Risk Factors For Recurrence of Peptic Ulcer Disease: A Retrospective Study In Tertiary Care Referral Center

Backgrounds: Peptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. The aim of this study was to evaluate the five-year recurrence rate for treated patients with PUD and risk factors contributing to PUD relapses.Methods: From 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroid were analyzed by univariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.Results: Among 223 patients, there were 187 (83.8%), who diagnosed endoscopy-proved PUD and 36 (16.2%), who diagnosed clinical PUD. Among them, 126 (56.5%) patients were males and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroid and NSAID and H. pylori infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05). Conclusion: Our findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroid and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

Pretreatment of Garlic Oil Extracts Hampers Epithelial Damage in Cell Culture Model of Peptic Ulcer Disease

Background and Objectives: Peptic ulcer disease is a chronic disease affecting up to 10% of the world’s population. Proton pump inhibitors, such as lansoprazole are the gold standard in the treatment of ulcer disease. However, various studies have shown the effectiveness of garlic oil extracts in the treatment of ulcer disease. A cellular model can be established in the human gastric cell line by sodium taurocholate. The aim of this study was to explore the effects of garlic oil extracts pretreatment and LPZ addition in the cell culture model of peptic ulcer disease by examining oxidative stress and F-actin distribution. Materials and Methods: Evaluation was performed by determination of glutathione and prostaglandin E2 concentrations by ELISA; human gastric cell line proliferation by cell counting; expression of ATP-binding cassette, sub-family G, member 2; nuclear factor kappa B subunit 2 by RT PCR; and F-actin cytoskeleton visualization by semi-quantification of Rhodamine Phalloidin stain. Results: Our results showed significant reduction of cell damage after sodium taurocholate incubation when the gastric cells were pretreated with lansoprazole (p < 0.001) and increasing concentrations of garlic oil extracts (p < 0.001). Pretreatment with lansoprazole and different concentrations of garlic oil extracts increased prostaglandin E2 and glutathione concentrations in the cell culture model of peptic ulcer disease (p < 0.001). Positive correlation of nuclear factor kappa B subunit 2 (p < 0.01) with lansoprazole and garlic oil extracts pretreatment was seen, while ATP-binding cassette, sub-family G, member 2 expression was not changed. Treatment with sodium taurocholate as oxidative stress on F actin structure was less pronounced, although the highest concentration of garlic oil extracts led to a statistically significant increase of total amount of F-actin (p < 0.001). Conclusions: Hence, pretreatment with garlic oil extracts had gastroprotective effect in the cell model of peptic ulcer disease. However, further experiments are needed to fully elucidate the mechanism of this protective role.

REVIEW ARTIKEL : TANAMAN YANG MEMILIKI AKTIVITAS ANTI-ULSER DI ASIA

Pendahuluan: Obat-obatan herbal dapat berpotensi tinggi dalam menangani berbagai penyakit termasuk tukak lambung karena dinilai lebih aman dan nyaman. Tukak atau ulser lambung merupakan gangguan pada lambung akibat ketidakseimbangan faktor agresif (sekresi asam lambung, pepsin, dan infeksi Helicobacter pylori) dengan faktor defensif (prostaglandin, mukus, bikarbonat, aliran darah mukosa, dan sel epitel intrisnik). Metode: Metode yang digunakan yaitu studi tinjauan pustaka yang dilakukan dengan mencari kata kunci seperti peptic ulcer disease, tanaman herbal, anti-tukak lambung dan lain-lain pada basis data berupa PubMed dan Google Scholar. Hasil: Dari hasil tinjauan pustaka, diperoleh 29 tanaman obat di Asia dengan potensi aktivitas anti-ulser yang dapat mencegah dan membantu mengobati tukak lambung. Tabel tanaman obat disusun berdasarkan analisis fitokimia, bagian yang digunakan, serta negara tempat tanaman berasal. Kesimpulan: Tanaman yang berpotensi dalam mencegah dan membantu menyembuhkan tukak lambung yang tersebar di Asia diantaranya memiliki kandungan fitokimia flavonoid, tanin, polifenol, alkaloid, glikosida, terpenoid, saponin dengan berbagai mekanisme yaitu gastroprotektif, antioksidan, antiinflamasi, anti-sekretori, anti-Helicobacter pylori, dan astringen.

