Andrographis paniculata as Promising Novel Protective Therapy of Oxidative Stress in Indomethacin-Induced Gastric Ulcer in Rats

This research investigated the effect of Andrographis paniculata (AP) on oxidative stress following indomethacin-induced gastric ulcer in rats. A total of 20 male albino Wistar rats (150-180g) used for this study were grouped into four (n=5): 1, Negative Control; 2, Positive Control and 3, test group treated with normal chow, 20mg/kg indomethacin, 20 mg/kg indomethacin plus omeprazole at 20mg/kg and 20mg/kg indomethacin plus AP at 16.7 mg/kg respectively. After treatment period, estimation of oxidative stress parameters was carried out on the animals. The LD50 of aqueous extract of AP was 50mg/kg bw. Body weight change was significantly reduced in omeprazole treated group compared to all other groups while extract treated group had significantly increased body weight change. There was a significant increase in malondialdehyde (MDA) level of ulcer untreated group compared to other groups. The two treated groups had significantly reduced MDA compared to ulcer untreated group. There was a significant decrease in the levels of GPx and SOD of ulcer untreated group compared to control. Meanwhile, these were significantly increased in extract and omeprazole treated groups compared to ulcer untreated group. Catalase was significantly increased in all three groups when compared to control but its level was significantly increased in extract treated group compared to ulcer untreated and omeprazole treated groups. From this study, AP has proved to protect against oxidative stress implicated in the pathogenesis of ulcer. If this result is applicable to humans, further research and use of AP in ameliorating debilitating consequences of peptic ulcer should be encouraged.

Change in prevalence and pattern of peptic ulcer disease in the Northern Savannah of Nigeria: An endoscopic study

Background: Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria. Aim: This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world. Methods: Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed. Results: Over a 9 year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 14­85), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged 40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU. Conclusion: The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed ­ patients were predominantly male and older, and GU predominated.

Predictive Value of Neutrophil-to-Lymphocyte Ratio for Differentiating Organic Dyspepsia from Functional Dyspepsia

ABSTRACT Objective: Dyspepsia, one of the most commonly seen symptoms, can be due to organic dyspepsia (OD) or functional dyspepsia (FD). The aim of this study is to evaluate neutrophil-tolymphocyte ratio (NLR) for the predictability of OD due to peptic ulcer disease (PUD) and gastric cancer (GC). Methods: We investigated retrospectively the patients with dyspepsia who underwent endos-copy. The study included 119 patients with OD (41 patients with biopsy-proven GC and 78 patients with PUD) and 100 patients with FD diagnosed. Results: The NLR among the patients with GC and PUD was significantly higher than FD subject (p < 0.001 each). The NLR in patients with GC was also significantly higher than that in patients with PUD (p < 0.005). When OD was compared with FD, NLR and white blood cell were statistically significantly higher (p < 0.001 and p < 0.05 respectively). The best predictive cut-off value of NLR was 1.72 with a specificity of 63% and a sensitivity of 66% for OD, on receiver-operating characteristic curve analysis. Conclusion: Neutrophil-to-lymphocyte ratio was higher in patients with OD compared with those with FD, and even higher in patients with GC. Our findings suggest that NLR should be calculated in patients with dyspepsia and patients with high levels of NLR should undergo endoscopy.

Mechanism of Magnoliae Officinalis Cortex in treatment of peptic ulcer based on network pharmacology and molecular docking / 中国中药杂志

Magnoliae Officinalis Cortex(Houpo) can treat peptic ulcer disease(PUD), the mechanism of which remains unclear. In this study, network pharmacology and molecular docking were employed to predict the mechanism of Houpo in the treatment of PUD. Through literature review and TCMSP screening, 15 main active ingredients were obtained. The SwissTargetPrediction database was used to predict the potential targets of the ingredients, and Therapeutic Target Database(TTD), DrugBank, and Human Phenotype Ontology(HPO) to screen the disease-related targets. A total of 49 potential targets were obtained by the intersection of active ingre-dients-related targets and disease-related targets. Cytoscape 3.6.1 was employed to construct the protein-protein interaction network for the targets with high confidence(score>0.700) screened out by STRING. The DAVID database was used for GO and KEGG pathway enrichment of potential targets. GO enrichment analysis showed that the treatment mechanism was mostly related to nuclear receptor activity, ligand-activated transcription factor activity, and G protein-coupled acetylcholine receptor activity. KEGG enrichment analysis found that Houpo could regulate material metabolism, endocrine system, p53 signaling pathway, and PPAR signaling pathway. Molecu-lar docking verified that all 15 ingredients had good binding activities with key targets(CHRM1, CHRM2, FABP1, mTOR, and STAT3). The results mean that Houpo can treat PUD by participating in cell metabolism, inhibiting inflammatory cytokines, and regulating cell proliferation and apoptosis.

