Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

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.

Prevalencia de neoplasia en úlceras gástrica perforada en el Servicio de Cirugía General- Hospital Central IPS, 2015-2020 / Prevalence of neoplasm in perforated gastric ulcers in the General Surgery Department - IPS Central Hospital, 2015-2020

Introducción: La úlcera gástrica perforada es la complicación ulcerativa más frecuente después del sangrado y la más grave de todas. A medida que se desarrolla el proceso inflamatorio la lesión gástrica evoluciona pasando por los siguientes estadíos: gastritis superficial, gastritis atrófica crónica, metaplasia intestinal, displasia y finalmente cáncer. En este proceso de evolución natural de la enfermedad radica la importancia de realizar una biopsia durante el abordaje quirúrgico de la úlcera gástrica perforada. Objetivos: Determinar la prevalencia de neoplasia en úlceras gástrica perforada en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo 2015-2020. Materiales y métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal con datos retrospectivos. Resultados: Se incluyeron 50 pacientes sometidos a cirugía por úlcera gástrica perforada. El promedio de edad fue 67,1 ±17,1 años, el 60% correspondían al sexo masculino; en el 94% se realizó reavivamiento de bordes y en el 6% antrectomía. Con respecto al diagnóstico anatomopatológico, en el 90% se confirmó proceso infamatorio, la prevalencia de neoplasia fue del 6% y en el total de los pacientes postoperados por úlcera gástrica perforada se constató un 46% de mortalidad. Conclusión: La prevalencia de neoplasia fue mínima en los pacientes sometidos a cirugía por úlcera gástrica perforada. Se identificó un alto porcentaje de mortalidad en los pacientes postoperados por úlcera gástrica perforada. El promedio de edad fue 67,1 años y predominó el sexo masculino. El procedimiento quirúrgico más frecuente fue el reavivamiento de bordes y el diagnóstico anatomopatológico más prevalente fue proceso inflamatorio.

Introduction: Perforated gastric ulcer is the most frequent ulcerative complication after bleeding and the most serious of all; as inflammation progresses, gastric lesion evolves, beginning with superficial gastritis, then chronic atrophic gastritis, intestinal metaplasia, dysplasia, and finally cancer; hence the importance of performing a biopsy in the surgical approach of perforated gastric ulcer. Objectives: To determine the prevalence of neoplasia in perforated gastric ulcers in the General Surgery service of the Hospital Central del Instituto de Previsión Social in the period 2015-2020. Materials and methods: An observational descriptive cross-sectional study with retrospective data was carried out. Results: 50 patients who underwent surgery for perforated gastric ulcer were included. The average age was 67.1 ± 17.1 years, 60% were male; 94% underwent edge revival and 6% antrectomy. Regarding the anatomopathological diagnosis, 90% confirmed the inflammatory process, the prevalence of neoplasia was 6%, and in the total number of postoperative patients for perforated gastric ulcer, 46% mortality was confirmed. Conclusion: The average age was 67.1 years and the male sex predominated. The most frequent surgical procedure was edge revival and the most prevalent pathological diagnosis was inflammatory process. The prevalence of neoplasia was minimal in patients undergoing surgery for perforated gastric ulcer. A high percentage of mortality was identified in postoperative patients for perforated gastric ulcer.

Impact of the coronavirus disease 2019 pandemic on the management of acute peptic ulcer perforation: to be reconsidered(?)

SUMMARY OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

Mechanism of action of oxidative stress in severe traumatic brain injury and its complications: recent progress / 中华创伤杂志

Severe traumatic brain injury (sTBI) is characterized by critical condition, high lethality and poor prognosis. Its development and progression will lead to the damage and death of a large number of nerve cells, eventually causing a series of serious complications. The current treatments of sTBI and its complications are not optimistic due to problems such as unclear mechanism of action, challenges in treatment, and lack of effective prevention strategies. In recent years, more research evidences have shown that oxidative stress plays an important role in the development and progression of sTBI and its related complications. Therefore, it is of great significance to clarify the relationship of oxidative stress with sTBI and its complications and to understand the way of oxidative stress participating in the development and progression of sTBI. However, relevant researches are scattered and there lacks comprehensive and systematic summaries of oxidative stress participating in sTBI and its related complications. To this end, the authors reviewed the progress of the mechanism by which oxidative stress involves in sTBI and its complications, hoping to provide references for the research, treatment and prevention of sTBI.

