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1.
Rev. colomb. cir ; 37(3): 505-510, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378847

ABSTRACT

Introducción. La úlcera duodenal perforada es una entidad de etiología no clara que rara vez ocurre en la población pediátrica. Generalmente se diagnostica de manera intraoperatoria y el tratamiento ideal incluye el uso del parche de epiplón o de ser necesario, la resección quirúrgica. Caso clínico. Se presenta un paciente de 12 años con abdomen agudo y diagnóstico tomográfico prequirúrgico de úlcera duodenal perforada, tratado por vía laparoscópica con drenaje de peritonitis y parche de Graham. La evolución y el seguimiento posterior fueron adecuados. Discusión. La úlcera duodenal perforada es una entidad multifactorial, en la que se ha implicado el Helicobacter pylori. El diagnóstico preoperatorio es un reto y el tratamiento debe ser quirúrgico. Conclusiones. Cuando se logra establecer el diagnóstico preoperatorio, se puede realizar un abordaje laparoscópico y el uso del parche de Graham cuando las úlceras son menores de dos centímetros.


Introduction. Perforated duodenal ulcer is an entity of unclear etiology that rarely occurs in the pediatric population. It is usually diagnosed intraoperatively and the ideal treatment includes the use of the omentum patch or, if necessary, surgical resection. Clinical case. A 12-year-old patient with acute abdomen and preoperative tomographic diagnosis of perforated duodenal ulcer, treated laparoscopically with peritonitis drainage and Graham patch is presented. The evolution and subsequent follow-up were adequate. Discussion. Perforated duodenal ulcer is a multifactorial entity, in which Helicobacter pylori has been implicated. Preoperative diagnosis is challenging and treatment must be surgical. Conclusions. When the preoperative diagnosis is established, a laparoscopic approach and the use of the Graham patch can be performed when the ulcers are less than two centimeters.


Subject(s)
Humans , Duodenal Ulcer , Intestinal Perforation , Omentum , Helicobacter pylori , Laparoscopy
2.
Article in Chinese | WPRIM | ID: wpr-928616

ABSTRACT

OBJECTIVES@#To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.@*METHODS@#A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups.@*RESULTS@#A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05).@*CONCLUSIONS@#Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.


Subject(s)
Abdominal Pain , Child , Duodenal Ulcer/epidemiology , Endoscopy, Gastrointestinal/adverse effects , Female , Helicobacter Infections/diagnosis , Helicobacter pylori , Humans , Male , Retrospective Studies , Ulcer
3.
Iatreia ; 34(4): 365-369, oct.-dic. 2021. graf
Article in English | LILACS | ID: biblio-1350836

ABSTRACT

SUMMARY Introduction: Gastric bypass is one of the strategies that have shown better results in the management of obesity, since this technique is the one that strikes a better balance between risk, side effects and long-term results. It consists in the creation of a gastric reservoir that anastomosis to the jejunum, reducing the size of the gastric chamber and thus the patient tolerates less food and decreasing its intake. One of the less frequent late complications is duodenal perforation. For this reason, we present this case report, according to the CARE guideline. Case presentation: 47-year-old male patient with a history of gastric bypass due to obesity, who consults for sudden onset of abdominal pain. Physical examination showed signs of peritoneal irritation and systemic inflammatory response. Exploratory laparoscopy was performed with suspected hollow viscus perforation, which evidenced a 1 cm ulcer on the anterior aspect of the duodenal bulb, requiring omentoplasty by laparotomy. Conclusions: Perforated duodenal ulcer in patients with a history of gastric bypass is a rare diagnosis. It has a non-specific clinical presentation, which is why exploratory laparoscopy is considered a valid diagnostic and therapeutic strategy.


