Therapeutic endoscopy in combination with quadruple therapy in treating bleeding caused by gastric ulcer

Objective: To analyze the efficacy of therapeutic endoscopy in combination with quadruple therapy in treating bleeding caused by gastric ulcer and investigate the factors inducing rebleeding

Methods: Two hundred and twelve patients with bleeding caused by gastric ulcer who were admitted to Binzhou People's Hospital, Shandong, China between April 2015 and April 2016 were selected as research subjects. The patients were randomly divided into a control group and an experimental group. Patients in the control group were treated by quadruple therapy, while patients in the observation group received therapeutic endoscopy treatment in addition to the same treatment as the control group. The treatment efficacy, adverse reaction, H pylori [Hp] clearance rate and rebleeding were compared between the two groups

Results: The effective rate of the observation group was 98.1%, which was significantly higher than that of the control group [80.2%], and the difference had statistical significance [P<0.05]. The incidence of adverse reactions in the observation group was lower than that in the control group. The Hp clearance rate of the observation group was higher than that of the control group, and the difference had statistical significance [P<0.05]. The multi-factor analysis on rebleeding suggested that whether therapeutic endoscopy was performed or not, hemoglobin level and presence of peptic ulcer stage A1 were independent risk factors

Conclusion: Endoscopic treatment in combination with quadruple therapy is better in the treatment of bleeding caused by gastric ulcer as compared to medical treatment alone. Patients with high-risk factors such as low content of hemoglobin and ulcer at stage A1 should be monitored more carefully to prevent the occurrence of rebleeding

Comparison of 12-hour with 72-hour terlipressin therapy for bleeding esophageal varices

Objective: To determine the efficacy of 12-hour of Terlipressin therapy as compared to 72-hour therapy in preventing rebleeding after endoscopic therapy

Study Design: Interventional study

Place and Duration of Study: Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, from January to March 2016

Methodology: Cirrhotic patients presenting to our hospital with Gl [gastrointestinal] bleeding received Terlipressin 2 mg intravenous bolus, followed by 1mg 6-hourly until undergoing endoscopy.;Those with esophageal varices as the source of bleeding underwent band ligation and were recruited. Of the 93 enrolled patients, 90 remained and were randomized into 25 [27.8%] in control Group-A and 65 [72.2%] in test Group-B. Group-A received 72-hour of Terlipressin while Group-B received it for 12-hour. Both groups were monitored for rebleeding for 5 days

Results: Rebleeding occurred in 1 [4%] patient in Group-A and 3 [4.6%] in Group-B during the 5-day period. All 4 [4.4%] underwent repeat endoscopy. The Group-A patient and 2 [3%] of 3 Group-B patients showed ulcers over band ligation sites as source of bleed. The third Group-B patient showed varices requiring repeat banding. One [4%] patient [Group-A]

died due to persistent encephalopathy. No drug related adverse effects were seen

Conclusion: A 12-hour duration of Terlipressin as an adjunct to endoscopic band ligation shows similar results to 72-hour therapy

Eficacia de sutura y epiploplastia con tratamiento médico posterior en la úlcera perforada / Epiploplasty and Suture Efficiency Using Further Medical Treatment in Perforated Ulcer

Introducción: la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior para erradicar el Helicobacter pylori, ha disminuido la recurrencia de la úlcera péptica, lo cual renueva el interés en este proceder ante las técnicas definitivas. Objetivos: determinar la eficacia a mediano plazo de este proceder en pacientes operados de úlcera péptica perforada. Métodos: se realizó un estudio observacional analítico en el Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2010 hasta diciembre de 2013. El estudio estuvo conformado por los pacientes operados de úlcera perforada con más de un año de evolución (45 casos). Los datos obtenidos se procesaron mediante el paquete estadístico SPSS para Windows versión 15.0, con técnica estadística de comparación de la prueba de hipótesis de proporciones en una computadora Pentium IV. Resultados: el sexo más afectado fue el masculino y predominó en la cuarta y quinta décadas de la vida. La localización más frecuente de la perforación fue duodenal y la mayoría, menores de 1 cm. Las complicaciones posoperatorias más frecuentes fueron las infecciones respiratorias. El tabaquismo y la ingestión de café fueron los factores de riesgo actuales más frecuentes. La mayoría de los pacientes recibieron tratamiento médico completo en el posoperatorio, con buenos resultados de acuerdo a la clasificación de Visick y en la endoscopia realizada, donde solo una paciente presentó enfermedad ulcerosa. Conclusiones: se comprobó que la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior completo es eficaz a mediano plazo(AU)

