Science.gov

Sample records for active duodenal ulcer

  1. Physical activity at work and duodenal ulcer risk.

    PubMed Central

    Katschinski, B D; Logan, R F; Edmond, M; Langman, M J

    1991-01-01

    To determine whether the social class differences in duodenal ulcer frequency may be explained by differences in physical activity at work, the energy expenditure during work, smoking habits, and social class were compared in 76 recently diagnosed duodenal ulcer patients and in age and sex matched community controls. As anticipated, the relative risk of duodenal ulcer showed significant associations with smoking and social class. Social class and physical activity at work were associated with one another. After adjusting for age, sex, smoking, and social class, physically active work was still associated with duodenal ulcer, with relative risks for moderate and high activity compared with sedentary work being 1.3 (0.6-3.0) and 3.6 (1.3-7.8) respectively. Within each social class stratum, the relative risk of having a duodenal ulcer was greater in those with a high level of occupational activity than in those undertaking sedentary work. PMID:1916502

  2. Enhanced gastric nitric oxide synthase activity in duodenal ulcer patients.

    PubMed Central

    Rachmilewitz, D; Karmeli, F; Eliakim, R; Stalnikowicz, R; Ackerman, Z; Amir, G; Stamler, J S

    1994-01-01

    Nitric oxide, the product of nitric oxide synthase in inflammatory cells, may have a role in tissue injury through its oxidative metabolism. Nitric oxide may have a role in the pathogenesis of duodenal ulcer and may be one of the mechanisms responsible for the association between gastric infection with Helicobacter pylori and peptic disease. In this study, calcium independent nitric oxide synthase activity was detected in human gastric mucosa suggesting expression of the inducible isoform. In 17 duodenal ulcer patients gastric antral and fundic nitric oxide synthase activity was found to be two and 1.5-fold respectively higher than its activity in the antrum and fundus of 14 normal subjects (p < 0.05). H pylori was detected in the antrum of 15 of 17 duodenal ulcer patients and only in 7 of 14 of the control subjects. Antral nitric oxide synthase activity in H pylori positive duodenal ulcer patients was twofold higher than in H pylori positive normal subjects (p < 0.05). In duodenal ulcer patients antral and fundic nitric oxide synthase activity resumed normal values after induction of ulcer healing with ranitidine. Eradication of H pylori did not further affect gastric nitric oxide synthase activity. These findings suggest that in duodenal ulcer patients stimulated gastric mucosal nitric oxide synthase activity, though independent of the H pylori state, may contribute to the pathogenesis of the disease. PMID:7525417

  3. Effect of the hexapeptide dalargin on ornithine decarboxylase activity in the duodenal mucosa of rats with experimental duodenal ulcer

    SciTech Connect

    Yarygin, K.N.; Shitin, A.G.; Polonskii, V.M.; Vinogradov, V.A.

    1987-08-01

    The authors study the effect of dalargin on ornithine decarboxylase in homogenates of the duodenal ulcer from rats with experimental duodenal ulcer induced by cysteamine. Activity of the enzyme was expressed in pmoles /sup 14/CO/sub 2//mg protein/h. Protein was determined by Lowry's method. The findings indicate that stimulation of ornithine decarboxylase and the antiulcerative effect of dalargin may be due to direct interaction of the peptide with cells of the intestinal mucosa and with enterocytes.

  4. Refractory duodenal ulcer.

    PubMed Central

    Bardhan, K D

    1984-01-01

    A refractory duodenal ulcer was arbitrarily defined as one that had failed to heal completely after treatment with cimetidine 1 g daily for three months. Of 66 patients with refractory duodenal ulcer, healing eventually occurred in 37 patients, after treatment for an average of 7.4 months. But 28 patients did not heal despite treatment for an average of 9.4 months; and one patient defaulted. In 41 patients the daily dose of cimetidine was increased to 2 g: the ulcers in 31 patients healed. In eight patients the daily dose was increased to 3 g and healing occurred in four patients. Eighteen patients required admission on 22 occasions because of severe symptoms despite treatment. Nine patients underwent surgery but in five the results were poor. Differences in clinical and endoscopic features between refractory and non-refractory ulcer patients were small. Acid and pepsin secretion were similar and gastrin concentrations normal. Blood levels of the drug and suppression of acid secretion were both satisfactory. Identification of refractory ulcer patients at the start of treatment was therefore not possible. Refractoriness could occur at any time during the course of the disease, previous treatment with cimetidine often having resulted in rapid healing, but subsequent relapses were also usually refractory. The cause of refractoriness remains unknown and the rather poor results of surgery in this series suggests that optimal management of these patients remains to be determined. Refractoriness probably indicates a changed natural history of the disease and in some patients a more poor prognosis. PMID:6428982

  5. Structure-activity relations between alkyl nucleophilic chemicals causing duodenal ulcer and adrenocortical necrosis

    SciTech Connect

    Szabo, S.; Reynolds, E.S.; Unger, S.H.

    1982-10-01

    Structure-activity relationships were qualitatively and quantitatively examined for 56 chemicals (e.g., derivatives of propionitrile, acrylonitrile and cysteamine) which caused duodenal ulcer and/or adrenocortical necrosis in rats. For the first time the duodenal ulcerogenic property of numerous chemicals has been studied in a rational and predictive manner. Ulcerogenic activity was most intense in the carbonitriles attached to two or three carbon backbones and diminished by shortening, lengthening, branching, unsaturating, halogenating or hydroxylating the carbon chains. Different modes of action are implied. Adrenocorticolytic potency was associated with unsaturation of the carbon chain and substitution of the nitrile by thiol or amine radicals. An action of these chemicals on the central nervous system has been suggested.

  6. Abnormalities in the duodenal transit and motility in duodenal ulcer patients: studies with a new isotopic technique.

    PubMed Central

    Quon, M G; Mena, I; Valenzuela, J E

    1989-01-01

    Abnormalities of duodenal motility have been described in patients with duodenal ulcer and in experimental ulcers in rats and it has been postulated that they could be pathogenic in peptic ulcer disease. We have investigated with an isotopic technique whether duodenal bulb clearance or duodenal transit are abnormal in duodenal ulcer. Six patients with inactive and six with active duodenal ulcers, all men, and six healthy male controls were studied. Motility of the duodenum was simultaneously monitored. A bolus of 99mTcDTPA was injected into the duodenum while water or acid were perfused on different occasions. Duodenal bulb clearance and transit to the ligament of Treitz were calculated. Duodenal transit in duodenal ulcer patients 108.8 (23) sec was faster than in controls, 194.9 (5.1) sec (p less than 0.05) during the quiescent period of the motility cycle. The frequency of duodenal bulb contractions during acid perfusion was higher in duodenal ulcer patients 1.7 (0.4) cont/min, than in controls 0.8 (0.1) cont/min (p less than 0.05). No other significant differences were observed between ulcer patients and controls. These data suggest that patients with duodenal ulcers do not have major abnormalities of duodenal bulb clearance, nor of duodenal transit and that duodenal motility does not play a primary role in the pathogenesis of the ulcer. Images Fig. 2 Fig. 3 Fig. 4 PMID:2659441

  7. [Surgical treatment of duodenal ulcer].

    PubMed

    Lese, M; Naghi, I; Pop, C

    2001-01-01

    The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology.

  8. Duodenal pH in health and duodenal ulcer disease: effect of a meal, Coca-Cola, smoking, and cimetidine.

    PubMed

    McCloy, R F; Greenberg, G R; Baron, J H

    1984-04-01

    Intraluminal duodenal pH was recorded using a combined miniature electrode and logged digitally every 10 or 20 seconds for five hours (basal/meal/drink) in eight control subjects and 11 patients with duodenal ulcer (five on and off treatment with cimetidine). Over the whole test there were no significant differences in duodenal mean pH or log mean hydrogen ion activity (LMHa) between control subjects and patients with duodenal ulcer, but there were significantly longer periods of duodenal acidification (pH less than 4) and paradoxically more periods of duodenal alkalinisation (pH greater than 6) in the duodenal ulcer group compared with controls. After a meal duodenal mean pH and LMHa fell significantly in both controls and patients with duodenal ulcer, with more periods of duodenal acidification and alkalinisation in the duodenal ulcer group. An exogenous acid load (Coca-Cola) significantly increased the periods of duodenal acidification, and reduced alkalinisation, in both groups. Cimetidine significantly increased mean pH and LMHa and abolished the brief spikes of acidification in four of five patients with duodenal ulcer. Peak acid output (but not basal acid output) was significantly correlated with duodenal mean pH and LMHa but not with the periods of duodenal acidification. Smoking did not affect duodenal pH in either group.

  9. Antiulcer activity of Andrographis paniculata (Burm.f.) wall. against cysteamine-induced duodenal ulcer in rats.

    PubMed

    Saranya, P; Geetha, A

    2011-07-01

    Antiulcer activity of Andrographis paniculata was evaluated by cysteamine induced duodenal ulcer model in rats. Male albino Wistar rats were pre-administered with 200 mg/kg body wt. of hydroalcoholic extact of Andrographis paniculata (HAEAP) orally, for 30 days prior to i.p. administration of 420 mg/kg body wt. of cysteamine as a single dose. Rats preadministered with 30 mg/kg body wt. of ranitidine served as standard drug. Ulcer index, thiobarbituric acid reactive substances, mucin, glutathione peroxidase and myeloperoxidase activities, reduced glutathione/oxidized glutathione (GSH/GSSG) ratio, glycoproteins and membrane bound enzyme activities were measured in duodenum of experimental animals. The ulcer score and myeloperoxidase activity were significantly minimized in rats treated with HAEAP. Mucin content was found to be preserved in rats treated with the extract. GSH/GSSG ratio and glutathione peroxidase activities were found to be maintained by the HAEAP. Level of lipid peroxidation products was found to be significantly low in HAEAP treated rats compared to ulcer control rats. The basolateral and brush border membrane bound enzyme activities which were depleted significantly in ulcer control rats were found to be maintained in rats pre-treated with the extract. The ulcer preventing effect was comparable to that of ranitidine treated rats. Level of glycoproteins was also found to be preserved in rats treated with the extract. The normal rats treated with the HAEAP did not show any abnormal alterations in the parameters studied. Histopathological observations also showed the ulcer preventing effect of the HAEAP. It is suggested that the ulcer preventing effect may be due to its mucin preserving and antioxidant nature.

  10. Multiple giant duodenal ulcers associated with duodenal gastrinoma.

    PubMed

    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Kobara, Hideki; Masaki, Tsutomu

    2012-02-01

    A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection. The patient's symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor by inverting a transnasal endoscope into the duodenal bulb.

  11. [Melatonin production in patients with duodenal ulcer at different stages of disease].

    PubMed

    Komarov, F I; Rapoport, S I; Malinovskaia, N K; Voznesenskaia, L A; Sharov, A A; Vetterberg, L

    1998-01-01

    Melatonin secretion was measured in patients with duodenal ulcer in exacerbation and remission. Melatonin production was found abnormal both in duodenal ulcer remission and exacerbation. It is suggested that melatonin may participate in pathogenesis of duodenal ulcer.

  12. Thyroid storm precipitated by duodenal ulcer perforation.

    PubMed

    Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Ando, Takao; Kawakami, Atsushi

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  13. Effects of captopril on the cysteamine-induced duodenal ulcer in the rat.

    PubMed

    Saghaei, Firoozeh; Karimi, Iraj; Jouyban, Abolghasem; Samini, Morteza

    2012-05-01

    Oxidative stress is important factor underlying in a variety of diseases. Antioxidative enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) are part of the physiological defenses against oxidative stress. Malondialdehyde (MDA) is a lipid peroxidation biomarker and its elevated level in various diseases is related to free radical damage. Cysteamine is a cytotoxic agent, acting through generation of reactive oxygen species (ROS) and may decrease defense activity of antioxidative enzymes against ROS and induce duodenal ulcer. Captopril, acts as free radical scavengers and protect against injuries from oxidative damage to tissues.The aim of this study was the evaluation of the effect of captopril against cysteamine-induced duodenal ulcer by determining duodenal damage, duodenal tissue SOD and GSH-PX activities and plasma MAD level. This study was performed on 3 groups of 7 rats each: saline, cysteamine and cysteamine plus captopril treated groups. The effect of captopril against cysteamine-induced duodenal ulcer is determined by evaluating the duodenal damage, duodenal tissue SOD and GSH-PX activities and plasma MDA level. All animals were euthanized 24h after the last treatment and 2 ml blood and duodena samples were collected for calculation of ulcer index, histopathological assessment and measurement of tissue SOD, GSH-PX activities and plasma MDA level. Cysteamine produced severe duodenal damage, decreased the activity of duodenal tissue SOD and GSH-PX and increased the plasma MDA level compared with saline pretreated rats. Pretreatment with captopril decreased the cysteamine-induced duodenal damage and plasma level of MDA and increased the activities of SOD and GSH-PX in duodenal tissue compared with cysteamine pretreated animal. Our results suggest that captopril protects against cysteamine-induced duodenal ulcer and inhibits the decrease in SOD and GSH-PX activities and lipid peroxidation by increasing antioxidant defenses.

  14. Octatropine-methyl-bromide and sulglycotide salt in the short-term treatment of active duodenal ulcer. A double blind endoscopic study of 40 outpatients.

    PubMed

    Dobrilla, G; Valentini, M; Bonoldi, M C; Piazzi, L

    1989-01-01

    Forty outpatients with endoscopically confirmed duodenal ulcers were entered in a double blind trial. They were randomly allocated to octatropine-methyl-bromide and sulglycotide salt (GVP) or placebo. The results show that the combination of the two drugs is less efficacious than the two constituent substances taken separately, is not more efficacious than placebo in ulcer healing, and is ineffective with regard to ulcer pain.

  15. One week's anti-Helicobacter pylori treatment for duodenal ulcer.

    PubMed Central

    Logan, R P; Gummett, P A; Misiewicz, J J; Karim, Q N; Walker, M M; Baron, J H

    1994-01-01

    This open study tested whether eradication of Helicobacter pylori (H pylori) heals duodenal ulcers as well as decreasing recurrence. H pylori was detected in patients with endoscopic duodenal ulcers by histology, CLO-test, culture, and 13C-urea breath test (13C-UBT). Tripotassium dicitrato bismuthate (120 mg) and amoxycillin (500 mg) each four times daily, were given for seven days, with 400 mg metronidazole five times a day on days 5-7. The 13C-UBT was repeated immediately after treatment and endoscopy repeated within 21 days. After treatment unhealed ulcers were reinspected one month later and healed ulcers followed up by 13C-UBT alone for 12 months. Of 45 patients, 44 were available for follow up. Mean pretreatment excess delta 13CO2 excretion was 25.6 per mil, which fell to 2.4 per mil immediately after finishing treatment, indicating clearance of H pylori in every patient. At the second endoscopy (median interval 20 days from start of treatment) 33 of 44 (75%) duodenal ulcers had healed. Ten of the remaining 11 duodenal ulcers were smaller and those 10 healed in the next two weeks with no further treatment. Two patients' ulcers that initially healed with clearance of H pylori recurred three weeks later (both had metronidazole resistant H pylori). H pylori was eradicated in 28 of 44 (64%) patients (13C-UBT negative for median follow up 10.2 months). Overall 41 of 43 (93%, 95% confidence intervals 81%-99%) duodenal ulcers were healed at one month. This study suggests that one week of anti-H pylori triple treatment is effective in healing duodenal ulcers. PMID:8307442

  16. [Treatment of chronic aphthous stomatitis combined with duodenal ulcer].

    PubMed

    Dudchenko, M A; Skrypnikova, T P; Dudchenko, M A

    2014-01-01

    It is currently proved ulcerous stomatitis and duodenal ulcer to have common pathogenetic infectious link (the most studied agent being Helicobacter pylori) by concominant decrease of local and general immunity with hyperoxidation events. Eighty patients (44 female and 36 male aged 15-60) with chronic aphthous stomatitis (AS) combined with duodenal ulcer were included in the study and divided in two equal groups according to treatment received (control group of 40 patients was treated according to conventional scheme, while in 40 patients a new formulation Vipromak was added to treatment protocol). The symptoms of AS tend to resolve faster in vipromak group thus proving its efficiency in treatment of AS and duodenal ulcer.

  17. Ghrelin accelerates the healing of cysteamine-induced duodenal ulcers in rats

    PubMed Central

    Warzecha, Zygmunt; Ceranowicz, Dagmara; Dembiński, Artur; Ceranowicz, Piotr; Cieszkowski, Jakub; Kuwahara, Atsukazu; Kato, Ikuo; Dembiński, Marcin; Konturek, Peter C.

    2012-01-01

    Summary Background Previous studies have shown that administration of ghrelin exhibits protective and therapeutic effects in the gut. The aim of the present investigation was to examine the influence of ghrelin administration on the course of cysteamine-induced duodenal ulcers, as well as effects on mucosal production of oxygen free radicals and duodenal antioxidant defense. Material/Methods Duodenal ulcers were induced in male Wistar rats by cysteamine administered intragastrically at the dose of 200 mg/kg in 1 ml of saline, 3 times at 4-h intervals. Starting 24 h after the first dose of cysteamine, rats were treated intraperitoneally twice a day with saline or ghrelin given at the dose of 4, 8 or 16 nmol/kg/dose. Seven days after administration of the first dose of cysteamine, the study was terminated. Results Induction of ulcers by cysteamine was accompanied by a reduction in duodenal blood flow, mucosal DNA synthesis and mucosal activity of superoxide dismutase (SOD); whereas mucosal concentration of interleukin-1β and malonyldialdehyde (MDA – an index of lipid peroxidation) were increased. Treatment with ghrelin increased healing rate of duodenal ulcers and enhanced duodenal blood flow, mucosal DNA synthesis and mucosal activity of SOD, and reduced mucosal concentration of interleukin-1β and MDA. Conclusions Treatment with ghrelin increases the healing rate of duodenal ulcers and this effect is related, at least in part, to improvement of duodenal mucosal blood flow, mucosal cell proliferation and antioxidant defense, as well as being related to reduction in mucosal oxidative stress and inflammatory response. PMID:22534700

  18. Perforated duodenal ulcer in a young child: an uncommon condition.

    PubMed

    Yadav, R P; Agrawal, C S; Gupta, R K; Rajbansi, S; Bajracharya, A; Adhikary, S

    2009-01-01

    Duodenal ulcer is an uncommonly diagnosed entity in children. H. pylori infection, blood group 'O' or secondary to medications like non steroidal anti-inflammatory drugs (NSAID) and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer.

  19. [Duodenal ulcers caused by chloroquine-proguanil association].

    PubMed

    Roux, X; Imbert, P; Rivière, F; Méchaï, F; Rapp, C

    2010-12-01

    Chloroquine-proguanil association is recommended for prophylaxis against falciparum malaria in countries with a low prevalence of chloroquine resistance. It is usually well tolerated with mild side effects consisting mainly of transient digestive discomfort and buccal manifestations (mouth sores or ulcers). The purpose of this report is to describe a case of duodenal ulcers presenting as epigastric pain with 10-kg weight-loss in a 32-year-old man taking chloroquine-proguanil for malaria prophylaxis during a stay in Haiti. No other causes of duodenal ulcers or weight-loss were found. Chloroquine-proguanil prophylaxis was discontinued and replaced by omeprazole for four weeks. Symptoms improved quickly and full recovery was observed within one month. To our knowledge, the occurrence of duodenal ulcers under chloroquine-proguanil association is quite rare, but possibly severe. Upper digestive endoscopy should be performed if a patient under chloroquine-proguanil develops abdominal pain especially in association with weight-loss. If endoscopy reveals duodenal ulcers, chloroquine-proguanil should be discontinued and replaced by another prophylactic regimen.

  20. A Bleeding Duodenal GIST Masquerading as Refractory Peptic Ulcer Disease

    PubMed Central

    Jones, Jason D.; Oh, Stephen; Clark, Clancy

    2016-01-01

    Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract; however, the occurrence of a GIST in the duodenum is rare. Our case demonstrates the importance of considering GIST in the evaluation of refractory duodenal ulcers, as well as the utilization of endoscopic ultrasound in the evaluation of these lesions. PMID:28119940

  1. Duodenal ulcer perforation: the effect of H2 antagonists?

    PubMed Central

    Gillen, P.; Ryan, W.; Peel, A. L.; Devlin, H. B.

    1986-01-01

    One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible. PMID:3789618

  2. Autoradiographic study on healing process of cysteamine-induced duodenal ulcer in rat. Possible importance of Brunner's glands in ulcer healing

    SciTech Connect

    Fuse, Y.; Tsuchihashi, Y.; Sugihara, H.; Kodama, T.; Takino, T.; Fujita, S.

    1988-09-01

    The healing process of cysteamine-induced duodenal ulcer was studied by (/sup 3/H)thymidine autoradiography. After the development of ulcer in the duodenum, cell proliferation was markedly activated not only in the crypts but also in the Brunner's glands near the ulcer. In the initial stages of ulcer healing, they both contributed to form the surface covering regenerating epithelium. Granulation tissue also proliferated at the base of the ulcer. In later stages of ulcer healing, new crypts were formed in the floor of the ulcer. New villi regenerated from these crypts and Brunner's glands regenerated by proliferation in situ. The ulcer base then was completely covered with new villi and granulation tissue was replaced by dense fibrous connective tissue. The present study suggested that the Brunner's glands, together with the crypts of Lieberkuehn, play an important role in the healing process of cysteamine-induced duodenal ulcer.

  3. Perforated duodenal ulcer: a rare complication of deferasirox in children.

    PubMed

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  4. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.

    PubMed

    Graham, David Y

    2014-05-14

    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

  5. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer

    PubMed Central

    Graham, David Y

    2014-01-01

    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease” or for “Sippy” diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori

  6. Formulation and Evaluation of Omeprazole Tablets for Duodenal Ulcer

    PubMed Central

    Choudhury, A.; Das, S.; Bahadur, S.; Saha, S.; Roy, A.

    2010-01-01

    Omeprazole pellets containing mucoadhesive tablets were developed by direct punch method. Three mucoadhesive polymers namely hydroxypropylemethylcellulose K4M, sodium carboxy methylcellulose, carbopol-934P and ethyl cellulose were used for preparation of tablets which intended for prolong action may be due to the attachment with intestinal mucosa for relief from active duodenal ulcer. Mucoadhesive tablets were coated with respective polymer and coated with Eudragit L100 to fabricate enteric coated tablets. The prepared tablets were evaluated for different physical parameters and dissolution study were performed in three dissolution mediums like 0.1N hydrochloric acid for 2h, pH 6.5 and pH 7.8 phosphate buffer solution for 12hr. Sodium carboxymethylcellulose showed above 95% release within 10 h where as carbopol-934P showed slow release about 88% to 92% over a period of 12 h. having excellent mucoadhesive strength but ethyl cellulose containing tablets showed less than 65% release. The release mechanism of all formulation was diffusion controlled confirmed from Higuchi’s plot. Thus, the present study concluded that, carbopol-934P containing mucoadhesive tablets of omeprazole pellets can be used for local action in the ulcer disease as well as for oral controlled release drug delivery. PMID:21218061

  7. [Cycloferon in treating duodenal ulcers in rats].

    PubMed

    Bul'on, V V; Khnychenko, L K; Sapronov, N S; Kuznetsova, N N; Anikin, V B; arinenko, R Iu; Kovalenko, A L; Alekseeva, L E

    2001-01-01

    The possibility of using cycloferon (interferon inductor) for a complex treatment (in combination with the main drug solcoseryl possessing pronounced therapeutic properties) of duodenum ulcers was experimentally studied in male rats. The experiments showed a considerable difference in the interferon status of animals with model duodenum ulcers treated with cycloferon, solcoseryl, their combination, and placebo (control). The healing effect of solcoseryl administered in combination with cycloferon exceeded that of each component administered separately.

  8. From cysteamine to MPTP: structure-activity studies with duodenal ulcerogens

    SciTech Connect

    Szabo, S.; Cho, C.H.

    1988-01-01

    Cysteamine is the first chemical identified that induces acute and chronic duodenal ulcers in rodents. Structure-activity studies with cysteamine, propionitrile and their derivatives, as well as with analogues of toluene, revealed numerous alkyl and aryl duodenal ulcerogens. Among these, one of the most interesting from an etiologic and pathogenetic point of view is the dopaminergic neurotoxin MPTP, which shows structural similarities with toluene. The chemically-induced duodenal ulcers are similar and localized on the anterior and posterior wall of the duodenal bulb. Both cysteamine and MPTP affect endogenous dopamine; MPTP is especially potent in depleting central dopamine and inducing lesions in the substantia nigra. MPTP given in high doses induces Parkinson's disease-like syndrome and gastric ulcers. Cysteamine and propionitrile also cause dyskinesia in large and multiple doses. The motility disorders and duodenal ulcers are abolished by dopamine agonists. Cysteamine and MPTP have been known to increase and decrease gastric acid secretion, respectively. However, both compounds induced duodenal dysmotility, decreased bicarbonate production, and reduced its delivery from distal to proximal duodenum. These factors decrease acid neutralization in the duodenal bulb and contribute to duodenal ulceration. Thus, studies with animal models may reveal endogenous mediators and specific receptors which might be involved in the pathogenesis of duodenal ulceration. Specific structure-activity studies in toxicology may lead to new insights in the pathogenesis and pharmacology of a poorly understood human disorder such as duodenal ulceration. 39 references.

  9. Inhibition of nocturnal acidity is important but not essential for duodenal ulcer healing.

    PubMed Central

    Bianchi Porro, G; Parente, F; Sangaletti, O

    1990-01-01

    We have determined the relative importance of day and night time gastric acid inhibition for duodenal ulcer healing by comparing the anti-ulcer efficacy of a single morning with that of a single bedtime dose of ranitidine. One hundred and thirty patients with active duodenal ulcer were randomly assigned to a double-blind therapy with ranitidine 300 mg at 8 am or the same dose at 10 pm for up to eight weeks. The antisecretory effects of these regimens were also assessed by 24 h intragastric pH monitoring in 18 of these patients. At four weeks ulcers had healed in 41/61 (67%) of patients taking the morning dose and in 47/63 (75%) of those receiving the nocturnal dose (95% CI for the difference -0.09 +0.25; p ns). At eight weeks, the corresponding healing rates were 82% and 85.5%, respectively (95% CI for the difference -0.11 +0.17; p ns). Both treatments were significantly superior to placebo in raising 24 h intragastric pH, although the effects of the morning dose were of shorter duration than those of the nocturnal dose. These findings suggest that suppression of nocturnal acidity is important but not essential to promote healing of duodenal ulcers; a prolonged period of acid inhibition during the day (as obtained with a single large morning dose of H2-blockers) may be equally effective. PMID:2186980

  10. [Vagotomy in emergency surgery for duodenal ulcer].

    PubMed

    Khalimov, E V; Sigal, Z M; Kapustin, B B

    2003-01-01

    We examined acid-producing stomach functions, local hemodynamics and motility of the stomach and duodenum in performing organ preservation surgery: combined gastric vagotomy, selective proximal vagotomy and extended selective proximal vagotomy. Changes of hemodynamics and motility in the early postoperative period are related to the technical peculiarities of performing various types of vagotomy. Restoration of the functional state of the stomach and duodenum takes place in the late postoperative period. The acid-producing function in the late postoperative period is reduced to the safe level concerning ulceration, irrespective of the vagotomy type.

  11. Effect of Pithecellobium dulce (Roxb.) Benth. fruit extract on cysteamine induced duodenal ulcer in rats.

    PubMed

    Megala, Jayaraman; Geetha, Arumugam

    2015-10-01

    The edible fruits of Pithecellobium dulce (Roxb.) Benth. are traditionally used for various gastric complications in India. Here, we investigated the antiulcer activity of hydroalcoholic fruit extract of P. dulce (HAEPD) by applying cysteamine induced duodenal ulcer model in rats. Duodenal ulcer was induced in male albino Wistar rats by oral administration of cysteamine @ 420 mg/kg body wt. as a single dose. The rats were pre-administered orally with HAEPD @ 200 mg/kg body wt. for 30 days prior to ulcer induction. Rats pre-administered with ranitidine @ 30 mg/kg body wt. served as reference drug control. Ulcer score, thiobarbituric acid reactive substances (TBARS), glycoproteins, superoxide dismutase, catalase and glutathione peroxidase and reduced glutathione levels were measured in the duodenum. Rats pre-administered with the HAEPD showed significantly reduced ulcer score comparable to that of ranitidine pretreated rats. The co-administration of HAEPD lowered the TBARS level and also restored the levels of glycoproteins, enzymatic and non-enzymatic antioxidants. Histopathological observations confirmed the presence of inflammation, necrosis and hemorrhagic spots in the duodenum of ulcer control rats which were significantly reduced due to HAEPD treatment. No abnormal alterations were observed in normal rats treated with HAEPD at the dosage studied. The results demonstrated antioxidant and cytoprotective nature of P. dulce, and thereby its significant anti ulcer property.

  12. [Rate of recurrence of duodenal ulcer in smokers and nonsmokers].

    PubMed

    Bretzke, G

    1988-07-15

    In 70 patients (35 non-smokers and smokers each) with an endoscopically established duodenal ulcer the number of recidivations was investigated. In this case in the group of smokers an inclination to recidivations was found which was nearly double the size. Patients with a great consumption of nicotine per day were particularly affected. Apart from this the question was investigated whether the form of the ulcer has any influence on the frequency of recidivations. No remarkable differences between the forms of ulcer round, irregular, oval and linear could be proved. The economic disadvantages by inability to work considerably differ in the two groups. The number of days at which was not worked on account of putting the patients on the sick-list is nearly thrice as great in the group of smokers.

  13. Placebo effect in the treatment of duodenal ulcer

    PubMed Central

    de Craen, Anton J M; Moerman, Daniel E; Heisterkamp, Simon H; Tytgat, Guido N J; Tijssen, Jan G P; Kleijnen, Jos

    1999-01-01

    Aims To assess whether frequency of placebo administration is associated with duodenal ulcer healing. Methods A systematic literature review of randomized clinical trials was undertaken. 79 of 80 trials that met the inclusion criteria. The pooled 4 week placebo healing rate of all duodenal ulcer trials that employed a four times a day regimen was compared with the rate obtained from trials with a twice a day regimen. Results The pooled 4 week healing rate of the 51 trials with a four times a day regimen was 44.2% (805 of 1821 patients) compared with 36.2% (545 of 1504 patients) in the 28 trials with a twice a day regimen (difference, 8.0% [equal effects model]; 95% confidence interval, 4.6% to 11.3%). Depending on the statistical analysis, the rate difference ranged from 6.0% (multivariable random effects model) to 8.0% (equal effects model). A number of sensitivity analyses showed comparable differences between the two regimens. Most of these sensitivity analyses were not significant, probably because a number of trials were excluded resulting in a loss of power. Conclusions We found a relation between frequency of placebo administration and healing of duodenal ulcer. We realize that the comparison was based on nonrandomized data. However, we speculate that the difference between regimens was induced by the difference in frequency of placebo administration. A better knowledge of various placebo effects is required in order to make clinically relevant assessments of treatment effects derived from placebo-controlled trials. PMID:10594490

  14. Different effect of antiulcer agents on rat cysteamine-induced duodenal ulcer after sialoadenectomy, but not gastrectomy.

    PubMed

    Bedekovic, Vlado; Mise, Stjepan; Anic, Tomislav; Staresinic, Mario; Gjurasin, Miroslav; Kopljar, Mario; Kalogjera, Livije; Drvis, Petar; Boban Blagaic, Alenka; Batelja, Lovorka; Seiwerth, Sven; Sikiric, Predrag

    2003-09-05

    The focus was on salivary glands in cysteamine-induced duodenal ulcer and the different effects of antiulcer agents on cysteamine-induced duodenal ulcer in sialoadenectomized but not gastrectomized rats. We tested antiulcer agents on cysteamine-induced duodenal ulcer in rats (agents/kg i.p.) simultaneously with cysteamine 400 mg/kg s.c., rat killed 24 h thereafter subjected to no surgery (normal), to gastrectomy (24 h before) or sialoadenectomy, acute (24 h before) or chronic (21 days before). (i) Ulcerogenesis: cysteamine-induced duodenal ulcer had the same severity and incidence in normal, gastrectomized or acutely or chronically sialoadenectomized rats. (ii) Antiulcer effect under normal conditions or following gastrectomy: in normal or gastrectomized rats all agents tested, gastric pentadecapeptide BPC 157 [currently in clinical trials for inflammatory bowel disease (PL-10, PLD-116, PL-14736, Pliva) (10.0 microg or 10.0 ng), ranitidine (10 mg), atropine (10 mg), omeprazole (10 mg)] inhibited cysteamine-induced duodenal ulcers, acting through gastric acid-independent mechanisms. Following sialoadenectomy, acute or chronic: ranitidine, omeprazole and atropine were completely ineffective, while pentadecapeptide BPC 157 could protect. Thus, we found that contrary to stomach, salivary glands are implicated in cytoprotective agent activity (standard agents were ineffective after sialoadenectomy). Also, gastric pentadecapeptide BPC 157 was consistently associated with a cytoprotective effect, suggesting a beneficial activity distinctive from that of H2-receptor blockers, proton-pump inhibitors and anticholinergics; but probably replacing missing salivary glands factors.

  15. Healing and recurrence of duodenal ulcer after treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine.

    PubMed

    Hamilton, I; O'Connor, H J; Wood, N C; Bradbury, I; Axon, A T

    1986-01-01

    Eighty patients with duodenal ulcer were randomly allocated to treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine. Ulcers healed in 78% of patients treated with TDB and in 74% treated with cimetidine, supporting previous observations that the efficacy of these two agents is similar. Duodenal ulcer recurred in 43% of patients in the 12 months after treatment with TDB and in 78% of patients treated with cimetidine, with a significantly greater incidence of recurrence 6-12 months after cimetidine treatment. Tripotassium dicitrato bismuthate tablets may be preferable to cimetidine in the initial management of duodenal ulcer, because they offer a smaller likelihood of recurrence in the 12 months after successful treatment.

  16. Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion.

    PubMed

    Garancini, Mattia; Luperto, Margherita; Delitala, Alberto; Maternini, Matteo; Uggeri, Franco

    2011-12-01

    Scopinaro's bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro's bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding. Hypovolemic shock indicated laparotomy and an intraoperative enteroscopy performed through a small enterotomy showed an ulcerative perforation sourced in an ischemic portion of a distended duodenal stump, with a bleeding branch of gastro-duodenal artery at the bottom. Hemorrhage was stopped with stitches. Two years later a new episode of duodenal bleeding associated with severe malnutrition occurred. A covered chronic ischemic perforation sustained by duodenal distension due to biliopancreatic limb sub-obstruction appeared to be the most probable etiology of the recurrent duodenal bleeding. The patient underwent again to laparotomy and adhesiolysis; hemorrhage was stopped by means of ligation of gastroduodenal artery and bilio-pancreatic diversion was converted into a standard Roux-en-Y gastroenterostomy with an entero-entero anastomosis 40 cm from the Treitz ligament in order to restore an anatomo-functional condition guaranteeing normal absorption and intestinal transit. After Scopinaro's bilio-pancreatic diversion duodenal bleeding can represent a rare serious presentation of biliopancreatic limb obstruction; because of the complex anatomical reconstruction performed during this intervention, the duodenum results unavailable during upper gastro-intestinal endoscopy, and if a duodenal bleeding is suspected laparotomy followed by enteroscopy represents an effective diagnostic approach.

  17. Acid secretion in Zulu and Indian patients with duodenal ulcers.

    PubMed

    Angorn, I B; Moshal, M G; Baker, L W

    1976-01-31

    Pentagastrin-stimulated maximal acid output (MAO) was measured in 337 male patients with duodenal ulcers, 209 of whom were Indian, and 128 of whom were Zulus. The mean MAO standard deviation (SD) value for Zulu patients with uncomplicated ulcers was 36,2 +/- 10,5 mEq/h. In the patients with complicated ulcers, the maximal acid output was 38,5 +/- 6,3 mEq/h in patients with pyloric stenosis, 31,5 +/- 13,7 mEq/h in patients with haemorrhage and 42,9 +/- 9,2 mEq/h in patients with perforation. A statistically significant difference was obtained only in the group with perforation (Pless than0.05). The mean MAO +/- SD value for Indian patients with uncomplicated ulcers was 29,2 +/- 17,0 mEq/h. In those with complicated ulcers, the MAO value in pyloric stenosis was 30,5 +/- 5,5 mEq/h in those with haemorrhage 22,0 +/- 13,7 mEq/h and for patients with perforation, 27,8 +/- 7,5 mEq/h. A statistically significant difference in values was not obtained in Indian patients. In the Zulu patients, 77,6% had MAO values above the upper limit of normal (mean + 2 SD), while in Indian patients only 17.6% had MAO values above the upper limit of normal. The difference between the 2 percentages is highly significant (Pless than0,0001). The proportion of male patients with stimulated acid secretion measurements above the upper limit of normal in other reported series is 30-50%.

  18. Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child.

    PubMed

    Lee, Na Mi; Yun, Sin Weon; Chae, Soo Ahn; Yoo, Byoung Hoon; Cha, Seong Jae; Kwak, Byung Kook

    2009-10-14

    Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.

  19. Tripotassium dicitrato-bismuthate tablets v liquid in the treatment of duodenal ulcers.

    PubMed

    Lane, M; Lee, S; Tasman-Jones, C; Nicholson, G

    1985-03-27

    Thirty-five patients with duodenal ulcers were treated with tripotassium dicitrato-bismuthate (TDB) in a double-blind, double-dummy endoscopically controlled trial. Healing rates were comparable in patients treated with either tablet or liquid, 74% and 72% at four weeks and 89% in both groups at eight weeks. It is concluded that the tablet formulation of TDB is as effective as the liquid in the treatment of acute duodenal ulceration.

  20. Effect of tyrosine administration on duodenal ulcer induced by cysteamine in the rat

    SciTech Connect

    Oishi, T.; Szabo, S.

    1987-03-01

    Duodenal ulcers were produced by administering cysteamine to rats. Pretreatment with the catecholamine precursor, L-tyrosine (40 mg/100 g i.p. for 5 days), decreased the intensity of duodenal ulcers induced by cysteamine. Equimolar doses of tyrosine methyl ester (51.2 mg/100 g i.p. or s.c.) were equally effective in reducing ulcer intensity. Other amino acids (i.e., alanine, aspartic acid, glutamic acid, glycine, leucine, lysine, tryptophan and valine) did not prevent experimental duodenal ulcers. Coadministration of other large neutral amino acids (e.g., leucine and valine) that compete with tyrosine for uptake into the brain did not inhibit the effect of tyrosine on duodenal ulcers induced by cysteamine. Gastric, duodenal and brain dopamine concentrations were increased 1 hr after the injection of tyrosine methyl ester (25.6 mg/100 g s.c.). These results suggest that the effect of tyrosine on duodenal ulcer induced by cysteamine may be mediated by changes in gastrointestinal dopamine metabolism.

  1. Effect of sucralfate on gastric emptying in duodenal ulcer patients

    SciTech Connect

    Petersen, J.M.; Caride, V.J.; Prokop, E.K.; Troncale, F.; McCallum, R.W.

    1985-05-01

    Duodenal ulcer (DU) patients may have accelerated gastric emptying (GE) suggesting that there is an increase in unbuffered gastric acid reaching the duodenum contributing to DU disease. Aluminum-containing antacids were shown to delay GE. The authors' aim was to investigate whether another aluminum-containing compound, Sucralfate, affects GE in normal and DU patients. Nine normal volunteers and 10 patients with documented DU disease were studied. For each test the subject ingested a meal composed of chicken liver Tc-99m-S-C mixed with beef stew and eaten with 4 oz. of water labelled with 100..mu..Ci of III-in-DTPA. On two separate days, subjects received 1 gram of Sucralfate (190 mg of aluminum per gram) or placebo in a randomized double-blind fashion one hour prior to the test meal. GE of liquids and solids in normal subjects was not significantly changed by Sucralfate. Sucralfate in the DU patients significantly slowed liquid emptying in the initial 40 min and solid food throughout the study compared to placebo (p<0.05). This paper summarizes that; GE of solids but not liquids is accelerated in DU patients compared to normal subjects; and sucralfate delays GE of both liquid and solid components of a meal in DU patients but has no effect on GE in normals. The authors conclude that a slowing of gastric emptying possibly mediated by aluminum ions, may be one mechanism by which Sucralfate enhances healing and decreases recurrence of DU.

  2. [Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helicobacter pylori].

    PubMed

    Khayat, Olfa; Kilani, Afef; Chedly-Debbiche, Achraf; Zeddini, Abdelfattah; Gargouri, Dalila; Kharrat, Jamel; Souissi, Adnene; Ghorbel, Abdel Jabbar; Ben Ayed, Mohamed; Ben Khelifa, Habib

    2006-06-01

    It's a prospective study leaded between September 1997 and july 1999 (23 months ) in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one month later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realised. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomisation in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concering activity 80%, intestinal metaplasia 12%. inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus (p<0.005). After treatment, a significative fall of Helicobacter pylori and activity and atrophy was established, contrarity to intestinal metaplasia and chronic inflammation witch are persisted. The prevalence of follicular gastritis was 57%. The better rate of ulcer cicatrisation and Helicobacter pylori eradication was respectively of 79% and 66% in group 1 treated by omeprazol, amoxcillin, metronidazol by comparison with the others 3 groups (p<0.005).

  3. Somatostatin depletion by cysteamine: mechanism and implication for duodenal ulceration

    SciTech Connect

    Szabo, S.; Reichlin, S.

    1985-06-01

    Cysteamine (CSH) and its close derivatives deplete immunoreactive somatostatin (SS) in rat organs. The effect of CSH is dose and time dependent and reversible. Structural requirements of the analogs are the presence of either -SH or -NH2 on a two- or three-carbon alkyl molecule; both radicals together increase, whereas insertion of carboxyl abolishes potency. The duodenal ulcerogenic potency of CSH derivatives is correlated significantly with their SS-depleting activity in the gastric mucosa. The mechanism of this action of CSH is poorly understood, but it is not caused by increased release, enhanced degradation of the peptide, or selective necrosis of SS cells. It is likely that in the intracellular environment CSH causes a conformational change in the peptide that affects the antigenic and functional properties of SS.

  4. Increased healing of gastric and duodenal ulcers in a controlled trial using tripotassium dicitrato-bismuthate.

    PubMed

    Lee, S P; Nicholson, G I

    1977-05-28

    Thirty-seven outpatients with benign gastric ulcers proved by endoscopy were randomized and treated with tripotassium dicitrato-bismuthate (TDB) and a placebo for four weeks. They were assessed on the basis of symptoms and endoscopy examination. Ulcer healing observed by endoscopy was significantly better in the TDB treated group (18 of 20) than in the placebo treated group (six of 17). There was no statistical difference in symptomatic improvement. Nineteen patients with duodenal ulcers proved by endoscopy were randomized in a double-blind trial and given TDB and a placebo for four weeks. Ulcer healing in the TDB treated group (eight of nine) was significantly better than in the placebo treated group (two of 10). No significant difference was found in the symptomatic improvement of both groups. It is concluded that TDB is an effective agent for the treatment of chronic gastric and duodenal ulcers.

  5. [Sulglycotide combined with H2-antagonists in the prevention of duodenal ulcer recurrence. Multicenter study].

    PubMed

    Ciaco, A; Papi, C; Capurso, L

    1992-01-01

    The aim of the present study was to evaluate the role of sulglycotide, a molecule with gastroprotective properties, in monotherapy and in association with H2-antagonists in the maintenance treatment of duodenal ulcer. The study was performed using a fully randomized experimental design. Following endoscopic confirmation, 626 patients with healed duodenal ulcer were treated for 6 months with sulglycotide 200 mg tid (293 patients) or sulglycotide + H2-antagonists (333 patients). After 2, 4 and 6 months patients underwent a clinical control whereas an endoscopic control was performed after 6 months. The cumulative percentage of recidivation was 3.6% in the sulglycotide + H2-antagonist treated group, whereas the group treated with sulglycotide alone showed a recidivation rate of 15.4% (p < 0.001). These findings suggest the utility of combined sulglycotide and H2-antagonist treatment in the maintenance therapy for duodenal ulcer.

  6. A Case of Acute Ischemic Duodenal Ulcer Associated with Superior Mesenteric Artery Dissection After Transarterial Chemoembolization for Hepatocellular Carcinoma

    SciTech Connect

    Jang, Eun Sun; Jeong, Sook-Hyang Kim, Jin Wook; Lee, Sang Hyub; Yoon, Chang Jin; Kang, Sung Gwon

    2009-03-15

    We report a case of transarterial chemoembolization (TACE)-related acute ischemic duodenal ulcer that developed in association with dissection of the superior mesenteric artery. We conclude that the acute duodenal ulcer was developed by ischemia related to superior mesenteric artery dissection during TACE. TACE should be conducted carefully with continuous observation of abdominal arteries.

  7. Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report

    PubMed Central

    Amouei, Abdolhamid; Ehsani, Fatemeh; Tabatabaei, Seyed Mostafa; Ghodratipour, Zahra

    2016-01-01

    Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality. PMID:28050434

  8. Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate.

    PubMed

    Martin, D F; Hollanders, D; May, S J; Ravenscroft, M M; Tweedle, D E; Miller, J P

    1981-01-03

    In a double-blind randomised trial in 75 patients with duodenal ulceration diagnosed endoscopically, 38 patients were given tripotassium dicitrato bismuthate and 37 cimetidine. There was no significant difference in the healing rates between the two drugs after 1 and 2 months, although relief of symptoms was marginally quicker with cimetidine. During follow-up for at least a year, relapse was significantly more common in patients whose ulcers had healed during treatment with cimetidine than in those whose ulcers had healed during treatment with tripotassium dicitrato bismuthate. This difference appears to be related to the medication rather than to any other difference between the two groups of patients. These results suggest that drug treatment given for a short period in duodenal-ulcer disease influences the progress of the disease.

  9. Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report.

    PubMed

    Amouei, Abdolhamid; Ehsani, Fatemeh; Zarch, Mojtaba Babaei; Tabatabaei, Seyed Mostafa; Ghodratipour, Zahra

    2016-11-01

    Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality.

  10. Management of duodenal ulcer bleeding resistant to endoscopy: Surgery is dead!

    PubMed Central

    Loffroy, Romaric

    2013-01-01

    Acute massive duodenal bleeding is one of the most frequent complications of peptic ulcer disease. Endoscopy is the first-line method for diagnosing and treating actively bleeding peptic ulcers because its success rate is high. Of the small group of patients whose bleeding fails to respond to endoscopic therapy, increasingly the majority is referred for embolotherapy. Indeed, advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage from peptic ulcers over the past decade. Embolization may be effective for even the most gravely ill patients for whom surgery is not a viable option, even when extravasation is not visualized by angiography. However, it seems that careful selection of the embolic agents according to the bleeding vessel may play a role in a successful outcome. The role of the surgeon in this clinical sphere is dramatically diminishing and will certainly continue to diminish in ensuing years, surgery being typically reserved for patients whose bleeding failed to respond all previous treatments. Such a setting has become extremely rare. PMID:23467545

  11. Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

    PubMed Central

    Fam, Maged Nassef Abdalla; Attia, Khaled Mostafa Elgharib; Khalil, Safaa Maged Fathelbab

    2014-01-01

    Gas within the portal circulation has been known to be associated with a number of conditions most commonly mesenteric ischemia and necrosis. Systemic venous gas is described with few conditions and is mostly iatrogenic in nature. We describe a case of combined portal and systemic venous gas detected by computed tomography in a patient with perforated duodenal ulcer. PMID:25426236

  12. Omeprazole versus famotidine in the healing and relapse of duodenal ulcer.

    PubMed

    Misra, S C; Dasarathy, S; Sharma, M P

    1993-08-01

    Sixty patients with symptomatic duodenal ulcer were randomized to receive either omeprazole (20 mg each morning) or famotidine (40 mg at night time) for 2-4 weeks in a double-blind parallel group clinical trial. Healing rates were higher with omeprazole in comparison with famotidine after 2 weeks (77% vs. 40%, P < 0.001) and 4 weeks (93% vs. 80%, P = 0.2) of treatment. Assessment of daily diary cards completed by all patients revealed that omeprazole rapidly relieved ulcer-related day pain and nocturnal pain in comparison to famotidine. Treatment with omeprazole for 2 weeks was also associated with lower cumulative antacid intake (P < 0.05) and reduced absenteeism from work. Helicobacter pylori infection was present in all patients and remained unaffected by treatment with either of the drugs. None of the drugs produced any significant adverse effects. During 6 months follow-up of all the patients after ulcer healing (without maintenance therapy), ulcer relapse was seen in 40% of omeprazole- and 37% of famotidine-treated patients (P > 0.1). The duration of ulcer-free period following initial healing of ulcer was also similar in both the groups (median time: 22 weeks for omeprazole, 21 weeks for famotidine). We conclude that omeprazole is superior to famotidine in rapidly healing duodenal ulcers and achieving more rapid pain relief, but does not influence subsequent ulcer relapse.

  13. The effect of tri-potassium di-citrato bismuthate on the duodenal mucosa during ulceration. An ultrastructural study.

    PubMed

    Gregory, M A; Moshal, M G; Spitaels, J M

    1982-07-10

    The manner in which tri-potassium di-citrato bismuthate (TDB) promotes duodenal ulcer healing is not known. Endoscopic biopsy specimens were taken from the edges of duodenal ulcers from 5 patients before and after treatment with TDB. Using the bismuth contained within this drug as an electron-dense marker, the mode of action of TDB was determined by transmission electron microscopy. TDB was found to promote ulcer healing by adhering to the ulcerative mucosa, thereby providing an effective barrier to the substances which cause and maintain ulceration.

  14. Comparison of cimetidine and tripotassium dicitrato bismuthate in healing and relapse of duodenal ulcers.

    PubMed

    Shreeve, D R; Klass, H J; Jones, P E

    1983-01-01

    A comparison between cimetidine and tripotassium dicitrato bismuthate liquid (TDB) in the treatment of endoscopically diagnosed duodenal ulcer by single-blind randomized trial in 48 patients has shown 18 (75%) out of 24 patients receiving TDB and 13 (54%) out of 24 patients receiving cimetidine healed after 4 weeks' therapy. Symptomatic improvement within 1 month was seen in 19 patients on TDB and 18 patients on cimetidine, but did not only occur in patients whose ulcers healed. On follow-up, endoscopically proven relapse occurred within 1 year in 47% of patients whose ulcers had healed during treatment with TDB in comparison with 60% of those healing on cimetidine.

  15. Twice daily tripotassium dicitrato bismuthate in the treatment of duodenal ulceration.

    PubMed

    Hollanders, D

    1986-01-01

    Fifty three patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of tripotassium dicitrato bismuthate (TDB) at standard dosage administered either twice or four times daily. No statistically significant difference has been found to exist between ulcer healing in the two groups at 4 weeks (72% and 67%, P = 0.944) or at 8 weeks (92% and 81%, P = 0.504) and it is concluded that twice daily TDB maintains the effectiveness of the drug and has advantages for patient compliance.

  16. Effects of tripotassium dicitrato bismuthate (TDB) tablets or cimetidine in the treatment of duodenal ulcer.

    PubMed

    Hamilton, I; Worsley, B W; O'Connor, H J; Axon, A T

    1983-12-01

    Forty patients with duodenal ulcer were randomly allocated to treatment with either tripotassium dicitrato bismuthate tablets or cimetidine for six weeks. Endoscopically confirmed healing of the ulcer occurred in 80% treated with tripotassium dicitrato bismuthate tablets and in 85% treated with cimetidine. Symptomatic improvement was also similar in the two groups. Treatment with cimetidine was associated with an increase in pH of gastric aspirate during treatment and increased numbers of bacteria were isolated from the gastric aspirate during treatment, while the pH and bacterial flora of gastric aspirate did not change during tripotassium dicitrato bismuthate treatment. Serum and urinary bismuth levels rose during treatment with tripotassium dicitrato bismuthate and urinary excretion remained raised two weeks after cessation of treatment. Tripotassium dicitrato bismuthate tablets appear to be as effective as cimetidine in the treatment of duodenal ulcer without the potentially undesirable effects of a reduction in gastric acid secretion.

  17. [Surgical treatment of bleeding duodenal ulcer in elderly and senile patients with intraoperative verification of the diagnosis].

    PubMed

    Ivashchuk, O I

    2000-01-01

    The method of duodenotomy performance for duodenal ulcer with hemorrhage was proposed. Duodenum was dissected longitudinally across the ampulla lower edge going all over medial edge of pars descendens, permitting not only doing the revision but revealing the hemorrhage source, securing homeostasis. The rules of local hemostasis performance were elaborated. Application of the above mentioned access prevents damage of nervi vagi duodenal anterior brunch, guaranteeing the duodenal motor-evacuation function preservation.

  18. How diet and lifestyle affect duodenal ulcers. Review of the evidence.

    PubMed Central

    Ryan-Harshman, Milly; Aldoori, Walid

    2004-01-01

    OBJECTIVE: To demonstrate the role of diet in reducing or aggravating risk of duodenal ulcer (DU). QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 2001 for articles on the relationship between diet and lifestyle and DU using the key words duodenal ulcer and diet, fibre, or lifestyle. Evidence that these factors are associated with DU arose mainly from three case-control and three prospective studies (level II evidence) and from expert opinion (level III evidence). MAIN MESSAGE: A high-fibre diet appears to reduce risk of DU; soluble fibre might be associated with reduced risk also. Vitamin A intake is associated with lower risk of DU. Little evidence indicates that fat, type of fat, protein intake, or consumption of alcohol or caffeine affect the etiology of DU. CONCLUSION: A high-fibre diet, particularly if the fibre comes from fruit and vegetables, could reduce risk of DU; vitamin A might also be beneficial. PMID:15171675

  19. [Cimetidine and tripotassium-dicitrato bismuthate (Duosol) in chronic duodenal ulcer].

    PubMed

    Bergoz, R

    1985-07-20

    In an open study, 40 patients with duodenal ulcer of several years' standing were treated for relapse with either TDB (De-Nol) or cimetidine. No difference in the relapse rate was observed during the subsequent 12 months. Analysis of the data in relation to smoking habits did, however, reveal an advantage (p less than 0.05) for non-smokers during the first 6 months.

  20. Biochemical changes in tissue catecholamines and serotonin in duodenal ulceration caused by cysteamine or propionitrile in the rat

    SciTech Connect

    Szabo, S.; Horner, H.C.; Maull, H.; Schnoor, J.; Chiueh, C.C.; Palkovits, M.

    1987-03-01

    Previous structure-activity and pharmacologic studies with duodenal ulcerogens cysteamine and propionitrile implicating catecholamines in the pathogenesis of duodenal ulceration have now been followed up by dose- and time-response biochemical investigations to assess the importance of monoamines in the development of duodenal ulcers. The concentrations of norepinephrine (noradrenaline), dopamine, serotonin and their metabolites were measured in total brain, brain regions, stomach, duodenum, pancreas and adrenals in the rat. Turnover of catecholamines was determined in rats pretreated with the inhibitor of tyrosine hydroxylase alpha-methyl-p-tyrosine. The duodenal ulcerogens caused a dose- and time-dependent depletion of norepinephrine in virtually all the tissues examined. The effect was maximal 4 or 7 hr after cysteamine or propionitrile, and norepinephrine levels returned to normal in 24 hr. Dopamine changes were selective and often biphasic, e.g., elevation in adrenals, biphasic in brain cortex, hippocampus and midbrain, but uniformly decreasing in glandular stomach and duodenum. In the median eminence dopamine levels decreased by 181 and 324% at 15 and 30 min, respectively, after cysteamine, but neither dopamine nor 3,4-dihydroxyphenylacetic acid was modified in the periventricular nucleus. Serotonin levels were relatively stable, revealing slight elevations or no changes in most of the tissues. The turnover of norepinephrine was accelerated by both chemicals in virtually all brain regions, but dopamine turnover was affected only in a few areas, e.g., in the corpus striatum and medulla oblongata cysteamine decreased dopamine turnover, whereas propionitrile first (at 1 hr) accelerated then (at 8 hr) significantly suppressed it.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Randomised crossover trial of tripotassium dicitrato bismuthate versus high dose cimetidine for duodenal ulcers resistant to standard dose of cimetidine.

    PubMed

    Lam, S K; Lee, N W; Koo, J; Hui, W M; Fok, K H; Ng, M

    1984-07-01

    Of 212 patients with duodenal ulcer treated with four weeks of one gram daily cimetidine, 25 had ulcers which underwent no reduction in size despite treatment. The effects of tripotassium dicitrato bismuthate (TDB) tablet four times a day or cimetidine 1.6 g daily on the healing of these cimetidine resistant ulcers were compared in a randomised crossover trial. Ten of 12 patients on tripotassium dicitrato bismuthate and five of 13 patients on high dose cimetidine had complete healing (p less than 0.02). On crossing over, seven of the eight ulcers not healed by high dose cimetidine completely healed with TDB in another four weeks, and one of the two ulcers not healed by TDB healed with high dose cimetidine. Overall, TDB healed 85% of cimetidine resistant ulcers, whereas high dose cimetidine healed 40% (p less than 0.006). Tripotassium dicitrato bismuthate is recommended for cimetidine resistant duodenal ulcers.

  2. Effect of dopamine-related drugs on duodenal ulcer induced by cysteamine or propionitrile: prevention and aggravation may not be mediated by gastrointestinal secretory changes in the rat

    SciTech Connect

    Gallagher, G.; Brown, A.; Szabo, S.

    1987-03-01

    Dose- and time-response studies have been performed with dopamine agonists and antagonists using the cysteamine and propionitrile duodenal ulcer models in the rat. The experiments demonstrate that the chemically induced duodenal ulcer is prevented by bromocriptine, lergotrile and reduced by apomorphine or L-dopa. Aggravation of cysteamine-induced duodenal ulcer was seen especially after (-)-butaclamol, (-)-sulpiride, haloperidol and, less effectively, after other dopaminergic antagonists. The duodenal antiulcerogenic action of dopamine agonists was more prominent after chronic administration than after a single dose, whereas the opposite was found concerning the proulcerogenic effect of dopamine antagonists. In the chronic gastric fistula rat, both the antiulcerogens bromocriptine or lergotrile and the proulcerogens haloperidol, pimozide or (-)-N-(2-chlorethyl)-norapomorphine decreased the cysteamine- or propionitrile-induced gastric secretion. No correlation was apparent between the influence of these drugs on duodenal ulcer development and gastric and duodenal (pancreatic/biliary) secretions. In the chronic duodenal fistula rat, decreased acid content was measured in the proximal duodenum after haloperidol, and diminished duodenal pepsin exposure was recorded after bromocriptine. Furthermore, the aggravation by dopamine antagonists of experimental duodenal ulcer probably involves a peripheral component. The site of dopamine receptors and physiologic effects which modulate experimental duodenal ulcer remain to be identified, but their elucidation may prove to be an important element in the pathogenesis and treatment of duodenal ulcer.

  3. Double-blind trial of cimetidine versus tri-potassium di-citrato bismuthate in chronic duodenal ulceration.

    PubMed

    Ward, M; Pollard, E J; Cowen, A

    1981-04-04

    Thirty-seven patients with chronic duodenal ulceration were entered into an endoscopically controlled trial of cimetidine (Tagamet) versus tri-potassium di-citrato bismuthate (De-Nol). At six weeks, 83% of patients taking cimetidine showed complete ulcer healing compared with 74% of patients taking tri-potassium di-citrato bismuthate. By ten weeks, the corresponding figures were 89% and 84% respectively. Symptomatic relief was similar in both treatment groups and, despite advice to the contrary, continued smoking and alcohol consumption did not appear to adversely affect healing. Both drugs appear to be equally effective in healing chronic duodenal ulcers.

  4. Famotidine in the short and long-term treatment of duodenal ulcer.

    PubMed

    Zaterka, S; de Paula Castro, L; Villalobos, J J; Massuda, H K; Eisig, J N; Dias Avelar, C; Coelho, L G; Bettarello, A

    1988-01-01

    Famotidine was compared to ranitidine in a short-term study on the treatment of duodenal ulcer. Famotidine 20 mg. b.i.d., 40 mg. b.i.d. and 40 mg. nocte heal as many ulcer as ranitidine (90.9%, 91.7%, 83.3% and 100% respectively). A single 20 mg. bedtime dose shows to be effective on preventing ulcer recurrence for as long as 48 weeks; the 38% recurrence rate observed with famotidine was statistically different from the 78% observed with placebo. Diarrhoea was the most common complain observed during the short-term trial, followed by sleepiness and headache. The few and small biochemical alterations during the long-term treatment (increase in transaminases, alkaline phosphatase, glucose, BUN) could in no instance be directly related to the substances on use.

  5. Paroxysmal nocturnal hemoglobinuria associated with venous thrombosis and papillary endothelial hyperplasia presenting as ulcerated duodenal mass.

