Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal

Introduction: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community.Methods: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy.Results: The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (p=0.005). Variceal bleed patients presented earlier to the hospital (p=0.005), had lower MAP at presentation (p=0.0002), had lower hemoglobin level (p=0.0001) and higher serum creatinine level at presentation (p=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (p=0.006).Conclusions: Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.Keywords: bleeding; endoscopy; peptic ulcer; upper gastrointestinal;varices. [PubMed]

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Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started

Canadian Journal of Gastroenterology ◽

10.1155/2009/181059 ◽

2009 ◽

Vol 23 (9) ◽

pp. 604-608 ◽

Cited By ~ 41

Author(s):

Marcel JM Groenen ◽

Ernst J Kuipers ◽

Bettina E Hansen ◽

Rob J Th Ouwendijk

Keyword(s):

Gastric Ulcers ◽

Bleeding Complications ◽

Upper Gastrointestinal Endoscopy ◽

Peptic Ulcers ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Treatment Regimens ◽

H Pylori ◽

Upper Gastrointestinal ◽

Over Time

BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.METHODS: From a computerized endoscopy database of a district hospital, the data of all patients who underwent upper gastrointestinal endoscopy from 1996 to 2005 were analyzed. The incidence of duodenal and gastric ulcers, with and without complications, were compared over time.RESULTS: Overall, 20,006 upper gastrointestinal endoscopies were performed. Duodenal ulcers were diagnosed in 696 (3.5%) cases, with signs of bleeding in 158 (22.7%). Forty-five (6.5%) of these ulcers were classified as Forrest I and 113 (16.2%) as Forrest II. Gastric ulcers were diagnosed in 487 cases (2.4%), with signs of bleeding in 60 (12.3%). A Forrest 1 designation was diagnosed in 19 patients (3.9%) and Forrest 2 in 41 patients (8.4%). The incidence of gastric ulcers was stable over time, while the incidence of duodenal ulcers declined.CONCLUSIONS: The incidence of duodenal ulcer disease in the Dutch population is steadily decreasing over time. Test and treatment regimens for H pylori have possibly contributed to this decline. With a further decline in the prevalence of H pylori, the incidence of gastric ulcers is likely to exceed the incidence of duodenal ulcers in the very near future, revisiting a similar situation that was present at the beginning of the previous century.

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Peptic Ulcer Disease in Children: Etiology, Clinical Findings, and Clinical Course

PEDIATRICS ◽

10.1542/peds.82.3.410 ◽

1988 ◽

Vol 82 (3) ◽

pp. 410-414

Author(s):

Brendan Drumm ◽

J. Marc Rhoads ◽

David A. Stringer ◽

Phillip M. Sherman ◽

Lynda E. Ellis ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Emergency Surgery ◽

Clinical Course ◽

Clinical Findings ◽

Gastric Ulcers ◽

Peptic Ulcers ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Initial Symptoms

The records of all children with peptic ulcer disease at the Hospital for Sick Children were retrospectively evaluated, excluding neonates, throughout a 5-year period. Only cases with a definite ulcer crater identified either at endoscopy or at surgery were included. There were 36 patients, 20 boys and 16 girls. Duodenal ulcers were more common than gastric ulcers (2.8:1). Ages ranged from 3 months to 17 years, with a mean age of 10 years. Patients were reviewed with respect to etiology of peptic ulcer disease, age when first examined, initial symptoms, and clinical course. Patients were divided into two groups, those with primary (n = 19) and those with secondary (n = 17) peptic ulcer disease. All peptic ulcers in patients younger than 10 years of age were secondary in nature. Secondary ulcers occurred generally in association with a severe underlying illness (11/17), and many ulcers necessitated emergency surgery because of perforation and/or severe hemorrhage (8/17). None of these patients had chronic or recurrent symptoms. In contrast, in children with primary peptic ulcer disease, initial symptoms were more benign. Most patients had abdominal pain and only one required emergency surgery. Children with primary duodenal ulcer disease had a high incidence of recurrent symptoms (67%), however, with surgery for intractable disease necessitated in 40%. Single-contrast barium meals were found to be unreliable in establishing a diagnosis of peptic ulcer disease, particularly cases of gastric ulcer disease.

