Evolución del tratamiento de la Úlcera péptica duodenal / Evolution of duodenal peptic ulcer treatment

Introducción: Como consecuencia del desarrollo del tratamiento médico de la úlcera péptica duodenal, el tratamiento quirúrgico ha disminuido notablemente. Objetivo: El objetivo del estudio es describir la progresión del tratamiento de la úlcera péptica duodenal. Material y Métodos: Estudio descriptivo, de corte, desde finales del siglo XIX hasta la actualidad. Se utilizó el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: A pesar de ser la úlcera una entidad clínica reconocida desde la antigüedad, los cirujanos la consideraron causada por el ácido, y todos los esfuerzos fueron concentrados en eliminar el ácido por medio de una operación. A partir de 1881, se comenzaron a conocer las complicaciones. En la década de los años 30 del pasado siglo, se tratan las complicaciones y también la enfermedad. Desde 1940, además, se conserva el funcionamiento digestivo y aparecen las tres formas básicas de vagotomía. En la década de 1970, se desarrollaron novedosas técnicas quirúrgicas, la endoscopía, la radiología intervencionista y la cirugía mínimamente invasiva. Sin embargo, el tratamiento médico llegó con los poderosos supresores del ácido y el descubrimiento del Helicobacter pylori. Nuevamente la cirugía ha quedado relegada a tratar las úlceras refractarias y las complicadas. Conclusiones: El tratamiento médico, por medio de la terapia anti-Helicobacter asociada a potentes inhibidores de la secreción gástrica ha conseguido su curación; sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera refractaria o complicada(AU)

Introduction: Surgical treatment of duodenal peptic ulcer has notably decreased as a consequence of the development of medical treatment. Objective: The objective of this study is to describe the advances in the treatment of duodenal peptic ulcer. Material and Methods: A descriptive study was conducted from the end of the 19th century to the present. The historical-logical method and a deductive-inductive analysis of multiple bibliographic sources were used. Development: Despite ulcer has been recognized as a clinical entity since ancient times, surgeons considered that it is caused by acid; therefore, all efforts were concentrated on removing the acid through an operation. From 1881 on, complications began to be treated. In the decade of the 30s of the last century, complications and the disease were treated. Since 1940, the digestive function has also been preserved and the three basic forms of vagotomy appeared. In the 1970s, novel surgical techniques such as endoscopy, interventional radiology, and minimally invasive surgery were developed. However, powerful acid suppressants as well as the discovery of Helicobacter pylori were taken into consideration for medical treatment. Once again, surgery was relegated to the treatment of refractory ulcers and complicated ulcers. Conclusions: Medical treatment with anti-Helicobacter therapy associated with potent inhibitors of gastric acid secretion has managed its healing; however, surgery still plays an important role in the treatment of refractory or complicated ulcer(AU)

Helicobacter pylori infection in India from a western perspective.

Helicobacter pylori is a common bacterial infectious disease whose manifestations predominately affect the gastrointestinal tract. India is the prototypical developing country as far as H. pylori infection is concerned and more than 20 million Indians are estimated to suffer from peptic ulcer disease. Considering the high level of medical research and of the pharmaceutical industry, one would expect that India would be the source of much needed information regarding new therapies and approaches that remain effective in the presence of antimicrobial resistance, new methods to reliably prevent reinfection, and the development of therapeutic and preventive vaccines. Here we discuss H. pylori as a problem in India with an emphasis on H. pylori infection as a serious transmissible infectious disease. We discuss the pros and cons of eradication of H. pylori from the entire population and come down on the side of eradication. The available data from India regarding antimicrobial use and resistance as well as the effectiveness of various treatments are discussed. Rigorous ongoing studies to provide current regional antibiotic resistance patterns coupled with data concerning the success rate with different treatment regimens are needed to guide therapy. A systematic approach to identify reliably effective (e.g., 90% or greater treatment success) cost-effective regimens is suggested as well as details of regimens likely to be effective in India. H. pylori is just one of the health care problems faced in India, but one where all the resources are on hand to understand and solve it.

