scholarly journals A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

2018 ◽  
Vol 6 (11) ◽  
pp. 3488
Author(s):  
Uday Mahajan ◽  
Dhiraj Kapoor ◽  
B. S. Rana ◽  
Pankaj Kumar ◽  
Dinesh Kumar ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Continuous Infusion ◽  
High Dose ◽  
Ulcer Disease ◽  
Upper Gastrointestinal Bleed ◽  
Ligament Of Treitz ◽  
Rockall Score ◽  
The Difference ◽  
To Receive ◽  
Intermittent Regimen

Background: UGI bleeding is defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Intermittent dosage regimen IV bolus and high dose IV continuous infusion forms helps in achieving and maintaining this pH goal of more than 6 which forms optimal environment for peptic ulcer healing and clot stabilization to occur. Theoretically, high-dose IV continuous infusion should provide the most potent acid suppression. Aims and objective was to compare the efficacy of intermittent dose of pantoprazole given for 3 days i.e. 40mg intravenous twice a day versus continuous infusion dose of pantaprazole i.e. 80mg intravenous bolus followed by 8mg/hour for first 72hours in the treatment of UGI bleed.Methods: Patients of UGI bleed were randomly assigned to receive either continuous or intermittent regimen of pantaprazole as a part of management.Results: Among 118 patients of peptic ulcer disease, 7 patients had rebleed and 111 patients had no rebleed.3 patients among 59 patients who received continuous regimen and 4 patients among 59 patients who received intermittent regimen had rebleed with a total of 7 patients among 118 patients. Among 118 patients only 2 patients of the total had need for surgery for stabilization. Among 59 patients who received continuous regimen 2 patients needed surgery while none of the 59 patients who received intermittent regimen needed for surgery. Of the 118 patients 10 patients had mortality at the end of 30 day period. In both the regimes 5 patients died.Conclusions: The difference between Rockall score of the intermittent and continuous regimen group was statistically insignificant. The incidence of rebleed was 5.1 % for continuous and 6.7% for intermittent regimen which was statiscally insignificant. The incidence of mortality was similar 8.5%in both regimen.

scholarly journals Identification of Markers for Helicobacter pylori Strains Isolated from Children with Peptic Ulcer Disease by Suppressive Subtractive Hybridization

2006 ◽  
Vol 74 (7) ◽  
pp. 4064-4074 ◽  
Author(s):  
Mónica Oleastro ◽  
Lurdes Monteiro ◽  
Philippe Lehours ◽  
Francis Mégraud ◽  
Armelle Ménard
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Subtractive Hybridization ◽  
Suppressive Subtractive Hybridization ◽  
Ulcer Disease ◽  
Lipopolysaccharide Biosynthesis ◽  
The Difference ◽  
H Pylori

ABSTRACT Peptic ulcer disease (PUD) occurs after a long-term Helicobacter pylori infection. However, the disease can develop earlier, and rare cases have been observed in children, suggesting that these H. pylori strains may be more virulent. We used suppressive subtractive hybridization for comparative genomics between H. pylori strains isolated from a 5-year-old child with duodenal ulcer and from a sex- and age-matched child with gastritis only. The prevalence of the 30 tester-specific subtracted sequences was determined on a collection of H. pylori strains from children (15 ulcers and 30 gastritis) and from adults (46 ulcers and 44 gastritis). Two of these sequences, jhp0562 (80.0% versus 33.3%, P = 0.008) and jhp0870 (80.0% versus 36.7%, P = 0.015), were highly associated with PUD in children and a third sequence, jhp0828, was less associated (40.0% versus 10.0%, P = 0.048). Among adult strains, none of the 30 sequences was associated with PUD. However, both jhp0562 and jhp0870 were less prevalent in adenocarcinoma strains than in PUD strains from children and adults, the difference being statistically significant for jhp0870. In conclusion, two H. pylori genes were identified as being strongly associated with PUD in children, and their putative roles as an outer membrane protein for jhp0870 and in lipopolysaccharide biosynthesis for jhp0562, suggest that they may be novel virulence factors of H. pylori.

Nonvariceal Upper Gastrointestinal Bleeding

2020 ◽  
Author(s):  
John R. Saltzman ◽  
Wasif Abidi
Keyword(s):  
Differential Diagnosis ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Endoscopic Therapy ◽  
Scoring Systems ◽  
Gi Bleeding ◽  
Ulcer Disease ◽  
Treatment Regimens ◽  
Consensus Statements ◽  
Ligament Of Treitz

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

Nonvariceal Upper Gastrointestinal Bleeding

2020 ◽  
Author(s):  
John R. Saltzman ◽  
Wasif Abidi
Keyword(s):  
Differential Diagnosis ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Endoscopic Therapy ◽  
Scoring Systems ◽  
Gi Bleeding ◽  
Ulcer Disease ◽  
Treatment Regimens ◽  
Consensus Statements ◽  
Ligament Of Treitz

Gastrointestinal (GI) bleeding that is proximal to the ligament of Treitz is considered upper GI bleeding (UGIB). UGIB can be further divided into variceal and nonvariceal, differentiated by etiology, presentation, management, and mortality. This review of nonvariceal UGIB addresses the epidemiology, diagnosis, treatment (including endoscopic therapy), prognosis, and differential diagnosis. Recommendations presented are evidence based and consistent with consensus statements and society guidelines. Figures show stigmata of recent hemorrhage, endoscopic therapy, peptic ulcer disease, Mallory-Weiss syndrome, angiodysplasia, Dieulafoy lesion, and arterioenteric fistula. Tables list the manifestation of GI bleeding and the presumed source of the bleeding, clues in the symptom and presentation of the patient that may suggest the diagnosis, medical history and physical examination findings that can suggest a specific diagnosis, a comparison of different prognostic scoring systems, differential diagnosis of UGIB, various etiologies of peptic ulcer disease, and treatment regimens for Helicobacter pylori. This review contains 7 highly rendered figures, 10 tables, and 85 references