Introduction: suture and epiploplasty of perforated ulcer using further medical treatment for helicobacter pylori eradication has decreased recurrence of peptic ulcer, renewing interest in this proceeding in contrast to final techniques. Objective: determine the medium term efficacy of this procedure in patients undergoing surgery for perforated peptic ulcer. Methods: an observational study was conducted at Manuel Ascunce Domenech University Hospital in Camagüey, from January 2010 to December 2013. The study consisted of patients operated on for perforated ulcer over a year (45 cases). The obtained data were processed using SPSS for Windows version 15.0, with statistical technique of comparing the proportions hypothesis test on a Pentium IV computer. Results: the most affected patients were male aging forty and fifty. The most frequent location was duodenal perforation and most of them less than 1 cm. The most frequent postoperative complications were respiratory infections. Smoking habits and coffee intake were the most common risk factors. Most patients received full medical treatment in the postoperative period, with good results according to Visick classification and the endoscopy, where only one patient had ulcer disease. Conclusions: suture and perforated ulcer epiploplasty with subsequent full medical treatment, definitively, cure patients(AU)

Gastroprotective effects of D-002 (beeswax alcohols) and Lyprinol® on experimentally-induced gastric ulceration in rats

Introduction: D-002, a mixture of beeswax alcohols, has been effective in osteoarthritis models and for reducing osteoarthritis symptoms. Unlike the classic anti-inflammatory drugs, D-002 elicits gastroprotective rather than gastrotoxic effects. Lyprinol, used for ameliorating inflammation and arthritic symptoms, improves gastrointestinal dysfunction symptoms in osteoarthritis subjects. Both D-002 and Lyprinol inhibit cyclooxygenase and 5?lipoxygenase activities, and have been similarly effective for reducing inflammation experimentally. Objective: to compare the effects of D-002 and Lyprinol on gastric mucosa of normal and experimentally-induced ulcer rats. Methods: ulcer indexes were measured in normal rats and in rats with ethanol or pylorus ligation-induced ulcers, in which gastric volume and mucus secretion were also measured. Normal rats were randomized into a vehicle control, one acetic salicylic acid (150 mg/kg), three D-002, three Lyprinol groups; rats with ethanol-ulcers into a vehicle control, three D-002 and three Lyprinol-treated groups; and the experiment on pylorus ligation included a negative control and eight pylorus-ligated groups: one vehicle control, three D-002, three Lyprinol, one omeprazole 10 mg/kg. In all cases, D-002 and Lyprinol (50, 200 and 400 mg/kg) were given orally. Results: unlike D-002 and Lyprinol (50-400 mg/kg), acetic salicylic acid increased ulcer indexes and the incidence of ulcers versus the vehicle control. Single oral doses of D-002 (50-400 mg/kg) or Lyprinol (200 and 400 mg/kg) decreased significantly (p<0.01) and in a similar way ulcer indexes versus the ethanol-positive control. D-002 and Lyprinol (50-400 mg/kg) lowered significantly (p<0.01) and comparably ulcer indexes in rats with pylorus ligation versus the positive controls. D-002 (200 and 400 mg/kg) decreased gastric volume and increased gastric mucus secretion versus the positive control whereas only Lyprinol 400 mg/kg increased the gastric mucus secretion but without modifying the gastric volume. Omeprazole significantly reduced ulcer index (p<0.05) and gastric volume (p< 0.01), with no change in mucus secretion. Conclusion: D-002 and Lyprinol did not show gastrotoxic effects and similar efficacy in protecting against ethanol and pylorus ligation-induced gastric ulceration in rats(AU)