protective role of aegle marmelos on aspirin-induced gastroduodenal ulceration in albino rat model: a possible involvement of antioxidants

Gastro duodenal ulcer is a common disorder of the gastrointestinal tract. Several Indian medicinal plants have been traditionally and extensively used to prevent different diseases. In the present research studies, Bael fruit [Aegle marmelos [AM], family: Rutaceae] which are also called as Bilva in ancient Sanskrit was used as a herbal drug and its antioxidative role in aspirin- induced gastroduodenal ulceration in albino rat was evaluated using essential biochemical parameters. Mucosal thickness [MT], ulcer index [UI], different biochemical parameters, such as aspartate aminotransferase [AST], alanine aminotransferase [ALT], catalase [CAT], superoxide dismutase [SOD], reduced glutathione [GSH], and lipid peroxidation [LPO] were measured in all the groups, to study the possible involvement of antioxidants with gastroduodenal protection. A significant decrease in MT, SOD and CAT activities and GSH level and a significant increase in UI, AST, ALT, and ALP activities and LPO level were observed in aspirin treated stomach and duodenum of albino rats. Pretreatment with AM fruit pulp extract for 14 consecutive days showed the reverse effects of aspirin suggesting gastro-duodenal protective and anti- ulcerogenic properties of AM through its antioxidant mechanism

Evolução histórica da úlcera péptica: da etiologia ao tratamento / History of peptic ulcer: from etiology to treatment

Objetivos: revisar os principais aspectos históricos da progressão do conhecimento sobre a etiologia da úlcera péptica e das terapêuticas clínicas e cirúrgicas empregadas no tratamento desta enfermidade.Fonte de dados: revisão bibliográfica através do PubMed. Foram analisados artigos selecionados sobre a história da úlcera péptica.Síntese dos dados: durante décadas, cirurgiões acreditaram que a doença da úlcera péptica era causada pelo excesso de ácido. O aforisma ?sem ácido, sem úlcera? foi enraizado em todos os residentes de cirurgia, e todos os esforços foram concentrados em eliminar o ácido através de uma operação. Com o advento da terapêutica farmacológica, houve melhora no sucesso do tratamento clínico e o número de casos cirúrgicos diminuiu. Com a descoberta do Helicobacter pylori, ainda mais pacientes foram tratados clinicamente e o número de casos cirúrgicos diminuiu novamente, persistindo apenas para casos refratários, hemorragia ou perfuração.Conclusões: úlcera péptica é uma doença reconhecida desde a antiguidade. A compreensão da evolução gradual das várias formas de seu tratamento serve de alerta e ensinamento de como evolui o conhecimento científico, onde as certezas efinitivas podem ser alteradas por inovações e resultados de pesquisas metodologicamente bem delineadas e realizadas, bem como elucidar a difícil trajetória que tem sido percorrida para poder solucionar o sofrimento dos pacientes que possuem essa enfermidade.

Aims: To review the main aspects of the historical progression of knowledge about the etiology of peptic ulcer and the clinical and surgical treatment used in the treatment of this disease.Source of data: A search was carried out at PubMed. Selected papers about the history of the peptic ulcer were reviewed.Summary of findings: For decades, surgeons were taught and believed that peptic ulcer disease was caused by acid.The dictum ?no acid, no ulcer? was engrained into every resident of surgery, and all efforts were focused on eliminating acid through operation. With the advent of pharmacological therapy, more ulcers were successfully treated medically and the number of surgical cases decreased. With the discovery of Helicobacter pylori, even more patients were successfully treated medically and the number of surgical cases decreased again, usually only to include refractory cases, hemorrhage or perforation.Conclusions: Peptic ulcer is a disease recognized since ancient times. The understanding of the gradual evolution of several forms of treatment serves as a warning and teaching of how scientific knowledge evolves, where the final certainties can be changed by innovations and research findings methodologically well designed and executed, and to clarify the difficult path that has been traversed in order to solve the suffering of patients who have this disease.