Peptic ulcer bleeding in the elderly and analysis of its correlation with Helicobacter pylori infection / 公共卫生与预防医学

Objective To analyze the risk factors of bleeding in elderly patients with peptic ulcer disease (PUD) and its correlation with Helicobacter pylori (Hp) infection, and to provide a theoretical basis for clinical diagnosis and treatment of elderly patients with PUD bleeding. Methods A total of 418 elderly PUD patients admitted to our hospital from June 2019 to June 2020 were selected. The 13C-urea breath test was used to determine HP infection. PUD patients were divided into observation group (n=87, bleeding) and control group (n=331, no bleeding). Age, sex, ulcer number, ulcer location, ulcer stage, ulcer diameter and other clinical data were collected. Univariate analysis and logistic regression were used to analyze the risk factors of bleeding in elderly PUD patients. The Forrest classification was used to evaluate the severity of PUD bleeding patients. Pearson correlation analysis was performed between Forrest classification and Hp infection in elderly PUD bleeding patients. Results There were statistically significant differences between the two groups in the course of disease, PUD history, NSAIDs application/ulcer number, ulcer diameter, ulcer location, ulcer stage, Hp infection and NSAIDs application (P<0.05). Multivariate logistic regression analysis showed that the use of NSAIDs, active ulcer, Hp infection and ulcer diameter ≥2 cm were risk factors for bleeding in elderly patients with PUD (P<0.05). The Hp positive rate in Forrest I patients was significantly higher than that in Forrest II and Forrest III patients (P<0.05). The positive rate of Hp in Forrest II patients was significantly higher than that in Forrest III patients. Pearson correlation analysis showed that Hp infection was positively correlated with the severity of peptic ulcer bleeding in the elderly (r=0.512, P<0.05). Conclusion The risk of bleeding from PUD is higher in the elderly, especially in patients with active ulcer, Hp infection and ulcer diameter ≥ 2 cm. In the treatment process of PUD patients, the eradication therapy of Hp should be emphasized, which can reduce the risk of bleeding.

Correlation of serum gastrin, C-reactive protein and tumor necrosis factor α with the degree of peptic ulcer bleeding / 中国医师进修杂志

