Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada / Epidemiological analysis and use of rapid urease test in patients with perforated peptic ulcers

OBJETIVO: Analisar o perfil epidemiológico de pacientes com úlcera péptica gastroduodenal perfurada e verificar se a presença do H. pylori nas secreções peritoneais e intraluminais desses pacientes pode ser avaliada pelo teste rápido da urease. MÉTODOS: Realizou-se estudo prospectivo, transversal, descritivo, com dados de pacientes atendidos em um hospital de abrangência regional, em portadores de úlcera péptica perfurada. Coletou-se, no transoperatório, amostras de líquido peritoneal (na proximidade da perfuração) e da secreção intraluminal, sendo encaminhadas para cultura e teste rápido de urease. RESULTADOS: Quatorze pacientes foram analisados. A média etária foi 41,06 anos, todos homens, brancos (71,4%), tabagistas (57,2%), IMC < 30 (85,7%), com história prévia de dispepsia (78,6%). Sorologia para H. pylori foi positiva em 84,6% dos casos. O teste rápido da urease foi positivo em 78,6% das amostras do tubo digestivo e em 42,8% das amostras da cavidade peritoneal; 41,6% foram positivos em ambos os locais, 50% somente na cavidade digestiva e 8,4% exclusivamente na cavidade peritoneal. Dos 11 pacientes com sorologia positiva para H. pylori 100% apresentaram positividade em pelo menos um dos sítios pesquisados. CONCLUSÃO: Verificou-se que a incidência foi menor que a esperada. Há associação significativa entre a infecção pelo H. pylori e a ocorrência de perfuração. A presença deste patógeno pode ser avaliada tanto pela sorologia quanto pela realização do teste rápido da urease do fluido coletado na cavidade peritoneal e na luz gástrica/duodenal.

OBJECTIVE: To analyze the epidemiological profile of patients with gastroduodenal ulcer perforation and verify if the presence of H. pylori in the peritoneal and intraluminal secretions of these patients can be assessed by rapid urease test. METHODS: We conducted a prospective, descriptive, cross-sectional study with data from patients in a hospital at a regional level, in patients with peptic ulcer. During surgery, we collected peritoneal fluid samples (in the vicinity of the perforation) and intraluminal secretion, sending them for culture and rapid urease test. RESULTS: Fourteen patients were analyzed. The average age was 41.06 years, all men, Whites (71.4%), smokers (57.2%), BMI <30 (85.7%), with a history of dyspepsia (78.6%). Serology for H. pylori was positive in 84.6% of cases. The rapid urease test was positive in 78.6% of the samples of the digestive tract and 42.8% of samples from the peritoneal cavity; 41.6% were positive at both sites, 50% only in the digestive cavity and 8.4% only in the peritoneal cavity. Of the 11 patients with positive serology for H. pylori, 100% were positive in at least one of the sites surveyed. CONCLUSION: It was found that the incidence was lower than expected. There is significant association between infection with H. pylori and the occurrence of perforation. The presence of this pathogen can be assessed both by serology and by the realization of the rapid urease test from fluid collected in the peritoneal cavity and the gastric / duodenal lumen.

Ulcus péptico perforado: revisión de 102 casos en el Hospital Dr. "Domingo Luciani" / Perforated peptic ulcer: a review of 102 cases at the Hospital Dr. Domingo Luciani

Determinar los aspectos epidemiológicos y el tratamiento quirúrgico en los pacientes con ulcus péptico perforado atendidos en el Departamento de Cirugía General del Hospital Domingo Luciani. IVSS, Caracas. Estudio retrospectivo, transversal, descriptivo y observacional, realizado en el período correspondiente de julio de 1989 a julio de 2007, mediante la revisión de historias clínicas de pacientes intervenidos quirúrgicamente por ulcus péptico perforado. Un total de 102 pacientes fueron intervenidos por ulcus péptico perforado, en su mayoría hombres (90 por ciento), con edad promedio de 40 años. El principal síntoma fue el dolor. Los pacientes acudieron en las primeras 24 horas del inicio de los síntomas. Los antecedentes más importantes fueron el hábito tabáquico y alcohólico (62 por ciento y 56 por ciento). La localización más frecuente de la úlcera fue prepilórica (64 por ciento). La técnica de reparación quirúrgica más empleada fue la rafia de la úlcera más parche de epiplón (44 por ciento). La morbilidad fue de 27.5 por ciento y la mortalidad de 5 por ciento. El ulcus péptico perforado se presenta con mayor frecuencia en hombres fumadores. La raparación quirúrgica con rafia y parche de epiplón es segura.