effect of Cedrus deodara root oil on the histopathology of rat stomach

The aim of this study was to observe the anti-ulcer effects of Cedrus deodara root oil on the rat's stomach and compare it with standard anti-ulcer drugs, femotidine and protonix. The study was conducted on 50 albino Wistar rats in three different doses i.e. 30, 40, and 50 mg/kg. The animals were divided into five groups, each group comprised of 10 rats [5 male and 5 female]. The oil was extracted from the plant root by dry destructive distillation method and the dose was calculated by dissolving 1.25 gms of Cedrus deodara in 25ml of 10% ethanol. The drugs were administered to the treated animals orally through feeding tube for two weeks. Animals received the dose of 50 mg cedar oil only, showed the healing effects on the mucosal epithelium of stomach, decreased inflammatory cells and granulation tissues on the submucosal layer upon histopathological examination. Therefore it may be concluded that Cedrus deodara root oil has anti-ulcerative effects and may be used in the management of gastrointestinal disorders particularly in peptic ulcer

Diagnóstico tardio da imunodeficiência comum variável / Late diagnosis of common variable immunodeficiency

A imunodeficiência comum variável (ICV) é uma doença primária do sistema imunológico associada a infecções recorrentes, principalmente no trato respiratório, fenômenos autoimunes e neoplasias. Sua incidência é relativamente baixa, mas é considerada entre as imunodeficiências primárias sintomáticas a mais comum; mesmo assim o atraso no seu diagnóstico costuma ser muito frequente. Os autores apresentam um caso de um paciente com diagnóstico prévio de anemia perniciosa que apresentava infecções respiratórias de repetição quando o diagnóstico de ICV foi suspeitado

Common variable immunodeficiency (CVID) is a primary disease of the immune system, associated with recurrent infections, mainly in the respiratory tract, autoimmune phenomena and malignancies. Although its incidence is relatively low, it is considered the most common among symptomatic primary immunodeficiencies. Still, the delay in diagnosis is very frequent. The authors present a case of a patient with previous diagnosis of pernicious anemia who presented with recurrent respiratory infections when the diagnosis of CVID was suspected

Tratamento cirúrgico da estenose pilórica / Surgical treatment of pyloric stenosis

Úlcera péptica é definida como uma lesão de mucosa gástrica e/ou duodenal que ocorre quando há desequilíbrio entre fatores de proteção e agressão. É um dos maiores problemas de saúde, com incidência em torno de 1.500 a 3.000 casos a cada 100.000 habitantes por ano. Atualmente, a cirurgia eletiva para essa doença está virtualmente excluída, reservando-se apenas para casos de emergência. A grande maioria desses procedimentos consiste em rafia da parede gástrica ou duodenal por úlcera perfurada. A hemorragia dessas lesões aparece como segunda complicação mais frequente. E, finalmente, apenas cerca de 1 a 2% dos pacientes necessitam de tratamento cirúrgico para aliviar uma obstrução gástrica ou duodenal, já que o processo ulceroso crônico deixa fibrose e estenose na região. No presente estudo, são relatados 3 casos em nossa instituição em que executamos cirurgia devido à estenose péptica do piloro e duodeno refratária ao tratamento clínico num período menor que 8 meses. Em todos os casos, foi realizada uma hemigastrectomia, com reconstrução à Y de Roux, obtendo resultados satisfatórios

Peptic ulcer is defined as injury to the gastric or duodenal mucosa which occurs when there is an imbalance between protective factors and aggression to it. It is one of the biggest health problems, with an incidence of around 1500 to 3000 cases per 100,000 people per year. Currently, elective surgery for this disorder is virtually excluded, reserved for emergency cases only. The vast majority of these surgical procedures consists in suturing the stomach or duodenal wall with perforated ulcer. Hemorrhage from these lesions appears as the second most frequent complication. And finally, only about 1-2% of patients require surgery to relieve a gastric or duodenal obstruction, since the chronic ulcerous process causes fibrosis and ulcerative stenosis in the region. In the present study we report three cases in which we performed surgery due to peptic stenosis of the pylorus and duodenum refractory to medical treatment in a period less than 8 months. In all cases, hemigastrectomy with Roux-Y reconstruction was performed, with satisfactory results

Helicobacter pylori infection in India from a western perspective.