    PubMed

    Dunphy, C H; Sotelo-Avila, C; Luisiri, A; Chu, J Y

    1994-08-01

    Paroxysmal nocturnal hemoglobinuria is an acquired clonal expansion of bone marrow stem cells that are deficient in the decay-accelerating factor, which is a complement regulatory glycoprotein (CD55), as well as in the membrane inhibitor of reactive lysis (CD59) and the C8-binding protein. These proteins are deficient on the membranes of red blood cells, granulocytes, monocytes, and platelets. The disorder is associated with intermittent hemolytic anemia, hemoglobinuria, infection, a tendency toward bone marrow aplasia, and venous thromboses. The thromboses, on resolution, may give rise to endothelial proliferation that may cause ischemia and ulceration, or, alternatively, the thromboses may cause ulceration leading to a granulation tissue response with exaggerated endothelial proliferation. We report a second case of paroxysmal nocturnal hemoglobinuria that presented roentgenographically as an ulcerated circumferential duodenal mass secondary to venous thrombosis accompanied by florid papillary endothelial hyperplasia. We also review the literature concerning this phenomenon.

  6. The prevalence of Helicobacter pylori infection in patients with gastric and duodenal ulcers – a 10-year, single-centre experience

    PubMed Central

    Tankurt, Ethem; Şarkış, Cihat; Simsek, Ilkay

    2015-01-01

    Introduction Helicobacter pylori (H. pylori) occurs throughout the world and causes gastroduodenal diseases. There is data indicating a change in the prevalence of H. pylori infection worldwide. The prevalence of H. pylori is 80% in Turkey, while it is higher in many developing countries, and the rate of infection varies throughout the world. In many developing countries, the prevalence of infection exceeds 90% by adulthood. Aim To determine the change in the rate of H. pylori infection in gastric ulcers and duodenal ulcers for a 10-year period in a single centre. Material and methods The study population included 550 patients (342 in 2004, 208 in 1994) with gastric and duodenal ulcers. Results In 2004 there were 125 (36.5%) patients with gastric ulcer and 217 patients with duodenal ulcer (64.5%). CLO test positivity was 39.2% in patients with gastric ulcers and 60% in patients with duodenal ulcers. In 1994 there were 208 patients (159 duodenal ulcers, 49 gastric ulcers). Urease test was positive in 74.2% of patients with duodenal ulcer and in 65.2% of patients with gastric ulcer. The decrease in the rate of urease positivity in patients with gastric ulcer was statistically significant (p = 0.01) during this 10-year period. Conclusions In the present study we found that the urease positivity decreased significantly in patients with gastric ulcer between 1994 and 2004. PMID:26516382

  7. A comparison of unrefined wheat and rice diets in the management of duodenal ulcer.

    PubMed Central

    Malhotra, S. L.

    1978-01-01

    Twenty-one chronic duodenal ulcer patients in a rice-eating area were put on to an unrefined wheat diet and twenty-one continued on their previous rice diet. After 5 years only 14% of the first group had had relapses compared with 81% of the second group. A similar 5-year relapse rate (80%) was obtained in a group of thirty patients from another area with a more varied rice diet. The author attributes this difference to the increased mastication required by the unrefined wheat diet, which is associated with an increase in saliva, lower stomach acidity and reduced bile output. PMID:625462

  8. The presence of dupA in Helicobacter pylori is not significantly associated with duodenal ulceration in Belgium, South Africa, China, or North America.

    PubMed

    Argent, Richard H; Burette, Alain; Miendje Deyi, Véronique Y; Atherton, John C

    2007-11-01

    A previous study suggested that Helicobacter pylori strains possessing dupA are positively associated with duodenal ulceration and negatively associated with gastric adenocarcinoma. We determined the prevalence of dupA in H. pylori strains recovered from 4 independent populations and found a significant association with gastric cancer but not with duodenal ulceration.

  9. [Endorphin-containing cells in the gastric antral mucosa in duodenal ulcer].

    PubMed

    Zverkov, I V; Vinogradov, V A; Smagin, V G

    1983-10-01

    Immunohistochemical staining with the use of peroxidase-antiperoxidase was applied to study cells producing gamma- and alpha-endorphines in the gastric antral mucosa in duodenal ulcer. The cells producing gamma-endorphines were discovered to be mainly located in the epithelium of the cervical and upper third of the pyloric glands and to be alike G-cells producing gastrin. The cells producing alpha-endorphine were found both in the epithelium of the upper third of the gastric pyloric glands and in the gastric mucosa lamina proper. In peptic ulcer, there was an almost two-fold increase in the amount of gamma-endorphine-producing cells and diminution of epithelial endocrine cells producing alpha-endorphine.

  10. A Non-invasive 24 Hours Stabilization of Duodenal Ulcer Perforation by a Combination Regimen

    PubMed Central

    Zil-E-Ali, Ahsan; Bin Shafique, Muhammad; Ali, Hammad; Ghani, Usman

    2016-01-01

    Surgical repair of perforated gastroduodenal ulcer has been extensively practiced in emergency clinical situations. Non-invasive conservation treatment is regaining the attention towards management of such ulcers. We report the case of a 50-year-old male smoker who presented in the emergency unit with acute generalized abdominal pain and guarding in the epigastric and right upper quadrant region. He is a known regular user of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) for more than 10 years for his osteoarthiritis and myalgias. A differential diagnosis of gastritis and duodenal perforation was made owing to the symptoms and long usage of NSAIDs. He was managed with an intravenous proton pump inhibitor and intravenous antibiotics. This therapy lead to stabilization of the clinical symptoms as well as laboratory and imaging studies. PMID:28083452

  11. Management of necrotising appendicitis associated with widespread necrotising enterocolitis of the small and large bowel and perforated duodenal ulcer.

    PubMed

    Gupta, Vaibhav; Zani, Augusto; Jackson, Paul; Singh, Shailinder

    2015-06-08

    A 7-year-old boy presented in septic shock secondary to appendicitis with generalised peritonitis. Following crystalloid resuscitation, he underwent surgery. Faecopurulent contamination and free air were found. This was secondary to a perforated and gangrenous appendix, multiple large and small bowel segments with perforations, patches of necrosis, interspersed with healthy bowel and segments of questionable viability. There was also a perforated duodenal ulcer. Necrotic segments were resected using a 'clip-and-drop' technique to shorten operative duration and guide resection to preserve bowel length. After six laparotomies and multiple bowel resections, the child was discharged home with an ileostomy that was subsequently reversed. He is currently on a normal diet and pursuing all activities appropriate for his age. Perforated appendicitis can be associated with widespread bowel necrosis and multiple perforations. A conservative damage limitation approach using the 'clip-and-drop' technique and relook laparotomies is useful in the management of extensive bowel necrosis in children.

  12. Omeprazole-amoxycillin therapy for eradication of Helicobacter pylori in duodenal ulcer bleeding: preliminary results of a pilot study.

    PubMed

    Jaspersen, D; Körner, T; Schorr, W; Brennenstuhl, M; Hammar, C H

    1995-06-01

    Thirty-five patients with duodenal ulcer bleeding and Helicobacter pylori-colonization were assigned to receive 2 x 20 mg omeprazole and 3 x 750 mg amoxycillin daily for 2 weeks. Eradication was defined as no evidence of H. pylori infection by urease test and by histology 4 weeks after completion of therapy. Two patients were lost to follow up. All ulcers healed completely (100% ulcer healing rate). Twenty-nine out of the 33 patients were H. pylori-negative (87.9% eradication rate). Three patients complained of typical side effects of amoxycillin (9.1% side effect rate). The patients were prospectively followed for 12 months. After ulcer healing, no maintenance therapy was given. One of the 29 patients in whom H. pylori eradication had been successful suffered a second ulcer hemorrhage with H. pylori reinfection (3.4% relapse rate of ulcer bleeding), and this was managed endoscopically. Recurrent ulcer hemorrhage occurred in 2 out of 4 H. pylori-resistant patients. At the end of the follow-up period, of the patients in whom H. pylori eradication had been initially successful, only the patient with re-bleeding remained reinfected. The 4 H. pylori-resistant patients showed persistent H. pylori colonization. In conclusion, omeprazole plus amoxycillin is a safe and effective treatment for eradicating H. pylori; this treatment reduces the relapse rate of duodenal ulcer bleeding.

  13. homB status of Helicobacter pylori as a novel marker to distinguish gastric cancer from duodenal ulcer.

    PubMed

    Jung, Sung Woo; Sugimoto, Mitsushige; Graham, David Y; Yamaoka, Yoshio

    2009-10-01

    The hom family of Helicobacter pylori outer-membrane proteins, especially the homB gene, has been suggested as a novel virulence factor; however, the clinical association and function of this gene are still unclear. We evaluated the presence of the homA, homB, and cagA genes in 286 strains isolated from patients in the U.S. and Colombian populations (126 with gastritis, 96 with duodenal ulcer, and 64 with gastric cancer) by PCR. The results were compared with the clinical presentation and gastric injury. The prevalence of the homB gene was significantly higher in strains isolated from gastric-cancer patients (71.9%) than in those from duodenal ulcer patients (52.1%) (P = 0.012). In a multivariate analysis, the presence of the cagA gene significantly increased the risk for developing gastric cancer and duodenal ulcer, with the presence of the homB gene acting as a factor that could distinguish gastric cancer from duodenal ulcer (adjusted odds ratio, 3.033; 95% confidence interval, approximately 1.37 to approximately 6.73). cagA status was correlated with homB status (r = 0.323; P < 0.01). A histological analysis showed that cagA status was associated with inflammation and atrophy both in the antrum and in the corpus, while homB status was associated with inflammation and atrophy in the corpus. homB gene status might be susceptible to gastric-cancer development such that the homB gene is used as a factor for discriminating the risk of gastric cancer from that of duodenal ulcer.

  14. Tripotassium dicitrato bismuthate (TDB) versus two different dosages of cimetidine in the treatment of resistant duodenal ulcers.

    PubMed

    Bianchi Porro, G; Parente, F; Lazzaroni, M

    1987-07-01

    The use of tripotassium dicitrato bismuthate (TDB) has been suggested recently for cimetidine resistant duodenal ulcers. This study compares the efficacy of TDB with two different cimetidine dosages in the treatment of duodenal ulcer patients who failed to respond to an eight week therapy with H2-blockers. Fifty two patients (40 men, 12 women) were randomly allocated to one of the following three oral regimens: (1) TDB 120 mg quid, (2) cimetidine 400 mg tid, (3) cimetidine 400 mg with meals plus 800 mg at bedtime. Endoscopy was carried out after four weeks; if the ulcer had not healed patients continued with the same treatment for a further four week period when they were endoscopically reassessed. After four weeks similar percentages of ulcer healing were registered in the two cimetidine schedules (39% with 1.2 g and 44% with 2 g), whereas TDB resulted in a significantly higher healing rate (82%) compared with cimetidine 1.2 g (p = 0.01) and with cimetidine 2 g (p = 0.025). After eight weeks the cumulative percentages of healing were 65% on cimetidine 1.2 g, 75% on cimetidine 2 g, and 94% on TDB (TDB v cimetidine 1.2 p = 0.042). These results confirm previous data that resistant duodenal ulcers are more responsive to an agent which strengthens the mucosal defences than to antisecretory compounds.

  15. Tripotassium dicitrato bismuthate (TDB) versus two different dosages of cimetidine in the treatment of resistant duodenal ulcers.

    PubMed Central

    Porro, G B; Parente, F; Lazzaroni, M

    1987-01-01

    The use of tripotassium dicitrato bismuthate (TDB) has been suggested recently for cimetidine resistant duodenal ulcers. This study compares the efficacy of TDB with two different cimetidine dosages in the treatment of duodenal ulcer patients who failed to respond to an eight week therapy with H2-blockers. Fifty two patients (40 men, 12 women) were randomly allocated to one of the following three oral regimens: (1) TDB 120 mg quid, (2) cimetidine 400 mg tid, (3) cimetidine 400 mg with meals plus 800 mg at bedtime. Endoscopy was carried out after four weeks; if the ulcer had not healed patients continued with the same treatment for a further four week period when they were endoscopically reassessed. After four weeks similar percentages of ulcer healing were registered in the two cimetidine schedules (39% with 1.2 g and 44% with 2 g), whereas TDB resulted in a significantly higher healing rate (82%) compared with cimetidine 1.2 g (p = 0.01) and with cimetidine 2 g (p = 0.025). After eight weeks the cumulative percentages of healing were 65% on cimetidine 1.2 g, 75% on cimetidine 2 g, and 94% on TDB (TDB v cimetidine 1.2 p = 0.042). These results confirm previous data that resistant duodenal ulcers are more responsive to an agent which strengthens the mucosal defences than to antisecretory compounds. PMID:3308650

  16. [Short-term effects of cimetidine in patients with bleeding duodenal ulcer. Presentation of cases].

    PubMed

    Uggeri, G; Monti, G; Rumi, A; Testone, G

    1983-10-01

    The authors here present a work dealing pith two groups of subjects, both groups having the diagnose of bleeding duodenal ulcer; one group using therapy antacid alone, the other using cimetidine and antacid. This last is more affected in controlling bleeding then just using antacids alone. Moreover the use of cimetidine reduces the period of bleeding, increases the number of subject who stop bleeding and reduces the amount of blood transfused in these subjects. We are also convenced that the use of cimetidine even prolong in time, does not protect these subjects from having other relapse. Therefore propose the Billroth II and from own experience this is a good therapy to prevent other bleeding.

  17. Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

    SciTech Connect

    Mistiaen, W.; Van Hee, R.; Blockx, P.; Hubens, A. )

    1990-03-01

    In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with (99mTc)stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

  18. [Prevalence and treatment of Helicobacter pylori in gastro-duodenal ulcers. An experience in Liege].

    PubMed

    Lutgen, N; Delforge, M; Bastens, B; Demoulin, J C; Fontaine, F; Gillard, V; Gerard, A

    2001-01-01

    Between April 1998 and July 1999, we prospectively investigated 152 patients with gastric or duodenal ulcer and we observed concomitant H. pylori infection in 72.8% and 78.5% respectively. We proposed to the GPs of these patients the recommended triple therapy (omeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg (OAC) twice daily for 7 or 10 days). H. pylori eradication was tested using the C13-urea breath test. Our results showed a modest overall eradication rate of about 70%. We have to persuade the patients and the GPs of the benefit of antibiotics and of the importance of the correct dosages. We have to continue to follow the resistance against antibiotics.

  19. Early ultrastructural changes in rat duodenal mucosa associated with cysteamine-induced ulcer

    SciTech Connect

    Pfeiffer, C.J.; Pfeiffer, D.C.; Szabo, S.

    1987-02-01

    The early morphologic sequelae induced by the duodenal ulcerogen, cysteamine, have been studied in rats by transmission electron microscopy. Cysteamine was administered per os at 70 mg/100 g body wt to groups of female rats sacrificed at 30 min, 1, 2, 4, 8, 12, 20, and 24 hr after chemical treatment, and duodenal tissue sampled from the antimesenteric side of the proximal duodenum, where ulcers develop, was studied. Emphasis was placed on early times as our previous scanning electron microscopic data had demonstrated enhanced in situ cellular necrosis and surface cavitation at 2-4 hr after cysteamine treatment. Results indicated intracellular changes as early as 30 min after treatment and prior to damage of the columnar cell microvilli or epithelial tight junctions. A staging of observed cellular degenerative changes suggested early apical endoplasmic reticular swelling and loss of cytoplasmic ground substance, followed later by moderate internal disruption of mitochondria. Through these stages the cell surface microvilli remained morphologically normal. Subsequently, microvilli degenerated and mitochondrial fine structure became severely disrupted and cell contents were expelled. Deeper villous changes such as separation of columnar cells from the lamina propria and alterations of selected elements within the lamina propria were observed. These data suggest that intracellular cytotoxic reactions at the villous tips occur early and may precede the influence of intraluminal damaging factors induced by cysteamine.

  20. Five-day bismuth-free triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse

    SciTech Connect

    Coelho, L.G.; Passos, M.C.; Chausson, Y.; Castro L de, P. )

    1991-08-01

    Previous studies have demonstrated that the eradication of Helicobacter pylori (H. pylori) is associated with a significant reduction of the rate of duodenal ulcer (DU) relapse. The aim of this study was to assess the long-term effect of a bismuth-free triple therapy on the eradication of H. pylori and reduction of DU relapse. After informed consent, 61 patients with endoscopically proven DU and H. pylori infection detected on 14C-urea breath test (BT) were included in the study. All patients received a combination of furazolidone, amoxicillin, and metronidazole, three times a day, for 5 days, in addition to eventual classical antiulcer agents prescribed by their attending physicians. BT was repeated after an interval of at least 60 days to evaluate H. pylori eradication. Endoscopy and another BT were performed again at 6.5 months after therapy to detect possible recurrences. Forty-eight patients completed the trial: 26 (54%) patients were negative for H. pylori at 6.5 months after the end of treatment, and 22 (46%) persisted H. pylori positive. Ninety-two percent of the patients in whom the bacteria were eradicated showed endoscopically healed ulcers and were asymptomatic, and two that were symptomatic presented only occasional pain not requiring therapy. Among the 22 patients who persisted H. pylori positive, six (27%) showed endoscopically active ulcers (p = 0.012) and eight (36%) patients continued to be symptomatic (p less than 0.01), and were still using antiulcer drugs (p = 0.002) 6.5 months after treatment. It is concluded that combined treatment with furazolidone, amoxicillin, and metronidazole for 5 days represents a well-tolerated, inexpensive, and effective therapeutic regime for the eradication of H. pylori and abolition of DU relapse in more than 50% of the patients during a follow-up period of 6.5 months.

  1. Successful Endoscopic Management of Non-Healing Perforated Duodenal Ulcer with Polyglycolic Acid Sheet and Fibrin Glue

    PubMed Central

    Shibagaki, Kotaro; Matsuda, Kayo; Fukuyama, Chika; Okada, Mayumi; Mikami, Hironobu; Izumi, Daisuke; Yamashita, Noritsugu; Okimoto, Eiko; Fukuda, Naoki; Aimi, Masahito; Fukuba, Nobuhiko; Oshima, Naoki; Takanashi, Toshihiro; Matsubara, Takeshi; Ishimura, Norihisa; Ishihara, Shunji; Kinoshita, Yoshikazu

    2016-01-01

    In recent years, treatment techniques in which polyglycolic acid sheets are applied to various situations with fibrin glue have exhibited great clinical potential, and previous studies have reported safety and efficacy. We describe closure of a non-healing perforated duodenal ulcer with the use of a polyglycolic acid sheet and fibrin glue in an elderly patient who was not a candidate for surgery. PMID:28119948

  2. Comparison of intraduodenal and intravenous administration of amino acids on gastric secretion in healthy subjects and patients with duodenal ulcer.

    PubMed Central

    Konturek, S J; Kwiecień, N; Obtułowicz, W; Mikoś, E; Sito, E; Oleksy, J

    1978-01-01

    The ability of an amino acid mixture given intraduodenally or intravenously to stimulate gastric secretion is compared in healthy subjects and in duodenal ulcer patients. Graded amounts of amino acids by both routes produced a similar increase in acid output in healthy subjects, reaching about 30% of the maximal response to pentagastrin. Serum gastrin concentrations remained virtually unchanged but serum alpha amino acid nitrogen levels were about twice as high with intravenous as with intraduodenal administration. Intravenously administered amino acids produced a significantly higher acid output in patients with duodenal ulcer than in healthy subjects, but did not produce a significant increase in gastric acid or pepsin secretion when combined with a pentagastrin infusion as compared with pentagastrin alone. Cimetidine (2 mg/kg/h) added to intravenous amino acid infusions caused almost complete suppression of acid secretion. This study indicates that amino acids are capable of stimulating gastric secretion after intraduodenal and after intravenous administration. The response to the latter is significantly higher in patients with duodenal ulcer than in healthy subjects, does not appear to involve gastrin release, is not affected by pentagastrin, and is strongly suppressed by histamine H2-blocker. PMID:361509

  3. Anti-inflammatory and carbonic anhydrase restoring actions of yam powder (Dioscorea spp) contribute to the prevention of cysteamine-induced duodenal ulcer in a rat model.

    PubMed

    Park, Jong-Min; Kim, Yoon-Jae; Kim, Ju-Seung; Han, Young-Min; Kangwan, Napapan; Hahm, Ki Baik; Kim, Tae-Sok; Kwon, Oran; Kim, Eun-Hee

    2013-08-01

    Increased acid output, accompanied with a defective defense system, is considered a fundamental pathogenesis of duodenal ulcer (DU). However, relapse of DU occurs despite proton pump inhibitors and H2 receptor antagonists, hence imposing the enforcement of the defense system. Dried powder of the yam tuber (Dioscorea spp) has been used in traditional folk medicine as a nutritional fortification. We hypothesized that dried-yam powder would prevent DU through improvement of anti-inflammatory actions and carbonic anhydrase (CA) activity. Therefore, we investigated the preventive effects of dried-yam powder against the cysteamine-induced DU and elucidated the underlying mechanisms. Duodenal ulcers were induced in Sprague-Dawley rats by intragastric administration of 500 mg/kg cysteamine-HCl. The dried-yam powder was used as a pretreatment before the cysteamine-HCl. The number and size of DU were measured. The expressions of inflammation mediators were checked in duodenal tissues, and the expressions of CAs and malondialdehyde levels were also examined. Cysteamine provoked perforated DU, whereas dried-yam powder significantly prevented DU as much as pantoprazole and significantly reduced the incidence of perforation. The messenger RNA expressions of cyclooxygenase-2 and inducible nitric oxide synthase were remarkably decreased in the yam group compared with the cysteamine group, and the serum levels of proinflammatory cytokines including interleukin-1β, interleukin-6, and tumor necrosis factor were significantly attenuated in the yam group. Cysteamine significantly decreased the expression of CAs, whereas yam treatment significantly preserved the expressions of CA IX, XII, and XIV. In conclusion, dried-yam powder exerts a significant protective effect against cysteamine-induced DU by lowering the activity of inflammatory cytokines and free radicals and restoring the activity of CAs, except in CA IV.

  4. The Effect of Eradication of Helicobacter pylori upon the Duodenal Ulcer Recurrence

    PubMed Central

    Kim, Na Young; Oh, Hyun Sook; Jung, Hyung Man; Wee, Sung Ho; Choi, Jeong Heui; Lee, Kye Heui

    1994-01-01

    Objectives To evaluate the effect of eradication of Helicobacter pylori(H.pylori) in the patients with duodenal ulcer(Du) upon the DU recurrence. Methods This study was performed for 190 patients with DU. Four different methods-microscopy of Gram stained mucosal smear, specific culture, biopsy urease test, histology of H&E staining-were taken for identifying colonization of H. pylori before treatment, and for finding the eradication of H. pylori 4 weeks after completion of therapy in each treatment group (cometidine, omeprazole, colloidal bismuth subcitrate(CBS), CBS and metronidazole double therapy, CBS. metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12, 18, and 24 months after therapy. Results The eradication rate of the cimetidine group, the omeprazole group, and the CBS group were 0%, 7.7%, 0%, respectively, and that of the double therapy group and the triple therapy group were 44.4% and 89.3%, respectively. Seventy three patients who were followed up for 2 years were categorized into two groups according to the eradication of H. pylori. The recurrence rate was 3.2% both in 1 year and 2 years later in the former group-one consisting of 31 patients with H. pylori eradicated, while the recurrence rate was 57.1% in 1 year and 78.6% in 2 years later, in the latter group-the other of 42 patients with H. pylori not eradicated. Conclusion The eradication of H. pylori in patients with DU reduces the recurrence of DU. PMID:7865492

  5. The safety and efficacy of tripotassium dicitrato bismuthate (De-Nol) maintenance therapy in patients with duodenal ulceration.

    PubMed

    Dunk, A A; Prabhu, U; Tobin, A; O'Morain, C; Mowat, N A

    1990-04-01

    Seventy-one patients whose duodenal ulcers had healed after a 4-week treatment period with tripotassium dicitrato bismuthate (TDB) were randomly allocated to receive maintenance treatment with either one TDB swallow tablet nocte (equivalent to 120 mg Bi2O3) or an identical placebo. During 12 months of follow-up, no side-effects were reported by TDB-treated patients, blood bismuth levels did not rise above discontinuation threshold concentrations (greater than 50 micrograms/L in the first 6 months, or greater than 100 micrograms/L in the second 6 months), and there were no adverse effects on haematological or biochemical indices. Ulcer relapse was significantly less in TDB-treated patients (P less than 0.025). Cumulative relapse rates at 6 and 12 months were 51% and 66%, respectively, for placebo-treated patients and 26% and 31%, respectively, for those who received TDB. It is likely that TDB is a safe and effective maintenance treatment for patients with duodenal ulcer disease.

  6. Increasing gastric juice pH level prior to anti-Helicobacter pylori therapy may be beneficial to the healing of duodenal ulcers.

    PubMed

    Fan, Hong-Yun; Wang, Juan; Yan, Guo-Chao; Huo, Xiao-Hui; Mu, Li-Juan; Chu, Jian-Kun; Niu, Wei-Wei; Duan, Zhi-Ying; Ma, Jin-Cheng; Wang, Jing; Wang, Zhi-Yu

    2013-03-01

    The aim of this study was to observe the efficacy of clarithromycin-based triple therapy for Helicobacter pylori (Hp)-infected duodenal ulcer when combined with different pH levels of gastric juices. A total of 160 patients with Hp-infected duodenal ulcers were randomly allocated into two groups. Patients in the treatment group (n=80) were administered a 20-mg dose of omeprazole twice daily for 1 week and then the treatment and control groups (n=80) received therapy for Hp infection and duodenal ulcers. We observed the ulcer healing stage, the content of anti-Hp IgA in gastric juice and the Hp eradication rate before and after proton pump inhibitor therapy in the two groups. Results revealed that the Hp eradication rate in the treatment group was 93% compared with 81% in the control group, and the difference was statistically significant (P<0.05). The ulcer healing rate in the treatment group was 93%, compared with 70% in the control group (P<0.05). A positive linear correlation was observed between gastric pH and the content of anti-Hp IgA in gastric juice (P<0.05). Increasing gastric pH prior to anti-Hp therapy may be beneficial to the eradication of Hp and for promoting the healing of duodenal ulcers.

  7. Effect of antisecretory agents and vagotomy on healing of chronic cysteamine-induced duodenal ulcers in rats

    SciTech Connect

    Poulsen, S.S.; Raaberg, L.; Therkelsen, K.; Skov Olsen, P.; Kirkegaard, P.

    1986-07-01

    Penetrated cysteamine-induced duodenal ulcers in rats have a very prolonged course of healing. In this study, it was investigated how much the healing of these ulcers is accelerated by some treatments. The treatments included omeprazole, cimetidine, and truncal vagotomy. In addition, the effect of omeprazole and cimetidine on gastric acid secretion was investigated in chronic gastric fistula rats. After 25 days of treatment, significantly more rats in the treated groups had healed ulcers than in the control group. There was little further improvement up to 100 days of treatment, and the difference between treated and untreated groups decreased. The morphology of healing ulcers in treated and untreated rats was also compared. In controls, there was a simultaneous regeneration of mucosa and the submucosal Brunner's glands from the edges of the ulcer, the slow proliferation rate of the latter probably being decisive for the prolonged healing. In the treated rats, the mucosa first regenerated with formation of crypts and low villi and subsequently, the Brunner's glands were formed by proliferation from the bottom of the crypts.

  8. Helicobacter pylori associated with a high prevalence of duodenal ulcer disease and a low prevalence of gastric cancer in a developing nation.

    PubMed Central

    Hu, P J; Li, Y Y; Zhou, M H; Chen, M H; Du, G G; Huang, B J; Mitchell, H M; Hazell, S L

    1995-01-01

    This study examines the relationship between Helicobacter pylori infection and peptic ulcer disease and gastric cancer--in particular, the presence or absence of bacteria, the grading of gastritis, and the degree of inflammation in the antral and oxyntic mucosae. The grading of gastritis and the detection of H pylori were determined by histology using the Sydney system. Of the 1006 patients examined, 34.5% had duodenal ulcer disease, 3.5% gastric ulcer disease, and 2% with coexistent ulceration. Most patients (50.2%) were classified as having non-ulcer dyspepsia. Altogether 2.4% of patients had gastric cancer and two further patients had carcinoma in the gastric stump. Of the ulcer disease patients, 87.2% had histological evidence of H pylori infection. After patients who had taken antibiotics or bismuth compounds in the preceding four weeks were excluded, 98.9% of the duodenal ulcer disease, 100% of the gastric ulcer disease, and 100% of the coexistent ulcer disease patients had evidence of H pylori infection. In patients with gastric cancer who had not taken antimicrobial agents in the four weeks before endoscopy, 83.3% had evidence of H pylori infection. Thus, there was a high rate of duodenal ulcer disease and a low rate of gastric ulcer disease in southern China, an area of low gastric cancer mortality. There was a specific topographical relationship between H pylori, the histological response, and gastroduodenal disease. Our data suggest that the status of a nation as either 'developed' or 'developing' can not be used to predict the upper gastrointestinal disease profile of its population. PMID:7883217

  9. Comparison of tri-potassium di-citrato bismuthate tablets with ranitidine in healing and relapse of duodenal ulcers.

    PubMed

    Lee, F I; Samloff, I M; Hardman, M

    1985-06-08

    120 patients were randomly allocated to receive ranitidine 150 mg twice daily or a tri-potassium di-citrato bismuthate (TDB) tablet four times a day in a trial comparing the effects of these drugs in the short-term healing and post-healing relapse rates of duodenal ulceration. At 4 weeks 81% of those on ranitidine and 90% of those on TDB had healed ulcer craters. At 8 weeks 97% of those on ranitidine and 97% of those on TDB had healed. These differences are not significant. After ulcer healing, the cumulative rates of relapse, as determined endoscopically, for symptomatic and symptomless ulcers were 74% for ranitidine and 41% for TDB at 4 months (p less than 0.001), 87% for ranitidine and 55% for TDB at 8 months (p less than 0.001), and 89% for ranitidine and 62% for TDB at 12 months (p less than 0.001). Females had significantly lower relapse rates than males. In the ranitidine group smokers had a higher rate of early relapse and failure to remain healed at 12 months than did non-smokers; no such difference occurred in the TDB-treated group.

  10. A porspective study of parietal cell vagotomy and selective vagotomy-antrectomy for treatment of duodenal ulcer.

    PubMed Central

    Jordan, P H

    1976-01-01

    A prospective, randomized, study involving 92 patients who required elective operation for treatment of duodenal ulcer was performed to compare the results of Parietal Cell Vagotomy (PCV) and selective vagotomy-antrectomy Billroth I (SV-A-BI). The protocol was broken twice. One patient was unable to undergo PCV because of pyloric stenosis and one patients underwent Billroth II anastomosis instead of Billroth I because of post-bulbar stenosis. Performance of PCV was never aborted because a patient was obese. There were no deaths. Diarrhea, dumping and other gastric complaints were less frequent after PCV than after SV-A-BI for all time periods studies up to two years. Two months after operation, the Hollander tests were negative in 59% of patients after PCV and in 100% after SV-ABI. Inhibition of Bao and MAO were also significantly less after PCV than after SV-A-BI. Since vagotomy of the parietal cell mass was identical in both groups of patients it was concluded that the differences in the secretory rates and the fewer negative Hollander tests in the PCV group than in the SV-A-BI group were due to retention of the antrum irrespective of its innervation. There was no explanation for the gradual increase in the BAO in the PCV group. One recurrent ulcer occurred in the PCV group in a patient who overindulged in alcohol and aspirin. After 4 days of medical management, this superficial ulcer healed as demonstrated by endoscopy. There were no recurrent ulcers after SV-A-BI. As a result of this study, it is concluded that PCV is superior to SV-A-BI because of the lower frequency of postoperative complications, diarrhea, dumping and other symptoms associated with gastric surgery. PCV may be the operation of choice for the elective treatment of duodenal ulcer; however, it remains undetermined whether the recurrent ulcer rate following PCV will be sufficiently low that the procedure can retain a position of superiority over SV-A-BI. PMID:973749

  11. Vacuolating Cytotoxin Genotypes Are Strong Markers of Gastric Cancer and Duodenal Ulcer-Associated Helicobacter pylori Strains: a Matched Case-Control Study

    PubMed Central

    Hussein, Nawfal R.; Miendje Deyi, Véronique Y.; Burette, Alain; Atherton, John C.

    2014-01-01

    The Helicobacter pylori virulence gene, cagA, and active forms of the vacuolating cytotoxin gene, vacA, are major determinants of pathogenesis. However, previous studies linking these factors to disease risk have often included patients using aspirin/nonsteroidal anti-inflammatory agents (NSAIDs) or acid-suppressing drugs, both of which may confound results. Also, particularly for gastric cancer (GC), controls have often been of quite different ages. Here, we performed a careful study in a “clean” Belgian population with gastric cancer cases age and sex matched to 4 controls and with a parallel duodenal ulcer (DU) group. As in other populations, there was a close association between the presence of cagA and the vacA s1 genotype. For GC, associations were found for vacA s1-positive (P = 0.01, odds ratio [OR], 9.37; 95% confidence interval [CI], 1.16 to 201.89), i1-positive (P = 0.003; OR, 12.08; 95% CI, 1.50 to 259.64), and cagA-positive status (P < 0.05; OR, infinity; 95% CI, 0.76 to infinity). For DU, associations were found with vacA s1 (P = 0.002; OR, 6.04; 95% CI, 1.52 to 27.87) and i1 (P = 0.004; OR, 4.35; 95% CI, 1.36 to 14.78) status but not with cagA status. Neither condition showed independent associations with the vacA m1 allele or with more biologically active forms of cagA with longer 3′ variable regions. In this Belgian population, the best markers of gastric cancer- and duodenal ulcer-associated strains are the vacA s1 and i1 genotypes. This fits with experimental data showing that the s and i regions are the key determinants of vacuolating cytotoxin activity. PMID:24920772

  12. babA2- and cagA-positive Helicobacter pylori strains are associated with duodenal ulcer and gastric carcinoma in Brazil.

    PubMed

    Oliveira, Adriana Gonçalves; Santos, Adriana; Guerra, Juliana Becattini; Rocha, Gifone Aguiar; Rocha, Andreia Maria Camargos; Oliveira, Celso Affonso; Cabral, Mônica Maria Demas Alvares; Nogueira, Ana Margarida Miguel Ferreira; Queiroz, Dulciene Maria Magalhães

    2003-08-01

    The babA2 and cagA genes were investigated in 208 Brazilian Helicobacter pylori strains. A strong association between babA2 and duodenal ulcer or gastric carcinoma was observed, even after adjusting for confounding factors, such as age, gender, and cagA status. cagA-positive strains were also independently associated with H. pylori-related diseases.

  13. Life-threatening Duodenal Ulcer Bleeding from a Ruptured Gastroduodenal Artery Aneurysm in a Patient with Neurofibromatosis Type 1.

    PubMed

    Im, Kyu Sung; Kim, Sunyong; Lim, Jun Uk; Jeon, Jung Won; Shin, Hyun Phil; Cha, Jae Myung; Joo, Kwang Ro; Lee, Joung Il; Park, Jae Jun

    2015-09-01

    Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.

  14. The effect of tri-potassium di-citrato bismuthate (De-Nol) on the healing of chronic duodenal ulcers.

    PubMed

    Coughlin, G P; Kupa, A; Alp, M H

    1977-02-26

    Forty-six patients suffering from chronic duodenal ulcer, proven endoscopically, were treated in a randomized double-blind cross-over trial with either tri-potassium di-citrato bismuthate (De-Nol) or placebo for four weeks and assessed symptomatically and endoscopically. Those patients who failed to heal after treatment with either agent were crossed over to the alternative preparation and reassessed after a further 28 days. Forty-two patients completed the study involving 57 patient treatments. A highly significant improvement in both symptomatic response (P less than 0.01) and endoscopic healing (P less than 0.01) was seen in those patients receiving tri-potassium di-citrato bismuthate (De-Nol) as against placebo therapy.

  15. [Which therapeutic regimen for eradicating Helicobacter pylori and cicatrization of a duodenal ulcer. Is there a role for short-term treatment?].

    PubMed

    Chassany, Olivier; Duracinsky, Martin

    2002-08-24

    CURRENT REGIMENS: The regimen recommended for the eradication of Helicobacter pylori and cicatrization of a duodenal ulcer is the association, for 7 days, of a double-dose of gastric anti-secretory drug and 2 antibiotics, followed by a usual dose of an anti-secretory for a further 3 weeks. During randomized studies, this therapeutic regimen led to an eradication rate of 80 to 90%. However, in current practice in France, the eradication rate is of only 60 to 75%. THE QUESTIONS RAISED: Phenomena of resistance to antibiotics are not the only cause. Lack of compliance is frequent, partly generated by poor tolerance to the antibiotherapy. Many recently published studies have provided elements of response to several questions concerning the eradication of Helicobacter pylori: can one reduce the duration of treatment by associating a triple antibiotherapy or, to the contrary, should one prolong treatment to be sure that patients fully comply to the 7 days of treatment? Should the dose of anti-secretory drug be doubled? And, with regard to cicatrizing the duodenal ulcer: can one reduce the duration of the anti-secretory agent? WITH THE RESULTS OF RECENTLY PUBLISHED CLINICAL TRIALS: It is legitimate today to prescribe double antibiotherapy for 10 to 14 days, associated with a double dose of an anti-secretory, without having to prolong the anti-secretory after this initial period, in order to cicatrize the duodenal ulcer. Further studies will specify the optimal duration between 10 and 14 days. However, till now, this therapeutic regimen for eradicating Helicobacter pylori and cicatrizing a duodenal ulcer has not obtained marketing authorization and is not appropriate for treating gastric ulcers and for complicated (notably hemorrhagic) gastroduodenal lesions.

  16. Perforated duodenal ulcer in pregnancy-a rare cause of acute abdominal pain in pregnancy: a case report and literature review.

    PubMed

    Essilfie, Papa; Hussain, M; Bolaji, I

    2011-01-01

    Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition.

  17. Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralfate alone.

    PubMed Central

    Bianchi Porro, G; Parente, F; Lazzaroni, M

    1993-01-01

    Thirty two patients with Helicobacter pylori positive duodenal ulcers resistant to treatment were randomly assigned to 4 weeks' treatment with sucralphate 4 g/day or colloidal bismuth subcitrate 480 mg/day plus amoxycillin from days 1 to 7 and tinidazole from days 8 to 14. After 4 weeks, patients with unhealed ulcers were crossed over to the other form of treatment for a further 4 week period. Patients with healed ulcers were followed up for 1 year without maintenance therapy with clinical and endoscopic investigations 3, 6, and 12 months after healing. Complete healing rates at 4 weeks were 88% (15 of 17) in the colloidal bismuth subcitrate plus antibiotics group and 40% (six of 15) in the sucralphate group (p < 0.05). After cross over, overall healing rates were 88% (22 of 25) and 47% (eight of 17), respectively (p < 0.05). H pylori eradication occurred in 83% of patients treated with the triple therapy. Cumulative relapse rates at 12 months were 12% (two of 17) in patients in whom H pylori had been eradicated and 100% (10 of 10) in those with persistent infection after short term therapy (p < 0.05). These results show that a colloidal bismuth subcitrate plus antibiotics regimen is highly effective in the short term treatment of resistant duodenal ulcers and that H pylori eradication can change the natural tendency to early recurrence of these ulcers. PMID:8491391

  18. The association of ranitidine and sucralfate in the short-term treatment of duodenal ulcers, as compared to other forms of treatment.

    PubMed

    Magnanelli, M; Belvisi, A; Toninelli, A; Matergi, M; Camarri, E

    1984-01-01

    Results of the treatment of duodenal ulcer with ranitidine (150 mg X 2/die) and sucralfate (1 gr X 2/die) have been compared with other common schemes of therapy. Administration of the drugs was carried out for 8 weeks, and the evolution of the ulcer lesion was followed with endoscopic controls at the beginning and end of the treatment. Ulcer healing occurred in 92% of 25 patients, as compared with 83,3% of 30 cases treated with ranitidine only; 80% of 30 cases with cimetidine 1 g/day; 80% of 20 cases with cimetidine 800 mg/b.i.d.; 75% of 20 cases with sucralfate 3 g/day; 73,3% of 30 patients with pirenzepine 150 mg/day; 60% of 20 cases with sulglycotide 0.5-1 g/day; and 50% of 40 ulcerous patients treated with placebo. From these results it is concluded that the association of sucralfate with an H2-antagonist improves the possibility of short-term healing of duodenal ulcer.

  19. Indigenous anti-ulcer activity of Musa sapientum on peptic ulcer

    PubMed Central

    Prabha, P.; Karpagam, Thirunethiran; Varalakshmi, B.; Packiavathy, A. Sohna Chandra

    2011-01-01

    Background: Peptic ulcer disease (PUD), encompassing gastric and duodenal ulcers is the most prevalent gastrointestinal disorder. The pathophysiology of PUD involves an imbalance between offensive factors like acid, pepsin and defensive factors like nitric oxide and growth factors. The clinical evaluation of antiulcer drugs showed tolerance, incidence of relapses and side-effects that make their efficacy arguable. An indigenous drug like Musa sapientum possessing fewer side-effects is the major thrust area of present day research, aiming at a better and safer approach for the management of PUD. Material and Methods: The unripe plantain bananas (Musa sapientum) were shade-dried, powdered and used for phytochemical analysis and as antiulcer drug. In our present study Group I rats served as control and were treated with saline, Group II was indomethacin-induced ulcerated rats, Group III received aqueous extract of Musa sapientum along with indomethacin and Group IV received esomeprazole along with indomethacin for 21 days. The anti-ulcerogenic activity was investigated by performing hematological, mucosal, antioxidant profile in comparison with the standard drug esomeprazole. Results: Our findings from High - Performance Thin Layer Chromatography (HPTLC) analysis showed that Musa sapientum has an active compound a monomeric flavonoid (leucocyanidin) with anti-ulcerogenic activity. Results were expressed as mean ± SD. All our results are in congruous with the results of standard drug esomeprazole. Conclusion: It could be clearly concluded that administration of the aqueous extract of Musa sapientum at the dose used in this study tends to ameliorate ulcers. Its use in indigenous medicine should be scientifically scrutinized with further research. PMID:22224045

  20. Endoscopic laser Doppler flowmetry in the experiment and in the bleeding gastric and duodenal ulcer clinic

    NASA Astrophysics Data System (ADS)

    Kapralov, S. V.; Shapkin, Y. G.; Lychagov, V. V.; Tuchin, V. V.

    2007-05-01

    One of the most complex problems of emergency surgery is the choice of surgical tactics to deal with bleeding peptic ulcer. Endoscopic hemostasis is prescribed to patients with continuing bleedings and prerelapse syndrome. But till nowdays the objective verification of the prerelapse condition had not been worked out. What is more there are no objective criteria to judge the effectiveness of the carried endohemostasis. The aim of the study was to work out a new objective diagnostic method of pre-recurrence syndrome that can be able to make prognosis for possible gastroduodenal ulcer bleeding recurrence more precise. Laser Doppler flowmetry was the method of studies the regional perfusion. The device used in this work was made at the Optics and Biophysics Department of Saratov State University.

  1. Modified Sequential Therapy Regimen versus Conventional Triple Therapy for Helicobacter Pylori Eradication in Duodenal Ulcer Patients in China: A Multicenter Clinical Comparative Study

    PubMed Central

    Zhou, Ying-Qun; Xu, Ling; Wang, Bing-Fang; Fan, Xiao-Ming; Wu, Jian-Ye; Wang, Chun-Yan; Guo, Chuan-Yong; Xu, Xuan-Fu

    2012-01-01

    Objective. Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide. To observe the effect of eradicating Helicobacter pylori (H. pylori) and the treatment of duodenal ulcer by 2 kinds of modified sequential therapy through comparing with that of 10-day standard triple therapy. Methods. A total of 210 patients who were confirmed in duodenal ulcer active or heal period by gastroscopy and H. pylori positive confirmed by rapid urease test, serum anti-H. pylori antibody (ELASE), or histological examination enrolled in the study. All the patients were randomly divided into three groups: group A (70 cases) and group B (70 cases) were provided 10-day modified sequential therapy; group C (70 cases) was provided 10-day standard triple therapy. Patients of group A received 20 mg of Esomeprazole, 500 mg of Clarithromycin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group B received 20 mg of Esomeprazole, 1000 mg of Amoxicillin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group C received 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for standard 10-day therapy. All drugs were given twice daily. H. pylori eradication rate was checked four to eight weeks after taking the medicine by using a 13C urea breath test. In the first, second, third, seventh, twenty-first, thirty-fifth days respectively, the symptoms of patients such as epigastric gnawing, burning pain, and acidity were evaluated simultaneously. Results. Overall, 210 patients accomplished all therapy schemes, 9 case patients were excluded. The examination result indicated that the H. pylori eradication rate of each group was as follows: group A 92.5% (62/67), group B 86.8% (59/68), and group C 78.8% (52/66). The H. pylori eradication rate of

  2. Helicobacter pylori cagA 12-bp insertion can be a marker for duodenal ulcer in Okinawa, Japan

    PubMed Central

    Matsuo, Yuichi; Shiota, Seiji; Matsunari, Osamu; Suzuki, Rumiko; Watada, Masahide; Binh, Tran Thanh; Kinjo, Nagisa; Kinjo, Fukunori; Yamaoka, Yoshio

    2013-01-01

    Backgrounds Helicobacter pylori cagA can be classified into mainly two types (East-Asian-type and Western-type cagA) according to the repeat regions located in the 3′ region. Recent studies showed that the Western-type cagA in strains from Okinawa, Japan formed a different cluster (J-Western-type cagA subtype). We also reported that J-Western-type cagA possess a 12-bp insertion located in the 5′ region of cagA sequence. Methods The prevalence of 12-bp insertion in cagA in Okinawa and the United States (U.S.) was examined by DNA sequencing. We then designed the primer pair which can detect the 12-bp insertion only by polymerase chain reaction (PCR). The prevalence of strains with 12-bp insertion was examined in 336 strains isolated from Okinawa by PCR. Results In case of Western-type cagA/vacA s1m2 strains, the prevalence of 12-bp insertion was significantly higher in strains isolated from Okinawa than that from the U.S. (P = 0.002). Phylogenetic tree showed that strains with 12-bp insertion formed two individual clusters within J-Western-type cagA subtype; one is from Okinawa and another is from the U.S. Our designed primer set showed high sensitivity (100%) and specificity (90.8%) in Okinawa. The 12-bp insertion was found in 23.7%, 14.3%, 4.2%, and 4.0% of strains with duodenal ulcer (DU), gastritis, gastric cancer (GC), and gastric ulcer (GU), respectively (P < 0.001 for DU vs. GU) in Okinawa. Conclusions Although the mechanisms are unknown, the presence of 12-bp insertion was associated with the presence of DU and might have a suppressive action on GU and GC. PMID:23190390

  3. Rosiglitazone for Active Ulcerative Colitis

    PubMed Central

    Lewis, James D.; Lichtenstein, Gary R.; Deren, Julius J; Sands, Bruce E.; Hanauer, Stephen B.; Katz, Jeffry A.; Lashner, Bret; Present, Daniel H.; Chuai, Shaokun; Ellenberg, Jonas H.; Nessel, Lisa; Wu, Gary D.

    2008-01-01

    Background Thiazolidinedione ligands for the gamma subtype of peroxisome proliferator-activated receptors (PPARγ), widely used to treat type 2 diabetes mellitus, have been proposed as novel therapies for ulcerative colitis. Methods This multicenter randomized, double blind, placebo-controlled clinical trial compared the efficacy of rosiglitazone (Avandia™) 4 mg orally twice daily versus placebo twice daily for 12 weeks in 105 patients with mild to moderately active UC. Disease activity was measured with the Mayo Score. The primary endpoint was clinical response (≥ 2 point reduction) at week 12. Clinical remission (Mayo Score ≤2), endoscopic remission, and quality of life were secondary outcomes. Results After 12 weeks of therapy, 23 patients (44%) treated with rosiglitazone and 12 patients (23%) treated with placebo achieved clinical response (p=0.04). Remission was achieved in 9 patients (17%) treated with rosiglitazone and 1 patient (2%) treated with placebo (p=0.01). Endoscopic remission was uncommon in either treatment arm (8% rosiglitazone vs. 2% placebo, p=0.34). Clinical improvement was evident as early as 4 weeks (p=0.049). Quality of life was significantly improved at week 8 (p=0.01) but not at week 4 (p=0.48) or 12 (p=0.14). Serious adverse events were rare. Conclusions Rosiglitazone was efficacious in the treatment of mild to moderately active ulcerative colitis. PMID:18325386

  4. Differences in Genome Content among Helicobacter pylori Isolates from Patients with Gastritis, Duodenal Ulcer, or Gastric Cancer Reveal Novel Disease-Associated Genes▿ †

    PubMed Central

    Romo-González, Carolina; Salama, Nina R.; Burgeño-Ferreira, Juan; Ponce-Castañeda, Veronica; Lazcano-Ponce, Eduardo; Camorlinga-Ponce, Margarita; Torres, Javier

    2009-01-01

    Helicobacter pylori establishes a chronic infection in the human stomach, causing gastritis, peptic ulcer, or gastric cancer, and more severe diseases are associated with virulence genes such as the cag pathogenicity island (PAI). The aim of this work was to study gene content differences among H. pylori strains isolated from patients with different gastroduodenal diseases in a Mexican-Mestizo patient population. H. pylori isolates from 10 patients with nonatrophic gastritis, 10 patients with duodenal ulcer, and 9 patients with gastric cancer were studied. Multiple isolates from the same patient were analyzed by randomly amplified polymorphic DNA analysis, and strains with unique patterns were tested using whole-genome microarray-based comparative genomic hybridization (aCGH). We studied 42 isolates and found 1,319 genes present in all isolates, while 341 (20.5%) were variable genes. Among the variable genes, 127 (37%) were distributed within plasticity zones (PZs). The overall number of variable genes present in a given isolate was significantly lower for gastric cancer isolates. Thirty genes were significantly associated with nonatrophic gastritis, duodenal ulcer, or gastric cancer, 14 (46.6%) of which were within PZs and the cag PAI. Two genes (HP0674 and JHP0940) were absent in all gastric cancer isolates. Many of the disease-associated genes outside the PZs formed clusters, and some of these genes are regulated in response to acid or other environmental conditions. Validation of candidate genes identified by aCGH in a second patient cohort allowed the identification of novel H. pylori genes associated with gastric cancer or duodenal ulcer. These disease-associated genes may serve as biomarkers of the risk for severe gastroduodenal diseases. PMID:19237517

  5. Tri-potassium di citrato bismuthate chewing tablets and cimetidine tablets in the treatment of duodenal ulcers. A double-blind double-dummy comparative study.

    PubMed

    Moshal, M G; Spitaels, J M; Khan, F

    1981-09-12

    A randomized, double-blind, double-dummy comparative 6-week study of tri-potassium di-citrato bismuthate (TDB) (Ulcerone; De-Nol) chewing tables and cimetidine was carried out in 60 patients suffering from duodenal ulceration. The data on 51 patients (27 on TDB and 24 on cimetidine) were analysed (9 patients absconded). Both treatments appeared to be highly effective in ulcer healing at the 6-week endoscopic assessment. The healing rate for TDB chewing tablets was 89% and that for cimetidine tablets 92%. Both forms of therapy were comparable in respect of improvement of pain and effect on all other observed symptoms. Neither drug had a statistically significant effect on any of the haematological or clinical chemical parameters tested during the trial, except that the cimetidine-treated group showed a significant linear reduction in white blood cell count. No side-effects were reported. It is suggested that TDB chewing tablets are a safe, effective and cheaper alternative to cimetidine in the treatment of patients with duodenal ulceration.

  6. [Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

    PubMed

    Razarenova, T G; Koshel', A P; Klokov, S S; Dibina, T V

    2010-01-01

    The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

  7. Perforated Duodenal Ulcer in Pregnancy—A Rare Cause of Acute Abdominal Pain in Pregnancy: A Case Report and Literature Review

    PubMed Central

    Essilfie, Papa; Hussain, M.; Bolaji, I.

    2011-01-01

    Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition. PMID:22567500

  8. Multicenter evaluation of dual-therapy (omeprazol and amoxycillin) for Helicobacter pylori-associated duodenal and gastric ulcer (two years of the observation).

    PubMed

    Gabryelewicz, A; Laszewicz, W; Dzieniszewski, J; Ciok, J; Marlicz, K; Bielecki, D; Popiela, T; Legutko, J; Knapik, Z; Poniewierka, E

    1997-09-01

    Treatment with the proton pump inhibitor (omeprazole) and single antibiotic (amoxycillin), two synergistic compounds, can cure Helicobacter pylori (H. pylori) infection, but this therapy is not as effective as had been expected. However, some studies show promising results. The aim of our study was to evaluate the effect of two weeks dual-therapy with omeprazole (O) and amoxycillin (A) on gastric (GU) and duodenal ulcer (DU) patients: ulcer healing, eradication of the H. pylori and recurrence rate of the ulcer. We studied 216 patients (aged 18-70) endoscopically proven GU (58 patients) and DU (158 patients). Rapid urease test from the two antrum biopses and two antral and two corporeal biopses using Giemsa stain method for confirmation of the H. pylori infection were used. The patients were treated with omeprazole 20 mg BID and amoxycillin 1.0 g BID for 2 weeks and investigated every 4 months during 2 years. Clearance effect of Hp infection was achieved in 65.1% GU and 66.4% DU patients. Eradication ("check point" after 4 months) in 43% DU and 56.6% GU patients was confirmed. Reinfection rate was found in 16% during 2 years. We conclude--dual-therapy (O and A) is not sufficiently effective to be recommended as an anti-H. pylori treatment. H. pylori eradication prevents recurrence of peptic ulcer and is an important issue in attempts to achieve permanent ulcer healing.

  9. Efficacy of Proton Pump Inhibitors for Patients with Duodenal Ulcers: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Hu, Zhan-Hong; Shi, Ai-Ming; Hu, Duan-Min; Bao, Jun-Jie

    2017-01-01

    Background/Aim: To compare the efficacy and tolerance of different proton pump inhibitors (PPIs) in different doses for patients with duodenal ulcers. Materials and Methods: An electronic database was searched to collect all randomized clinical trials (RCTs), and a pairwise and network meta-analysis were performed. Results: A total of 24 RCTs involving 6188 patients were included. The network meta-analysis showed that there were no significant differences for the 4-week healing rate of duodenal ulcer treated with different PPI regimens except pantoprazle 40 mg/d versus lansoprazole 15 mg/d [Relative risk (RR) = 3.57; 95% confidence interval (CI) = 1.36–10.31)] and lansoprazole 30 mg/d versus lansoprazole 15 mg/d (RR = 2.45; 95% CI = 1.01–6.14). In comparison with H2 receptor antagonists (H2 RA), pantoprazole 40 mg/d and lansoprazole 30 mg/d significantly increase the healing rate (RR = 2.96; 95% CI = 1.78–5.14 and RR = 2.04; 95% CI = 1.13–3.53, respectively). There was no significant difference for the rate of adverse events between different regimens, including H2 RA for a duration of 4-week of follow up. Conclusion: There was no significant difference for the efficacy and tolerance between the ordinary doses of different PPIs with the exception of lansoprazle 15 mg/d. PMID:28139495

  10. Effects of transdermal scopolamine, alone or in combination with cimetidine, on total 24 hour gastric acid secretion in patients with duodenal ulcer.

    PubMed Central

    Richardson, C T; Feldman, M

    1986-01-01

    Transdermal scopolamine is an antimuscarinic preparation approved for use in the United States for prevention of motion sickness. A recent study using this drug (0.5 mg/patch) suggested that enough scopolamine was absorbed through the skin to reduce basal gastric acid secretion in patients with duodenal ulcer. We have compared the effect of transdermal scopolamine and oral cimetidine (400 mg twice daily) in seven men with chronic duodenal ulcer, both alone and in combination, on acid secretion throughout an entire 24 hour period in a placebo-controlled, randomised, double blinded cross over study. The effect of these drugs on basal, interprandial, and nocturnal gastric juice volume and hydrogen ion concentration also was measured. Transdermal scopolamine had no significant effect on mean 24 hour acid secretion (placebo, 409.4 mmol/day; scopolamine, 364.0 mmol/day) nor did it have a significant effect on gastric juice volume or hydrogen ion concentration. The combination of transdermal scopolamine plus cimetidine was not more effective than cimetidine alone in reducing total 24 hour acid secretion (mean, 231.8 versus 235.3 mmol/day) nor in reducing gastric juice volume or hydrogen ion concentration. PMID:3804025

  11. [In vivo evaluation of the effect of antacids and H2 receptor blockaders on the intragastric pH in gastric and duodenal ulcer].

    PubMed

    Waserstein, M; Dacoll, C; Cohen, H; Gamboa, L; Brener, A; de Mizrahi, J B; Sempol, D; Neumark, A; Nieto, F; Tenzer, S

    1985-01-01

    The aim of this work is to establish the best treatment for patients with gastric and duodenal ulcer, by measuring the effects of antiacids and H2-receptor antagonists on gastric pH. 16 patients were studied: 9 of them had a duodenal ulcer, 2 a gastric ulcer and 5 had both. All the patients remained fasting and receiving no drug for 24 hrs. During this 24 hrs., a nasogastric tube was inserted into the stomach and the gastric content was obtained by aspiration each hour from 8 A.M. to 8 P.M. Three days after, each patient received a daily dose of 1 g of Cimetidine, and the whole procedure was repeated. The same was done with 300 mg of Ranitidine daily, 150 ml of Al-Mg antiacids daily, and at last, the same procedure was performed with the association of Ranitidine and Al-Mg antiacids at the mentioned dosage. For the statistical analysis of the data, the mean ordinate of the pH was used as a representative value of each individual's pH. Individual differences (pH with treatment minus pH without treatment) were obtained. The mean effect of each treatment was obtained averaging that differences. For comparison among different drugs, the same procedure was used. Student's paired t tests were performed in a signification level. The buffering capacity was measured in the following way: The percentage of the gastric secretion samples with pH equal or higher than 4 in each treatment and in the total number of patients was confronted with the results obtained in the same patients with no treatment. All the drugs were useful for buffering the gastric acidity, but in different intensity. The association of Ranitidine and Al-Mg antiacids showed to be the most efficient statistically when compared with Cimetidine and Al-Mg antiacids; no statistical difference appeared in the comparison with Ranitidine.

  12. Ulcers

    MedlinePlus

    An ulcer is a crater-like sore on the skin or mucous membrane . Ulcers form when the top layers of skin or ... Ulcers can be caused by inflammation or infection. Some ulcers may be caused by a cancer.

  13. Tissue plasminogen activator and plasminogen activator inhibitor type 1 gene polymorphism in patients with gastric ulcer complicated with bleeding.

    PubMed Central

    Kim, Hong-Soo; Hwang, Kyu-Yoon; Chung, Il-Kwon; Park, Sang-Heum; Lee, Moon-Ho; Kim, Sun-Joo; Hong, Sae-Yong

    2003-01-01

    Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) may be involved in the pathogenesis of peptic ulcers through suppression of fibrinolysis. This study was designed to investigate associations of t-PA and PAI-1 genes with clinical features of the patients with bleeding gastric ulcers. Eighty-four patients with peptic ulcers and 100 controls were studied between January 1998 and April 2000. We used polymerase chain reaction and endonuclease digestion to genotype for 4G/5G polymorphism in the promoter region of the PAI-1 gene and the Alurepeat insertion/deletion (I/D) polymorphism in intron h of the t-PA gene. Various clinical features, including lesion site, bleeding event, recurrence of ulcer, and rebleeding, were assessed using a multiple logistic regression model. The genotype distributions of both the t-PA and PAI-1 genes did not differ between the patient and control groups. The occurrence of the I/D or D/D genotype of t-PA was significantly higher in cases of duodenal ulcer (adjusted OR=4.39, 95% CI=1.12-17.21). When a dominant effect (i.e., 4G/4G or 4G/5G versus 5G/5G) of the 4G allele was assumed, the PAI-1 4G/4G genotype was independently associated with rebleeding after hemostasis (adjusted OR=5.07, 95% CI=1.03-24.87). Our data suggest that t-PA gene polymorphism is associated with duodenal ulcers, and that the PAI-1 gene may be a risk factor leading to recurrent bleeding after initial hemostasis. PMID:12589088

  14. CT of gastro-duodenal obstruction.

    PubMed

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  15. [Various mechanisms of cytoprotective effect of omeprazole and low intensity laser radiation on the gastroduodenal mucosa in the treatment of patients with duodenal ulcer].