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Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain at Tertiary Care Institute of Gujarat

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.2.8 ◽

2020 ◽

Vol 3 (2) ◽

pp. 30-32

Author(s):

Rahul Charpot ◽

Jaydeep M Gadhavi

Keyword(s):

Peptic Ulcer ◽

Abdominal Pain ◽

Peptic Ulcer Disease ◽

Tertiary Care ◽

Gastric Ulcers ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Care Institute ◽

Disease Information ◽

One Year

Background: To establish the occurrence of peptic ulcer disease amid the Subjects with abdominal pain at tertiary care institute of Gujarat. Subjects and Methods: present research was performed at the Department of Surgery, tertiary care institute of Gujarat, for the period of one year in 200 patients with abdominal pain and diagnosed with peptic ulcer disease. Information was composed utilizing pre-designed questionnaire. Results:The majorities of participants was females, most were aged between 18 to 25 years. Around 97% had pain in the epigastric region. Gastric ulcers preponderate for 65% patients in current research, except refused during the later existence of the epoch, as the occurrence of duodenal ulcers stayed stable, however amplified rather the later phase. Conclusion: An extensive diversity of subjects with abdominal pain was documented amid the subjects. On the other hand, the socio-economic situation and educational levels of the Subjects with the illness were below par.

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Perforation Peritonitis and the Developing World

ISRN Surgery ◽

10.1155/2014/105492 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 17

Author(s):

Rajandeep Singh Bali ◽

Sushant Verma ◽

P. N. Agarwal ◽

Rajdeep Singh ◽

Nikhil Talwar

Keyword(s):

Peptic Ulcer ◽

Single Unit ◽

Tertiary Care ◽

Exploratory Laparotomy ◽

Gastric Ulcers ◽

Peptic Ulcer Perforation ◽

Care Hospital ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Perforation Peritonitis

Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of perforation peritonitis managed in a single unit of a tertiary care hospital in Delhi. Methods. A retrospective study was carried out between May 2010 and June 2013 in a single unit of the department of Surgery, Lok Nayak Hospital, Delhi. It included 400 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included. Results. The commonest cause of perforation peritonitis included 179 cases of peptic ulcer disease (150 duodenal ulcers and 29 gastric ulcers) followed by appendicitis (74 cases), typhoid fever (48 cases), tuberculosis (40 cases), and trauma (31). The overall mortality was 7%. Conclusions. Perforation peritonitis in India has a different spectrum as compared to the western countries. Peptic ulcer perforation, perforating appendicitis, typhoid, and tubercular perforations are the major causes of gastrointestinal perforations. Early surgical intervention under the cover of broad spectrum antibiotics preceded by adequate aggressive resuscitation and correction of electrolyte imbalances is imperative for good outcomes minimizing morbidity and mortality.

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Causes and Management of Gastric and Duodenal Ulcer in Adolescents

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i37b32052 ◽

2021 ◽

pp. 289-297

Author(s):

Bader Maiedh Mohsen Aladainan ◽

Mahdi Turki Bin Ali Alfataih ◽

Alhassan Ahmed Mohammed Aldundur ◽

Rashed Saleh Mohammed Balhareth ◽

Eisa Yazeed Ghazwani

Keyword(s):

Duodenal Ulcer ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Review Literature ◽

Peptic Ulcers ◽

Significant Progress ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Last 300 Years ◽

Made In

Many etiological hypotheses have been suggested to explain the development of peptic ulcers during the last 300 years (including gastric ulcer and duodenal ulcer). In the last two decades, significant progress has been made in understanding the pathophysiology of peptic ulcer disease, particularly with regard to the involvement of Helicobacter pylori and nonsteroidal anti-inflammatory medications (NSAIDs). This study will attempt to review literature on etiology and management of gastric and duodenal ulcers among adolescents.

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ENDOSCOPIC PROFILE OF UPPER GASTROINTESTINAL BLEEDING IN A TERTIARY CARE CENTRE.