RESUMEN Introducción: una de las estrategias que han demostrado resultados superiores para el manejo de la obesidad es el bypass gástrico, ya que esta técnica es la que reúne un major equilibrio entre el riesgo, efectos secundarios y los resultados a largo plazo. Consiste en la creación de un reservorio gástrico que se anastomosa al yeyuno, reduciendo el tamaño de la cámara gástrica y haciendo que el paciente tolere menos los alimentos, para que se disminuya la ingesta de estos. Dentro de las complicaciones tardías menos frecuentes se encuentra la perforación duodenal, motivo por el cual se presenta este reporte de caso de acuerdo con la guía CARE. Presentación del caso: hombre de 47 años y antecedente de bypass gástrico por obesidad, que consulta por dolor abdominal de inicio súbito. A la valoración con examen físico con hallazgos de irritación peritoneal y signos de respuesta inflamatoria sistémica. Es llevado a laparoscopia exploratoria con sospecha de perforación de la víscera hueca. Se evidenció una úlcera en la cara anterior del bulbo duodenal de 1 cm que requirió de epiploplastia por laparotomía. Conclusiones: la úlcera duodenal perforada en pacientes con antecedente de bypass gástrico es un diagnóstico poco frecuente con presentación clínica inespecífica, por esto se considera la laparoscopia exploratoria como una estrategia diagnóstica y terapéutica válida.


Subject(s)
Humans , Gastric Bypass , Duodenal Ulcer , Obesity
4.
Rev. medica electron ; 43(3): 616-628, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289808

ABSTRACT

RESUMEN Introducción: la infección por Helicobacter pylori es la enfermedad bacteriana crónica que afecta con mayor prevalencia al ser humano. Objetivo: identificar la frecuencia de infección por Helicobacter pylori y su relación con variables consideradas factores de riesgo de esta infección. Materiales y métodos: estudio de corte transversal realizado en el Policlínico Docente Camilo Cienfuegos, del municipio Habana del Este, durante el año 2018, en un universo de 42 pacientes con 18 años y más de edad, con sospecha clínica y hallazgo endoscópico de úlcera duodenal e informe del resultado de estudio histológico para el diagnóstico de la infección. Se confeccionó una planilla de recolección de datos que incluyó variables como hacinamiento, agua de consumo, lugar de nacimiento, estancia en una institución, contacto con animales y antecedentes familiares. Se determinó relación entre variables con la prueba de chi cuadrado (c2) con significación estadística ɒ = 0,05, y se identificaron variables cuyos coeficientes fueron significativamente diferentes de 0 (p < 0,05). La fuerza de asociación se determinó mediante odds ratio. Resultados: la prevalencia fue de 59,5 %. Se encontró asociación estadística y constituyeron factores de riesgo de infección por Helicobacter pylori, el hacinamiento (c2 = 4,37; OR = 3,89), el agua de consumo (c2 = 4,92; OR = 3,43), el contacto con animales (c2 = 7,41; OR = 6,17) y los antecedentes familiares (c2 = 13,18; OR = 13). Conclusiones: el estudio permitió determinar la prevalencia de infección por Helicobacter pylori y las principales variables asociadas, coincidiendo con otros estudios revisados que tratan el tema (AU).


ABSTRACT Introduction: the infection by Helicobacter pylori is the chronic bacterial disease that affects the human being with greater prevalence. Objective: to identify the frequency of the infection by Helicobacter pylori and its relationship with variables considered risk factors for this infection. Materials and methods: a cross-sectional study was carried out in the teaching Polyclinic Camilo Cienfuegos, municipality Habana del Este, during 2018. In a universe of 42 patients aged 18 years and over, with clinical suspicion and endoscopic diagnosis of duodenal ulcer and histological study report for the diagnosis of the infection. A data collection form was made, which included variables such as: overcrowding, consumption water, place of birth, staying in an institution, contact with animals, and family history. The relationship within variables was found using the chi-square test (c2) with statistical significance ɒ = 0.05, and there were identified variables significantly different from 0 (p < 0.05). The association strength was determined through odds ratio. Results: the prevalence was 59.5%. Statistical association was found and overcrowding (c2 = 4.37, OR = 3.89), consumption water (c2 = 4.92; OR = 3.43), contact with animals (c2 = 7.41, OR = 6.17) and family history (c2 = 13.18, OR = 13) were found risk factors for Helicobacter pylori infection. Conclusions: the study allowed to determine the prevalence of Helicobacter pylori infection and the main associated variables, coinciding with other reviewed studies dealing with the subject (AU).


Subject(s)
Humans , Male , Female , Helicobacter pylori/virology , Duodenal Ulcer/diagnosis , Signs and Symptoms , Prevalence , Risk Factors , Helicobacter pylori/pathogenicity , Virulence Factors/physiology
5.
Article in Chinese | WPRIM | ID: wpr-878724

ABSTRACT

Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.