A study on surgical complications of peptic ulcer disease: a prospective study at a tertiary care center

Background: Peptic ulcer was defined as a disruption of the mucosal integrity of the abdominal esophagus, stomach, duodenum leading to local defect or excavation due to active inflammation. Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy & low tachyphylaxis associated with those drugs. This study aims to evaluate the surgical complications of peptic ulcer disease and tested the hypothesis that despite the decrease in hospitalization for PUD, the incidence of elective surgery for PUD during the recent three decades tends to decrease and in contrast, the frequency of emergency surgical interventions for complications of the PUD has remained consistent.Methods: A total of 60 patients operated for complications of PUD, admitted to PES Institute of Medical Sciences, Kuppam, from January 2018 to September 2019. All data that may be potential predictors concerning complications of PUD were prospectively analyzed.Results: In the present study, the most common complication was perforated peptic ulcer (78.3%) followed by Gastric outlet obstruction (15%) and rest bleeding peptic ulcer.Conclusions: Despite the efficacy of modern medical therapy, decreasing the overall PUD hospitalizations, the volume of procedures to treat complications of PUD has not declined.

Effect of quercetin on histamine induced gastric ulcers in male guinea pigs

Background: Peptic ulcer disease is the most prevalent gastrointestinal diseases caused by an imbalance between gastric stimulant or aggressive factors and the mucosal defensive factors. The defence of flavonoids against the tissue oxidative stress is being proved in various animal models for wide pharmacological effects. The aim of the present study is to evaluate the anti-oxidant effect of quercetin in histamine induced gastric ulcers.Methods: Male guinea pigs were divided into 4 groups (n=6). Group I includes normal control. Group 2, 3 and 4 were induced gastric ulcers with histamine as intraperitoneal (IP) injection. Group 2 serves as the gastric ulcer control. Group 3 and Group 4 are pre-treated with quercetin 200 mg/kg per orally (PO) and ranitidine 100 mg/kg PO respectively 45mins before histamine injection. After 4 hours of histamine injection, the animals were sacrificed to collect blood samples and stomach tissue for estimation of plasma and tissue antioxidant levels.Results: On estimation of antioxidant levels both in plasma and stomach tissues the SOD and CAT levels increased in the Group 3 and 4 significantly and also a significant reduction in MDA levels were noted in the Group 3 and 4 compared to the gastric ulcer control group.Conclusions: Hence, with flavonoids quercetin utilization in histamine induced gastric ulcers, the antioxidants showed comparative levels with ranitidine treatment groups. So a permanent cure for the chronic gastric ulcers could be proved in further studies as this is the milestone, tough to achieve in general clinical practice.

A Study on the Healing of Peptic Ulcer Disease after Eradication of Helicobacter Pylori Infection in Rural People Bangladesh

Objective: In this study our main aim is to evaluate the healingof peptic ulcer disease after eradication of helicobacter pyloriinfection in rural people Bangladesh.Methodology: This Prospective observational study wasconducted at tertiary hospital Dhaka district from Tertiarymedical college and hospital among 100 patients diagnosedcoming to the gastroenterology outpatient departmentaccording to inclusion and exclusion criteria was included inthe study.Result: In our study among 100 patients, most of the patientsbelong to 31-40 years age group, which was 37.78% and 57%were male and 43% were female. 15.07% patients hadduodenal ulcer and 21.09% had gastric ulcer for H. pyloripositive.18% patients were still positive for H.pylori aftereradication therapy.Conclusion: In conclusion, we can say that, prolonged Followup with upper GI endoscopy for additional period for recurrenceof ulcer should have been done for patients whose peptic ulcerdisease had resolved but could not attain H. pylori eradication.

