Is tramadol associated to bleeding peptic ulcer? A nationwide case-control study in hospitalized Swedish patients.

AIMS: Tramadol, a widely used analgesic drug, inhibits the reuptake of noradrenaline and serotonin impairing the aggregation function of thrombocytes. However, the risk for severe bleeding has previously not been studied. The aim of the present study is to investigate the association between tramadol and bleeding peptic ulcer in the Swedish population. METHODS: In this register based case-control study based on the Swedish national patient registry and prescription drug registry, we included 18 306 patients hospitalized with a first-time diagnosis of bleeding peptic ulcer. For every case, 4 matched controls were included. To investigate the temporal aspects of tramadol induced bleeding ulcer, exposure was divided into patients with newly initiated and ongoing treatment. To explore a possible confounding by indication, the effect of codeine, a drug also prescribed for the treatment of moderate pain, but not known to affect thrombocyte function, was investigated. Univariable and multivariable logistic regression was used to analyse the association between tramadol use and bleeding ulcer. RESULTS: Tramadol was associated with an increased risk of bleeding ulcer (adjusted odds ratio (aOR) 2.1, 95% confidence interval: (2.0-2.3). The association was stronger for newly initiated treatment with tramadol 2.8 (2.5-3.2) and weaker for ongoing treatment 1.7 (1.6-1.9). Codeine was also associated with an increased risk of bleeding ulcer 1.9 (1.7-2.1) and this association was also stronger for newly initiated treatment with codeine 2.3 (2.0-2.6) and weaker for ongoing treatment 1.7 (1.5-1.9). CONCLUSION: Treatment with tramadol was associated with an increased risk of bleeding peptic ulcer. Most of this association may be mediated by factors related to the pain condition rather than the pharmacologic effect per se.

Use of Enteral Nutrition for Gastrointestinal Bleeding Prophylaxis in the Critically Ill: Review of Current Literature.

PURPOSE OF REVIEW: This review provides a comprehensive overview of the etiology of stress-related mucosal disease, current acid suppression therapy recommendations, and the role enteral nutrition may play in disease prevention. RECENT FINDINGS: Recent literature indicates enteral nutrition may prevent complications of stress-related mucosal disease by increasing splanchnic blood flow, enhancing gastrointestinal motility, and promoting cellular immunity and integrity through local nutrient delivery. Stress-related mucosal disease is a common complication of hospitalization in the critically ill which may lead to overt gastrointestinal bleeding and enhanced mortality. High-risk patients have historically been prescribed acid suppression therapy, though enteral nutrition may also have a role in disease mitigation.

Effect of prolonged and intermittent treatment on the clinical course of peptic ulcer.

OBJECTIVE: Introduction: The number of patients with peptic ulcer increases annually. According to published data, patients with peptic ulcer constitute about 15% of those hospitalized with gastrointestinal diseases. The aim: That is why we set the task to evaluate the methods of preventive treatment and to choose the most effective one. PATIENTS AND METHODS: Materials and methods: For this purpose, we selected 103 patients with peptic ulcer without severe exacerbations and complications from one region (main group) and 101 patients from another region (control group) for observations. Making diagnosis was based on the study of complaints, anamnestic data, physical examination of the patient, evaluation of the functional state of the gastroduodenal system, as well as the X-ray and endoscopic examination. The sources of the study were medical records of outpatients, control cards for dispensary surveillance, registers of temporary disability records, sick leave records and others. RESULTS: Results: Most patients, from both the main and control groups, who were on prophylactic treatment, noticed that they had an increased working capacity, normalized sleep, better appetite and fewer dyspeptic disorders. Patients in the main group for two years were on prolonged prophylactic treatment according to the method that we had developed. by us. Patients in the control group received an intermittent preventive treatment twice a year (in spring and autumn). In the complex of therapeutic measures the following were used: dietary recommendations, antacids, cholinolytics, multivitamins, etc. CONCLUSION: Conclusions: Prolonged prophylactic treatment is an effective means to combat exacerbations and complications of peptic ulcer and can be recommended for implementation in practice.