Subject(s)
Duodenal Ulcer/therapy , Embolization, Therapeutic , Endoscopy , Gastrointestinal Hemorrhage/etiology , Hemostasis, Endoscopic , Humans , Recurrence , Retrospective Studies
6.
Article in English | WPRIM | ID: wpr-827431

ABSTRACT

OBJECTIVES@#To compare the features of patients with peptic ulcer between Han and Uyghur ethnicity from 2013 to 2018 in Xinjiang and to provide the evidence of prevention and treatment for the different ethnicity.@*METHODS@#Data of 3 586 patients with peptic ulcer (3 293 Han and 293 Uyghur) in the Karamay Central Hospital of Xinjiang, including the detection rate of peptic ulcer, () detection rate of population, season, gender, lesion location and complication, were collected from January 2013 to December 2018 and compared between 2 nationalities.@*RESULTS@#There were significant difference in the detection rate of peptic ulcer and population's between Han and Uyghur (<0.01). The detection rates for peptic ulcer of Han were sustainable declined from 15.20% to 10.23%, while Uyghur's detective rates for peptic ulcer were raised again from 17.49% to 8.38%. The detection rate of Uyghur's population was higher than that of Han (<0.01). There were significant difference in the season's detection rate for peptic ulcer between Han and Uyghur (<0.01). The detection rate for peptic ulcer of Han was the highest in the winter, while that of Uyghur was the highest in the spring. The detective rate of Uyghur's peptic ulcer was significant higher than that of Han in the spring (<0.01). The detection rates for peptic ulcer of 2 nationality were the highest at ≤25 age groups, the detection rate for Uyghur's peptic ulcer was higher than that of Han at ≤35 age groups (<0.05). There were more men than women in peptic ulcer in the 2 nationalities. The approximate proportion was 2꞉1. The rates of multiple gastric ulcer and compound duodenal ulcer of Han were more than those of Uyghur (<0.05), but the rate for pyloric obstruction of Uyghur patient was higher than that of Han (<0.05).@*CONCLUSIONS@#There are statistical difference in detection rate of PU, detection rate of population, morbidity season, age, complication and the rate of complex ulcer between Han and Uyghur, However, there aren't statistical difference in detection rate of peptic ulcer patient, the gender, lesion location between the 2 nationalities during last 6 years.


Subject(s)
Child, Preschool , Duodenal Ulcer , Ethnicity , Female , Helicobacter Infections , Helicobacter pylori , Humans , Male , Stomach Ulcer
7.
Rev. medica electron ; 41(1): 189-195, ene.-feb. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-991337

ABSTRACT

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.


ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.


Subject(s)
Humans , Male , Aged, 80 and over , Pylorus/abnormalities , Pylorus/physiopathology , Pylorus/diagnostic imaging , Endoscopy, Gastrointestinal/methods , Diverticulum, Colon/diagnostic imaging , Duodenal Ulcer/diagnostic imaging , Proton Pump Inhibitors/therapeutic use , Aspirin/therapeutic use , Melena/diagnosis , Barium Enema/methods , Smokers , Hypertension/diagnosis
8.
Article in English | WPRIM | ID: wpr-719607

ABSTRACT

PURPOSE: This study was performed to assess the clinical usefulness of transabdominal ultrasonography (TUS) in detecting peptic ulcer disease (PUD) in children. METHODS: Twenty-four patients (19 boys, 5 girls; mean age, 10.6±4.5 years [range, 3.0–17.9 years]) who were admitted to the hospital for acute abdomen or gastrointestinal bleeding and diagnosed with PUD by endoscopy and who underwent TUS were included. Clinical data were retrospectively collected by reviewing patient medical records. Gastric ulcer (GU) was suspected when the gastric wall exceeded 8 mm in thickness and had lost its five-layer structure on TUS. Duodenal ulcer (DU) was suspected if the duodenal wall thickness exceeded 5 mm. RESULTS: Sensitivity of TUS in diagnosing PUD was 66.7% for GU and 38.9% for DU. Mean age and body weight of the 11 patients suspected with PUD on TUS were 10.9±4.4 years and 38.1±17.2 kg, respectively. For 13 patients without suspected PUD, they were 12.1±4.1 years and 39.6±17.0 kg, respectively. There was a significant difference in height, weight, and body mass index between patients who were suspected to have PUD and those who were not suspected on TUS (p=0.014, 0.008, and 0.005, respectively). A significant difference in the sensitivity of TUS in diagnosing PUD was found between patients under 30 kg and those over 30 kg (88.9% and 20.0%, respectively; p=0.003). CONCLUSION: TUS investigation of the stomach and duodenum is an efficient method for PUD detection in children with low body weight. TUS can be used in preliminary diagnostic work-up before further invasive tests.