Objective:To investigate the correlation between serum gastrin, C-reactive protein (CRP), tumor necrosis factor α (TNF-α) and the degree of peptic ulcer bleeding.Methods:The clinical data of 90 peptic ulcer bleeding patients (test group) from April 2019 to September 2020 in Hangzhou Hospital of Zhejiang Medical and Health Group were retrospectively analyzed, including 15 cases with low-risk, 40 cases with intermediate-risk and 35 cases with high-risk of Blatchford score; 40 physical examination volunteers were selected as the control group during the same period. The serum levels of CRP and TNF-α were measured by enzyme-linked immunosorbent assay, and the serum level of gastrin was measured by radioimmunoassay. The correlation between CRP, TNF-α, gastrin and the Blatchford score was analyzed by Pearson method; the independent risk factors affecting high-risk peptic ulcer bleeding were analyzed by multivariate Logistic regression; the value of CRP, TNF-α and gastrin in predicting high-risk peptic ulcer bleeding was analyzed by the receiver operating characteristic (ROC) curve.Results:The CRP, TNF-α and gastrin in test group were significantly higher than those in control group: (19.69 ± 3.41) mg/L vs. (2.28 ± 0.64) mg/L, (26.63 ± 4.24) ng/L vs. (1.35 ± 0.31) ng/L and (149.77 ± 21.41) μg/L vs. (72.65 ± 12.39) μg/L, and there were statistical differences ( P<0.01). The hemoglobin and platelets in intermediate-risk and high-risk patients were significantly lower than those in low-risk patients: (59.21 ± 4.63) and (28.94 ± 4.69) g/L vs. (89.68 ± 5.12) g/L, (162.14 ± 12.47) and (122.05 ± 10.39) × 10 9/L vs. (213.58 ± 16.98) × 10 9/L, the indexes in high-risk patients were significantly lower than those in intermediate-risk patients, and there were statistical differences ( P<0.05); the prothrombin time, CRP, TNF-α and gastrin in intermediate-risk and high-risk patients were significantly higher than those in low-risk patients: (13.98 ± 1.29) and (16.97 ± 1.15) s vs. (11.00 ± 2.07) s, (18.87 ± 4.68) and (22.69 ± 2.96) mg/L vs. (15.45 ± 5.54) mg/L, (27.43 ± 5.05) and (31.02 ± 4.56) ng/L vs. (21.39 ± 8.54) ng/L, (140.89 ± 22.36) and (160.58 ± 25.52) μg/L vs. (121.39 ± 15.17) μg/L, the indexes in high-risk patients were significantly higher than those in intermediate-risk patients, and there were statistical differences ( P<0.05). Multivariate Logistic regression analysis result showed that hemoglobin, platelets, CRP, TNF-α and gastrin were independent risk factors for high-risk peptic ulcer bleeding ( OR = 0.224, 0.321, 3.687, 3.058 and 4.051; 95% CI 0.004 to 0.894, 0.121 to 8.547, 1.912 to 5.525, 3.012 to 10.609 and 2.012 to 7.525; P<0.05 or <0.01). Pearson correlation analysis result showed that CRP, TNF-α and gastrin were positive correlation with the Blatchford score ( r = 0.501, 0.526 and 0.542; P<0.01). ROC curve analysis result showed that the areas under the curve of CRP, TNF-α and gastrin for predicting high-risk peptic ulcer bleeding was 0.890, 0.825 and 0.901, with optimal cut-off values of 17.95 mg/L, 22.16 ng/L and 135.36 μg/L, sensitivity of 97.14%, 94.29% and 82.86%, and specificity of 80.00%, 66.67% and 86.67%. Conclusions:CRP, TNF-α and gastrin are correlated to the degree of peptic ulcer bleeding, and can be used as indexes to evaluate the bleeding degree of peptic ulcer.

Manejo y tratamiento de la ulcera peptica / Management and treatment of peptic ulcer

El objetivo de este artículo de actualización tiene como objetivo hacer referencia acerca de la Ulcera péptica, una de las patologías muy frecuente en el sistema digestivo que afecta la mucosa gástrica o intestinal, cuya patogenia es multifactorial y cuyas complicaciones pueden ser graves, requiriendo un adecuado manejo y tratamiento hospitalario. Esta revisión hace referencia a los factores patogénicos más frecuentes, la fisiopatología, el abordaje clínico y su tratamiento, haciendo énfasis en la terapia farmacológica, en la que se hace una revisión sucinta y completa de todas sus propiedades farmacológicas.

The objective of this update article aims to refer to peptic ulcer, one of the very common pathologies in the digestive system affecting the gastric or intestinal mucosa, whose pathogenesis is multifactorial and whose complications can be serious, requiring adequate management and hospital treatment. This review refers to the most frequent pathogenic factors, pathophysiology, clinical approach and their treatment, emphasizing pharmacological therapy, in which a succinct and complete review of all its pharmacological properties is made.

CHAMPS score in predicting mortality of patients with acute nonvariceal upper gastrointestinal bleeding

SUMMARY OBJECTIVE: The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score. METHODS: The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score. RESULTS: A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106). CONCLUSION: The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.

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.

A unique formulation of sodium bicarbonate buffered pantoprazole powder for oral suspension: perspectives from an active controlled cross-over bioequivalence study