Prevalence of Peptic Ulcer Disease and Associated Factors Among Dyspeptic Patients At Endoscopy Unit, University of Gondar Hospital, Northwest Ethiopia

Background: Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Peptic Ulcer Disease (PUD) occurs in 5-15% of patients with dyspepsia. Helicobacter pylori (H.pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin (ASA) use are widely known risk factors for PUD. This research article aimed to determine the prevalence of PUD and associated factors among dyspeptic patients at the endoscopy unit, University of Gondar hospital, Northwest Ethiopia.Methods: A hospital-based cross-sectional study was conducted at University of Gondar hospital. A sample of 218 adults who presented with the complaint of dyspepsia, and underwent endoscopic evaluation were interviewed from June 1 to November 30, 2020. A consecutive sampling method was used to recruit the study subjects. Relevant clinical history was obtained from patients’ medical records. Upper gastrointestinal endoscopy was used to confirm the presence of peptic ulcer disease. The Data were entered into EpiData version 4.6.0.2 and exported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with the occurrence of PUD among dyspeptic patients. P-value <0.05 was used to declare a statistically significant association.Results: A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The PUD was diagnosed in one-third of patients with dyspepsia. Dyspeptic patients with active H. pylori infection (AOR=6.3, 95%CI: 2.96-13.38) and NSAIDs/ASA use (AOR=6.2, 95%CI: 2.93-13.36) were at higher risk of developing PUD.Conclusion: The magnitude of active H. pylori infection among symptomatic PUD patients was high. So then, a “test-and-treat” strategy is advised. Cautious use of NSAIDs/ASA is required as it is readily available over-the-counter.

Modern Clinical and Epidemiological Features and New Technological Possibilities in the Treatment of Bleeding Gastroduodenal Ulcers

The aim of this research was to study the current clinical and epidemiological features of ulcerative gastroduodenal bleeding (GDB) and to evaluate the outcomes of using new technological approaches in patients with bleeding from acute (symptomatic) and chronic (peptic ulcer disease) gastroduodenal ulcers (GDUs). Methods and Results: The present study involved 221 patients with bleeding GDUs. Depending on the source of bleeding, all patients were divided into 2 groups. Group 1 included 143 patients with acute symptomatic GDUs; Group 2 consisted of 78 patients with peptic ulcer disease complicated by bleeding. In the complex treatment of patients of all the studied groups, an individual approach was used that included the innovative technologies of endoscopic cytoprotective treatment of GDB, based on the combined use of traditional means of EH in combination with the use of endoscopic pneumoinsufflation of biologically active drainage sorbent of a new generation Aseptisorb-D and powdered hemostatic Zhelplastan. Our analysis showed that acute symptomatic GDUs prevailed in the structure of GDB – 143(64.7%) patients; PUD complicated by bleeding was diagnosed in 78(35.3%) cases. The use of new technological approaches, including cytoprotective treatment of bleeding defects with biologically active draining sorbents of a new generation in combination with local hemostatics in the complex therapy of patients with ulcerative GDB, has significantly improved the results of treatment, which is confirmed by high rates of final hemostasis (95.0%), indicators of the effectiveness of primary EH in type FIA-IB (93.1%) and prevention of recurrence of FIIA-IIB bleeding (92.5%), with a low frequency of repeated bleeding (4.07%), emergency surgeries (2.7%), and mortality (3.2%). Conclusion: Currently, in the structure of ulcerative GDB, acute symptomatic GDUs are the most common – 64.7%, and the share of PUD complicated by bleeding accounts for 35.3% of cases only. PUD and GDUs complicated by bleeding have certain clinical and epidemiological features, which must be taken into account when treating these patients. Symptomatic GDUs are more difficult to treat, which shows the need to develop new complex technologies for their treatment.

The Surgical Management of Peptic Ulcer Disease

The treatment of peptic ulcer disease has evolved substantially through the decades since the discovery of acid-reducing agents and helicobacter pylori bacteria. With the success of medical treatment, surgical therapy continues to play a less prominent role in the care of this disease. Operative candidates include the naive patient treated with over-the-counter NSAIDs who are often those with undiagnosed Helicobacter pylori, requiring less complicated initial surgery. With more surgeons graduating with less experience operating on PUD with evolving operative techniques, the question arises as to what constitutes the optimal surgical approach, especially in the elective vs. emergent settings. Recent literature discussing GI bleeding associated with COVID-19 also merits discussion of surgical options in this chapter. Future surgical options may include minimally invasive endoscopic surgeries akin to per-oral endoscopic myotomy of the pylorus; however, this has not yet been described in this disease.