Surgical management of perforated duodenal ulcer: the changing scene

To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58 of cases presented before age 50 years. Perforations in acute ulcers occurred in 80 of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11 of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers

Ulcera perforada post crisis financiera 2002: aumento de incidencia en el Hospital Pasteur / Perforated ulcer subsequent to year 2002 finantial crisis: intensification of incidence at the Hospital Pasteur

Con el objetivo de demostrar el aumento de la incidencia de úlcera gastroduodenal perforada en el Hospital Pasteur y su relación con factores socio económicos, se analizó la frecuencia de esta patología en los últimos 40 meses, así como la evolución de los indicadores socio-económicos que sobrevinieron a partir de la crisis financiera del año 2002. Se operaron 86 pacientes desde 1/2000 hasta 4/2003, 70 (81,4 por ciento) hombres, con una edad promedio de 49 (16-84), destacando un aumento del 83,35 por ciento en el año 2002, respecto del año anterior, lo cual resultó ser estadísticamente significativo. El 36,5 por ciento de los pacientes no presentaba síntomas previos, siendo la perforación el debut de su enfermedad ulcerosa. Se muestra la tendencia negativa de múltiples indicadores socioeconómicos en la misma fecha y basados en la literatura sobre el tema, se demuestra una relación causal entre ambos.

Current management of peptic ulcer perforations

Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of omental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with <10mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori [H. pylori] in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The shortlisted articles were analysed and studies which were well designed and had important inferences were selected. Based on these inferences, the controversies surrounding the management of peptic ulcer perforation have been discussed in this review article

Avaliação de úlceras cloridro-pépticas gastroduodenais perfuradas em pacientes atendidos no serviço de urgência de um hospital universitário / Evaluation of chloridro-peptic gastroduodenal perforated ulcers in patients treated at the emergency department of university hospital

Objetivo: Analisar a incidência dos aspectos epidemiológicos dos pacientes com diagnóstico de úlcera cloridro-péptica gastroduodenal perfurada (UCPGDP), atendidos no serviço de urgência do Hospital de Clinicas da Universidade Federal de Uberlândia, no Período de 1989 a 2000, divididos em quatro triênios Método: estudo epidemiológico, retrospectivo, realizado em hospital universitário, público, com capacidade de 480 leitos, de nível terciário, com serviço de atendimento de urgência, por meio da análise de 354 prontuários de pacientes com diagnóstico de úlcera pépfica gastroduodenal perfurada, submetidos a tratamento cirúrgico de urgência. Foram avaliados sexo, idade, cor, procedência, local da perfuração, exames laboratoriais, exames de imagem (radiológico do tórax ou abdome, endoscopia digestiva alta, ultra-sonografia de abdome), exames microbiológicos, tipo de cirurgia realizada, tempo de internação, complicações gerais e especificas e a evolução do paciente. Resultados: observou-se aumento na incidência da úlcera cloridro-péptica gastroduodenal perfurada do primeiro triênio (58 pacientes) para o segundo triênio (104 pacientes), permanecendo constante nos demais, 97 pacientes para o terceiro triênio e 95 pacientes para o quarto triênio. O exame radiológico do tórax ou abdome foi o exame complementar de escolha para o diagnóstico do pneumoperitônio, algumas vezes auxiliado pelo leucograma para avaliar o grau de infecção e amilasemia para afastar a possibilidade de pancreatite aguda. O local mais freqüente de perfuração das úlceras foi a região pilórica (justa pilórica e pilórica, com 64,9%), sendo a ulcerorrafia o procedimento cirúrgico mais realizado (91,8%). A bacterioscopia foi realizada em amostras de líquidos peritoniais de 222 (62,7%) pacientes, sendo negativa em 145(65,3%) delas. Nos casos positivos (77 bacterioscopias), os patógenos mais encontrados foram os cocos Oram positivos(74/42,3%), seguidos pelos bastonetes Gram negativos(68/38,9%) e leveduras...