Helicobacter pylori is a common bacterial infectious disease whose manifestations predominately affect the gastrointestinal tract. India is the prototypical developing country as far as H. pylori infection is concerned and more than 20 million Indians are estimated to suffer from peptic ulcer disease. Considering the high level of Medicine and of the pharmaceutical industry, one would expect that India would be the source of much needed information regarding new therapies and approaches that remain effective in the presence of antimicrobial resistance, new methods to reliably prevent reinfection, and the development of therapeutic and preventive vaccines. Here, we discuss H. pylori as an Indian problem with an emphasis on H. pylori infection as a serious transmissible infectious disease. We discuss the pros and cons of eradication of H. pylori from the entire population and come down on the side of eradication. The available data from India regarding antimicrobial use and resistance as well as the effectiveness of various treatments is discussed. Rigorous ongoing studies to provide current regional antibiotic resistance patterns coupled with data concerning the success rate with different treatment regimens are needed to guide therapy. A systematic approach to identify reliably effective (e.g., 90% or greater treatment success) cost-effective regimens is suggested as well as details of regimens likely to be effective in India. H. pylori is just one of the health care problems faced in India, but one where all the resources are on hand to understand and solve it.

Reinfecção pelo Helicobacter pylori em pacientes brasileiros com úlcera péptica, em seguimento de 5 anos / Helicobacter pylori reinfection in brazilian patients with peptic ulcer disease, a five year follow-up

Introdução: A reinfecção pelo Helicobacter pylori em países em desenvolvimento parece ser maior do que nos países desenvolvidos. O retratamento da bactéria e o controle periódico de cura são necessários, quando elevadas taxas de reinfecção são verificadas. O objetivo do trabalho foi determinar a taxa anual de reinfecção, em pacientes brasileiros com úlcera péptica, num seguimento de cinco anos. Métodos: Pacientes com úlcera péptica, diagnosticada por endoscopia digestiva alta e infecção pelo Helicobacter pylori documentada por histologia, teste da urease, reação em cadeia da polimerase e teste respiratório, foram tratados para erradicação da bactéria. A cura da infecção foi verificada com os mesmos exames, três meses após o término do tratamento. Avaliação clínica e teste respiratório foram realizados aos seis e nove meses. Com um ano de seguimento, endoscopia, exame histológico, teste da urease, reação em cadeia da polimerase e teste respiratório foram novamente realizados. Até o quinto ano de seguimento, foram feitas consultas semestrais e testes respiratórios anuais. Na inclusão dos pacientes e nos reinfectados foram estudados 15 diferentes genes da bactéria. Resultados: Cento e quarenta e sete pacientes foram seguidos: 19 por um ano, oito por dois anos, quatro por três anos, cinco por quatro anos e 98 por cinco anos, num total de 557 pacientes/ano. Não ocorreu reinfecção no primeiro ano. No segundo ano, dois pacientes se reinfectaram, no terceiro quatro pacientes, no quarto três pacientes e no quinto um paciente, num total de 10 reinfecções. A taxa anual de reinfecção por pacientes/ano foi de 1,8%. Conclusão: O Brasil, um país em desenvolvimento com alta prevalência da infecção pelo Helicobacter pylori, apresenta uma taxa de reinfecção semelhante à dos países desenvolvidos.