Nutritional care in peptic ulcer / Cuidados nutricionais na úlcera péptica

INTRODUCTION: Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. AIM: To update nutritional therapy in adults' peptic ulcer. METHODS: Exploratory review without restrictions with primary sources indexed in Scielo, PubMed, Medline, ISI, and Scopus databases. RESULTS: Dietotherapy, as well as caloric distribution, should be adjusted to the patient's needs aiming to normalize the nutritional status and promote healing. Recommended nutrients can be different in the acute phase and in the recovery phase, and there is a greater need of protein and some micronutrients, such as vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some studies have shown that vitamin C has a beneficial effect in eradication of H. pylori. Fibers and probiotics also play a important role in the treatment of peptic ulcer, because they reduce the side effects of antibiotics and help reduce treatment time. CONCLUSION: A balanced diet is vital in the treatment of peptic ulcer, once food can prevent, treat or even alleviate the symptoms involving this pathology. However, there are few papers that innovate dietotherapy; so additional studies addressing more specifically the dietotherapy for treatment of peptic ulcer are necessary. .

INTRODUÇÃO: A úlcera péptica é uma lesão que ocorre na mucosa do trato gastrointestinal, sendo caracterizada por um desequilíbrio entre fatores agressores e protetores da mucosa gástrica, tendo como principal fator etiológico o H. pylori. A dietoterapia é fundamental na prevenção e tratamento dessa patologia. OBJETIVO: Rever a terapia nutricional na úlcera péptica em adultos. MÉTODOS: A metodologia utilizada foi um estudo exploratório de revisão do conhecimento disponível na literatura científica. RESULTADOS: A dietoterapia bem como a distribuição calórica deve ser ajustada as necessidades do paciente com objetivo de normalizar o estado nutricional e promover a cicatrização. As recomendações de nutrientes podem ser diferenciadas nas fases aguda e de recuperação, havendo uma maior necessidade proteica e de alguns micronutrientes como vitamina A, zinco, selênio e vitamina C na fase de recuperação. Além disso, alguns estudos evidenciam que a vitamina C tem efeito benéfico na erradicação do H. pylori. As fibras e probióticos também possuem um importante papel no tratamento da úlcera péptica, reduzindo os efeitos colaterais dos antibióticos e auxiliando na redução do tempo de tratamento. CONCLUSÃO: Percebe-se que poucos são os trabalhos que evidenciam a terapia nutricional da úlcera e não há consenso sobre o tema. Com isso, mais estudos são necessários para abordar com maior especificidade o tratamento dietoterápico da úlcera péptica. Dieta equilibrada é fundamental no tratamento da úlcera péptica, uma vez que o alimento pode prevenir, tratar ou mesmo aliviar os sintomas que envolvem esta doença. No entanto, existem poucos trabalhos que inovam dietoterapia; assim, são necessários estudos adicionais abordando mais especificamente a dietoterapia para o tratamento de úlcera péptica. .

Nutritional care in peptic ulcer.

INTRODUCTION: Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. AIM: To update nutritional therapy in adults' peptic ulcer. METHODS: Exploratory review without restrictions with primary sources indexed in Scielo, PubMed, Medline, ISI, and Scopus databases. RESULTS: Dietotherapy, as well as caloric distribution, should be adjusted to the patient's needs aiming to normalize the nutritional status and promote healing. Recommended nutrients can be different in the acute phase and in the recovery phase, and there is a greater need of protein and some micronutrients, such as vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some studies have shown that vitamin C has a beneficial effect in eradication of H. pylori. Fibers and probiotics also play a important role in the treatment of peptic ulcer, because they reduce the side effects of antibiotics and help reduce treatment time. CONCLUSION: A balanced diet is vital in the treatment of peptic ulcer, once food can prevent, treat or even alleviate the symptoms involving this pathology. However, there are few papers that innovate dietotherapy; so additional studies addressing more specifically the dietotherapy for treatment of peptic ulcer are necessary.

[Nutrition of patients with stomach acid-dependent pathology and inflammatory diseases of the urogenital system].

In work some, often meeting nosological forms urogenithal surgical diseases which last years frequently proceed against gastritises, stomach ulcer of a stomach and 12-perstnoj guts owing to increase of occurrence of the last are presented. For treatment various medicamentous schemes, which do-polnjajutsja rational diet-correction for the purpose of increase efficaci and qualities of treatment are used. The work purpose--to present features ratsional pathogenetic correctic a food at persons from an aggravation acid-deprndent to a pathology against constant reception prepara apropos urogenithal diseases.