    PubMed

    Akhmadkhodzhaev, A M

    2002-01-01

    Clinical studies were made in 130 patients with duodenal ulcer in the phase of exacerbation of the disease. There were 98 men and 32 women who ranged from 17 to 50 years old. Results of examination of 7 essentially healthy subjects were regarded as control. The patients were divided into three groups. Group I patients (n = 48) received a conventional therapy; in group II patients, the adopted therapy was supplemented by omeprazol, 20 mg twice daily, group III patients (n = 43) were (in addition to the above therapeutic regimen) exposed to a session of endoscopic low-intensity laser irradiation (LILI) for 5 min (overall 6 to 8 LILI procedures). It has been ascertained that omeprazol exerts a cytoprotective effect on the mucozal barrier of the gastroduodenal zone brought about by increase in the synthesis of glucoproteins in the mucous membrane, improvement of the water-and-elastic properties, and enhancement of resistance of the mucosal barrier to the action of the aggressive factors. Administration of endoscopic LILI treatments in DU patients has also been found out to have a cytoprotective effect but superior to omeprazol. A protective action of LILI is believed to be caused by stimulation of synthesis of the most important components of glycoproteins. A cytoprotective effect of omeprazol and endoscopic LILI is ccompanied by a significant shortening of time for the clinical symptoms to get dispelled, the ulcer cicatrization frequency increased.

  16. Ulcers

    MedlinePlus

    ... give me an ulcer!" "There's been so much stress at work lately, I'm sure I'll get an ulcer." "Don't worry so much. Do you want an ulcer?" When people talk like this, it sounds like ulcers are easy to give and easy to get. It also sounds like stress is to blame. But is that the real ...

  17. Duodenal atresia

    MedlinePlus

    ... would. Many infants with duodenal atresia also have Down syndrome. Duodenal atresia is often associated with other birth ... abnormality. Other problems (such as those related to Down syndrome) must be treated as appropriate. Outlook (Prognosis) Recovery ...

  18. Reduced Duodenal Cytochrome P450 3A Protein Expression and Catalytic Activity in Patients with Cirrhosis

    PubMed Central

    McConn, Donavon J.; Lin, Yvonne S.; Mathisen, Terri L.; Blough, David K.; Xu, Yang; Hashizume, Takanori; Taylor, Shari L.; Thummel, Kenneth E.; Shuhart, Margaret C.

    2009-01-01

    The small intestine and liver express high levels of cytochrome P450 3A (CYP3A), an enzyme subfamily contributing significantly to drug metabolism. In patients with cirrhosis, reduced metabolism of drugs is typically attributed to decreased liver function, but it is unclear whether intestinal drug metabolism is also compromised. In this study, we compared CYP3A protein expression and in vitro midazolam hydroxylation in duodenal mucosal biopsies from subjects with normal liver function (controls; n=20) and subjects with varying severity of cirrhosis (n=23). Compared to samples from controls, duodenal CYP3A expression and total midazolam hydroxylation was reduced by 47% and 34%, respectively in samples from subjects with cirrhosis. Greater decreases in CYP3A expression were seen in subjects with increasing severity of cirrhosis. Thus, patients with advanced cirrhosis may have increased drug exposure following oral dosing as a result of both impaired liver function and decreased intestinal CYP3A expression and activity. PMID:19212316

  19. [Omeprazol and ezomeprazol pharmacokinetics, duration of antisecretory effect, and reasons for their probable changes in duodenal ulcer].

    PubMed

    Serebrova, S Iu; Starodubtsev, A K; Pisarev, V V; Kondratenko, S N; Vasilenko, G F; Dobrovol'skiĭ, O V

    2009-01-01

    There were authentic distinctions between the groups of healthy volunteers and patients with a peptic ulcer disease in Cmax, Tmax, AUC(0-t), AUC(0-infinity), CIt, Vd of omeprazole and Cmax of esomeprazole (Nexium, AstraZeneca). When the pharmacokinetics of omeprazole and ezomeprazole were compared in both groups, there were authentic distinctions in Cmax, AU(0-t), AUC(0-infinity), CIt, T1/2. The patients who had taken omeprazole the time of hypoacide condition was much shorter than in other groups. Disintegration test modeling pHmax for pH oscillation with large amplitude, that is typical for ulcer disease, demonstrated a possibility of early partial release of omeprazole, its acid-depended degradation and reduction of its bioavailability.

  20. Weight loss and decubitus duodenal ulcer in Parkinson's disease treated with levodopa-carbidopa intestinal gel infusion.

    PubMed

    Martino, Tommaso; Melchionda, Donato; Tonti, Paolo; De Francesco, Vincenzo; Lalla, Alessandra; Specchio, Luigi Maria; Avolio, Carlo

    2016-12-01

    Apparently, unexplained weight loss is a common symptom experienced by patients affected by Parkinson's disease, especially in those treated by levodopa-carbidopa infusion gel (LCIG) with a poor control of dyskinesias. Weight loss is considered part of gastrointestinal dysfunction seen in patients affected by Parkinson's disease, along with gastroparesis and reduced bowel peristalsis. In patients treated with LCIG, weight loss needs to be accurately evaluated, because of possible underlying life-threatening adverse events, like duodenum decubitus ulcer.

  1. Misoprostol in peptic ulcer disease.

    PubMed

    Watkinson, G; Akbar, F A

    1987-01-01

    Misoprostol, a synthetic prostaglandin E1 (PGE1) methyl ester analog has potent antisecretory and cytoprotective effects on the gastric and duodenal mucosa which should make it an effective drug in the treatment of gastric and duodenal ulcer. In two multicenter, randomised, double-blind, controlled studies involving over 900 patients with endoscopically proven benign gastric ulcer and in six similar studies involving over 2000 patients with active duodenal ulcers, differing doses of misoprostol have been compared with either placebo therapy or with conventional doses of cimetidine. In these studies misoprostol 800 mcg daily given as two or four divided doses has been shown to produce rates of complete ulcer healing and pain relief which were significantly superior to placebo therapy and comparable to those achieved with cimetidine. Drug related adverse effects were infrequent. A dose related diarrhea occurred in a small proportion of patients which seldom necessitated suspension of therapy. Because of the known uterotropic effect of prostaglandins the drug should not be used in pregnant women or women of child bearing age unless they are using adequate contraceptive measures. No clinically significant adverse, hematological or biochemical effects have been reported. Two studies suggested that misoprostol reduced the adverse effect of smoking on the healing of duodenal ulcer. In addition, misoprostol has been shown to protect the gastro-duodenal mucosa from the damaging effects of alcohol and non-steroidal anti-inflammatory drugs. This action may prove of value in the treatment of ulcer patients who are inveterate smokers, alcohol users or who are compelled to consume non-steroidal anti-inflammatory drugs for pain relief from rheumatic and allied diseases.

  2. Duodenal Perforation Precipitated by Scrub Typhus.

    PubMed

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  3. Umami Receptor Activation Increases Duodenal Bicarbonate Secretion via Glucagon-Like Peptide-2 Release in Rats

    PubMed Central

    Wang, Joon-Ho; Inoue, Takuya; Higashiyama, Masaaki; Guth, Paul H.; Engel, Eli; Kaunitz, Jonathan D.

    2011-01-01

    Luminal nutrient chemosensing during meal ingestion is mediated by intestinal endocrine cells, which regulate secretion and motility via the release of gut hormones. We have reported that luminal coperfusion of l-Glu and IMP, common condiments providing the umami or proteinaceous taste, synergistically increases duodenal bicarbonate secretion (DBS) possibly via taste receptor heterodimers, taste receptor type 1, member 1 (T1R1)/R3. We hypothesized that glucose-dependent insulinotropic peptide (GIP) or glucagon-like peptide (GLP) is released by duodenal perfusion with l-Glu/IMP. We measured DBS with pH and CO2 electrodes through a perfused rat duodenal loop in vivo. GIP, exendin (Ex)-4 (GLP-1 receptor agonist), or GLP-2 was intravenously infused (0.01–1 nmol/kg/h). l-Glu (10 mM) and IMP (0.1 mM) were luminally perfused with or without bolus intravenous injection (3 or 30 nmol/kg) of the receptor antagonists Pro3GIP, Ex-3(9-39), or GLP-2(3-33). GIP or GLP-2 infusion dose-dependently increased DBS, whereas Ex-4 infusion gradually decreased DBS. Luminal perfusion of l-Glu/IMP increased DBS, with no effect of Pro3GIP or Ex-3(9-39), whereas GLP-2(3-33) inhibited l-Glu/IMP-induced DBS. Vasoactive intestinal peptide (VIP)(6–28) intravenously or NG-nitro-l-arginine methyl ester coperfusion inhibited the effect of l-Glu/IMP. Perfusion of l-Glu/IMP increased portal venous concentrations of GLP-2, followed by a delayed increase of GLP-1, with no effect on GIP release. GLP-1/2 and T1R1/R3 were expressed in duodenal endocrine-like cells. These results suggest that luminal l-Glu/IMP-induced DBS is mediated via GLP-2 release and receptor activation followed by VIP and nitric oxide release. Because GLP-1 is insulinotropic and GLP-2 is intestinotrophic, umami receptor activation may have additional benefits in glucose metabolism and duodenal mucosal protection and regeneration. PMID:21846840

  4. Anti-ulcer activity of essential oil constituents.

    PubMed

    Oliveira, Francisco de Assis; Andrade, Luciana Nalone; de Sousa, Elida Batista Vieira; de Sousa, Damião Pergentino

    2014-05-05

    Essential oils have attracted considerable worldwide attention over the last few decades. These natural products have wide-ranging pharmacological activities and biotechnological applications. Faced with the need to find new anti-ulcer agents and the great effort on the development of drugs for the treatment of ulcers, in this review, the anti-ulcer activities of 21 bioactive compounds found in essential oils are discussed.

  5. [Peptic ulcer

    PubMed

    Carvalho, A S

    2000-07-01

    OBJECTIVE: To present a current review about pathogenesis, pathophysiology, diagnosis, and treatment of peptic ulcer disease in children, based on the reviewed publications and the author personal experience. METHODS: We revised the most relevant articles about peptic ulcer in children, published from the last 20 years. RESULTS: The gastroduodenal peptic ulcer is very common in adults, mostly in the developing countries. Although it is less frequent in children, the optical fibroendoscopy has improved the number of diagnosed cases. The peptic ulcer is classified as its etiology in primary and secondary. The secondary peptic ulcer is related to a subjacent disease or use of drugs, while the primary ulcer happens in the absence of underlying systemic diseases The primary duodenal ulcer is the most common presentation, and there are strong evidences of the H. pylori association in the etiology. Clinical presentation changes with age and ulcer type. Secondary ulcers are mostly acute and sometimes dramatic, while the primary ones have a chronic evolution mostly similar to patients with functional recurrent abdominal pain, but the presence of epigastric pain, feeding-related pain, vomiting, bleeding, familiar history for peptic ulcer, nocturnal pain, and male gender are strongly related to peptic ulcer. The acid antisecretory agents have great efficacy on relieving symptoms and solving ulcerate lesion, although the H. pylori eradication itself prevents primary duodenal ulcer recurrence. CONCLUSIONS: The primary peptic ulcer involve many factors in Its etiopathogenesis, being H. pylori the most important of them Although there isn t yet a ideal therapeutic course. The antibiotics play an important role in peptic ulcer and the H. pylori research must be done for na accurate diagnosis and treatment.

  6. Anti-ulcer activity of higher primary alcohols of beeswax.

    PubMed

    Carbajal, D; Molina, V; Valdés, S; Arruzazabala, L; Más, R

    1995-09-01

    The anti-ulcer effects of a natural mixture of higher aliphatic primary alcohols, designated D-002, isolated from beeswax, were compared with those of cimetidine on indomethacin-, ethanol-, water-immersion-induced ulcers and on gastric secretion in rats. D-002 (25-50 mg kg-1 p.o.) was similar to cimetidine in dose-dependently reducing the duration of indomethacin-induced ulcers while also being effective in preventing ethanol-induced ulcers, which are not affected by cimetidine. On the other hand, D-002 (100 mg kg-1) moderately decreased the volume of gastric basal secretion in pylorus-ligated rats, but not the acidity. Nevertheless, it inhibited gastric ulcer induced by pylorus-ligation at doses (50 mg kg-1) that were ineffective in decreasing the volume. In addition, 100 mg kg-1 of D-002 prevented the formation of acute gastric ulcers induced in rats by water-immersion stress. The results demonstrate the anti-ulcer activity of the preparation in different experimental models suggesting its potential value for ulcer therapy.

  7. Inhibitory potency of twice-a-day omeprazole on gastric acidity is enhanced by eradication of H. pylori in duodenal ulcer patients.

    PubMed

    Thomson, A B R; Keelan, M; Lastiwka, R; Appelman-Eszczuk, S; Zuk, L; Drozdowski, L; Prentice, A; Sinclair, P

    2003-10-01

    The gastric pH-elevating effect of proton pump inhibitors such as omeprazole has been reported to be greater in the presence than in the absence of an H. pylori infection. It is unknown if this effect persists when a higher dose of omeprazole is taken. We undertook both 24-hr pH-metry and 24-hr aspiration studies in 12 H. pylori-positive patients with a history of duodenal ulcer (DU); (1) when not on omeprazole; (2) when on omeprazole 20 mg twice a day for 8 days; (3) two months after eradication of H. pylori and when not on omeprazole; and (4) after eradication of H. pylori and when on omeprazole twice a day. Eradication of H. pylori in DU results in lower mean and median pH; decreased percent pH > or = 3/ > or = 4, and greater median H+ after breakfast, after lunch, and overnight; and omeprazole appears to have less of a pH-elevating effect in the absence than in the presence of an H. pylori infection. The fall in gastric juice NH3 concentration as a result of eradicating H. pylori partially explained the lower pH-elevating effect of omeprazole. The variation in acid inhibitory effect of omeprazole after as compared with before eradication of H. pylori could not be explained by differences; (1) in gastric juice concentrations of IL-1alpha, IL-8, IL-13, or epidermal growth factor; (2) in the fasting or fed total concentration of gastric juice bile acids; (3) in the fasting concentrations or area under-the-curve (AUC) of the gastric H+ concentrations in response to food; or (4) in the pharmacokinetics of omeprazole. The difference in H+ AUC without omeprazole minus with omeprazole was actually greater when compared after versus before eradication of H. pylori. Thus, in DU the pH-elevating potency of omeprazole taken twice a day is greater in the presence than in the absence of an H. pylori infection.

  8. Duodenal ulcerogens cysteamine and propionitrile decrease duodenal neutralization of acid in the rat

    SciTech Connect

    Adler, R.S.; Gallagher, G.T.; Szabo, S.

    1983-08-01

    Neutralization of acid was evaluated in rat proximal duodenal segments isolated from biliary and pancreatic secretions. Duodenal ulcerogenic doses of cysteamine produced a significant decrease in acid disposal 0.5-2 hr after treatment. Oral or subcutaneous administration of the duodenal ulcerogen was effective. The potent ulcerogen cysteamine produced a more pronounced decrease than propionitrile (a weak duodenal ulcerogen). The failure of ethanolamine, a nonulcerogenic structural analog of cysteamine to significantly alter acid disposal suggests that the effect is not due to the toxic properties of the duodenal ulcerogen. The results reinforce the concept that the duodenum is able to dispose of significant quantities of acid. The decrease in acid-handling may contribute to duodenal susceptibility to acid after treatment with ulcerogens and possibly reflects pathophysiologic changes early in duodenal ulceration.

  9. Ulcers

    MedlinePlus

    ... if they cause heartburn.Does what I eat affect my ulcer?It may. But this isn't true for everyone. Certain foods and drinks may be more likely to make your pain worse. These include both regular and decaffeinated coffee, tea, chocolate, meat extracts, alcohol, black pepper, chili powder, mustard ...

  10. Dietary phosphilipids and sterols protective against peptic ulceration.

    PubMed

    Tovey, F I; Bardhan, K D; Hobsley, M

    2013-09-01

    The prevalence of duodenal ulceration in regions of developing countries with a stable diet is related to the staple food(s) in that diet. A higher prevalence occurs in areas where the diet is principally milled rice, refined wheat or maize, yams, cassava, sweet potato or green bananas, and a lower prevalence in areas where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments using animal peptic ulcer models showed that the lipid fraction in foods from the staple diets of low prevalence areas gave protection against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs), and also promoted healing of ulceration. The protective activity was found to lie in the phospholipid, sterol and sterol ester fractions of the lipid. Amongst individual phospholipids present in the phospholipid fraction, phosphatidyl ethanolamine (cephalin) and phosphatidyl choline (Lecithin) predominated. The sterol fraction showing activity contained β-sitosterol, stigmasterol and an unidentified isomer of β-sitosterol. The evidence shows that dietary phytosterols and phospholipids, both individually and in combination, have a protective effect on gastroduodenal mucosa. These findings may prove to be important in the prevention and management of duodenal and gastric ulceration including ulceration due to NSAIDs.

  11. Ulcer Protective Activity of Jatropha gossypiifolia Linn. in Wistar Rats

    PubMed Central

    Vijayakumar, Arumugam Ramamoorthy; Daniel, Epison Prabu; Ilavarasan, Raju; Venkataraman, S.; Vijayakumar, S.

    2016-01-01

    Background: Several synthetic drugs are useful in the treatment of peptic ulcer, but almost of these drugs are used in prolonging time, it may cause several adverse reactions. However, the herbal medicines are more potent to the treatment and minimize the side effects. Objective: To evaluate the methanol extract of Jatropha gossypiifolia Linn. (MEJG) for gastro protective activity against Wistar rats. Materials and Methods: Anti-ulcer potency of MEJG (100 and 200 mg/kg, b.w.) was assessed using aspirin (200 mg/kg, p.o.) plus pylorus ligation ulcer model and the parameters studied were ulcer index (UI), gastric juice volume, pH, total acidity, and total acid output. Same extract was studied by ethanol-induced (80%, 5 mL/kg, intragastrically) ulcer model, and the UI and biochemical parameters were studied. Results: The oral administration of MEJG (100 and 200 mg/kg) significantly (P < 0.001) attenuated the ulcer score and anti-secretary parameters (such as the volume of gastric content, free acidity, total acidity, and total acid output) in the aspirin plus pylorus ligation rats. The extract also significantly attenuated (P < 0.001) ulcer score in ethanol-induced ulcer model and lipid peroxidation level and significantly increased the level of glutathione peroxides, catalase, and superoxide dismutase activity. The MEJG may possess active constituents such as alkaloids, glycosides, flavonoids, and terpenes, which may play a major role in gastroprotective effect in Wistar rats. Conclusion: The present study provides scientific support for the anti-ulcer activities of extracts of JG and also claimed that antioxidant potential of the extracts. However, substantiates the traditional claims for the usage of this drug in the treatment of gastric ulcer. SUMMARY The methanolic extract of jatropha gossypiifolia Linn. for gastro protective activity against aspirin plus pyloric ligation and ethanol induced ulcer models was studied in Wistar rats. JG shows significantly

  12. Notch1 activation up-regulates pancreatic and duodenal homeobox-1.

    PubMed

    Liu, Shi-He; Zhou, Guisheng; Yu, Juehua; Wu, James; Nemunaitis, John; Senzer, Neil; Dawson, David; Li, Min; Fisher, William E; Brunicardi, F Charles

    2013-07-19

    Transcription factor pancreatic and duodenal homeobox-1 (PDX-1) plays an essential role in pancreatic development, β-cell differentiation, maintenance of normal β-cell function and tumorigenesis. PDX-1 expression is tightly controlled through a variety of mechanisms under different cellular contexts. We report here that overexpression of Notch1 intracellular domain (NICD), an activated form of Notch1, enhanced PDX-1 expression in both PDX-1 stable HEK293 cells and mouse insulinoma β-TC-6 cells, while NICD shRNA inhibited the enhancing effect. NICD-enhanced PDX-1 expression was accompanied by increased insulin expression/secretion and cell proliferation in β-TC-6 cells, which was reversed by NICD shRNA. Cre activation-induced specific expression of NICD in islet β cells of transgenic βNICD+/+ mice induced increased expression of PDX-1, insulin and proliferating cell nuclear antigen (PCNA) and decreased expression of p27 with accompanied fasting hyperinsulinemia and hypoglycemia and altered responses to intraperitoneal glucose tolerance test. Systemically delivered NICD shRNA suppressed islet expression of PDX-1 and reversed the hypoglycemia and hyperinsulinemia. Moreover, expression levels of NICD were correlated with those of PDX-1 in human pancreatic neuroendocrine tumor. Thus, Notch1 acts as a positive regulator for PDX-1 expression, cooperates with PDX-1 in the development of insulin overexpression and islet cell neoplasia and represents a potential therapeutic target for islet neoplasia.

  13. Medical therapy of peptic ulcer disease.

    PubMed

    McQuaid, K R; Isenberg, J I

    1992-04-01

    The gastric duodenal mucosa normally is protected from the damaging effects of gastric acid and pepsin by ill-defined mechanisms. Ulcers may arise when there is an imbalance between the aggressive and defensive factors that renders the mucosa susceptible to damage. A variety of factors have been identified that may favor the development of peptic ulcers, but no single pathophysiologic defect applies in all ulcer patients. In duodenal ulcers, gastric acid hypersecretion is observed in as many as one third of patients; however, most patients with duodenal ulcers secrete normal amounts of gastric acid. Decreased mucosal bicarbonate secretion may be important in at least some duodenal ulcer patients. Use of NSAIDs may cause either gastric or duodenal ulcers, probably through the inhibition of mucosal prostaglandin synthesis and disruption of mucosal defenses. Finally, a recently identified bacterium, H. pylori, causes a chronic gastritis that is found in the overwhelming majority of patients with duodenal ulcers and non-NSAID-associated gastric ulcers. This bacterium may play a pivotal role in ulcer pathogenesis and, especially, in ulcer recurrences. A number of drugs of proved efficacy are available for the treatment of acute duodenal and gastric ulcers. The H2 receptor antagonists administered once daily remain the mainstay of ulcer therapy because of their efficacy, ease of use, and excellent safety profile. More thorough and long-lasting acid inhibition is afforded by the H+/K(+)-ATPase inhibitor omeprazole. This agent also promotes more rapid ulcer healing, but in most patients, this minor advantage may not justify the higher cost. It is not known whether more rapid healing will translate into lower ulcer complication rates. Until further data are available, this drug may be preferable in patients with large or complicated ulcers. In patients with refractory ulcers, omeprazole is clearly superior to other available agents. Agents that promote mucosal defense

  14. Role of dietary phospholipids and phytosterols in protection against peptic ulceration as shown by experiments on rats.

    PubMed

    Tovey, Frank I

    2015-02-07

    Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher in regions where the diet is based on milled rice, refined wheat or maize, yams, cassava, sweet potato, or green bananas, and is lower in regions where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs). It also promoted ulcer healing. The lipid from the pulse, Dolichos biflorus, horse gram which was highly protective was used to identify the fractions with protective activity in the lipid. The protective activity lay in the phospholipid, sterol and sterol ester fractions. In the phospholipid fraction phosphatidyl choline (lethicin) and phosphatidyl ethanolamine (cephalin) were predominant. In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol, stigmasterol, and an unidentified isomer of β-sitosterol. The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration, both singly and in combination. This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers. A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.

  15. Peptic ulcer perforation: sonographic imaging of active fluid leakage.

    PubMed

    Minardos, Ioannis; Ioannis, Minardos; Ziogana, Dimitra; Dimitra, Ziogana; Hristopoulos, Hristos; Hristos, Hristopoulos; Dermitzakis, Ioannis; Ioannis, Dermitzakis

    2006-01-01

    Sonography is not the method of choice for the evaluation of suspected peptic ulcer perforation (PUP). However, indirect sonographic signs and direct visualization of PUP have been reported by several authors in recent years. We report a case of an elderly woman who presented with severe abdominal pain and positive rebound sign, in whom abdominal sonography demonstrated indirect signs of PUP, the site of perforation, and active air fluid leakage through the perforated anterior prepyloric antral wall.

  16. Validation of binding of SE-75 labeled sucralfate to sites of gastrointestinal ulceration

    SciTech Connect

    Maurer, A.H.; Knight, L.C.; Kollman, M.; Krevsky, B.; Pleet, D.; D'Ercole, F.; Siegel, J.A.; Fisher, R.S.; Malmud, L.S.

    1985-05-01

    This study was performed to determine if and for how long sucralfate (SU) binds selectively to sites of gastro-intestinal (GI) ulceration. Se-Su was prepared by sulfating sucrose with tracer Se-75 and precipitating it as the basic Al salt. All patients (pts) had endoscopy to confirm the presence of either: esophagitis (n=5), gastritis (GA) (n=5), gastric ulcers (GU) (n=5), duodenal ulcers (DU) (n=5), or no ulceration (NU) (n=5). Following an overnight fast the pts swallowed 1 gm with 100 ..mu..Ci of Se-SU and were imaged continuously over 24 hours or until no activity remained in the upper GI tract. Pts with GU visually demonstrated focal SU binding at the ulcers for an average of 3.9 +- 1.1 hrs. with a mean GET of 68 +- 25 min. Mean GET for pts with DU was prolonged, 171 +- 63 min, however focal binding at duodenal ulcers was not seen. All pts with GA had diffuse retention of SU in the stomach with a mean GET of 118 +- 34 min. Focal binding of SU at all sites of esophagitis was seen with a T-1/2 of 65 +- 32 min at the ulcerations. In conclusion these data support the theory that the mechanism of ulcer healing with SU is related to its ability to adhere to the ulcer site forming a protective barrier. In addition Se-SU is a potential ulcer imaging agent which can be used to noninvasively assess healing.

  17. Inferior vena caval filter strut perforation causing intramural duodenal haematoma

    PubMed Central

    Williams, Zoheb Berry; Organ, Nicole M.; Deane, Stephen

    2016-01-01

    We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means. Causes of duodenal haematoma include blunt trauma, haematologic malignancy, coagulopathy, percutaneous or endoscopic procedures, pancreatic pathology, peptic ulcer disease and aortoenteric fistula. Duodenal haematoma is rare and is usually managed conservatively or by percutaneous drainage. While this patient had a typical presentation, IVC filter strut perforation has not been described in the literature as a cause for duodenal haematoma. PMID:27887016

  18. Cushing's ulcer: Further reflections

    PubMed Central

    Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health. Results: Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was “reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem.” Conclusion: Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway. PMID:25972936

  19. Andrographis paniculata Extract (HMPL-004) for Active Ulcerative Colitis

    PubMed Central

    Sandborn, William J; Targan, Stephan R; Byers, Vera S; Rutty, Dean A; Mu, Hua; Zhang, Xun; Tang, Tom

    2013-01-01

    OBJECTIVES: Andrographis paniculata has in vitro inhibitory activity against TNF-α, IL-1β and NF-κB. A pilot study of A. paniculata extract (HMPL-004) suggested similar efficacy to mesalamine for ulcerative colitis. METHODS: A randomized, double-blind, placebo-controlled trial evaluated the efficacy of A. paniculata extract (HMPL-004) in 224 adults with mild-to-moderate ulcerative colitis. Patients were randomized to A. paniculata extract (HMPL-004) 1,200 mg or 1,800 mg daily or placebo for 8 weeks. RESULTS: In total, 45 and 60% of patients receiving A. paniculata 1,200 mg and 1,800 mg daily, respectively, were in clinical response at week 8, compared with 40% of those who received placebo (P=0.5924 for 1,200 mg vs. placebo and P=0.0183 for 1,800 mg vs. placebo). In all, 34 and 38% of patients receiving A. paniculata 1,200 mg and 1,800 mg daily, respectively, were in clinical remission at week 8, compared with 25% of those who received placebo (P=0.2582 for 1,200 mg vs. placebo and P=0.1011 for 1,800 mg vs. placebo). Adverse events developed in 60 and 53% of patients in the A. paniculata 1,200 mg and 1,800 mg daily groups, respectively, and 60% in the placebo group. CONCLUSIONS: Patients with mildly to moderately active ulcerative colitis treated with A. paniculata extract (HMPL-004) at a dose of 1,800 mg daily were more likely to achieve clinical response than those receiving placebo. PMID:23044768

  20. Laparoscopic resection of duodenal gastrointestinal stromal tumour

    PubMed Central

    Zioni, Tammy; Dizengof, Vitaliy; Kirshtein, Boris

    2017-01-01

    Only a few studies have revealed using laparoscopic technique with limited resection of gastrointestinal stromal tumour (GIST) of the duodenum. A 68-year-old man was admitted to the hospital due to upper gastrointestinal (GI) bleeding. Evaluation revealed an ulcerated, bleeding GI tumour in the second part of the duodenum. After control of bleeding during gastroduodenoscopy, he underwent a laparoscopic wedge resection of the area. During 1.5 years of follow-up, the patient is disease free, eats drinks well, and has regained weight. Surgical resection of duodenal GIST with free margins is the main treatment of this tumour. Various surgical treatment options have been reported. Laparoscopic resection of duodenal GIST is an advanced and challenging procedure requiring experience and good surgical technique. The laparoscopic limited resection of duodenal GIST is feasible and safe, reducing postoperative morbidity without compromising oncologic results. PMID:28281485

  1. Prevalence of peptic ulcer in dyspeptic patients and the influence of age, sex, and Helicobacter pylori infection.

    PubMed

    Wu, Hui-Chao; Tuo, Bi-Guang; Wu, Wei-Min; Gao, Yuan; Xu, Qing-Qing; Zhao, Kui

    2008-10-01

    We investigated the prevalence of peptic ulcer in dyspeptic patients in China to analyze the influence of age, sex, and Helicobacter pylori (H. pylori) infection. The results showed that the prevalence of gastric and duodenal ulcer increased with age. In patients under 60 years old, the prevalence of duodenal and gastric ulcers in females was markedly lower than that in males, especially the prevalence of duodenal ulcer. The prevalence of duodenal ulcer and gastric ulcer in H. pylori-infected patients was markedly higher than in patients without H. pylori infection. In the patients under 60 years old, sex differences were still seen in both H. pylori-positive and H. pylori-negative patients. The prevalence of gastric and duodenal ulcers was markedly increased with age in both H. pylori-positive and H. pylori-negative patients. Multivariate logistic regression analysis showed that age, male sex, and H. pylori infection were three independent risk factors for gastric and duodenal ulcers.

  2. Role of dietary polyphenols in the management of peptic ulcer.

    PubMed

    Farzaei, Mohammad Hosein; Abdollahi, Mohammad; Rahimi, Roja

    2015-06-07

    Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.

  3. Role of dietary polyphenols in the management of peptic ulcer

    PubMed Central

    Farzaei, Mohammad Hosein; Abdollahi, Mohammad; Rahimi, Roja

    2015-01-01

    Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proinflammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer. PMID:26074689

  4. Peptic Ulcer Disease in Bangladesh: A Multi-centre Study.

    PubMed

    Ghosh, C K; Khan, M R; Alam, F; Shil, B C; Kabir, M S; Mahmuduzzaman, M; Das, S C; Masud, H; Roy, P K

    2017-01-01

    The incidence of peptic ulcer has steadily declined through out the world. This decreasing trend is also noticeable in this subcontinent. The point prevalence of peptic ulcer (PUD) in Bangladesh was around 15% in eighties. The aim of this study was to see the present prevalence of peptic ulcer at endoscopy and to identify changing trends in the occurrence of peptic ulcer in Bangladesh. This retrospective analysis of the endoscopic records of multiple tertiary referral centres of Dhaka city were done from January 2012 to July 2013. A total of 5608 subjects were the study samples. We included those patients having peptic ulcer in the form of duodenal ulcer, benign gastric ulcer including pre-pyloric ulcer and gastric outlet obstruction due to peptic ulcer. Duodenal ulcer and benign gastric ulcer were found in 415(7.4%) and 184(3.28%) patients respectively and gastric outlet obstruction due to peptic ulcer was found in 23(0.40%) patients.

  5. Sympathetic overactivity in active ulcerative colitis: effects of clonidine.

    PubMed

    Furlan, Raffaello; Ardizzone, Sandro; Palazzolo, Laura; Rimoldi, Alexandra; Perego, Francesca; Barbic, Franca; Bevilacqua, Maurizio; Vago, Luca; Bianchi Porro, Gabriele; Malliani, Alberto

    2006-01-01

    Previous reports suggest that inflammatory bowel diseases may be accompanied by abnormalities in the neural autonomic profile. We tested the hypotheses that 1) an exaggerated sympathetic activity characterizes active ulcerative colitis (UC) and 2) a reduction of sympathetic activity by clonidine would be associated with clinical changes of UC. In 23 patients with UC and 20 controls, muscle sympathetic nerve activity (MSNA), ECG, blood pressure, and respiration were continuously recorded, and plasma catecholamine was evaluated both at rest and during a 75 degrees head-up tilt. Autonomic profile was assessed by MSNA, norepinephrine, epinephrine, spectral markers of low-frequency (LF) cardiac sympathetic (LF(RR); normalized units) and high-frequency (HF) parasympathetic (HF(RR); normalized units) modulation and sympathetic vasomotor control (LF systolic arterial pressure; LF(SAP)), obtained by spectrum analysis of the R-R interval and systolic pressure variability. Among UC patients, 16 agreed to be randomly assigned to 8-wk transdermal clonidine (15 mg/wk, 9 subjects), or placebo (7 patients). An autonomic profile, Disease Activity Index (DAI), and endoscopic pattern were compared before and after clonidine/placebo. At rest, MSNA, heart rate (HR), LF(RR), LF/HF, and LF(SAP) were higher and HF(RR) was lower in patients than in controls. Tilt decreased HF(RR) and increased MSNA and LF(RR) less in patients than in controls. Clonidine decreased HR, MSNA, epinephrine, LF(RR), and increased HF(RR), whereas placebo had no effects. Changes of the autonomic profile after clonidine were associated with reduction of DAI score. An overall increase of sympathetic activity characterized active UC. Normalization of the autonomic profile by clonidine was accompanied by an improvement of the disease.

  6. Detection of Active Epstein-Barr Virus Infection in Duodenal Mucosa of Patients With Refractory Celiac Disease.

    PubMed

    Perfetti, Vittorio; Baldanti, Fausto; Lenti, Marco Vincenzo; Vanoli, Alessandro; Biagi, Federico; Gatti, Marta; Riboni, Roberta; Dallera, Elena; Paulli, Marco; Pedrazzoli, Paolo; Corazza, Gino Roberto

    2016-08-01

    Refractory celiac disease is characterized by mucosal damage in patients with celiac disease despite a gluten-free diet. Little is known about the mechanisms that cause persistent intestinal inflammation in these patients. We performed a case-control study of 17 consecutive patients diagnosed with refractory celiac disease from 2001 through 2014 (median age, 51 y; 10 women) and 24 patients with uncomplicated celiac disease (controls) to determine whether refractory disease is associated with infection by lymphotropic oncogenic viruses. We performed real-time PCR analyses of duodenal biopsy samples from all patients to detect Epstein-Barr virus (EBV), human herpesvirus-8, and human T-cell lymphotropic virus-I, -II, or -III. We used in situ hybridization and immunohistochemical analyses to identify infected cells and viral proteins. We did not detect human herpesvirus-8 or human T-cell lymphotropic viruses in any of the biopsy specimens. However, 12 of 17 (70.5%) biopsy specimens from patients with refractory celiac disease were positive for EBV, compared with 4 of 24 (16.6%) biopsy specimens from controls (P < .001). EBV was detected in inflammatory cells and enterocytes. An analysis of latency- and replication-associated proteins confirmed active infection. Further studies are needed to determine whether EBV infection contributes to the pathogenesis of refractory celiac disease and enteropathy-associated T-cell lymphoma.

  7. Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers

    PubMed Central

    Zhang, Ting; Wang, Yuexin; Jia, Yanni; Liu, Dongle; Li, Suxia; Shi, Weiyun

    2016-01-01

    Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results. The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8 ± 3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (P = 0.001). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers. PMID:27830086

  8. Anti-ulcer actions of phytosphingosine hydrochloride in different experimental rat ulcer models.

    PubMed

    Baek, Seung Woo; Kim, Nam Ki; Jin, Hwan-Jun; Koh, Chang-Woong; Kim, Chul Kyung; Kwon, O-Hyep; Kim, Jun-Sung; Cho, Myung-Haing; Park, Chan-Koo

    2005-01-01

    The gastroprotective activity of phytosphingosine hydrochloride (PS-HCl, CAS 554-62-1) was assessed in four different rat models of experimentally induced gastric ulcer. Various doses (2.5-10 mg/kg) of PS-HCI were orally administered to rats 30 min before the treatment with HCl/ethanol, indometacin, cysteamine, or to rats with ligated pylorus. Oral administration of PS-HCl (2.5-10 mg/kg) to rats prevented the acute ulcer formation in 4 different types of ulcer in a dose-dependent manner as follows: (1) HCl/ethanol-induced gastric mucosal membrane lesions (20.1-47.8% inhibition), (2) indometacin-induced gastric mucosal membrane lesions (4.6-31.9% inhibition), (3) duodenal ulcer induced by cysteamine (10-20% inhibition), (4) gastric secretion and ulceration following pylorus ligation (33.3-61.9% inhibition). These results indicate that PS-HCI may be useful for the prevention of gastric ulcer.

  9. Duodenal perforation with an unusual presentation: a case report.

    PubMed

    Sarmast, Arif Hussain; Parray, Fazl Q; Showkat, Hakim Irfan; Lone, Yasir A; Bhat, Naseer A

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation.

  10. Duodenal Perforation with an Unusual Presentation: A Case Report

    PubMed Central

    Sarmast, Arif Hussain; Parray, Fazl Q.; Showkat, Hakim Irfan; Lone, Yasir A.; Bhat, Naseer A.

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation. PMID:22567473

  11. Gastro-duodenal fluid induced nuclear factor-κappaB activation and early pre-malignant alterations in murine hypopharyngeal mucosa

    PubMed Central

    Vageli, Dimitra P.; Prasad, Manju L.; Sasaki, Clarence T.

    2016-01-01

    We recently described the role of gastro-duodenal fluids (GDFs) in generating changes consistent with hypopharyngeal neoplasia through activation of NF-κB pathway, using an in vitro model of human hypopharyngeal normal keratinocytes. Here, we further provide evidence that gastro-duodenal reflux is a risk factor for early pre-malignant alterations in hypopharyngeal mucosa (HM) related to an activated NF-κB oncogenic pathway, using both an in vitro and a novel in vivo model of C57Bl/6J mice. Histological, immunohistochemical and automated quantitative analysis documents significant NF-κB activation and early pre-malignant alterations in HM topically exposed to GDFs, compared to acid alone and other controls. Early pre-malignant histologic lesions exhibited increased Ki67, CK14 and ΔNp63, cell proliferation markers, changes of cell adhesion molecules, E-Cadherin and β-catenin, and STAT3 activation. The in vivo effect of NF-κB activation is positively correlated with p-STAT3, Ki67, CK14 or β-catenin expression, while GDFs induce significant transcriptional activation of RELA(p65), bcl-2, TNF-α, STAT3, EGFR and wnt5A, in vivo. Our in vivo model demonstrates selectively activated NF-κB in response to topically administrated GDFs, leading to early pre-malignant events in HM. PMID:26745676

  12. The prevalence of lymphoid follicles in Helicobacter pylori associated gastritis in patients with ulcers and non-ulcer dyspepsia.

    PubMed Central

    Zaitoun, A M

    1995-01-01

    AIMS--To determine the prevalence of lymphoid follicles in Helicobacter pylori positive and negative gastritis in antral and body type gastric mucosa in patients with non-ulcer dyspepsia (NUD), duodenal ulcer, or gastric ulcer; to correlate follicle presence with patient age; to evaluate the correlation between the prevalence of lymphoid follicles and active and inactive gastritis and its severity; and to assess the positive predictive value of lymphoid follicle prevalence with respect to H pylori infection. METHODS--Gastric biopsy specimens, graded according to the Sydney system, from 337 patients were studied. RESULTS--Lymphoid follicles occurred more often in antral mucosa (78%) than in body type mucosa (41%) and were observed in 85% of patients with H pylori positive gastritis. There was no significant difference between NUD and gastric and duodenal ulcer disease with regard to the presence of lymphoid follicles. The positive predictive value of the presence of lymphoid follicles in H pylori infection was 96%. Lymphoid follicles were more commonly observed in patients aged between 10 and 29 years. Lymphoid follicles were more frequently found in pangastritis of all subtypes than in antral gastritis and also in active gastritis than in inactive gastritis. The presence of lymphoid follicles correlated strongly with the degree and severity of gastritis. CONCLUSION--Lymphoid follicles are a constant morphological feature of H pylori associated gastritis. Images PMID:7615851

  13. Chylomicron components activate duodenal vagal afferents via a cholecystokinin A receptor-mediated pathway to inhibit gastric motor function in the rat.

    PubMed

    Glatzle, Jörg; Wang, Yuhua; Adelson, David W; Kalogeris, Theodore J; Zittel, Tilman T; Tso, Patrick; Wei, Jen-Yu; Raybould, Helen E

    2003-07-15

    Nutrients in the intestine initiate changes in secretory and motor function of the gastrointestinal (GI) tract. The nature of the 'sensors' in the intestinal wall is not well characterized. Intestinal lipid stimulates the release of cholecystokinin (CCK) from mucosal entero-endocrine cells, and it is proposed that CCK activates CCK A receptors on vagal afferent nerve terminals. There is evidence that chylomicron components are involved in this lipid transduction pathway. The aim of the present study was to determine (1) the pathway mediating reflex inhibition of gastric motility and (2) activation of duodenal vagal afferents in response to chylomicrons. Mesenteric lymph was obtained from awake rats fitted with lymph fistulas during intestinal perfusion of lipid (Intralipid, 170 micromol h(-1), chylous lymph) or a dextrose and/or electrolyte solution (control lymph). Inhibition of gastric motility was measured manometrically in urethane-anaesthetized recipient rats in response to intra-arterial injection of lymph close to the upper GI tract. Chylous lymph was significantly more potent than control lymph in inhibiting gastric motility. Functional vagal deafferentation by perineural capsaicin or CCK A receptor antagonist (devazepide, 1 mg kg(-1), i.v.) significantly reduced chylous lymph-induced inhibition of gastric motility. The discharge of duodenal vagal afferent fibres was recorded from the dorsal abdominal vagus nerve in an in vitro preparation of the duodenum. Duodenal vagal afferent nerve fibre discharge was significantly increased by close-arterial injection of CCK (1-100 pmol) in 43 of 83 units tested. The discharge of 88% of CCK-responsive fibres was increased by close-arterial injection of chylous lymph; devazepide (100 microg, i.a.) abolished the afferent response to chylous lymph in 83% of these units. These data suggest that in the intestinal mucosa, chylomicrons or their products release endogenous CCK which activates CCK A receptors on vagal afferent

  14. Emergency Pancreaticoduodenectomy in Duodenal Paraganglioma: Case Report

    PubMed Central

    Parray, Fazl Q.; Lone, Iqbal M.; Chowdri, Nisar A.; Wani, Imtiaz; Wani, Mehmood A.; Gulzar, G. M.; Thakur, Natasha

    2011-01-01

    Duodenal gangliocytic paraganglioma (DGP) is a rare tumor that characteristically occurs in the second part of duodenum. These appear as submucosal masses that protrude into the lumen of a duodenum. Gastrointestinal bleeding is the commonest manifestation of DGP. Metastatic spread to regional lymph nodes occurs rarely. Surgical resection is the treatment of choice for DGP. A case of a DGP is reported in young female who presented with a recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy (UGIE) documented a mass in the ampullary region with ulceration in its middle which was bleeding. Recurrent gastrointestinal bleeding necessitated an emergency pancreaticoduodenectomy. Histopathology of specimen documented gangliocytic paraganglioma. PMID:22084750

  15. Emergency pancreaticoduodenectomy in duodenal paraganglioma: case report.

    PubMed

    Parray, Fazl Q; Lone, Iqbal M; Chowdri, Nisar A; Wani, Imtiaz; Wani, Mehmood A; Gulzar, G M; Thakur, Natasha

    2011-01-01

    Duodenal gangliocytic paraganglioma (DGP) is a rare tumor that characteristically occurs in the second part of duodenum. These appear as submucosal masses that protrude into the lumen of a duodenum. Gastrointestinal bleeding is the commonest manifestation of DGP. Metastatic spread to regional lymph nodes occurs rarely. Surgical resection is the treatment of choice for DGP. A case of a DGP is reported in young female who presented with a recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy (UGIE) documented a mass in the ampullary region with ulceration in its middle which was bleeding. Recurrent gastrointestinal bleeding necessitated an emergency pancreaticoduodenectomy. Histopathology of specimen documented gangliocytic paraganglioma.

  16. Enhanced colonic nitric oxide generation and nitric oxide synthase activity in ulcerative colitis and Crohn's disease.

    PubMed Central

    Rachmilewitz, D; Stamler, J S; Bachwich, D; Karmeli, F; Ackerman, Z; Podolsky, D K

    1995-01-01

    Recent studies have suggested that nitric oxide (NO.), the product of nitric oxide synthase in inflammatory cells, may play a part in tissue injury and inflammation through its oxidative metabolism. In this study the colonic generation of oxides of nitrogen (NOx) and nitric oxide synthase activity was determined in ulcerative colitis and Crohn's disease. Colonic biopsy specimens were obtained from inflammatory bowel disease patients and from normal controls. Mucosal explants were cultured in vitro for 24 hours and NOx generation was determined. Nitric oxide synthase activity was monitored by the conversion of [3H]-L-arginine to citrulline. Median NOx generation by inflamed colonic mucosa of patients with active ulcerative colitis and Crohn's colitis was 4.2- and 8.1-fold respectively higher than that by normal human colonic mucosa. In ulcerative colitis and Crohn's colitis nitric oxide synthase activity was 10.0- and 3.8-fold respectively higher than in normal subjects. Colonic NOx generation is significantly decreased by methylprednisolone and ketotifen. The decrease in NOx generation by cultured colonic mucosa induced by methylprednisolone suggests that NO synthase activity is induced during the culture and the steroid effect may contribute to its therapeutic effect. Enhanced colonic NOx generation by stimulated nitric oxide synthase activity in ulcerative colitis and Crohn's disease may contribute to tissue injury. PMID:7541008

  17. Physical activity in patients with venous leg ulcer – between engagement and avoidance. A patient perspective

    PubMed Central

    Biguet, Gabriele; Elfving, Britt

    2011-01-01

    Objective: To identify and describe the qualitative variations in how physical activity is perceived and understood by individuals with current or previous venous leg ulcer. Design: A qualitative study using semi-structured interviews. Method: Twenty-two individuals aged 60–85 years were interviewed. The interviews were recorded, transcribed verbatim and analysed by three researchers using a phenomenographic research approach. A set of categories of descriptions and their internal relationships were constructed based on the essential features of the variation in patients’ perceptions of physical activity. Results: Four categories of descriptions were identified: (i) ‘self-management’, (ii) ‘instructions and support’, (iii) ‘fear of injury’ and (iv) ‘a wish to stay normal’. The categories could be interpreted by a two-dimensional construct: (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity. Chronicity and behaviour combined together formed a 2 × 2 square housing the four qualitatively different categories. Irrespective of category, the participants reported that information given by caregivers regarding leg ulcer and physical activity was insufficient or contradictory. Written information or exercise programmes were not obtained regularly and not at all in primary care. Conclusion: A dichotomous view emerged from participants’ experiences of physical activity based on (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity. PMID:21148268

  18. Molecular hydrogen in human breath: a new strategy for selectively diagnosing peptic ulcer disease, non-ulcerous dyspepsia and Helicobacter pylori infection.

    PubMed

    Maity, Abhijit; Pal, Mithun; Maithani, Sanchi; Ghosh, Barnali; Chaudhuri, Sujit; Pradhan, Manik

    2016-07-22

    The gastric pathogen Helicobacter pylori utilizes molecular hydrogen (H2) as a respiratory substrate during colonization in the gastric mucosa. However, the link between molecular H2 and the pathogenesis of peptic-ulcer disease (PUD) and non-ulcerous dyspepsia (NUD) by the enzymatic activity of H. pylori still remains mostly unknown. Here we provide evidence that breath H2 excretion profiles are distinctly altered by the enzymatic activity of H. pylori for individuals with NUD and PUD. We subsequently unravelled the potential molecular mechanisms responsible for the alteration of H2 in exhaled breath in association with peptic ulcers, encompassing both gastric and duodenal ulcers, along with NUD. We also established that carbon-isotopic fractionations in the acid-mediated bacterial environment regulated by bacterial urease activity cannot discriminate the actual disease state i.e. whether it is peptic ulcer or NUD. However, our findings illuminate the unusual molecular H2 in breath that can track the precise evolution of PUD and NUD, even after the eradication of H. pylori infection. This deepens our understanding of the pathophysiology of PUD and NUD, reveals non-invasively the actual disease state in real-time and thus offers a novel and robust new-generation strategy for treating peptic-ulcer disease together with non-ulcer related complications even when the existing (13)C-urea breath test ((13)C-UBT) fails to diagnose.

  19. Recovery from activity-stress ulcer by ad lib feeding in rats.

    PubMed

    Hirao, M; Tanaka, M; Emoto, H; Ishii, H; Yokoo, H; Yoshida, M; Tsuda, A

    1997-12-31

    In order to investigate the recovery from activity-stress ulcers by ad lib-feeding and/or cessation of running, male Wistar rats were exposed to the activity-stress paradigm, and the rats that revealed hypothermia (their rectal temperature fell below 36 degrees C) were sacrificed either immediately or after several 24 h periods of healing. Rats that were sacrificed immediately after the appearance of hypothermia and those that were exposed to restricted feeding plus cessation of running revealed severe activity-stress ulcers, whereas few ulcers were observed in rats given ad lib-feeding and those that were given ad lib-feeding plus cessation of running. Although no significant differences in relative weights of spleen and thymus were obtained among the different recovery conditions, the relative weights of the adrenal glands were highest in the restricted feeding plus cessation of running group, whereas, the other animals exposed to the activity-stress paradigm showed no differences. These results indicate that activity-stress ulcers recover under conditions of ad lib-feeding within 24 h, but they are not influenced by cessation of running. These data also suggest that organ weights are not affected by any manipulations employed in the present study.

  20. Deficient interleukin 2 dependent proliferation pathway in T lymphocytes from active and inactive ulcerative colitis patients.

    PubMed Central

    Manzano, L; Alvarez-Mon, M; Vargas, J A; Girón, J A; Abreu, L; Fernández-Corugedo, A; Román, L I; Albarran, F; Durántez, A

    1994-01-01

    There is increasing evidence that ulcerative colitis is associated with an abnormality of the immune system. Although the aetiology remains unknown, it has been suggested that the immune system of these patients is implicated in the pathogenesis of their disease. T cell function was investigated in ulcerative colitis patients and defective phytohaemagglutinin induced T cell mitogenesis was found. The DNA synthesis induced by stimulation with phorbol esters plus ionophore (ionomycin), however, was normal. These changes cannot be ascribed to either decreased interleukin 2 synthesis or to a defective interleukin 2 receptor expression after cellular activation. Moreover, this defective proliferative response of the T lymphocytes was observed even in the presence of saturated concentrations of exogenous interleukin 2. These results emphasise that the interleukin 2 dependent proliferation pathway is deficient in T lymphocytes from ulcerative colitis patients. PMID:8063224

  1. Gallbladder carcinoma - a rare cause of pyloric-duodenal stenosis.

    PubMed

    Niculescu, Zizi; Ulmeanu, Victoria; Ghinea, Mihaela Maria; Mocanu, Liliana; Niculescu, Costin; Grigorian, Mircea

    2016-01-01

    Pyloric duodenal stenosis is usually caused by pyloric, juxtapyloric or duodenal ulcer, or by postbulbar ulcer. Gallbladder cancer (GBC), duodenal diverticula, annular pancreas and superior mesenteric artery syndrome (Wilkie's syndrome) are rare causes of pyloric duodenal stenosis. The case of a 66-year-old female patient is presented. The patient was admitted to hospital presenting anorexia, repeated alimentary vomiting, epigastric pain, and weight loss. Objective clinical examination upon admission: clapotage à jeun is present, triggered by tapping the epigastric region. Laboratory tests reveal moderate anemia, hypokalemic alkalosis, increased levels of cholestatic enzymes and of tumor markers. Gastroendoscopy: Stomach presenting stasis fluid in large quantity. Deformed antropyloric region caused by extrinsic compression. Abdominal native magnetic resonance imaging (MRI) and with contrast medium: cholecyst lumen entirely obstructed with calculi; thickened wall, with heterogeneous gadolinophilia; gadolinophilic mass erasing the bordering limit in relation to the cholecyst wall and the colon hepatic angle, and leaving a print on the pyloric region. During surgery, upon opening the peritoneal cavity, a tumoral pericholecystic block was observed, including the pyloric-duodenal region and the transverse mesocolon. Histopathology tests of tissue samples showed adipose conjunctive tissue with invasive adenocarcinoma. Immunohistochemical tests [cytokeratin (CK) 7, CK17, CK19, CK20, CDX2, mucin (MUC) 1, MUC2, MUC5AC, MUC6, epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA)] were consistent with infiltrating neoplastic carcinoma, originating in the gallbladder epithelium. Gastrointestinal obstruction cases caused by gallbladder carcinoma are rare. The pyloric-duodenal region is more frequently affected, as compared to the small intestine or the colon.

  2. Laparoscopic-endoscopic cooperative surgery is a safe and effective treatment for superficial nonampullary duodenal tumors.

    PubMed

    Kyuno, Daisuke; Ohno, Keisuke; Katsuki, Shinichi; Fujita, Tomoki; Konno, Ai; Murakami, Takeshi; Waga, Eriko; Takanashi, Kunihiro; Kitaoka, Keisuke; Komatsu, Yuya; Sasaki, Kazuaki; Hirata, Koichi

    2015-11-01

    The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors.

  3. Risk factors and therapeutic response in Chinese patients with peptic ulcer disease

    PubMed Central

    Lee, Shou-Wu; Chang, Chi-Sen; Lee, Teng-Yu; Yeh, Hong-Zen; Tung, Chun-Fang; Peng, Yen-Chun

    2010-01-01

    AIM: To assess the risk factors and the efficacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan. METHODS: Patients with peptic ulcers, diagnosed by upper endoscopy, were retrospectively collected between January 2008 and December 2008. The differences were compared. RESULTS: Among all 448 cases, 254 (56.6%) and 194 (43.4%) patients had gastric ulcers and duodenal ulcers respectively. Patients with gastric ulcers were younger than those with duodenal ulcers. Although more men existed, there was a female predominance in middle-aged cases. Patients with duodenal ulcers had a higher rate of Helicobacter pylori (H. pylori) infection (62.4% vs 43.3%, P = 0.001), and those with gastric ulcers owned a significantly higher amount of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use (7.5% vs 1.5%, 6.7% vs 2.1%, P = 0.001). Tobacco smoking and alcohol drinking had no different impact between these two groups. Proton-pump inhibitors and H2-receptor antagonists (H2RA) were effective, but significantly less so in cases with duodenal ulcers receiving H2RAs, or in those with H. pylori infection and a history of NSAID use. CONCLUSION: Patients with gastric ulcers had lower H. pylori infection but more aspirin or NSAID use. Antisecretory therapy was ineffective in gastric ulcers underwent H2RA treatment, and cases combined H. pylori infection and NSAID use. PMID:20419840

  4. The limitations of current therapy in peptic ulcer disease.

    PubMed

    Salena, B J; Hunt, R H

    1987-05-01

    The current therapeutic approach to peptic ulcer disease includes agents that reduce gastric acidity and hence peptic activity, inactivate or adsorb pepsin, create a physical barrier against the effects of acid and pepsin, or enhance mucosal defence. Profound gastric acid reduction may predispose to infection, and it has been suggested that carcinogenesis is possible, although a cause-effect relationship has never been established. The side-effects of therapy are well-described, and may limit the therapeutic approach. Healing rates correlate closely with acid suppression in duodenal ulcer, but not entirely in gastric ulcer. Maintenance therapy lowers the relapse rate, but does not alter the ulcer diathesis. The optimal strategy for long-term management remains unclear, but in the future one should consider outcome measures which include a decrease in pain, improvement in the quality of life, reduction work loss, and a reduction of complications, in addition to ulcer healing. The ideal therapy should be efficacious, safe, and convenient--with no side-effects--and cost-effective. New agents should suppress acid and peptic activity, while enhancing the gastric mucosal defence mechanisms (such as mucosal blood flow, mucus, and bicarbonate secretion) and stimulating gastric cellular regeneration and restitution.

  5. Duodenal luminal nutrient sensing

    PubMed Central

    Rønnestad, Ivar; Akiba, Yasutada; Kaji, Izumi; Kaunitz, Jonathan D

    2016-01-01

    The gastrointestinal mucosa is exposed to numerous chemical substances and microorganisms, including macronutrients, micronutrients, bacteria, endogenous ions, and proteins. The regulation of mucosal protection, digestion, absorption and motility is signaled in part by luminal solutes. Therefore, luminal chemosensing is an important mechanism enabling the mucosa to monitor luminal conditions, such as pH, ion concentrations, nutrient quantity, and microflora. The duodenal mucosa shares luminal nutrient receptors with lingual taste receptors in order to detect the five basic tastes, in addition to essential nutrients, and unwanted chemicals. The recent ‘de-orphanization’ of nutrient sensing G protein-coupled receptors provides an essential component of the mechanism by which the mucosa senses luminal nutrients. In this review, we will update the mechanisms of and underlying physiological and pathological roles in luminal nutrient sensing, with a main focus on the duodenal mucosa. PMID:25113991

  6. Evaluation of gastric anti-ulcer activity of fixed oil of Ocimum basilicum Linn. and its possible mechanism of action.

    PubMed

    Singh, S

    1999-03-01

    Fixed oil of O. basilicum was found to possess significant antiulcer activity against aspirin, indomethacin, alcohol, histamine, reserpine, serotonin and stress-induced ulceration in experimental animal models. Significant inhibition was also observed in aspirin-induced gastric ulceration and secretion in pylorus ligated rats. The lipoxygenase inhibiting, histamine antagonistic and antisecretory effects of the oil could probably contribute towards antiulcer activity. O. basilicum fixed oil may be considered to be a drug of natural origin which possesses both antiinflammatory and anti-ulcer activity.

  7. Increased absorption of polyethylene glycol 600 deposited in the colon in active ulcerative colitis.

    PubMed Central

    Almer, S; Franzén, L; Olaison, G; Smedh, K; Ström, M

    1993-01-01

    A defect in the barrier function of the intestinal mucosa has been proposed as important in both the pathogenesis and systemic manifestations of inflammatory bowel disease. After colonoscopy, polymers of polyethylene glycol (PEG) with molecular weights of 414-810 (mean 600), were instilled in the descending colon of patients with ulcerative colitis (n = 17) and in controls without intestinal inflammation (n = 8). The patients with active ulcerative colitis (n = 6) had a significantly increased uptake of PEGs in the molecular weight range 458-810, measured as urinary excretion over the first 6 hours after instillation. The median values for their excretion were 2.85-3.80% of PEGs instilled compared with 0.32-0.94% for patients in remission (n = 11) (p < 0.05-0.01) and 0.17-0.60% for the controls (p < 0.05-0.01). The differences in absorption of PEG 414 did not reach the present level of statistical significance. There was a positive correlation between PEG absorption and the endoscopic and histological grading of inflammatory activity in the sigmoid colon (p < 0.01-0.001). These findings support a correlation between the presence of active inflammation and PEG absorption. There was little evidence to support the presence of a primary defect in the colonic barrier in patients with ulcerative colitis. PMID:8491399

  8. [Duodenal complications of rheumatoid purpura. Endoscopic aspects].

    PubMed

    Chapoy, P; Guidon, M J; Louchet, E

    1984-01-01

    The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

  9. Evaluation of anti-ulcer activity of the leaf extract of Osyris quadripartita Decne. (Santalaceae) in rats

    PubMed Central

    Abebaw, Mastewal; Mishra, Bharat; Gelayee, Dessalegn Asmelashe

    2017-01-01

    Osyris quadripartita (OQ) Salzm. ex Decne. has been used to treat peptic ulcer disease in Ethiopian folk medicine, but its efficacy has not been validated. The present study was therefore carried out to evaluate the anti-ulcer activity of 80% methanol leaf extract of OQ in rats. The effect of OQ extract on gastric ulcer in rats in pylorus ligation-induced and ethanol-induced models was studied using single dosing (100, 200, 400 mg/kg) and repeated dosing (200 mg/kg for 10 and 20 days) approaches. Ranitidine (50 mg/kg) and sucralfate (100 mg/kg) were used as the standard drugs. Depending on the model, outcome measures were volume and pH of gastric fluid, total acidity, ulcer score, percent inhibition of ulcer score, ulcer index as well as percent inhibition of ulcer index. Data were analyzed using one-way analysis of variance followed by Tukey’s post hoc test, and P<0.05 was considered as statistically significant. OQ significantly (P<0.001) reduced gastric ulcer index by 55.82% and 62.11%, respectively, in pylorus ligation-induced and ethanol-induced ulcer models at the 400 mg/kg dose, which is comparable to the standard drugs. Ten and 20 days pre-treatment with OQ200 exhibited significant (P<0.001) ulcer inhibition by 66.48% and 68.36% (pylorus ligation-induced model) as well as 71.48% and 85.35% (ethanol-induced model), respectively. OQ possesses both dose-dependent and time-dependent anti-ulcer effect in the two models. The oral median lethal dose (LD50) is estimated to be higher than 2000 mg/kg for the crude hydroalcoholic extract, and secondary metabolites such as flavonoids, tannins, and saponins were present. The findings of this study confirmed that OQ has anti-ulcer pharmacologic activity due to one or more of the secondary metabolites present in it. Therefore, this study validates its anti-ulcer use in Ethiopian folk medicine. Further investigations on isolation of specific phytochemicals and elucidating mechanisms of action are needed. PMID:28144167

  10. Roles of platelets and proteinase-activated receptors in gastric ulcer healing.

    PubMed

    Perini, Rafael; Wallace, John L; Ma, Li

    2005-10-01

    Proteinase-activated receptors (PARs) are expressed on the surface of many cells, but those on the platelet have been among the most thoroughly characterized. PARs act as key receptors mediating the proaggregatory and pro-secretory effects of thrombin. In addition to contributing to hemostasis, platelets are increasingly being viewed as important contributors to healing and to tumor growth. This is attributable to the many pro- and anti-angiogenic factors that are stored within platelets, which can be released at the sites of injury and new vessel growth. In this paper, we review the importance of the platelet in gastric ulcer healing, the contribution of platelet-contained angiogenic factors to the healing of gastric ulcers, and the role of PARs in regulating the release of angiogenic factors from platelets. Taken together, our results suggest that PARs, including those expressed on platelets, are a rational therapeutic target for modulating healing processes and tumor growth.