Frequency of Peptic Ulcer Disease Increases with Severity of Cirrhosis of Liver: Experience of Tertiary Level Hospital of Dhaka

Introduction: Cirrhosis of Liver is prevalent in Bangladesh.PUD can coexist with portal hypertension with cirrhosis.Objectives: To identify frequency of peptic ulcer diseaseincreases with severity of cirrhosis of liver.Materials & Methods: Consecutive 96 patients of cirrhosis ofliver had enrolled when found oesophageal varices at ourendoscopy unit during endoscopic evaluations in 4 monthsperiod (August 2017 to November 2017).Results: Total cirrhotic patients enrolled were 114 (M=75,F=39), mean age was 51.80 ± 14.20 yrs (18-86years). HBVwas the leading cause of cirrhosis in 54.18%, HCV 5.22 %,proven NASH were 12.24% and rest were from unknownaetiology. Their average CTP score were 8.6 (12-5), 37.6%associated with portal hypertensive gastropathy. Grade-IIIoesophageal varicose found in 52 patients, whereas grade-II in25 patients. Among this 114 patients 46 (40.62%) revealedpeptic ulcer disease more in the form of gastric ulcer (n=31)than duodenal ulcer (n=10) and both (n=5).Most of the ulcersbelonged to Forrest class III (76.92%).Conclusion: Variceal bleeding and portal hypertensivegastropathy in patients with liver cirrhosis are prevalent causesof bleeding and anaemia. One of the potential causes ofhaematemesis, melaena, and anaemia among these patientsin Bangladesh has been discovered to be peptic ulcer illness.To verify the findings, large, multicenter-controlled trials arerequired.

Intervention experience of omeprazole in the treatment of peptic ulcer disease / 中国生化药物杂志

Objective To observe the effect of omeprazole combined with nursing intervention in the treatment of peptic ulcer disease and evaluate its clinical effect. Methods 83 cases from January 2014 to March 2017 were as the research object, using randomly divided into the control group of 41 patients treated with omeprazole alone, during perioperative treatment give nursing intervention, 42 patients in study group were given omeprazole treatment and nursing intervention, compared two groups of patients with clinical treatment. Results After treatment, the two groups of patients with various indicators of statistical data show that the total efficiency of the study group was 95.24% (40/42), control group was 80.49%(33/42), with statistical significance in two groups the difference (P< 0.05); in addition, compared with before treatment, two groups of patients after treatment, stomach burning sensation, epigastric pain, postprandial protection, belching symptoms and SDS scores, SAS scores were significantly improved, and the improvement in the study group The effect is obviously better than that of control group (P<0.05). Conclusion The treatment of omeprazole combined with nursing intervention in patients with peptic ulcer, can play a satisfactory effect, effectively improve the clinical symptoms of the disease and improve the negative emotions of patients, with clinical application value.

A Case Report of An End-Stage Renal Failure Patient with Peptic Ulcer Disease

@#A 64-year-old man with a background of chronic kidney disease (CKD) was admitted to hospital for symptoms of uraemia and was subsequently initiated on haemodialysis (HD). On day 13 of HD, he developed per rectal bleeding with a significant drop in his haemoglobin (Hb) level. Oesophagoduodenoscopy (OGD) was performed and showed several antral and duodenal ulcers. Colonoscopy was unremarkable. He was started on high-dose PPI and his Hb level remained stable with no recurrence of symptoms. This case report highlights the association between HD and the increased risk of developing peptic ulcer disease (PUD) in patients with end-stage renal failure. Abdominal symptoms are common in the primary care setting and it is crucial for family physicians to be able to recognise the red flags of PUD in this group of high-risk patients as timely referral and intervention reduces morbidity and mortality.