Celiac-associated peptic disease at upper endoscopy: how common is it?

OBJECTIVE: Recently, several publications in adults have shown an increased incidence of non-Helicobacter pylori (HP), non-non-steroidal anti-inflammatory drug (NSAID) peptic disease (PD). There are only a few case reports linking celiac disease (CD) to PD. We therefore aimed to review our experience of CD presenting with PD. MATERIAL AND METHODS: We retrospectively reviewed all the endoscopies performed for children and young adults diagnosed with CD between 1 January, 2004 and 31 October, 2008. The diagnosis of CD was based on accepted guidelines. Patients with a doubtful diagnosis of CD were excluded. RESULTS: We had 240 patients with the diagnosis of CD. We had 29 (12.0%) patients [15 males (52%), 14 females (48%)] for whom the diagnosis of PD was ascertained. The age range was 1-50 years (mean 16.9 +/- 12.1 years). Twenty-three of the 29 patients (79%) were HP-negative. Duodenal PD was noted in 22 patients (76%) and 16 (73%) were HP-negative. Gastric PD was noted in eight patients (28%) and 7 (87%) were HP-negative. The PD group was significantly older at diagnosis (p < 0.001) compared to the whole CD group. CONCLUSIONS: PD is not uncommon in the presentation of CD. It is more likely to be found in the second decade of life. CD should be included in the differential diagnosis of patients with non-HP PD and we suggest routine CD serology and small bowel biopsy in patients with unexplained PD.

Body mass index and per capita income influence duodenal ulcer healing and H. pylori eradication whilst dietary factors play no part.

BACKGROUND: The role of dietary and sociodemographic factors in the healing of duodenal ulcer following H. pylori eradication remains undefined. AIM: To assess the role of diet, sociodemography and body mass index in the healing of duodenal ulcer and eradication of H. pylori. METHODS: A cross-sectional study consisting of 67 consecutive duodenal ulcer patients was undertaken. Sociodemographic factors studied included age, sex, occupation, educational status, religion, type of family, number of family members, per capita income and residence (urban vs. rural). Personal habits studied included alcohol consumption and smoking. Regular dietary intake over a two-month period was assessed using the food frequency questionnaire. All patients had documented H. pylori infection at the time of inclusion and received standard triple eradication therapy. Follow-up endoscopy and testing for H. pylori were done 4 weeks after completion of eradication therapy. RESULTS: The mean age of the 67 patients (60 male, 7 female) was 39.9+/-13.6 years. Healing of duodenal ulcer was documented in 51 patients. H. pylori infection was successfully eradicated in 31 patients but not in the other 36. There was no difference between the groups (Group A1: H. pylori eradicated, Group B1: H. pylori not eradicated) with regard to dietary and socio-demographic variables, except for BMI, which was significantly higher in patients in whom H. pylori had been eradicated. Per capita income was significantly higher in Group A2 (healed duodenal ulcer) as compared to Group B2 (duodenal ulcer not healed) while there was no difference in dietary and socio-demographic variables in these two groups. CONCLUSION: We found that higher body mass index and higher per capita income were associated with successful H. pylori eradication and duodenal ulcer healing, respectively, and that diet had no role to play in either. Further epidemiological studies from different parts of India and studies that control for Helicobacter pylori are required to establish predictive factors.

[Nutrition of patients operated for complicated gastroduodenal ulcers at the early postoperative period].

The investigation is based on an analysis of results of treatment of 102 patients after an emergency resection of the stomach for complicated gastroduodenal ulcers. The probe was inserted into the jejunum intraoperatively. The period of enteral probe nutrition (EPN) was 5-7 days. At the early postoperative period in patients who had undergone the emergency resection of the stomach EPN is an effective method of nutrition maintenance as compared with the infusion-transfusion therapy. The method is simple and open to general use, and is economically advantageous under conditions of any hospital.

Cómo convivir con su úlcera / How to live with your ulcer

El artículo presenta un plan básico de educación para pacientes que sufren de úlcera péptica. Describe características, síntomas, tratamiento, complicaciones y prevención de las lesiones ulcerosas (AU)

Cómo convivir con su úlcera / How to live with your ulcer

El artículo presenta un plan básico de educación para pacientes que sufren de úlcera péptica. Describe características, síntomas, tratamiento, complicaciones y prevención de las lesiones ulcerosas

Nuevos conceptos sobre la dieta en el tratamiento dela úlcera péptica / New concepts on the treatment of peptic ulcer

Gracias a los nuevos conocimientos en esta última década acerca de la úlcera péptica, tanto la patogenia como el tratamiento han variado. El descubrimiento del helicobacter pylori y su hallazgo en la superficie de las células epiteliales gástricas sitúan a la úlcera péptica como una enfermedad infecciosa. También han variado las concepciones que hacían que la dieta del ulceroso fuera una de las más restrictivas y se ha podido minimizar la larga lista de alimentos prohibidos en la dieta terapéutica de esta enfermedad(AU)

Nuevos conceptos sobre la dieta en el tratamiento dela úlcera péptica / New concepts on the treatment of peptic ulcer

Gracias a los nuevos conocimientos en esta última década acerca de la úlcera péptica, tanto la patogenia como el tratamiento han variado. El descubrimiento del helicobacter pylori y su hallazgo en la superficie de las células epiteliales gástricas sitúan a la úlcera péptica como una enfermedad infecciosa. También han variado las concepciones que hacían que la dieta del ulceroso fuera una de las más restrictivas y se ha podido minimizar la larga lista de alimentos prohibidos en la dieta terapéutica de esta enfermedad

Vegetarianism, dietary fibre and gastro-intestinal disease.

PURPOSE: To review the association between vegetarianism, dietary fibre and gastro-intestinal disease. DATA: There is an increasing trend towards vegetarianism in the United Kingdom. Studies have shown a lower than expected death rate in vegetarians with a significant association between meat eating and mortality from all causes in men. Vegetarians were found to have a lower incidence of gastro-intestinal cancer, gallstones, diverticular disease and constipation. Patients treated with vegetarian/high-fibre diets have not experienced significant benefits when diets are used in gastro-intestinal cancer, peptic ulcer disease or inflammatory bowel disease. CONCLUSION: The benefits of a vegetarian life-style may be conferred to non-vegetarians by eating a carefully planned non-vegetarian diet consisting of increased fruit, vegetables and fibre.

[Effect of diet therapy on the changes of vitamin C content in the blood and urine of patients with chronic gastritis and peptic ulcer]. / Izmenenie v soderzhanii vitamina C v krovi i moche bolnykh khronicheskimi gastritami, iazvennoi bolezníu zheludka i dvenadtsatiperstnoi kishki v protsesse dietoterapii.

Estimation and analytical methods were employed to investigate real rations of patients with gastroduodenal ulcer. Chemical composition of diet N 1 was found unsatisfactory both by ascorbic acid and carbohydrates content responsible for low-caloric value of the diet. The ration correction with additional provision of vegetables, fruit, greens raised vitamin C intake by the patients though the deficiency was not abolished.

Mechanisms of NSAID-induced ulcerogenesis: structural properties of drugs, focus on the microvascular factors, and novel approaches for gastro-intestinal protection.

The multifactorial ulcer-producing actions of non-steroidal anti-inflammatory drugs (NSAIDs) are briefly reviewed and the main actions highlighted as the focus for potential strategies for reducing the ulcerogenic effects of these drugs. While some clinical benefits are evident from long-term clinical studies from application of PG analogues (misoprostol) and H+/K(+)-ATP-ase inhibitors (omeprazole) these are, ultimately, expensive approaches. Chemical structural properties of the NSAIDs underlying differences in their ulcerogenicity are analyzed with the objective of establishing the reasons for the low ulcerogenicity of some of these drugs (e.g. azapropazone). These studies serve as a basis for developing less gastrotoxic drugs in the future. In the studies we have undertaken analysis of the benefits of micronutrients and of modulating eicosanoid metabolism have been considered. The results of some clinical trials with micronutrients have proven encouraging. These and other approaches and pitfalls reported give further encouragement to explore the mechanisms of the protective effects of these latter agents and serve as a basis for future developments.