Peptic ulcer disease

2020 ◽  
pp. 2849-2861
Author(s):  
Joseph Sung
Keyword(s):  
Peptic Ulcer ◽  
Proton Pump Inhibitor ◽  
Peptic Ulcer Disease ◽  
Proton Pump ◽  
Gastric Ulcers ◽  
High Dose ◽  
Recurrent Bleeding ◽  
Ulcer Disease ◽  
H Pylori ◽  
Line Of Therapy

Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, and smoking are the most important causes of peptic ulcer disease. Peptic ulcer disease is characterized by a history of waxing and waning symptoms of localized, dull, aching pain in the upper abdomen. Bleeding is the most common complication; free perforation of the stomach or duodenum into the peritoneal cavity is uncommon but serious. The diagnosis of peptic ulcer disease is made by endoscopy, which offers an opportunity for biopsy of gastric ulcers (which may be malignant) and reveals important prognostic indicators in patients with bleeding ulcers. A single daily dose of a proton pump inhibitor gives quick relief of symptoms and effective healing of peptic ulcers in 4 to 6 weeks. The management of patients with upper gastrointestinal haemorrhage requires a multidisciplinary medical and surgical approach. Early risk stratification based on clinical and endoscopic criteria allows delivery of appropriate care, with endoscopic intervention now widely accepted as the first line of therapy. This should be followed by administration of a high dose of an intravenous proton pump inhibitor to further reduce recurrent bleeding. Treatment of H. pylori is a cure for peptic ulcer disease in most patients. This usually requires at least two antimicrobial agents, with the most popular triple therapy combining a proton pump inhibitor with any two of amoxicillin, metronidazole, and clarithromycin for 7 to 14 days. Eradication of H. pylori infection, avoidance of high-dose NSAIDs or aspirin, and the maintenance use of proton pump inhibitors in high-risk individuals are the best ways to prevent recurrence of ulcer and ulcer complications.

Prevention of acute emesis in cancer patients following high-dose cisplatin with the combination of oral dolasetron and dexamethasone.

1997 ◽  
Vol 15 (5) ◽  
pp. 2135-2138 ◽  
Author(s):  
M G Kris ◽  
K B Pendergrass ◽  
R M Navari ◽  
T H Grote ◽  
A M Nelson ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cancer Patients ◽  
Dose Regimen ◽  
High Dose ◽  
Acute Emesis ◽  
Dose Oral ◽  
The Difference ◽  
The One ◽  
Combination Regimens ◽  
To Receive

PURPOSE Dolasetron is a 5-HT3 antagonist antiemetic with active oral and intravenous formulations. The effects of this class are enhanced when combined with dexamethasone. This study tested the ability of the combination of oral dolasetron 200 mg and oral dexamethasone 20 mg to prevent acute emesis in cancer patients receiving initial cisplatin at doses > or = 70 mg/m2. Additionally, patients were randomly assigned to receive a second dosage of the regimen 16 hours later to improve control of acute symptoms. PATIENTS AND METHODS A total of 75 patients were entered, with 38 randomized to the two-dose regimen. Thirty-five percent were women and 77% had lung cancer. RESULTS Overall, the regimen prevented acute vomiting in 76% (95% confidence interval, 65% to 85%), including 74% of 35 patients who received cisplatin at doses > or = 100 mg/m2. There was no observed difference in emesis prevention between the one-dose (76%) and two-dose (76%) regimens (95% confidence interval for the difference, -20% to 19%). The median time to the onset of emesis was 19 hours for the one-dose regimen and 17 hours for the two-dose regimen in those patients with emesis. Headache occurred in 11% who received one dose and 16% who received two doses. CONCLUSION The combination of oral dolasetron 200 mg and dexamethasone 20 mg given only once prevented acute emesis in 76% of patients who received cisplatin > or = 70 mg/m2. Administration of a second dose of the regimen did not improve the observed prevention rate or delay the time to emesis. This one-dose oral regimen has comparable or better effectiveness than reported results of intravenous combination regimens in preventing cisplatin-induced vomiting and merits further study and use.

scholarly journals COMPARISON OF NON-ENDOSCOPIC SCORES FOR THE PREDICTION OF OUTCOMES IN PATIENTS OF UPPER GASTROINTESTINAL BLEED IN AN EMERGENCY OF A TERTIARY CARE REFERRAL HOSPITAL: A PROSPECTIVE COHORT STUDY

2021 ◽  
Vol 58 (4) ◽  
pp. 534-540
Author(s):  
Anurag SACHAN ◽  
Deba Prasad DHIBAR ◽  
Ashish BHALLA ◽  
Ajay PRAKASH ◽  
Sunil TANEJA ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Cohort Study ◽  
Peptic Ulcer Disease ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Early Warning Score ◽  
Ulcer Disease ◽  
Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

scholarly journals Sa1128 Can Patients With Low Rockall Score With Established Diagnosis of Peptic Ulcer Disease Be Managed out of Hospital?

2013 ◽  
Vol 144 (5) ◽  
pp. S-208
Author(s):  
Dileep Mangira ◽  
Jayne Sandford ◽  
Peter A. Bampton ◽  
Robert J. Fraser
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Ulcer Disease ◽  
Rockall Score
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