Surgical management of peptic ulcer disease in proton pump inhibitor era

To evaluate the important risk factors involved in complications of peptic ulcer disease and the need, timing, extent and outcome of surgery with the evolution of proton pump inhibitors. Descriptive study. POF Hospital Wah Cantt, from December 2006 to December 2008. All the patients presenting with complications of peptic ulcer disease [perforation, bleeding duodenal ulcers and gastric outlet obstruction] were included in this study. A total of 46 patients were included in this study. Thirty five patients had peptic ulcer perforation, 8 patients presented with bleeding peptic ulcer that failed to respond to medical and endoscopic treatment and 3 patients presented with gastric outlet obstruction. Smoking was the most common risk factor followed by the use of non streroidal anti inflammatory [NSAID] drugs and steroids. Ramadan fasting was also a factor in patients with history of dyspepsia. Peptic ulcer perforation was more common in patients in second and third decade of life as compared to bleeding which was more prevalent in fourth decade. Modern medical and endoscopic therapy has caused a decline in complications of peptic ulcer disease but they are still prevalent in developing world. Smoking is one of the most common and important risk factors

Stress ulcer prophylaxis in patients on ventilator.

The objective of the study was to assess the efficacy of the H2-receptor antagonists and sucralfate for the prophylaxis of stress ulcer in patients on a ventilator in an intensive care unit in the general intensive care unit of our institute. A randomized, clinical controlled trial was conducted. Fifty-two critically ill patients, who required mechanical ventilation for more than 24 hours, were randomly divided into 3 groups. Group I received ranitidine 50 mg (intravenous) 8 hourly, group II received tablet sucralfate 1 g 8 hourly through a Ryle's tube, whereas group III was not given any drug. The incidence of upper gastrointestinal bleed, change in gastric pH and growth of gram-negative organisms in the gastric juice and bronchoalveolar lavage (BAL) culture were noted and analysed. The treatment groups were similar with respect to the baseline characteristics. The incidence of upper gastrointestinal bleeding was similar in the ranitidine (12.5%) and sucralfate groups (14.35%) but was high in the control group (57.14%). The mean gastric pH was significantly low in the control group (mean pH 2.07) compared to the ranitidine (mean pH 5.25) and sucralfate groups(mean pH 3.54)(p < 0.05). The incidence of positive culture for gram-negative organisms was significantly high in the ranitidine group (75%) in comparison with the sucralfate group (33.33%) (p < 0.002). However, the incidence of positive growth in the BAL culture was similar in all three groups. We conclude that both ranitidine and sucralfate are equally effective in decreasing the incidence of upper gastrointestinal haemorrhage and other stress- related lesions. Though ranitidine was more effective in increasing the gastric pH, the incidence of gastric colonization was higher in the ranitidine group compared to the sucralfate group.

Omeprazol IV vs. ranitidina IV, para el control de la hemorragia digestiva alta en una sala de emergencia / Omeprazol vs ranitidine in upper digestive bleeding

La causa más frecuente de hemorragia digestiva es la úlcera péptica. Los mecanismos homeostáticos del sangrado, así como la coagulación, no ocurre a niveles de pH inferiores a 5,0; por tanto, la neutralización de la acidez gástrica (pH mayor de 5,0) es un recurso para mejorar la evolución y cicatrización de la úlcera péptica y evitar el resangrado. El objetivo de este estudio fue comparar los resultados de omeprazol y ranitidina, en 57 pacientes admitidos por la emergencia del Hospital Central de la Policía Nacional del Perú, con endoscopía diagnóstica de úlcera sangrante utilizando la clasificación Forrest. Los pacientes recibieron omeprazol 40 mg en bolo EV, seguido de una infusión continua de 8 mg/hora por 72 horas (grupo A) o ranitidina 50 mg EV cada 8 horas por 72 horas (grupo B). La endoscopía de control realizada a las 72 horas, demostró una terapia satisfactoria en ambos grupos. El sangrado se detuvo en 26/27 pacientes en el grupo A(96,2 por ciento) y en 23/30 pacientes en el grupo B(76,6 por ciento) (p menor 0,05). Los resultados del estudio demuestran que el omeprazol IV es más efectivo que la ranitidina IV, en el control de la HDA por úlcera péptica y facilita su rápida cicatrización.

Atualizaçäo em úlcera de estresse / Actualization in stress ulcer

Este trabalho sobre atualizaçäo de úlcera por estresse focaliza os fatores de riscos, patogenia, métodos de detecçäo e, principalmente, a profilaxia. Muitos progressos foram alcançados na profilaxia do sangramento digestivo alto, com o advento de novos agentes redutores da acidez e das drogas citoprotetoras. Assim, foi obtida uma significativa reduçäo na incidência de hemorragia digestiva clinicamente evidenciável. Embora todos os tratamentos tenham se mostrado eficazes, notamos maior freqüência de pneumonia nosocomial no grupo de pacientes que utilizou redutores da acidez gástrica (antiácidos e bloqueadores H2). Por fim, pudemos comprovar que a maioria dos sangramentos cessa apenas com tratamento clínico, posto que as técnicas endoscópicas e angiográficas säo pouco úteis, em funçäo da natureza difusa desses sangramentos.

Alteraçäo do pH gástrico em pacientes críticos com o uso de nutriçäo enteral / Changes of gastric pH in critical patients with the use of enteral nutrition

Este trabalho compara uso da nutriçäo enteral e os meios usuais de alcalinizaçäo gástrica, e comprova a eficácia, bem como menor custo deste método no controle da ulceraçäo gastrointestinal