Subject(s)
Abdomen, Acute , Body Mass Index , Body Weight , Child , Diagnosis , Duodenal Ulcer , Duodenum , Endoscopy , Female , Hemorrhage , Humans , Medical Records , Methods , Peptic Ulcer , Retrospective Studies , Stomach , Stomach Ulcer , Ultrasonography
9.
Article in English | WPRIM | ID: wpr-719436

ABSTRACT

Intramural hematoma of the duodenum is a relatively unusual complication associated with the endoscopic treatment of bleeding peptic ulcers. Intramural hematomas are typically resolved spontaneously with conservative treatment alone. We report a case of an intramural duodenal hematoma following endoscopic hemostasis with epinephrine injection therapy, which was associated with transient obstructive jaundice in a patient undergoing hemodialysis. The patient developed biliary sepsis due to obstruction of the common bile duct secondary to the huge hematoma. He was treated with fluoroscopy-guided drainage catheter insertion, which spontaneously resolved the biliary sepsis through conservative treatment in 6 weeks. Fluoroscopy-guided drainage may impact the treatment of intramural hematomas that involve life-threatening complications.


Subject(s)
Catheters , Cholestasis , Common Bile Duct , Drainage , Duodenal Ulcer , Duodenum , Epinephrine , Hematoma , Hemorrhage , Hemostasis, Endoscopic , Humans , Jaundice, Obstructive , Peptic Ulcer , Renal Dialysis , Sepsis
10.
Article in English | WPRIM | ID: wpr-765785

ABSTRACT

PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.


Subject(s)
Diet , Duodenal Ulcer , Humans , Korea , Laparoscopy , Length of Stay , Mortality , Observational Study , Peptic Ulcer Perforation , Pneumothorax , Postoperative Complications , Prospective Studies , Reoperation , Risk Factors , Seoul
11.
Cambios rev. méd ; 17(2): 94-104, 28/12/2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-1005258

ABSTRACT

El sangrado digestivo alto (SDA) se define como la presencia de sangre en el tracto digestivo alto, proveniente de la mucosa o vasos sanguíneos que se localizan entre el esófago y el ángulo de Treitz. Las principales manifestaciones clínicas asociadas al SDA están dadas por la presencia de hematemesis, melena y en algunos casos hematoquezia, esta última relacionada con sangrados que cursan con aceleración del tránsito intestinal. En el Hospital de Especialidades Carlos Andrade Marín el SDA es un motivo frecuente de consulta en urgencias, que implica además un importante número de ingresos tanto al área crítica de Urgencias, Unidad de Cuidados Intensivos y hospitalización. La mortalidad por esta causa es variable, se estima en 3,5% al 10,0% y esta depende sobre todo de la edad del paciente y sus posibles enfermedades asociadas, la cuantía del sangrado y los hallazgos que se encuentren durante la realización del procedimiento endoscópico. El sangrado digestivo alto es autolimitado o cesa espontáneamente en el 80,0% de los casos. La causa más frecuente es la hemorragia por úlcera péptica (25,0% ulcera duodenal­23,0% ulcera gástrica). Con este protocolo clínico buscamos normar el manejo hospitalario de los pacientes que ingresan al área de Urgencias con el fin de unificar criterios que conlleven al manejo adecuado de los pacientes con sangrado digestivo alto.


Upper digestive tract bleeding (SDA) is defined as the presence of blood in the upper digestive tract, coming from the mucosa or blood vessels that are located between the esophagus and the Treitz angle. The main clinical manifestations associated with SDA are given by the presence of hematemesis, melena and in some cases hematochezia, the latter related to bleeding that occurs with the acceleration of intestinal transit. In the Hospital of Specialties Carlos Andrade Marín, the SDA is a frequent reason for consultation in the emergency room, which also implies an important number of admissions to the critical area of Emergency, Intensive Care Unit and hospitalization. Mortality from this cause is variable, it is estimated at 3,5% to 10,0% and this depends above all on the age of the patient and their possible associated diseases, the amount of bleeding and the findings that are found during the performance of the endoscopic procedure. High digestive bleeding is self-limiting or ceases spontaneously in 80,0% of cases. The most frequent cause is peptic ulcer hemorrhage (25,0% duodenal ulcer -23,0% gastric ulcer). With this clinical protocol, we seek to regulate the hospital management of patients who enter the Emergency Department to unify criteria that lead to the proper management of patients with high digestive bleeding.