  11. Mycolactone activation of Wiskott-Aldrich syndrome proteins underpins Buruli ulcer formation

    PubMed Central

    Guenin-Macé, Laure; Veyron-Churlet, Romain; Thoulouze, Maria-Isabel; Romet-Lemonne, Guillaume; Hong, Hui; Leadlay, Peter F.; Danckaert, Anne; Ruf, Marie-Thérèse; Mostowy, Serge; Zurzolo, Chiara; Bousso, Philippe; Chrétien, Fabrice; Carlier, Marie-France; Demangel, Caroline

    2013-01-01

    Mycolactone is a diffusible lipid secreted by the human pathogen Mycobacterium ulcerans, which induces the formation of open skin lesions referred to as Buruli ulcers. Here, we show that mycolactone operates by hijacking the Wiskott-Aldrich syndrome protein (WASP) family of actin-nucleating factors. By disrupting WASP autoinhibition, mycolactone leads to uncontrolled activation of ARP2/3-mediated assembly of actin in the cytoplasm. In epithelial cells, mycolactone-induced stimulation of ARP2/3 concentrated in the perinuclear region, resulting in defective cell adhesion and directional migration. In vivo injection of mycolactone into mouse ears consistently altered the junctional organization and stratification of keratinocytes, leading to epidermal thinning, followed by rupture. This degradation process was efficiently suppressed by coadministration of the N-WASP inhibitor wiskostatin. These results elucidate the molecular basis of mycolactone activity and provide a mechanism for Buruli ulcer pathogenesis. Our findings should allow for the rationale design of competitive inhibitors of mycolactone binding to N-WASP, with anti–Buruli ulcer therapeutic potential. PMID:23549080

  12. An endoscopic laser Doppler flowmetry of a gastroduodenal mucosa at bleeding ulcer

    NASA Astrophysics Data System (ADS)

    Shapkin, U. G.; Kapralov, C. V.; Gogolev, A. A.; Lychagov, V. V.; Tuchin, V. V.

    2006-08-01

    One of the important problems of a bleeding gastroduodenal ulcer surgery is a prognosis of the recurrent hemorrhage and appraisal of endoscopic hemostasis quality. Endoscopic Laser Doppler Flowmetry of a mucous coat of stomach and a duodenum was made on 34 patients for the purpose of investigation of features of microcirculation. Analogous researches are made on 30 patients with a peptic ulcer and on 28 practically healthy people. Analysis of LDF-grams has shown certain differences in regional microcirculations in stomach and duodenal at normal and at a pathology. Increase of regional perfusion in periulcerose zone with its pathology disbalance can serve as a criterion for activities of an alteration processes in gastroduodenal ulcer defining the risk of possible hemorrhage.

  13. Duodenal bacterial overgrowth during treatment in outpatients with omeprazole.

    PubMed Central

    Fried, M; Siegrist, H; Frei, R; Froehlich, F; Duroux, P; Thorens, J; Blum, A; Bille, J; Gonvers, J J; Gyr, K

    1994-01-01

    The extent of duodenal bacterial overgrowth during the pronounced inhibition of acid secretion that occurs with omeprazole treatment is unknown. The bacterial content of duodenal juice of patients treated with omeprazole was therefore examined in a controlled prospective study. Duodenal juice was obtained under sterile conditions during diagnostic upper endoscopy. Aspirates were plated quantitatively for anaerobic and aerobic organisms. Twenty five outpatients with peptic ulcer disease were investigated after a 5.7 (0.5) weeks (mean (SEM)) treatment course with 20 mg (nine patients) or 40 mg (16 patients). The control group consisted of 15 outpatients referred for diagnostic endoscopy without prior antisecretory treatment. No patient in the control group had duodenal bacterial overgrowth. In the omeprazole group bacterial overgrowth (> or = 10(5) cfu/ml) was found in 14 (56%) patients (p = 0.0003). The number of bacteria (log10) in duodenal juice in patients treated with omeprazole was distinctly higher (median 5.7; range < 2-8.7) when compared with the control group (median < 2; range < 2-5.0; p = 0.0004). As well as orally derived bacteria, faecal type bacteria were found in seven of 14 and anaerobic bacteria in three of 14 patients. Bacterial overgrowth was similar with the two doses of omeprazole. These results indicate that duodenal bacterial overgrowth of both oral and faecal type bacteria occurs often in ambulatory patients treated with omeprazole. Further studies are needed to determine the clinical significance of these findings, particularly in high risk groups during long term treatment with omeprazole. PMID:8307444

  14. Brain processing of duodenal and portal glucose sensing.

    PubMed

    Boubaker, J; Val-Laillet, D; Guérin, S; Malbert, C-H

    2012-08-01

    Peripheral and central glucose sensing play a major role in the regulation of food intake. Peripheral sensing occurs at duodenal and portal levels, although the importance of these sensing sites is still controversial. The present study aimed to compare the respective influence of these sensing pathways on the eating patterns; plasma concentrations of glucose, insulin and glucagon-like peptide-1 (GLP-1); and brain activity in juvenile pigs. In Experiment 1, we characterised the changes in the microstructure as a result of a 30-min meal in eight conscious animals after duodenal or portal glucose infusion in comparison with saline infusion. In Experiment 2, glucose, insulin and GLP-1 plasma concentrations were measured during 2 h after duodenal or portal glucose infusions in four anaesthetised animals. In Experiment 3, single photon emission computed tomography brain imaging was performed in five anaesthetised animals receiving duodenal or portal glucose or saline infusions. Both duodenal and portal glucose decreased the amount of food consumed, as well as the ingestion speed, although this effect appeared earlier with the portal infusion. Significant differences of glucose and GLP-1 plasma concentrations between treatments were found at the moment of brain imaging. Both duodenal and portal glucose infusions activated the dorsolateral prefrontal cortex and primary somatosensory cortex. Only duodenal glucose infusion was able to induce activation of the prepyriform area, orbitofrontal cortex, caudate and putamen, as well as deactivation of the anterior prefrontal cortex and anterior entorhinal cortex, whereas only portal glucose infusion induced a significant activation of the insular cortex. We demonstrated that duodenal and portal glucose infusions led to the modulation of brain areas that are known to regulate eating behaviour, which probably explains the decrease of food intake after both stimulations. These stimulation pathways induced specific systemic and

  15. Phytochemical composition, protective and therapeutic effect on gastric ulcer and α-amylase inhibitory activity of Achillea biebersteinii Afan.

    PubMed

    Abd-Alla, Howaida I; Shalaby, Nagwa M M; Hamed, Manal A; El-Rigal, Nagy Saba; Al-Ghamdi, Samira N; Bouajila, Jalloul

    2016-01-01

    Three sesquiterpene lactones [two germacranolides (micranthin and sintenin) and one guaianolide (4β,10α-dihydroxy-5β,7β,8βH-guaia-1,11(13)dien-12,8α-olide)] and four derivatives of 3-methoxy flavones (santin, quercetagetin-3,6,3'-trimethyl ether, quercetagetin-3,6-dimethyl ether, and 5,7 dihydroxy 3,3',4'-trimethoxy flavone) were isolated from the ethyl acetate extract (EAE) of the aerial parts of Achillea biebersteinii Afan. (Asteraceae). Evaluation of protective and therapeutic effects of EAE against ethanol-induced gastric ulcer in rats was carried. Antiulcer activity evaluation was done through measuring ulcer indices, stomach acidity, gastric volume and lesion counts. Oxidative stress markers; malondialdehyde, glutathione and superoxide dismutase were also estimated. The work was extended to determine the histopathological assessment of the stomach. Gastric ulcer exhibited a significant elevation of the ulcer index and oxidative stress markers. The extract attenuated these increments and recorded protective and therapeutic effects against gastric ulcer. Hyperglycaemia increases the mucosal susceptibility to ulcerogenic stimuli and predisposes gastric ulceration. In vitro α-amylase inhibitory assay was applied to evaluate the post prandial antihyperglycaemia activity. The result showing that the EAE has the ability to reduce starch-induced postprandial glycaemic excursions by virtue of potent intestinal α-amylase inhibitory activity. These findings demonstrated the remarkable potential of A. biebersteinii as valuable source of antiulcer agent with post prandial hyperglycaemia lowering effect.

  16. Evaluation of inflammatory activity in Crohn’s disease and ulcerative colitis

    PubMed Central

    Vilela, Eduardo Garcia; Torres, Henrique Osvaldo da Gama; Martins, Fabiana Paiva; Ferrari, Maria de Lourdes de Abreu; Andrade, Marcella Menezes; da Cunha, Aloísio Sales

    2012-01-01

    Crohn’s disease and ulcerative colitis evolve with a relapsing and remitting course. Determination of inflammatory state is crucial for the assessment of disease activity and for tailoring therapy. However, no simple diagnostic test for monitoring intestinal inflammation is available. Noninvasive markers give only indirect assessments of disease activity. Histopathological or endoscopical examinations accurately assess inflammatory activity, but they are invasive, time consuming and expensive and therefore are unsuitable for routine use. Imaging procedures are not applicable for ulcerative colitis. The usefulness of ultrasound and Doppler imaging in assessing disease activity is still a matter of discussion for Crohn’s disease, and an increased interest in computed tomography enterograph (CTE) has been seen, mainly because it can delineate the extent and severity of bowel wall inflammation, besides detecting extraluminal findings. Until now, the available data concerning the accuracy of magnetic resonance enterography in detecting disease activity is less than CTE. Due to this, clinical activity indices are still commonly used for both diseases. PMID:22408345

  17. Activation of nuclear factor κB in colonic mucosa from patients with collagenous and ulcerative colitis

    PubMed Central

    Andresen, L; Jørgensen, V L; Perner, A; Hansen, A; Eugen-Olsen, J; Rask-Madsen, J

    2005-01-01

    Background and aims: Expression of inducible nitric oxide synthase (iNOS) is greatly upregulated in the colonic mucosa of patients with collagenous and ulcerative colitis. As the transcription factor nuclear factor κB (NFκB) is a major inducer of iNOS gene expression, we compared activation and transcriptional activity of NFκB in colonic mucosal biopsies from these patients. Patients: Eight patients with collagenous colitis, six with relapsing ulcerative colitis, and eight with uninflamed bowel were studied. Methods: NFκB DNA binding activity was assessed by electrophoretic mobility shift assay and inhibitor of NFκB (IκB) kinase (IKK) activity by immunocomplex kinase assay. In vivo recruitment of NFκB to the iNOS promoter was determined by chromatin immunoprecipitation analysis and transcriptional activity by NFκB gene expression profiling arrays. Cells showing NFκB activation were identified by immunohistochemistry. Results: In collagenous and ulcerative colitis, as opposed to uninflamed bowel, IKKβ activity and strong NFκB DNA binding gave rise to activation of identical NFκB subunits and recruitment of transcriptionally active p65 to the iNOS promoter. In collagenous colitis, activated NFκB was observed only in epithelial cells while up to 10% of lamina propria macrophages showed activation in ulcerative colitis. Conclusions: In collagenous and ulcerative colitis, colonic mucosal NFκB is activated and recruited to the iNOS promoter in vivo via an IKKβ mediated pathway. As collagenous colitis is not associated with tissue injury, these data challenge the prevailing view that activation of NFκB per se mediates tissue injury. Our results suggest that downstream inflammatory reactions leading to tissue damage originate in lamina propria immune cells, as increased NFκB activity in collagenous colitis was localised solely in epithelial cells, but present also in macrophages in ulcerative colitis. PMID:15753535

  18. Ugh! Ulcers

    MedlinePlus

    ... Going to the Doctor Medicines for Ulcers Ulcer Prevention "If you kids don't stop yelling, you'll give me an ulcer!" "Don't worry so much. You'll give yourself an ulcer." Have you ever heard people talk like this about ulcers? It ...

  19. Cysteamine-induced inhibition of acid neutralization and the increase in hydrogen ion back-diffusion in duodenal mucosa

    SciTech Connect

    Ohe, K.; Okada, Y.; Fujiwara, T.; Inoue, M.; Miyoshi, A.

    1982-03-01

    To investigate the possible impairment of defensive mechanisms in cysteamine-induced duodenal ulceration, the effect of cysteamine on the neutralization of acid by the duodenum and the back-diffusion of hydrogen ions into the duodenal mucosa has been studied. The results obtained were as follows. (1) The intraduodenal pH started to decrease between 3 and 4 hr after cysteamine injection. (2) By perfusion of the duodenal loop excluding the opening of bile and pancreatic ducts, the amount of hydrogen ions (H+) neutralized was found to be significantly lower in cysteamine-treated animals than in the controls. (3) the back-diffusion of luminal H+ into the duodenal mucosa, estimated by measuring the H+ disappearance from the test solution including 100 mM HCl, was significantly increased by cysteamine. From these findings, it has been concluded that cysteamine reduces the resistance of duodenal mucosa to acid coming from the stomach.

  20. Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae.

    PubMed

    van Ierland-van Leeuwen, Marloes; Peringa, Jan; Blaauwgeers, Hans; van Dam, Alje

    2014-10-29

    A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.

  1. Intramural hematoma of duodenum: An unusual complication after endoscopic therapy for a bleeding peptic ulcer.

    PubMed

    Kumar, Ramesh; Sharma, Manoj Kumar; Bhatia, Vikram; Garg, Hitendra Kumar; Sundar, Shyam

    2011-04-01

    Intramural hematoma of duodenum (IDH) is a relatively unusual complication associated with endoscopic treatment of bleeding peptic ulcer. This unusual condition is usually seen in children following blunt trauma to the abdomen. We describe here a case of IDH occurring following endoscopic therapy for bleeding duodenal ulcer in an adult patient with end-stage renal disease. The hematomas appeared on the second day of endoscopic intervention, caused transient duodenal obstruction and resolved spontaneously with conservative treatment in a week.

  2. Functional impairment of natural killer cells in active ulcerative colitis: reversion of the defective natural killer activity by interleukin 2.

    PubMed Central

    Manzano, L; Alvarez-Mon, M; Abreu, L; Antonio Vargas, J; de la Morena, E; Corugedo, F; Duràntez, A

    1992-01-01

    We have studied the functional characteristics and clinical importance of the natural killer (NK) cytotoxicity of peripheral blood mononuclear cells (PBMNC) from patients with ulcerative colitis. Normal NK activity was observed in PBMNC from patients with inactive disease, but a pronounced decrease was found in those with active disease. Clinical change from active to inactive disease was associated with enhancement of the depressed NK activity. The impairment of NK cytotoxicity found in patients with active disese could not be ascribed to a deficient number of NK cells as the amounts of HNK-1+, CD16+ (Leu 11), and CD11b (OKM1) cells in PBMNC were within normal ranges. This defective cytotoxic PBMNC activity was normalised by short term (18 hour) incubation with recombinant interleukin 2 (rIL-2). Moreover, long term (5 day) incubation of these effector cells with rIL-2 induced strong cytotoxic activity against NK resistant and NK sensitive target cells in patients with active and inactive disease. We also found that both precursors and effectors of cytotoxic activity promoted by short term and long term incubation with rIL-2 of PBMNC from the patients showed the phenotype of NK cells (CD16+, CD3-). Taken together, these results show that active ulcerative colitis is associated with a defective function of NK cells that is found to be normal in the inactive stage of the disease. The possible pathogenic and therapeutic implications of these findings are discussed. PMID:1541421

  3. Gedunin and photogedunin of Xylocarpus granatum show significant anti-secretory effects and protect the gastric mucosa of peptic ulcer in rats.

    PubMed

    Lakshmi, V; Singh, N; Shrivastva, S; Mishra, S K; Dharmani, P; Mishra, V; Palit, G

    2010-07-01

    In the present study, the gastroprotective mechanism of Xylocarpus granatum fruit and its active constituents gedunin and photogedunin was investigated. Chloroform fraction (Fr-CHCl(3)) of X. granatum fruit was evaluated against cold restraint (CRU), aspirin (AS), alcohol (AL) and pyloric ligation (PL) induced gastric ulcer models in rats and histamine (HA) induced duodenal ulcer model in guinea pigs. Potential anti-ulcer activity of Fr-CHCl(3) was observed against CRU (58.28%), AS (67.81%), AL (84.38%), PL (65.66%) and HA (61.93%) induced ulcer models. The standard drug omeprazole (10mg/kg, p.o.) showed 68.25% protection against CRU, 57.08% against AS and 69.42% against PL model and 70.79% against HA induced duodenal ulcer. Sucralfate, another standard drug (500 mg/kg, p.o.) showed 62.72% protection in AL induced ulcer model. Fr-CHCl(3) significantly reduced free acidity (51.42%), total acidity (30.76%) and upregulated mucin secretion by 58.37% respectively. Phytochemical investigations of Fr-CHCl(3) yielded gedunin (36%), photogedunin (2%). Further, Fr-CHCl(3) and its compounds gedunin and photogedunin significantly inhibited H(+) K(+)-ATPase activity in vitro with IC(50) of 89.37, 56.86 and 66.54 microg/ml respectively as compared to the IC(50) value of omeprazole (30.24 microg/ml) confirming their anti-secretory activity. Conclusively, Fr-CHCl(3) of Xylocarpus granatum was found to possess anti-ulcerogenic activity which might be due to its anti-secretory activity and subsequent strengthening of the defensive mechanism. This study is the first of its kind to show significant anti-secretory effect of gedunin and photogedunin. Therefore it could act as a potent therapeutic agent against peptic ulcer disease.

  4. [Oral ulcers].

    PubMed

    Bascones-Martínez, Antonio; Figuero-Ruiz, Elena; Esparza-Gómez, Germán Carlos

    2005-10-29

    Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology.

  5. The Gastroprotective Role of Acanthus ilicifolius – A Study to Unravel the Underlying Mechanism of Anti-Ulcer Activity

    PubMed Central

    Mani Senthil Kumar, K. T.; Puia, Zothan; Samanta, Samir K.; Barik, Rajiv; Dutta, Arnab; Gorain, Bapi; Roy, Dilip K.; Adhikari, Dipan; Karmakar, Sanmoy; Sen, Tuhinadri

    2012-01-01

    Acanthus ilicifolius (Acanthaceae), a mangrove medicinal plant, is widely used by the local inhabitants of the Sundarbans (India) to treat a variety of diseases. As a part of our continued search for novel bioactive products from mangrove medicinal plants, we were able to document the anti-inflammatory effects of this plant. In the present study, we have performed a detailed evaluation of the gastroprotective activity of the methanolic extract of Acanthus ilicifolius using different models of gastric ulceration. Unlike the conventional non-steroidal anti-inflammatory drugs, a methanolic extract of Acanthus ilicifolius leaves (MEAL) possessing significant anti-inflammatory properties, as revealed from our previous studies displayed in rats in dosages of 200 mg and 400 mg/kg BW after intraperitoneal administration, showed significant protective activity (anti-ulcer activity) against the gastric lesions induced by aspirin, indomethacin, stress, ethanol, and pylorus ligation. In pylorus-ligated rats, administration of Methanolic extract of Acanthus ilicifolius leaves (MEAL) significantly decreased gastric volume, acidity, and peptic activity. Moreover, pre-treatment with MEAL significantly restored the levels of reduced glutathione (GSH) and the antioxidant enzyme superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX), along with significant inhibition of both lipid peroxidation and myeloperoxidase (MPO) activity in pylorus-ligated animals. Ulceration induced with ethanol was significantly inhibited with MEAL, and the extract also resulted in the reduction of both lipid peroxidation and myeloperoxidase activity. Furthermore, in this experimental model, administration of MEAL improved the activities of SOD, CAT, GSH, and GPX. A similar pattern of action was also noticed in cold-restraint stress-induced (CRS) ulceration, where MEAL pre-treatment inhibited CRS-induced ulceration, improved the status of antioxidant enzymes, and also reduced the level

  6. Role of peroxisome proliferator-activated receptors alpha and gamma in gastric ulcer: An overview of experimental evidences

    PubMed Central

    Saha, Lekha

    2015-01-01

    Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. Three subtypes, PPARα, PPARβ/δ, and PPARγ, have been identified so far. PPARα is expressed in the liver, kidney, small intestine, heart, and muscle, where it activates the fatty acid catabolism and control lipoprotein assembly in response to long-chain unsaturated fatty acids, eicosanoids, and hypolipidemic drugs (e.g., fenofibrate). PPARβ/δ is more broadly expressed and is implicated in fatty acid oxidation, keratinocyte differentiation, wound healing, and macrophage response to very low density lipoprotein metabolism. This isoform has been implicated in transcriptional-repression functions and has been shown to repress the activity of PPARα or PPARγ target genes. PPARγ1 and γ2 are generated from a single-gene peroxisome proliferator-activated receptors gamma by differential promoter usage and alternative splicing. PPARγ1 is expressed in colon, immune system (e.g., monocytes and macrophages), and other tissues where it participates in the modulation of inflammation, cell proliferation, and differentiation. PPARs regulate gene expression through distinct mechanisms: Ligand-dependent transactivation, ligand-independent repression, and ligand-dependent transrepression. Studies in animals have demonstrated the gastric antisecretory activity of PPARα agonists like ciprofibrate, bezafibrate and clofibrate. Study by Pathak et al also demonstrated the effect of PPARα agonist, bezafibrate, on gastric secretion and gastric cytoprotection in various gastric ulcer models in rats. The majority of the experimental studies is on pioglitazone and rosiglitazone, which are PPARγ activators. In all the studies, both the PPARγ activators showed protection against the gastric ulcer and also accelerate the ulcer healing in gastric ulcer model in rats. Therefore, PPARα and PPARγ may be a target for gastric ulcer therapy

  7. Curcumin Blocks Naproxen-Induced Gastric Antral Ulcerations through Inhibition of Lipid Peroxidation and Activation of Enzymatic Scavengers in Rats.

    PubMed

    Kim, Jeong-Hwan; Jin, Soojung; Kwon, Hyun Ju; Kim, Byung Woo

    2016-08-28

    Curcumin is a polyphenol derived from the plant Curcuma longa, which is used for the treatment of diseases associated with oxidative stress and inflammation. The present study was undertaken to determine the protective effect of curcumin against naproxen-induced gastric antral ulcerations in rats. Different doses (10, 50, and 100 mg/kg) of curcumin or vehicle (curcumin, 0 mg/kg) were pretreated for 3 days by oral gavage, and then gastric mucosal lesions were caused by 80 mg/kg naproxen applied for 3 days. Curcumin significantly inhibited the naproxen-induced gastric antral ulcer area and lipid peroxidation in a dose-dependent manner. In addition, curcumin markedly increased activities of radical scavenging enzymes, such as superoxide dismutase (SOD), catalase, and glutathione peroxidase in a dose-dependent manner. Specifically, 100 mg/kg curcumin completely protected the gastric mucosa against the loss in the enzyme, resulting in a drastic increase of activities of radical scavenging enzymes up to more than the level of untreated normal rats. Histological examination obviously showed that curcumin prevents naproxen-induced gastric antral ulceration as a result of direct protection of the gastric mucosa. These results suggest that curcumin blocks naproxen-induced gastric antral ulcerations through prevention of lipid peroxidation and activation of radical scavenging enzymes, and it may offer a potential remedy of gastric antral ulcerations.

  8. Prevention and treatment of ulcers induced by nonsteroidal anti-inflammatory drugs: an update.

    PubMed

    Dajani, E Z; Agrawal, N M

    1995-03-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are most frequently used for the treatment of rheumatic disease due to their anti-inflammatory and analgesic properties. All NSAIDs have the potential to cause damage to the gastrointestinal (GI) tract and have been associated with the induction of peptic ulcers and massive life-threatening bleeding. The therapeutic approaches for the treatment and prevention of NSAID-induced ulcers is critically reviewed using data derived from carefully controlled, world-wide clinical studies with anti-ulcer drugs. Histamine (H2) antagonists, omeprazole, sucralfate and E-prostaglandin (PGE) analogs are effective for the treatment of NSAID-induced gastric and duodenal ulcers, if NSAIDs are discontinued. However, if NSAIDs are continued while GI damage is present, the PGE analogs misoprostol, arbaprostil and enprostil have shown efficacy in healing NSAID-induced ulcers. Furthermore, one limited clinical study demonstrated that omeprazole has efficacy in healing NSAID-associated ulcers. Neither H2 antagonists, sucralfate and sulglycotide (a cytoprotective drug) have shown efficacy in preventing NSAID-induced gastric ulcers. However H2 antagonists have shown efficacy in preventing NSAID-induced duodenal ulcers. In contrast, only misoprostol prevents the development of NSAID-induced gastric and duodenal ulcers. Such pharmacological observations suggest that the pathophysiologic mechanisms for the induction of NSAID-induced gastric ulcer are distinctly different from those of NSAID-induced duodenal ulcers. Mild diarrhea and GI intolerance were the predominant adverse reactions experienced by patients receiving synthetic PGEs, particularly enprostil and arbaprostil. From the published data, we conclude that misoprostol is the only anti-ulcer drug proven to be well tolerated and effective for the treatment and prevention of NSAID-induced gastric and duodenal ulcers in patients receiving chronic NSAIDs therapy.

  9. Disease activity, quality of life, and indirect costs of ulcerative colitis in Poland

    PubMed Central

    Stawowczyk, Ewa; Mossakowska, Małgorzata; Pilc, Andrzej

    2017-01-01

    Introduction Ulcerative colitis (UC) require expensive, lifelong treatment, which generates huge direct costs and has a significant impact on the quality of life, especially in the active state of the disease. Aim To assess the indirect costs, health-related quality of life, and clinical characteristics of patients with UC in Poland. Additionally, we investigated the association between activity of UC and productivity loss of patients in a Polish setting. Material and methods A questionnaire survey was conducted using the Patient Simple Clinical Colitis Activity Index (P-SCCAI) to assess disease activity, as well as the modified Work Productivity and Activity Impairment Questionnaire to assess productivity loss. The quality of life was presented as utility calculated with the EQ-5D-3L questionnaire. Indirect costs were assessed with the Human Capital Approach and were expressed in Polish zlotys (PLN) as well as in euros (€). Correlations were presented using the Spearman coefficient. Results We performed our analysis based on 202 full questionnaires collected. Mean patient age and age at disease onset were 33.14 years (standard deviation (SD): 9.90) and 26.35 years (SD: 8.89), respectively. The mean P-SCCAI score in the analysed group of patients was 8.26, and the mean utility was 0.8651. Average and median annual indirect costs per working person were €2043 and €1389 (8543 PLN and 5808 PLN), respectively, calculated using the gross domestic product, as well as €4791 and €3257 (20,026 PLN and 13,615 PLN), respectively, calculated using the gross value added. Total productivity loss was significantly correlated with the disease activity. Conclusions Ulcerative colitis causes a decrease in the quality of life as well as patients’ productivity loss associated with both absenteeism and with presenteeism. PMID:28337239

  10. Theoretical and experimental study of aparisthman: A natural product with anti-ulcer activity

    NASA Astrophysics Data System (ADS)

    Brasil, D. S. B.; Moreira, R. Y. O.; Müller, A. H.; Alves, C. N.

    Aparisthman is a furan diterpenoid with a clerodane skeleton isolated from Aparisthmium cordatum (Juss.) Bail. (Euphorbiaceae). This natural product presents significant anti-ulcer activity to the level of cimetidine (Tagamet®), a compound used for the treatment of ulcers provoked by stress. The structure of X-ray diffraction of the aparisthman was compared with theoretical calculations and the results showed that the theory is in accordance with the experimental data. The infrared (IR) and nuclear magnetic resonance (NMR) spectra also were obtained and compared with theoretical calculations. The B3LYP theory level, with the 6-31G(d,p) basis set, leads the value to the IR absorption close to the value experimentally observed. NMR theoretical obtained with HF/6-311+G(2d,p) shows little deviation of experimental results. Calculations of molecular electrostatic potential and stabilization energies suggest that the protonation of aparisthman will be able to occur on carbonyl oxygen atom (O4).

  11. Antiulcerogenic activity of Scutia buxifolia on gastric ulcers induced by ethanol in rats

    PubMed Central

    Boligon, Aline Augusti; de Freitas, Robson Borba; de Brum, Thiele Faccim; Waczuk, Emily Pansera; Klimaczewski, Cláudia Vargas; de Ávila, Daiana Silva; Athayde, Margareth Linde; de Freitas Bauermann, Liliane

    2014-01-01

    Gastric ulcers affect many people around the world and their development is a result of the imbalance between aggressive and protective factors in the gastric mucosa. Scutia buxifolia, commonly known as coronilha, has attracted the interest of the scientific community due to its pharmacological properties and its potential therapeutic applications. In this study, the preventive effects of the crude extract of Scutia buxifolia (ceSb) against gastric ulcer induced by 70% ethanol were evaluated in male Wistar rats. In addition, the composition of ceSb was clarified by high-performance liquid chromatography (HPLC). S. buxifolia extract (100, 200 and 400 mg/kg body weight) attenuated oxidative and histopathological features induced by ethanol. Moreover, all evaluated doses of ceSb caused significant (P<0.001 and P<0.0001) and dose-dependent increase in sulfhydryl groups (NPSH) levels, catalase (CAT) and superoxide dismutase (SOD) activities. Furthermore, the administration of ceSb reversed the increase in lipid peroxidation produced by ethanol. The protective effect of the extract could be attributed to antioxidant compounds present in the ceSb, such as flavonoids and phenolic acids, which were quantified by HPLC. Thus, an antioxidant effect of the extract leads to a protection on gastric tissue. These results indicate that S. buxifolia could have a beneficial role against ethanol toxicity by preventing oxidative stress and gastric tissue injury. PMID:26579405

  12. Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer

    SciTech Connect

    Kelly, Patrick; Das, Prajnan; Pinnix, Chelsea C.; Beddar, Sam; Briere, Tina; Pham, Mary; Krishnan, Sunil; Delclos, Marc E.; Crane, Christopher H.

    2013-03-01

    Purpose: Improving local control is critical to improving survival and quality of life for patients with locally advanced unresectable pancreatic cancer (LAPC). However, previous attempts at radiation dose escalation have been limited by duodenal toxicity. In order to guide future studies, we analyzed the clinical and dosimetric factors associated with duodenal toxicity in patients undergoing fractionated chemoradiation for LAPC. Methods and Materials: Medical records and treatment plans of 106 patients with LAPC who were treated with chemoradiation between July 2005 and June 2010 at our institution were reviewed. All patients received neoadjuvant and concurrent chemotherapy. Seventy-eight patients were treated with conventional radiation to 50.4 Gy in 28 fractions; 28 patients received dose-escalated radiation therapy (range, 57.5-75.4 Gy in 28-39 fractions). Treatment-related toxicity was graded according to Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to assess prognostic influence of clinical, pathologic, and treatment-related factors by using Kaplan-Meier and Cox regression methods. Results: Twenty patients had treatment-related duodenal toxicity events, such as duodenal inflammation, ulceration, and bleeding. Four patients had grade 1 events, 8 had grade 2, 6 had grade 3, 1 had grade 4, and 1 had grade 5. On univariate analysis, a toxicity grade ≥2 was associated with tumor location, low platelet count, an absolute volume (cm{sup 3}) receiving a dose of at least 55 Gy (V{sub 55} {sub Gy} > 1 cm{sup 3}), and a maximum point dose >60 Gy. Of these factors, only V{sub 55} {sub Gy} ≥1 cm{sup 3} was associated with duodenal toxicity on multivariate analysis (hazard ratio, 6.7; range, 2.0-18.8; P=.002). Conclusions: This study demonstrates that a duodenal V{sub 55} {sub Gy} >1 cm{sup 3} is an important dosimetric predictor of grade 2 or greater duodenal toxicity and establishes it as a

  13. Gastrointestinal ulceration in the guinea pig in response to dimaprit, histamine, and H1- and H2-blocking agents

    SciTech Connect

    Cho, C.H.; Pfeiffer, C.J.

    1981-04-01

    Histamine is known to induce gastric ulcers in guinea pigs after intraperitoneal administration and duodenal ulcers after repeated intramuscular administrations. This study was undertaken to clarify further the differential role of H1 and H2 receptor sites in respect to gastric and duodenal ulcer in the guinea pig. Groups of guinea pigs were treated with histamine, intraperitoneal (1.81 mg/kg intraperitoneal) or intramuscular (0.09 mg/kg intramuscular X 8 doses); the selective H2 agonist dimaprit (0.09-0.18 mg/kg X 8 doses intramuscular or 1.81-3.62 mg/kg intraperitoneal); NaCl, 154 mM (control); and the selective H1 and H2 antagonists, diphenhydramine (125 mg/kg X 2 doses, intramuscular) or cimetidine (50 mg/kg X 3 doses, intramuscular). Gastric and duodenal lesions were evaluated and residual gastric contents were analyzed. The selective induction of gastric or duodenal ulceration by histamine was confirmed, and the H2 agonist, dimaprit, has been shown to be ulcerogenic to the guinea pig duodenum by intraperitoneal or intramuscular administration. Diphenhydramine produced considerably more protection against histamine-induced gastric ulceration (62% decrease in incidence), while cimetidine was particularly effective in the prevention of histamine-induced duodenal ulcer (64% decrease in incidence). A differential role of histamine in the pathogenesis of gastric as opposed to duodenal ulcer is suggested by the present findings.

  14. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers.

    PubMed Central

    Chung, S. S.; Lau, J. Y.; Sung, J. J.; Chan, A. C.; Lai, C. W.; Ng, E. K.; Chan, F. K.; Yung, M. Y.; Li, A. K.

    1997-01-01

    OBJECTIVE: To compare endoscopic adrenaline injection alone and adrenaline injection plus heat probe for the treatment of actively bleeding peptic ulcers. DESIGN: Randomised prospective study of patients admitted with actively bleeding peptic ulcers. SETTING: One university hospital. SUBJECTS: 276 patients with actively bleeding ulcers detected by endoscopy within 24 hours of admission: 136 patients were randomised to endoscopic adrenaline injection alone and 140 to adrenaline injection plus heat probe treatment. MAIN OUTCOME MEASURES: Initial endoscopic haemostasis; clinical rebleeding; requirement for operation; requirement for blood transfusion; hospital stay, ulcer healing at four weeks; and mortality in hospital. RESULTS: Initial haemostasis was achieved in 131/134 patients (98%) who received adrenaline injection alone and 135/136 patients (99%) who received additional heat probe treatment (P = 0.33). Outcome as measured by clinical rebleeding (12 v 5), requirement for emergency operation (14 v 8), blood transfusion (2 v 3 units), hospital stay (4 v 4 days), ulcer healing at four weeks (79.1% v 74%), and in hospital mortality (7 v 8) were not significantly different in the two groups. In the subgroup of patients with spurting haemorrhage 8/27 (29.6%; 14.5% to 50.3%) patients from the adrenaline injection alone group and 2/31 (6.5%; 1.1% to 22.9%) patients from the dual treatment group required operative intervention. The relative risk of this was lower in the dual treatment group (0.17; 0.03 to 0.87). Hospital stay was significantly shorter in the dual treatment group than the adrenaline injection alone group (4 v 6 days, P = 0.01). CONCLUSION: The addition of heat probe treatment after endoscopic adrenaline injection confers an advantage in ulcers with spurting haemorrhage. PMID:9158465

  15. Gastric and duodenal antiulcer and cytoprotective effects of proglumide in rats

    SciTech Connect

    Tariq, M.; Parmar, N.S.; Ageel, A.M.

    1987-05-01

    Proglumide has been studied for its ability to inhibit gastric secretion and to protect the gastroduodenal mucosa against the injuries caused by pyloric ligation, hypothermic restraint stress, acetic acid, nonsteroid anti-inflammatory drugs, reserpine, cysteamine and the cytodestructing agents: 80% ethanol, 0.6 M HCl, 0.2 M NaOH, 25% NaCl and 30 mg of acetylsalicylic acid in 0.35 M HCl in rats. The results of this study demonstrate that proglumide has both prophylactic and curative effects on various experimentally induced ulcers. It produced a dose-dependent inhibition of gastric secretion in the pylorus-ligated rats and reduced significantly the intensity of gastric lesions induced by pyloric ligation, hypothermic restraint stress, acetic acid, mucosal damaging agents and that of duodenal ulcers induced by cysteamine. The intensity of gastric lesions induced by nonsteroid anti-inflammatory drugs and reserpine was also reduced significantly by proglumide. Cimetidine, which was used as a standard antiulcer drug for comparison, also produced a similar protective effect in most of the models used by us. It was found to have a more potent antisecretory effect but failed to protect the rats against the gastric mucosal damage induced by hyperthermic restraint stress and 0.2 M NaOH. Our findings suggest that proglumide exerts these antiulcer effects by its antisecretory, gastric mucosal resistance increasing and cytoprotective activities. Further studies are required to find out its exact mechanism of action and therapeutic usefulness.

  16. Evaluation of Anti-Secretory and Anti-Ulcerogenic Activities of Avipattikar Churna on The Peptic Ulcers in Experimental Rats

    PubMed Central

    Gyawali, Sudesh; Khan, Gulam Muhammad; Lamichane, Shreekrishna; Gautam, Jaya; Ghimire, Saurav; Adhikari, Rashmi; Lamsal, Reshma

    2013-01-01

    Background: Avipattikar churna, a poly-herbal formulation, is one of the popular ayurvedic formulations which is used for peptic ulcer diseases but the scientific documentation with regards to its effect for the indication is lacking. Aims: This study was carried out to evaluate the anti-secretory and the anti-ulcerogenic activities of the churna and to compare its activity with that of ranitidine in a pyloric ligated model of rats. Material and methods: Four groups of rats with 6 animals in each served as the ulcer controls, churna low dose (500 mg/kg), churna high dose (750mg/kg) and ranitidine (25mg/kg). The control group rats received only vehicle (2% (v/v) gum acacia), while the rats of the other groups received the respective dose of the churna or ranitidine which was suspended in the vehicle. The treatments were given twice a day, orally, for two days. After 1 hour of the last dose, pyloric ligations were performed and the rats were sacrificed for evaluation after four hours of the ligations. The gastric contents were collected and its volume, pH and acidity were measured. The numbers of ulcers and their lengths were measured which were used to calculate the gastric irritancy index and the curative ratio. The histological examinations of the gastric tissues were also performed. Results: The churna, in both doses, significantly decreased the volumes of the gastric contents, the ulcer score, the length of the ulcer, the gastric irritancy index and pH increased as compared to those in the control group. The effects of the churna were comparable to that of ranitidine. The histopathological evaluation of the gastric tissue also supported the results. Conclusion: Avipattikar churna has anti-secretory and anti-ulcerogenic effects which are comparable to those of ranitidine in peptic ulcer diseases. PMID:23905120

  17. Antioxidant activity of bovine alpha lactalbumin Maillard products and evaluation of their in vitro gastro-duodenal digestive proteolysis.

    PubMed

    Joubran, Yousef; Moscovici, Alice; Lesmes, Uri

    2015-04-01

    Food processing offers various pathways to tailor food functionality and digestibility. This work sought to study the impact of thermally-induced Maillard reaction between bovine alpha-lactalbumin (α-la) and fructose or fructo-oligosacchrides on physicochemical properties, antioxidant capacity and in vitro digestive fate under simulated adult and infant conditions. Colloidal stability (measured by DLS) was decreased as a result of the Maillard glycation, while antioxidant capacity (determined by FRAP) and surface hydrophobicity (H0 measurements) were elevated. Semi-dynamic in vitro digestion of Maillard conjugates revealed a mixed trend as a result of postulated competing effects of glycation on α-la's susceptibility to proteolysis; steric hindrance accompanied by protein unfolding could hinder or promote the availability of enzymatic cleavage sites. Results also showed thermal processing altered the digestive breakdown profile of α-la under infant conditions contrary to negligible effects observed under adult conditions. Evaluation of the antioxidant capacity during digestion (via DPPH assay) revealed that adult digesta possessed increased antioxidant activity throughout the gastric phase compared to infant digesta, whereas infant digesta of conjugates exhibited an increase in antioxidant capacity in the duodenum compared to adult. Moreover, during infant digestion of conjugates, an increase in antioxidant capacity was observed in the later stages of the digestion. Overall, this work demonstrates that controlled thermal processing of bovine α-la could potentially modulate its functionality and digestibility, particularly as it pertains to its ability to interfere with oxidative reactions in the lumen, possibly through the generation of bioactive peptides.

  18. Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

    PubMed Central

    Ichikawa, Daisuke; Komatsu, Shuhei; Dohi, Osamu; Naito, Yuji; Kosuga, Toshiyuki; Kamada, Kazuhiro; Okamoto, Kazuma; Itoh, Yoshito; Otsuji, Eigo

    2016-01-01

    AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors. METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique. RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient. CONCLUSION LECS can be a safe and minimally

  19. Solcoseryl in prevention of stress-induced gastric lesions and healing of chronic ulcers.

    PubMed

    Konturek, S J; Drozdowicz, D; Pytko-Polonczyk, J; Brzozowski, T; Bielański, W

    1991-03-01

    Solcoseryl, a deproteinized extract of calf blood, protects the gastric mucosa against various topical irritants and enhances the healing of chronic gastric ulcerations but the mechanisms of these effects have been little studied. This study was designed to elucidate the active principle in Solcoseryl and to determine the role of prostaglandins (PG) and polyamines in the antiulcer properties of this agent. Using both, the radioimmunoassay and radioreceptor assay, EGF-like material was detected in Solcoseryl preparation. Solcoseryl given s.c. prevented the formation of stress-induced gastric lesions and this was accompanied by an increase in the generation of PGE2 in the gastric mucosa. Similar effects were obtained with EGF. Pretreatment with indomethacin, to suppress mucosal generation of prostaglandins (PG), greatly augmented stress-induced gastric ulcerations and antagonized the protection exerted by both Solcoseryl and EGF. Solcoseryl, like EGF, enhanced the healing of chronic gastro-duodenal ulcerations. This effect was abolished by the pretreatment with difluoromethylornithine, an inhibitor of ornithine decarboxylase, the key enzyme in the biosynthesis of polyamines. The healing effects of Solcoseryl and EGF was also reduced by prednisolone which decreased the angiogenesis in the granulation tissue in the ulcer area. These results indicate that Solcoseryl 1. contains EGF-like material, 2. displays the protective and ulcer healing effects similar to those of EGF and involving both PG and polyamines and 3. acts via similar mechanism as does EGF.

  20. [Radical operative treatment of perforative gastroduodenal ulcer disease].

    PubMed

    Gostishchev, V K; Evseev, M A; Golovin, R A

    2009-01-01

    Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.

  1. [Impact of isovolumic hemodilution on the local hemodynamics of the resected stomach in patients with ulcer disease].

    PubMed

    Khalimov, E V; Strelkov, N S; Kapustin, B B

    2005-01-01

    The influence of isovolumic hemodilution on the local hemodynamics of the resected stomach in patients with a complicated course of duodenal ulcer was studied. In the course of the analysis of parameters of the local blood flow of the intact and resected stomach, the best indices were received in patients with preoperative isovolumic hemodilution. Preoperative isovolumic hemodilution in patients with a complicated course of duodenal ulcer after the stomach resection reduces the risk of early postoperative complications.

  2. DUODENAL CYTOCHROME B: A NOVEL FERRIREDUCTASE IN AIRWAY EPITHELIAL CELLS

    EPA Science Inventory

    Catalytically active iron in the lung causes oxidative stress and promotes microbial growth that can be limited by intracellular sequestration of iron within ferritin. Because cellular iron uptake requires membrane ferrireductase activity that in the gut can be provided by duoden...

  3. Inflammatory duodenal necrosis complicating gastroschisis

    PubMed Central

    Fouad, Dina; Lee, Geraint J.; Upadhyaya, Manasvi; Drake, David

    2016-01-01

    Babies with gastroschisis have an increased risk of necrotizing enterocolitis (NEC) that can lead to short bowel syndrome, a long-term parenteral nutrition requirement, and its associated complications. To our knowledge, this is the first case report of recurrent duodenal ischemia and necrosis associated with gastroschisis in the absence of NEC totalis. PMID:27695214

  4. Peptic Ulcers

    MedlinePlus

    ... the stomach lining), peptic ulcer disease, and even stomach cancer later in life. In the past, having peptic ulcers meant living with a chronic condition for several years or even a lifetime. But ... pylori infection, and gastric ulcers, which may stem from other causes. It's ...

  5. Spinal Cord Injury and Pressure Ulcer Prevention: Using Functional Activity in Pressure Relief

    PubMed Central

    Stinson, May; Gillan, Cathy; Morton, Julie; Gardner, Evie; Sprigle, Stephen

    2013-01-01

    Background. People with spinal cord injury (SCI) are at increased risk of pressure ulcers due to prolonged periods of sitting. Concordance with pressure relieving movements is poor amongst this population, and one potential alternative to improve this would be to integrate pressure relieving movements into everyday functional activities. Objectives. To investigate both the current pressure relieving behaviours of SCI individuals during computer use and the application of an ergonomically adapted computer-based activity to reduce interface pressure. Design. Observational and repeated measures design. Setting. Regional Spinal Cord Injury Unit. Participants. Fourteen subjects diagnosed with SCI (12 male, 2 female). Intervention.Comparing normal sitting to seated movements and induced forward reaching positions. Main Outcome Measures. Interface pressure measurements: dispersion index (DI), peak pressure index (PPI), and total contact area (CA). The angle of trunk tilt was also measured. Results. The majority of movements yielded less than 25% reduction in interface pressure compared to normal sitting. Reaching forward by 150% of arm length during an adapted computer activity significantly reduced DI (P < 0.05), angle of trunk tilt (p<0.05), and PPI for both ischial tuberosity regions (P < 0.001) compared to normal sitting. Conclusion. Reaching forward significantly redistributed pressure at the seating interface, as evidenced by the change in interface pressures compared to upright sitting. PMID:23691301

  6. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review.

    PubMed

    Crews, Ryan T; Schneider, Kristin L; Yalla, Sai V; Reeves, Neil D; Vileikyte, Loretta

    2016-11-01

    Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Acute Reversible Duodenitis Following Non-Therapeutic Upper Gastrointestinal Endoscopy. Is Duodenal Diverticulum a Predisposing Factor?

    PubMed Central

    Unal, Emre; Ayan, Elif Nurbegum; Yazgan, Sibel

    2016-01-01

    Summary Background Diagnostic upper gastrointestinal (UGI) endoscopy has been regarded as a safe procedure. Case report We report of a 67-year-old woman who developed epigastric pain and dyspeptic complaints following an uneventful upper gastrointestinal endoscopy. The diagnosis of an acute reversible duodenitis was made on the basis of imaging studies. A duodenal diverticulum was also found on CT images, which raised the suspicion that duodenal diverticulum could be a predisposing factor for duodenitis. Conclusions Despite significant inflammation the patient demonstrated rapid clinical improvement with conservative treatment. Presence of a duodenal diverticulum may predispose to acute duodenitis following diagnostic UGI endoscopy. PMID:27994697

  8. Helicobacter pylori Genetic Diversity and Gastro-duodenal Diseases in Malaysia

    PubMed Central

    Gunaletchumy, Selva Perumal; Seevasant, Indran; Tan, Mun Hua; Croft, Laurence J.; Mitchell, Hazel M.; Goh, Khean Lee; Loke, Mun Fai; Vadivelu, Jamuna

    2014-01-01

    Helicobacter pylori infection results in diverse clinical conditions ranging from chronic gastritis and ulceration to gastric adenocarcinoma. Among the multiethnic population of Malaysia, Indians consistently have a higher H. pylori prevalence as compared with Chinese and Malays. Despite the high prevalence of H. pylori, Indians have a relatively low incidence of peptic ulcer disease and gastric cancer. In contrast, gastric cancer and peptic ulcer disease incidence is high in Chinese. H. pylori strains from Chinese strains predominantly belong to the hspEAsia subpopulation while Indian/Malay strains mainly belong to the hspIndia subpopulation. By comparing the genome of 27 Asian strains from different subpopulations, we identified six genes associated with risk of H. pylori-induced peptic ulcer disease and gastric cancer. This study serves as an important foundation for future studies aiming to understand the role of bacterial factors in H. pylori-induced gastro-duodenal diseases. PMID:25503415

  9. Active post-marketing surveillance of the intralesional administration of human recombinant epidermal growth factor in diabetic foot ulcers

    PubMed Central

    2013-01-01

    Background After several exploratory and confirmatory clinical trials, the intralesional administration of human recombinant epidermal growth factor (hrEGF) has been approved for the treatment of advanced diabetic foot ulcers (DFU). The aim of this work was to evaluate the effectiveness and safety of this procedure in medical practice. Methods A prospective, post-marketing active pharmacosurveillance was conducted in 41 hospitals and 19 primary care polyclinics. Patients with DFU received hrEGF, 25 or 75 μg, intralesionally 3 times per week until complete granulation of the ulcer or 8 weeks maximum, adjuvant to standard wound care. Outcomes measured were complete granulation, amputations, and adverse events (AE) during treatment; complete lesion re-epithelization and relapses in follow-up (median: 1.2; maximum 4.2 years). Results The study included 1788 patients with 1835 DFU (81% Wagner’s grades 3 or 4; 43% ischemic) treated from May 2007 to April 2010. Complete granulation was observed in 76% of the ulcers in 5 weeks (median). Ulcer non-ischemic etiology (OR: 3.6; 95% CI: 2.8-4.7) and age (1.02; 1.01-1.03, for each younger year) were the main variables with influence on this outcome. During treatment, 220 (12%) amputations (171 major) were required in 214 patients, mostly in ischemic or Wagner’s grade 3 to 5 ulcers. Re-epithelization was documented in 61% of the 1659 followed-up cases; 5% relapsed per year. AE (4171) were reported in 47% of the subjects. Mild or moderate local pain and burning sensation, shivering and chills, were 87% of the events. Serious events, not related to treatment, occurred in 1.7% of the patients. Conclusions The favorable benefit/risk balance, confirms the beneficial clinical profile of intralesional hrEGF in the treatment of DFUs. PMID:24004460

  10. [Glycoproteins of mucus of gastric and duodenal wall surface during ulcerogenesis and the impact of fenugreek].

    PubMed

    Khil'ko, T D; Iakubtsova, I V; Preobrazhens'ka, T D; Ostapchenko, L I

    2013-01-01

    The comparative evaluation of qualitative and quantitative composition of glycoproteins of gastric and duodenal wall surface layer of protective mucus in the normal, at the modeling of ulcers in rats and at the introduction to animals with ulcerative lesions of fenugreek extract carried out. It was shown in control (normally) the general level of glycosylation of glycoproteins gastric mucus is 1.7 times more than the duodenum. Under acute stress model ulceration in the stomach mucus decrease in hexosamine (1.4 times), galactose (2.2 times), fucose (1.3-fold) and an increase in NANA (3.6 times) observed. Under cysteamine model ulceration in duodenal mucus increase galactose (2.7 times), NANA (2.4 times), fucose (1.8-fold) but significant decrease in the amount of hexosamines 3 times compared to the control occurred. It was proved the protective effect of fenugreek extract to the wall surface mucus of the stomach and duodenum mucosa under conditions modeling ulceration in rats.

  11. Comparative Characteristics Of Coherent And Incoherent Radiation In The Photography Of Ulcer

    NASA Astrophysics Data System (ADS)

    Novikov, V. F.; Paramonov, L. V.

    1985-01-01

    The efficiency of He-Ne laser radiation and incoherent radiation by red light sources with different spectral bandwidths is compared for the endoscopic phototherapy of gastric and duodenal ulcers. Coherent and incoherent radiation is determined to result in the same theraputic effect when doing the treatment of ulcer deseases. The methods of ulcer treatment is suggested with a conventional fibrogastroscope fitted with red glass filter.

  12. The Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series

    PubMed Central

    Izzo, Valentina; Meloni, Marco; Giurato, Laura; Ruotolo, Valeria; Uccioli, Luigi

    2017-01-01

    Objective: Despite several works have described the usefulness of negative pressure therapy (NPT) in the treatment of diabetic foot ulcers (DFUs), no studies have reported its ability in the proteases modulation in DFUs. The aim of this work was to evaluate the role of NPT as a protease-modulating treatment in DFUs. Approach: We conducted a prospective study of a series of diabetic patients affected by chronic DFUs. Each ulcer was assessed for matrix metalloproteinases (MMPs) activity with a protease status diagnostic test at the baseline and after 2 weeks of NPT. Results: Four patients were included. All patients had type 2 diabetes with a disease duration of ≈20 years. A1c was 79.5 ± 15.3 mmol/mol. Ulcer area was >5 cm2 in all cases. All wounds showed elevated protease activity (EPA) at the baseline. After 2 weeks, all patients showed a normalization of MMPs activity. Innovation: NPT showed its effectiveness in the reduction of EPA in chronic DFUs. Conclusion: This study confirms the role of NPT in the positive modulation of protease activity also in chronic DFUs. PMID:28116227

  13. Cytotoxic isolates of Helicobacter pylori from Peptic Ulcer Diseases decrease K+-dependent ATPase Activity in HeLa cells

    PubMed Central

    Shanjana, Awasthi; Archana, Ayyagari

    2003-01-01

    Background Helicobacter pylori is a Gram negative bacterium that plays a central role in the etiology of chronic gastritis and peptic ulcer diseases. However, not all H. pylori positive cases develop advanced disease. This discriminatory behavior has been attributed to the difference in virulence of the bacteria. Among all virulence factors, cytotoxin released by H. pylori is the most important factor. In this work, we studied variation in H. pylori isolates from Indian dyspeptic patients on the basis of cytotoxin production and associated changes in K+-dependent ATPase (one of its targets) enzyme activity in HeLa cells. Methods The patients were retrospectively grouped on the basis of endoscopic and histopathological observation as having gastritis or peptic ulcer. The HeLa cells were incubated with the broth culture filtrates (BCFs) of H. pylori isolates from patients of both groups and observed for the cytopathic effects: morphological changes and viability. In addition, the K+-dependent ATPase activity was measured in HeLa cells extracts. Results The cytotoxin production was observed in 3/7 (gastritis) and 4/4 (peptic ulcer) H. pylori isolates. The BCFs of cytotoxin producing H. pylori strains reduced the ATPase activity of HeLa cells to 40% of that measured with non-cytotoxin producing H. pylori strains (1.33 μmole Pi/mg protein and 3.36 μmole Pi/mg protein, respectively, p < 0.05). The decreased activity of ATPase enzyme or the release of cytotoxin also correlated with the increased pathogenicity indices of the patients. Conclusions Our results suggest that the isolation of cytotoxic H. pylori is more common in severe form of acid peptic diseases (peptic ulcer) than in gastritis patients from India. Also the cytotoxin released by H. pylori impairs the ion-transporting ATPase and is a measure of cytotoxicity. PMID:14604441

  14. Duodenal bulb control of the flow rate of digesta in the fasted and fed dog.

    PubMed Central

    Malbert, C H; Ruckebusch, Y

    1989-01-01

    1. Continuous measurement of the flow of digesta near the pylorus, and 5 cm aborally, was assessed in the conscious dog using a chronically implanted flowmeter. The patterns of flow were related to motor activity of the gastroduodenal junction. 2. Electromagnetic measurement of the flow was calibrated in vitro by means of a pulsatile pump. Validation was obtained in vivo by direct evaluation of the amount of chyme collected from an open duodenal cannula and indirectly by a dye-dilution technique. 3. After a 12 h fast, only small amounts of gastric contents were delivered into the duodenum. This transfer occurred during periods of irregular motor activity recorded along the gastroduodenal junction, which occupied less than 25% of the recording time. The patterns of flow near the pylorus and beyond the duodenal bulb were correlated to antral and duodenal contractions respectively. 4. After a meal, gastric emptying occurred intermittently and was related to enhanced antral motor activity beyond the duodenal bulb; digesta flowed in clusters of gushes which were related to the duodenal contractions. 5. It is concluded that the mechanical role of the duodenal bulb is to change the intermittent juxtapyloric flow of digesta into a uniform flow at the duodenal level. PMID:2585295

  15. Antiulcer Activity of Ethanolic Extract of Salvadora indica (W.) Leaves on Albino Rats

    PubMed Central

    Sahoo, Saroj Kumar; Priyadarshini, D.; Soundarya, G.; Kumar, Ch. Kishore; Rani, K. Usha

    2016-01-01

    Background Ulcer can be developed inside the inner lining of the stomach (gastric ulcer) or the small intestine (duodenal ulcer). Both the ulcers are also cumulatively referred as peptic ulcers. It affects nearly 10% of world population. Aim To investigate the antiulcer activity of ethanolic extract of Salvadora indica W. leaves (ESIL) on albino rats. Materials and Methods The present study was carried by pylorus ligation, ethanol and cysteamine induced ulcer models in albino rats. The antiulcer activity of ESIL (150, 300 and 600 mg/kg p.o. for 7 days) was compared with standard drugs (Ranitidine). In pyloric ligation induced ulcer model, the studied parameters were gastric volume, pH, total acidity, free acidity, and ulcer index whereas in ethanol and cysteamine induced ulcer model, the ulcer index was determined for severity of ulcers. The parameters studied were ulcer index, gastric juice volume, pH, free acidity and total acidity. Results In pyloric ligation model; the volume of gastric content, total/free acidity and pepsin activity was significantly decreased at p<0.05 and p<0.01 and pH of the gastric juice was significantly increased at p<0.05 and p<0.01 in ESIL treated groups as compared to control group. All the doses of ESIL showed dose dependent antiulcer effect as well as significant (p<0.05 and p<0.01) reduction in the ulcer index as compared to control group in all the experimental models. Conclusion The results of the study indicate that the ESIL have better potential against ulcer which supports the traditional claims in folklore medicine. PMID:27790462

  16. Supplementation of a grape seed and grape marc meal extract decreases activities of the oxidative stress-responsive transcription factors NF-κB and Nrf2 in the duodenal mucosa of pigs

    PubMed Central

    2013-01-01

    Background In pigs, enteric infections and the development of gut disorders such as diarrhoea are commonly observed, particularly after weaning. The present study investigated the hypothesis that feeding a grape seed and grape marc extract (GSGME) as a dietary supplement has the potential to suppress the inflammatory process in the small intestine of pigs by modulating the activities of NF-κB and Nrf2 due to its high content of flavonoids. Methods Twenty-four crossbred, 6 weeks old pigs were randomly assigned to 2 groups of 12 animals each and fed nutritionally adequate diets without or with 1% GSGME for 4 weeks. Results Pigs administered GSGME had a lower transactivation of NF-κB and Nrf2 and a lower expression of various target genes of these transcription factors in the duodenal mucosa than control pigs (P < 0.05). Concentrations of α-tocopherol and thiobarbituric acid reactive substances (TBARS) in liver and plasma and total antioxidant capacity of plasma and relative mRNA abundances of NF-κB and Nrf2 target genes in the liver did not differ between the two groups. However, the ratio of villus height:crypt depth and the gain:feed ratio was higher in the pigs fed GSGME than in control pigs (P < 0.05). Conclusions This study shows that dietary supplementation of a polyphenol rich GSGME suppresses the activity of NF-κB in the duodenal mucosa of pigs and thus might provide a useful dietary strategy to inhibit inflammation in the gut frequently occurring in pigs. Feeding GSGME did not influence vitamin E status and the antioxidant system of the pigs but improved the gain:feed ratio. In overall, the study suggests that polyphenol-rich plant extracts such GSGME could be useful feed supplements in pig nutrition, in order to maintain animal health and improve performance. PMID:23453040

  17. Increased Expression and Cellular Localization of Spermine Oxidase in Ulcerative Colitis and Relationship to Disease Activity

    PubMed Central

    Hong, Shih-Kuang S.; Chaturvedi, Rupesh; Blanca Piazuelo, M.; Coburn, Lori A.; Williams, Christopher S.; Delgado, Alberto G.; Casero, Robert A.; Schwartz, David A.; Wilson, Keith T.