Background:The aim was determining bioequivalence between pantoprazole buffered powder for oral suspension and pantoprazole enteric coated tablets under fasting conditions in healthy volunteers.Methods:In randomized cross-over study, participants were administered a single oral dose of pantoprazole powder as suspension 40 mg (sodium bicarbonate as buffer) or one enteric coated tablet of pantoprazole 40 mg, with240�ml of water as per the randomization schedule in each study period. Blood samples were collected at pre-dose and at 0.33, 0.67, 1, 1.33, 1.67, 2, 2.33, 2.67, 3, 3.33, 3.67, 4, 4.5, 5, 5.5, 6, 7, 8, 9, 10, 12, 14, 16and 24hours post-dose. Plasmaconcentration of pantoprazole was determined with LC-MS and various pharmacokinetic parameters like Cmax, AUC0-t, AUC0-inf were compared between test and reference groups.Results:Amongst 41 subjects, Cmax(3752.4�84.6 vs. 3521.7�99.5 ng/ml)was achieved higher in less Tmaxtime (1 (0.28) vs. 2.3 (0.83) hrs)with test drug as compared to reference drug. The ratios of geometric least square mean and its 90% confidence interval on log transformed Cmax, AUC0-t and AUC0-inffor pantoprazole fall within the acceptance criteria of 80% to 125%. No adverse events were observed.Conclusions:Pantoprazole powder for oral suspension 40 mg (sodium bicarbonate as buffer) was well tolerated and bioequivalent with pantoprazole enteric coated tablets IP 40 mg in terms of rate and extent of absorption under fasting conditions. At same time, the shift in AUC to the left with reduction in Tmaxwith the new formulation is suggestive of faster rate of absorption.

Management of Gastric Ulcer w.s.r. Annadrava Shool in Ayurveda: A Case Study

Annadrava shoola is one of the diseases of the alimentary canal in which there is colic occurs after digestion, during digestion or at any time and Patient feels relief after vomiting. It can be said gastric ulcer on the basis of its signs and symptoms. Gastric ulcers are most commonly located on the lesser curvature, whereas duodenal ulcers are most common at the duodenal bulb. The ulcer is round to oval with a smooth base. Acute ulcers have regular borders, while chronic ulcers have elevated borders with inflammation. An ulcer extends beyond the muscularis mucosa. Ayurveda encourages lifestyle interventions and natural therapies to regain a balance between the body, mind and the environment. In this paper, a case study on Annadrava shoola has been explained. A female patient of 42 years of age came to the Kayachikitsa OPD (OPD REG.no-6836) Government Ayurvedic College and Hospital, Patna-03 having complain of pain and burning sensation in abdomen for 5 months as well as irregular bowel evacuation (>3episode) in the last 3 months. The nature of pain was gradual on onset and burning type and exaggerated after meal. On the basis of history of the patient and endoscopy report, he was diagnosed as gastric ulcer and pan gastritis. We have done the Shamana Chikitsa for the patient. In Shamana Chikitsa was done with combinations of Sutashekhar Ras, Tab Aciloss and Shatavari Churna for one month. Endoscopy was repeated after one and half months of treatment. Report showed only that the treatment cured the Annadrava shoola (gastric ulcer) of the patient. So, there is hope in Ayurveda for the treatment of Annadrava shoola.

Role of Peptic Ulcer Perforation (PULP) score to Predict the Outcome in Patients with Perforated Peptic Ulcer