Subject(s)
Humans , Stomach Ulcer , Hematemesis , Duodenal Ulcer , Hemorrhage , Angiography , Clinical Protocols
12.
Arq. gastroenterol ; 55(2): 122-127, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-950513

ABSTRACT

ABSTRACT BACKGROUND: The association between infection with Helicobacter pylori and different gastroduodenal diseases is related to bacterial, host and environmental factors. Studies have demonstrated an association between the genetic diversity of H. pylori, especially in the vacA and cagA genes, and the development of digestive diseases such as peptic ulcer and gastric cancer. In addition, the nature of the host inflammatory response may explain these different manifestations of infection caused by this microorganism. In this respect, host factors that regulate the immune and inflammatory responses involving the functional interaction of H. pylori infection with different components of the immune system, particularly T cells, in gastroduodenal diseases still need further investigation. OBJECTIVE: To characterize the immune response, including immunity induced by infection with H. pylori, especially virulent strains (vacA alleles and cagA gene), by analyzing the cytokine profile and T-cell population present in gastroduodenal diseases in a Brazilian population. METHODS: In a prospective study, gastric biopsies were collected from 554 patients with different gastroduodenal diseases for histological analysis and for the determination of bacterial genotype and cytokine production (IL-4, IL-10, IFN-γ and IL-12) by ELISA. RESULTS: The predominant genotype of the H. pylori strains isolated from the patients studied was s1m1cagA+, which was more common among patients with gastric ulcer, duodenal ulcer and gastric cancer. A significant association was observed between the s1m1cagA+ genotype and a higher degree of inflammation, higher neutrophil activity and the development of intestinal metaplasia. The gastric concentrations of IFN-γ and IL-12 were significantly higher in patients infected with H. pylori than in uninfected individuals. Higher levels of these cytokines were detected in patients with gastric ulcer and cancer, while the levels of IL-4 and IL-10 in the gastric mucosa were lower in these patients. In addition, IFN-γ and IL-12 concentrations in gastric biopsies were higher in patients infected with the virulent s1m1cagA+ genotype. In contrast, IL-4 and IL-10 levels were higher in tissue infected with s2m2cagA in gastric biopsies. CONCLUSION: Our study shows that the interaction between the type of infectious strain and the Th1 immune response can influence and perpetuate gastric inflammation, and thus contributes to the development of the different clinical manifestations of H. pylori infection.