Introduction: The Helicobacter pylori reinfection rate seems to be higher in developing countries, than in developed ones. If a high reinfection rate is verified, periodical exams and bacterial retreatment would be necessary. The objective of this study was to determine the annual reinfection rate of Helicobacter pylori, in Brazilian patients with peptic ulcer disease, in a five year follow-up. Methods: Patients, with peptic ulcer disease diagnosed by upper digestive endoscopy and Helicobacter pylori infection verified by histological examination, rapid urease test, polymerase chain reaction and urea breath test, were treated for bacterial eradication. The infection cure was determined by the same proceedings, three months after the treatments end. Clinical evaluation and urea breath test were performed at sixth and ninth months of the follow-up. At one year of the follow-up, upper digestive endoscopy, histological examination, rapid urea test, polymerase chain reaction and urea breath test were repeated. Up to the fifth year of follow-up semester clinical evaluation and annual urea breath test were performed. All the patients included in the study and all the reinfected patients were tested for fifteen different genes of the Helicobacter pylori. Results: One hundred and forty-seven patients were followed: nineteen patients for one year, eight patients for two years, four patients for three years, five patients for four years and ninety-eight patients for five years. The total of patients/years follow-up was 557. Reinfection did not occur in the first year of the follow-up. In the second year, two patients became reinfected; in the third year, four patients; in the fourth, three and in the fifth, one patient. The total of reinfected patients was 10. The annual reinfection rate was 1,8%. Conclusion: Brazil, a developing country, presents a high prevalence of Helicobacter pylori infection. Nonetheless, the reinfection rate is similar to the developed countries.

Guidelines of Treatment for Peptic Ulcer Disease in Special Conditions / 대한소화기학회지

The pathogenesis, incidence, complication rates, response to acid suppression and Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer associated with chronic disease such as liver cirrhosis, chronic renal failure, diabetes mellitus, and critically ill conditions are different from those with general population, so that the management strategies also should be differentiated. The eradication of H. pylori are not so effective for preventing recurrence of peptic ulcer in liver cirrhosis patients as shown in general population, and conservative managements such as preventing deterioration of hepatic function and decrease in portal pressure are mandatory to reduce the risk of ulcer recurrence. The standard triple therapy for H. pylori eradication are as effective in chronic renal failure patients as in normal population, but the frequency of side effects of amoxicillin is higher in the patients not receiving dialysis therapy. Delay in eradication therapy until beginning of dialysis therapy or modification of eradication regimen should be considered in such cases. High prevalence of asymptomatic peptic ulcers and increased mortality in complicated peptic ulcer disease warrant regular endoscopic surveillance in diabetic patients, especially with angiopathy. The prolongation of duration of eradication therapy also should be considered in diabetic patients with angiopathic complication because of lower eradication rate with standard triple regimens as compared to normal population. Prophylactic acid suppressive therapy is highly recommended in critically ill patients with multiple risk factors. Herein, we propose evidence-based treatment guidelines for the management of peptic ulcer disease in special conditions based on literature review and experts opinion.

Hemorragia digestiva alta: análisis de 100 casos / Upper gastrointestinal bleeding: report of 100 cases

La hemorragia digestiva (HDA) es relativamente frecuente y su manejo varía de acuerdo a los distintos centros. El objetivo de este trabajo es evaluar nuestra incidencia de HDA comparando factores de riesgo con hallazgos endoscópicos e histopatológicos. A su vez el tratamiento recibido y el seguimiento posterior de los pacientes.

Curso Terapêutica em Gastroenterologia: aula 6: Doença ulceropéptica / Gastroenterology Therapeutic Course: class 6: Peptic ulcer disease

A doença ulceropéptica, que acomete principalmente as regiões do estômago e duodeno, tem como principais etiologias o Helicobacter pylori eo uso prolongado de antiinflamatórios não-hormonais. A incidência da doença, assim como suas complicações, vêm diminuindo progressivamente, especialmente com a possibilidade de erradicação do Helicobacter pylori. Entretanto, a doença ulceropéptica permanece como condição clínica freqüentemente encontrada na prática diária, motivo pelo qual sua terapêutica deve ser amplamente conhecida por clínicos gerais e especialistas

Pharmacological and safety evaluation studies on cardamom elettaria cardamomum: an important ingredient of gahwa [arabian coffee]