Introducción: el D‒002, una mezcla de alcoholes de la cera de abejas, efectivo en modelos de osteoartritis y para reducir los síntomas de la misma. A diferencia de los medicamentos antiinflamatorios clásicos el D‒002 produce efectos gastroprotectores más que efectos gastrotóxicos. El Lyprinol, usado para disminuir la inflamación y los síntomas artríticos, mejora los síntomas de disfunción gastrointestinal en sujetos con dicha enfermedad. D‒002 y Lyprinol inhiben las actividades de cyclooxigenasa y 5‒lipooxigenasa, y son similarmente efectivos para reducir la inflamación en modelos experimentales. Objetivo: comparar los efectos del D‒002 y el Lyprinol sobre la mucosa gástrica de ratas normales y de ratas con úlcera gástrica inducida experimentalmente. Métodos: se determinó el índice de úlcera en ratas normales y en ratas con úlceras gástricas inducidas por etanol e inducidas por ligadura de píloro, en las cuales se midió el volumen gástrico y la secreción de mucus. Las ratas normales se distribuyeron en un grupo control (vehículo), uno con ácido acetil salicílico (150 mg/kg), tres con D‒002 y tres con Lyprinol; las ratas con úlcera inducida por etanol en un grupo control (vehículo), tres con D‒002 y tres con Lyprinol; y el experimento con ligadura de píloro en un grupo control (vehículo), tres D‒002, tres Lyprinol y uno con omeprazol (10 mg/kg). En todos los casos, el D‒002 y el Lyprinol (50, 200 y 400 mg/kg) se administraron por vía oral. Resultados: el ácido acetil salicílico, no el D‒002 ni el Lyprinol (50‒400 mg/kg), incrementó el índice de úlceras y la incidencia de úlceras comparadas con el grupo control. Dosis orales únicas de D‒002 (50‒400 mg/kg) o Lyprinol (200 y 400 mg/kg) redujeron significativa (p<0,01) y similarmente el índice de úlceras comparado con el grupo control positivo con úlceras por etanol. El D‒002 y el Lyprinol (50‒400 mg/kg) redujeron significativamente (p<0,01) y comparablemente el índice de úlceras en ratas con ligadura de píloro comparado con el grupo control positivo. El D‒002 (200 y 400 mg/kg) redujo el volumen gástrico e incrementó la secreción de mucus gástrico respecto al grupo control positivo; mientras solo el Lyprinol 400 mg/kg aumentó la secreción de mucus gástrico pero sin modificar el volumen gástrico. El omeprazol redujo significativamente el índice de úlcera (p<0,05) y el volumen gástrico (p<0,01), sin modificar la secreción de mucus. Conclusiones: el D‒002 y el Lyprinol no presentaron efectos gastrotóxicos, y protegieron con eficacia similar de las úlceras gástricas inducidas por etanol y por ligadura del píloro en ratas(AU)

Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study? / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. METHODS: Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n=62), hemoclipping only; group 2 (n=88), hemoclipping plus epinephrine injection; and group 3 (n=36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. RESULTS: Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p<0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups. CONCLUSIONS: Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

Clinical and Radiologic Review of Uncommon Cause of Profound Iron Deficiency Anemia: Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome is an anatomic and clinical entity characterized by dynamic compression of the proximal celiac artery by the median arcuate ligament, which leads to postprandial epigastric pain, vomiting, and weight loss. These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. In this report, we presented a 72-year-old male patient with celiac artery compression syndrome causing recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia. This association is relatively uncommon and therefore not well determined. In addition, we reported the CT angiography findings and three-dimensional reconstructions of this rare case.

The Prevalence of Barrett's Esophagus and the Comparison of Barrett's Esophagus with Cardiac Intestinal Metaplasia in the Health Screening at a Secondary Care Hospital / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.

Eficacia del tratamiento convencional para helicobacter pylori en niños / Efficacy of conventional treatment for Helicobacter pylori in children

Introducción: La infección por Helicobacter Pylori tiene una prevalencia elevada en países en vías de desarrollo, en los niños produce principalmente gastritis crónica, se han probado múltiples esquemas para el tratamiento de Helicobacter pylori, para considerar un régimen de tratamiento efectivo debe alcanzar una tasa de éxito en erradicación de 80%. El objetivo del presente trabajo fue establecer el perfil clínico epidemiológico de la infección por Helicobacter pylori en niños y su respuesta al tratamiento de primera línea o convencional. Métodología: Se realizó un estudio descriptivo, retrospectivo, en el hospital de especialidades del Instituto Hondureño del Seguro Social de Tegucigalpa, de enero de 2007 a diciembre de 2009, en niños menores de 11 años con enfermedad por Helicobacter pylori. que recibieron tratamiento con amoxicilina 60mg/kg/día, claritromicina 20mg/kg/día y lanzoprazol 30mg/día por 14 días, y se valoró la respuesta terapéutica. Resultados: Se incluyeron 144 pacientes, siendo el 55.6% del sexo femenino, el promedio de edad fue de 5.8 años, 81.9% era de procedencia urbana, el síntoma más frecuente fue dolor en epigastrio en 88.1% de los pacientes. El 79.2% de los pacientes reportó mejoría clínica y el antígeno fecal negativo posterior al tratamiento de primera línea. Discusión: el tratamiento convencional continúa siendo eficaz para la erradicación de Helicobacter pylori en la población estudiada...