RESUMO CONTEXTO: A associação da infecção por Helicobacter pylori com diferentes doenças gastroduodenais pode estar associada a fatores bacterianos, do hospedeiro e do ambiente. Nesse contexto, estudos têm demonstrado que a diversidade genética do H. pylori, sobretudo nos genes vacA e cagA, está associada ao desenvolvimento de doenças gastroduodenais como a úlcera péptica e o câncer gástrico. Além disso, a natureza da resposta inflamatória do hospedeiro pode explicar essas diferentes manifestações da infecção por esse microrganismo. Portanto, fatores do hospedeiro que regulam as respostas imunológica e inflamatória, envolvendo a interação funcional da infecção por H. pylori com diferentes membros do compartimento imunológico, especialmente respostas imunes de células T nas doenças gastroduodenais, ainda precisam ser melhor estudados. OBJETIVO: Caracterizar a resposta imune, incluindo imunidade induzida por infecção pelo H. pylori, especialmente com cepas virulentas de H. pylori (alelos vacA e gene cagA), através da análise do perfil de citocinas e da caracterização da população de células T presentes em doenças gastroduodenais em nossa população. MÉTODOS: Em um estudo prospectivo, foram coletadas biópsias gástricas de 554 pacientes portadores das diferentes doenças gastroduodenais. Nas amostras biológicas destes pacientes foi realizada a determinação do genótipo bacteriano e a detecção das citocinas IL-4, IL-10, INF-γ e IL-12 através do método Elisa. Foram obtidas biópsias gástricas para avaliação histológica. RESULTADOS: Observamos que o genótipo predominante nas cepas de H. pylori isoladas dos pacientes estudados foi s1m1cagA positivo, sendo mais frequentes entre os pacientes com úlcera gástrica, úlcera duodenal e câncer gástrico. Houve associação significativa das cepas com o genótipo s1m1cagA positivo com maior grau de inflamação, atividade neutrofílica e desenvolvimento de metaplasia intestinal. As concentrações gástricas de INF-γ e IL-12 foram significativamente mais elevadas em pacientes infectados pelo H. pylori do que nos não infectados. Foram detectados níveis mais elevados dessas citocinas nos portadores de úlcera e câncer gástrico, sendo que nesses pacientes foram observados níveis mais baixos de IL-4 e IL-10 na mucosa gástrica. Além disso, as concentrações de INF-γ e IL-12 em biópsias gástricas, foram mais elevadas nos pacientes portadores das cepas bacterianas virulentas s1m1cagA+. Contrariamente, os níveis de IL-4 e IL-10 foram maiores em tecido infectado por cepas s2m2cagA. Pacientes com maior grau de inflamação, de atividade neutrofílica e presença de metaplasia intestinal, apresentaram níveis mais elevados de INF-γ e IL-12 e uma concentração mais baixa de IL-4 e IL-10 nas biópsias gástricas. CONCLUSÃO: Nosso estudo demonstra que a interação entre o tipo de cepa infectante e resposta imunológica com perfil Th1, podem influenciar e perpetuar a inflamação gástrica contribuindo para o desenvolvimento de diferentes manifestações clínicas na infecção pelo H. pylori.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Stomach Neoplasms/immunology , Helicobacter pylori/genetics , Helicobacter Infections/immunology , Duodenal Ulcer/immunology , Gastric Mucosa/immunology , Gastritis/immunology , Stomach Neoplasms/microbiology , Bacterial Proteins/genetics , DNA, Bacterial , Polymerase Chain Reaction , Prospective Studies , Cytokines/biosynthesis , Helicobacter pylori/isolation & purification , Helicobacter Infections/microbiology , Duodenal Ulcer/microbiology , Gastric Mucosa/microbiology , Gastric Mucosa/pathology , Gastritis/microbiology , Genes, Bacterial/immunology , Genotype , Middle Aged , Antigens, Bacterial/genetics
13.
Rev. Soc. Bras. Med. Trop ; 51(2): 183-189, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-897069

ABSTRACT

Abstract INTRODUCTION: Helicobacter pylori, a water contaminant, is the primary pathogenic agent associated with gastric diseases in humans. Exposure to H. pylori is more likely higher in developing countries. This study aimed to evaluate the risk factors associated with H. pylori infection in patients undergoing endoscopy to validate the cause of dyspeptic symptoms in an urban population in northeast Brazil and to compare the urease test and polymerase chain reaction assay results with the histopathological findings. METHODS: We evaluated 200 of 759 individuals with dyspeptic complaints from Campina Grande, State of Paraiba, northeast Brazil. Patients underwent endoscopy, followed by gastric biopsies. Logistic regression analysis was performed to adjust for confounders and to determine significant risk factors of dyspeptic disorders. RESULTS: Women accounted for 72.5% (145/200) of the participants. Approximately 59.8% (120/200) of the samples tested positive for H. pylori based on histological examinations. The specificity of polymerase chain reaction assay was higher than that of the urease test (77% vs. 64%, p=0.034). City drinking water [odds ratio (OR): 2.6; 95% confidence interval (CI): 1.3-5.21; p=0.004] and smoking (OR: 4.0; 95% CI: 1.13-14.5; p=0.031) were the risk factors of H. pylori infection. Belching was the most common symptom associated with H. pylori infection (p=0.05). CONCLUSIONS: The increased risk of H. pylori infection associated with non-treated water consumption indicates the need for improvements in public water treatment and better sanitary conditions because these can be a source of not only H. pylori infections but also other water-borne pathogen infections.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Helicobacter pylori/isolation & purification , Helicobacter Infections/diagnosis , Duodenal Ulcer/microbiology , Dyspepsia/microbiology , Gastritis/microbiology , Socioeconomic Factors , Urban Population , Polymerase Chain Reaction , Risk Factors , Endoscopy, Gastrointestinal , Helicobacter pylori/genetics , Sensitivity and Specificity , Duodenal Ulcer/diagnosis , Dyspepsia/diagnosis , Gastritis/diagnosis , Middle Aged
14.
Article in English | WPRIM | ID: wpr-718290

ABSTRACT

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.