    2010-01-01

    Background Polyamines are important in cell growth and wound repair, but have also been implicated in inflammation-induced carcinogenesis. Polyamine metabolism includes back-conversion of spermine to spermidine by the enzyme spermine oxidase (SMO), which produces hydrogen peroxide that causes oxidative stress. In ulcerative colitis (UC), levels of spermine are decreased compared to spermidine. Therefore, we sought to determine if SMO is involved in UC. Methods Colon biopsies and clinical information from subjects undergoing colonoscopy for evaluation of UC or colorectal cancer screening were utilized from 16 normal controls and 53 UC cases. Histopathologic disease severity was graded and the Mayo Disease Activity Index (DAI) and endoscopy subscore assessed. SMO mRNA expression was measured in frozen biopsies by Taq-Man-based real-time polymerase chain reaction (PCR). Formalin-fixed tissues were used for SMO immunohistochemistry. Results There was a 3.1-fold upregulation of SMO mRNA levels in UC patients compared to controls (P = 0.044), and a 3.7-fold increase in involved left colon versus paired uninvolved right colon (P < 0.001). With worsening histologic injury in UC there was a progressive increase in SMO staining of mononuclear inflammatory cells. There was a similar increase in SMO staining with worsening endoscopic disease severity and strong correlation with the DAI (r = 0.653, P < 0.001). Inflammatory cell SMO staining was increased in involved left colon versus uninvolved right colon. Conclusions SMO expression is upregulated in UC tissues, deriving from increased levels in mononuclear inflammatory cells. Dysregulated polyamine homeostasis may contribute to chronic UC by altering immune responses and increasing oxidative stress. PMID:20127992

  18. Seasonal pattern in the incidence of bleeding caused by peptic ulcer in Israel.

    PubMed

    Bendahan, J; Gilboa, S; Paran, H; Neufeld, D; Pomerantz, I; Novis, B; Freund, U

    1992-06-01

    We have reviewed all endoscopies performed in our hospital between 1977 and 1986. During that period, 1337 endoscopies were performed to identify bleeding from peptic ulcers. Excluded were cases in which a predisposing factor was found, such as the use of ulcerogenic drugs. Also excluded were chronic or critically ill patients. The remaining 540 cases were reviewed. In 447 of those cases, the bleeding lesion was a duodenal ulcer, whereas, in 93 cases, a gastric ulcer was found (a ratio of 5:1). The seasonal variation in the incidence of bleeding from peptic ulcers was evaluated. We found a significant difference in bleeding in the cold and hot seasons, the incidence being significantly greater during the cold season (November until February). A similar pattern was found for bleeding from both duodenal and gastric ulcers.

  19. PUMA project: Active involving of end users to achieve a smart solution to prevent pressure ulcer.

    PubMed

    Laparra-Hernández, José; Chicote, Juan Carlos; Medina, Enrique; Barberà, Ricard; Durà-Gil, Juan V; Lozano, Vicente; Gil, Ángel; Bermejo, Ignacio

    2015-01-01

    This paper shows the benefits to include spinal cord injury users and the other stakeholders during the development of a new system to prevent pressure ulcers. The complementary of information has been key and has enhanced the possibility to achieve market acceptance and introduction.

  20. Peptic ulceration may be a hormonal deficiency disease.

    PubMed

    Love, Jack W

    2008-01-01

    Evidence is reviewed that Helicobacter pylori infection may cause a deficiency of the hormone secretin that allows peptic ulcer disease to develop by impairing the body's defenses to gastric acid. Secretin is released into the circulation from the S-cells of the duodenal crypts in response to gastric acid entering the duodenum. Once in the circulation, secretin has five well-documented effects that protect the upper intestine from gastric acid: it stimulates secretion of bicarbonate rich exocrine pancreatic juice; it stimulates secretion of alkaline bile; it stimulates secretion of alkaline mucus from the duodenal submucosal glands of Brunner; it inhibits the humoral phase of gastric secretion; and it inhibits gastric motility, thereby delaying gastric emptying. Impaired secretin release and reduced duodenal S-cells have been documented in peptic ulcer patients compared with control patients. Clinical evidence that patients with H. pylori infection and peptic ulceration have increased gastric secretion and motility and decreased duodenal bicarbonate response to gastric acid, all of which normalize after eradication of the infection, could be explained by reversible impairment of the secretin mechanism. Gastric metaplasia in the duodenum with H. pylori infection is known to reduce the S-cell population. The fact that not all patients with H. pylori infection develop peptic ulceration suggests that degree of secretin deficiency determined by extent of the infection must reach a critical level for peptic ulceration to occur. Peptic ulceration may be a hormonal deficiency disease, a result of secretin deficiency caused by H. pylori infection. It may be the first example of a specific hormonal deficiency disease caused by a specific bacterial infection.

  1. Assessment of the influence of the inflammatory process on the activation of blood platelets and morphological parameters in patients with ulcerative colitis (colitis ulcerosa).

    PubMed

    Polińska, Beata; Matowicka-Karna, Joanna; Kemona, Halina

    2011-01-01

    Ulcerative colitis (colitis ulcerosa) is a non-specific inflammatory bowel disease of unknown etiology. The symptoms which are observed in the course of ulcerative colitis are: an increase in the number of leukocytes and blood platelets, an increase in the concentration of IL-6 and anemia. Blood platelets are the key element, linking the processes of hemostasis, inflammation and the repair of damaged tissues. Activation of blood platelets is connected with changes in their shape and the occurrence of the reaction of release. P-selectin appears on the surfaces of activated blood platelets and the concentration level of soluble P-selectin increases in the blood plasma. The aim of this study was to define whether the increased number of blood platelets in patients with ulcerative colitis accompanies changes in their activation and morphology. A total of 16 subjects with ulcerative colitis and 32 healthy subjects were studied. Mean platelet count, morphological parameters of platelets and MPC were measured using an ADVIA 120 hematology analyzer. Concentrations of sP-selectin and IL-6 in serum were marked by immunoassay (ELISA). MPC, concentration of sP-selectin and IL-6 were significantly higher in subjects with ulcerative colitis compared to those in the healthy group. There was a decrease of MPV in patients with ulcerative colitis, which is statistically significant. Chronic inflammation in patients with ulcerative colitis causes an increase in the number of blood platelets, a change in their morphology and activation. Decreased MPV value reflects activation and the role blood platelets play in the inflammatory process of the mucous membrane of the colon. A high concentration of sP-selectin, which is a marker of blood platelet activation, demonstrates their part in the inflammatory process. The increase in the concentration of sP-selectin correlated positively with the increase in concentration of IL-6. This is why it may be a useful marker of the activity of colitis

  2. Soluble ST2: A new and promising activity marker in ulcerative colitis

    PubMed Central

    Díaz-Jiménez, David; Núñez, Lucía E; Beltrán, Caroll J; Candia, Enzo; Suazo, Cristóbal; Álvarez-Lobos, Manuel; González, María-Julieta; Hermoso, Marcela A; Quera, Rodrigo

    2011-01-01

    AIM: To correlate circulating soluble ST2 (sST2) levels with the severity of ulcerative colitis (UC) and serum levels of pro-inflammatory cytokines, and to demonstrate the predictive power of sST2 levels for differentiation between active and inactive UC. METHODS: We recruited 153 patients: 82 with UC, 26 with Crohn’s disease (CD) and 43 disease controls [non-inflammatory bowel disease (IBD)]. Subjects were excluded if they had diagnosis of asthma, autoimmune diseases or hypertension. The serum levels of sST2 and pro-inflammatory cytokines [pg/mL; median (25th-75th)] as well as clinical features, endoscopic and histological features, were subjected to analyses. The sST2 performance for discrimination between active and inactive UC, non-IBD and healthy controls (HC) was determined with regard to sensitivity and specificity, and Spearman’s rank correlation coefficient (r). To validate the method, the area under the curve (AUC) of receiver-operator characteristic (ROC) was determined (AUC, 95% CI) and the total ST2 content of the colonic mucosa in UC patients was correlated with circulating levels of sST2. RESULTS: The serum sST2 value was significantly higher in patients with active [235.80 (90.65-367.90) pg/mL] rather than inactive UC [33.19 (20.04-65.32) pg/mL], based on clinical, endoscopic and histopathological characteristics, as well as compared with non-IBD and HC (P < 0.001). The median level of sST2 in CD patients was 54.17 (35.02-122.0) pg/mL, significantly higher than that of the HC group only (P < 0.01). The cutoff was set at 74.87 pg/mL to compare active with inactive UC in a multicenter cohort of patients. Values of sensitivity, specificity, and ability to correctly classify UC, according to activity, were 83.33%, 83.33% and 83.33%, respectively. The AUC of the ROC curve to assess the ability of this molecule to discriminate between active vs inactive UC was 0.92 (0.86-0.97, P < 0.0001). The serum levels of sST2 in patients with UC significantly

  3. Tri-potassium di-citrato bismuthate: a report of its pharmacological properties and therapeutic efficacy in peptic ulcer.

    PubMed

    Brogden, R N; Pinder, R M; Sawyer, P R; Speight, T M; Avery, G S

    1976-12-01

    Tri-potassium di-citrato bismuthate is a complex bismuth salt stable in colloidal form advocated for the treatment of peptic ulcer. Preliminary placebo-controlled trials in small numbers of ambulant patients with endoscopically proven peptic ulcer, strongly suggest that the compound accelerates the rate of healing of gastric and duodenal ulcer within 4 weeks of treatment. However, trials involving larger numbers of patients followed-up for longer periods are required before a clear verdict on the efficacy of tripotassium di-citrato bismuthate in gastric and duodenal ulcer can be given. There are no reliable data on the effect of the drug on ulcer recurrence rate. Side-effects are negligible and the drug could become an important therapeutic agent in peptic ulcer therapy if results of further study are conclusive. The drug causes dark discolouration of the stools and this should be borne in mind when considering the possibility of the presence of intestinal bleeding.

  4. Calmodulin independence of human duodenal adenylate cyclase.

    PubMed Central

    Smith, J A; Griffin, M; Mireylees, S E; Long, R G

    1991-01-01

    The calmodulin and calcium dependence of human adenylate cyclase from the second part of the duodenum was assessed in washed particulate preparations of biopsy specimens by investigating (a) the concentration dependent effects of free [Ca2+] on enzyme activity, (b) the effects of exogenous calmodulin on enzyme activity in ethylene glycol bis (b-aminoethyl ether)N,N'-tetra-acetic acid (EGTA) washed particulate preparations, and (c) the effects of calmodulin antagonists on enzyme activity. Both basal (IC50 = 193.75 (57.5) nmol/l (mean (SEM)) and NaF stimulated (IC50 = 188.0 (44.0) nmol/l) adenylate cyclase activity was strongly inhibited by free [Ca2+] greater than 90 nmol/l. Free [Ca2+] less than 90 nmol/l had no effect on adenylate cyclase activity. NaF stimulated adenylate cyclase activity was inhibited by 50% at 2.5 mmol/l EGTA. This inhibition could not be reversed by free Ca2+. The addition of exogenous calmodulin to EGTA (5 mmol/l) washed particulate preparations failed to stimulate adenylate cyclase activity. Trifluoperazine and N-(8-aminohexyl)-5-IODO-1-naphthalene-sulphonamide (IODO 8) did not significantly inhibit basal and NaF stimulated adenylate cyclase activity when measured at concentrations of up to 100 mumol/l. These results suggest that human duodenal adenylate cyclase activity is calmodulin independent but is affected by changes in free [Ca2+]. PMID:1752461

  5. A Case of Small Bowel Ulcer Associated with Helicobacter pylori

    PubMed Central

    Kim, Eun Young; Kim, Ji Hyun; Woo, Saet Byul; Lee, Jeong Won; Lee, Kon Hee; Shin, Su Rin

    2012-01-01

    The etiology of peptic ulcer disease in children may be primary, associated with Helicobacter pylori infection, or secondary, relied on underlying disease. Ulcerative lesions by H. pylori are mainly distributed in the duodenal bulb and they are rare below the ampulla of Vater because H. pylori growth is inhibited by bile juice. In this reason, there are only some restrictive reports presented small bowel ulcer associated H. pylori. We found multiple small bowel ulcerative lesions associated with H. pylori in an 11-year-old girl without any systemic disease while performing esophagogastroenteroscopy to the level of the proximal jejunum for differentiating bezoar. The abdominal pain improved after the patient was administered H. pylori eradication therapy. Because a small bowel ulcer associated with H. pylori has rarely been reported, we report it here with literature review. PMID:24010097

  6. Gastroprotective effects of several H2RAs on ibuprofen-induced gastric ulcer in rats.

    PubMed

    Liu, Jing; Sun, Dan; He, Jinfeng; Yang, Chengli; Hu, Tingting; Zhang, Lijing; Cao, Hua; Tong, Ai-Ping; Song, Xiangrong; Xie, Yongmei; He, Gu; Guo, Gang; Luo, Youfu; Cheng, Ping; Zheng, Yu

    2016-03-15

    Ibuprofen is the first line of treatment for osteoarthritis and arthritis. The main side effects of ibuprofen especially in long-term treatment include gastric ulcer, duodenal ulcer and indigestion etc. Therefore, screening drugs with effective gastric protective effects and low toxicity for combination therapy with ibuprofen is necessary. The mechanism of gastric damage induced by ibuprofen is still unclear, however, cell damage caused by reactive oxygen species (ROS) is considered as the main reason. Preliminary screening of literature with the criteria of low toxicity led to four histamine-2 receptor antagonists (H2RAs): nizatidine, famotidine, lafutidine, and roxatidine acetate, which were selected for further investigation. These drugs were evaluated systemically by examining the gastric ulcer index, lipid peroxidation (LPO), membrane permeability, toxicity to main organs, and the influence on the activity of antioxidant enzymes, and myeloperoxidase (MPO). Nizatidine was found to be the best gastric protective agent. It exhibited excellent protective effect by increasing antioxidant enzyme activity, decreasing MPO activity, reducing LPO, and membrane permeability. Combination treatment with nizatidine and ibuprofen did not show any significant toxicity. Nizatidine was considered as a good option for combination therapy with ibuprofen especially for diseases that require long-term treatment such as arthritis and osteoarthritis.

  7. Strategies for the Care of Adults Hospitalized for Active Ulcerative Colitis

    PubMed Central

    Pola, Suresh; Patel, Derek; Ramamoorthy, Sonia; McLemore, Elisabeth; Fahmy, Marianne; Rivera-Nieves, Jesus; Chang, John T; Evans, Elisabeth; Docherty, Michael; Talamini, Mark; Sandborn, William J

    2014-01-01

    Ulcerative colitis is a chronic inflammatory disease of the colon; as many as 25% of patients with this disease require hospitalization. The goals of hospitalization are to assess disease severity, exclude infection, administer rapidly acting and highly effective medication regimens, and determine response. During the hospitalization, patients should be given venous thromboembolism prophylaxis and monitored for development of toxic megacolon. Patients who do not respond to intravenous corticosteroids should be considered for rescue therapy with infliximab or cyclosporine. Patients who are refractory to medical therapies or who develop toxic megacolon should be evaluated promptly for colectomy. Patients who do respond to medical therapies should be discharged on an appropriate maintenance regimen when they meet discharge criteria. We review practical evidence-based management principles and propose a day-by-day algorithm for managing patients hospitalized for ulcerative colitis. PMID:22835577

  8. Pressure Relief Behaviors and Weight-Shifting Activities to Prevent Pressure Ulcers in Persons with SCI

    DTIC Science & Technology

    2014-10-01

    just be reasonable) 20 Upright Sitting upright in the chair without leaning. 60 Beach ball volleyball Bounce the beach ball back and forth...ulcer etiology has demonstrated that the damaging effects of pressure are related to both its magnitude and duration. Based upon this and related...demonstrated that the damaging effects of pressure are related to both its magnitude and duration. Based upon this and related work, clinical

  9. Ugh! Ulcers

    MedlinePlus

    ... sores, or ulcers, are caused. continue Who Has H. Pylori Infection? By testing someone's blood or bowel movements ( ... she has been exposed to and might have H. pylori . When tested, lots of people have H. pylori ...

  10. Ulcerative colitis

    MedlinePlus

    ... proctocolectomy - discharge Types of ileostomy Ulcerative colitis - discharge Review Date 8/14/2015 Updated by: Subodh K. ... gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Internal review and ...

  11. Stomach ulcer

    MedlinePlus Videos and Cool Tools

    ... are absorbed in the small intestine. It produces acid and various enzymes that break down food into ... wall of the stomach is protected from the acid and enzymes by a mucous lining. Ulcers are ...

  12. Involvement of cyclooxygenase-1 and cyclooxygenase-2 activity in the therapeutic effect of ghrelin in the course of ethanol-induced gastric ulcers in rats.

    PubMed

    Warzecha, Z; Ceranowicz, P; Dembinski, M; Cieszkowski, J; Ginter, G; Ptak-Belowska, A; Dembinski, A

    2014-02-01

    proliferation, and reduction in mucosal expression of proinflammatory cytokines. Ghrelin is able to reverse a deleterious effect of COX-1 inhibitor on healing of ethanol-induced gastric ulcers. Activity of COX-2 is necessary for the therapeutic effect of ghrelin in healing of ethanol-induced gastric ulcers.

  13. Chronic diarrhea due to duodenal candidiasis in a patient with a history of kidney transplantation.

    PubMed

    Nouri-Majalan, Nader; Moghaddasi, Sarasadat; Qane, Mohammad Davud; Shefaie, Farzane; Masoumi Dehshiri, Roghayyeh; Amirbaigy, Mohammad Kassem; Baghbanian, Mahmoud

    2014-11-01

    Candida infection in the small intestine is uncommon. We report an unusual case of duodenal candidiasis that presented as chronic diarrhea in a patient who had previously undergone kidney transplantation. A 60-year-old man presented with profuse watery diarrhea that had lasted 6 months 13 years after kidney transplantation. Upper gastrointestinal endoscopy results indicated candidiasis within the esophagus and duodenum. Biopsy results revealed active duodenitis with hyphal and yeast forms of Candida overlying the duodenal epithelium in periodic acid Schiff staining. The patient was successfully treated with fluconazole. After 6 months of follow-up, the patient had no complaint of diarrhea. Duodenal candidiasis may be the result of chronic diarrhea in patients with a history of kidney transplantation.

  14. [Curative and preventive treatment of NSAID-associated gastroduodenal ulcers].

    PubMed

    Dupas, Jean-Louis; Grigy, Claire

    2004-04-01

    The use of treatments to heal or to prevent nonsteroidal anti-inflammatory drugs (NSAIDs) associated gastroduodenal lesions is based on replacement of mucosal prostaglandin deficiency or inhibition of acid secretion. Four-week acid suppression by proton pump inhibitors (PPI) with 7-day eradication triple therapy in Helicobacter pylori positive patients is effective in healing gastric and duodenal ulcer upon discontinuation of NSAIDs. In the event NSAIDs must be continued, PPIs (omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg) are more effective than H2-blockers and cytoprotective agents (sucralfate, misoprostol) to heal mucosal lesions. In long-term prevention studies, omeprazole 20 mg, lansoprazole 15 mg, and pantoprazole 20 mg significantly reduce gastric and duodenal ulcer rates. Misoprostol 800 microg is as effective as PPIs for preventing symptomatic and complicated gastric ulcers, but less effective to prevent duodenal ulcer, with a high rate of adverse effects such as diarrhea. Helicobacter pylori eradication in infected patients decrease the risk of NSAIDs-associated lesions but is less effective than concomitant antisecretory treatment. Current data from comparative studies of PPIs vs ranitidine or misoprostol are in favor of the PPIs as well tolerated and effective drugs in the prophylaxis of NSAIDs-related gastroduodenal lesions in high-risk patients.

  15. Evaluation of anti-ulcer activity of Samanea saman (Jacq) merr bark on ethanol and stress induced gastric lesions in albino rats

    PubMed Central

    Arumugam, Suresh; Selvaraj, Senthil Velan; Velayutham, Suresh; Natesan, Senthil Kumar; Palaniswamy, Karthikeyan

    2011-01-01

    Objective: To evaluate the antiulcer activity of Samanea saman (Jacq) Merr bark on ethanol and stress induced gastric lesions in albino rats. Materials and Methods: Gastric lesions were induced in rats by oral administration of absolute ethanol (5 ml/kg) and stress induced by water immersion. The antiulcer activity of methanolic extract of Samanea saman (Jacq) Merr bark (100 mg/kg, 200 mg/kg, 400 mg/kg) was compared with standard drugs. The parameters studied were ulcer index, gastric juice volume, pH, free acidity and total acidity. Result: Samanea saman (Jacq) Merr showed a dose dependent curative ratio compared to ulcer control groups. The extract at 400 mg/kg showed significant anti ulcer activity which is almost equal to that of the standard drug in both models. The volume of acid secretion, total and free acidity was decreased and pH of the gastric juice was increased compared to ulcer control group. Conclusions: The present study indicates that Samanea saman (Jacq) Merr bark extracts have potential anti ulcer activity. PMID:22022006

  16. Duodenal carcinoid tumor - a case report.

    PubMed

    Debnath, C R; Debnath, M R; Haque, M A; Das, S N; Moshwan, M M; Karim, R; Uddoula, M S

    2014-01-01

    Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article.

  17. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis.

    PubMed

    Del Hierro, Piedad Magdalena

    2011-12-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved.

  18. Annular pancreas associated with duodenal carcinoma

    PubMed Central

    Brönnimann, Enrico; Potthast, Silke; Vlajnic, Tatjana; Oertli, Daniel; Heizmann, Oleg

    2010-01-01

    Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics. PMID:20593508

  19. Jianpi Qingchang decoction alleviates ulcerative colitis by inhibiting nuclear factor-κB activation

    PubMed Central

    Zheng, Lie; Zhang, Ya-Li; Dai, Yan-Cheng; Chen, Xuan; Chen, De-Liang; Dai, Yue-Ting; Tang, Zhi-Peng

    2017-01-01

    AIM To investigate the therapeutic effect of Jianpi Qingchang decoction (JPQCD) on dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) in mice. METHODS C57BL/c mice were injected intragastrically with 5% DSS instead of drinking water for 7 d, and their body weight, diarrhea severity and fecal bleeding were monitored, while the mice in the control group were treated with standard drinking water, without DSS. After 7 d, the DSS drinking water was changed to normal water and the DSS group continued with DSS water. The control and DSS groups were given normal saline by intragastric injection. The 5-aminosalicylic acid (5-ASA) group was treated orally with 5-ASA at a dose of 100 mg/kg daily. The JPQCD group was treated orally with JPQCD at a dose of 17.1 g/kg daily. On day 14, the colon length was measured, the colorectal histopathological damage score was assessed, and protein levels of interleukin (IL)-1β, IL-8 and tumor necrosis factor-alpha (TNF-α) in colon supernatants were measured by enzyme-linked immunosorbent assay. mRNA expression of IL-1β, IL-8, TNF-α and nuclear factor-kappa B (NF-κB) was detected by real-time quantitative polymerase chain reaction. Western blotting was used to detect the protein expression of NF-κB and inhibitor of kappa B. RESULTS Acute inflammation occurred in the mice administered DSS, including the symptoms of losing body weight, loose feces/watery diarrhea and presence of fecal blood; all these symptoms worsened at 7 d. The colons of mice treated with DSS were assessed by histological examination, and the results confirmed that acute inflammation had occurred, as evidenced by loss of colonic mucosa and chronic inflammatory cell infiltration, and these features extended into the deeper layer of the colon walls. The expression levels of IL-1β, IL-8 and TNF-α in the DSS group were higher than those in the control group (P < 0.05), and the expression levels of IL-1β, IL-8 and TNF-α in the JPQCD and 5-ASA groups were

  20. Platelet activating factor: release from colonic mucosa in patients with ulcerative colitis and its effect on colonic secretion.

    PubMed Central

    Wardle, T D; Hall, L; Turnberg, L A

    1996-01-01

    Inflammatory mediators have been implicated in the pathophysiology of ulcerative colitis. They may stimulate intestinal secretion and contribute to the production of diarrhoea. Platelet activating factor (PAF) may be responsible for a high proportion of this secretory response. Biopsy specimens from inflamed and quiescent mucosa of patients with ulcerative colitis and normal human colonic mucosa were cultured or co-cultured. The release of PAF, prostaglandin E2, and leukotriene D4 into the culture medium was measured and the ability of this culture medium, from inflamed and normal tissues, to influence secretion in rat colonic mucosa was assessed. PAF was liberated by inflamed tissue. Its release from quiescent but not normal tissue was stimulated by medium in which inflamed mucosal biopsy tissues had been cultured and by exogenous bradykinin and 5-hydroxytryptamine, but not by histamine. PAF stimulated eicosanoid production. The rise in short circuit current produced in vitro by inflamed tissue culture medium was inhibited by the PAF receptor antagonist (CV 6209) (46%) (32.4 (2.9) v 17.5 (1.19) muA.cm-2, p < 0.005) and further by combined cyclooxygenase and lipoxygenase inhibition (indomethacin plus ICI 207968) (58%) (32.4 (2.9) v 13.6 (1.9) muA.cm-2, p < 0.005). Mepacrine and hydrocortisone attenuated considerably the electrical response evoked by medium from inflamed mucosa to a similar extent (32.4 (2.9) v 6.3 (1.2) v 5.1 (0.9) muA.cm-2, p < 0.001). These data suggest that PAF accounted for 46% of the culture medium secretory effect. Thus, any attempt to block its release in patients with ulcerative colitis may have only a partial effect on their symptoms. PMID:8675086

  1. Non-Helicobacter pylori, non-NSAIDs peptic ulcers: a descriptive study on patients referred to Taleghani hospital with upper gastrointestinal bleeding

    PubMed Central

    Rajabalinia, Hasan; Ghobakhlou, Mehdi; Nikpour, Shahriar; Dabiri, Reza; Bahriny, Rasoul; Sherafat, Somayeh Jahani; Moghaddam, Pardis Ketabi

    2012-01-01

    Aim The purpose of the present study was to evaluate the number and proportion of various causes of upper gastrointestinal bleeding and actual numbers of non-NSAID, non-Helicobacter pylori (H.pylori) peptic ulcers seen in endoscopy of these patients. Background The number and the proportion of patients with non- H.pylori, non-NSAIDs peptic ulcer disease leading to upper gastrointestinal bleeding is believed to be increasing after eradication therapy for H.pylori. Patients and methods Medical records of patients referred to the emergency room of Taleghani hospital from 2010 with a clinical diagnosis of upper gastrointestinal bleeding (hematemesis, coffee ground vomiting and melena) were included in this study. Patients with hematochezia with evidence of a source of bleeding from upper gastrointestinal tract in endoscopy were also included in this study. Results In this study, peptic ulcer disease (all kinds of ulcers) was seen in 61 patients which were about 44.85% of abnormalities seen on endoscopy of patients. Among these 61 ulcers, 44 were duodenal ulcer, 22 gastric ulcer (5 patients had the both duodenal and gastric ulcers). Multiple biopsies were taken and be sent to laboratory for Rapid Urease Test and pathological examination. About 65.53% of patients had ulcers associated with H.pylori, 9.83% had peptic ulcer disease associated with NSAIDs and 11.47% of patients had ulcers associated with both H.pylori and consumption of NSAIDs. 13.11% of patients had non-NSAIDs non- H.pylori peptic ulcer disease. Conclusion The results of this study supports the results of other studies that suggest the incidence of H.pylori infection related with duodenal ulcer is common, and that non-H pylori and non-NSAIDs duodenal ulcer is also common. PMID:24834225

  2. Telemetry provides new insights into entrainment of activity wheel circadian rhythms and the role of body temperature in the development of ulcers in the activity-stress paradigm.

    PubMed

    Murphy, Helen M; Wideman, Cyrilla H; Aquila, Louise A; Nadzam, George R

    2002-01-01

    Two methods of monitoring the circadian rhythm of activity in rodents: (1) an activity wheel cage, which detects the number of wheel revolutions, and (2) an internal radio transmitter, which records gross motor activity (GMA) of the animal, were compared in both normal circadian cycles and during the development of activity-stress ulcers. Rats were implanted with a biotelemetry transmitter that detected GMA and body temperature (BT) and placed in activity wheel cages. A 12 hour/12 hour light/dark cycle was maintained throughout the experiment. Subjects were subdivided into two groups: (1) unlimited access to activity wheel (AW) cages and (2) locked activity wheel (LW) cages. Following an ad-libitum habituation period, animals were allowed food access for 1 hour/day during the light. In the habituation period, the animals showed higher GMA and BT during the dark phase when housed in AW cages than in LW cages. Both GMA and number of wheel revolutions increased dramatically after the onset of food restriction for the AW animals. There was a deleterious drop in BT in AW animals as the food-restricted period continued and a significant correlation existed between severity of ulcerations and BT. The findings of this experiment demonstrate that the activity wheel imposes an alternation of the circadian cycle, which, in turn, influences rhythmicity through reentrainment. Additionally, in the activity-stress paradigm, a significant drop in BT correlates with severity of ulcerations. A disrupted circadian cycle, involving hypothermia, is proposed as the mechanism underlying the demise of animals in the activity-stress paradigm.

  3. Comparison of solcoseryl and epidermal growth factors (EGF) in healing of chronic gastroduodenal ulcerations and mucosal growth in rats.

    PubMed

    Konturek, S J; Brzozowski, T; Dembinski, A; Warzecha, A; Drozdowicz, D

    1988-02-01

    Solcoseryl, a deproteinized extract of calf blood, and EGF, produced by salivary glands, have been shown to enhance the healing of peptic ulcerations, but the mechanism of this effect is unknown. Since both solcoseryl and EGF have been reported to stimulate cell proliferation, we designed the study to compare the ulcer healing and growth promoting actions of these two agents in the same animals. Gastric and duodenal ulcerations were produced by serosal application of 100% acetic acid on an area of 13.8 mm2 of gastric and duodenal wall, respectively. In the control animals, 7 days after ulcer induction, the mean ulcer area was reduced to 7.1 +/- 1.2 mm2 in the stomach, and to 6.1 +/- 0.8 mm2 in the duodenum. After 14 days all ulcers were healed, both in the stomach and duodenum. Oral administration of solcoseryl (10 ml/kg-day) or EGF (30 micrograms/kg-day) for 7 days after ulcer induction resulted in a significant reduction in the ulcer area in the stomach, and to a greater extent in the duodenum. This enhancement of ulcer healing by solcoseryl was accompanied by a significant increase in the weight of the duodenal mucosa and the total contents of DNA and RNA after 7 days of treatment, and in the weight and nucleic acid contents in both the gastric and duodenal mucosa after 14 days of treatment. EGF also increased the weights and the nucleic acid contents in gastric and duodenal mucosa, but this was significant only after 14 days of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature

    PubMed Central

    Wani, Majid; Tiwari, Priyanka; Ramaswamy, Palaniswamy Kalipatti; Kumar, Reddy Prasanna

    2016-01-01

    Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules. PMID:27437304

  5. Variant on Manifestation of Duodenal Metastasis 26 Years after Initial Diagnosis of Primary Cutaneous Melanoma

    PubMed Central

    Kitajima, Kumiko; Bardier-Dupas, Armelle; Breton, Sylvie; Rousseau, Géraldine; Siksik, Jean-Michel; Vaillant, Jean-Christophe; Hannoun, Laurent

    2010-01-01

    Malignant duodenal neoplasms are relatively rare, and the diagnosis is often delayed because of their vague and nonspecific symptoms. We report the case of a 79-year-old female who had a medical history of malignant melanoma of the cheek that had initially been diagnosed at 53 years of age. Work-up revealed severe stenosis of the duodenum caused by a large mass with ulceration at the tip of its mucosal surface. Tumor biopsy led to a histological diagnosis of extremely poorly differentiated carcinoma, but it was impossible to determine whether the lesion was a primary neoplasm or represented secondary involvement. Pancreatoduodenectomy was performed, and the surgical specimen showed a protuberant tumor in the nonampullary region of the second portion of the duodenum. Final diagnosis of metastatic duodenal melanoma was made by immunohistological examination. She is currently alive without recurrence 28 months after the surgical treatment. PMID:21103234

  6. Cytoprotection with misoprostol: use in the treatment and prevention of ulcers.

    PubMed

    Ballinger, A

    1994-01-01

    Prostaglandins protect the gastric mucosa by decreasing gastric acid secretion, increasing mucus and bicarbonate production and maintaining mucosal blood flow. Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastroduodenal damage and this is due, at least in part, to inhibition of mucosal prostaglandin production. Misoprostol is a synthetic analogue of prostaglandin E1 which has been used in the healing of ulcers and prevention of peptic ulcers in patients taking NSAIDs. Misoprostol is of equal efficacy to H2 antagonists in the healing of ordinary peptic ulcers (not associated with NSAIDs). Misoprostol is superior to placebo in healing NSAID ulcers during continued NSAID treatment but there have been no comparative trials with other ulcer-healing drugs. Misoprostol, H2 antagonists and sucralfate are of similar efficacy in prevention of NSAID-associated duodenal ulcers but misoprostol is more effective in prevention of gastric ulcers. Misoprostol has not been compared to omeprazole in this situation.

  7. Fatty acid composition and mechanisms of the protective effects of myrtle berry seed aqueous extract in alcohol-induced peptic ulcer in rat.

    PubMed

    Jabri, Mohamed-Amine; Rtibi, Kais; Tounsi, Haifa; Hosni, Karim; Marzouki, Lamjed; Sakly, Mohsen; Sebai, Hichem

    2016-11-10

    This study aimed to investigate the antiulcer and antioxidant activities of myrtle berry seed aqueous extract (MBSAE) in a peptic ulcer model induced by ethanol in male Wistar rats. MBSAE is rich in total polyphenols, total flavonoids, and unsaturated fatty acids, particularly linoleic (18:2) and oleic (18:1) acids. MBSAE also exhibited in vitro antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) (IC50 = 172.1 μg/mL) and superoxide anion (IC50 = 200.24 μg/mL) scavenging activities. In vivo, MBSAE provided dose-dependent protection against ethanol-induced gastric and duodenal macroscopic and histological alterations. Also, it inhibited secretory profile disturbances and lipid peroxidation, and preserved normal antioxidant enzyme activities and nonenzymatic antioxidant levels. More importantly, we showed that acute alcohol intoxication increased gastric and duodenal calcium, hydrogen peroxide, and free iron levels, whereas MBSAE treatment protected against intracellular mediator deregulation. In conclusion, we suggest that MBSAE has potent protective effects against alcohol-induced peptic ulcer in rat. This protection might be related in part to its antioxidant properties as well as its opposite effects on some studied intracellular mediators.

  8. Identification of a dicaffeoylquinic acid isomer from Arctium lappa with a potent anti-ulcer activity.

    PubMed

    Carlotto, Juliane; da Silva, Luisa M; Dartora, Nessana; Maria-Ferreira, Daniele; Sabry, Diego de A; Filho, Arquimedes P S; de Paula Werner, Maria F; Sassaki, Guilherme L; Gorin, Philip A J; Iacomini, Marcello; Cipriani, Thales R; de Souza, Lauro M

    2015-04-01

    Leaves of Arctium lappa contain several mono- and dicaffeoylquinic acids, as evaluated by liquid chromatography-mass spectrometry. In order to investigate the protection on gastric mucosa against ulcers, rats were treated with fractions from leaf extract prior to ethanol-induced ulcers. The original fraction obtained as ethanol soluble fraction from hot aqueous extract was able to protect de gastric mucosa, and this effect was retained in the ethyl acetate fraction, obtained from liquid/liquid fractionation. The main compound in this fraction was isolated and chemically characterized by nuclear magnetic resonance and mass spectrometry, assisted by isopropylidene derivatization which gave rise a mass increment of 40 units. Therefore, the underivatized compound that had m/z 515.119 [M-H](-) was shifted to m/z 555.151, being confirmed as 1,3-O-dicaffeoylquinic acid, which presented an ED50 of 57 µg kg(-1) on gastric protection, lesser than the therapeutic concentration of omeprazole (40 mg kg(-1)).

  9. Future directions of duodenal endoscopic submucosal dissection

    PubMed Central

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-01-01

    Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure. PMID:25901218

  10. Duodenal Somatostatinoma: A Case Report and Review

    PubMed Central

    Kim, Jung A; Choi, Won-Ho; Kim, Chul Nam; Moon, Young Soo; Chang, Sun Hee

    2011-01-01

    Somatostatinomas are rare functioning carcinoid tumors that usually arise in the pancreas and duodenum. They are seldom associated with typical clinical symptoms; their diagnosis is confirmed only by histological and immunohistochemical studies and the presence of specific hormones. Two distinct clinicopathological forms of somatostatinoma exist: duodenal and pancreatic somatostatinomas. Clinically, compared to pancreatic somatostatinomas, duodenal somatostatinomas are more often associated with nonspecific symptoms and neurofibromatosis, but less often with somatostatinoma syndrome or metastasis. Histologically, duodenal somatostatinomas frequently have psammoma bodies in the tumor cells. We report a case of duodenal somatostatinoma in 58-year-old man with vague epigastric pain and nausea. He did not have diabetes, steatorrhea, or cholelithiasis. Abdominal computed tomography showed a 25-mm mass in the duodenum and 25-mm nodule in the liver. Endoscopic retrograde cholangiopancreatography showed a duodenal submucosal tumor. Although the endoscopic biopsies were free of malignancy, the patient subsequently underwent Whipple's operation for the duodenal mass. Examination revealed as a somatostatinoma using a special stain for somatostatin. PMID:21437171

  11. Childhood chronic gastritis and duodenitis: Role of altered sensory neuromediators

    PubMed Central

    Islek, Ali; Yilmaz, Aygen; Elpek, Gulsum Ozlem; Erin, Nuray

    2016-01-01

    AIM To investigate the roles of the neuropeptides vasoactive intestinal peptide (VIP), substance P (SP), and calcitonin gene-related peptide (CGRP) in chronic gastritis and duodenitis in children. METHODS Biopsy samples from the gastric and duodenal mucosa of 52 patients and 30 control subjects were obtained. Samples were taken for pathological examination, immunohistochemical staining, enzyme activity measurements and quantitative measurements of tissue peptide levels. RESULTS We observed differential effects of the disease on peptide levels, which were somewhat different from previously reported changes in chronic gastritis in adults. Specifically, SP was increased and CGRP and VIP were decreased in patients with gastritis. The changes were more prominent at sites where gastritis was severe, but significant changes were also observed in neighboring areas where gastritis was less severe. Furthermore, the degree of changes was correlated with the pathological grade of the disease. The expression of CD10, the enzyme primarily involved in SP hydrolysis, was also decreased in patients with duodenitis. CONCLUSION Based on these findings, we propose that decreased levels of VIP and CGRP and increased levels of SP contribute to pathological changes in gastric mucosa. Hence, new treatments targeting these molecules may have therapeutic and preventive effects. PMID:27729741

  12. Manuka Honey Exerts Antioxidant and Anti-Inflammatory Activities That Promote Healing of Acetic Acid-Induced Gastric Ulcer in Rats

    PubMed Central

    Almasaudi, Saad B.; Al-Hindi, Rashad R.; Abdel-dayem, Umama A.; Ali, Soad S.; Saleh, Rasha M.; Al Jaouni, Soad K.

    2017-01-01

    Gastric ulcers are a major problem worldwide with no effective treatment. The objective of this study was to evaluate the use of manuka honey in the treatment of acetic acid-induced chronic gastric ulcers in rats. Different groups of rats were treated with three different concentrations of honey. Stomachs were checked macroscopically for ulcerative lesions in the glandular mucosa and microscopically for histopathological alterations. Treatment with manuka honey significantly reduced the ulcer index and maintained the glycoprotein content. It also reduced the mucosal myeloperoxidase activity, lipid peroxidation (MDA), and the inflammatory cytokines (TNF-α, IL-1β, and IL-6) as compared to untreated control group. In addition, honey-treated groups showed significant increase in enzymatic (GPx and SOD) and nonenzymatic (GSH) antioxidants besides levels of the anti-inflammatory cytokine IL-10. Flow cytometry studies showed that treatment of animals with manuka honey has normalized cell cycle distribution and significantly lowered apoptosis in gastric mucosa. In conclusion, the results indicated that manuka honey is effective in the treatment of chronic ulcer and preservation of mucosal glycoproteins. Its effects are due to its antioxidant and anti-inflammatory properties that resulted in a significant reduction of the gastric mucosal MDA, TNF-α, IL-1β, and IL-6 and caused an elevation in IL-10 levels. PMID:28250794

  13. Acid-NSAID/aspirin interaction in peptic ulcer disease.

    PubMed

    Hunt, Richard H; Yuan, Yuhong

    2011-01-01

    The presence of gastric acid plays a critical role in the mechanisms of NSAIDs/aspirin-associated gastric and duodenal mucosal injury and ulceration. The role of gastric acid and its relationship to NSAIDs/aspirin in mucosal damage, ulcer and ulcer complications continues to be an important concern because of the increasing worldwide use of NSAIDs and aspirin. Acid suppression continues to be an important prevention strategy for NSAID-associated gastric and duodenal ulcer and ulcer complications. While a coxib or an NSAID and PPI in combination are considered to have comparable safety profiles, the evidence from direct comparisons in high-risk patients is limited, and the cardiovascular safety of coxibs and NSAIDs remains a concern especially in patients with a high risk of cardiovascular disease. An evaluation of individual gastrointestinal and cardiovascular risks and benefits, selection of the most appropriate NSAID and dose for each particular patient should always be emphasized. Twice daily PPI is more appropriate to protect a patient who is taking NSAIDs twice daily. PPI co-therapy is still recommended in patients receiving dual antiplatelet treatment, although conflicting results have been reported about adverse drug interactions between PPIs and clopidogrel.

  14. Venous leg ulcers

    PubMed Central

    2011-01-01

    Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids

  15. Diagnosis and treatment of venous ulcers.

    PubMed

    Collins, Lauren; Seraj, Samina

    2010-04-15

    Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures.

  16. [Bioelectrical activity and evacuation function of the gastric stump in an early period after different means of gastric resection and variations in the formation of anastomoses].

    PubMed

    Kapustin, B B; Khalimov, E V

    2003-01-01

    The results of the stomach resection on the occasion of stomach and duodenal ulcer were analyzed. Bioelectric activity of the stomach stump was studied in a comparative aspect, and early recovery of the motor function of the resected stomach after the formation of pyloroimitating gastroduodenal anastomoses was shown. Revealed roentgenologic mechanisms of the evacuator function of the stomach stump let us determine evacuation types for the early postoperative period. The formation of pyloroimitating gastroduodenal anastomoses is functionally advantageous.

  17. [Soy products for dietary treatment of children with erosive-ulcerative lesions of the alimentary tract].

    PubMed

    Kolupaeva, Iu I; Anisimova, Iu N; Borovskiĭ, V R

    2008-01-01

    The usage of soy products for dietary treatment of children with erosive-ulcer lesions of alimentary tract brings positive clinical dynamics, normalization of colon function and protein metabolism, acceleration of erosive defects repair, immune status correction. The obtained results justify inclusion of soy products into duodenal pathology treatment--especially when accompanied by protein deficiency.

  18. [Is the successful eradication of Helicobacter pylori sufficient for the healing of peptic ulcer?].

    PubMed

    Pregun, István; Herszényi, László; Juhász, Márk; Miheller, Pál; Tulassay, Zsolt

    2006-03-12

    Helicobacter pylori has a major role in the pathogenesis of peptic ulcer disease. Cure of the infection is essential in ulcer healing, but an additional PPI therapy after completing eradication treatment is widespread in clinical practice. In the present work clinical studies evaluating peptic ulcer healing followed or not by PPI treatment after eradication therapy were analyzed. The results of these trials are concordant that only a minority of patients with duodenal ulcer would benefit from prolonged acid suppressive treatment, a successful eradication therapy (that counts for a large proportion) is sufficient. There are less data available concerning gastric ulcer: successful eradication is also essential to ulcer healing and to avoid relapse, however it seems that post-eradication PPI therapy might be beneficial.

  19. Melatonin inhibits alcohol-induced increases in duodenal mucosal permeability in rats in vivo.

    PubMed

    Sommansson, Anna; Saudi, Wan Salman Wan; Nylander, Olof; Sjöblom, Markus

    2013-07-01

    Increased intestinal permeability is often associated with epithelial inflammation, leaky gut, or other pathological conditions in the gastrointestinal tract. We recently found that melatonin decreases basal duodenal mucosal permeability, suggesting a mucosal protective mode of action of this agent. The aim of the present study was to elucidate the effects of melatonin on ethanol-, wine-, and HCl-induced changes of duodenal mucosal paracellular permeability and motility. Rats were anesthetized with thiobarbiturate and a ~30-mm segment of the proximal duodenum was perfused in situ. Effects on duodenal mucosal paracellular permeability, assessed by measuring the blood-to-lumen clearance of ⁵¹Cr-EDTA, motility, and morphology, were investigated. Perfusing the duodenal segment with ethanol (10 or 15% alcohol by volume), red wine, or HCl (25-100 mM) induced concentration-dependent increases in paracellular permeability. Luminal ethanol and wine increased, whereas HCl transiently decreased duodenal motility. Administration of melatonin significantly reduced ethanol- and wine-induced increases in permeability by a mechanism abolished by the nicotinic receptor antagonists hexamethonium (iv) or mecamylamine (luminally). Signs of mucosal injury (edema and beginning of desquamation of the epithelium) in response to ethanol exposure were seen only in a few villi, an effect that was histologically not changed by melatonin. Melatonin did not affect HCl-induced increases in mucosal permeability or decreases in motility. Our results show that melatonin reduces ethanol- and wine-induced increases in duodenal paracellular permeability partly via an enteric inhibitory nicotinic-receptor dependent neural pathway. In addition, melatonin inhibits ethanol-induced increases in duodenal motor activity. These results suggest that melatonin may serve important gastrointestinal barrier functions.

  20. Venous Ulcers

    PubMed Central

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  1. Aberrant expression of circulating Th17, Th1 and Tc1 cells in patients with active and inactive ulcerative colitis.

    PubMed

    Dong, Zhaogang; Du, Lutao; Xu, Xiaofei; Yang, Yongmei; Wang, Haiyan; Qu, Ailin; Qu, Xun; Wang, Chuanxin

    2013-04-01

    Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease, yet its etiology and pathogenesis remain poorly understood. The aberrant expression of T lymphocytes plays an essential role in the progression of UC. This study aimed to evaluate the expression profile of circulating Th17, Th1 and Tc1 cells in patients with active and inactive UC. Our results revealed that the percentage of circulating Th17 cells (CD3+CD8-IL-17+) was significantly increased in patients with active UC when compared with the percentage in patients with inactive UC, Crohn's disease (CD) and healthy controls. The percentages of circulating Th1 (CD3+CD8-IFN-γ+) and Tc1 (CD3+CD8+IFN-γ+) cells were also higher in patients with active UC when compared with the percentages in patients with inactive UC and normal controls, although levels were lower than that in CD. Further analysis showed that Th17 cells were positively correlated with Th1 cells, but not with Tc1 cells. Notably, the three cells had a positive correlation with disease activity, extent of disease, detection of erythrocyte sedimentation rate and c-reactive protein in active UC. Moreover, plasma IL-17 was higher in patients with active UC, and a similar trend applied to the mRNA levels of RORγt and T-bet in peripheral blood mononuclear cells (PBMCs). The levels of p-STAT3 and p-STAT5 in PBMCs, as well as the ratio of p-STAT3/p-STAT5, were also elevated in active UC patients. Taken together, our findings revealed that elevated circulating Th17, Th1 and Tc1 cells and the aberrant activation of the STAT pathway may be implicated in the progression of UC. These findings may provide preliminary experimental clues for the development of new therapies for UC.

  2. Expression of guanylate cyclase-C, guanylin, and uroguanylin is downregulated proportionally to the ulcerative colitis disease activity index

    PubMed Central

    Lan, Danfeng; Niu, Junkun; Miao, Jiarong; Dong, Xiangqian; Wang, Hong; Yang, Gang; Wang, Kunhua; Miao, Yinglei

    2016-01-01

    The transmembrane receptor guanylate cyclase-C (GC-C) signaling pathway has been implicated in several gastrointestinal disorders. Activation of GC-C via guanylin (Gn) and uroguanylin (Ugn) regulates intestinal fluid and electrolyte homeostasis. However, how it regulates the pathogenesis of inflammatory bowel disease (IBD) is still unclear. Here, we investigated the activation of GC-C signaling in ulcerative colitis (UC) of different clinical severities. A total of 60 UC patients and 20 normal controls were recruited. Evaluation of the UC disease activity index (DAI) was performed using a modified Mayo scoring system. The expression of GC-C, Gn and Ugn in the colonic mucosa was measured by quantitative real-time PCR and Western blot. We found that the UC patients had significantly lower expression of GC-C, Gn and Ugn than the controls. Furthermore, there were significant differences for GC-C, Gn and Ugn expression for the UC groups of Grade 1, 2 and 3, and their expression levels were reduced with increases in their DAI. Taken together, our results demonstrate that GC-C, Gn and Ugn are downregulated in UC, and this downregulation is more significant with aggravation of the clinical condition. Therefore, the GC-C signaling pathway may be implicated in the progression of UC. PMID:27125248

  3. Psychological status in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life

    PubMed Central

    Tabatabaeian, Mahshid; Afshar, Hamid; Roohafza, Hamid Reza; Daghaghzadeh, Hamed; Feizi, Awat; Sharbafchi, Mohammad Reza; Tabatabaeian, Maryam; Naji, Fateme; Adibi, Peyman

    2015-01-01

    Background: Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC) and its relationship with disease activity and quality of life (QOL). Materials and Methods: A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients. Results: From 120 studied patients, 35 (29.2%), 48 (40.0%), and 46 (38.3%) had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r = 0.357 to 0.439, P < 0.01). Disease activity was negatively correlated with all QOL dimensions (r = −0.245 to −0.550, P < 0.01). Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r = −0.356 to −0.789, P < 0.01). In the regression models, anxiety was independently associated with active disease (β = 4.150, P = 0.049). Furthermore, disease activity was associated with the physical health (β = −0.371, P < 0.001). For almost all of the QOL domains, depression and psychological distress were independent predictors (β = −0.296 to −0.453, P < 0.001). Conclusion: Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard. PMID:26600833

  4. Venous ulcer review

    PubMed Central

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  5. Helicobacter pylori eradication as prevention against chronic peptic ulcer disease in children.

    PubMed

    Maciorkowska, E; Kaczmarski, M; Skowrońska, J; Cieśla, J M; Chrzanowska, U; Olejnik, B T; Sacharewicz, A; Ryszczuk, E

    2005-01-01

    The changes caused by Helicobacter pylori are a slow, progressing inflammatory process developing from several to dozen years. H. pylori infection leads to an inflammatory response in the gastric mucosa with granulocyte infiltrates in an acute form of the inflammation, and lymphocytes, plasmatic, macrophages and eosinophils in a chronic form inducing the development of gastric and duodenal ulcers and gastric cancer in some patients. The frequency and the type of morphological changes in the gastric mucosa were analyzed in children with positive IgG against H. pylori and the incidence of gastric and duodenal ulcers in family members of children examined was evaluated in our study. Gastritis was reported in 68.8% of children with positive IgG against H. pylori. Gastric ulcer was confirmed in 37.1% of families of children included in the study. Duodenal ulcers were found in 22.9% of families. The results obtained, indicate the usefulness of long-term observation and clinical follow-up of children with chronic gastritis of H. pylori ethiology taking into consideration bacterium eradication as prophylaxis of peptic ulceration.

  6. Proximal small bowel obstruction caused by a massive intraluminal thrombus from a stress ulcer

    PubMed Central

    Siddiky, AH; Gupta, P

    2012-01-01

    We describe a case of proximal small bowel obstruction caused by an occlusive thrombus as a result of bleeding from a duodenal ulcer, which is likely to be stress induced. Initial presentation was confused as a bleeding duodenal ulcer and resultant ileus. Such reports are incredibly rare in the literature and never has one been reported as a result of a stress ulcer. Obstructive symptoms in the acute postoperative patient may be confused for an ileus but mechanical causes must be excluded. The presence of upper gastrointestinal bleeding must not detract from that possibility. Future identification of an occlusive clot on endoscopy that is impossible to circumnavigate may benefit from intraluminal injection of thrombolytic agents to prevent obstruction but this must be weighed with the risk of exacerbating any bleeding. Clearly a risk versus benefit analysis will be necessary on an individual basis. PMID:24960721

  7. Feasibility and safety of endoscopic cryoablation at the duodenal papilla: Porcine model

    PubMed Central

    Yang, Dennis; Reinhard, Mary K; Wagh, Mihir S

    2015-01-01

    no bleeding, infection, or perforation on necropsy. Endoscopic on POD#7 showed edema and ulceration at the duodenal papilla. On histology, there was loss of crypt architecture with moderate to severe necrosis and acute mixed inflammatory infiltration in each specimen following cryotherapy. The extent of cryogen-induced tissue necrosis (depth of injury) was limited to the mucosa on full-thickness specimen evaluation. CONCLUSION: Endoscopic liquid nitrogen spray cryotherapy is feasible and safe for ablation at the duodenal papilla in a porcine model. PMID:26140100

  8. Ulcerative Colitis Activity Presenting as Fever of Unknown Origin, in a Patient with Longstanding Disease under Continuous Treatment with Mesalazine

    PubMed Central

    Sfendouraki, Elissavet; Karianos, Theodoros; Saranti, Sofia; Tsitsimelis, Dimitrios; Vrettos, Ioannis; Kalliakmanis, Andreas

    2016-01-01

    Background. The presence of ulcerative colitis (UC) with no bowel symptoms, as fever of unknown origin (FUO), is uncommon. Objective. To describe the case of an 80-year-old woman who presented with fever, with a history of UC under treatment with mesalazine. Case Presentation. She was admitted due to fever lasting for 12 days with no associated symptoms. Seven years earlier, she was diagnosed with UC. After an extended workup for FUO that failed to reach the diagnosis, she underwent a gallium-67 scintigraphy. This revealed a persistent diffuse concentration of gallium-67 in the ascending colon at 24-hour imaging that remained stable at 48- and 72-hour imaging without any topographic change after the use of laxatives. Considering the results and in the absence of another diagnosis, the patient was treated with 30 mg prednisone daily and mesalazine, as treatment of active UC. Subsequently, the patient's condition improved markedly and the fever retreated. One month later, she was reevaluated with a gallium-67 scintigraphy with total absence of gallium-67 concentration in the ascending colon. Conclusion. UC activity must be included in the differential diagnosis of FUO in patients with longstanding disease, since fever may present alone, with no other manifestations. PMID:27504121

  9. Duodenal organ injury severity (OIS) and outcome.

    PubMed

    Kline, G; Lucas, C E; Ledgerwood, A M; Saxe, J M

    1994-07-01

    The effect of organ injury severity on outcome was assessed in 101 patients treated for duodenal trauma. Most patients were men (89%) and victims of penetrating wounds (93%). Grade I is minor hematoma or incomplete perforation; Grade II is major hematoma or small complete perforation; Grade III is large perforation excluding ampulla; Grade IV is large perforation at ampulla; Grade V is duodenopancreatic crunch. The injuries were as follows: Grade I (5 patients), Grade II (31), Grade III (40), Grade IV (12), and Grade V (13). Fourteen patients exsanguinated from associated vessel injury; each had Grade IV or Grade V injury. All 36 patients with Grade I and Grade II injury had primary repair; the single death was due to liver necrosis. Most (31 patients) Grade III injuries and three Grade IV injuries were treated by primary repair alone; the three deaths were unrelated to the duodenal injury. Other major injuries were treated by duodenal exclusion (4 patients), duodenal diverticulization (6), or resection (4); the single death was unrelated to the duodenum. Primary closure is favored for minor injuries and most Grade III injuries. Severe injuries may require exclusion, diverticulization, or resection.

  10. Duodenal Amyloidosis Masquerading as Iron Deficiency Anemia

    PubMed Central

    Hurairah, Abu

    2016-01-01

    The present study is a unique illustration of duodenal amyloidosis initially manifesting with iron deficiency anemia. It underscores the importance of clinical suspicion of amyloidosis while performing upper gastrointestinal endoscopy with a biopsy to establish the definite diagnosis in patients with unexplained iron deficiency anemia. PMID:27625911

  11. Duodenal web with preduodenal portal vein.

    PubMed

    Golombek, S; Bilgi, J; Ukabiala, O

    1995-06-01

    This article described an unusual case of an infant with duodenal atresia and preduodenal portal vein without Down's syndrome or other anatomical anomalies associated with this condition. Duodenoduodenostomy was effective. Enteral feeding was re-established 72 hours post-operatively and the patient was discharged home one day later.

  12. Duodenal leiomyosarcoma mimicking a pancreatic pseudocyst.

    PubMed

    Sperti, C; Pasquali, C; Di Prima, F; Baffa, R; Pedrazzoli, S

    1994-01-01

    A case of duodenal leiomyosarcoma presenting as a cystic mass is reported. Amylase, tumour markers levels in the cyst fluid and radiological findings suggested an inflammatory pancreatic pseudocyst. Exploratory laparotomy and frozen section examination showed a smooth muscle tumour of the duodenum. Pancreatoduodenectomy with pylorus-preser vation was performed and the patient remained symptom-free at 8 months follow-up.

  13. Campylobacter pylori-associated gastritis: attempts to eradicate the bacteria by various antibiotics and anti-ulcer regimens.

    PubMed

    Glupczynski, Y; Burette, A; Nyst, J F; De Prez, C; De Koster, E; Deltenre, M

    1988-01-01

    The efficacy of various antimicrobial and anti-ulcer agents on the eradication of Campylobacter pylori in patients with antral gastritis or duodenal ulcers was investigated by several open studies or double-blind, placebo-controlled protocols. Among the anti-ulcer agents, ranitidine, cimetidine or sucraflate had no effect on C. pylori. Colloidal bismuth subcitrate achieved clearance of C. pylori in 40% of treated patients at the end of therapy but a high relapse rate (14/16 patients) was observed after a 6-month follow-up period. The antibacterial agents doxycycline, minocycline, ofloxacin, clindamycin, paromomycin and nifuroxazide failed to eradicate C. pylori in most patients. By contrast, short term elimination of C. pylori could be achieved in more than 90% of patients treated with amoxycillin. However, relapse occurred as a rule in all amoxycillin-treated patients within one month after therapy. Overall, we observed no correlation between the in-vitro activity of the different antibacterial agents and their in vivo efficacy. Development of resistance during therapy does not seem to account for this discrepancy since it occurred only with ofloxacin. On the basis of these results, we conclude that long term eradication of C. pylori from the gastric antrum cannot be achieved after monotherapy either with antibiotics or with bismuth salts.

  14. Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers

    PubMed Central

    Lin, Hwai-Jeng; Lo, Wen-Ching; Perng, Chin-Lin; Tseng, Guan-Ying; Li, Anna Fen-Yau; Ou, Yueh-Hsing

    2005-01-01

    AIM: Helicobacter pylori (H pylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma. Conventional invasive tests are less sensitive than non-invasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers. METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test, histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of H pylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2), iceA1, iceA2 and cag A. RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%) and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity, positive predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79% and 81

  15. Prolonged duodenal paralysis after PEG placement in a patient with traumatic brain injury: a case report.

    PubMed

    Mammi, P; Zaccaria, B; Dazzi, F; Saccavini, M

    2011-03-01

    Percutaneous endoscopic gastrostomy (PEG) has recently become a usual procedure for patients with prolonged disorders of consciousness after brain injuries. Despite a high rate of success and a very low procedure-related mortality, morbidity associated to PEG placement reaches 9.4% in a recent large meta-analysis. This case report describes an uncommon complication of PEG placement in a patient with vegetative state after traumatic brain injury: the development of prolonged duodenal paralysis. This patient was treated by placement of a transient jejunostomy until recovery of duodenal functional activity, to permit adequate nutrition. This procedure-related complication is previously unreported in scientific literature.

  16. [The treatment of aorto-duodenal fistula with the use of the endovascular prosthesis].

    PubMed

    Milnerowicz, Artur; Milnerowicz, Aleksandra; Pawłowskii, Stanisław; Skóra, Jan; Pupka, Artur

    2012-01-01

    One of the most common and serious complications after implantation of aortic or aorto-femoral prosthesis are aortoduodenal fistula. Secondary aorto-duodenal fistula is the most commonly observed form of a fistula between the abdominal aorta and gastrointestinal tract. 76 years old male with infected vascular prosthesis was admitted to Clinic with syndroms of active bleeding from aorto-duodenal fistula. Because of general condition, patient was qualified to endovascular procedure, and a new stentgraft was implanted. After the procedure patient was treated with antibiotic compatible with inoculation from blood and he did not gave agreement for further surgical operations. He lived next 28 months and died because of lung cancer.