10.36106/ijsr/3904472 ◽

2021 ◽

pp. 45-46

Author(s):

Pavan Kumar V ◽

Kani Shaikh Mohamed

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Care ◽

Gi Bleeding ◽

Care Centre ◽

Gastric Erosions ◽

Tertiary Care Centre ◽

Upper Gi ◽

Upper Gastrointestinal

Background:Astudy describing the endoscopic prole of upper gastrointestinal bleeding in a tertiary care centre. Aim:The aim was to study endoscopic prole in patients presenting with upper GI bleeding. Introduction: Upper gastrointestinal bleeding is a common medical emergency associated with signicant morbidity and mortality. The presentation of bleeding depends on the amount and location of bleed. The primary diagnostic test for evaluation of upper gastrointestinal bleeding is endoscopy. The aim was to study endoscopic prole in patients presenting with upper GI bleeding. Methods: This is a cross sectional study data conducted in Department of Gastroenterology DDHD Anna nagar Chennai from January 2019 to January 2020 . In this patients presenting with manifestations of upper gastrointestinal bleed were included and were subjected to upper GI endoscopy. Results: Atotal of 160 patients presenting with hematemesis and melena were studied. 124(77.5%) were males and 36(22.5%) were females. The mean age was 47.15 ± 17.12 . The most common ndings on endoscopy of upper gastrointestinal bleeding was portal hypertension related (esophageal and gastric varices, portal hypertensive gastropathy ) seen in 40% of patients, gastric erosions in 17.5% patients, peptic ulcer disease was seen in 13.75%, Esophagitis in 6.25% cases, Mallory-Weiss tear was seen in 6.25% patients, gastric malignancy in 5% patients, post EVL ulcers in 3.75% patients, Normal study in 3.75%, Duodenal erosions in 2.5% patients, Vascular ectasia of stomach in 1.25%. Conclusion: The present study reported portal hypertension as the most common cause of upper gastrointestinal bleeding, while most common endoscopic lesions reported were esophageal varices, followed by gastric erosions and peptic ulcer.

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Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.3224 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1916-1924

Author(s):

Naresh Kumar Seetlani ◽

Khalid Imran ◽

Pooja Deepak ◽

Fizza Tariq ◽

Daniyal Mirza ◽

...

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Peptic Ulcer Disease ◽

Scoring System ◽

Upper Gastrointestinal Bleeding ◽

Morbidity And Mortality ◽

Mortality Data ◽

Ulcer Disease ◽

Variceal Bleed ◽

Upper Gastrointestinal

Objectives: Acute upper gastrointestinal bleed is one of the most common emergencies. Despite advancement in the medical field, gastrointestinal bleeding still carries significant mortality and fiscal burden on healthcare system. At present, limited data is available on the predictors of morbidity and mortality associated with acute upper gastrointestinal bleeding in our part of the country. Study Design: Descriptive analytical study. Setting: Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Material and Methods: 260 patients of 12 years and above with complaint of upper gastrointestinal bleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastro-duodenoscopy at the endoscopy suite of the hospital. Their personal data and endoscopic findings were recorded after obtaining a written consent. The patients were followed for 2 weeks to document the factors leading to their morbidity and mortality. We used Rockall scoring system to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0. Results: The survey included 260 patients having males (62·3%) more than females (37·7%) with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%) patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease being the most common etiology. The overall mortality rate of our study was 5·76%. Some factors influencing mortality of the patients were age > 60 years, comorbid, use of NSAIDS, rebleeding, deranged laboratory tests at the time of presentation- anemia (hemoglobin of < 10 g\dl), grade 3 thrombocytopenia (platelet count of < 50 cells\dl), serum creatinine > 1·5 and serum INR of > 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patient mortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding was found as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcer disease. Certain factors are found that are strongly related in deteriorating patient’s outcome. Along with it, Rockall score is also a good predictor of outcome of patients.

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Prevalence of Helicobacter pylori in patients with peptic ulcer disease

International Surgery Journal ◽

10.18203/2349-2902.isj20181011 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1315

Author(s):

Mrutyunjay I. Uppin ◽

Kapildev K. Hannurkar

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Histopathological Examination ◽

Rapid Urease Test ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Urease Test ◽

H Pylori ◽

Upper Gastrointestinal

Background: Prevalence of Helicobacter pylori (H. pylori) emerges throughout the world and instigates peptic ulcer disease (PUD). The study was conducted with the aim to determine the prevalence of H. pylori in patients with PUD undergoing upper gastrointestinal endoscopy.Methods: This prospective study was conducted on 150 cases of PUD from August 2009 to February 2011. Endoscopy was done in all cases. Biopsy was done and sent for histopathological examination and rapid urease test for confirmation of presence of H. pylori.Results: Out of 150 patients with mean age of 45.76 years, 109 patients were diagnosed to have been infected with Helicobacter pylori (72.66%). Out of 89 patients with gastric ulcer, 61 patients were infected with Helicobacter pylori (68.53%). Forty two out of 51 patients (82.35%) with duodenal ulcers and 06 of 10 patients (60%) with carcinoma of stomach were positive for H. pylori. The remaining patients were found to be negative for the H. pylori infection.Conclusions: The findings of the study conclude that H. pylori was consistently associated with PUD.