Background: Peptic ulcer disease is a global burden of disease associated with potentially life-threatening complications, including bleeding, perforation and obstruction. Perforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated morbidity and mortality. Variations in the clinical presentation, as well as delay in diagnosis and work-up at admission to the hospital, may potentially cause a worsening of symptoms and a deterioration of the clinical condition, with a detrimental outcome. Therefore, accurate and early identification of high-risk surgical patients with perforated peptic ulcers (PPUs) is important for triage and risk stratification. Currently, the ASA score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. Yet, the ASA score is a general surgical risk score not intended for PPU patients in particular. Moreover, the external validation of the Boey score is uncertain. PULP score appears to have the greatest predictability of the outcome of perforated PUD. Aim of the study: The objective of the study was to evaluate the role of the PULP score in the prediction of outcomes in patients with a perforated ulcer.Material & Methods:It is an observational cross-sectional study, carried out in the Department of Surgery, Dhaka Medical College Hospital, Dhaka. Ethical approval was obtained from the Dhaka Medical College ethical review board. Patients aged 18 to 60 years admitted to the emergency department with a clinical diagnosis of perforated peptic ulcer disease, confirmed by different investigation modalities, e.g, imaging, sonography, laboratory test, etc were enrolled in the study. The data regarding sociodemographic, clinical, biochemical, radiological and surgical profiles were recorded. The operation was done by upper midline incision under general anesthesia. A modified Graham’s patch technique was used to repair the duodenal ulcer. Postoperative follow up was conducted meticulously. Patient outcome was assessed during their hospital stay and then OPD follow-up or by telephone interviews up to 30 days after the intervention. All the information is recorded in the data collection sheet. All collected questionnaires were checked very carefully to identify the error in the data. Data processing work consisted of registration schedules, editing computerization, preparation of dummy tables, and analyzing and matching data. Data was processed and analysed with the help of the computer program SPSS and Microsoft excel. Quantitative data are expressed as mean and standard deviation and qualitative data as frequency and percentage. The comparison was done by tabulation and graphical presentation in the form of tables, pie charts, graphs, bar diagrams, histograms &charts etc.Results:Present study demonstrates that the maximum number of patients (43.0%) was between 51-60 years of age group, mean age of the patient was 49.35 ± 11.7 years. The male and female ratio was 3.54:1. Maximum (57%) patients came from urban, (36%) rural and (7%) urban non-slum areas. In this study, the most common signs were tachycardia (100%), abdominal tenderness (100%), abdominal rigidity (100%), absence of vowel sound (86.2%), and obliteration of liver dullness (78.7%), dehydration (67.5%). The time lapse between the onset of symptoms and admission to the hospital varied from 4 hours to 4 days. Most of the patients (76.0%) were admitted after 24 hours. In this study, PULP score was assessed according to the operational definition of optimal cut-off point 7, below this considered as low-risk patients. in this study 85% were 0-7 PULP scores and 15% were PULP scores 8-18. Patients’ condition after proper treatment, symptoms, degree of abnormalities or dependence on the daily physiological activity and the clinical outcome had evaluated and measured by follow up and close monitoring. The study shows that 69.0% of the patients recovered completely, but 24.0% of patients had developed complications. The mortality rate in this study was 7.0%. Finally, a correlation of the PULP score with mortality of perforated PUD was carried out. Among the 7 expired cases the, PULP score was correlated with 6 cases like high risk. In 93 cases of recovered, the PULP score was predicted in 84 cases as low risk. So the effectiveness of PULP has proven significant in the prediction of mortality in perforated PUD patients. The Sensitivity and Specificity of the Peptic Ulcer Perforation (PULP) score was 85.7% and 90.3% respectively. Similarly, the positive predictive value and accuracy rate for the same was 40.0% and 90.0% respectively.Conclusion: Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Several prognostic scoring systems have been suggested to identify high-risk surgical patients with perforated peptic ulcers accurately and early. The present study demonstrates that the PULP score can be used to predict 30-day mortality accurately in patients operated for PPU. The prognostic predictors included in the PULP score can be readily identified prior to surgery. The PULP score can assist in the accurate and early identification of high-risk patients with PPU.

La Vagotomía Altamente Selectiva es aún un adecuado tratamiento para la úlcera péptica duodenal / Highly Selective Vagotomy is still a suitable treatment for duodenal peptic ulcer

RESUMEN Introducción: El tratamiento de la úlcera péptica duodenal (UPD) ha cambiado radicalmente en el transcurso de los últimos 50 años debido a la efectividad del tratamiento médico. Sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera duodenal; y dentro de éste la vagotomía. Objetivo: Describir el origen y evolución de la vagotomía altamente selectiva (VAS), y su papel en el tratamiento quirúrgico de la UPD. Material y métodos: Se revisó la bibliografía publicada durante los últimos 50 años relacionada con la VAS en el tratamiento quirúrgico de la UPD. La fuente de los datos utilizados fue obtenida de Clinical Key, Pubmed, Google, Scopus y Scielo, desde 1970 hasta 2020. Desarrollo: La VAS se aplicó por primera vez en el humano en 1967 por Holle y Hart. Posteriormente, Johnston y Wilkinson y Amdrup y Jensen en 1970, informan sus resultados, conservando el píloro. La única debilidad que se le atribuye a la VAS es una alta tasa de recurrencia de la úlcera; sin embargo, su mortalidad y morbilidad son mínimas, por lo que es la intervención de elección para la úlcera duodenal intratable o complicada. Conclusiones: Debido a la disminución en la necesidad del tratamiento quirúrgico, pocos cirujanos están entrenados y experimentados en esta operación técnicamente difícil; lo que ha sido el principal factor para las altas tasas de recurrencia. Sin embargo, consideramos que la VAS tiene vigencia actual en manos de cirujanos entrenados y experimentados.