Subject(s)
Anesthesia, General , Duodenal Ulcer , Mortality , Peptic Ulcer Perforation , Self Expandable Metallic Stents , Stents
15.
Article in French | AIM | ID: biblio-1264199

ABSTRACT

L'ulcère gastrique ou duodénal (UGD) est une affection plurifactorielle. Une prévalence de 16,6% en avait été rapportée en 2005 au Bénin. Le but de notre étude est de décrire les aspects épidémiologiques, cliniques, endoscopiques et thérapeutiques des UGD observés de nos jours à Cotonou. Patients et méthodes : Il s'agissait d'une étude prospective, transversale, descriptive et analytique. Elle a colligé du 1er octobre 2015 au 30 avril 2016, tous les sujets de plus de 15 ans ayant présenté un UGD à l'endoscopie dans les services des maladies digestives de l'hôpital de Zone de Mènontin et de l'hôpital d'Instruction des Armées de Cotonou. Résultats : Sur 411 patients inclus, 30 avaient un UGD soit une prévalence de 7,3 %. Les ulcères duodénaux étaient observés chez des sujets jeunes avec un âge moyen de 38 ± 6,9 ans ; tandis que les ulcères gastriques étaient observés chez des sujets plus âgés avec un âge moyen de 58 ± 7 ans. La sex-ratio était de 2,8. Les épigastralgies étaient la principale manifestation présente dans 70% des cas. La localisation de l'ulcère était gastrique dans 36,7%, duodénale dans 53,3 %, double dans 10% des cas. Les principales causes étaient la consommation de médicaments gastro-toxiques et l'Helicobacter pylori. Les Inhibiteurs de la pompe à protons étaient prescrits dans tous les cas et l'éradication de l'Helicobacter pylori faite dans 94,7% des cas avec une évolution favorable à 2 mois de contrôle. Conclusion : la prévalence des UGD a diminué de plus de 50% en onze ans à Cotonou. L'amélioration du niveau d'hygiène et la sensibilisation contre l'automédication pourraient davantage contribuer à réduire cette prévalence


Subject(s)
Benin , Duodenal Ulcer/drug therapy , Duodenal Ulcer/epidemiology , Epidemiology , Stomach Ulcer/drug therapy , Stomach Ulcer/epidemiology
16.
Arq. gastroenterol ; 54(4): 297-299, Oct.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-888214

ABSTRACT

ABSTRACT BACKGROUND: As being the first bacteria determined to be carcinogenic, Helicobacter pylori (H. pylori) is a pathogen localized in the stomach in more than half of the world population. Some earlier studies have found a relation between tissue histocompatibility antigens and gastric cancers depending on the regions. OBJECTIVE: The present study aimed to determine the distribution of human leukocyte antigen (HLA) class I and class II antigens in H. pylori-positive pediatric patients with active gastritis and duodenal ulcer, excluding cancer cases, in our center. METHODS: The study included 40 patients diagnosed with H. pylori-positive active gastritis and duodenal ulcer and 100 controls consisting of healthy donor candidates. The HLA class I and class II antigens were studied in the isolated DNA samples using the polymerase chain reaction sequence-specific oligonucleotide probes. RESULTS: The frequency of HLA-B*51 antigen was significantly higher in the patient group than in the control group (40% vs 17%; P=0.003). There was no difference between the two groups in terms of the frequencies of HLA-A, HLA-C, HLA-DR, and HLA-DQ antigens. CONCLUSION: It was determined that HLA-B*51 plays a critical role in H. pylori infection.