Gastropericardial Fistula as a Complication in a Refractory Gastric Ulcer after Esophagogastrostomy with Gastric Pull-Up

A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence. Such a fistula is usually associated with a huge ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of esophagogastric surgery, the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), or Zollinger-Ellison syndrome. The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer. Despite the severity of the condition, the patient showed great improvement after medical treatment and the fistula was cured at the end.

Caracterìsticas de fìstulas enterocutàneas en pacientes postoperados del tubo digestivo concurrentes al servicio de cirugìa general del HC-IPS. Periodo de marzo-mayo del 2009 / Characteristics of postoperative enterocutaneous fistulas in patients with concurrent gastrointestinal tract of general surgery at the HC-IPS marzo-may period of 2009

Se denomina fìstula a un trayecto cuyas paredes estàn formadas,generalmente,por tejido de granulaciòn y que comunica dos superficies revestidas de epitelio.

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

Serial Episodes of Gastric and Cecal Perforation in a Patient with Behcet's Disease Involving the Whole Gastrointestinal Tract: A Case Report / 대한소화기학회지

Behcet's disease (BD) has been recognized as multi-systemic chronic vasculitic disorder of recurrent inflammation, characterized by the involvement of multiple organs and resulting in orogenital ulcers, uveitis, and skin lesions. Involvement of the central nervous system, vessels, and intestines in BD often leads to a poor prognosis. Digestive manifestations in BD have been reported in up to 1-60% of cases, although the rate varies in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. Gastric or esophageal involvement is reported to be very rare. Moreover, there have been no reports on the simultaneous involvement of the esophagus, stomach, ileum, and colon. Here, we present a 55-year-old Korean man with intestinal BD and multiple ileal and colonic ulcerations complicated by perforation, gastric ulcer with bleeding followed by perforation, and esophageal ulcers with bleeding.

Acidez gástrica, Helicobacter pylori y giardiasis en pacientes con síndrome ulceroso: informe preliminar / Gastric acidity, Helicobacter pylori and giardiasis in patients with ulcerous syndrome: preliminary report

OBJETIVO: Evaluar el papel de la acidez gástrica, la infección por Helicobacter pylori y la giardiasis en las enfermedades que se manifiestan como un síndrome ulceroso. MÉTODOS: Estudio prospectivo, analítico, de corte transversal. Se realizó endoscopia superior con toma de muestra para estudio del estado de la mucosa gástrica, prueba de ureasa, frotis duodenal y gastroquimograma en 54 pacientes que presentaron manifestaciones clínicas de síndrome ulceroso. RESULTADOS: El diagnóstico endoscópico más frecuente fue la gastritis (29/54; 50,8 por ciento). Se encontraron patrones de hipoacidez y de hiperacidez, sin diferencias significativas (p= 0,817). La presencia de Helicobacter pylori fue significativamente elevada (p= 0,001) sin diferencias en los caso de úlcera (p= 0,804) o gastritis (p= 0,743). Se demostró relación entre la infección por Helicobacter pylori y la presencia de cambios en el patrón secretor de ácido (p= 0,001). No se encontró relación positiva entre la infección conjunta por Helicobacter pylori y Giardia lamblia (p= 0,176). CONCLUSIONES: Existe una elevada asociación entre infección por Helicobacter pylori, lesión endoscópica, histológica y secretora en pacientes que presentan clínica de un síndrome ulceroso.

OBJECTIVE: To assess the role of gastric acidity, the Helicobacter pylori infection, and giardiasis in the diseases manifested as an ulcerous syndrome. METHODS: A cross-sectional, analytical and prospective study was conducted. An upper endoscopy with sample-taking was performed to study the gastric mucosa status, as well as urease test, duodenal smear, and gastrochemogram in 54 patients with clinical manifestations of ulcerous syndrome. RESULTS: Gastritis was the most frequent endoscopic diagnosis (29/54; 50.8 percent). We found patterns of hypo- and hyperacidity without significant differences (p = 0.817. The presence of Helicobacter pylori was very high (p = 0.001) without differences in the cases of ulcer (p = 0.804) or gastritis (p = 0.743). A relation between H. pylori infection and the presence of changes in the secretory pattern of acid (p = 0,001) was proved. No positive relation was observed between the H.pylori joint infection and Giardia lamblia (p = 0.176). CONCLUSIONS: There is a high association between H.pylori infection, endoscopic, histological and secretory lesion in patients with a clinic of ulcerous syndrome.