Long-Term Recurrence Rates of Peptic Ulcers without Helicobacter pylori

BACKGROUND/AIMS: The purpose of this study is to investigate the recurrence rate of peptic ulcer disease (PUD) over a long follow-up period with PUD patients without Helicobacter pylori. METHODS: We retrospectively reviewed patients diagnosed with PUD on endoscopy and divided them into two groups: a H. pylori-negative group (HP-negative group), and a group of patients with untreated H. pylori (HP noneradicated group). We compared the recurrence rates of PUD in these two groups and analyzed the factors that affected ulcer recurrence. RESULTS: Total of nine hospitals in Korea participated, and a total of 1,761 patients were retrospectively reviewed. The HP-negative group included 553 patients, and the HP noneradicated group included 372 patients. The 5-year cumulative probabilities of PUD recurrence were 36.4% in the HP-negative group and 43.8% in the HP noneradicated group (p=0.113). The factors that were found to affect recurrence in the HP-negative group were elder, male, and comorbid chronic kidney disease. CONCLUSIONS: The 5-year cumulative probability of PUD recurrence without H. pylori infection after a long-term follow-up was 36.4% and the factors that affected recurrence were elder, male, and comorbid chronic kidney disease.

Diagnosis and Treatment of Peptic Ulcer Disease: Present and Future Perspective / 대한소화기학회지

Peptic ulcer disease is one of the most commonly encountered diseases in gastroenterology clinics. After the discovery of Helicobacter pylori by Warren and Marshall, it has been identified as the most important cause of peptic ulcer. Eradication of H. pylori markedly reduces the post-treatment recurrence rate of peptic ulcer. However, as human populations age, the incidence of cardiovascular and musculoskeletal diseases increases and consequent use of aspirin and non-steroidal anti-inflammatory drugs increases. Thus causes and presenting patterns of peptic ulcer have changed. In this review, I describe new diagnostic and therapeutic strategies for peptic ulcer disease and explore future perspectives.

"Helicobacter pylori, hoy": una historia de 30 años / "Helicobacter pylori, today": a 30 year history

En 1983, hace 30 años, Warren JR y Marshall BJ publican el artículo en Lancet1, que revolucionó el entendimiento de varias patologías gástricas, al encontrar un bacilo curvo no identificado en el epitelio gástrico, en gastritis crónica activa, de forma casi fortuita, al bacilo llamado subsecuentemente, Campylobacter pylori y con la nomenclatura de hoy, Helicobacter pylori. Fue considerado por la OMS carcinogenético gástrico el año 2001 (Figura 1). En el 2005, fueron galardonados con el Premio Nobel de Medicina, por su contribución (Figura 2). Es el tópico que más publicaciones científicas ha generado en la literatura. En la presente revisión, nos ocuparemos de un enfoque eminentemente práctico, sobre hechos de relevancia clínica de su presencia, de su diagnóstico, de la terapéutica y sus variables actuales y de los diferentes escenarios, en los cuales nos desenvolvemos. Se hace mención de un excelente documento generado en un Consenso actualizado en Latinoamérica2.

In 1983, 30 years ago, Warren JR & Marshall BJ, published in Lancet, their leading revolutionary article1, modifying the understanding of several gastric pathologies, thanks to the discovery of an unidentified curved bacilli in the gastric epithelium, in chronic active gastritis, almost unvoluntariously, nominated sequentially Campylobacter pylori and according to the today's nomenclature Helicobacter pylori. It has been considered gastric carcinogen by WHO in 2001 (Figure 1). In 2005, they were awarded with the Nobel Prize of Medicine for their contribution (Figure 2). It is the topic generating the highest number of scientific publications, in the literature. In this publication, we deal with a practical focus on clinical relevant aspects, related with its presence, its diagnosis, the therapeutic approach and its variables, and tackling the different clinical scenarios. A recently published practical Latin American consensus, has been preferently considered2.

Why do we still have Helicobacter Pylori in our Stomachs?

The existence of any infectious agent in a highly acidic human stomach is contentious, but the chance finding of Helicobacter pylori is by no means an accident. Once H. pylori colonises the gastric mucosa, it can persist for a lifetime, and it is intriguing why our immune system is able to tolerate its existence. Some conditions favour the persistence of H. pylori in the stomach, but other conditions oppose the colonisation of this bacterium. Populations with high and extremely low prevalence of H. pylori provide useful insights on the clinical outcomes that are associated with this type of infection. Adverse clinical outcomes including peptic ulcer disease and gastric cancer depend on a delicate balance between a harmless inflammation and a more severe kind of inflammation. Is the only good H. pylori really a dead H. pylori? The jury is still out.