  17. Biphasic effect of duodenal ulcerogens cysteamine (C), mepirizole (M) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropryridine (MPTP) on gastric emptying in the rat

    SciTech Connect

    Pihan, G.; Kline, T.J.; Szabo, S.

    1986-03-01

    The effect of acute or chronic administration of duodenal ulcerogens on gastric emptying (GE) of a liquid meal was investigated. In Sprague-Dawley rats (150-200g) 2 ml of /sup 51/Cr in 2% dextrose (5000 CPM) was given intragastrically and the GE half life was established as 7.6 min (controls). In acute experiments, C (30mg/100g), M (40mg/100g) or MPTP (4mg/100g) injected subcutaneously all delayed GE at 1, 2, 4, 8 and 24 hr by 15-77%. Maximal GE delay (p<0.05) by 77, 48 or 71% was found 1, 1 or 2 hr after C, M or MPTP, respectively. In chronic experiments, C (22mg/100g) was given x3 on the first day and once daily (25mg/100g) for 3 or 10 additional days. M (20mg/100g) once daily and MPTP (4mg/100g) x3 daily were given for 4 or 11 days. GE was measured on the 5th and 12th day. Chronically, MPTP accelerated GE by 63 and 31% at 5 and 12 days (p<0.05) and C and M did not change GE. The severity of duodenal ulcers correlated (p<0.05) with the amount of /sup 51/Cr remaining in the stomach: r=-0.68, -0.74 and -0.70 after C, M and MPTP, respectively. Acute administration of duodenal ulcerogens delay GE in rats. Chronic treatment with duodenal ulcerogens either accelerates or does not change GE. The most severe chronic ulcers exhibit the most rapid emptying. The authors data suggest that rapid GE might be a secondary rather than a primary alteration in duodenal ulceration.

  18. Disease Severity and Immune Activity Relate to Distinct Interkingdom Gut Microbiome States in Ethnically Distinct Ulcerative Colitis Patients

    PubMed Central

    Mar, Jordan S.; LaMere, Brandon J.; Lin, Din L.; Levan, Sophia; Nazareth, Michelle; Mahadevan, Uma

    2016-01-01

    ABSTRACT Significant gut microbiota heterogeneity exists among ulcerative colitis (UC) patients, though the clinical implications of this variance are unknown. We hypothesized that ethnically distinct UC patients exhibit discrete gut microbiotas with unique metabolic programming that differentially influence immune activity and clinical status. Using parallel 16S rRNA and internal transcribed spacer 2 sequencing of fecal samples (UC, 30; healthy, 13), we corroborated previous observations of UC-associated bacterial diversity depletion and demonstrated significant Saccharomycetales expansion as characteristic of UC gut dysbiosis. Furthermore, we identified four distinct microbial community states (MCSs) within our cohort, confirmed their existence in an independent UC cohort, and demonstrated their coassociation with both patient ethnicity and disease severity. Each MCS was uniquely enriched for specific amino acid, carbohydrate, and lipid metabolism pathways and exhibited significant luminal enrichment of the metabolic products of these pathways. Using a novel ex vivo human dendritic cell and T-cell coculture assay, we showed that exposure to fecal water from UC patients caused significant Th2 skewing in CD4+ T-cell populations compared to that of healthy participants. In addition, fecal water from patients in whom their MCS was associated with the highest level of disease severity induced the most dramatic Th2 skewing. Combined with future investigations, these observations could lead to the identification of highly resolved UC subsets based on defined microbial gradients or discrete microbial features that may be exploited for the development of novel, more effective therapies. PMID:27531910

  19. Duodenal active transport of calcium and phosphate in vitamin D-deficient rats: effects of nephrectomy, Cestrum diurnum, and 1alpha,25-dihydroxyvitamin D3.

    PubMed

    Walling, M W; Kimberg, D V; Wasserman, R H; Feinberg, R R

    1976-05-01

    Both the methanol:chloroform extractable material from the leaves of the Solanaceous plant, Cestrum diurnum (C.d.), and a 270 ng dose of 1alpha, 25-dihydroxyvitamin D3 (1alpha,25-(OH)2D3) increased the active absorption of calcium and phosphate across the proximal duodenum, studied in vitro, from sham-operated and nephrectomized (NPX) vitamin D-deficient rats. In these studies, conducted 24 h after surgery, the uremic state in the NPX animals markedly diminished the intestinal transport response to 1alpha,25-(OH)2D3 and also lowered baseline transport values across duodenum from the NPX vitamin D-deficient controls. Both C.d. and 1alpha, 25-(OH)2D3 elevated plasma Ca levels equally well in the sham-operated and NPX groups. The stimulation of intestinal Ca absorption in NPX animals indicates that, like the leaves of the South American plant, Solanum glaucophyllum, C.d. contains materials which can function in an analogous manner to compounds in the vitamin D group that have either a 1alpha hydroxyl group or its steric equivalent.

  20. Once-daily budesonide MMX in active, mild-to-moderate ulcerative colitis: results from the randomised CORE II study

    PubMed Central

    Travis, Simon P L; Danese, Silvio; Kupcinskas, Limas; Alexeeva, Olga; D'Haens, Geert; Gibson, Peter R; Moro, Luigi; Jones, Richard; Ballard, E David; Masure, Johan; Rossini, Matteo; Sandborn, William J

    2014-01-01

    Objective Budesonide MMX is a novel oral formulation of budesonide that uses Multi-Matrix System (MMX) technology to extend release to the colon. This study compared the efficacy of budesonide MMX with placebo in patients with active, mild-to-moderate ulcerative colitis (UC). Design Patients were randomised 1:1:1:1 to receive budesonide MMX 9 mg or 6 mg, or Entocort EC 9 mg (budesonide controlled ileal-release capsules; reference arm) or placebo once daily for 8 weeks. The primary endpoint was combined clinical and endoscopic remission, defined as UC Disease Activity Index score ≤1 with a score of 0 for rectal bleeding and stool frequency, no mucosal friability on colonoscopy, and a ≥1-point reduction in endoscopic index score from baseline. Results 410 patients were evaluated for efficacy. Combined clinical and endoscopic remission rates with budesonide MMX 9 mg or 6 mg, Entocort EC and placebo were 17.4%, 8.3%, 12.6% and 4.5%, respectively. The difference between budesonide MMX 9 mg and placebo was significant (OR 4.49; 95% CI 1.47 to 13.72; p=0.0047). Budesonide MMX 9 mg was associated with numerically higher rates of clinical (42.2% vs 33.7%) and endoscopic improvement (42.2% vs 31.5%) versus placebo. The rate of histological healing (16.5% vs 6.7%; p=0.0361) and proportion of patients with symptom resolution (23.9% vs 11.2%; p=0.0220) were significantly higher for budesonide MMX 9 mg than placebo. Adverse event profiles were similar across groups. Conclusion Budesonide MMX 9 mg was safe and more effective than placebo at inducing combined clinical and endoscopic remission in patients with active, mild-to-moderate UC. PMID:23436336

  1. Another 'Cushing ulcer'.

    PubMed

    Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

    2011-04-09

    The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing's disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background.

  2. Epstein-Barr Virus Association with Peptic Ulcer Disease

    PubMed Central

    Cárdenas-Mondragón, María G.; Torres, Javier; Flores-Luna, Lourdes; Carreón-Talavera, Ricardo; Camorlinga-Ponce, Margarita; Fuentes-Pananá, Ezequiel M.

    2015-01-01

    Background. Helicobacter pylori (HP) infection and nonsteroidal anti-inflammatory drugs (NSAID) use are considered the main risk to develop peptic ulcer disease (PUD). However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV) reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129), and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers). Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5), while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1). Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD. PMID:26199856

  3. Healing of aspirin-associated peptic ulcer disease despite continued salicylate ingestion.

    PubMed

    O'Laughlin, J C; Silvoso, G R; Ivey, K J

    1981-05-01

    Patients who have rheumatic disease and who are undergoing long-term aspirin therapy have a high incidence of peptic ulcer disease. Whether it is possible to heal long-term aspirin-related peptic ulcer disease if aspirin intake is continued is unknown. Nine patients with rheumatic disease who were receiving long-term aspirin therapy and who had 15 endoscopically verified gastric and/or duodenal ulcers were studied. Patients were treated daily with 1,200 mg of cimetidine plus at least 120 mL of antacid (Mylanta II), while continuing aspirin therapy at the same dose and type. By eight weeks, 14 ulcers had healed. This study shows that some aspirin-associated peptic ulcers can be healed, despite continued aspirin intake, by intensive medical therapy aimed at lowering intragastric acidity.

  4. Functional association between proximal and distal gastric motility during fasting and duodenal nutrient stimulation in humans.

    PubMed

    Nguyen, N Q; Fraser, R J; Bryant, L K; Holloway, R H

    2007-08-01

    A functional integration exists between proximal and distal gastric motor activity in dogs but has not been demonstrated in humans. To determine the relationship between proximal and distal gastric motor activity in humans. Concurrent proximal (barostat) and distal (antro-pyloro-duodenal (APD) manometry) gastric motility were recorded in 10 healthy volunteers (28 +/- 3 years) during (i) fasting and (ii) two 60-min duodenal infusions of Ensure((R)) (1 and 2 kcal min(-1)) in random order. Proximal and APD motor activity and the association between fundic and propagated antral waves (PAWs) were determined. During fasting, 32% of fundic waves (FWs) were followed by a PAW. In a dose-dependent fashion, duodenal nutrients (i) increased proximal gastric volume, (ii) reduced fundic and antral wave (total and propagated) activity, and (iii) increased pyloric contractions. The proportion of FWs followed by a distal PAW was similar between both infusions and did not differ from fasting. During nutrient infusion, nearly all PAWs were antegrade, propagated over a shorter distance and less likely to traverse the pylorus, compared with fasting. In humans, a functional association exists between proximal and distal gastric motility during fasting and duodenal nutrient stimulation. This may have a role in optimizing intra-gastric meal distribution.

  5. [Acid-base blood balance in patients with ulcer under treatment by the gastric secretion inhibitors and antacids].

    PubMed

    Grinevich, V B; Sablin, O A; Uspenskiĭ, Iu L

    2002-01-01

    There was an analysis of the results of the study of intragastric acidity and acid-base balance (ABB) of the blood in 25 patients with duodenal ulcer. The patients were examined before and against the background of the 14-day monotherapy with one of the following preparations: Losec, 40 mg (omeprazole), famotidine, 80 mg (Quamatel), Phosphalugel, or placebo.

  6. Extraintestinal Helminth Infection Limits Pathology and Proinflammatory Cytokine Expression during DSS-Induced Ulcerative Colitis: A Role for Alternatively Activated Macrophages and Prostaglandins.

    PubMed

    Ledesma-Soto, Yadira; Callejas, Blanca E; Terrazas, César A; Reyes, Jose L; Espinoza-Jiménez, Arlett; González, Marisol I; León-Cabrera, Sonia; Morales, Rosario; Olguín, Jonadab E; Saavedra, Rafael; Oghumu, Steve; Satoskar, Abhay R; Terrazas, Luis I

    2015-01-01

    Chronic inflammation of the intestinal mucosa is characteristic of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Helminth parasites have developed immunomodulatory strategies that may impact the outcome of several inflammatory diseases. Therefore, we investigated whether Taenia crassiceps infection is able to decrease the inflammatory effects of dextran sulfate sodium- (DSS-) induced ulcerative colitis in BALB/c and C57BL/6 mice. Preinfection significantly reduced the manifestations of DSS-induced colitis, as weight loss and shortened colon length, and decreased the disease activity index independently of the genetic background of the mice. Taenia infection decreased systemic levels of proinflammatory cytokines while increasing levels of IL-4 and IL-10, and the inflammatory infiltrate into the colon was also markedly reduced. RT-PCR assays from colon showed that T. crassiceps-infected mice displayed increased expression of Arginase-1 but decreased expression of iNOS compared to DSS-treated uninfected mice. The percentages of T regulatory cells were not increased. The adoptive transfer of alternatively activated macrophages (AAMФs) from infected mice into mice with DSS-induced colitis reduced the severity of colon inflammation. Administration of indomethacin abrogated the anticolitic effect of Taenia. Thus, T. crassiceps infection limits the pathology of ulcerative colitis by suppressing inflammatory responses mechanistically associated with AAMФs and prostaglandins.

  7. Extraintestinal Helminth Infection Limits Pathology and Proinflammatory Cytokine Expression during DSS-Induced Ulcerative Colitis: A Role for Alternatively Activated Macrophages and Prostaglandins

    PubMed Central

    Ledesma-Soto, Yadira; Callejas, Blanca E.; Terrazas, César A.; Reyes, Jose L.; Espinoza-Jiménez, Arlett; González, Marisol I.; León-Cabrera, Sonia; Morales, Rosario; Olguín, Jonadab E.; Saavedra, Rafael; Oghumu, Steve; Satoskar, Abhay R.; Terrazas, Luis I.

    2015-01-01

    Chronic inflammation of the intestinal mucosa is characteristic of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Helminth parasites have developed immunomodulatory strategies that may impact the outcome of several inflammatory diseases. Therefore, we investigated whether Taenia crassiceps infection is able to decrease the inflammatory effects of dextran sulfate sodium- (DSS-) induced ulcerative colitis in BALB/c and C57BL/6 mice. Preinfection significantly reduced the manifestations of DSS-induced colitis, as weight loss and shortened colon length, and decreased the disease activity index independently of the genetic background of the mice. Taenia infection decreased systemic levels of proinflammatory cytokines while increasing levels of IL-4 and IL-10, and the inflammatory infiltrate into the colon was also markedly reduced. RT-PCR assays from colon showed that T. crassiceps-infected mice displayed increased expression of Arginase-1 but decreased expression of iNOS compared to DSS-treated uninfected mice. The percentages of T regulatory cells were not increased. The adoptive transfer of alternatively activated macrophages (AAMФs) from infected mice into mice with DSS-induced colitis reduced the severity of colon inflammation. Administration of indomethacin abrogated the anticolitic effect of Taenia. Thus, T. crassiceps infection limits the pathology of ulcerative colitis by suppressing inflammatory responses mechanistically associated with AAMФs and prostaglandins. PMID:26090422

  8. [Duodenal perforation after blunt abdominal trauma].

    PubMed

    Schneider, R; Moebius, C; Thelen, A; Jonas, S

    2009-12-01

    Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis.

  9. [Peritonitis following gastroduodenal ulcer perforation disease in children: report of 4 cases].

    PubMed

    Ndour, O; Bansouda, J; Fall, A F; Alumeti, D M; Diouf, C; Ngom, G; Ndoye, M

    2012-10-01

    Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this

  10. Adenosine deaminase, 5'-nucleotidase, xanthine oxidase, superoxide dismutase, and catalase activities in gastric juices from patients with gastric cancer, ulcer, and atrophic gastritis.

    PubMed

    Durak, I; Ormeci, N; Akyol, O; Canbolat, O; Kavutçu, M; Bülbül, M

    1994-04-01

    Adenosine deaminase (ADA), 5'-Nucleotidase (5NT), Xanthine oxidase (XO), Cu-Zn Superoxide dismutase (SOD) and Catalase (CAT) activities were determined in gastric juices from patients with gastric cancer, ulcer, gastritis and from healthy subjects. Enzyme activities were given as units per ml gastric juice and units per mg protein in gastric juice. ADA, 5NT and XO activities were found lower and protein concentrations were found higher in the cancer group than controls. There was however no significant difference between Cu-Zn SOD activities of the cancer and control groups. In all groups including control one, we could not find catalase activities in most of the samples. On the other hand, ADA, 5NT activities and protein concentrations in the gastric juice were lower in the gastritis group than control group. In the ulcer group, we found higher Cu-Zn SOD and XO activities and lower 5NT activity and protein concentrations compared with control values. In an attempt to establish statistical correlations between mean enzyme activities, pH and protein concentrations in the gastric juices of the groups, we found noticeable intra and inter-correlations, which indicated possible relations between DNA and free radical metabolizing enzymes.

  11. A duodenal role in gastrin release

    PubMed Central

    Hayes, J. R.; Ardill, Joy; Kennedy, T. L.; Buchanan, K. D.

    1974-01-01

    Observations on the plasma gastrin response to feeding protein in patients with the dumping syndrome, patients with pyloric stenosis, and patients asymptomatic after gastric surgery suggested that the duodenum might be important in the mechanism of gastrin release. This duodenal role was confirmed by the finding that when the stimulus was placed directly in the duodenum peak gastrin levels occurred earlier than when the stimulus was placed directly in the stomach. PMID:4422726

  12. An Overview of History, Pathogenesis and Treatment of Perforated Peptic Ulcer Disease with Evaluation of Prognostic Scoring in Adults

    PubMed Central

    Prabhu, V; Shivani, A

    2014-01-01

    Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer. PMID:24669326

  13. An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults.

    PubMed

    Prabhu, V; Shivani, A

    2014-01-01

    Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer.

  14. Optimal management of peptic ulcer disease in the elderly.

    PubMed

    Pilotto, Alberto; Franceschi, Marilisa; Maggi, Stefania; Addante, Filomena; Sancarlo, Daniele

    2010-07-01

    Recent data report that the incidence of peptic ulcer is decreasing in the general population; conversely, the rates of gastric and duodenal ulcer hospitalization and mortality remain very high in older patients. Two major factors that might explain this epidemiological feature in the elderly population are the high prevalence of Helicobacter pylori infection and the increasing prescriptions of gastroduodenal damaging drugs, including NSAIDs and/or aspirin (acetylsalicylic acid). The main goals for treating peptic ulcer disease in old age are to reduce recurrence of the disease and to prevent complications, especially bleeding and perforation. The available treatments for peptic ulcer are essentially based on gastric acid suppression with antisecretory drugs and the eradication of H. pylori infection. The aim of this article is to report the available data on clinical efficacy and tolerability of peptic ulcer treatments in elderly patients and provide recommendations for their optimal use in this special population. Proton pump inhibitor (PPI)-based triple therapies for 7 days are highly effective for the cure of H. pylori-positive peptic ulcers as well as for reducing ulcer recurrence. Antisecretory drugs are also the treatment of choice for NSAID- or aspirin-related peptic ulcers and are useful as preventive therapy in chronic users of NSAIDs and low-dose aspirin as antiplatelet therapy. Antisecretory PPI therapy has a favourable tolerability profile in geriatric patients; however, monitoring is suggested in older patients with frequent pulmonary infections, gastrointestinal malabsorption, unexplained chronic diarrhoea, osteoporosis or those taking concomitant cytochrome P450 2C19-metabolized medications. The overall approach to the geriatric patient should include a comprehensive geriatric assessment that ensures multidimensional evaluation of the patient in order to better define the clinical risk of adverse outcomes in the older patient with peptic ulcer and

  15. Calcium transport by rat duodenal villus and crypt basolateral membranes

    SciTech Connect

    Walters, J.R.F.; Weiser, M.M.

    1987-02-01

    Rat duodenal cells were isolated sequentially to give fractions enriched for villus and crypt cells. From each of these fractions, basolateral-enriched membrane vesicles were prepared and ATP-dependent calcium uptake was studied. Calcium uptake was sensitive to temperature, was inhibited by vanadate and by A23187, and was lower in vitamin D-deficient animals. In normal animals, (UVCa)-transport was approximately twofold greater in villus-tip than in crypt cell-fraction basolateral membranes though the affinity of the uptake for calcium was similar (K/sub m/ = 0.3 M). In vitamin D-deficient animals, the crypt-to-villus gradient was reduced, and in all fractions, calcium transport was similar to or lower than that in the crypts of normal animals. Six hours after vitamin D-deficient animals were repleted with 1,25-dihydroxycholecalciferol, a significant increase in calcium transport by everted gut sacs was present; however, basolateral calcium transport was significantly increased in only the mid-villus fractions, and no change was seen in the villus-tip fractions. Thus vitamin D appears necessary for the development of increased basolateral membrane calcium pump activity in duodenal villus cells, but not all cells in vitamin D-deficient rats are able to respond to 1,25-dihydroxycholecalciferol.

  16. Pressure Relief Behaviors and Weight Shifting Activities to Prevent Pressure Ulcers in Persons with SCI

    DTIC Science & Technology

    2015-10-01

    PRINCIPAL INVESTIGATOR: Stephen Sprigle, PhD, PT CONTRACTING ORGANIZATION: Georgia Tech Research Corporation Atlanta GA 30332-0001 REPORT DATE...AND ADDRESS(ES) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Georgia Tech Research Corporation 505 10th St NW Atlanta GA 30332-0001 9...activities in persons with SCI Submitted to and Approved by: - Georgia Tech , Shepherd Center, Kessler have each approved the protocol - HRPO

  17. Clinical significance of pyloric aperture in the aetiology of peptic ulcer disease: a prospective study.

    PubMed

    Saha, Sisir Kumar

    2009-04-01

    Despite so much contributions reported in the literature, the aetiology of the duodenal ulcer remains an enigmatic subject to the medical profession. Findings of Helicobacter pylori seem to have overshadowed the real issue, in that, how a small area of the duodenal mucosa could be inflicted with the acid-pepsin injury has not been questioned? One hundred and sixty-eight consecutive patients, presented with epigastric pain were included in the endoscopic study. The aim of the study was to find out the prevalence and its clinical importance on the sizes of the pyloric aperture in the aetiology of peptic ulcer disease. Demographic data on the sizes of the pyloric aperture were divided into two groups, in that, those up to 3 mm in diameter were included in one and those over the size of 3 mm in another. Among the 168 cases, the gastric ulcer was found in 12 and duodenal ulcer in 27 patients. The sex ratio of men to women was 1.4:1 found in the former and 8:1 in the latter. Among other findings, a knuckle of duodenal mucoa was noticed prolapsing through the large pyloric aperture. It could be postulated that a knuckle of the mucosa that keeps peeping through the pylorus acts as a mucosal plug in empty stomach, like a cork in the acid bottle. The main physiological function is to protect the mucosa from being damaged by the acid-pepsin injury or by the reflux of bile, but the tip of the plug seems to be subjected to such injury. Furthermore, the surface epithelial cells could also be subjected to ischaemic change while prolapsing through the pylorus. This may lead to reduced production of the mucosal gel and bicarbonate secretion, thus exposing the damaged mucosa to acid bath. This supports the concept, how a small area of the stomach or duodenum could be inflicted with ulceration.

  18. More Distally Located Duodenal Webs: A Case Series

    PubMed Central

    Gupta, Rahul; Mathur, Praveen; Gubbi, Sharanabasappa; Gupta, Pradeep Kumar; Shukla, Ramendra; Bhandari, Anu

    2016-01-01

    Duodenal atresia is a frequent cause of intestinal obstruction in the newborn. Obstruction due to duodenal web is infrequent, but its location other than second part of duodenum is rare with only a few cases reported in the literature. We are reporting three patients where we found duodenal webs at unusual locations. In one neonate the web was located at third part of duodenum and in other two patients the web was present at duodeno-jejunal junction (DJ). PMID:27896164

  19. Postoperative Gastric Perforation in a Newborn with Duodenal Atresia

    PubMed Central

    Antabak, Anko; Bogović, Marko; Vuković, Jurica; Grizelj, Ruža; Babić, Vinka Barbarić; Papeš, Dino; Luetić, Tomislav

    2016-01-01

    Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation. PMID:27896170

  20. Prostaglandin Analogous and Antioxidant Activity Mediated Gastroprotective Action of Tabernaemontana divaricata (L.) R. Br. Flower Methanolic Extract against Chemically Induced Gastric Ulcers in Rats

    PubMed Central

    Mat Jais, Abdul Manan; Afreen, Adiba

    2013-01-01

    The present study was conducted to evaluate the antiulcerogenic effect and recognize the basic mechanism of action of Tabernaemontana divaricata (L.) R. Br. flowers. T. divaricata flower methanolic extract (TDFME) was screened for antiulcer activity versus aspirin and ethanol induced gastric ulcers at three doses—125, 250, and 500 mg/kg—orally using misoprostol as a standard. Besides histopathological examination, seven parameters, that is, ulcer index, total protein, nonprotein sulphhydryls, mucin, catalase, malondialdehyde, and superoxide dismutase levels, were estimated. In addition to HPLC profiling, GC-MS analysis and electrospray ionization—high resolution mass spectral (ESI-HRMS) analysis of crude TDFME were carried out in an attempt to identify known phytochemicals present in the extract on the basis of m/z value. The results revealed a significant increase in the levels of catalase, superoxide dismutase, mucin, and nonprotein sulphhydryls, while they revealed a reduction in ulcer index, the levels of total protein, and malondialdehyde. Histopathological observations also demonstrated the protective effect. Though all the doses of TDFME exhibited gastroprotective function, higher doses were found to be more effective. Mass spectral analysis gave a few characteristic m/z values suggesting the presence of a few known indole alkaloids, while HPLC profiling highlighted the complexity of the extract. TDFME was found to exhibit its gastroprotective effect through antioxidant mechanism and by enhancing the production of gastric mucous. PMID:24350249

  1. Definition and Facts for Peptic Ulcers (Stomach Ulcers)

    MedlinePlus

    ... Nutrition Clinical Trials Definition & Facts for Peptic Ulcers (Stomach Ulcers) What is a peptic ulcer? A peptic ... is a sore on the lining of your stomach or duodenum. Rarely, a peptic ulcer may develop ...

  2. Time trends in peptic ulcer surgery, 1956 to 1986. A nation-wide survey in Sweden.

    PubMed Central

    Gustavsson, S; Nyrén, O

    1989-01-01

    To establish time trends in surgical rates for peptic ulcer disease, all surgical departments in Sweden were requested to complete a questionnaire regarding elective operations for gastric and duodenal ulcers and emergency operations for ulcer perforations performed in 1956, 1966, 1976, and 1986. A total of 8558 operations were reported for these years. The incidence of elective surgery declined steadily, the rates being 72.1, 45.0, 31.9, and 10.7 per 100,000 inhabitants. The male:female ratio fell from 4.2 to 1.5:1, while the duodenal/gastric ulcer ratio remained virtually unchanged. The operation rate for perforation decreased by 50%, from 12.8 to 6.4 per 100,000 inhabitants. We conclude that there has been a dramatic decline in elective peptic ulcer surgery in Sweden that began long before the advent of fiberoptic endoscopy, highly selective vagotomy, or H2-receptor antagonists. The comparable decline in emergency procedures suggests that true changes in the incidence or severity of the disease have occurred. In the future the few patients still needing elective surgery for peptic ulcer may have to be served by a small number of specialized centers. PMID:2589883

  3. Comparison of the upper gastrointestinal safety of Arthrotec 75 and nabumetone in osteoarthritis patients at high risk for developing nonsteroidal anti-inflammatory drug-induced gastrointestinal ulcers.

    PubMed

    Agrawal, N M; Caldwell, J; Kivitz, A J; Weaver, A L; Bocanegra, T S; Ball, J; Dhadda, S; Hurley, S; Hancock, L

    1999-04-01

    A 6-week, multicenter, double-masked, placebo-controlled, parallel-group study compared the upper gastrointestinal (UGI) safety of Arthrotec 75 (diclofenac sodium 75 mg-misoprostol 200 microg; G.D. Searle & Co., Skokie, Illinois) administered twice daily with that of nabumetone 1500 mg administered once daily in 1203 patients with symptomatic osteoarthritis (OA) of the hip or knee. All patients had a documented clinical history of endoscopically confirmed gastric, pyloric-channel, or duodenal ulcer or > or = 10 erosions in the stomach or duodenum. UGI endoscopy was performed at baseline and again at week 6 or early withdrawal. Treatment with Arthrotec 75 resulted in a significantly lower combined incidence of endoscopically confirmed gastric and duodenal ulcers compared with nabumetone (4% vs 11%), and its rate of endoscopically confirmed ulceration was equivalent to that of placebo. The incidence of gastric ulcers alone was also significantly lower with Arthrotec 75 than with nabumetone (1% vs 9%). The incidence of duodenal ulcer with Arthrotec 75 was not significantly different from that with nabumetone (4% vs 3%). Types of adverse events were similar for all treatment groups, with GI adverse events predominating. Arthrotec 75 was well tolerated by the majority of patients. The results of this study demonstrate that Arthrotec 75 has a superior UGI safety profile, causing significantly fewer UGI ulcers, in comparison with nabumetone in patients with symptomatic OA and a documented history of ulcers or > or = 10 erosions.

  4. Niacin ameliorates ulcerative colitis via prostaglandin D2-mediated D prostanoid receptor 1 activation.

    PubMed

    Li, Juanjuan; Kong, Deping; Wang, Qi; Wu, Wei; Tang, Yanping; Bai, Tingting; Guo, Liang; Wei, Lumin; Zhang, Qianqian; Yu, Yu; Qian, Yuting; Zuo, Shengkai; Liu, Guizhu; Liu, Qian; Wu, Sheng; Zang, Yi; Zhu, Qian; Jia, Daile; Wang, Yuanyang; Yao, Weiyan; Ji, Yong; Yin, Huiyong; Nakamura, Masataka; Lazarus, Michael; Breyer, Richard M; Wang, Lifu; Yu, Ying

    2017-03-24

    Niacin, as an antidyslipidemic drug, elicits a strong flushing response by release of prostaglandin (PG) D2 However, whether niacin is beneficial for inflammatory bowel disease (IBD) remains unclear. Here, we observed niacin administration-enhanced PGD2 production in colon tissues in dextran sulfate sodium (DSS)-challenged mice, and protected mice against DSS or 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in D prostanoid receptor 1 (DP1)-dependent manner. Specific ablation of DP1 receptor in vascular endothelial cells, colonic epithelium, and myeloid cells augmented DSS/TNBS-induced colitis in mice through increasing vascular permeability, promoting apoptosis of epithelial cells, and stimulating pro-inflammatory cytokine secretion of macrophages, respectively. Niacin treatment improved vascular permeability, reduced apoptotic epithelial cells, promoted epithelial cell update, and suppressed pro-inflammatory gene expression of macrophages. Moreover, treatment with niacin-containing retention enema effectively promoted UC clinical remission and mucosal healing in patients with moderately active disease. Therefore, niacin displayed multiple beneficial effects on DSS/TNBS-induced colitis in mice by activation of PGD2/DP1 axis. The potential efficacy of niacin in management of IBD warrants further investigation.

  5. Characteristics and interactions of Helicobacter pylori and H. pylori-infected human gastroduodenal epithelium in peptic ulcer: a transmission electron microscopy study.

    PubMed

    Bai, Hongyuan; Li, Qian; Liu, Xiaolian; Li, Yingchao

    2010-01-01

    Helicobacter pylori (H. pylori) has been presumed to be an initiating factor in a previously recognized chain of events, starting with active chronic gastritis and leading to atrophy of the mucosal membrane, intestinal metaplasia, dysplasia (intraepithelial neoplasia), and finally culminating in gastric carcinoma. Adherence of H. pylori to the gastroduodenal epithelium is believed to be an important step in the induction of active chronic inflammation of the mucosal layer. However, it is not clear how the pathogen chronically colonizes the gastroduodenal epithelium. In this study, 30 biopsy specimens from H. pylori-positive peptic ulcer (15 for gastric ulcer, 15 for duodenal ulcer) patients were examined by transmission electron microscopy (TEM) to observe the structural adherence of H. pylori to gastroduodenal epithelium while ten healthy postulants were served as controls. We also investigated the interaction between H. pylori and gastroduodenal epithelial cells. Morphological appearances of both the pathogen and the cells as well as features of colonization, attachment, and internalization were observed. H. pylori exhibited both spiral and coccoid forms. Cytoplasmic vacuolar degeneration played by the vacuolating toxin (VacA) was apparent in gastroduodenal epithelial cells. Specially, a number of tumor cells were found in H. pylori-positive gastric intestinal metaplasia (IM) mucosa under TEM which provided an ultrastructural evidence of IM carrying a particularly high risk for the development of gastric cancer.

  6. Russell body duodenitis with immunoglobulin kappa light chain restriction.

    PubMed

    Munday, William R; Kapur, Lucy Harn; Xu, Mina; Zhang, Xuchen

    2015-01-16

    Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis.

  7. Anti-ulcer and ulcer healing potentials of Musa sapientum peel extract in the laboratory rodents

    PubMed Central

    Onasanwo, Samuel Adetunji; Emikpe, Benjamin Obukowho; Ajah, Austin Azubuike; Elufioye, Taiwo Olayemi

    2013-01-01

    Background: This study investigated the anti-ulcer and ulcer healing potentials of the methanol extract of Musa sapientum peel in the laboratory rats. Materials and Methods: Methanol extract of the peels on Musa sapientum (MEMS) was evaluated for its anti-ulcer using alcohol-induced, aspirin-induced, and pyloric ligation-induced models, and for its ulcer healing employing acetic acid-induced ulcer models in rats. Results: The findings from this experiment showed that MEMS (50, 100 and 200 mg/kg, b.w.) anti-ulcer and ulcer healing activity (P ≤ 0.05) is dose-dependent. Also, MEMS exhibited healing of the ulcer base in all the treated groups when compared with the control group. Conclusion: The outcomes of this experiment revealed that the anti-ulcer effect of MEMS may be due to its anti-secretory and cyto-protective activity. The healing of the ulcer base might not be unconnected with basic fibroblast growth factors responsible for epithelial regeneration. PMID:23900937

  8. Clinical Effects of a Topically Applied Toll-like Receptor 9 Agonist in Active Moderate-to-Severe Ulcerative Colitis

    PubMed Central

    Atreya, Raja; Bloom, Stuart; Scaldaferri, Franco; Gerardi, Viviana; Admyre, Charlotte; Karlsson, Åsa; Knittel, Thomas; Kowalski, Jan; Lukas, Milan; Löfberg, Robert; Nancey, Stephane; Petryka, Robert; Rydzewska, Grazyna; Schnabel, Robert; Seidler, Ursula; Neurath, Markus F.

    2016-01-01

    Background and Aims: Toll-like receptors [TLRs] are potential drug targets for immunomodulation. We determined the safety and efficacy of the TLR-9 agonist DNA-based immunomodulatory sequence 0150 [DIMS0150] in ulcerative colitis [UC] patients refractory to standard therapy. Methods: In this randomized, double-blind, placebo-controlled trial, 131 patients with moderate-to-severe active UC were randomized to receive two single doses of the oligonucleotide DIMS0150 [30 mg] or placebo administered topically during lower GI endoscopy at baseline and Week 4. The primary endpoint was clinical remission, defined as Clinical Activity Index [CAI] ≤4, at Week 12. Secondary endpoints included mucosal healing and symptomatic remission of key patient-reported outcomes [absence of blood in stool and weekly stool frequency <35]. Results: There was no statistical significant difference between the groups in the induction of clinical remission at Week 12, with 44.4% in the DIMS0150 group vs. 46.5% in the placebo group. However, the proportion of patients who achieved symptomatic remission was 32.1% in the DIMS0150 group vs. 14.0% in the placebo group at Week 4 [p = 0.020], and 44.4% vs. 27.9% at Week 8 [p = 0.061]. More patients on DIMS0150 compared with those on placebo had mucosal healing [34.6% vs. 18.6%; p = 0.09] and histological improvement regarding the Geboes score [30.9% vs. 9.3%; p = 0.0073] at Week 4. Significantly more patients on DIMS0150 were in clinical remission with mucosal healing at Week 4: 21% vs. 4.7% in the placebo group [p = 0.02]. DIMS0150 was well tolerated, and no safety signals compared with placebo were evident. Conclusions: Therapy with the topically applied TLR-9 agonist DIMS0150 is a promising and well-tolerated novel therapeutic option for treatment-refractory, chronic active UC patients, warranting further clinical trials. PMID:27208386

  9. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis

    PubMed Central

    Magee, Elizabeth A; Edmond, Laurie M; Tasker, Shiona M; Kong, San Choon; Curno, Richard; Cummings, John H

    2005-01-01

    Background The relapsing nature and varying geographical prevalence of ulcerative colitis (UC) implicates environmental factors such as diet in its aetiology. Methods In order to determine which foods might be related to disease activity in UC a new method of dietary analysis was developed and applied. Eighty-one UC patients were recruited at all stages of the disease process. Following completion of a 7 d diet diary, clinical assessment including a sigmoidoscopic examination (scale 0 (normal mucosa) to 6 (very active disease)) was conducted. Food weights for each person were adjusted (divided) by the person's calorific intake for the week. Each food consumed was given a food sigmoidoscopy score (FSS) calculated by summing the products of the (adjusted) weight of food consumed and sigmoidoscopy score for each patient and occurrence of food and dividing by the total (adjusted) weight of the food consumed by all 81 patients. Thus, foods eaten in large quantities by patients with very active disease have high FSSs and vice versa. Foods consumed by <10 people or weighing <1 kg for the whole group were excluded, leaving 75 foods. Results High FSS foods were characterized by high levels of the anti-thiamin additive sulfite (Mann-Whitney, p < 0.001), i.e. bitter, white wine, burgers, soft drinks from concentrates, sausages, lager and red wine. Caffeine also has anti-thiamin properties and decaffeinated coffee was associated with a better clinical state than the caffeine containing version. Beneficial foods (average intake per week) included pork (210 g), breakfast cereals (200 g), lettuce (110 g), apples and pears (390 g), milk (1250 ml), melon (350 g), bananas (350 g), bacon (120 g), beef and beef products (500 g), tomatoes (240 g), soup (700 g), citrus fruits (300 g), fish (290 g), yogurt (410 g), cheese (110 g), potatoes (710 g) and legumes (120 g). Conclusions The dietary analysis method described provides a new tool for establishing relationships between diet and

  10. A mutein of human basic fibroblast growth factor TGP-580 accelerates colonic ulcer healing by stimulating angiogenesis in the ulcer bed in rats.

    PubMed

    Satoh, H; Szabo, S

    2015-10-01

    Previously, we reported that TGP-580, a mutein of human basic fibroblast growth factor (bFGF), accelerated the healing of gastric and duodenal ulcers in rats. In the present study, we examined the effect of TGP-580 on the healing of colonic ulcers. In male Sprague Dawley rats, ulcers were induced in the colon 6 cm from the anus by enema of 50 μl of 3% N-ethylmaleimide, a sulfhydryl alkylator. The lesions were examined under a dissecting microscope (x10). The concentration of bFGF in the ulcerated colon was measured by enzyme immunoassay, and both the distribution of bFGF and the density of microvessels in the ulcer bed were examined by immunohistochemical staining. The content of bFGF in the ulcerated colon was markedly increased associated with ulcer healing, and ulcer healing was significantly delayed by intravenous administration of a monoclonal antibody for bFGF (MAb 3H3) once daily for 10 days. In the ulcer bed, many cells such as fibroblasts, vascular endothelial cells and macrophages were positively stained with bFGF antiserum. TGP-580, human bFGF or dexamethasone was given intracolonally twice daily for 10 days, starting the day after ulcer induction. TGP-580 (0.2 - 20 μg/ml, 200 μl/rat) dose-dependently accelerated ulcer healing, and its effect was more than 10 times stronger than that of human bFGF. Density (μm/0.01 mm(2)) of microvessels in the ulcer bed was significantly increased by treatment with TGP-580, and there was a good correlation between the density of microvessels and the decrease of ulcerated area (R(2) = 0.633). On the other hand dexamethasone (20 μg/ml) inhibited angiogenesis in the ulcer bed and delayed ulcer healing. These results suggest that angiogenesis in the ulcer bed plays an important role in ulcer healing, and that bFGF mutein TGP-580 accelerated colonic ulcer healing, at least in part, by stimulating angiogenesis, whereas glucocorticoids may delay the healing by inhibiting angiogenesis.

  11. Acute genital ulcers

    PubMed Central

    Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora

    2014-01-01

    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers. PMID:24473429

  12. Accelerated Ulcer Healing and Resistance to Ulcer Recurrence with Gastroprotectants in Rat Model of Acetic Acid-induced Gastric Ulcer

    PubMed Central

    Young Oh, Tae; Ok Ahn, Byung; Jung Jang, Eun; Sang Park, Joo; Jong Park, Sang; Wook Baik, Hyun; Hahm, Ki-Baik

    2008-01-01

    Quality of ulcer healing (QOUH) is defined as ideal ulcer healing featuring with the fine granular ulcer scar, high functional restoration and the resistance to recurrence. This study was designed to compare the rates of QOUH achievement in rat gastric ulcer model between acid suppressant treated group and gastroprotectant treated group accompanied with elucidations of molecular mechanisms. Serosal injection of acetic acids for generating gastric ulcer and intraperitoneal (ip) injection of recombinant interleukin 1-beta (IL-1β) for recurring healed ulcer was done in SD rats. The 72 rats were divided into three groups according to treatment as follows; Group I, no further treatment, Group II, 8 weeks treatment of omeprazole, and Group III, 8 weeks of gastroprotectant treatment. IL-1β was administered for ulcer recurrence after 28 weeks of acetic acid injection. At four weeks after gastric ulcerogenesis, 58.3% (7/12) of active gastric ulcer were converted to healing stage in Group III, but 16.7% (2/12) in Group II and none in Group I, for which significant levels of epidermal growth factor, mucin, and pS2/trefoil peptide1 were contributive to these accelerated healings of Group III. ip injections of rIL-1β (200 µg/kg) at 28 weeks after acetic acid injection led to 100% of ulcer recurrence in Group I and 75.0% in Group II, but only 16.7% of Group III rats showed ulcer recurrence. Significantly attenuated levels of inflammatory cytokines including IL-2, transforming growth factor-alpha (TNF-α), cyclooxygenase-2 (COX-2), nitrotyrosine were responsible for the resistance to ulcer recurrence in Group III. Conclusively, gastroprotectant might be prerequisite in order to achieve ideal QOUH through significant inductions of remodeling. PMID:18545642

  13. Once daily versus three times daily mesalazine granules in active ulcerative colitis: a double-blind, double-dummy, randomised, non-inferiority trial

    PubMed Central

    Kruis, W; Kiudelis, G; Rácz, I; Gorelov, I A; Pokrotnieks, J; Horynski, M; Batovsky, M; Kykal, J; Boehm, S; Greinwald, R; Mueller, R

    2009-01-01

    Objectives: To determine the therapeutic equivalence and safety of once daily (OD) versus three times daily (TID) dosing of a total daily dose of 3 g Salofalk (mesalazine) granules in patients with active ulcerative colitis. Design: A randomised, double-blind, double-dummy, parallel group, multicentre, international, phase III non-inferiority study. Setting: 54 centres in 13 countries. Patients: 380 patients with confirmed diagnosis of established or first attack of ulcerative colitis (clinical activity index (CAI)>4 and endoscopic index ⩾4 at baseline) were randomised and treated. Interventions: 8-week treatment with either 3 g OD or 1 g TID mesalazine granules. Main outcome measures: Clinical remission (CAI⩽4) at study end. Results: 380 patients were evaluable for efficacy and safety by intention-to-treat (ITT); 345 for per protocol (PP) analysis. In the ITT population, 79.1% in the OD group (n = 191) and 75.7% in the TID group (n = 189) achieved clinical remission (p<0.0001 for non-inferiority). Significantly more patients with proctosigmoiditis achieved clinical remission in the OD group (86%; n = 97) versus the TID group (73%; n = 100; p = 0.0298). About 70% of patients in both treatment groups achieved endoscopic remission, and 35% in the OD group and 41% in the TID group achieved histological remission. About 80% of all patients preferred OD dosing. Similar numbers of adverse events occurred in 55 patients (28.8%) in the OD group and in 61 patients (32.3%) in the TID group, indicating that the two dosing regimens were equally safe and well tolerated. Conclusions: OD 3 g mesalazine granules are as effective and safe as a TID 1 g schedule. With respect to the best possible adherence of patients to the treatment, OD dosing of mesalazine should be the preferred application mode in active ulcerative colitis. ClinicalTrials.gov Identifier: NCT00449722 PMID:18832520

  14. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration.

  15. Potassium Channelopathies and Gastrointestinal Ulceration

    PubMed Central

    Han, Jaeyong; Lee, Seung Hun; Giebisch, Gerhard; Wang, Tong

    2016-01-01

    Potassium channels and transporters maintain potassium homeostasis and play significant roles in several different biological actions via potassium ion regulation. In previous decades, the key revelations that potassium channels and transporters are involved in the production of gastric acid and the regulation of secretion in the stomach have been recognized. Drugs used to treat peptic ulceration are often potassium transporter inhibitors. It has also been reported that potassium channels are involved in ulcerative colitis. Direct toxicity to the intestines from nonsteroidal anti-inflammatory drugs has been associated with altered potassium channel activities. Several reports have indicated that the long-term use of the antianginal drug Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, increases the chances of ulceration and perforation from the oral to anal regions throughout the gastrointestinal (GI) tract. Several of these drug features provide further insights into the role of potassium channels in the occurrence of ulceration in the GI tract. The purpose of this review is to investigate whether potassium channelopathies are involved in the mechanisms responsible for ulceration that occurs throughout the GI tract. PMID:27784845

  16. Effects of sucralfate and sulglycotide treatment on active gastritis and Helicobacter pylori colonization of the gastric mucosa in non-ulcer dyspepsia patients.

    PubMed

    Barbara, L; Biasco, G; Capurso, L; Dobrilla, G; Lalli, A; Paganelli, G M; Pallone, F; Torsoli, A

    1990-09-01

    We conducted a double-blind randomized treatment study on patients affects by non-ulcer dyspepsia in whom multiple biopsy specimens showed active gastritis. Patients were given either 3 g/day of sucralfate (n = 39) or 600 mg/day of sulglycotide (n = 50) for 6 wk, a glycopeptide isolated from pig duodenum constituents. Endoscopy was carried out at baseline and at the end of treatment. We took biopsies from the gastric body (twice) and antrum (six times) at each endoscopy in order to determine grade and extent of gastritis and Helicobacter pylori colonization. Both treatments induced a marked regression of active gastritis (sucralfate group: p less than 0.05 and p less than 0.0001, respectively, in body and in antrum; sulglycotide group: p less than 0.01 and p less than 0.001, respectively). Conversely, Helicobacter pylori colonization remained unchanged at the end of the treatments. At baseline, a close relationship was found between grade of active inflammation in each biopsy and Helicobacter pylori density. After therapy, the association was lost in each treatment group. These results suggest that there can be a remission of active gastritis in patients with non-ulcer dyspepsia even without changes in Helicobacter pylori colonization. This result can be achieved by enhancing the protective properties of the gastric mucosa.

  17. Idiopathic duodenal obstruction: an unappreciated complication of pancreatitis.

    PubMed Central

    Bradley, E L; Clements, J L

    1981-01-01

    Intestinal obstruction as a complication of pancreatitis is infrequently recognized. Only four cases of idiopathic duodenal obstruction associated with pancreatitis have been previously reported. In a three-year study of 878 patients with pancreatitis, nine cases of idiopathic duodenal obstruction associated with pancreatitis have been found. Each of the nine cases was characterized by frank obstruction in the second or third portions of the duodenum and an intact mucosa in the area of stricture. Four patients gave an abrupt history of moderately severe pancreatitis. Resolution of the duodenal obstruction occurred by three weeks in each of these four cases. Surgical exploration in one of these patients revealed marked duodenal edema with intramural hematoma. The remaining five patients reported a chronic history of obstruction. Inadequate resolution of the obstruction after four weeks of hyperalimentation led to surgical bypass. Duodenal biopsy specimens revealed inflammation, muscle destruction, and extensive fibrosis. Duodenal involvement in the inflammatory process of moderately severe pancreatitis was discovered in 25% of the upper gastrointestinal studies, but was usually self-limiting and of a mild degree. Since contiguous duodenal edema is common and fibrosing pancreatoduodenitis only occurs in an occasional patient, surgical intervention for duodenal obstruction associated with pancreatitis should only be considered after demonstrated failure of conservative management. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. PMID:7235767

  18. Congenital duodenal obstruction due to a preduodenal portal vein.

    PubMed

    Pathak, D; Sarin, Yogesh Kumar

    2006-05-01

    Only about 80 cases of pre-duodenal portal vein (PDPV), a rare congenital anomaly of portal vein development that was first described by Knight in 1921, have been reported till date.[1] We report a neonate with duodenal obstruction caused by PDPV and briefly review the available literature.

  19. A New Strategy to Address Loss of Submarine Qualifications in Submariners Who are Helicobacter Pylori Positive and Diagnosed with Peptic Ulcer Disease: Background to the Change in Policy.

    DTIC Science & Technology

    2007-11-02

    peptic ulcer disease has been changed. FINDINGS: The medical literature shows that infection with Helicobacter pylori is causally related to the...drugs such as ibuprofen (Motrin, Advil, etc). Repeated studies have demonstrated that eradication of Helicobacter pylori infection in patients with...duodenal, gastric, and complicated ulcers. Re-infection with Helicobacter pylori is uncommon in western countries, with rates ranging between zero and

  20. Inflammation in chronic venous ulcers.

    PubMed

    Raffetto, J D

    2013-03-01

    Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age. CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA. Overall, CVD has been estimated to account for 1-3% of the total health-care budgets in countries with developed health-care systems. The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.

  1. Protective effects of nedocromil sodium and sodium cromoglycate on gastroduodenal ulcers: a comparative study in rats.

    PubMed

    Tariq, Mohammad; Moutaery, Meshal Al; Elfaki, Ibrahim; Arshaduddin, Mohammad; Khan, Haseeb Ahmad

    2006-08-01

    Stabilization of mast cells plays a key mechanism to protect gastrointestinal tract from injury. This study presents a comparative evaluation of mast cell stabilizers nedocromil sodium (NDS) and sodium cromoglycate (SCG) in experimental gastric and duodenal ulcers in rats. Wistar rats of either sex were used in this study. Both NDS and SCG, in the doses of 10, 30 and 100 mg/kg were given intraperitoneally for gastric secretion studies and by gavage for antiulcer studies. Acid secretion studies were undertaken in pylorus-ligated rats. Gastric lesions were induced by water immersion restraint stress (WIRS), indomethacin and ethanol whereas duodenal ulcers were produced by cysteamine. The level of glutathione (GSH) and gastric wall mucus were measured in glandular stomach of rats following ethanol-induced gastric lesions. SCG was more effective than NDS in preventing WIRS- and indomethacin-induced gastric lesions whereas reverse was true in ethanol- and cysteamine-induced ulcers. All the 3 doses of SCG offered almost equal protection against WIRS-induced gastric lesions whereas only medium and high dose of NDS provided significant protection in this model of ulcer. NDS significantly inhibited cysteamine-induced duodenal ulcers whereas SCG failed to do so. Pretreatment with NDS or SCG significantly and dose-dependently protected gastric mucosa against ethanol-induced injury, while the former drug appeared to be more effective. The cytoprotective effects of these two drugs were accompanied by the attenuation of ethanol-induced depletion of gastric wall mucus and GSH. The differential effects of NDS and SCG against various gastric lesions rationalize the possible benefits of a combined therapy (NDS+SCG) for the treatment of complex gastroduodenal ulcers.

  2. Cyclooxygenase (COX)-1 and COX-2 both play an important role in the protection of the duodenal mucosa in cats.

    PubMed

    Satoh, Hiroshi; Amagase, Kikuko; Ebara, Satomi; Akiba, Yasutada; Takeuchi, Koji

    2013-01-01

    Although nonsteroidal anti-inflammatory drugs often cause ulcers in the duodenum in humans, the role of cyclooxygenase (COX) isoforms in the pathogenesis of duodenal ulcers has not been fully elucidated. We examined in cats the 1) ulcerogenic effects of selective COX-1 (SC-560, ketorolac) and COX-2 (celecoxib, meloxicam) inhibitors on the gastrointestinal mucosa, 2) effect of feeding and cimetidine on the expression of COX isoforms and prostaglandin E(2) (PGE(2)) level in the duodenum, and 3) localization of COX isoforms in the duodenum. COX inhibitors were administered after the morning meal in cats once daily for 3 days. Gastrointestinal lesions were examined on day 4. Localization and expression of COX isoforms (by immunohistochemistry, Western blot) and PGE(2) level (by enzyme immunoassay) were examined. Results were as follows. First, selective COX-1 or COX-2 inhibitors alone produced marked ulcers in the duodenum but did not cause obvious lesions in the small intestine. Coadministration of SC-560 and celecoxib produced marked lesions in the small intestine. Second, feeding increased both the expression of COX isoforms and PGE(2) level in the duodenum, and the effects were markedly inhibited by pretreatment with cimetidine. Third, COX-1 was localized in goblet and Brunner's gland cells, Meissner's and Auerbach's plexus, smooth muscle cells, and arterioles; and COX-2 was observed in capillaries, venules, and basal granulated cells. The expression of COX isoforms in the duodenum is up-regulated by feeding, and inhibition of either COX-1 or COX-2 causes ulcers in the duodenum, suggesting that both isoforms play an important role in the protection of the duodenal mucosa.

  3. Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation

    PubMed Central

    Matevossian, Edouard; Doll, Dietrich; Weirich, Gregor; Burian, Maria; Knebel, Carolin; Thorban, Stefan; Hüser, Norbert

    2008-01-01

    Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative. PMID:21490847

  4. CT and ultrasound of gastric and duodenal duplications

    SciTech Connect

    Guibaud, L.; Genin, G.; Fouque, P.

    1996-05-01

    We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen. 10 refs., 4 figs.

  5. Increased Duodenal Eosinophil Degranulation in Patients with Functional Dyspepsia: A Prospective Study

    PubMed Central

    Du, Lijun; Shen, Jinhua; Kim, John J.; Yu, Yunxian; Ma, Liqin; Dai, Ning

    2016-01-01

    Functional dyspepsia (FD) is a functional gastrointestinal disorder diagnosed by symptom-based criteria. It has been said that duodenal immune activation plays a role in the pathogenesis of FD. The primary aims of the study were to compare the total number of duodenal eosinophil and evaluate the eosinophil degranulation rate, number of duodenal degranulated eosinophil and mast cell between patients with FD and healthy subjects. We enrolled 96 patients with FD and 24 healthy controls at Sir Run Run Shaw Hospital. The total number of eosinophil was comparable in the second portion of duodenum (D2) and duodenal bulb (D1) between patients with FD and healthy controls (all P > 0.05). Significant higher eosinophil degranulation positive rate in D2 (P = 0.003) and a trend towards higher in D1 (P = 0.084) were observed in patients with FD compared with healthy controls. Moreover, the number of duodenal degranulated eosinophil in patients with FD were significantly increased than healthy controls in D1(9.8 ± 6.3 vs 2.9 ± 2.1 per HPF, P = 0.0002) and a trend towards increase in D2 (10.7 ± 7.7 vs 5.3 ± 0.9 per HPF, P = 0.077), respectively. However, degranulated mast cells in patients with FD were almost same with healthy controls. Increased eosinophils degranulation in duodenum play an important role in pathogenesis of FD. PMID:27708358

  6. New mechanistic explanation for the localization of ulcers in the rat duodenum: role of iron and selective uptake of cysteamine.

    PubMed

    Khomenko, Tetyana; Kolodney, Joanna; Pinto, John T; McLaren, Gordon D; Deng, Xiaoming; Chen, Longchuan; Tolstanova, Ganna; Paunovic, Brankica; Krasnikov, Boris F; Hoa, Neil; Cooper, Arthur J L; Szabo, Sandor

    2012-09-01

    Cysteamine, a coenzyme A metabolite, induces duodenal ulcers in rodents. Our recent studies showed that ulcer formation was aggravated by iron overload and diminished in iron deficiency. We hypothesized that cysteamine is selectively taken up in the duodenal mucosa, where iron absorption primarily occurs, and is transported by a carrier-mediated process. Here we report that cysteamine administration in rats leads to cysteamine accumulation in the proximal duodenum, where the highest concentration of iron in the gastrointestinal tract is found. In vitro, iron loading of intestinal epithelial cells (IEC-6) accelerated reactive oxygen species (ROS) production and increased [(14)C]cysteamine uptake. [(14)C]Cysteamine uptake by isolated gastrointestinal mucosal cells and by IEC-6 was pH-dependent and inhibited by unlabeled cysteamine. The uptake of [(14)C]cysteamine by IEC-6 was Na(+)-independent, saturable, inhibited by structural analogs, H(2)-histamine receptor antagonists, and organic cation transporter (OCT) inhibitors. OCT1 mRNA was markedly expressed in the rat duodenum and in IEC-6, and transfection of IEC-6 with OCT1 siRNA decreased OCT1 mRNA expression and inhibited [(14)C]cysteamine uptake. Cysteamine-induced duodenal ulcers were decreased in OCT1/2 knockout mice. These studies provide new insights into the mechanism of cysteamine absorption and demonstrate that intracellular iron plays a critical role in cysteamine uptake and in experimental duodenal ulcerogenesis.

  7. A case of Cushing ulcer in an 8-month-old patient with medulloblastoma

    PubMed Central

    Sivakumar, Walavan; Spader, Heather S.; Scaife, Eric

    2016-01-01

    The authors present the first case of a Cushing ulcer in an infant with medulloblastoma who, despite being administered stress ulcer prophylaxis, worsened after corticosteroids were initiated. An 8-month-old boy presented with progressive vomiting, lethargy, and decreased oral intake. Imaging revealed a heterogeneous fourth ventricular mass. Preoperatively, the patient was started on dexamethasone. The patient underwent an uncomplicated external ventricular drain placement and suboccipital craniotomy for resection of the lesion. The results of the pathological analysis were consistent with medulloblastoma. Postoperatively, the patient had melanotic stools, which were reported to be occurring for months prior to presentation. Two proximal duodenal bulb ulcers were found and required definitive surgical repair. The patient recovered from the acute postsurgical course after continued stress ulcer prophylaxis and is currently undergoing chemotherapy. PMID:27186526

  8. Molecular pathogenesis of sporadic duodenal cancer.

    PubMed Central

    Achille, A.; Baron, A.; Zamboni, G.; Orlandini, S.; Bogina, G.; Bassi, C.; Iacono, C.; Scarpa, A.

    1998-01-01

    Whether duodenal adenocarcinoma should be considered as a gastrointestinal or as a peripancreatic cancer is a matter of debate, as is the opportunity and type of treatment. We investigated 12 such cancers for the genetic anomalies involved in the pathogenesis of gastrointestinal malignancies, including (a) those occurring in common-type cancers - allelic losses at chromosomes 3p, 5q, 17p and 18q, and Ki-ras and p53 alterations; and (b) those characteristic of mutator-phenotype cancers - microsatellite instability and TGF-betaRII gene mutations. We found Ki-ras and p53 mutations in five (42%) and eight cancers (67%), respectively; chromosome 3p, 5q, 17p and 18q allelic losses in two of nine (22%), six of ten (60%), six of nine (67%) and three of ten (30%) informative cancers, respectively. Finally, three cancers (25%) showed widespread microsatellite instability and two of them had a TGF-betaRII gene mutation. Our data suggest that duodenal cancers may arise from either of the two known pathogenetic molecular pathways of gastric and colorectal cancers. The majority of our cases were highly aggressive cancers with frequent chromosomal changes and p53 mutations as observed in the common-type gastrointestinal malignancies, while widespread subtle alterations characteristic of mutator-phenotype cancers occurred in a minority, which also showed a favourable long-term outcome. Images Figure 1 Figure 2 Figure 3 PMID:9514055

  9. A retrospective clinical study of 188 consecutive patients to examine the effectiveness of a biologically active cryopreserved human skin allograft (TheraSkin®) on the treatment of diabetic foot ulcers and venous leg ulcers.

    PubMed

    Landsman, Adam Scott; Cook, Jeremy; Cook, Emily; Landsman, Arnold Robert; Garrett, Philip; Yoon, Joonhyun; Kirkwood, Alfred; Desman, Eric

    2011-02-01

    A biologically active human skin allograft, currently distributed under the brand name TheraSkin(®), was examined for safety and efficacy in the treatment of venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). The objective was to determine if TheraSkin could serve as a safe and effective alternative to bioengineered skin substitutes such as Apligraf(®) and Dermagraft(®). The authors conducted a retrospective study of 214 consecutive patients seen at the Inova Wound Center (Mt Vernon, Virginia), with either a DFU or a VLU. After excluding patients who did not meet the study criteria, the final eligible cohort consisted of 188 subjects, with 134 VLUs and 54 DFUs. Multivariate logistic regression was used to evaluate the relationship between baseline wound size and the proportion of healed wounds after 12 and 20 weeks from initial allograft application. The authors found that by the 12th week, DFUs closed 60.38% of the time and VLUs closed 60.77% of the time. After 20 weeks, the number of closed DFUs increased to 74.1% and the number of VLUs increased to 74.6%. The mean wound size in the DFU group was 6.2 cm(2) (±11.8) and 11.8 cm(2) (±22.5) in the VLU group. The mean number of TheraSkin allografts required ranged from 1 to 8, with an average of 2.03 (±1.47) at the 12-week point and an average of 3.23 (±2.77) at the 20-week point. Multivariate logistic regression was used to calculate the odds of wound healing by week 12 and week 20 in each group. The authors also analyzed adverse events and found TheraSkin to be noncontributory to any adverse events, verifying the safety of TheraSkin in this study population. In this study, TheraSkin has been shown to be highly effective for the treatment of both VLUs and DFUs with an acceptable safety profile.