According to the literature, the incidence of chloridropeptic gastroduodenal perforated ulcer (CPGDPU) has been decreasing. The incidence and the epidemiological aspects of CPCDPIJ o patients treated at the Hospital de Clínicas, Universidade Federal de Uberlândia, from 1989 to 2000, was surveyed. The occurrence of CPGDPU in 354 patients was analyzed. An increase in the incidence of CPGDPU was observed from the first to the second triennia, becorning stabilized in the following periods. The thoracic or abdominal X-ray is still the preferred complementary exam for diagnosis of CPGDPU. Leukogram and amylasemia are complemmentary exams. The most com mon area of incidence of perforated ulcers was the pyloric region. The ulceroraphy was the most common surgical procedure. The lethality factor was 8,71%, showing a prevalence in elderly people.

Incidencia de úlcera peptica perforada en el Hospital Dr. Luis E. Aybar durante el período febrero 1990 febrero 1995 / Incidence of perforated peptic ulcer in Dr. Luis E. Aybar Hospital durint the period February 1990-February 1995

Se realizó un estudio retrospectivo con el fin de conocer la incidencia de úlcera péptica perforada en el Hospital Dr. Luis E. Aybar durante el periodo feb 90-feb 95 en el Hospital Dr. Luis E. Aybar en Santo Domingo, República Dominicana. Encontramos un total de 49 casos en este periodo, de los que obtuvimos los siguientes datos: Mayor incidencia entre la segunda y tercera década de la vida, más frecuente en el sexo masculino, el cuadro clínico evolucionó por mas de 24 horas antes de recibir atención médica, los pacientes no tenían antecedentes de úlcera péptica, ni de haber recibido tratamiento alguno para esta enfermedad. El tratamiento quirúrgico efectuado fue el cierre de Graham modificado en casi todos los casos; la mayoría de los pacientes permaneció en el hospital menos de ocho días

Ulcera gastroduodenal perforada / Perforated duodenal ulcer

Se estudiaron los aspectos etiológicos, clínicos y diagnósticos en 107 casos de úlceras perforadas. Se comprobaron úlceras duodenales en el 61,6% y gástricas en el 38,4%, la edad promedio fue de 52 años, presentaban historia ulcerosa previa el 54% de los casos, consumo medicamentoso previo el 12% y tabaquismo el 72%. El intervalo medio perforación-intervención fue de l6 hs. Se comenta el número estable de perforaciones a pesar del tratamiento con anti H2.

Ulcera gastroduodenal perforada: revisión estadística / Perforating gastroduodenal ulcer: statistical review

Se revisan 94 historias clínicas de pacientes operados por úlcera gastroduodenal perforada en el período comprendido de enero de 1980 a diciembre de 1985. Se extraen, de dichas historias clínicas, los datos siguientes: edad, sexo, procedencia, hábitos tóxicos, ocupación, antecedentes de úlcera otrastorno digestivos, diagnóstico clínico y radiológico, procederes quirúrgicos realizados, complicaciones y mortalidad. Se observó mayor afectación en los pacientes masculinos cuya edad oscilaba entre los 30 y los 40 años, de procedencia rural, que eran fumadores y que poseían antecedentes de trastornos digestivos. Se obtuvo también, en los casos en que fue posible, el diagnóstico clínico (90,3

Ulcera péptica perforada / Perforated peptic ulcer

De las complicaciones de la úlcera péptica, la perforación es la más grave y, si se considera todas sus variedades, es también la más frecuente. En el presente artículo se analizan todas las formas de perforación, vale decir de avance del proceso necrótico más allá de de la serosa del órgano comprometido. Se analiza en forma preferente el cuadro clásico de perforación a peritoneo libre, revisando su incidencia, manifestaciones clínicas, radiológicas y de laboratorio y su tratamiento tanto médico como quirúrgico