Triple and Quadruple Eradication Therapy for H. pylori in Iraqi Patients with Peptic Ulcer Disease a Comparative Study.

The eradication of H. pylori has become an important issue; since Helicobacter pylori infection can cause chronic gastritis, peptic ulcer, gastric cancer and (MALT) lymphoma. Standard triple therapy efficacy has decreased gradually worldwide during the last decade and quadruple therapy is recommended as an alternate treatment option for the management of H. pylori. The aim of this study was to compare between triple and quadruple therapy for eradication of H. pylori in Iraqi patients with peptic ulcer disease, and to treat the patients who relapsed after triple therapy. In addition to that; response to therapy (triple and quadruple) have been evaluated according to the Body Mass Index (BMI). A prospective case controlled study was carried on 60 patients who had peptic ulcer disease and positive H. pylori infection confirmed by (histology; stool antigen test and anti-H. pylori IgG antibody test) patients were divided into 3 groups first group involved 38 patients treated with triple therapy (500 mg clarithromycin capsules; 1 g amoxicillin capsules; and 20 mg esomeprazole capsules) for 14 days. The second group involved 22 patients treated with quadruple therapy (pylera)®; (140 mg bismuth sub citrate potassium, 125 mg metronidazole, and 125 mg tetracycline hydrochloride) for 10 days, while third group involved patients un responding to triple therapy treated with secondline quadruple therapy for 10 days. The results showed that the eradication rate of the per-protocol and intention-to-treat for quadruple therapy was 88.57%, 83.78% respectively which was more than 57.89% per-protocol and 50% intention-to-treat for standard triple therapy with high significant difference (p<0.01). Patients compliance with quadruple and triple therapy was good for the two regimens in spite of the more adverse effect of quadruple regimen compared to triple regimen. On conclusion; the 10 days treatment with quadruple therapy was more effective than 14 days triple therapy that could be attributed to more eradication rate for H. pylori.

Association between Helicobacter pylori Infection, ABO Blood Groups and Rhesus Factor in Peptic Ulcer Disease Patients, in Gezira, Central Sudan.

Blood group antigens were associated with peptic ulcer disease, which is potentially caused by Helicobacter pylori. It was recently demonstrated that the receptor for H. pylori is the blood group antigen lewisb, which is exposed only in blood group O. Objectives: To report the possible correlation among H. Pylori Infection, ABO and Rhesus (Rh) blood groups in patients with peptic ulcer disease. Methods: This cross-sectional, prospective study was carried out between Jan 2010 and Dec 2010 among patients suffering from dyspeptic symptoms attending to Wad Medani Teaching Hospital-Endoscopy Unit. All patients had their blood group phenotype and Rhesus determined by the slide hemagglutination test. All patients underwent oesophagogastrodudenoscopy to diagnose peptic ulcer disease. Gastric biopsies were obtained and examined for H. pylori by urease test. Results: 40 patients were enrolled in this study, 29 were males and 11 were females with a mean age of 50.75 ± 18.18 years. 28 patients were both H. pylori biopsy-urease and Rhesus factor positive (93.3%), while 2 patients were H. pylori positive and Rhesus negative (6.7%). Among patients who were H. Pylori urease positive; 3 were blood group A (10%), 9 were B (30%) and 18 were O (60%).Most patients 31(77.5%) had duodenal ulcers, while 9(22.5%) had gastric ulcers at oesophagogastrodudenoscopy. Out of those who had D.U at oesophagogastrodudenoscopy; 3 were Blood group A (9.7%), 10 were B (32.3%) and 18 were O (58.1%).while among those with G.U; 3 were Blood group B (33.3%) and 6 were O (66.7%). Rhesus factor was positive in 28 patients (93.3%) and negative in 2 patients (6.7%) among those who were urease positive. Patients with DU; 29(93.5%) were Rhesus positive and 2(6.5%) were negative. All patients with GU (9 patients) were Rhesus positive (100%). This implies that there was statistically significant correlation between the O blood group, positive Rhesus factor and H. Pylori infection in peptic ulcer disease patients. γ=0.023 and 0.024 respectively. Conclusion: This study suggests that can be a significant association between Rhesus positive group O and H. pylori infection.