An aqueous suspension of cardamom, Elettaria cardamomum was tested for its ability to inhibit gastric secretion and to protect gastric mucosa against the injuries caused by pylorus ligation, indomethacin and cytodestructive agents [80% ethanol, 0.2 M NaOH and 25% NaCI] in rats. The cardamom suspension at doses [250 and 500 mg/kg] exhibited significant decrease in basal gastric secretions and ulcers induced by Shay rats and indomethacin in rats. The suspension also significantly protected gastric mucosal against necrotizing agents. Histopathological evaluation revealed no significant pathological changes in the stomach of rats after 80% ethanol challenge. The LD[50] of cardamom was found to be 26.0 g/kg in mice. A large margin of safety was observed in animals in acute and chronic toxicity tests. Treatment with cardamom suspension did not induce any significant changes in the micronucleated polychromatic erythrocytes [PCE] and the ratio of PCE and normochromatic erythrocytes [NCE] at both doses used as compared to control group. In conclusion, cardamom showed a significant antisecretory and antiulcer activities without causing any deleterious effects in acute, prolong administration and genotoxicity in the animals

[Azithromycin in one week quadruple therapy for H, pylori eradication]

In developing countries primary antibiotic-resistance and poor compliance are the main causes of helicobacter pylori [HP] eradication failure of standard regimens. AIM: To investigate eradication rate, patient's compliance and tolerability of a 1-wk Azithromycin based quaruple therapy versus the 2-wk conventional therapy. A total of 129 HP-positive patients were randomized to either omeprazole 20mg, bismuth subcitrate 240 mg, azithromycin 250 mg, metronidazole 500 mg, all twice daily for 1- wk [BOAzM] or omeprazole 20mg, bismuth subcitrate 240 mg, amoxicillin 1g, metronidazole 500 mg all twice daily for 2-wk [B-OAM]. HP infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test. HP eradication rates of B-OAzM and B-OAM were74.1% and 70.4% respectively at intention to treat and per-protocol analysis 78.1%versus 75.7% respectively. incidence of poor compliance was lower, although not significant, in patients randomized to B-OAzM than for B-OAM [3.5% versus 4.3%] but intolerability was similar in two groups [35% versus 33.3%]. 1-wk azithromycin based quadruple regimen achieves an HP eradication rate comparable to that of standard 2-wk quadruple Therapy and is associated with same patient's compliance and complications

Studies on the antiulcer activity of Mirabilis jalapa Linn

The antiulcer activity of the aerial parts of Mirabilis jalapa Linn. [fam. Nyctaginaceae] was studied on albino rats. The antiulcer activity of the chloroform extract, ethanolic extract and aqueous extract was evaluated by using pyloric ligation models and alcohol induced ulceration model. All the test samples revealed significant antiulcer activity. The order of decreasing ulcer score was found to be aqueous extract < ethanol extract < chloroform extract in all performed models. The results indicate that the aerial parts of Mirabilis jalapa are endowed with potential antiulcer activity

Invitro comparitive study of the efficacy of licorice decoctant and choice antibiotics on helicobacter pylori growth

Glycyrrhiza Glabra [Licorice] root, a member of the pea family has been used since ancient times as both food and medicine. Licorice has been used as an antioxidant, antimicrobial and anti inflammatory in researches.Extraction of this medical plant is used as the basis of anti-ulcer medicine for treatment of peptic ulcer. In the present study, licorice decoction [20gr/dl,33gr/dl] was prepared and anti microbial activity on helicobacter pylori growth was studied by disk diffusion method and cup plate method. The results showed that licorice decoction 33gr/dl by disk diffusion method inhibited growth of helicobacter pylori in vitro the same as metronidazole.[P value=0.709] However, it does not have anti bacterial activity against helicobacter pylori like amoxicillin and clarythromycin [Pvalue-0.000]. Decoction licorice [20gr/dl, 33gr/dl] can not be used as an alternative to choice antibiotic [amoxicillin, clarythromycin] in vitro