ABSTRACT Introduction: The treatment of duodenal peptic ulcer (DPU) has radically changed over the last 50 years due to success of medical treatment. However, surgery still has an important role in the treatment of duodenal ulcer; and with this, vagotomy. Objective: To describe the origin and evolution of highly selective vagotomy (HSV), as well as its role in the surgical treatment of DPU. Material and Methods: We reviewed the bibliography published during the last 50 years in relation to highly selective vagotomy (HSV). The data used were obtained from the search carried out in Clincal Key, Pumed, Google, Scopus and Scielo databases during the period 1970-2020. Development: Highly Selective Vagotomy was first performed in humans by Holle and Hart in 1967. Later, their results were informed by Johnston and Wilkinson and Amdrup and Jensen in 1970, preserving the pylorus. The only weakness attributed to HSV is a higher ulcer recurrence rate; however, mortality and morbidity are minimal, so it is the intervention of choice for intractable or complicated duodenal ulcers. Conclusions: Because of the decline in the need for surgical management, fewer surgeons are trained and and have enough experince to perform this technically challenging surgery, which has been the main factor associated with higher recurrence rates. However, we consider that HSV has a current relevance when it is performed by trained and experienced surgeons.

Rifabutina: terapia de rescate eficaz para la infección por Helicobacter pylori, revisión de la literatura actual / Rifabutin: therapeutic alternative for Helicobacter pylori infection, actual literature review

Resumen La infección por Helicobacter pylori se asocia con enfermedades gastroduodenales como gastritis crónica, úlcera péptica y adenocarcinoma gástrico. Actualmente se dispone de diferentes esquemas terapéuticos, sin embargo, el uso indiscriminado de antibióticos generó resistencia en este agente, razón para estudiar alternativas y reevaluar los criterios que determinan la selección de un esquema en específico. El objetivo de esta revisión fue describir los principios generales de tratamiento de acuerdo a guías de referencia y recomendaciones de autores independientes, y exponer el uso de la rifabutina como alternativa terapéutica. En la búsqueda bibliográfica se usaron los términos "Helicobacter pylori" AND "rifabutin", en las bases de datos PubMed, SciELO y el motor de búsqueda Google Scholar®. La evidencia actual sugiere que el uso de rifabutina como terapia de rescate es apropiado y seguro, y sería la alternativa ideal en casos de multirresistencia o difícil acceso a pruebas de susceptibilidad antibiótica. MÉD.UIS.2022;35(1): 31-42.

Abstract Helicobacter pylori infection is associated with gastroduodenal diseases such as chronic gastritis, peptic ulcer, and gastric adenocarcinoma. Nowadays, there are different therapeutic regimens, however, the indiscriminate use of antibiotics generated resistance in this agent, reason to study alternatives and reevaluate the criteria that determines the selection of a specific regimen. The aim of this review was to describe the general principles of treatment according to reference guidelines and recommendations of independent authors, and to present the use of rifabutin as a therapeutic alternative. The bibliographic search was performed using the terms "Helicobacter pylori" AND "rifabutin" in the databases PubMed, SciELO and the search engine Google Scholar®. Current evidence suggests that the use of rifabutin as rescue therapy is appropriate and safe, and would be an ideal alternative in cases of multidrug resistance or difficult access to antibiotic susceptibility tests. MÉD.UIS.2022;35(1): 31-42.

Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

The cagA, cagE, vacA, dupA and iceA1 genes of Helicobacter pylori in Sudanese gastritis patients: Distribution and relationship with clinical outcomes and histological alterations

Aims@#Helicobacter pylori is a gastrointestinal bacterium that causes peptic ulcers and stomach cancer in nearly half of the world’s population. Many virulence factors influence the outcome of H. pylori related disorders. The purpose of this study was to see if there was a relationship between H. pylori virulence factors and histological and endoscopic findings in stomach biopsy specimens from Sudanese gastritis patients.@*Methodology and results@#In the period between March 2018 and January 2020, a total of 290 gastric biopsies were taken from patients in Khartoum State hospitals. Histopathology and polymerase chain reaction (PCR) assays were performed on all specimens. Histological investigation revealed H. pylori in 103/290 (35.5%) samples, while PCR revealed H. pylori 16S rRNA positivity in 88/290 (30.3%) samples. Eighty-eight positive PCR specimens were subjected to PCR for genotypic detection of cagA, cagE, vacA, dupA and iceA1 genes. All of strains were vacA positive 100% (88/88) followed by dupA 50.0% (44/88), cagA 40.9% (36/88), cagE gene 38.6% (34/88) and iceA1 gene was detected in only 15.9% (14/88). The vacA s1/m1 68.2% (60/88) was the most prevalent vacA subtype.@*Conclusion, significance and impact of study@#Helicobacter pylori virulence genes were widespread and diversified in Sudanese gastritis patients. Helicobacter pylori cagA and iceA1 were significantly in association with gastric mucosa inflammation degree, whereas the dupA gene was found to be associated with the clinical outcomes.

Correlation of endoscopy findings with symptoms in patients undergoing gastroscopy: a prospective study / 中华消化内镜杂志

Objective:To investigate the correlation of endoscopy findings with symptoms in patients undergoing gastroscopy.Methods:Patients who underwent gastroscopy for the first time in Renji Hospital of Shanghai Jiao Tong University School of Medicine from January to December 2017 were included in the questionnaire survey. The participants were asked to report their main symptoms of the digestive tract in details, and gastroscopy was completed within 2 weeks. Final gastroscopic diagnosis was made based on both gastroscopy and pathology, then patients were divided into the major-lesion (peptic ulcer and malignancy) group and the non-major-lesion (chronic gastritis, reflux esophagitis and others) group. The correlation of gastrointestinal symptoms with gastroscopic findings was analyzed. The risk for major gastroscopic lesions (peptic ulcer and malignant tumors) was assessed by multivariate Logistic regression analysis.Results:A total of 5 885 patients completed the questionnaire, 5 496 (93.4%) of whom completed gastroscopy. The detection rates of peptic ulcer were 12.3% (373/3 028), 12.6% (52/412), 17.9% (49/273), 9.5% (64/675) and 9.2% (102/1 108) in patients with dyspepsia, reflux, alarm, other symptoms and no symptoms, respectively, the detection rates of malignant tumors were 1.2% (36/3 028), 0.7% (3/412), 7.7% (21/273), 0.7% (5/675) and 0.4% (4/1 108), respectively in these patients. The most common symptoms was dyspepsia, accounted for 58.3% (373/640) and 52.2% (36/69) patients with peptic ulcer and malignant tumors, respectively. Alarm symptoms were found in 30.4% (21/69) patients with malignant tumors, and 15.9% (102/640) peptic ulcer patients and 5.8% (4/69) malignant tumor patients had no gastrointestinal symptoms. Compared to asymptomatic individuals, patients with dyspepsia ( P<0.001, OR=1.52, 95% CI: 1.21-1.92) and those with warning symptoms ( P<0.001, OR=2.87, 95% CI: 2.02-4.08) had significantly increased risk for major lesions (peptic ulcer and malignant tumors) detected by gastroscopy. Conclusion:Although dyspepsia and alarm symptoms are positively associated with upper gastrointestinal malignancy and peptic ulcer, they are of limited predictive value for upper gastrointestinal diseases.