RESUMO CONTEXTO: Determinada como sendo a primeira bactéria cancerígena, o Helicobacter pylori (H. pylori) é um patógeno localizado no estômago em mais da metade da população mundial. Alguns estudos anteriores têm encontrado uma relação entre câncer gástrico e antígenos de histocompatibilidade de tecido dependendo das regiões. OBJETIVO: O presente estudo teve como objetivo determinar a distribuição em nosso centro do antígeno leucocitário humano (HLA) de classe I e antígenos classe II em pacientes pediátricos H. pylori-positivos com gastrite e úlcera duodenal ativas, excluindo casos de câncer. MÉTODOS: O estudo incluiu 40 pacientes H. pylori-positivos diagnosticados com gastrite e úlcera duodenal ativas e 100 controles consistindo de candidatos doadores saudáveis. Foram estudadas nas amostras de DNA isoladas o antígeno leucocitário humano classe I e antígenos classe II, utilizando-se as cadeias de sequência específica de polimerase do oligonucleotideo. RESULTADOS: A frequência do antígeno HLA - B * 51 foi significativamente maior no grupo de pacientes do que no grupo controle (40% vs 17%; P=0,003). Não houve diferença entre os dois grupos em termos das frequências dos antígenos HLA-A, HLA-DR, HLA-DQ e HLA-C. CONCLUSÃO: Determinou-se que o HLA - B * 51 desempenha um papel crítico na infecção pelo H. pylori.


Subject(s)
Humans , Male , Female , Child , Histocompatibility Antigens Class I/immunology , Histocompatibility Antigens Class II/immunology , Helicobacter pylori , Helicobacter Infections/immunology , Duodenal Ulcer/immunology , Gastritis/immunology , Case-Control Studies , Helicobacter Infections/complications , Gastritis/microbiology
17.
Article in English | WPRIM | ID: wpr-199020

ABSTRACT

Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD.


Subject(s)
Cholangiopancreatography, Magnetic Resonance , Drainage , Duodenal Ulcer , Endoscopy , Female , Hemorrhage , Hemostasis, Endoscopic , Humans , Ligation , Melena , Methods , Middle Aged , Pancreas , Pancreatic Ducts , Pancreatitis , Peptic Ulcer , Ulcer
18.
Article in Korean | WPRIM | ID: wpr-223212

ABSTRACT

BACKGROUND/AIMS: As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.


Subject(s)
Aged , Aspirin , Cerebrovascular Disorders , Duodenal Ulcer , Endoscopy , Hemorrhage , Hemostasis , Hemostasis, Endoscopic , Humans , Incidence , Medical Records , Mortality , Retrospective Studies , Stomach Ulcer , Warfarin
20.
Article in English | WPRIM | ID: wpr-151267

ABSTRACT

BACKGROUND/AIMS: Duodenitis is not infrequent finding in patient undergoing endoscopy. However, hospitalized patients have a higher incidence of secondary duodenal mucosal lesions that might be related with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infection, tuberculosis, immunologic disorders, or other rare infections. We aimed to identify clinicopathologic features of duodenal mucosal lesions in hospitalized patients. METHODS: All hospitalized patients having duodenal mucosal lesions were identified by endoscopic registration data and pathologic data query from 2011 to 2014. The diagnostic index was designed to be sensitive; however, a detailed review of medical record and endoscopic findings was undertaken to improve specificity. Secondary duodenal lesion was defined as having specific reason to explain the duodenal lesion. RESULTS: Among 6,334 hospitalized patients have undergone upper endoscopy, endoscopic duodenal mucosal lesions was detected in 475 patients. Secondary duodenal lesions was 21 patients (4.4%) and the most frequent secondary cause was IBD (n = 7). The mean age of secondary group was significantly lower than that in primary group (42.3 ± 18.9 years vs. 58.5 ± 16.8 years, p = 0.00), and nonsteroidal anti-inflammatory drugs were less frequently used in secondary group, but there was no differences of gender or presence of Helicobacter pylori. The involvement of distal part of duodenum including postbulbitis or panduodenitis was more frequently detected in secondary group than in primary group. By multivariate regression analysis, younger age of 29 years and the disease extent were significant predictors for the secondary mucosal lesions. CONCLUSIONS: Secondary duodenal mucosal lesions with different pathophysiology, such as IBD or CMV infection, are rare. Disease extent and age seems the most distinctive feature of secondary duodenal mucosal lesions.


Subject(s)
Cytomegalovirus , Duodenal Ulcer , Duodenitis , Duodenum , Endoscopy , Helicobacter pylori , Humans , Incidence , Inflammatory Bowel Diseases , Medical Records , Sensitivity and Specificity , Tuberculosis
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