Helicobacter pylori Infection and Peptic Ulcer Disease in Patients with Liver Cirrhosis

BACKGROUND/AIMS: We investigated the prevalence and relationship of peptic ulcer disease and Helicobacter pylori infection to liver cirrhosis. METHODS: We examined 288 patients with liver cirrhosis, 322 patients with non-ulcer dyspepsia, and 339 patients with peptic ulcer disease. Rapid urease test and Wright-Giemsa staining were used for diagnosis of H. pylori infection. RESULTS: The prevalence of peptic ulcer disease in patients with cirrhosis was 24.3%. The prevalence of peptic ulcer disease in patients with cirrhosis divided into Child-Pugh classes A, B, and C was 22.3%, 21.0%, and 31.3%, respectively (p>0.05). The prevalence of H. pylori infection in the patients with cirrhosis, non-ulcer dyspepsia, and peptic ulcer without chronic liver disease were 35.1%, 62.4%, and 73.7%, respectively (p0.05). The prevalence of H. pylori infection in patients with hepatitis virus-related liver cirrhosis and in the patients with alcohol-related liver cirrhosis was 42.5% and 22.0%, respectively (p<0.001). The prevalence of H. pylori infection in patients with Child-Pugh classes A, B, and C liver cirrhosis was 51.5%, 30.5%, and 20.0%, respectively (p<0.001). CONCLUSIONS: Factors other than H. pylori may be involved in the pathogenesis of peptic ulcer disease in the setting of liver cirrhosis.

Incidence, types and complications of chronic gastric ulcer [a change in the indications of surgery]

Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation. Reviewing the incidence, types, complications and surgical indications for chronic gastric ulcer in Iraq and comparing it with other world reports. Retrospective study of the data base for 5166 patients with chronic peptic ulcer disease operated upon between 1965-2000. The incidence of chronic gastric ulcer, their age, sex, race, clinical presentation, diagnosis, types, size of ulcers and the indications of surgery during the period 1965-1980 [Group A] and 1981-2000 [Group B] were reviewed. Among the 5166 patients with peptic ulcer disease, 111 [2.15%] had chronic gastric ulcer.86 [77.5%] were male and 25 [22.5%] were females. 97 [87%] were Arabs and 14 [12.6%] were Kurds, a ratio: 8.1/1. Age ranges [mean] 19-79 [53.9] years. Duration of illness ranges [mean] 6 months to 9 years [4.2 years]. 68.5% of patients were among the low socioeconomic classes. 77.9% of males were smokers. Barium study showed the ulcer in the 89 patients examined. Malignancy was excluded by endoscopy and biopsy in 91 and frozen section biopsy during surgery in 49 patients. Types of ulcer were; Type I: 47 [42.3%], Type II: 44 [39.6%], Type III: 14 [12.6%] and Type IV 6 [5.4%] patients. The Size of ulcers was; < 2 cm 23 [20.7%], 2-4 cm 57 [51.4%] and > 4 cm 31 [27.9%] patients. Indications for surgery in Group A [67 patients] versus Group B [44 patients] were; dyspepsia 51 [67.1%] v 11 [25%], gastric outlet obstruction 9 [13.4%] v 18 [40.9%], bleeding 6 [9%] v 13 [29.5%] and perforation one [1.5%] v 2 [4.5%] patients. Surgical procedures were; vagotomy and drainage in 77 [69.4%] and B-I partial gastrectomy in 34 [30.6%] patients. 2 [1.8%] died post-operatively, 11 lost to follow after 6-9 months and 98 patients were followed for 5-32 years. Evidence of recurrent stomal ulcer in one patient. The incidence of chronic gastric ulcer in Iraq is low compared to chronic DU a ratio 1/45.5. Mean age 53.9 years. Male/female: 3.4/1 .Arabs/Kurds: 6.9/1. Coexistence of chronic duodenal ulcer with chronic gastric ulcer was 39.6%. The indications for surgery during the period 1965-1980 versus the period 1981-2000 were; elective in 51 [76%] v 11 [25%] and urgent or emergency in 16 [24%] v 33 [75%] patients. Operations were; vagotomy and drainage in 69.4% and resection in 30.6% of patients

Comparison of endoscopic findings in patients from different ethnic groups undergoing endoscopy for upper gastrointestinal bleed in eastern Nepal.