Efficacy of bifidobacteria combined with Kangfuxin liquid in the treatment of gastrointestinal ulcer in older adult patients and its effects on intestinal flora / 中国基层医药

Objective:To investigate the efficacy of bifidobacteria combined with Kangfuxin liquid in the treatment of gastrointestinal ulcer in older adult patients and its effects on intestinal flora. Methods:A total of 84 older adult patients with gastrointestinal ulcer who received treatment in The First People's Hospital of Yongkang from January 2020 to December 2021 were included in this study. They were randomly assigned to receive either Kangfuxin liquid treatment (control group, n = 42) or Kangfuxin liquid combined with bifidobacteria treatment (combined group, n = 42) based on conventional symptomatic treatment. Efficacy and intestinal flora were compared between the two groups. Results:Total response rate and Helicobacter pylori eradication rate in the combined group were 97.62% and 88.10%, respectively, which were significantly higher than those in the control group ( χ2 = 8.63, 7.25, both P < 0.05). After treatment, the numbers of Bifidobacteria, Lactobacilli, Digestive cocci and Eubacteria in the combined group were greater than those in the control group, and the numbers of Enterococci, Enterobacter and Clostridium were lower than those in the control group ( t = 11.84, 6.50, 6.33, 7.16, 3.21, 3.24, 6.98, all P < 0.05). After treatment, the levels of interleukin-6 (IL-6) and interleukin-17 (IL-17) in the combined group were (5.09 ± 0.85) ng/L and (6.13 ± 1.27) ng/L, respectively, which were significantly lower than those in the control group, and interferon-γ and prostaglandin E2 (PGE2) levels in the combined group were (25.95 ± 3.67) ng/L and (20.06 ± 0.92) ng/L, respectively, which were significantly lower than those in the control group ( t = 8.28, 7.28, 8.19, 9.10, all P < 0.001). Conclusion:Bifidobacteria combined with Kangfuxin liquid is highly effective on gastrointestinal ulcer in older adult patients. The combined method can adjust intestinal flora and improve inflammatory indicators, and therefore is worthy of clinical promotion.

Analysis of the relationship between high altitude polycythemia and peptic ulcer bleeding / 北京大学学报(医学版)

OBJECTIVE@#To explore the relationship between high altitude polycythemia (HAPC) and peptic ulcer bleeding, in order to provide the evidence for the clinical diagnosis and treatment of peptic ulcer disease in Tibet of China.@*METHODS@#A retrospective case-control study was conducted. Patients who hospitalized in the Department of Gastroenterology with the diagnosis of peptic ulcer bleeding from January 1, 2015 to April 30, 2021 in Tibet Autonomous Region People's Hospital were enrolled in the case group, and patients who hospitalized in the Department of Urology without tumor and without the history of peptic ulcer and gastrointestinal bleeding during the same period were selected as the control group. In the study, 1 ∶ 1 case matching was conducted between the two groups according to the gender, age (±2 years), ethnic group (Tibetan, Han), and the residence altitude level (grouped by < 4 000 m or ≥4 000 m), and 393 cases were included in the case group and the control group respectively. All the patients had lived in Tibet with the altitude >2 500 m for more than 1 year, and with age ≥ 18 years. The risk factors of peptic ulcer bleeding (place of residence, smoking, alcohol, the use of NSAIDs/anticoagulants, and combined with chronic diseases, such as HAPC, hypertension, diabetes mellitus, heart disease, hyperlipidemia, cerebrovascular disease, chronic lung disease, joint disease) were analyzed and compared between the two groups.@*RESULTS@#There were 28 (7.1%) patients with HAPC in the case group, and 5 (1.3%) in the control group. The incidence of HAPC in the case group was significantly higher than those in the control group, P < 0.001, and the OR value was 5.953. Multivariate Logistic regression analysis showed that HAPC (OR=5.270, 95%CI: 1.806-15.380), living in cities and towns (OR=2.369, 95%CI: 1.559-3.602), alcohol (OR=3.238, 95%CI: 1.973-5.317) and the use of NSAIDs/anticoagulants (OR=20.584, 95%CI: 2.639-160.545) were the independent risk factors for peptic ulcer bleeding in Tibet. After adjusting for the possible confounding factors, such as living in cities and towns, alcohol, and the use of NSAIDs/anticoagulants, HAPC was associated with an increased risk of peptic ulcer bleeding in Tibet, and the OR value was 5.270.@*CONCLUSION@#HAPC was associated with a significantly increased risk of peptic ulcer bleeding in Tibet. Patients with HAPC and peptic ulcer should be diagnosed and treated actively, in order to avoid gastrointestinal bleeding and other serious complications.