesions (p<0.0001), atrophy 20.83% vs 4.16% (p<0.0001) and intestinal metaplasia 18.75% vs 9.37% (p < 0.005). After successful eradication of H.pylori, these lesions were restored and improved significantly in patients received a new triple therapy for 7 days (OCA-7).

Presence of antibody against H. pylori among patients with gastro-duodenal ulceration and healthy Vietnamese

The results of study on the sera of 110 patients with gastro-duodenal disease and 31 healthy person by indirect immuno-fluorescence assay (IFA) show that prevalence of IgG anti-H. pylori is 98.2% on patients and 77.4% on healthy persons. The proportions of IgM seropositive on both groups are 6.5%-7.3%. The discriminated point of IgG by IFA is 1:32.

Results of treatment of patients with gastroduodenal ulceration by pansiron G

40 patients with gastroduodenal ulceration and positive H.pylori treated by pansiron, amoxycilline and metronidazole within 10 days. The results have shown that pansiron G was a drug that cover the gastric mucosa well and heal 70% of ulceration focuses. The H.pylori killing rate by the above outline was 65,7%.

Perforated gastroduodenal ulceration saturation via abdominal endoscopy

Remarks on laparoscopic suture of perforated peptic ulcer. Objectives: to evaluate the early result of laparoscopic repair of perforated peptic ulcer. Method: prospective study. The outcome of 26 patients having the lararoscopic repair of perforated peptic ulcer was compared with the outcome of 26 patients treated with suture via laparotomy during the same period – from Sept 1995 to Dec 1998. Results: the average operative time of laparoscopic suture was longer than for open suture (69.6 min Vs. 48.7 min; T test, p<0.05). There was no difference of the time between the laparoscopic and the open groups to resume normal diet (3.8 days). The everage hospitalization days for laparoscopic repair was shorter than for open repair (6 days; T test, p < 0.05). Conclusions: laparoscopic repair of perforated peptic ulcer is feasible, safe and effictive, has the additional and well – known advantages of minimally invasive surgery.

Several complication of gastroduodenal ulceration after urological operation

A study on 5 cases of severe complication of gastroduodenal ulceration after urological operation and restrospective study on the medical records in Viet Duc hospital have shown that the treatment of gastroduodenal ulceration involved ages, time of hospitalization, pathoanatomical lesions. The severe complication of gastroduodenal ulceration indicated by emergency operation for cutting 2/3 stomach with safe results.

Emergency Management of Acute Gastroduodenal Ulcer Perforation / 中国微创外科杂志

38 ℃),while in the open group,3 patients showed complications,12 had the body temperature over 38 ℃.Conclusions Laparoscopic repair,which is feasible and safety for acute gastroduodenal ulcer perforation,should be the first choice in emergency,while non-surgical treatments and emergency subtotal gastrectomy can be two alternatives.