  10. [Prevention of leg ulcer].

    PubMed

    Marinović Kulisić, Sandra

    2013-10-01

    Lower leg ulcers is the most common form of ulceration of the lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. In the majority of studies, 1% of the population develop leg ulcer at least once in lifetime. The prevalence is higher in elderly people. There are several hypotheses used to explain the pathophysiological steps leading from the popliteal venous hypertension in value. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Venous disease has a significant impact on quality of life and work productivity. In addition, costs associated with the prevention and treatment of lower leg ulcers are significant.

  11. Management of leg ulcers

    PubMed Central

    Sarkar, P; Ballantyne, S

    2000-01-01

    Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying cause is far more important than the choice of dressing. The aetiology, pathogenesis, treatment, and the future trends in the management of the leg ulcers are discussed in this review.
 PMID:11060140

  12. Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

    PubMed

    Satoh, Kiichi; Yoshino, Junji; Akamatsu, Taiji; Itoh, Toshiyuki; Kato, Mototsugu; Kamada, Tomoari; Takagi, Atsushi; Chiba, Toshimi; Nomura, Sachiyo; Mizokami, Yuji; Murakami, Kazunari; Sakamoto, Choitsu; Hiraishi, Hideyuki; Ichinose, Masao; Uemura, Naomi; Goto, Hidemi; Joh, Takashi; Miwa, Hiroto; Sugano, Kentaro; Shimosegawa, Tooru

    2016-03-01

    The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

  13. Therapy of peptic ulcer with semax peptide.

    PubMed

    Ivanikov, I O; Brekhova, M E; Samonina, G E; Myasoedov, N F; Ashmarin, I P

    2002-07-01

    Experiments used is combination with traditional preparations (omeprasole, de-nol, and solcoseril), Semax peptide (Met-Glu-His-Phe-Pro-Gly-Pro) possessing nootropic and neuroprotective activity significantly promoted ulcer healing in patients with refractory peptic ulcers. On day 14 of treatment ulcer healing was observed in 89.5% patients receiving intranasal Semax (1% solution, 2-4 drops 3 times a day for 10 days) vs. 30.8% in the control group. Clinical studies of antiulcer activity of Semax in different combinations with usual antiulcer drugs are needed.

  14. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis

    PubMed Central

    Böhm, Stephan Karl; Kruis, Wolfgang

    2014-01-01

    In 1977, 5-aminosalicylic acid (5-ASA) was discovered as a therapeutically active moiety of sulfasalazine (SASP) and was launched for topical and oral therapy of ulcerative colitis (UC) in 1984. As a first-step, delivery systems had to be developed to protect 5-ASA against absorption in the upper gastrointestinal tract, resulting in different and competing strategies (azo compounds, controlled release, and pH-dependent release). In a second step, at the beginning of the new century, coinciding with the expiration of patent protection for the first 5-ASA formulations, two component composite release mechanisms (pH-dependent and controlled release) were developed. Furthermore, the drug was formulated as granules instead of tablets, allowing higher unit strengths compared with tablets. Neither Salofalk Granu-Stix®, nor MMX 5-ASA, nor Pentasa® granules have initially been developed for once-daily (OD) dosing. A review of the achievements of 20 years of 5-ASA development has demonstrated that 5-ASA has equal efficacy compared with SASP at best, that there are no measurable differences in efficacy between various 5-ASA preparations, and that in a group of patients tolerating SASP, adverse event profiles of SASP and 5-ASA did not differ significantly, with SASP being the far cheaper substance. Therefore, drug adherence came into focus as a new goal for improving UC therapy. Although adherence is a complex and multifactorial construct, a simple dosing schedule may contribute to higher drug adherence and better efficacy of treatment. Simultaneously, the US 5-ASA market, estimated to be worth US$1.4 billion, is expected to grow continuously. Naturally, this very competitive market is not only driven by scientific progress but also by commercial interests. Thus, patents for minor changes to the formulation may serve as protection against drug companies trying to launch generic versions. Randomized controlled trials performed on OD dosing in induction of remission have

  15. Temporary duodenal stenting as a bridge to ERCP for inaccessible papilla due to duodenal obstruction: a retrospective study

    PubMed Central

    Donatelli, Gianfranco; Cereatti, Fabrizio; Dumont, Jean-Loup; Dhumane, Parag; Tuszynski, Thierry; Derhy, Serge; Meduri, Alexandre; Vergeau, Bertrand Marie; Meduri, Bruno

    2016-01-01

    Background and study aims: Duodenal obstruction may prevent performance of endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage (PTBD) or Endoscopic ultrasonograhy-guided biliary access (EUS-BD) are alternative treatments but are associated with a higher morbidity and mortality rate. The aim of the study is to report overall technical success rate and clinical outcome with deployment of temporary fully or partially covered self-expanding duodenal stent (pc/fcSEMS) as a bridge to ERCP in case of inaccessible papilla due to duodenal strictures. Patients and methods: This retrospective study included 66 consecutive patients presenting with a duodenal stricture impeding the ability to perform an ERCP. Provisional duodenal stenting was performed as a bridge to ERCP. A second endoscopic session was performed to remove the provisional stent and to perform an ERCP. Afterward, a permanent duodenal stent was delivered if necessary. Results: Sixty-six duodenal stents (17 pcSEMS and 49 fcSEMS) were delivered with a median indwelling time of 3.15 (1 – 7) days. Two migrations occurred in the pcSEMS group, 1 of which required lower endoscopy for retrieval. No other procedure-related complications were observed. At second endoscopy a successful ERCP was performed in 56 patients (85 %); 10 patients (15 %) with endoscopic failure underwent PTBD or EUS-BD. Forty patients needed permanent duodenal stenting. Conclusions: Provisional removable covered duodenal stenting as a bridge to ERCP for duodenal obstruction is safe procedure and in most cases allows successful performance of therapeutic ERCP. This technique could be a sound option as a step up approach before referring such cases for more complex techniques such as EUS-BD or PTBD. PMID:27652301

  16. Eradication of Helicobacter pylori infection in the management of patients with dyspepsia and non-ulcer dyspepsia.

    PubMed Central

    Huang, J. Q.; Hunt, R. H.

    1998-01-01

    Although H. pylori infection has been recognized as a major etiological agent for the development of chronic active gastritis, duodenal ulcer and benign non-NSAID related gastric ulcer, its role in the development of symptoms in patients with dyspepsia remains uncertain. Results from population-based epidemiological studies have been conflicting regarding a causal link between H. pylori infection and dyspepsia. Abnormalities in gastric acid secretion may exist in some dyspeptic patients. Whether disordered gastric motility seen in dyspeptic patients is related to the infection is not clear based on the results in the literature. Numerous clinical trials have been undertaken to eradicate H. pylori infection and improve the symptoms in dyspeptic patients; however, the results have been discrepant between studies. Many published studies suffer from methodological problems that have made interpretation difficult. Large, well-conducted, randomized, placebo-controlled, clinical trials with long-term follow-up are needed to justify the beneficial effect of H. pylori eradication treatment in dyspeptic patients seen in some small studies. H. pylori eradication therapy is cost-effective in H. pylori-infected dyspeptic patients although this benefit may take a long time to accrue, especially in younger patients. PMID:10378358

  17. Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

    SciTech Connect

    Lopera, Jorge E. Alvarez, Oscar A.; Perdigao, Joseph; Castaneda-Zuniga, Wilfrido

    2003-09-15

    Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention.

  18. Refractory Ulcerative Colitis Treatment

    PubMed Central

    Green, Jesse A.

    2007-01-01

    Treatment of refractory ulcerative colitis (UC) is a common clinical challenge. In either acute or chronic refractory UC, the disease may continue to remain active, even though the patient is on appropriate therapy. It is important to reassess and characterize the patient's disease before adding new medications to the current medical regimen. After determining the current extent and severity of the UC—ruling out other causes of bloody diarrhea and determining what complications are present—new treatment approaches can then be started. It is critical to first optimize oral 5-aminosalicylic acid (5-ASA) therapy combined with rectal 5-ASA or corticosteroid suppositories, plus corticosteroid or 5-ASA enemas or foam preparations. Oral or intravenous corticosteroids are appropriate to use if needed, but alternative approaches must be used for long-term maintenance. 6-Mercaptopurine (6-MP) or azathioprine can be very helpful for severe chronic refractory UC. In those patients who do not respond to 5-ASA medications, corticosteroids, and 6-MP or azathioprine, infliximab offers an important approach for induction and maintenance of remission for refractory chronic ulcerative colitis as well as for select cases of refractory acute UC. Cyclosporine use is an alternative medical approach for the refractory acute UC patient. Colectomy with ileal pouch-anal anastomosis remains a valuable option for the refractory chronic or acute UC patient, because it can provide both a “cure” for the disease, as well as eliminate ineffective medications with their associated side effects. PMID:21960779

  19. Duodenal obstruction due to a preduodenal portal vein.

    PubMed

    Vilakazi, Mnc; Ismail, F; Swanepoel, H M; Muller, E W; Lockhat, Z I

    2014-01-01

    An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery.

  20. Duodenal acidity may increase the risk of pancreatic cancer in the course of chronic pancreatitis: an etiopathogenetic hypothesis.

    PubMed

    Talamini, Giorgio

    2005-03-10

    Chronic pancreatitis patients have an increased risk of developing pancreatic cancer. The cause of this increase has yet to be fully explained but smoking and inflammation may play an important role. To these, we must now add a new potential risk factor, namely duodenal acidity. Patients with chronic pancreatitis very often present pancreatic exocrine insufficiency combined with a persistently low duodenal pH in the postprandial period. The duodenal mucosa in chronic pancreas patients with pancreatic insufficiency has a normal concentration of s-cells and, therefore, the production of secretin is preserved. Pancreatic ductal cells are largely responsible for the amount of bicarbonate and water secretion in response to secretin stimulation. When gastric acid in the duodenum is not well-balanced by alkaline pancreatic secretions, it may induce a prolonged secretin stimulus which interacts with the pancreatic ductal cells resulting in an increased rate of ductular cell activity and turnover. N-Nitroso compounds from tobacco, identified in human pancreatic juice and known to be important carcinogens, may then act on these active cells, thereby increasing the risk of cancer. Duodenal acidity is probably of particular concern in patients who have undergone a duodenum-preserving pancreatic head resection, since, in this anatomic situation, pancreatic juice transits directly via the jejunal loop, bypassing the duodenum. Patients undergoing a Whipple procedure or side-to-side pancreaticojejunostomy are probably less critically affected because secretions transit, at least in part, via the papilla. If the duodenal acidity hypothesis proves correct, then, in addition to stopping smoking, reduction of duodenal acid load in patients with pancreatic insufficiency may help decrease the risk of pancreatic cancer.

  1. Pharmacologic treatment of venous leg ulcers.

    PubMed

    Dormandy, J A

    1995-01-01

    In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline

  2. Pellagra revealing a congenital duodenal diaphragm in an adult.

    PubMed

    Khouloud, Bouslama; Haykel, Bedioui; Ahmed, Saidani; Houcine, Maghrebi; Yacine, Ben Safta; Farah, Jokho; Zoubeir, Ben Safta

    2013-12-01

    Pellagra is a nutritional disease caused by the deficiency of niacin. It is a clinical syndrome characterized by four "D's": diarrhea, dermatitis, dementia and ultimately death. We describe a case of pellagra as the initial presentation of congenital duodenal diaphragm.

  3. Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

    PubMed Central

    Wermers, Joshua D; Beteselassie, Nebiyu

    2017-01-01

    Lemmel syndrome occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Additional pathophysiologic processes may also contribute to the development of Lemmel syndrome. These include duodenal diverticula causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula. It is uncommon for duodenal diverticulum to become inflamed. We report the case of a 25-year-old female presenting with unintentional weight loss and fatigue. Since her initial labs were concerning for possible infection with hepatobiliary abnormalities, a contrast-enhanced CT was obtained. This study revealed a large periampullary diverticulum with mucosal enhancement and fat stranding consistent with diverticulitis.

  4. Tannins, Peptic Ulcers and Related Mechanisms

    PubMed Central

    de Jesus, Neyres Zinia Taveira; de Souza Falcão, Heloina; Gomes, Isis Fernandes; de Almeida Leite, Thiago Jose; de Morais Lima, Gedson Rodrigues; Barbosa-Filho, Jose Maria; Tavares, Josean Fechine; da Silva, Marcelo Sobral; de Athayde-Filho, Petrônio Filgueiras; Batista, Leonia Maria

    2012-01-01

    This review of the current literature aims to study correlations between the chemical structure and gastric anti-ulcer activity of tannins. Tannins are used in medicine primarily because of their astringent properties. These properties are due to the fact that tannins react with the tissue proteins with which they come into contact. In gastric ulcers, this tannin-protein complex layer protects the stomach by promoting greater resistance to chemical and mechanical injury or irritation. Moreover, in several experimental models of gastric ulcer, tannins have been shown to present antioxidant activity, promote tissue repair, exhibit anti Helicobacter pylori effects, and they are involved in gastrointestinal tract anti-inflammatory processes. The presence of tannins explains the anti-ulcer effects of many natural products. PMID:22489149

  5. Tannins, peptic ulcers and related mechanisms.

    PubMed

    de Jesus, Neyres Zinia Taveira; de Souza Falcão, Heloina; Gomes, Isis Fernandes; de Almeida Leite, Thiago Jose; de Morais Lima, Gedson Rodrigues; Barbosa-Filho, Jose Maria; Tavares, Josean Fechine; da Silva, Marcelo Sobral; de Athayde-Filho, Petrônio Filgueiras; Batista, Leonia Maria

    2012-01-01

    This review of the current literature aims to study correlations between the chemical structure and gastric anti-ulcer activity of tannins. Tannins are used in medicine primarily because of their astringent properties. These properties are due to the fact that tannins react with the tissue proteins with which they come into contact. In gastric ulcers, this tannin-protein complex layer protects the stomach by promoting greater resistance to chemical and mechanical injury or irritation. Moreover, in several experimental models of gastric ulcer, tannins have been shown to present antioxidant activity, promote tissue repair, exhibit anti Helicobacter pylori effects, and they are involved in gastrointestinal tract anti-inflammatory processes. The presence of tannins explains the anti-ulcer effects of many natural products.

  6. Peptic ulcer disease in children and adolescents.

    PubMed

    El Mouzan, Mohammad Issa; Abdullah, Asaad Mohammad

    2004-12-01

    Peptic ulcer disease (PUD) has been reported to occur in children worldwide, but no information is available for our community. The aim of the study was to report our experience on the pattern of this condition in Saudi Arabian children. The records of all children below 18 years of age who were diagnosed by endoscopy to have PUD over a period of 10 years were analysed. From 1993 to 2002, 24 children out of 521(5 per cent) who presented with upper gastrointestinal tract (GIT) symptoms were diagnosed by endoscopy to have PUD. All but one (96 per cent) were Saudi nationals, the average age was 15 years (range 5-18 years), and the male to female ratio was 7:1. The commonest presentation was chronic abdominal pain in 15/24 (63 per cent) of the children, followed by vomiting associated with abdominal pain in four (17 per cent). Hematemesis and melena occurred in three (13 per cent), and two children (8 per cent), respectively. There were 20 duodenal (92 per cent) and four gastric ulcers. The primary type was the most common, occurring in 19 (79 per cent) of the children. Histopathology results of antral biopsies were available for 15 children; all of them had antral gastritis. Helicobacter pylori organisms were present in 13/15 (87 per cent) of the antral biopsy specimens. In Saudi children, peptic ulcer disease occurs more commonly in boys. It is a rare cause of upper GIT symptoms, but highly associated with H. pylori antral gastritis. This study documents a pattern similar to descriptions from other countries.

  7. Antral Helicobacter Pylori Infection, Hypergastrinemia and Peptic Ulcers: Effect of Eradicating the Organism

    PubMed Central

    Park, Sill Moo; Yoo, Byung Chul; Lee, Hyo Rang; Yoon, Joon Hyun; Cha, Young Joo

    1993-01-01

    Background: A randomized prospective study on the response of fasting serum gastrin concentrations in peptic ulcer patients was performed in order to test the hypothesis that H. pylori infection in the gastric antrum increases gastrin release, and to examine whether the high fasting serum gastrin concentrations respond to treatment that eradicates H. pylori. Methods: One hundred and twenty-seven patients with gastric or duodenal ulcer were included in this study. Patients were divided into three groups on the basis of antral H. pylori status and therapeutic modalities. The first group, 58 patients infected by H. pylori, was treated with metronidazole and tripotassium dicitrato bismuthate combined with ranitidine and mylanta. The second group, 40 patients also infected by H. Pylori, was treated with ranitidine and mylanta. The third group, 29 patients, free of H. pylori infection, was designed to evaluate the influence of H2-receptor antagonist on the change of gastrin. When ulcers were completely healed, changes of gastrin concentrations and H. pylori status were re-examined. Results: H. pylori was eradicated in all patients who have received antibacterial therapy in 4 weeks, and serum gastrin concentrations were significantly decreased after eradication of the organism both in gastric and in duodenal ulcer diseases. (Gastric ulcer: 129.3±47.0 pg/ml before and 63.7±21.6 pg/ml after treatment. Duodenal ulcer: 108.3±35.0 pg/ml and 66.5±21.9 pg/ml, respectively. Total: 112.7±38.2 pg/ml vs 66.0±21.6 pg/ml) (p<0.01). In contrast, H. pylori-positive patients who have not received antibacterial therapy were still infected at the completion of the study, and serum gastrin concentrations increased even though the difference was not significant. (Gastric ulcer: 118.4±51.2 pg/ml vs 124.0±56.5 pg/ml. Duodenal ulcer: 85.4±35.1 pg/ml vs 104.6±43.5. Total: 99.5±45.3 vs 112.9±48.7 pg/ml.) (p>0.05) None of the patients who were initially H. pylori-negative has been

  8. Cyclophosphamide induced stomach and duodenal lesions as a NO-system disturbance in rats: L-NAME, L-arginine, stable gastric pentadecapeptide BPC 157.

    PubMed

    Luetic, Krešimir; Sucic, Mario; Vlainic, Josipa; Halle, Zeljka Belosic; Strinic, Dean; Vidovic, Tinka; Luetic, Franka; Marusic, Marinko; Gulic, Sasa; Pavelic, Tatjana Turudic; Kokot, Antonio; Seiwerth, Ranka Serventi; Drmic, Domagoj; Batelja, Lovorka; Seiwerth, Sven; Sikiric, Predrag

    2017-04-01

    We revealed a new point with cyclophosphamide (150 mg/kg/day intraperitoneally for 7 days): we counteracted both rat stomach and duodenal ulcers and increased NO- and MDA-levels in these tissues. As a NO-system effect, BPC 157 therapy (10 µg/kg, 10 ng/kg, intraperitoneally once a day or in drinking water, till the sacrifice) attenuated the increased NO- and MDA-levels and nullified, in rats, severe cyclophosphamide-ulcers and even stronger stomach and duodenal lesions after cyclophosphamide + L-NAME (5 mg/kg intraperitoneally once a day). L-arginine (100 mg/kg intraperitoneally once a day not effective alone) led L-NAME-values only to the control values (cyclophosphamide + L-NAME + L-arginine-rats). Briefly, rats were sacrificed at 24 h after last administration on days 1, 2, 3, or 7, and assessment included sum of longest lesions diameters (mm) in the stomach and duodenum, oxidative stress by quantifying thiobarbituric acid reactivity as malondialdehyde equivalents (MDA), NO in stomach and duodenal tissue samples using the Griess reaction. All these parameters were highly exaggerated in rats who underwent cyclophosphamide treatment. We identified high MDA-tissue values, high NO-tissue values, ulcerogenic and beneficial potential in cyclophosphamide-L-NAME-L-arginine-BPC 157 relationships. This suggests that in cyclophosphamide damaged rats, NO excessive release generated by the inducible isozyme, damages the vascular wall and other tissue cells, especially in combination with reactive oxygen intermediates, while failing endothelial production and resulting in further aggravation by L-NAME which was inhibited by L-arginine. Finally, BPC 157, due to its special relations with NO-system, may both lessen increased MDA- and NO-tissues values and counteract effects of both cyclophosphamide and L-NAME on stomach and duodenal lesions.

  9. In Vivo Antioxidant and Antiulcer Activity of Parkia speciosa Ethanolic Leaf Extract against Ethanol-Induced Gastric Ulcer in Rats

    PubMed Central

    Al Batran, Rami; Al-Bayaty, Fouad; Jamil Al-Obaidi, Mazen M.; Abdualkader, Abdualrahman Mohammed; Hadi, Hamid A.; Ali, Hapipah Mohd; Abdulla, Mahmood Ameen

    2013-01-01

    Background The current study was carried out to examine the gastroprotective effects of Parkia speciosa against ethanol-induced gastric mucosa injury in rats. Methodology/Principal Findings Sprague Dawley rats were separated into 7 groups. Groups 1–2 were orally challenged with carboxymethylcellulose (CMC); group 3 received 20 mg/kg omeprazole and groups 4–7 received 50, 100, 200 and 400 mg/kg of ethanolic leaf extract, respectively. After 1 h, CMC or absolute ethanol was given orally to groups 2–7. The rats were sacrificed after 1 h. Then, the injuries to the gastric mucosa were estimated through assessment of the gastric wall mucus, the gross appearance of ulcer areas, histology, immunohistochemistry and enzymatic assays. Group 2 exhibited significant mucosal injuries, with reduced gastric wall mucus and severe damage to the gastric mucosa, whereas reductions in mucosal injury were observed for groups 4–7. Groups 3–7 demonstrated a reversal in the decrease in Periodic acid-Schiff (PAS) staining induced by ethanol. No symptoms of toxicity or death were observed during the acute toxicity tests. Conclusion Treatment with the extract led to the upregulation of heat-shock protein 70 (HSP70) and the downregulation of the pro-apoptotic protein BAX. Significant increases in the levels of the antioxidant defense enzymes glutathione (GSH) and superoxide dismutase (SOD) in the gastric mucosal homogenate were observed, whereas that of a lipid peroxidation marker (MDA) was significantly decreased. Significance was defined as p<0.05 compared to the ulcer control group (Group 2). PMID:23724090

  10. Combined Gastric and Duodenal Perforation Through Blunt Abdominal Trauma

    PubMed Central

    Kaur, Adarshpal; Singla, Archan Lal; Kumar, Ashwani; Yadav, Manish

    2015-01-01

    Blunt abdominal traumas are uncommonly encountered despite their high prevalence, and injuries to the organ like duodenum are relatively uncommon (occurring in only 3%-5% of abdominal injuries) because of its retroperitoneal location. Duodenal injury combined with gastric perforation from a single abdominal trauma impact is rarely heard. The aim of this case report is to present a rare case of blunt abdominal trauma with combined gastric and duodenal injuries. PMID:25738037

  11. Preduodenal Portal Vein with Situs Inversus Totalis causing Duodenal Obstruction

    PubMed Central

    D’souza, Flavia; Bendre, Pradnya

    2016-01-01

    Congenital duodenal obstruction sometimes may be secondary to unusual entities like preduodenal portal vein (PDPV) the identification of which is very important to avoid inadvertent injury or incorrect surgery. A 6-day old neonate presented with congenital duodenal obstruction. Investigations revealed situs inversus totalis with many congenital cardiovascular anomalies. At operation preduodenal portal vein and malrotation were found. Correction of malrotation and bypass duodeno-duodenostomy were done. PMID:27398325

  12. Preduodenal portal vein: a cause of prenatally diagnosed duodenal obstruction.

    PubMed

    Choi, S O; Park, W H

    1995-10-01

    Preduodenal portal vein is a rare congenital anomaly that causes high intestinal obstruction. The authors report on a newborn who was diagnosed as having duodenal obstruction at 30 weeks' gestation. During surgery the patient was found to have duodenal obstruction caused by a preduodenal portal vein. Malrotation was an associated finding. Treatment consisted of Ladd's procedure and a diamond-shaped duodenoduodenostomy performed anterior to the portal vein.

  13. Preduodenal Portal Vein with Situs Inversus Totalis causing Duodenal Obstruction.

    PubMed

    D'souza, Flavia; Nage, Amol; Bendre, Pradnya

    2016-01-01

    Congenital duodenal obstruction sometimes may be secondary to unusual entities like preduodenal portal vein (PDPV) the identification of which is very important to avoid inadvertent injury or incorrect surgery. A 6-day old neonate presented with congenital duodenal obstruction. Investigations revealed situs inversus totalis with many congenital cardiovascular anomalies. At operation preduodenal portal vein and malrotation were found. Correction of malrotation and bypass duodeno-duodenostomy were done.

  14. Selective coating of gastric ulcer by tripotassium dicitrato bismuthate in the rat.

    PubMed

    Koo, J; Ho, J; Lam, S K; Wong, J; Ong, G B

    1982-05-01

    Controlled clinical trials have shown that tripotassium dicitrato bismuthate healed duodenal and gastric ulcers significantly better than placebo. One mechanism suggested is that it forms a protective coat at the ulcer base. We studied this coating action in rats with chronic gastric ulcers produced by a standardized technique for mucosal wounding at the fundoantral junction. Bismuth was identified by histochemical staining using Castel's reagent, the specificity of which was verified in vitro against 13 other metallic compounds and chemicals. Our results showed that tripotassium dicitrato bismuthate had a coating affinity for the ulcer base, but not for the adjacent normal mucosa. All rats treated with tripotassium dicitrato bismuthate 1, 2, 4, and 6 h previously, but not the control rats treated with water or those treated with four other bismuth compounds, manifested a layer of bismuth that coated the ulcer base. Light and electron microscopy of the tripotassium dicitrato bismuthate-treated ulcers--but not their controls-revealed an abundance of macrophages, which had ingested the bismuth. This unique bismuth coat may insulate the ulcer base from acid-pepsin digestion, while the influx of macrophages may expedite reparative processes.

  15. Treatment of venous leg ulcers with sulodexide.

    PubMed

    Scondotto, G; Aloisi, D; Ferrari, P; Martini, L

    1999-11-01

    Venous ulcers are still today one of the main socioeconomic problems of medical interest in terms of prevalence, morbidity, and costs to the health service. In the past, various studies have been carried out to identify a systemic pharmacologic treatment able to accelerate venous ulcer healing times, but frequently the results have not been satisfactory. The aim of this study was to evaluate the efficacy of sulodexide, a drug with profibrinolytic and antithrombotic activity, in accelerating venous ulcer's healing time. Ninety-four patients (32 men and 62 women), aged 72 years old on average, were randomly distributed between two groups. In the first group ("control group") a standard treatment was applied, which consisted of cleansing by washing with physiological solution and the application of elastic compression with short-extensibility, removable bandages. The second group ("sulodexide group") received the standard treatment plus sulodexide (600 lipoprotein lipase releasing units [LRU] by im route per day for 30 consecutive days, followed by 500 LRU by oral route per day for a further 30 days). After 2 months the venous ulcers were found healed in 15 patients (36%) in the control group and in 30 patients (58%) in the sulodexide group (p = 0.03). The life table showed that the healing times were shorter in the sulodexide group in the first 2 months of treatment. Total healing times amounted to 110 days in the control group and 72 days in the sulodexide group (p = 0.08) and the results were in proportion to the initial severity of the lesion. A significant correlation was noted between ulcer healing times and severity of the initial ulcerous lesion, the duration of the ulcer, and the group the patient belonged to. No correlation was found between age, gender of the patient and the etiology of the ulcer. In conclusion sulodexide was shown effective in the treatment of venous leg ulcers, yielding healing more quickly than the standard treatment.

  16. [6]-gingerol and [6]-shogaol, active ingredients of the traditional Japanese medicine hangeshashinto, relief oral ulcerative mucositis-induced pain via action on Na(+) channels.

    PubMed

    Hitomi, Suzuro; Ono, Kentaro; Terawaki, Kiyoshi; Matsumoto, Chinami; Mizuno, Keita; Yamaguchi, Kiichiro; Imai, Ryota; Omiya, Yuji; Hattori, Tomohisa; Kase, Yoshio; Inenaga, Kiyotoshi

    2017-03-01

    The traditional Japanese herbal medicine hangeshashinto (HST) has beneficial effects for the treatment of oral ulcerative mucositis (OUM) in cancer patients. However, the ingredient-based mechanism that underlies its pain-relieving activity remains unknown. In the present study, to clarify the analgesic mechanism of HST on OUM-induced pain, we investigated putative HST ingredients showing antagonistic effects on Na(+) channels in vitro and in vivo. A screen of 21 major ingredients using automated patch-clamp recordings in channel-expressing cells showed that [6]-gingerol and [6]-shogaol, two components of a Processed Ginger extract, considerably inhibited voltage-activated Na(+) currents. These two ingredients inhibited the stimulant-induced release of substance P and action potential generation in cultured rat sensory neurons. A submucosal injection of a mixture of [6]-gingerol and [6]-shogaol increased the mechanical withdrawal threshold in healthy rats. In a rat OUM model, OUM-induced mechanical pain was alleviated 30min after the swab application of HST despite the absence of anti-bacterial and anti-inflammatory actions in the OUM area. A swab application of a mixture of [6]-gingerol and [6]-shogaol induced sufficient analgesia of OUM-induced mechanical or spontaneous pain when co-applied with a Ginseng extract containing abundant saponin. The Ginseng extract demonstrated an acceleration of substance permeability into the oral ulcer tissue without an analgesic effect. These findings suggest that Na(+) channel blockage by gingerol/shogaol plays an essential role in HST-associated analgesia of OUM-induced pain. This pharmacological mechanism provides scientific evidence supporting the use of this herbal medicine in patients suffering from OUM-induced pain.

  17. Neonatal Pressure Ulcer Prevention.

    PubMed

    Scheans, Patricia

    2015-01-01

    The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described.

  18. [Abomasal ulcers in cattle].

    PubMed

    Hund, Alexandra; Wittek, Thomas

    2017-03-29

    Abomasal ulcers lead to several problems. They cause pain resulting in a decrease in productivity and even the possible loss of the animal. Because they are frequently difficult to diagnose, information on their prevalence is variable. Additionally, therapeutic options are limited. Abomasal ulcers are graded as type 1 through 4, type 1 being a superficial defect and type 2 an ulcer where a large blood vessel has been eroded, leading to substantial blood loss. Types 3 and 4 are perforated abomasal ulcers leading to local and diffuse peritonitis, respectively. Causes of abomasal ulcers are multifactorial, for example, mistakes in feeding that lead to gastrointestinal disturbances or other diseases that induce stress. Ulcers can also result from side effects of nonsteroidal anti-inflammatory drugs. In principal, the pathophysiological cause is the disturbance of the balance between protective and aggressive mechanisms at the abomasal mucosa due to stress. Clinical symptoms vary and are mostly non-specific. Fecal occult blood tests, hematology and blood chemistry as well as ultrasonographic examination and abdominocentesis can help to establish the diagnosis. Ulcers can be treated symptomatically, surgically and medically. To prevent abomasal ulcers, animals should be kept healthy by providing adequate nutrition and housing as well as early and effective medical care. Stressful management practices, including transport and commingling, should be avoided.

  19. [C. pylori colonization of the mucosa in patients with chronic ulcerative and non-ulcerative gastropathies].

    PubMed

    Loschiavo, F; Ventura-Spagnolo, T; Broccio, G

    1990-05-01

    C. pyloridis colonization was investigated in a selected group of 58 patients with upper gastrointestinal disorders submitted to endoscopy and biopsy. The following results were registered. C. pyloridis was isolated in 14 out of 18 cases of active chronic gastritis, in 15 out of 24 cases of non active chronic gastritis, and 7 out of 8 cases of antral ulceration. A negative finding was registered in 8 patients whose gastric mucosa was normal. Therefore, the Authors consider as valid the etiopathogenetic correlation between C. pyloridis and ulcerative or non-ulcerative chronic gastric diseases, suggested by others.

  20. [Ulcers of lower limb veins: venous ulcers].

    PubMed

    López Herranz, Marta; Bas Caro, Pedro; Moraleja Millán, Tania; Mateos García, Marina; García Jábega, Rosa Ma; López Corral, Juan Carlos

    2014-05-01

    The lower extremity vascular ulcers currently represent a major public health problem, particularly because of different situations: the chronic nature of the injury, a poor response to treatment, recurrence rates, high absenteeism, poor training in some cases of the health staff that treats, etc. Lower extremity ulcers mean a serious personal, family, health and social problem, with a significant expenditure of human and material resources. Since the prevalence and incidence of lower extremity vascular ulcers is high worldwide, it is necessary to go into detail about the knowledge of the epidemiology and to favour, in different countries, the creation of interdisciplinary research groups that addresses issues related to risk factors, pathogenesis, treatment, health care costs, quality of life and, above all, specialized training aimed at health professionals.

  1. Inferoposterior duodenal approach for laparoscopic pancreaticoduodenectomy

    PubMed Central

    Wang, Xiao-Ming; Sun, Wei-Dong; Hu, Ming-Hua; Wang, Gua-Nan; Jiang, Ya-Qi; Fang, Xiao-San; Han, Meng

    2016-01-01

    AIM: To investigate the advantages of inferoposterior duodenal approach (IPDA) for laparoscopic pancreaticoduodenectomy (LPD). METHODS: A total of 36 patients subjected to LPD were admitted to the Affiliated Yijishan Hospital of Wannan Medical College from December 2009 to February 2015. These patients were diagnosed with an ampullary tumour or a pancreatic head tumour through computed tomography, magnetic resonance imaging or endoscopic retrograde cholangiopancreatography preoperatively. The cases were selected on the basis of the following criteria: tumour diameter < 4 cm; no signs of peripheral vascular invasion; evident lymph node swelling; and distant metastasis. Of the 36 cases, 20 were subjected to anterior approach (AA; AA group) and 16 were subjected to IPDA (IPDA group). Specimen removal time, intraoperative blood loss and postoperative complications in the two groups were observed, and their differences were compared. RESULTS: During the operation, 2 cases in the AA group and 2 cases in the IPDA group were converted to laparotomy; these cases were excluded from statistical analysis. The remaining 32 cases successfully completed the surgery. The AA group and IPDA group exhibited the specimen removal time of 205 ± 52 and 160 ± 35 min, respectively, and the difference was significant (P < 0.01). The AA group and IPDA group revealed the intraoperative blood loss of 360 ± 210 mL and 310 ± 180 mL, respectively, but these values were not significantly different. Postoperative pathological results revealed 4 cases of inferior common bile duct cancer, 8 cases of duodenal papillary cancer, 6 cases of ampullary cancer, 13 cases of pancreatic cancer, 3 cases of chronic pancreatitis accompanied with cyst formation or duct expansion, and 2 cases of mucinous cystic tumour in the pancreatic head. The postoperative complications were pulmonary Staphylococcus aureus infection, incision faulty union, ascites induced poor drainage accompanied with infection, bile

  2. Polymyositis associated with ulcerative colitis.

    PubMed Central

    Chugh, S; Dilawari, J B; Sawhney, I M; Dang, N; Radotra, B D; Chawla, Y K

    1993-01-01

    An elderly woman with chronic ulcerative colitis who developed proximal muscle weakness, increased serum creatine phosphokinase activity, and histological and electromyographic abnormalities characteristic of polymyositis is described. Treatment with corticosteroids and 5-acetylsalicylic acid was followed by a remission in bowel symptoms, improvement in muscle power, and reversal of electromyographic changes. An autoimmune link between the two disorders seems likely. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:8491410

  3. Cytology Preparations of Formalin Fixative Aid Detection of Giardia in Duodenal Biopsy Samples.

    PubMed

    Panarelli, Nicole C; Gobara, Nariman; Hoda, Rana S; Chaump, Michael; Jessurun, Jose; Yantiss, Rhonda K

    2017-04-01

    Giardiasis is the most common intestinal parasitic infection in the United States. The organism elicits no, or minimal, inflammatory changes in duodenal biopsy samples, so it can be easily overlooked. We performed this study to determine whether Giardia could be isolated from the formalin fixative of biopsy samples, and to evaluate the value of fluid analysis in the assessment for potential infection. We prospectively evaluated duodenal biopsy samples from 92 patients with a clinical suspicion of giardiasis or symptoms compatible with that diagnosis (ie, diarrhea, bloating, or abdominal pain) Biopsy samples were routinely processed and stained with hematoxylin and eosin. Histologic diagnoses included giardiasis (5 cases, 4%), normal findings (64 cases, 70%), peptic injury/active duodenitis (12 cases, 13%), and intraepithelial lymphocytosis with villous blunting (10 cases, 12%). Fifteen cases (13%) showed detached degenerated epithelial cells or mucus droplets in the intervillous space that resembled Giardia. Cytology slides were prepared from formalin in the biopsy container using the standard Cytospin protocol and reviewed by a cytopathologist blinded to the biopsy findings. Cytologic evaluation revealed Giardia spp. in all 5 biopsy-proven cases, and identified an additional case that was not detected by biopsy analysis. Organisms were significantly more numerous (mean: 400 trophozoites; range, 120 to 810) and showed better morphologic features in cytology preparations compared with tissue sections (mean: 129 trophozoites; range, 37 to 253 organisms; P=0.05). Our findings suggest that cytology preparations from formalin fixative can resolve diagnostically challenging cases and even enhance Giardia detection in some cases.

  4. Peptic ulcer disease today.

    PubMed

    Yuan, Yuhong; Padol, Ireneusz T; Hunt, Richard H

    2006-02-01

    Over the past few decades, since the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors, cyclo-oxygenase-2-selective anti-inflammatory drugs (coxibs), and eradication of Helicobacter pylori infection, the incidence of peptic ulcer disease and ulcer complications has decreased. There has, however, been an increase in ulcer bleeding, especially in elderly patients. At present, there are several management issues that need to be solved: how to manage H. pylori infection when eradication failure rates are high; how best to prevent ulcers developing and recurring in nonsteroidal anti-inflammatory drug (NSAID) and aspirin users; and how to treat non-NSAID, non-H. pylori-associated peptic ulcers. Looking for H. pylori infection, the overt or surreptitious use of NSAIDs and/or aspirin, and the possibility of an acid hypersecretory state are important diagnostic considerations that determine the therapeutic approach. Combined treatment with antisecretory therapy and antibiotics for 1-2 weeks is the first-line choice for H. pylori eradication therapy. For patients at risk of developing an ulcer or ulcer complications, it is important to choose carefully which anti-inflammatory drugs, nonselective NSAIDs or coxibs to use, based on a risk assessment of the patient, especially if the high-risk patient also requires aspirin. Testing for and eradicating H. pylori infection in patients is recommended before starting NSAID therapy, and for those currently taking NSAIDs, when there is a history of ulcers or ulcer complications. Understanding the pathophysiology and best treatment strategies for non-NSAID, non-H. pylori-associated peptic ulcers presents a challenge.

  5. Duodenal perforation caused by a bird feather.

    PubMed

    Sahoo, Manash Ranjan; Kumar, Anil

    2013-02-15

    Ingestion of gastrointestinal (GI) foreign bodies represents a challenging clinical scenario. The greater risk is at extremes of age, in those wearing dentures, alcoholics and mentally handicapped. We present a case of duodenal perforation caused by a bird feather. A 64-year-old man was presented with abdominal pain for 4 days. Abdominal examination showed signs of peritonitis. The erect abdominal x-ray showed free gas under diaphragm. Exploratory laparotomy showed purulent fluid, but no definite site of perforation could be found. So the abdomen was closed with a drain in Morison's pouch. The postoperative recovery was uneventful. He came for a repeat check-up at 4 weeks with dull aching pain in the upper abdomen and was advised for a routine upper GI endoscopy which revealed a feather penetrating the first part of the duodenum, which was removed with a foreign body removing forceps. GI foreign bodies represent a significant problem and an increased level of suspicion is important for timely diagnosis and treatment.

  6. The terminal web of the duodenal enterocyte.

    PubMed

    Leeson, T S

    1982-06-01

    The terminal web-brush border complex of rodent duodenal enterocytes has been studied by electron microscopy to investigate its structure in relation to currently accepted models of motility in this region. The main adherens zone is composed chiefly of a fine feltwork of 5 to 7 nm filaments, some of which originate in zonulae adherentes. In some cells, this is not a complete layer or sheet. Passing into it from its deep aspect are 10 nm tonofilaments, which also form the basal zone. The filament density in the basal zone is less than that of the adherens zone, and many of the tonofilaments are associated with spot desmosomes. The apical zone contains a loose meshwork of 5 to 7 nm filaments with more filaments lying adjacent to plasmalemmae of the zonula occludens. The core of each microvillus contains a bundle of 17 to 48 microfilaments, 5-7 nm in diameter, apparently attached to the apical plasmalemma and with some slender cross filaments between core filaments and the plasmalemma. In the main, these core bundles of microfilaments pass deeply into and often through the adherens zone of the terminal web where they terminate abruptly. Filaments of the terminal web appear to interconnect microfilaments of adjacent core bundles but without positive evidence of 'splaying' of microfilaments of a core bundle within the adherens zone. These findings are discussed in relation to movement of microvilli.

  7. [Frequency, diagnosis and dependance of duodenitis upon the morphological status of the gastric mucosa (author's transl)].

    PubMed

    Konstantinidis, T; Wagner, P K

    1978-08-01

    In a attempt to prove the dependence of duodenitis upon the morphological status of the gastric mucosa, a biopsy of the corpus, antrum, and duodenal canal had been made of 354 patients. In 56 cases, a superficial duodenitis was histologically verified; however, this infection had not contaminated the Brunner' glands. A duodenitis was found to be more often associated with surface gastritis of the corpus and antrum than it was with atropic gastritis. A duodenitis was discovered by a biopsy in 16 patients possessing a normal antrum mucosa and in 25 patients having a normal corpus mucosa, thus proving the possibility of isolated duodenitis.

  8. Arterial supply to the bleeding diverticulum in the ascending duodenum treated by transcatheter arterial embolization- a duodenal artery branched from the inferior pancreaticoduodenal artery.

    PubMed

    Sanda, Hiroki H; Kawai, Nobuyuki N; Sato, Morio M; Tanaka, Fumihiro F; Nakata, Kouhei K; Minamiguchi, Hiroki H; Nakai, Motoki M; Sonomura, Tetsuo T

    2014-01-01

    We present a case of endoscopically unmanageable hemorrhagic diverticulum in the ascending duodenum. The ventral and dorsal walls of the ascending duodenum were supplied from the first jejunal artery (1JA) and inferior pancreaticoduodenal artery (IPDA), respectively. The hemorrhage mainly occurred from IPDA. The abruptly branching of IPDA from superior mesenteric artery enabled successful catheterization of the IPDA with an angled microcatheter. Hemostasis was obtained by embolization using n-butyl cyanoacrylate. Gastroendoscopy depicted a duodenal hemi-circumferential ulcer. No symptoms related to hemorrhage were found at the last follow-up at 12 months.

  9. ASSESSMENT OF THE GASTRO-JEJUNO-DUODENAL TRANSIT AFTER JEJUNAL POUCH INTERPOSITION

    PubMed Central

    da SILVA, Alcino Lázaro; GOMES, Célio Geraldo de Oliveira

    2015-01-01

    Background : The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. Aim : Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. Methods : Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. Results : Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). Conclusions : The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients. PMID:26734789

  10. Etiopathogenetic principles and peptic ulcer disease classification.

    PubMed

    Tytgat, G N J

    2011-01-01

    Ulceration corresponds to tissue loss, breaching the muscularis mucosae. When ulcers develop in the acid-peptic environment of the gastroduodenum, they are traditionally called peptic ulcer (PUD). Ulcers never develop spontaneously in a healthy gastroduodenal mucosa. Ulceration is the ultimate consequence of a disequilibrium between aggressive injurious factors and defensive mucosa-protective factors. The dominant aggressors are strong acid and high proteolytic (pepsin) activity in gastric secretions. The dominant defensors are the phospholipid surfactant layer, covering the mucus bicarbonate gel, the mucus bicarbonate layer covering the epithelium, the tight junctional structures between the epithelial cells, restricting proton permeability, and the epithelial trefoil peptides, contributing to healing after injury. Initially, acid-peptic aggression was considered the overwhelming cause of PUD, supported by the pioneering work of Schwartz, launching the dictum 'no acid, no ulcer'. This led to the universal therapy directed against intragastric acidity, also interfering with peptic activity when the pH was >4. The therapeutic sequence went from large doses of antacids to H(2)-receptor antagonists and finally to proton pump inhibitors (PPIs). The longer the intragastric pH was >3, the quicker ulcer healing was seen. Unfortunately, ulcers often recurred after stopping therapy, demanding maintenance therapy to keep the ulcers healed and to prevent the need for surgery (vagotomy, partial gastric resection). Later on, the emphasis gradually shifted to weakening/failing of the defensive factors, raising the vulnerability of the gastroduodenal mucosa to luminal secretions. Leading injurious mechanisms jeopardizing the mucosal integrity are numerous: infections, especially Helicobacter pylori, drug-induced injury, particularly acetylsalicylic acid (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs), physicochemical and caustic injury, vascular disorders, interfering

  11. Interleukin-10 Enhances the Intestinal Epithelial Barrier in the Presence of Corticosteroids through p38 MAPK Activity in Caco-2 Monolayers: A Possible Mechanism for Steroid Responsiveness in Ulcerative Colitis

    PubMed Central

    Lorén, Violeta; Cabré, Eduard; Ojanguren, Isabel; Domènech, Eugeni; Pedrosa, Elisabet; García-Jaraquemada, Arce; Mañosa, Miriam; Manyé, Josep

    2015-01-01

    Glucocorticosteroids are the first line therapy for moderate-severe flare-ups of ulcerative colitis. Despite that, up to 60% of patients do not respond adequately to steroid treatment. Previously, we reported that low IL-10 mRNA levels in intestine are associated with a poor response to glucocorticoids in active Crohn’s disease. Here, we test whether IL-10 can favour the response to glucocorticoids by improving the TNFα-induced intestinal barrier damage (assessed by transepithelial electrical resistance) in Caco-2 monolayers, and their possible implications on glucocorticoid responsiveness in active ulcerative colitis. We show that the association of IL-10 and glucocorticoids improves the integrity of TNFα-treated Caco-2 cells and that p38 MAPK plays a key role. In vitro, IL-10 facilitates the nuclear translocation of p38 MAPK-phosphorylated thereby modulating glucocorticoids-receptor-α, IL-10-receptor-α and desmoglein-2 expression. In glucocorticoids-refractory patients, p38 MAPK phosphorylation and membrane desmoglein-2 expression are reduced in colonic epithelial cells. These results suggest that p38 MAPK-mediated synergism between IL-10 and glucocorticoids improves desmosome straightness contributing to the recovery of intestinal epithelium and reducing luminal antigens contact with lamina propria in ulcerative colitis. This study highlights the link between the intestinal epithelium in glucocorticoids-response in ulcerative colitis. PMID:26090671

  12. Interleukin-10 Enhances the Intestinal Epithelial Barrier in the Presence of Corticosteroids through p38 MAPK Activity in Caco-2 Monolayers: A Possible Mechanism for Steroid Responsiveness in Ulcerative Colitis.

    PubMed

    Lorén, Violeta; Cabré, Eduard; Ojanguren, Isabel; Domènech, Eugeni; Pedrosa, Elisabet; García-Jaraquemada, Arce; Mañosa, Miriam; Manyé, Josep

    2015-01-01

    Glucocorticosteroids are the first line therapy for moderate-severe flare-ups of ulcerative colitis. Despite that, up to 60% of patients do not respond adequately to steroid treatment. Previously, we reported that low IL-10 mRNA levels in intestine are associated with a poor response to glucocorticoids in active Crohn's disease. Here, we test whether IL-10 can favour the response to glucocorticoids by improving the TNFα-induced intestinal barrier damage (assessed by transepithelial electrical resistance) in Caco-2 monolayers, and their possible implications on glucocorticoid responsiveness in active ulcerative colitis. We show that the association of IL-10 and glucocorticoids improves the integrity of TNFα-treated Caco-2 cells and that p38 MAPK plays a key role. In vitro, IL-10 facilitates the nuclear translocation of p38 MAPK-phosphorylated thereby modulating glucocorticoids-receptor-α, IL-10-receptor-α and desmoglein-2 expression. In glucocorticoids-refractory patients, p38 MAPK phosphorylation and membrane desmoglein-2 expression are reduced in colonic epithelial cells. These results suggest that p38 MAPK-mediated synergism between IL-10 and glucocorticoids improves desmosome straightness contributing to the recovery of intestinal epithelium and reducing luminal antigens contact with lamina propria in ulcerative colitis. This study highlights the link between the intestinal epithelium in glucocorticoids-response in ulcerative colitis.

  13. Presumptive mechanisms of peptic ulceration by Helicobacter pylori VacA involving mucoprotease and CagA.

    PubMed

    Choi, K M; Lim, W J; Park, J K; Hwang, S Y

    2001-06-30

    Helicobacter pylori vacuolating toxin (VacA) appears to be unusually stable, not only against extreme pH conditions or high temperatures, but also against common organic solvents or detergents. Under acidic conditions, its activity was markedly increased in the manner of temperature-independent, suggesting a spontaneous activation. A similar finding was also observed under alkaline conditions, however, it should have an appropriate temperature. From these observations, the mechanisms of VacA activation were suggested to be so redundant that either the case of acidic or basic amino acid residues could be involved in the VacA activation. Separately, we also found that the VacA production by H. pylori was pH-dependent: Its production was increased at a low pH region with a broad range (1.0-5.0), and at a high pH region with a narrow range (8.0-9.0). Astonishingly, a highly immunogenic CagA did not appear to be expressed under the acidic conditions. Its expression, however, was shown to be enhanced when the surrounding pH of this bacterium was raised. In contrast, mucoproteolytic activity in the H. pylori membrane was found to be increased at acidic conditions. Considering these observations, together with the stomach and duodenal pH of humans, two presumptive mechanisms of H. pylori VacA-associated ulceration may be deduced; namely, an acid- and an alkali-dependent type, involving mucoprotease and CagA, respectively.

  14. Beninese Medicinal Plants as a Source of Antimycobacterial Agents: Bioguided Fractionation and In Vitro Activity of Alkaloids Isolated from Holarrhena floribunda Used in Traditional Treatment of Buruli Ulcer

    PubMed Central

    Yemoa, Achille; Gbenou, Joachim; Affolabi, Dissou; Moudachirou, Mansourou; Bigot, André; Anagonou, Séverin; Portaels, Françoise; Martin, Anandi; Quetin-Leclercq, Joëlle

    2015-01-01

    Buruli ulcer (BU) imposes a serious economic burden on affected households and on health systems that are involved in diagnosing the disease and treating patients. Research is needed to find cost-effective therapies for this costly disease. Plants have always been an important source of new pharmacologically active molecules. Consequently we decided to undertake the study of plants used in traditional treatment of BU in Benin and investigate their antimycobacterial activity as well as their chemical composition. Extracts from forty-four (44) plant species were selected on account of reported traditional uses for the treatment of BU in Benin and were assayed for antimycobacterial activities. Crude hydroethanolic extract from aerial parts of Holarrhena floribunda (G. Don) T. Durand and Schinz was found to have significant antimycobacterial activity against M. ulcerans (MIC = 125 µg/mL). We describe here the identification of four steroidal alkaloids from Mycobacterium ulcerans growth-inhibiting fractions of the alkaloidal extract of the aerial parts of Holarrhena floribunda. Holadysamine was purified in sufficient amount to allow the determination of its MCI (=50 µg/mL). These results give some support to the use of this plant in traditional medicine. PMID:26180813

  15. Beninese Medicinal Plants as a Source of Antimycobacterial Agents: Bioguided Fractionation and In Vitro Activity of Alkaloids Isolated from Holarrhena floribunda Used in Traditional Treatment of Buruli Ulcer.

    PubMed

    Yemoa, Achille; Gbenou, Joachim; Affolabi, Dissou; Moudachirou, Mansourou; Bigot, André; Anagonou, Séverin; Portaels, Françoise; Martin, Anandi; Quetin-Leclercq, Joëlle

    2015-01-01

    Buruli ulcer (BU) imposes a serious economic burden on affected households and on health systems that are involved in diagnosing the disease and treating patients. Research is needed to find cost-effective therapies for this costly disease. Plants have always been an important source of new pharmacologically active molecules. Consequently we decided to undertake the study of plants used in traditional treatment of BU in Benin and investigate their antimycobacterial activity as well as their chemical composition. Extracts from forty-four (44) plant species were selected on account of reported traditional uses for the treatment of BU in Benin and were assayed for antimycobacterial activities. Crude hydroethanolic extract from aerial parts of Holarrhena floribunda (G. Don) T. Durand and Schinz was found to have significant antimycobacterial activity against M. ulcerans (MIC = 125 µg/mL). We describe here the identification of four steroidal alkaloids from Mycobacterium ulcerans growth-inhibiting fractions of the alkaloidal extract of the aerial parts of Holarrhena floribunda. Holadysamine was purified in sufficient amount to allow the determination of its MCI (=50 µg/mL). These results give some support to the use of this plant in traditional medicine.

  16. Peptic ulcer disease.

    PubMed

    Malfertheiner, Peter; Chan, Francis K L; McColl, Kenneth E L

    2009-10-24

    Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to an impressive fall in its incidence. Two important developments are associated with the decrease in rates of peptic ulcer disease: the discovery of effective and potent acid suppressants, and of Helicobacter pylori. With the discovery of H pylori infection, the causes, pathogenesis, and treatment of peptic ulcer disease have been rewritten. We focus on this revolution of understanding and management of peptic ulcer disease over the past 25 years. Despite substantial advances, this disease remains an important clinical problem, largely because of the increasingly widespread use of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. We discuss the role of these agents in the causes of ulcer disease and therapeutic and preventive strategies for drug-induced ulcers. The rare but increasingly problematic H pylori-negative NSAID-negative ulcer is also examined.

  17. Connective Tissue Ulcers

    PubMed Central

    Dabiri, Ganary; Falanga, Vincent

    2013-01-01

    Connective tissue disorders (CTD), which are often also termed collagen vascular diseases, include a number of related inflammatory conditions. Some of these diseases include rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), localized scleroderma (morphea variants localized to the skin), Sjogren’s syndrome, dermatomyositis, polymyositis, and mixed connective tissue disease. In addition to the systemic manifestations of these diseases, there are a number of cutaneous features that make these conditions recognizable on physical exam. Lower extremity ulcers and digital ulcers are an infrequent but disabling complication of long-standing connective tissue disease. The exact frequency with which these ulcers occur is not known, and the cause of the ulcerations is often multifactorial. Moreover, a challenging component of CTD ulcerations is that there are still no established guidelines for their diagnosis and treatment. The morbidity associated with these ulcerations and their underlying conditions is very substantial. Indeed, these less common but intractable ulcers represent a major medical and economic problem for patients, physicians and nurses, and even well organized multidisciplinary wound healing centers. PMID:23756459

  18. Tripotassium dicitrate bismuthate and ranitidine in duodenal ulcer. Healing and influence on recurrence.

    PubMed

    Bianchi Porro, G; Lazzaroni, M; Barbara, L; Corinaldesi, R; Dal Monte, P R; D'Imperio, N; Mazzacca, G; D'Arienzo, A; Cheli, R; Bovero, E

    1988-12-01

    One hundred patients were entered into a double-blind, double-dummy comparison of tripotassium dicitrate bismuthate (TDB) versus ranitidine, to evaluate short-term healing rates, and successfully healed patients were then entered into a follow-up phase to observe relapse rates. At 4 weeks 84% of patients treated with TDB and 68% of those treated with ranitidine had healed. At 8 weeks these figures had risen to 96% and 90%, respectively (p = NS). After a year's follow-up study 84% of patients healed initially with ranitidine had relapsed, whereas in the case of patients healed initially with TDB the relapse rate was 67% (p less than 0.05). The results confirm that in the short term, TDB is as effective as ranitidine, whereas the significantly better protection against relapse offered by TDB compared with ranitidine underlines the importance of restoring mucosal defence, an approach that to date has been somewhat overlooked.

  19. [Mannheim peritonitis index as a surgical criterion for perforative duodenal ulcer].

    PubMed

    Krylov, N N; Babkin, O V; Babkin, D O

    Цель - установить корреляцию величины Мангеймского индекса перитонита (МИП) в баллах и результатов различных вариантов радикального и паллиативного оперативного вмешательства при перфоративной язве двенадцатиперстной кишки. Материал и методы. Представлен опыт лечения 386 больных с перфоративной язвой двенадцатиперстной кишки. Проанализированы непосредственные результаты различных операций: резекции желудка, различных вариантов ваготомии с дренирующими операциями и без них, ушивания перфоративной язвы и иссечения краев перфоративной язвы с ушиванием в группах пациентов, имевших МИП менее 21 балла, 21-29 баллов и более 29 баллов. При анализе послеоперационных осложнений после радикальных операций использовали классификацию Clavien-Dindo. Результаты. Летальный исход при перфоративных язвах в 64,3% наблюдений обусловлен в основном перитонитом и связанными с ним осложнениями, в 35,7% наблюдений - особенностями оперативного вмешательства. При выполнении радикальных операций тяжелые осложнения, требующие повторных оперативных вмешательств, чаще всего отмечали после резекции желудка. Выводы. Для выбора метода лечения больного с перфоративной язвой двенадцатиперстной кишки необходимо рассчитывать МИП, использование которого является высокочувствительным методом и позволяет прогнозировать исход заболевания. При МИП менее 21 балла обосновано выполнение радикальных оперативных вмешательств, в остальных случаях целесообразно производить паллиативные - ушивание язвы или иссечение язвы с ушиванием. Если радикальные операции выполняют по строгим показаниям (МИП менее 21 балла), их объем и характер не оказывают существенного влияния на частоту летальных исходов.

  20. [Combination of endoscopic methods in diagnostics and surgical treatment of perforative duodenal ulcer].

    PubMed

    Timofeev, M E; Shapoval'yants, S G; Mikhalev, A I; Fedorov, E D; Konyukhov, G V

    2016-01-01

    Представлен анализ оперативного лечения 279 пациентов с перфоративной язвой луковицы двенадцатиперстной кишки за период с 1996 по 2012 г. Диагностика и лечебная тактика базировались на разработанном в клинике лечебно-диагностическом алгоритме, основу которого составляли два взаимодополняющих эндоскопических метода (эзофагогастродуоденоскопия и лапароскопия), позволившие в 100% наблюдений поставить правильный диагноз, определить лечебную тактику и индивидуализировать выбор метода и объем оперативного лечения. У 67 пациентов были выявлены противопоказания к лапароскопическому ушиванию, им выполнены традиционные операции, при этом послеоперационные осложнения имели место у 25 (37,3%), летальный исход — у 9 (13,4%). Лапароскопическое ушивание было произведено 212 пациентам, осложнения отмечены у 19 (8,9%) пациентов, в том числе интраоперационные у 8 (3,7%), послеоперационные у 11 (5,2%), летальных исходов не было.

  1. IMMUNOLOGICAL STUDIES IN ULCERATIVE COLITIS

    PubMed Central

    Lagercrantz, R.; Hammarström, S.; Perlmann, P.; Gustafsson, B. E.

    1968-01-01

    The incidence and height of antibody titers to colon, assayed by indirect hemagglutination with a heat stable colon extract from germ free rats, is significantly higher in sera from patients with ulcerative colitis than in those from healthy controls or from patients with amebic liver abscess or dysentery. While sera from ulcerative colitis patients and controls are indistinguishable in regard to incidence and height of antibody titers to Forsman antigen, Staphylococcus aureus S 209, Clostridium difficile, and several common strains of E. coli, they have elevated titers and increased incidence of antibodies to a heat stable antigen of E. coli O14. Patients with amebic dysentery have normal titers of such antibodies. Absorption of patients' sera with E. coli O14 antigen inhibits the colon directed hemagglutination reaction in approximately 30% of the cases tested. Likewise, the anti-E. coli O14 reaction can sometimes be inhibited with the colon extract. Other E. coli strains and other bacteria are inactive or have only weak inhibitory activity. Hemagglutination inhibition experiments show that germ free rat colon and E. coli O14 contain common structures, depicted by antibodies in the patients' sera. This pattern of reactivity closely resembles that seen in rats made autoimmune to colon by injection of newborn rabbit colon. E. coli O14 is known to carry a heterogenetic antigen present in lower concentration (or activity) in most Enterobacteriaceae. Hemagglutination inhibition experiments with rabbit antisera to E. coli O14 suggest that the antigen common for E. coli O14 and colon is related to this heterogenetic antigen. The findings imply that this antigen, which is constantly present in low concentrations in the human colon, may give rise to anticolon antibody formation in ulcerative colitis through breakage of tolerance. Since this antigen is present in healthy individuals as well, additional factors are required to explain the induction of anti

  2. CagA antibodies in Japanese children with nodular gastritis or peptic ulcer disease.

    PubMed

    Kato, S; Sugiyama, T; Kudo, M; Ohnuma, K; Ozawa, K; Iinuma, K; Asaka, M; Blaser, M J

    2000-01-01

    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.