Study on Marzulene combined with Omeprazole for treating peptic ulcer disease and the safety of Marzulene in children / 中华实用儿科临床杂志

Objective To assess the effect of Marzulene as an adjuvant therapy for peptic ulcer disease in children and the safety of Marzulene.Methods From Dec.2011 to Feb.2013,138 cases of peptic ulcer disease in children from Chongqing,Guiyang,Guangzhou,Chengdu and Xinjiang were randomly divided into trial group (n =75) and control group (n =63).The treatment protocls of the trial group was Marzulene combined with Omeprazole,and the control group gave Omeprazole only,all the cases with Helicobacter pylori (Hp) infection were treated by antibiotics,then clinical manifestations,gastroscopy and laboratory examinations were followed up after 8 weeks.Results The remission rates of clinical manifestations in the trial group were abdominal pain 91.8％ (56/61 cases),vomiting 90.2％(37/41 cases),melena 92.9％ (26/28 cases),nausea 93.1％ (27/29 cases),hematemesis 89.5％ (17/19 cases),abdominal discomfort 100.0％ (19/19 cases),abdominal distension 100.0％ (11/11 cases),sour regurgitation 100.0％ (9/9 cases),ozostomia 90.0％ (9/10 cases),eructaion 88.9 ％ (8/9 cases),bloody stools 100.0％ (4/4 cases),poor appetite 50.0％ (1/2 case),and abdominal tenderness 89.3 ％ (50/56 cases) ;the remission rates of clinical manifestations in the control group were abdominal pain 90.4％ (47/52 cases),vomiting 89.7％ (26/29 cases),melena 96.4％(27/28 cases),nausea 87.5 ％ (21/24 cases),hematemesis 92.9 ％ (13/14 cases),abdominal discomfort 58.3 ％ (7/12 cases),abdominal distension 85.7％ (12/14 cases),sour regurgitation 100.0％ (13/13 cases),ozostomia 80.0％(8/10 cases),eructaion 100.0％ (8/8 cases),bloody stools 100.0％ (4/4 cases),poor appetite 33.3％ (1/3 case),and abdominal tenderness 90.0％ (45/50 cases).Abdominal discomfort,abdominal distension,ozostomia,eructaion and poor appetite had significant statistical disparity between control group and trial group (P ＜ 0.05).One hundred and thirty-one cases reviewed gastroscopy,in the control group their ulcer clearance rate was 65.1％ (41/63 cases) ;the remission rates of gastroscopic manifestations were edema 54.8％ (34/62 cases),hyperemia 51.7％ (31/60 cases),areola 76.0％ (19/25 cases),atrophy 0％ (0/1 case),and hemorrhage 85.7％ (12/14 cases),the Hp clearance rate in the control group was 67.9％ (19/28 cases).In the trial group the ulcer clearance rate was 66.2％ (45/68 cases),and the remission rates of gastroscopic manifestation were edema 63.0％ (46/73 cases),hyperemia 64.7 ％ (44/68 cases),areola 86.1％ (31/36 cases),atrophy 50.0％ (1/2 case),and hemorrhage 100.0％ (19/19 cases) ;the Hp clearance rate in the trial group was 72.7％ (24/33 cases),and the remission rates of atrophy and hemorrhage had significant disparity between the control group and the trial group.The clinical effective rates of the trial and the control groups were 98.7％ (74/75 cases) and 98.4％ (62/63 cases),and the gastoscopic detection rates were 98.5％ (67/68 cases) and 96.8％ (61/63 cases).There was no adverse reaction in the trial group due to using marzulene for 8 weeks and 4 weeks' follow-up after its withdrawal.Conclusions Marzulene is helpful for improving the clinical and gastroscopic manifestations of peptic ulcer disease in children,and is effective and safe as an adjuvant therapy in children.