Upper gastrointestinal (UGI) bleed is one of the commonest medical emergencies. Cultural customs and practices may influence the development of disease conditions that may lead to UGI bleed. The purpose of this study was to compare the causes of UGI bleed in different ethnic groups among patients presenting to a large tertiary care hospital with acute UGI bleed. A retrospective study was conducted examining data available in the endoscopy register at the B. P. Koirala Institute of Health Sciences (BPKIHS) in Nepal for patients presenting with UGI bleed over one calendar year. Study subjects were categorized into one of a few broad categories of ethnic groups: Khas, Newar, SeTaMaGuRaLi, Maithali and others. Demographic information and endoscopic diagnoses were abstracted. The relative frequencies of different causes of UGI bleed were compared across the ethnic groups using the chi2 test. One hundred and eighty-nine patients underwent endoscopy for UGI bleed in the time period studied. The mean age of the study cohort was 49.6 years and consisted of 71.0% males and 29.0% females. Overall the commonest cause of upper GI bleed was gastric ulcer. Esophageal varices was the commonest cause in the SeTaMaGuRaLi group, accounting for 33.3%. The relative frequency of esophageal varices as the cause of upper GI bleed was statistically significantly different among the various ethnic groups, with the SeTaMaGuRaLi group having the highest relative frequency (p-value 0.02). Physicians taking care of patients with upper GI bleed in Nepal should be aware of the high relative frequency of esophageal varices as a cause of upper GI bleed, and especially so among certain ethnic groups.

Estado actual del tratamiento quirúrgico de la úlcera péptica perforada en el Hospital Regional de Talca: Experience of a regional hospital / Emergency surgical treatment of perforated peptic ulcer

La perforación de una úlcera péptica corresponde a una infrecuente y siempre grave complicación de la enfermedad ulcerosa. El tratamiento quirúrgico es la terapia de elección. Se operaron 22 pacientes (21 hombres) con una edad promedio de 50 años. Tres enfermos tenían el diagnóstico de úlcera péptica previo a la emergencia actual. El síntoma más frecuente de consulta fue el dolor epigástrico de inicio súbito en 21 (95,4 por ciento) pacientes. El diagnóstico se realizó con radiografía de tórax de pie o de abdomen simple en 11 enfermos. Se realizó sutura simple de la úlcera en 12 (54,5 por ciento) pacientes, sutura más epiploplastía en 7 (31,8 por ciento) y resección gástrica en tres enfermos (13,6 por ciento). Siete (31,8 por ciento) pacientes presentaron complicaciones post operatorias, de los cuales fallecieron 2 (9,1 por ciento) como consecuencia de la sepsis asociada. Se realizó un seguimiento endoscópico a 9 pacientes (45 por ciento) sobrevivientes al episodio agudo. En 5 de ellos se demostró que la úlcera péptica aun permanecía activa. A dos de estos últimos pacientes se les realizó, en forma electiva una cirugía resectiva definitiva. Se concluye que la perforación de una úlcera péptica corresponde a un cuadro grave, que se asocia a una morbilidad y mortalidad significativa. El tratamiento quirúrgico local es la terapia de elección para el episodio agudo, sin embargo este no es definitivo y no evita la recidiva.

Background: Peptic ulcer perforation is an uncommon by devastating complication that requires emergency surgical treatment. Aim: To review the results of surgical treatment of peptic ulcer perforation in a Chilean Regional Hospital. Material and Methods: Retrospective review of medical records of 22 patients (age range 21-88 years, 21 males) operated for a perforated peptic ulcer, between 1995 and 2000. Results: The most common presentation symptom was acute epigastric pain in 21 patients. The diagnosis was done with a plain abdominal X ray obtained in the standing position, in 11 patients. A simple suture of the ulcer was done in 12 patients, suture plus epiploplasty in seven and gastric resection in three. Seven patients (32 percent) had postoperative complications and two (9 percent) died as a consequence of an associated septic process. An endoscopic follow up was done in nine patients and in two, the peptic ulcer remained active. These two patients were subjected to an elective excisional surgery. Conclusions: Local surgical correction of peptic ulcer perforation is the emergency treatment of choice but does not avoid ulcer relapse.

Massive Gastric Ulcer Bleeding in a Healthy Full Term Infant / 대한소화기학회지

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother's serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination.