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Peptic ulcer bleeding

Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Manuele Furnari, Giorgia Bodini, Costanza De Maria, Gaia Pellegatta, Claudia Coppo, Edoardo Savarino
The introduction of proton pump inhibitors (PPIs) into clinical practice has greatly improved our therapeutic approach to acid-related diseases for their efficacy and safety. Areas Covered: The following evidence-based indications for PPI use are acknowledged by many scientific societies: treatment of the various forms and complications of gastroesophageal reflux disease, eradication of H. pylori infection in combination with two or more antibiotics, short- and long-term therapy of H. pylori-negative peptic ulcers, healing, and prevention of NSAID/COXIB-associated gastric ulcers, co-therapy with endoscopic procedures to control upper digestive bleeding and medical treatment of Zollinger Ellison syndrome...
October 8, 2018: Expert Review of Clinical Pharmacology
Mingliang Lu, Gang Sun, Xiao-Mei Zhang, You-Qing Xv, Shi-Yao Chen, Ying Song, Xue-Liang Li, Bin Lv, Jian-Lin Ren, Xue-Qing Chen, Hui Zhang, Chen Mo, Yan-Zhi Wang, Yun-Sheng Yang
BACKGROUND This study aimed to discover the common cause of non-variceal upper-gastrointestinal bleeding (NVUGIB) by conducting a multi-center retrospective study from 2008 to 2012. MATERIAL AND METHODS Hospitalized patients ages ≥18 years old, from 8 hospitals in China, diagnosed with NVUGIB by endoscopy from 1 January 2008 to 31 December 2012 were enrolled. Questionnaires were developed and a data-entry graphical user interface was designed by using EpiData software. RESULTS Total of 2977 hospitalized patients from 8 medical centers were included...
October 6, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Sagarika Satyavada, Perica Davitkov, Meer Akbar Ali, Gregory Cooper, Richard C K Wong, Amitabh Chak
Through-the-scope (TTS) endoscopic Doppler ultrasound probe technology is a tool that has garnered interest for the evaluation of variceal and non-variceal bleeding. In previous studies, this technology has been proposed as a more objective method of identifying the bleeding subsurface blood vessel in peptic ulcer hemorrhage. We describe 3 cases where the use of an endoscopic Doppler probe guided the diagnosis and management of upper gastrointestinal (GI) hemorrhage due to causes other than peptic ulcer disease...
2018: ACG Case Reports Journal
Justin Ch Ng, Neville David Yeomans
OBJECTIVE: To determine whether the risk of upper gastrointestinal bleeding in patients taking low dose aspirin (≤ 325 mg/day) is increased in people with Helicobacter pylori infections. STUDY DESIGN: A systematic search for all publications since 1989 (when H. pylori was named) using search term equivalents for "upper gastrointestinal haemorrhage" and "aspirin". Articles were assessed individually for inclusion of data on H. pylori infection, as not all relevant papers were indexed with this term...
September 1, 2018: Medical Journal of Australia
Jason W Kempenich, Kenneth R Sirinek
The management of peptic ulcer disease has radically changed over the last 40 years from primarily surgical treatment to medical therapy nearly eliminating the need for elective surgery in these patients. Although there has been a decline in patients requiring acute surgical intervention for complications of peptic ulcer disease (perforation, bleeding, and obstruction), these patients still make up a significant proportion of hospital admissions every year. The modern acute care surgeon must have significant knowledge of the multiple treatment modalities used to appropriately care for these patients...
October 2018: Surgical Clinics of North America
Y Vogel, I Wolff, C Zobel, R Hildenbrand
Duodenal ulcers are most often caused by Helicobacter pylori (HP) infection, followed by nonsteroidal anti-inflammatory drugs and hypoperfusion. Posttransplant lymphoproliferative disorder (PTLD) occurs in about 1-6.3% of patients with a heart transplant under immunosuppression therapy. Up to 25% of cases of PTLD have gastrointestinal involvement. Due to a wide spectrum of clinical symptoms and pathological entities, the diagnosis can be challenging. We report the case of a 55-year-old man 12 years after receiving a heart transplant being treated with immunosuppressive agents (tacrolimus) who presented with recurrent bleeding from peptic duodeni...
September 21, 2018: Der Internist
Mechu Narayanan, Kavya M Reddy, Elizabeth Marsicano
Peptic ulcer disease (PUD) is a common condition that both primary care providers and gastroenterologists encounter. Symptoms of peptic ulcer disease are variable and may include abdominal pain, nausea, vomiting, weight loss and bleeding or perforation with complicated disease. Identifying the risk factors and mechanisms that lead to the development of PUD helps to understand the approach behind diagnostic and treatment strategies.
May 2018: Missouri Medicine
Joaquim M Havens, Manuel Castillo-Angeles, Stephanie L Nitzschke, Ali Salim
BACKGROUND: While advances in diagnosis and treatment of peptic ulcer disease have led to a decrease in hospital admissions the socioeconomic distribution of these benefits is unknown. METHODS: We designed a retrospective cohort study using the National Inpatient Sample from 2012 to 2013 including all patients that were admitted for peptic ulcer disease. We compared the types of ulcer related complications, the rates of intervention and the outcomes based on race and insurance status...
September 7, 2018: American Journal of Surgery
Milan Lukáš
The modern therapy for peptic ulcer disease and other acid peptic diseases is based on administration of proton pump inhibitors (PPI) which have fully replaced anacids, parasympatholytics and histamine H2 receptor antagonists. The most effective way is to administer proton pump inhibitors in the morning on an empty stomach in a single daily dose. It is a very safe therapy, despite the fact that a potential adverse effect of long-term PPI treatment on the efficacy of other medications (clopidogrel), on bone metabolism and development of respiratory infections have been discussed recently...
2018: Vnitr̆ní Lékar̆ství
Emery C Lin, Jennifer Holub, David Lieberman, Chin Hur
BACKGROUND & AIMS: Esophagogastroduodenoscopy (EGD) is frequently used to evaluate gastroesophageal reflux disease (GERD) without alarm symptoms, although the benefits are not clear. We aimed to determine the prevalence of uncomplicated GERD as an indication for EGD, the demographic characteristics of these patients, and the endoscopic outcomes of these procedures. METHODS: We collected endoscopy data from a large national database of 543,103 EGDs performed at 82 sites from 2003 through 2014...
September 7, 2018: Clinical Gastroenterology and Hepatology
Hyun Woo Park, Seong Woo Jeon
BACKGROUND AND AIMS: Compared with ulcer bleeding (UB) in non-variceal upper gastrointestinal bleeding (NVUGIB), non-ulcer bleeding (NUB) is often considered to have a low risk of poor outcomes and is treated less intensively without any risk stratification. We conducted this study to assess the predictability of scoring systems for NUB and compare the outcomes of NUB and UB. METHODS: A total of 1831 UGIB patients were registered in the database during the period from February 2011 to December 2013...
August 21, 2018: Digestive Diseases and Sciences
Benjamin E Byrne, Michael Bassett, Chris A Rogers, Iain D Anderson, Ian Beckingham, Jane M Blazeby
OBJECTIVES: This study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement...
August 20, 2018: BMJ Open
Vijay Gayam, Amrendra Kumar Mandal, Mazin Khalid, Jaspreet Kaler, Shivani Thapa, Pavani Garlapati, Arshpal Gill, Ragin Alex, Binav Shrestha
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease which can manifest in many different organ systems. Gastrointestinal (GI) involvement is common in SLE, but the symptoms are usually mild. More severe GI complications including acute pancreatitis and peptic ulcer bleeding are rare but represent a significant risk of morbidity and mortality. We present a case of a 25-year-old Hispanic female with a severe SLE flare. The initial presentation included symptoms of hematemesis and epigastric abdominal pain secondary to both gastric ulceration and acute pancreatitis, an atypical presentation of an SLE flare...
August 2018: Gastroenterology Research
Polychronis Gatos-Gatopoulos, Georgios Tziatzios, Paraskevas Gkolfakis, Konstantinos Triantafyllou
Endoscopic placement of self-expandable metal stent (SEMS) is an efficient method for the palliative decompression of malignant gastro duodenal obstruction. However, its role in treating benign obstructive conditions is controversial. We herein present an unusual case of recurrent upper gastrointestinal (GI) bleeding episodes due to ischemic lesions induced by an uncovered SEMS placed several years before to treat post peptic ulcer pyloric obstruction. Patient's advanced age precluded any attempt for endoscopic or surgical removal of the stent and the patient was successfully treated only with proton pump inhibitors, remaining uneventful on the long term...
July 2018: Annals of Translational Medicine
Masayasu Horibe, Yuki Ogura, Juntaro Matsuzaki, Tetsuji Kaneko, Takuya Yokota, Osamu Okawa, Yukihiro Nakatani, Eisuke Iwasaki, Toshihiro Nishizawa, Naoki Hosoe, Tatsuhiro Masaoka, Naohisa Yahagi, Shin Namiki, Takanori Kanai
Background: The need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure for assessing the risk levels in patients with upper gastrointestinal bleeding (UGIB). However, not all patients with a low hemoglobin level have a poor prognosis. Objective: We assessed the clinical predictive factors associated with poor short-term prognosis in patients with a low hemoglobin level. Methods: In this prospective cohort study, all consecutive patients with suspected acute UGIB at Tokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015...
June 2018: United European Gastroenterology Journal
Patrick D Melmer, Trenton Banks, Sharon Holmes, Jason D Sciarretta, John Mihran Davis
The number of patients being treated surgically for gastroduodenal disease has decreased over the past five decades as a result of focus on medical treatment. However, perforated and bleeding peptic ulcer disease (PUD) continues to represent a significant percentage of patients who require emergency surgery. The aim of this study was to characterize these critically ill surgical patients treated for gastroduodenal disease in our hospital. A retrospective, single-center, consecutive cohort study of all patients identified from the hospital National Surgical Quality Improvement Program database who were admitted to our institution requiring emergent surgical intervention over the past two years was conducted...
July 1, 2018: American Surgeon
Ujjal Poddar
BACKGROUND: There is a lack of clarity about the approach to and management of upper gastrointestinal (UGI) bleeding in children. AIM: To examine the recent literature on UGI bleeding in children in order to outline the diagnostic approach and management. METHODS: The English language literature was searched for articles on UGI bleeding in children. Special attention was paid to its prevalence, risk factors, clinical approach and management...
July 30, 2018: Paediatrics and International Child Health
Byoung Wook Bang, Don Haeng Lee, Hyung Kil Kim, Kye Sook Kwon, Yong Woon Shin, Su Jin Hong, Jong Ho Moon
BACKGROUND: Endoscopically applicable hemostatic agents have been demonstrated to have high initial hemostasis rates in cases of upper gastrointestinal bleeding (UGIB). AIMS: The authors developed a new hemostatic powder (CEGP-003) and evaluated its hemostatic and ulcer healing effects in UGIB. METHODS: Patients with peptic ulcer or post-endoscopic resection bleeding were randomly assigned to be treated by epinephrine injection or CEGP-003 spray...
November 2018: Digestive Diseases and Sciences
S Di Saverio, E Segalini, A Birindelli, S Todero, M Podda, A Rizzuto, G Tugnoli, A Biondi
BACKGROUND: Ideal surgical treatment for acute duodenal injuries should offer a definitive treatment, with low morbidity and mortality. It should be simple and easily reproducible by acute care surgeons in an emergency. Duodenal injury, due to major perforated or bleeding peptic ulcers or iatrogenic/traumatic perforation, represents a surgical challenge, with high morbidity and mortality. The aim was to review definitive surgery with pancreas-sparing, ampulla-preserving duodenectomy for these patients...
July 19, 2018: British Journal of Surgery
Yutaka Kondo, Waku Hatta, Tomoyuki Koike, Yasushi Takahashi, Masahiro Saito, Takeshi Kanno, Kiyotaka Asanuma, Naoki Asano, Akira Imatani, Atsushi Masamune
BACKGROUND: Previous studies have shown that several factors such as hemodynamic instability at admission are risk factors for rebleeding of peptic ulcer bleeding. However, whether steroid use increases the risk of rebleeding remains elusive. AIMS: This study aimed to clarify the risk factors for rebleeding after endoscopic hemostasis for peptic ulcer bleeding. METHODS: A total of 185 patients who underwent endoscopic hemostasis for peptic ulcer bleeding at our institution between 2005 and 2017 were retrospectively analyzed...
November 2018: Digestive Diseases and Sciences
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