The Risk Factors and Quality of Life in Patients with Overlapping Functional Dyspepsia or Peptic Ulcer Disease with Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and peptic ulcer disease (PUD) impact the daily lives of affected individuals. The aim of this study was to compare the risk factors and impacts on life quality of overlapping FD or PUD in patients with GERD. METHODS: Data from patients diagnosed with GERD were collected between January and November 2009. FD was defined using the Rome III diagnostic criteria. The overlapping GERD-FD or GERD-PUD groups were classified as concomitant GERD and FD or peptic ulcers. The characteristics of these individuals were analyzed. RESULTS: There were 63, 48, and 60 patients in the GERD only, overlapping GERD-FD, and overlapping GERD-PUD groups, respectively. Significantly younger age, female gender, lower body weight and body mass index, and higher rates of tea consumption were noted in the GERD-FD group. Patients in the GERD-FD group exhibited the lowest quality of life scores, both with respect to physical and mental health, on the Short Form 36 domains. CONCLUSIONS: Patients with concomitant GERD and FD were more likely to be younger and female. Overlapping GERD and FD had the worst impact on the quality of life of the affected individuals.

Etiologia da hemorragia digestiva alta em hospital de emergência em Recife - Pernambuco / Etiology of upper gastrointestional hemorrhage in an emergency hospital in Recife, Pernambuco

A hemorragia digestiva alta (HDA) é uma importante emergência médica, com grande índice de morbidade e letalidade. A literatura sobre o tema evidencia as úlceras pépticas como as principais causas de sangramento, porém, em Pernambuco, devido à endemicidade da esquistossomose mansônica, há uma elevada frequência de hemorragia por ruptura de varizes esofágicas (VVEE). Há poucos relatos no estado sobre as características dos pacientes com HDA. Objetivos: descrever e analisar aspectos demográficos, antecedentes pessoais, dados clínicos e endoscópicos de pacientes com HDA para caracterizar as etiologias mais frequentes do sangramento digestivo. Pacientes e métodos: foi realizado estudo descritivo, tipo série de casos, de pacientes com HDA atendidos no Setor de Endoscopia Digestiva do Hospital da Restauração em Recife, referência no estado em hemorragia digestiva, no período de outubro de 2008 a outubro de 2009. Foram coletados dados sobre antecedentes pessoais, aspectos demográficos e clínicos, e realizado exame endoscópico para avaliação do sítio de sangramento e propedêutica para controle da hemorragia, se necessário. Resultados: foram analisados 385 pacientes com média de idade de 55,9 anos (11-96 anos), sendo 60,8% do sexo masculino. A maioria dos pacientes era natural (43,1%) e procedente (59,7%) da Região Metropolitana do Recife (RMR). O uso abusivo de álcool foi relatado por 38,7% dos pacientes, consumo de anti-inflamatórios (AINES) por 43,4%, história prévia de hemotransfusão por 47,3%, doença hepática crônica por 29,1%. A principal queixa clínica foi hematêmese em 50,4% dos casos, seguida pela associação de hematêmese e melena em 35,8%. A HDA foi classificada em não varicosa (41,3%) e varicosa (39,7%) e quanto à etiologia, secundária à VVEE em 38,1% dos casos, a úlcera péptica em 19,5% e não determinada em 19%. Observou-se relação entre o uso de AINES e o sangramento não varicoso (p<0,001). Conclusão: no presente estudo, observa-se que a maioria dos pacientes era do sexo masculino e procedente da RMR. Houve elevado consumo de AINES, principalmente nos pacientes com sangramento do tipo não varicoso. As causas de HDA não varicosa e varicosa apresentam uma frequência semelhante, mas quando se considera a etiologia isolada, nota-se o predomínio de sangramento por VVEE devido à endemicidade de esquistossomose mansônica em Pernambuco.