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CagA Antibodies in Japanese Children with Nodular Gastritis or Peptic Ulcer Disease

Journal of Clinical Microbiology ◽

10.1128/jcm.38.1.68-70.2000 ◽

2000 ◽

Vol 38 (1) ◽

pp. 68-70

Author(s):

Seiichi Kato ◽

Toshiro Sugiyama ◽

Mineo Kudo ◽

Kenji Ohnuma ◽

Kyoko Ozawa ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Gastric Ulcers ◽

Enzyme Linked Immunosorbent Assay ◽

Igg Antibodies ◽

Japanese Children ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Nodular Gastritis ◽

H Pylori

ABSTRACT cagA + Helicobacter pylori strains have been linked to more severe gastric inflammation, peptic ulcer disease, and gastric cancer in adults, but there have been few studies of cagA in children. We examined the relationship between H. pylori cagA status and clinical status in Japanese children. Forty H. pylori -positive children were studied: 15 with nodular gastritis, 5 with gastric ulcers, and 20 with duodenal ulcers. H. pylori status was confirmed by biopsy-based tests and serum anti- H. pylori immunoglobulin G (IgG) antibody. As controls, 77 asymptomatic children with sera positive for anti- H. pylori IgG were enrolled. Levels of IgG antibodies to CagA in serum were measured by an antigen-specific enzyme-linked immunosorbent assay. In 16 patients with successful H. pylori eradication, posttreatment levels of CagA and H. pylori IgG antibodies also were studied. The CagA antibody seropositivities of asymptomatic controls (81.8%) and patients with nodular gastritis, gastric ulcers, and duodenal ulcers (80.0 to 95.0%) were not significantly different. Compared with pretreatment levels of CagA antibodies, posttreatment levels decreased progressively and significantly. We conclude that, as in Japanese adults, a high prevalence of cagA + H. pylori strains was found in Japanese children, and that there was no association with nodular gastritis or peptic ulcer disease. In the assessment of eradicative therapies, monitoring of serum anti-CagA antibodies does not appear to offer any direct benefit over monitoring of anti- H. pylori antibodies.

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A REVIEW ON: PEPTIC ULCER

International Journal of Recent Advances in Science and Technology ◽

10.30750/ijarst.v3i3.14045 ◽

2016 ◽

Vol 3 (3) ◽

Author(s):

Chaudhary S ◽

Kapila A ◽

Sharma RB ◽

Vashist H

Keyword(s):

Peptic Ulcer ◽

Antimicrobial Agents ◽

Eating Habits ◽

Mucosal Blood Flow ◽

Nutritional Deficiencies ◽

Gastric Ulcers ◽

Cell Renewal ◽

Enzymatic Antioxidants ◽

Peptic Ulcers ◽

Ulcer Disease

A peptic ulcer is a sore on the lining of the stomach or duodenum. The two most common types of peptic ulcer are called gastric ulcers and duodenal ulcers. Peptic ulcers are found to be due to an imbalance between aggressive factors such as hydrochloric acid (HCL), pepsin, refluxed bile, leukotrienes (LTs), reactive oxygen species (ROS) and defensive factors, which include the function of the mucus bicarbonate barrier, prostaglandins(PGs), mucosal blood flow, cell renewal and migration, nonenzymatic and enzymatic antioxidants and some growth factors. H. pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the predominant causes of peptic ulcer disease. Also a numbers of factors are implicated in the pathogenesis of gastric ulcer, among which major factors involved are bacterial infection (Helicobacter pylori), certain medications (NSAID), chemicals (Hcl/ethanol), gastric cancer and minor factors are stress, smoking, spicy food and nutritional deficiencies. Due to changes in life style and eating habits an increase in frequency to be affected by ulceration in gastric contents can be observed now a day. At the same time a number of semi synthetic and synthetic drugs like proton pump inhibitors, H2 receptor antagonists, and mucosal defensive agents along with various antimicrobial agents are available for the treatment of ulcer.

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