Background: upper gastrointestinal bleeding (UGB) is an important medical emergency, with a high rate of morbidity and mortality. In other localities, peptic ulcers are the main causes of UGB, but in Pernambuco, where schistosomiasis mansoni is endemic, bleedings due to the rupture of esophageal varices are very frequent. However, there is little data on the characteristics of the patients with this disease in the state. Aim: to describe and analyze demographical aspects, personal history, endoscopic and clinical data of patients with UGB to characterize the most common etiologies of digestive bleeding. Patients and methods: it is a descritive study about patients with UGB assisted at the endoscopic unit of Restauração Hospital in Recife, which is reference in gastrointestinal bleeding in the state. The patients involved in the study filled out an application form regarding demographic features, personal history, clinical aspects and an endoscopy was performed to identify the area of the bleeding, as well as a propaedeutical endoscopy to control the bleeding, when necessary. Results: 385 patients were analyzed with specific-age rate of 55.9 years old (from 11 to 96 years old) and 60.8% of them were male. Most patients were born (43.1%) and lived (59.7%) in the metropolitan region of Recife. Alcohol abuse was detected in 38.7% of the patients, intake of NSAIDs (Non-steroidal anti-inflammatory drugs) in 43.4%, previous history of blood transfusion by 47.3% and hepatic chronic disease by 29.1%. The main clinical complaint was hematemesis in 50.4% of the cases followed by the association of hematemesis and melena in 35.8%. UGB was classified in nonvariceal (41.3%) and variceal (39.7%) bleeding, considering etiology causes, 38.1% of patients had esophageal varices, 19.5% peptic ulcer and 19% undetermined causes. A relation between use of NSAIDs and non-variceal bleeding was observed (p<0.001). Conclusion: at the current study, most of the patients were male and from the metropolitan region of Recife. There were high intake of anti-inflammatory drugs, specially in patients with nonvariceal bleeding. The causes of variceal and non-variceal UGB comprise a similar frequency, but when the single etiology is considered, there is a superiority bleedings due to esophageal varices, due triggered by the presence of schistosomiasis mansonin in an endemic level in Pernambuco.

Evaluación de la calidad de estudios farmacoeconómicos del uso de los inhibidores de la bomba de protones en enfermedad ácido péptica / Quality assessment of pharmacoeconomic studies of the use of proton pump inhibitors in peptic ulcer disease

Los inhibidores de la bomba de protones (IBP) son un grupo de fármacos que reducen la secreción de ácido en el estómago, por lo que son ampliamente utilizados en el tratamiento de la úlcera péptica. La notable prevalencia e incidencia de esta patología sugiere que los recursos económicos y humanos dedicados a su tratamiento son considerables y, por tanto, es necesario identificar fuentes fiables de información relacionadas con los costos y los beneficios de estos agentes terapéuticos que permitan valorarlos en términos de eficiencia para mejorar su prescripción racional. Este trabajo realizó una revisión de los estudios farmacoeconómicos correspondientes al uso de los ibp en la prevención y tratamiento de la enfermedad ácido péptica y se presenta una evaluación pareada de la calidad metodológica de la bibliografía basada en el instrumento qhes (Ofman et al., [10]). De los diez artículos revisados, cuatro son de costo-efectividad, dos de costo-utilidad, tres de descripción de costos y uno de minimización de costos. El puntaje global promedio obtenido por los estudios evaluados fue de 66,6 sobre 100. Cuatro de ellos puntuaron por debajo de 60, haciendo evidente deficiencias en la calidad de los estudios de acuerdo con el instrumento usado, además pone de manifiesto que se necesitan evaluaciones farmacoeconómicas en relación con el uso de los ibp para la prevención y el tratamiento de la úlcera péptica, especialmente estudios de costo-efectividad, que cumplan con los estándares de calidad metodológica.

Proton pump inhibitors (PPI) are a group of drugs that reduce gastric acid secretion and therefore are widely used in the treatment of peptic ulcer. The remarkable prevalence and incidence of this disease suggests that economic and human resources devoted to treatment are considerable and therefore it is necessary to identify reliable sources of information related to the costs and benefits of these therapeutic agents to appraise in terms of efficiency to improve rational prescribing. This paper conducted a review of pharmacoeconomic studies pertaining to the use of ppi in the prevention and treatment of peptic acid disease, as it presents a paired assessment of methodological quality of the literature instrument based on qhes (Ofman et al., [10]). Of the ten articles reviewed, four were cost-effectiveness, two cost-utility, three description of cost, and one of cost minimization. The average overall scored 66.6 out of 100. Four of them scored below 60.0, making it a clear need for pharmacoeconomic evaluations in connection with the use of ppi for prevention and treatment of peptic ulcer, especially cost-effectiveness studies that meet standards of methodological quality.