  3. [Endoscopic diagnosis of local chemical burn of mucous membranes of the stomach, induced with the purpose of simulation of gastric ulcer].

    PubMed

    Byzov, N V; Plekhanov, V N

    2013-01-01

    With the purpose of improvement of diagnosis of induced gastric ulcer were examined 11 patients who took aggressive agents for simulation of gastric ulcer and 33 patients who took pseudo-aggressive agents. Observables, conduced diagnosis of local chemical burn of mucous coat of stomach during initial 6 days after taking aggressive agents. Stages of ulcerous process, resulting from local chemical burn of mucous coat of stomach, coressponds to real gactric ulcer. Gelatin capsule using as a container for delivery of aggressive agents, melts in stomach in 5-6 minutes after taking. Independent from body position, mucous coat of greater curvature of the stomach is damaged. It is impossible to simulate duodenal bulb ulcer using the gelatine capsule or ball made of breadcrumb. The last method of delivery of aggressive agent can damage the small intestine because of uncontrollability of the place of breaking the ball.

  4. Hemoglobinopathies and Leg Ulcers.

    PubMed

    Alavi, Afsaneh; Kirsner, Robert S

    2015-09-01

    Major hemoglobinopathies, including sickle cell anemia, are becoming a global health issue. Leg ulcers are the most common cutaneous manifestation of sickle cell disease and an important contributor to morbidity burden in this population. Leg ulcers following sickling disorders are extremely painful, and hard to heal. The clinical evidence for the optimal management of these ulcers is limited. Treating the cause and the strategies to prevent sickling are the mainstay of treatment. The basic principles of wound bed preparation and compression therapy is beneficial in these patients.

  5. Corneal ulcers in horses.

    PubMed

    Williams, Lynn B; Pinard, Chantale L

    2013-01-01

    Corneal ulceration is commonly diagnosed by equine veterinarians. A complete ophthalmic examination as well as fluorescein staining, corneal cytology, and corneal bacterial (aerobic) and fungal culture and sensitivity testing are necessary for all infected corneal ulcers. Appropriate topical antibiotics, topical atropine, and systemic NSAIDs are indicated for all corneal ulcers. If keratomalacia (melting) is observed, anticollagenase/antiprotease therapy, such as autologous serum, is indicated. If fungal infection is suspected, antifungal therapy is a necessity. Subpalpebral lavage systems allow convenient, frequent, and potentially long-term therapy. Referral corneal surgeries provide additional therapeutic options when the globe's integrity is threatened or when improvement has not been detected after appropriate therapy.

  6. Expression of 5-HT3 receptors by extrinsic duodenal afferents contribute to intestinal inhibition of gastric emptying.

    PubMed

    Raybould, Helen E; Glatzle, Jorg; Robin, Carla; Meyer, James H; Phan, Thomas; Wong, Helen; Sternini, Catia

    2003-03-01

    Intestinal perfusion with carbohydrates inhibits gastric emptying via vagal and spinal capsaicin-sensitive afferent pathways. The aim of the present study was to determine the role of 1) 5-hydroxytryptamine (5-HT)(3) receptors (5-HT(3)R) in mediating glucose-induced inhibition of gastric emptying and 2) 5-HT(3)R expression in vagal and spinal afferents in innervating the duodenum. In awake rats fitted with gastric and duodenal cannulas, perfusion of the duodenum with glucose (50 and 100 mg) inhibited gastric emptying. Intestinal perfusion of mannitol inhibited gastric emptying only at the highest concentration (990 mosm/kgH(2)O). Pretreatment with the 5-HT(3)R antagonist tropisetron abolished both glucose- and mannitol-induced inhibition of gastric emptying. Retrograde labeling of visceral afferents by injection of dextran-conjugated Texas Red into the duodenal wall was used to identify extrinsic primary afferents. Immunoreactivity for 5-HT(3)R, visualized with an antibody directed to the COOH terminus of the rat 5-HT(3)R, was found in >80% of duodenal vagal and spinal afferents. These results show that duodenal extrinsic afferents express 5-HT(3)R and that the receptor mediates specific glucose-induced inhibition of gastric emptying. These findings support the hypothesis that enterochromaffin cells in the intestinal mucosa release 5-HT in response to glucose, which activates 5-HT(3)R on afferent nerve terminals to evoke reflex changes in gastric motility. The primary glucose sensors of the intestine may be mucosal enterochromaffin cells.

  7. UNUSUAL CAUSES OF CUTANEOUS ULCERATION

    PubMed Central

    Panuncialman, Jaymie; Falanga, Vincent

    2010-01-01

    Synopsis Skin ulceration is a major source of morbidity and is often difficult to manage. Ulcers due to an inflammatory etiology or microvascular occlusion are particularly challenging in terms of diagnosis and treatment. The management of such ulcers requires careful assessment of associated systemic conditions and a thorough analysis of the ulcer's clinical and histologic findings. In this report, we discuss several examples of inflammatory ulcers and the approach to their diagnosis and treatment. PMID:21074034

  8. Management of gastric and duodenal neuroendocrine tumors

    PubMed Central

    Sato, Yuichi; Hashimoto, Satoru; Mizuno, Ken-ichi; Takeuchi, Manabu; Terai, Shuji

    2016-01-01

    Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type I, II, and III. Type I G-NETs, which are the most common subtype (70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type II G-NETs (5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome (MEN1-ZES). Both type I and II G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type III G-NETs (10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type III G-NETs, while endoscopic resection and follow-up, which are acceptable for the treatment of most type I and II G-NETs, are only acceptable for small and well differentiated type III G-NETs. D-NETs include gastrinomas (50%-60%), somatostatin-producing tumors (15%), nonfunctional serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinomas (< 3%), and gangliocytic paragangliomas (< 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs (G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs. PMID:27570419

  9. Duodenal Atresia Associated with Apple Peel Atresia and Situs Inversus Abdominus: A Case Report

    PubMed Central

    Ben Hamida, H.; Hadj Salem, R.; Ben Ameur, K.; Rassas, A.; Chioukh, FZ.; Sakka, R.; Kechiche, N.; Bizid, M.; Sahnoun, L.; Monastiri, K.

    2016-01-01

    Duodenal atresia is rarely associated with situs inversus abdominus. We report a case of duodenal atresia associated with small bowel atresia of apple peel type and situs inversus abdominus. PMID:27896168

  10. Lithium Battery Diaper Ulceration.

    PubMed

    Maridet, Claire; Taïeb, Alain

    2016-01-01

    We report a case of lithium battery diaper ulceration in a 16-month-old girl. Gastrointestinal and ear, nose, and throat lesions after lithium battery ingestion have been reported, but skin involvement has not been reported to our knowledge.

  11. Simple closure of a perforated duodenal diverticulum: "a case report".

    PubMed

    Yokomuro, Shigeki; Uchida, Eiji; Arima, Yasuo; Mizuguchi, Yoshiaki; Shimizu, Tetsuya; Kawahigashi, Yutaka; Kawamoto, Masao; Takahashi, Ken; Arai, Masao; Arima, Yasuo; Tajiri, Takashi

    2004-10-01

    Spontaneous perforation of a duodenal diverticulum is a rare but serious complication with significant mortality rates. Just over 100 cases have been reported in the world literature. One case of perforated duodenal diverticulum treated by simple closure is reported. An elderly female was admitted to our hospital with an acute abdomen. Computed tomography of the abdomen showed retroperitoneal air around the duodenum and right kidney. Laparotomy with a Kocher maneuver disclosed a perforated diverticulum in the second portion of the duodenum. Although diverticulectomy is the most common treatment, simple closure of the perforated duodenal diverticulum with drainage was performed to avoid injury to the distal common bile duct and ampulla of Vater, which were close to the diverticulum. The patient has fully recovered and has been asymptomatic with no signs of recurrence for 25 months.

  12. Duodenal varices successfully treated with cyanoacrylate injection therapy

    PubMed Central

    Malik, Ahsan; Junglee, Naushad; Khan, Anwar; Sutton, Jonathon; Gasem, Jaber; Ahmed, Waqar

    2011-01-01

    Duodenal varices are a rare complication of portal hypertension secondary to liver cirrhosis. Compared to oesophageal varices, they bleed less often but are also more difficult to diagnose and treat. There is no established treatment for bleeding duodenal varices and different treatment strategies have been employed with variable results. The authors present a case of 52-year-old male who was admitted with melaena. Upper gastrointestinal endoscopy was performed which identified bleeding varices in the second part of duodenum. The varices were injected with cyanoacrylate and the outcome was favourable. Subsequent endoscopies showed complete resolution of the varices. The authors conclude that cyanoacrylate injection is an effective first-line treatment for bleeding duodenal varices. PMID:22694885

  13. A newborn with duodenal atresia and a gastric perforation.

    PubMed

    Akcora, Bulent; Eris, Ozge

    2010-01-01

    Congenital duodenal atresia complicated by gastric perforation (GP) is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

  14. Preduodenal portal vein with situs inversus and duodenal atresia.

    PubMed

    Ziv, Y; Lombrozo, R; Dintsman, M

    1986-02-01

    In a 7-day-old infant referred because of bile-stained vomiting, jaundice and lack of meconium, radiological examination revealed the 'double-bubble' sign of duodenal atresia as well as dextrocardia. This infant also had a strawberry haemangioma on the right shoulder. Operation disclosed situs inversus and a preduodenal portal vein as well as duodenal atresia. A side-to-side duodeno-jejunostomy was performed successfully without damage to the anomalous vein. The history of polyhydramnion during gestation, the presence of other anomalies, the rapid onset of bile-stained vomiting and the classic 'double-bubble' sign, together appeared to indicate that the duodenal atresia was intrinsic and not due to the external pressure of the anomalous vein on the duodenum.

  15. Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review

    PubMed Central

    Gupta, Pankaj; Debi, Uma; Sinha, Saroj Kant; Prasad, Kaushal Kishor

    2014-01-01

    Like other parts of the gastrointestinal tract (GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence, a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities. PMID:25170399

  16. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    PubMed Central

    Cloyd, Jordan M; George, Elizabeth; Visser, Brendan C

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles. PMID:27022448

  17. Four-Year Maintenance Treatment With Adalimumab in Patients with Moderately to Severely Active Ulcerative Colitis: Data from ULTRA 1, 2, and 3

    PubMed Central

    Colombel, Jean-Frederic; Sandborn, William J; Ghosh, Subrata; Wolf, Douglas C; Panaccione, Remo; Feagan, Brian; Reinisch, Walter; Robinson, Anne M; Lazar, Andreas; Kron, Martina; Huang, Bidan; Skup, Martha; Thakkar, Roopal B

    2014-01-01

    OBJECTIVES: The safety and efficacy of adalimumab for patients with moderately to severely active ulcerative colitis (UC) has been reported up to week 52 from the placebo-controlled trials ULTRA (Ulcerative Colitis Long-Term Remission and Maintenance with Adalimumab) 1 and 2. Up to 4 years of data for adalimumab-treated patients from ULTRA 1, 2, and the open-label extension ULTRA 3 are presented. METHODS: Remission per partial Mayo score, remission per Inflammatory Bowel Disease Questionnaire (IBDQ) score, and mucosal healing rates were assessed in adalimumab-randomized patients from ULTRA 1 and 2 up to week 208. Corticosteroid-free remission was assessed in adalimumab-randomized patients who used corticosteroids at lead-in study baseline. Maintenance of remission per partial Mayo score and mucosal healing was assessed in patients who entered ULTRA 3 in remission per full Mayo score and with mucosal healing, respectively. As observed, last observation carried forward (LOCF) and nonresponder imputation (NRI) were used to report efficacy. Adverse events were reported for any adalimumab-treated patient. RESULTS: A total of 600/1,094 patients enrolled in ULTRA 1 or 2 were randomized to receive adalimumab and included in the intent-to-treat analyses of the studies. Of these, 199 patients remained on adalimumab after 4 years of follow-up. Rates of remission per partial Mayo score, remission per IBDQ score, mucosal healing, and corticosteroid discontinuation at week 208 were 24.7%, 26.3%, 27.7% (NRI), and 59.2% (observed), respectively. Of the patients who were followed up in ULTRA 3 (588/1,094), a total of 360 patients remained on adalimumab 3 years later. Remission per partial Mayo score and mucosal healing after ULTRA 1 or 2 to year 3 of ULTRA 3 were maintained by 63.6% and 59.9% of patients, respectively (NRI). Adverse event rates were stable over time. CONCLUSIONS: Remission, mucosal healing, and improved quality of life were maintained in patients with moderately to

  18. Preduodenal Portal Vein Associated with Duodenal Obstruction of other Etiology: A Case Series

    PubMed Central

    Srivastava, Punit; Shaikh, Mishraz; Mirza, Bilal; Jaiman, Richa; Arshad, Muhammad

    2016-01-01

    DuodenalPreduodenal portal vein is a rare and interesting entity which often causes duodenal obstruction. It is also associated with other congenital anomalies. We report here three cases of preduodenal portal vein associated with other anomalies causing duodenal obstruction not related to direct compression by portal vein itself. PMID:27896162

  19. Preduodenal Portal Vein Associated with Duodenal Obstruction of other Etiology: A Case Series.

    PubMed

    Srivastava, Punit; Shaikh, Mishraz; Mirza, Bilal; Jaiman, Richa; Arshad, Muhammad

    2016-01-01

    DuodenalPreduodenal portal vein is a rare and interesting entity which often causes duodenal obstruction. It is also associated with other congenital anomalies. We report here three cases of preduodenal portal vein associated with other anomalies causing duodenal obstruction not related to direct compression by portal vein itself.

  20. Duodenal Lipoma as a Rare Cause of Upper Gastrointestinal Bleeding.

    PubMed

    Ouwerkerk, Helga M; Raber; Freling, G; Klaase, J M

    2010-12-01

    A 52-year-old female was referred because of melaena. After initital work-up, including gastroduodenoscopy, endosonography and CT scan, a duodenotomy was performed. Definite diagnosis was a duodenal lipoma based on histological findings. Lipomas of the gastrointestinal tract are rare. Only 4% occur in the duodenum. The peak incidence is around the 5th and 7th decade of life, with a slight female preponderance. Gastrointestinal lipomas are usually asymptomatic, but can present with mild to severe gastrointestinal bleeding, intussusceptions, abdominal pain, constipation and diarrhea. Clinical, endoscopical, surgical, and radiological features are described in this case of duodenal lipoma.

  1. Duodenal Lipoma as a Rare Cause of Upper Gastrointestinal Bleeding

    PubMed Central

    Ouwerkerk, Helga M.; Raber; Freling, G.; Klaase, J.M.

    2010-01-01

    A 52-year-old female was referred because of melaena. After initital work-up, including gastroduodenoscopy, endosonography and CT scan, a duodenotomy was performed. Definite diagnosis was a duodenal lipoma based on histological findings. Lipomas of the gastrointestinal tract are rare. Only 4% occur in the duodenum. The peak incidence is around the 5th and 7th decade of life, with a slight female preponderance. Gastrointestinal lipomas are usually asymptomatic, but can present with mild to severe gastrointestinal bleeding, intussusceptions, abdominal pain, constipation and diarrhea. Clinical, endoscopical, surgical, and radiological features are described in this case of duodenal lipoma. PMID:27942311

  2. Duodenal rupture secondary to blunt trauma from a football.

    PubMed

    Luther, Alison; Mann, Christopher; Hart, Colin; Khalil, Khalil

    2013-01-04

    Duodenal rupture secondary to blunt trauma is a relatively uncommon event and is usually a result of a road traffic accident. As the duodenum is a retroperitoneal organ, delays in diagnosis can occur, as the patient may present with vague abdominal symptoms and other non-specific signs. Computed tomographic scanning is therefore a useful tool in the diagnosis of this condition. We present a 19-year-old girl who was hit in the abdomen with a football and subsequently had a duodenal rupture.

  3. Duodenal adenocarcinoma presenting as a mass with aneurismal dilatation.

    PubMed

    Mama, Nadia; Ben Slama, Aïda; Arifa, Nadia; Kadri, Khaled; Sriha, Badreddine; Ksiaa, Mehdi; Jemni, Hela; Tlili-Graiess, Kalthoum

    2014-01-01

    Duodenal adenocarcinoma is frequent. Aneurysmal dilatation of the small bowel is reported to be a lymphoma characteristic imaging finding. A 57-year-old male was found to have a duodenal adenocarcinoma with aneurismal dilatation on imaging which is an exceptional feature. On laparotomy, the wall thickening of the dilated duodenum extended to the first jejunal loop, with multiple mesenteric lymph nodes and ascites. Segmental palliative resection with gastro-entero-anastomosis was done. Histopathology revealed a moderately differentiated adenocarcinoma with neuro-endocrine differentiation foci. Wide areas of necrosis and vascular emboli were responsible for the radiological feature of the dilated duodenum with wall thickening.

  4. Collagenous gastroduodenitis with recurrent gastric ulcer in 12-year-old girl.

    PubMed

    Koide, Tatsuo; Mochizuki, Takahiro; Kawai, Naoki; Yashiro, Kenta; Inoue, Takeshi; Tsujimoto, Masahiko; Nishigaki, Toshinori

    2015-08-01

    This report describes a rare case of collagenous gastroduodenitis found in a 12-year-old Japanese girl who had recurrent hematemesis. Gastrointestinal endoscopy showed many lotus leaf-like lesions on the gastric mucosa surrounded by atrophic gastric mucosa in the antrum, with a cobblestone appearance and a scarred duodenal ulcer in the duodenal bulb. A biopsy of the gastric mucosa indicated subepithelial collagen band. The patient was treated with H2-blockers for her symptoms for 4 years following the endoscopic findings. Follow-up endoscopy showed the same appearance as before. The pathology, however, showed a more prominent subepithelial collagen deposition. To make the correct diagnosis, it is critical to know from which part the pathological biopsy specimens were taken because there were numerous collagen bands in the atrophic membrane. It is important to monitor the patient regularly for evaluation of the etiology, pathogenesis and prognosis of this rare disease.

  5. Noninvasive evaluation of active pan-ulcerative colitis with multiple strictures using Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography.

    PubMed

    Santhosh, Sampath; Bhattacharya, Anish; Rana, Surinder Singh; Bhasin, Deepak Kumar; Gupta, Rajesh; Mittal, Bhagwant Rai

    2016-01-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by waxing and waning inflammation that changes in severity and extent and may progress to neoplasia, especially in the presence of strictures. When patients have nonnegotiable strictures or severe inflammation with ulcers, colonoscopy is difficult and carries the risk of perforation. The authors present a patient with pan-UC with multiple strictures, in whom fluorodeoxyglucose positron emission tomography/computed tomography was used to noninvasively evaluate the extent and severity of the disease.

  6. Differential expression of key regulators of Toll-like receptors in ulcerative colitis and Crohn's disease: a role for Tollip and peroxisome proliferator-activated receptor gamma?

    PubMed

    Fernandes, P; MacSharry, J; Darby, T; Fanning, A; Shanahan, F; Houston, A; Brint, E

    2016-03-01

    The innate immune system is currently seen as the probable initiator of events which culminate in the development of inflammatory bowel disease (IBD) with Toll-like receptors (TLRs) known to be involved in this disease process. Many regulators of TLRs have been described, and dysregulation of these may also be important in the pathogenesis of IBD. The aim of this study was to perform a co-ordinated analysis of the expression levels of both key intestinal TLRs and their inhibitory proteins in the same IBD cohorts, both ulcerative colitis (UC) and Crohn's disease (CD), in order to evaluate the potential roles of these proteins in the pathogenesis of IBD. Of the six TLRs (TLRs 1, 2, 4, 5, 6 and 9) examined, only TLR-4 was increased significantly in IBD, specifically in active UC. In contrast, differential alterations in expression of TLR inhibitory proteins were observed. A20 and suppressor of cytokine signalling 1 (SOCS1) were increased only in active UC while interleukin-1 receptor-associated kinase 1 (IRAK-m) and B cell lymphoma 3 protein (Bcl-3) were increased in both active UC and CD. In contrast, expression of both peroxisome proliferator-activated receptor gamma (PPARγ) and Toll interacting protein (Tollip) was decreased in both active and inactive UC and CD and at both mRNA and protein levels. In addition, expression of both PPARγ and A20 expression was increased by stimulation of a colonic epithelial cell line Caco-2 with both TLR ligands and commensal bacterial strains. These data suggest that IBD may be associated with distinctive changes in TLR-4 and TLR inhibitory proteins, implying that alterations in these may contribute to the pathogenesis of IBD.

  7. Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

    PubMed Central

    Madden, James J.; Hoffman, Ashley N.; Kim, Justine S.; Thayer, Wesley P.; Nanney, Lillian B.; Spear, Marcia E.

    2017-01-01

    Background: Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage. Methods: This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection. Results: All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34). Conclusions: Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction. PMID:28203494

  8. ZnO nanoparticles act as supportive therapy in DSS-induced ulcerative colitis in mice by maintaining gut homeostasis and activating Nrf2 signaling

    PubMed Central

    Li, Jinquan; Chen, Hanqing; Wang, Bing; Cai, Chengxu; Yang, Xu; Chai, Zhifang; Feng, Weiyue

    2017-01-01

    Inflammatory bowel diseases (IBD) are widespread inflammatory diseases that cause debilitating health problems including cancer. In this study, we show that ZnO nanoparticle (ZnONP) treatment has markedly dose-dependent effects on the remission of dextran sulfate sodium (DSS)-induced ulcerative colitis in mice. We demonstrate the mechanism involves the antioxidant and anti-inflammatory abilities of ZnONPs to suppress ROS and malondialdehyde (MDA) production; increase GSH level; suppress proinflammatory cytokines IL-1β and TNF-α and myeloperoxidase (MPO). The ZnONP treatment is able to activate the Nrf2 pathway in the cellular antioxidant defense system. The novel finding is that ZnONP combined with mesalazine (5-ASA) can enhance the therapeutic efficacy of 5-ASA in the treatment of DSS-induced colitis. Lastly, we found that ZnONP treatment can restore the changes in special colonic bacteria of DSS-mice while the drug 5-ASA cannot. These results indicate that ZnONPs can act as a medical additive for the therapy of IBD. PMID:28233796

  9. [Faecal lactate as a disease activity index of ulcerative colitis: application to assessment of efficacy in the treatment with total parenteral nutrition].

    PubMed

    Nakamura, M

    1989-08-01

    I investigated changes of faecal short-chain fatty acids (SCFA) in 52 hospitalized patients with ulcerative colitis (UC) who had bloody diarrhoea (severe and moderate colitis). The results suggest that molar ratios of faecal lactate could be helpful to monitor the disease activity of UC patients. Faecal SCFA output correlated directly with faecal output. This finding reflected an increase in output of lactate and acetate. In severe colitis, concentrations of faecal lactate were increased, whereas those of faecal major components of SCFA (acetate, propionate and n-buty-rate) were markedly reduced. Further, faecal lactate concentrations were increased in cases with bloody diarrhoea and reduced in those with formed stool. Patients were divided into two groups according with their treatments: patients treated with total parenteral nutrition (TPN) or low-residue UC diet. The molar ratio of faecal lactate in the TPN group was reduced below 2% in four weeks, whereas that in the UC diet group was reduced into the 2% mark in eight weeks. These findings support that patients in the former group were more rapidly induced into remission.

  10. Pressure Ulcer Prevention

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9

  11. Neuropeptide Y induces fasted pattern of duodenal motility via Y(2) receptors in conscious fed rats.

    PubMed

    Fujimiya, M; Itoh, E; Kihara, N; Yamamoto, I; Fujimura, M; Inui, A

    2000-01-01

    Neuropeptide Y (NPY), a 36-amino acid peptide abundantly expressed in the brain, has been implicated in the regulation of feeding and visceral functions. The present study was designed to investigate whether or not NPY specifically regulates duodenal motility. The manometric method was used to measure duodenal motility in conscious, freely moving rats. The rat duodenum showed phasic contractions mimicking the migrating motor complex in the fasted state that were replaced by irregular contractions after the ingestion of food. NPY powerfully affected the contractile activity after intracerebroventricular (i.c.v.) administration, changing fed (postprandial) patterns into phasic contractions characterized as fasted (interdigestive) patterns. This effect was mediated via receptors with pharmacological profiles similar to rat Y(2) and Y(4) receptors, although neither Y(1) nor Y(5) agonists had any effects on motility despite potent feeding-stimulatory effects. Immunoneutralization with anti-NPY antiserum administered i.c.v. abolished fasted patterns and induced fed-like motor activities. An i.c.v. dose of peptide YY produced a different effect from NPY, with increase in the motor activities of both fed and fasted patterns. These results indicate that fasted and fed motor activities are regulated processes and that NPY induces fasted activity through Y(2), and possibly Y(4), receptors, which may represent an integrated mechanism linked to the onset of feeding behavior.

  12. Massive Hemorrhage from Ectopic Duodenal Varices: Importance of a Multidisciplinary Approach

    PubMed Central

    House, Tyler; Webb, Patrick; Baarson, Chad

    2017-01-01

    Duodenal variceal bleeding is an uncommon complication of portal hypertension that can easily go unrecognized and reach mortality rates as high as 40%. Cirrhosis is the most common cause of duodenal varices. In most cases, duodenal varices occur concomitantly with esophageal varices, further complicating identification with initial endoscopy. Although many modalities have been explored with respect to management and treatment approaches, guidelines have yet to be established owing to the infrequency in which bleeding occurs from ectopic duodenal varices. We present a case of massive duodenal variceal hemorrhage that highlights the complexity of initial diagnosis and ultimately required a transesophageal intrahepatic portosystemic shunt with coil embolization for control of bleeding. PMID:28203136

  13. Oral administration of Lactobacillus plantarum K68 ameliorates DSS-induced ulcerative colitis in BALB/c mice via the anti-inflammatory and immunomodulatory activities.

    PubMed

    Liu, Yen-Wenn; Su, Yu-Wen; Ong, Wei-Kee; Cheng, Tzu-Hao; Tsai, Ying-Chieh

    2011-12-01

    Many different kinds of fermented food are consumed daily in Taiwan, such as stinky tofu, suan-tsai, and fu-tsai. We have previously reported the diversity of lactic acid bacteria (LAB) at different stages of fermentation in the production of suan-tsai and fu-tsai. In this study, the anti-inflammatory and immunomodulatory activities of Lactobacillus plantarum K68 (K68) isolated from fu-tsai were evaluated. K68 significantly inhibited the production of tumor necrosis factor-α (TNF-α) and prostaglandin E(2) (PGE(2)) in lipopolysaccharide (LPS)-induced murine macrophage RAW 264.7 cells and stimulated interferon-γ (IFN-γ) production in human peripheral blood mononuclear cells (hPBMCs). Additionally, orally administered K68 ameliorated dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) in BALB/c mice. Both the disease activity index (DAI) and histological scores (HIS) showed that the severity of UC was significantly reduced by oral administration of K68. Furthermore, the production of pro inflammatory cytokines TNF-α, interleukin-1β (IL-1β), and interleukin-6 (IL-6) was significantly reduced in K68-administered group. Colonic mRNA expression levels of TNF-α, cyclooxygenase-2 (COX-2), forkhead box P3 (Foxp3), suppressors of cytokine signaling 3 (SOCS3), and toll like receptor 4 (TLR4), were also reduced in the K68-administered group. These results suggest that K68 exhibits anti-inflammatory and immunomodulatory activities that ameliorate DSS-induced experimental colitis.

  14. Effectiveness of budesonide MMX (Cortiment) for the treatment of mild-to-moderate active ulcerative colitis: study protocol for a prospective multicentre observational cohort study

    PubMed Central

    Danese, Silvio; Hart, Ailsa; Dignass, Axel; Louis, Edouard; D'Haens, Geert; Dotan, Iris; Rogler, Gerhard; D'Agay, Laurence; Iannacone, Claudio; Peyrin-Biroulet, Laurent

    2016-01-01

    Introduction A study has been developed to assess the use and effectiveness of budesonide MMX for mild-to-moderate active ulcerative colitis (UC) in routine clinical practice. Methods and analysis A prospective, multicentre, observational, cohort study of 300 patients prescribed budesonide MMX for the treatment of mild-to-moderate active UC will be conducted in Europe, Israel and Canada. Patients will be treated with budesonide MMX9 mg daily for induction of remission for ≤8 weeks. Data on effectiveness, including patient-reported outcomes, tolerability and use will be recorded at the end of treatment and at ≥2 weeks after. The primary outcome (improvement ≥3 point in the clinical subscores of the UC Disease Activity Index score at the end of treatment) will be compared in: patients who receive budesonide MMX added to mesalazine >2 weeks after increased/optimised mesalazine dose for the treatment of flare (late add-on); patients who receive budesonide MMX added to mesalazine ≤2 weeks since mesalazine increased/optimised for the treatment of flare, or without mesalazine dose modification (early add-on); and patients who receive budesonide MMX as monotherapy for the treatment of flare (mono). Propensity scoring will be used to minimise bias and confounding inherent in observational studies. Ethics and dissemination First ethical approval: Ethikkommission der Ärztekammer Hamburg (12/22/2015). The results will be published in full. Discussion Completion of primary data collection is expected in December 2017. Our results will provide further evidence on the effectiveness of budesonide MMX to support clinicians in their daily practice and inform therapeutic guidelines. Trial registration number NCT02586259. PMID:27239329

  15. Selective granulocyte and monocyte adsorptive apheresis as a first-line treatment for steroid naïve patients with active ulcerative colitis: a prospective uncontrolled study.

    PubMed

    Suzuki, Yasuo; Yoshimura, Naoki; Saniabadi, Abby R; Saito, Yasushi

    2004-04-01

    Corticosteroid therapy of ulcerative colitis (UC) is associated with frequent adverse side effects and poor quality of life. Recently, adsorptive granulocyte and monocyte/macrophage apheresis has shown efficacy in patients with severe steroid refractory UC. The objective of this study was to investigate if, instead of corticosteroids, adsorptive leukocytapheresis has efficacy as the first-line therapy for steroid-naïve patients with active UC. Twenty patients, aged 15-49 years, with a mean clinical activity index (CAI) of 8.6 were recruited. Adsorptive leukocytapheresis was done with Adacolumn, which contains cellulose acetate beads as adsorptive carriers for granulocytes and monocytes (FcgammaR and complement receptors expressing leukocytes). Each patient received 6 to 10 leukocytapheresis sessions of 60-min duration, at 2 sessions/week. Efficacy was assessed 1 week after the last session. Post treatment, the mean CAI was 3.0 (P = 0001), and 17 of 20 patients (85%) were in remission. There were significant falls in C-reactive protein (P = 0.0003), total white cell counts (P = 0.003), neutrophils (P = 0.0029), and monocytes (P = 0.0038), an increase in lymphocytes (P = 0.001), and increases in the blood levels of soluble TNF-alpha receptors I (P = 0.0007) and II (P = 0.0045) in the column outflow (blood return to the patients). Further, at 8 months, 60% of patients had maintained their remission. No severe side effects were reported. In conclusion, adsorptive leukocytapheresis should reduce corticosteroid therapy in patients with moderate UC; cases with early-stage active disease may benefit most.

  16. Duodenal administered seal oil for patients with subjective food hypersensitivity: an explorative open pilot study

    PubMed Central

    Gregersen, Kine; Lind, Ragna A; Valeur, Jørgen; Bjørkkjær, Tormod; Berstad, Arnold; Lied, Gülen Arslan

    2010-01-01

    Short-term duodenal administration of n-3 polyunsaturated fatty acid (PUFA)-rich seal oil may improve gastrointestinal complaints in patients with subjective food hypersensitivity, as well as joint pain in patients with inflammatory bowel disease (IBD). The aim of the present explorative pilot study was to investigate whether 10-day open treatment with seal oil, 10 mL self-administrated via a nasoduodenal tube 3 times daily, could also benefit nongastrointestinal complaints and quality of life (QoL) in patients with subjective food hypersensitivity. Twenty-six patients with subjective food hypersensitivity, of whom 25 had irritable bowel syndrome (IBS), were included in the present study. Before and after treatment and 1 month posttreatment, patients filled in the Ulcer Esophagitis Subjective Symptoms Scale (UESS) and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal symptoms and subjective health complaints (SHC) inventory for nongastrointestinal symptoms in addition to short form of the Nepean dyspepsia index (SF-NDI) for evaluation of QoL. Compared with baseline, gastrointestinal, as well as nongastrointestinal, complaints and QoL improved significantly, both at end of treatment and 1 month posttreatment. The consistent improvements following seal oil administration warrant further placebo-controlled trials for confirmation of effect. PMID:21189836

  17. Congenital duodenal web: successful management with endoscopic dilatation

    PubMed Central

    Poddar, Ujjal; Jain, Vikas; Yachha, Surender Kumar; Srivastava, Anshu

    2016-01-01

    Background and study aims: Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. Cases and methods: In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. Results: All three children presented late (median age 8 [range 2 – 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 – 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. Conclusions: Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition. PMID:27004237

  18. Duodenal atresia in association with situs inversus abdominus

    PubMed Central

    Shankar, Raghu; Rao, Sadashiva P.; Shetty, Kishan B.

    2012-01-01

    We report a rare association of duodenal atresia with situs inversus abdominus in a newborn. The infantogram revealed “reverse double-bubble sign” without dextrocardia. The sonography and echocardiography confirmed the diagnosis of situs inversus abdominus with multiple cardiac anomalies. Laparotomy and a duodenoduodenostomy were carried out. PMID:22529552

  19. Management of a large mucosal defect after duodenal endoscopic resection

    PubMed Central

    Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Masaki, Tsutomu

    2016-01-01

    Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. PMID:27547003

  20. Effect of simulated gastro-duodenal digestion on the allergenic reactivity of beta-lactoglobulin

    PubMed Central

    2011-01-01

    Background Cow's milk (CM) allergy affects about 2% of infants. The allergenicity of dietary proteins, including those from CM, has been related to their digestibility although the generality of the link and its causality remains to be demonstrated. In this study we use an in vitro digestion system, to investigate the digestibility of β-lactoglobulin (blg) during gastrointestinal transit and to assess the impact of this process on blg allergenic reactivity in CM allergic children. Methods Blg digesta were prepared using an in vitro digestion protocol simulating either gastric digestion alone or followed by duodenal digestion with or without phosphatidylcholine (PC). Biochemical analysis of blg digesta was performed by SDS-PAGE and their concentration was measured by a sandwich ELISA. Assessment of their allergenic reactivity was done in vitro by EAST inhibition, specific basophil activation (basotest) and lymphocyte proliferation (PCNA-flow cytometry) assays using sera and cells from patients allergic to blg and in vivo by skin prick testing (SPT) of these patients. Results Blg was only broken down to smaller peptides after gastro-duodenal digestion although a sizeable amount of intact protein still remained. Digestion did not modify the IgE binding capacity of blg except for gastro-duodenal digestion performed in the absence of PC. These results are consistent with the quantity of intact blg remaining in the digesta. Overall both gastric and gastroduodenal digestion enhanced activation of sensitized basophils and proliferation of sensitized lymphocytes by blg. However, there was a tendency towards reduction in mean diameter of SPT following digestion, the PC alone during phase 1 digestion causing a significant increase in mean diameter. Conclusions Digestion did not reduce the allergenic reactivity of blg to a clinically insignificant extent, PC inhibiting digestion and thereby protecting blg allergenic reactivity. SPT reactivity was reduced compared to blg

  1. A case of HIV ulcer

    PubMed Central

    2015-01-01

    HIV-associated ulcers must be distinguished from idiopathic anal fissures in HIV-positive patients and from other sexually transmitted diseases that cause anogenital ulcers as the treatments differ. PMID:26266040

  2. Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management

    PubMed Central

    Lim, Chul-Hyun; Cho, Young-Seok

    2016-01-01

    Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas. PMID:26811631

  3. Ulcer disease of trout

    USGS Publications Warehouse

    Fish, F.F.

    1934-01-01

    During the summer of 1933, lesions of a disease were noted among some fingerling brook, rainbow, blackspotted, and lake trout at the Cortland (New York) trout hatchery. Although these lesions bore a marked superficial resemblance to those of furunculosis, they were sufficiently atypical to warrant further investigation. A more detailed examination of the lesions proved them to be of a distinct disease, which for lack of a better name is herein called "ulcer disease," for the lesions closely resemble those described by Calkins (1899) under this name. Because of the marked resemblance to furunculosis, ulcer disease has not been generally recognized by trout culturists, and any ulcer appearing on fish has been ascribed by them to furunculosis without further question.

  4. [Peripheral ulcerative keratitis].

    PubMed

    Stamate, Alina-cristina; Avram, Corina Ioana; Malciolu, R; Oprea, S; Zemba, M

    2014-01-01

    Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

  5. Peptic ulcer among Polish rural population and the nicotinic index.

    PubMed

    Schabowski, J

    2000-01-01

    patients with gastric and duodenal ulcer - 66.7% and those with gastric ulcer - 59.6%. A positive correlation was observed between peptic ulcer incidence rates, complications of the disease and the value of the nicotinic index. The relationship between state of health and the value of the nicotinic index was confirmed. The results of the study showed that the nicotinic index was useful for determining the negative effect of cigarette smoking on the human body.

  6. A case series to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis.

    PubMed

    Siddle, Heidi J; Firth, Jill; Waxman, Robin; Nelson, E Andrea; Helliwell, Philip S

    2012-03-01

    The aim of this study was to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis (RA). Adults with RA and current foot ulceration but without diabetes were recruited. Clinical examination included assessment of RA disease activity, foot deformity, peripheral vascular disease, neuropathy and plantar pressures. Location, wound characteristics and time to healing were recorded for each ulcer. Participants completed the Health Assessment Questionnaire and Leeds Foot Impact Scale. Thirty-two cases with 52 current ulcers were recruited. Thirteen patients (41%) experienced more than one current ulcer: 5 (16%) had bilateral ulceration, 15 (47%) had previous ulceration at a current ulcer site. The majority (n = 33) of open ulcers were located over the dorsal aspect of the interphalangeal joints (n = 12), plantar aspect of the metatarsophalangeal joints (MTPJs) (n = 12) and medial aspect of first MTPJs (n = 9). In ulcerated limbs (n = 37), ankle brachial pressure index (ABPI) was <0.8 in 2 (5%); protective sensation was reduced in 25 (68%) and peak plantar pressures were >6 kg/cm(2) in 6 (16%). Mean ulcer size was 4.84 by 3.29 mm. Most ulcers (n = 42, 81%) were superficial; five (9.6%) were infected. Time to healing was available for 41 ulcers: mean duration was 28 weeks. Three ulcers remained open. In conclusion, foot ulceration in RA is recurrent and multiple ulcers are common. Whilst ulcers are small and shallow, time to achieve healing is slow, posing infection risk. Reduced protective sensation is common in affected patients. The prevalence of arterial disease is low but may be under estimated due to high intolerance of ABPI.

  7. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors.

    PubMed

    Gincul, Rodica; Ponchon, Thierry; Napoleon, Bertrand; Scoazec, Jean-Yves; Guillaud, Olivier; Saurin, Jean-Christophe; Ciocirlan, Mihai; Lepilliez, Vincent; Pioche, Mathieu; Lefort, Christine; Adham, Mustapha; Pialat, Jean; Chayvialle, Jean-Alain; Walter, Thomas

    2016-11-01

    Background and study aim: As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. Patients and methods: We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. Results: A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Conclusions: Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.

  8. Loss of intestinal O-glycans promotes spontaneous duodenal tumors.

    PubMed

    Gao, Nan; Bergstrom, Kirk; Fu, Jianxin; Xie, Biao; Chen, Weichang; Xia, Lijun

    2016-07-01

    Mucin-type O-glycans, primarily core 1- and core 3-derived O-glycans, are the major mucus barrier components throughout the gastrointestinal tract. Previous reports identified the biological role of O-glycans in the stomach and colon. However, the biological function of O-glycans in the small intestine remains unknown. Using mice lacking intestinal core 1- and core 3-derived O-glycans [intestinal epithelial cell C1galt1(-/-);C3GnT(-/-) or double knockout (DKO)], we found that loss of O-glycans predisposes DKO mice to spontaneous duodenal tumorigenesis by ∼1 yr of age. Tumor incidence did not increase with age; however, tumors advanced in aggressiveness by 20 mo. O-glycan deficiency was associated with reduced luminal mucus in DKO mice before tumor development. Altered intestinal epithelial homeostasis with enhanced baseline crypt proliferation characterizes these phenotypes as assayed by Ki67 staining. In addition, fluorescence in situ hybridization analysis reveals a significantly lower bacterial burden in the duodenum compared with the large intestine. This phenotype is not reduced with antibiotic treatment, implying O-glycosylation defects, rather than bacterial-induced inflammation, which causes spontaneous duodenal tumorigenesis. Moreover, inflammatory responses in DKO duodenal mucosa are mild as assayed with histology, quantitative PCR for inflammation-associated cytokines, and immunostaining for immune cells. Importantly, inducible deletion of intestinal O-glycans in adult mice leads to analogous spontaneous duodenal tumors, although with higher incidence and heightened severity compared with mice with O-glycans constitutive deletion. In conclusion, these studies reveal O-glycans within the small intestine are critical determinants of duodenal cancer risk. Future studies will provide insights into the pathogenesis in the general population and those at risk for this rare but deadly cancer.

  9. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans.

    PubMed

    Mertz-Nielsen, A; Hillingsø, J; Bukhave, K; Rask-Madsen, J

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n = 17) and after pretreatment with high dose omeprazole (n = 17) and ranitidine (n = 9), respectively, by use of a technique permitting simultaneous measurements. Concentrations of bicarbonate were measured in the respective effluents by the method of back titration. Both omeprazole and ranitidine completely inhibited gastric acid secretion (pH 6.9 v 6.8; p > 0.05). Omeprazole caused higher rates of basal (mean (SEM)) (597 (48) v 351 (39) mumol/h; p < 0.02) and vagally stimulated (834 (72) v 474 (66) mumol/h; p < 0.02), but not acid stimulated (3351 (678) v 2550 (456) mumol/h; p > 0.05) duodenal bicarbonate secretion compared with control experiments. Also the combination of omeprazole and ranitidine increased (p = 0.05) duodenal bicarbonate secretion, while ranitidine alone caused no change in either basal or stimulated secretion. In the stomach basal as well as vagally stimulated bicarbonate secretion was independent of the means of acid inhibition. These results show that the proton pump inhibitor, omeprazole, promotes proximal duodenal mucosal bicarbonate secretion apparently independent of its gastric acid inhibitory effect. The mechanism of action remains speculative.

  10. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans.

    PubMed Central

    Mertz-Nielsen, A; Hillingsø, J; Bukhave, K; Rask-Madsen, J

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n = 17) and after pretreatment with high dose omeprazole (n = 17) and ranitidine (n = 9), respectively, by use of a technique permitting simultaneous measurements. Concentrations of bicarbonate were measured in the respective effluents by the method of back titration. Both omeprazole and ranitidine completely inhibited gastric acid secretion (pH 6.9 v 6.8; p > 0.05). Omeprazole caused higher rates of basal (mean (SEM)) (597 (48) v 351 (39) mumol/h; p < 0.02) and vagally stimulated (834 (72) v 474 (66) mumol/h; p < 0.02), but not acid stimulated (3351 (678) v 2550 (456) mumol/h; p > 0.05) duodenal bicarbonate secretion compared with control experiments. Also the combination of omeprazole and ranitidine increased (p = 0.05) duodenal bicarbonate secretion, while ranitidine alone caused no change in either basal or stimulated secretion. In the stomach basal as well as vagally stimulated bicarbonate secretion was independent of the means of acid inhibition. These results show that the proton pump inhibitor, omeprazole, promotes proximal duodenal mucosal bicarbonate secretion apparently independent of its gastric acid inhibitory effect. The mechanism of action remains speculative. PMID:8566861

  11. Lack of Plasma Protein Hemopexin Results in Increased Duodenal Iron Uptake

    PubMed Central

    Fiorito, Veronica; Geninatti Crich, Simonetta; Silengo, Lorenzo; Aime, Silvio; Altruda, Fiorella; Tolosano, Emanuela

    2013-01-01

    Purpose The body concentration of iron is regulated by a fine equilibrium between absorption and losses of iron. Iron can be absorbed from diet as inorganic iron or as heme. Hemopexin is an acute phase protein that limits iron access to microorganisms. Moreover, it is the plasma protein with the highest binding affinity for heme and thus it mediates heme-iron recycling. Considering its involvement in iron homeostasis, it was postulated that hemopexin may play a role in the physiological absorption of inorganic iron. Methods and Results Hemopexin-null mice showed elevated iron deposits in enterocytes, associated with higher duodenal H-Ferritin levels and a significant increase in duodenal expression and activity of heme oxygenase. The expression of heme-iron and inorganic iron transporters was normal. The rate of iron absorption was assessed by measuring the amount of 57Fe retained in tissues from hemopexin-null and wild-type animals after administration of an oral dose of 57FeSO4 or of 57Fe-labelled heme. Higher iron retention in the duodenum of hemopexin-null mice was observed as compared with normal mice. Conversely, iron transfer from enterocytes to liver and bone marrow was unaffected in hemopexin-null mice. Conclusions The increased iron level in hemopexin-null duodenum can be accounted for by an increased iron uptake by enterocytes and storage in ferritins. These data indicate that the lack of hemopexin under physiological conditions leads to an enhanced duodenal iron uptake thus providing new insights to our understanding of body iron homeostasis. PMID:23826373

  12. Peptic ulcer disease in endogenous hypercortisolism: myth or reality?

    PubMed

    Hatipoglu, Esra; Caglar, Asli Sezgin; Caglar, Erkan; Ugurlu, Serdal; Tuncer, Murat; Kadioglu, Pinar

    2015-11-01

    Many clinicians believe hypercortisolism is ulcerogenic. However, data from clinical studies show that prophylaxis for peptic ulcer disease is no longer recommended in patients receiving corticosteroid treatment. This has not yet been verified in endogenous hypercortisolism by controlled clinical studies. The purpose of the current study was to evaluate the relationship between endogenous Cushing's syndrome (CS) and peptic ulcer disease and Helicobacter pylori infection. The study group contained 20 cases with CS resulting from ACTH-dependent endogenous hypercortisolism. The control groups consisted of 14 age- and gender-matched cases receiving exogenous corticosteroid therapy and 100 cases of dyspepsia with non-cushingoid features. Upper gastrointestinal endoscopy was performed on all cases. Biopsies were taken from five different points: two samples from the antrum, two samples from the corpus, and one sample from the fundus. A histological diagnosis of Helicobacter pylori infection was also obtained from evaluation of biopsy specimens. The frequency of stomach and duodenal ulcers did not vary between the groups (p = 0.5 and p = 0.7). Antral gastritis was less frequent and pangastritis was more common in cases with CS compared to the healthy controls (p = 0.001 and p < 0.001). The incidence of Candida esophagitis was more frequent in cases with CS compared to cases with corticosteroid treatment and healthy controls (p = 0.03). Histopathological findings and frequency of Helicobacter pylori based on pathology results did not vary between the three groups. It is possible that neither exogenous nor endogenous corticosteroid excess directly causes peptic ulcer or Helicobacter pylori infection. Prophylactic use of proton pump inhibitors is not compulsory for hypercortisolism of any type.

  13. Effects of Ionizing Radiation and Restraint Stress on Activity, Avoidance Conditioning, and Stomach Ulcers in Albino Rats.

    DTIC Science & Technology

    1984-03-01

    of the potential for stress communication through pheromones . For the same reason, immobilized animals were always "*-."carried separately and tested...and D. J. Kimeldorf. The effect of x-irradiation on the diffuse activity performance of rats, guinea pigs and hamsters. Brit J Rad 32:386-389 (1959

  14. Noninvasive evaluation of active pan-ulcerative colitis with multiple strictures using Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography

    PubMed Central

    Santhosh, Sampath; Bhattacharya, Anish; Rana, Surinder Singh; Bhasin, Deepak Kumar; Gupta, Rajesh; Mittal, Bhagwant Rai

    2016-01-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by waxing and waning inflammation that changes in severity and extent and may progress to neoplasia, especially in the presence of strictures. When patients have nonnegotiable strictures or severe inflammation with ulcers, colonoscopy is difficult and carries the risk of perforation. The authors present a patient with pan-UC with multiple strictures, in whom fluorodeoxyglucose positron emission tomography/computed tomography was used to noninvasively evaluate the extent and severity of the disease. PMID:26917901

  15. Differential Expression of MUC12, MUC16, and MUC20 in Patients with Active and Remission Ulcerative Colitis.

    PubMed

    Yamamoto-Furusho, Jesús K; Ascaño-Gutiérrez, Ilse; Furuzawa-Carballeda, Janette; Fonseca-Camarillo, Gabriela

    2015-01-01

    Background. Patients with UC have shown an important defect in the secretion and maintenance of the mucosal barrier as part of inadequate expression of mucin genes. The aim of the present study was to determine the expression of MUC12, MUC16, and MUC20 in colonic tissue from patients with UC in regard to their clinical outcomes. Methods. We included a total of 40 patients with UC and 30 normal controls. Mucin gene expression was performed by RT-PCR and protein expression was detected by immunohistochemistry. Results. Patients with active UC showed no significant expression of MUC12 gene in mucosa compared to the group of patients with UC in remission and the normal control group. MUC16 gene expression was significantly increased in the UC active and remission groups compared to the normal control group (P = 0.03). MUC20 gene expression was found significantly decreased in patients with active UC compared to both remission group (P = 0.001) and normal controls (P = 0.001). Furthermore, an association was found between MUC20 gene expression and the presence of histological remission in patients with UC (P = 0.003, OR = 0.37). Conclusions. An increased gene expression of MUC16 and MUC20 was found in patients with remission UC.

  16. HYPERTENSIVE-ISCHEMIC LEG ULCERS

    PubMed Central

    Farber, Eugene M.; Schmidt, Otto E. L.

    1950-01-01

    Ischemic ulcers of the leg having characteristics different from those of ordinary leg ulcers have been observed in a small number of hypertensive patients, mostly women, during the past few years. Such ulcers are usually located above the ankle. They begin with a small area of purplish discoloration at the site of slight trauma, and progress to acutely tender ulceration. In studies of tissue removed from the margin and the base of an ulcer of this kind, obliterative arteriolar sclerotic changes, ischemic-appearing connective tissue and inflammatory changes were noted. Two additional cases are reported. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:15398887

  17. Diabetes - foot ulcers

    MedlinePlus

    ... such as high heels, flip-flops, or sandals. Wound Care and Dressings Care for your wound as instructed by your provider. You'll likely ... Keep the ulcer clean and bandaged. Cleanse the wound daily, using a wound dressing or bandage. Try ...

  18. Microcirculation and venous ulcers: a review.

    PubMed

    Pascarella, Luigi; Schönbein, Geert W Schmid; Bergan, John J

    2005-11-01

    Recent histological and immunocytochemical analyses of venous leg ulcers suggest that lesions observed in the different stages of chronic venous insufficiency (CVI) may be related to an inflammatory process. This inflammatory process leads to fibrosclerotic remodeling of the skin and then to ulceration. The vascular network of the most superficial layers of the skin appears to be the target of the inflammatory reaction. Hemodynamic forces such as venous hypertension, circulatory stasis, and modified conditions of shear stress appear to play an important role in an inflammatory reaction accompanied by leukocyte activation which clinically leads to CVI: venous dermatitis and venous ulceration. The leukocyte activation is accompanied by the expression of integrins and by synthesis and release of many inflammatory molecules, including proteolytic enzymes, leukotrienes, prostaglandin, bradykinin, free oxygen radicals, cytokines, and possibly other classes of inflammatory mediators. The inflammatory reaction perpetuates itself, leading to liposclerotic skin and subcutaneous tissue remodeling. In light of the mechanisms of venous ulcer formation cited above, therapy in the future might be directed against leukocyte activation in order to diminish the magnitude of the inflammatory response. With this in mind, the attention of many investigators has been drawn to two different drugs with an anti-inflammatory effect: pentoxifylline and flavonoids.

  19. Factors That Influence Perforator Thrombosis and Predict Healing Perforator Sclerotherapy for Venous Ulceration Without Axial Reflux

    PubMed Central

    Kiguchi, Misaki M.; Hager, Eric S.; Winger, Daniel G.; Hirsch, Stanley A.; Chaer, Rabih A.; Dillavou, Ellen D.

    2014-01-01

    OBJECTIVES Refluxing perforators contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that (1) impact rates of incompetent perforator vein (IPV) thrombosis with ultrasound-guided sclerotherapy (UGS) and (2) impact the healing of venous ulcers (CEAP 6) without axial reflux. METHODS Retrospective review of UGS of IPV injections from 1/2010–11/2012 identified 73 treated venous ulcers in 62 patients. Patients had no other superficial/axial reflux and were treated with standard wound care and compression. Ultrasound was used to screen for refluxing perforators near ulcer(s), and these were injected with sodium tetradecyl sulfate or polidocanol foam and assessed for thrombosis at 2 weeks. Demographic data, comorbidities, treatment details and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting IPV thrombosis and ulcer healing. RESULTS 62 patients with active ulcers for an average of 28 months with compression therapy prior to perforator treatment had an average age of 57.1 years, were 55% male, 36% had a history of DVT and 30% had deep venous reflux. 32 patients (52%) healed ulcers, while 30 patients (48%) had non-healed ulcer(s) in mean follow-up of 30.2 months. Ulcers were treated with 189 injections, with average thrombosis rate of 54%. Of 73 ulcers, 43 ulcers healed (59%), and 30 ulcers did not heal (41%). Patients that healed ulcers had an IPV thrombosis rate of 69 % vs. 38% in patients who did not heal (P<.001). Multivariate models demonstrated male gender and warfarin use negatively predicted thrombosis of IPVs (P=.03, P=.01). Multivariate model for ulcer healing found complete IPV thrombosis was a positive predictor (P=.02), while large initial ulcer area was a negative predictor (P=.08). Increased age was associated with fewer ulcer recurrences (P=.05). Hypertension and increased follow-up time predicted increased ulcer recurrences (P=.04, P=.02). Calf

  20. Induction of duodenal mucosal tumors of intestinal epithelial cell origin showing frequent nuclear β-catenin accumulation similar to the concurrently induced colorectal tumors in rats after treatment with azoxymethane.

    PubMed

    Kikuchihara, Yoh; Onda, Nobuhiko; Kimura, Masayuki; Kangawa, Yumi; Mizukami, Sayaka; Yoshida, Toshinori; Shibutani, Makoto

    2015-01-01

    Azoxymethane (AOM) is a potent carcinogen used for induction of colon tumors in rats and mice. It is also known that AOM treatment induces small bowel tumors in addition to colorectal tumors in rats. The present study examined the histogenesis of AOM-induced rat duodenal tumors in comparison with concurrently induced colorectal tumors by histochemical and immunohistochemical approaches. Duodenal and colorectal tumors were positive for both periodic acid-Schiff reaction and Alcian blue staining. Immunohistochemically, duodenal tumors were positive for intestinal epithelial markers such as cytokeratin (CK) 20 (100%) and mucin (MUC) 2 (91.7%) but negative for pancreaticobiliary markers such as CK7 (100%) and MUC1 (100%). All colorectal tumors were also negative for CK7 and MUC1 but positive for CK20. Eighty percent of colorectal tumors were positive for MUC2. In addition, nuclear accumulation of β-catenin was found in duodenal tumors (70.8%), which was similar to colorectal tumors (90.0%). These results indicate that duodenal tumors induced by AOM treatment of rats were derived from intestinal epithelium. Similar to colorectal tumors, nuclear accumulation of β-catenin indicates activation of Wnt signaling as a driving force for tumor progression in AOM-induced duodenal tumors.

  1. Microarray analysis of potential genes in the pathogenesis of recurrent oral ulcer.

    PubMed

    Han, Jingying; He, Zhiwei; Li, Kun; Hou, Lu

    2015-01-01

    Recurrent oral ulcer seriously threatens patients' daily life and health. This study investigated potential genes and pathways that participate in the pathogenesis of recurrent oral ulcer by high throughput bioinformatic analysis. RT-PCR and Western blot were applied to further verify screened interleukins effect. Recurrent oral ulcer related genes were collected from websites and papers, and further found out from Human Genome 280 6.0 microarray data. Each pathway of recurrent oral ulcer related genes were got through chip hybridization. RT-PCR was applied to test four recurrent oral ulcer related genes to verify the microarray data. Data transformation, scatter plot, clustering analysis, and expression pattern analysis were used to analyze recurrent oral ulcer related gene expression changes. Recurrent oral ulcer gene microarray was successfully established. Microarray showed that 551 genes involved in recurrent oral ulcer activity and 196 genes were recurrent oral ulcer related genes. Of them, 76 genes up-regulated, 62 genes down-regulated, and 58 genes up-/down-regulated. Total expression level up-regulated 752 times (60%) and down-regulated 485 times (40%). IL-2 plays an important role in the occurrence, development and recurrence of recurrent oral ulcer on the mRNA and protein levels. Gene microarray can be used to analyze potential genes and pathways in recurrent oral ulcer. IL-2 may be involved in the pathogenesis of recurrent oral ulcer.

  2. Effects of duodenal switch alone or in combination with sleeve gastrectomy on body weight and lipid metabolism in rats

    PubMed Central

    Gudbrandsen, O A; Kodama, Y; Mjøs, S A; Zhao, C-M; Johannessen, H; Brattbakk, H-R; Haugen, C; Kulseng, B; Mellgren, G; Chen, D

    2014-01-01

    Background: A combined procedure of sleeve gastrectomy and duodenal switch (SG+DS) has been applied to the treatment of super obesity. The aim of the present study was to test whether duodenal switch alone (DS) leads to similar weight loss and changes in lipid metabolism as SG+DS. Methods: Male Sprague–Dawley rats underwent sham surgery (Sham, N=7), duodenal switch alone (DS, N=5) or sleeve gastrectomy followed by duodenal switch (SG+DS, N=5). Body weight, feed and water intakes, and ambulatory activity were recorded 2 months post surgery. Tissue and faecal lipids, faecal bile acids, plasma cytokines and lipid metabolism-related gene expression in adipose tissue and liver were analysed. Results: Daily energy intake, relative feed uptake, ambulatory activity and body weight reduction were similar between DS and SG+DS rats. The hepatic triacylglycerol content was higher and faecal secretion of triacylglycerol was lower after SG+DS compared to DS (P<0.05). Faecal bile acid secretion was higher in SG+DS than in DS rats (P<0.05) despite similar hepatic CYP7A1mRNA level. Plasma levels of proinflammatory cytokines interleukin (IL)-1b, IL-2, IL-4, IL-5, IL-6, IL-12, granulocyte-macrophage colony stimulating factor and tumour necrosis factor alpha were higher in SG+DS than in DS rats (P<0.05). Conclusions: Although DS and SG+DS had similar efficacy in terms of body weight loss, SG+DS resulted in a poorer regulation of lipid metabolism than DS. PMID:24979153

  3. Helicobacter pylori virulence genes and host genetic polymorphisms as risk factors for peptic ulcer disease.

    PubMed

    Miftahussurur, Muhammad; Yamaoka, Yoshio

    2015-01-01

    Helicobacter pylori infection plays an important role in the pathogenesis of peptic ulcer disease (PUD). Several factors have been proposed as possible H. pylori virulence determinants; for example, bacterial adhesins and gastric inflammation factors are associated with an increased risk of PUD. However, differences in bacterial virulence factors alone cannot explain the opposite ends of the PUD disease spectrum, that is duodenal and gastric ulcers; presumably, both bacterial and host factors contribute to the differential response. Carriers of the high-producer alleles of the pro-inflammatory cytokines IL-1B, IL-6, IL-8, IL-10, and TNF-α who also carry low-producer allele of anti-inflammatory cytokines have severe gastric mucosal inflammation, whereas carriers of the alternative alleles have mild inflammation. Recent reports have suggested that the PSCA and CYP2C19 ultra-rapid metabolizer genotypes are also associated with PUD.

  4. Helicobacter pylori virulence genes and host genetic polymorphisms as risk factors for peptic ulcer disease

    PubMed Central

    Yamaoka, Yoshio; Miftahussurur, Muhammad

    2017-01-01

    Helicobacter pylori infection plays an important role in the pathogenesis of peptic ulcer disease (PUD). Several factors have been proposed as possible H. pylori virulence determinants; for example, bacterial adhesins and gastric inflammation factors are associated with an increased risk of PUD. However, differences in bacterial virulence factors alone cannot explain the opposite ends of the PUD disease spectrum, i.e., duodenal and gastric ulcers; presumably, both bacterial and host factors contribute to the differential response. Carriers of the high-producer alleles of the pro-inflammatory cytokines interleukin (IL)-1B, IL-6, IL-8, IL-10, and tumor necrosis factor-α who also carry low-producer allele carriers of anti-inflammatory cytokines have severe gastric mucosal inflammation, whereas carriers of the alternative alleles have mild inflammation. Recent reports have suggested that the PSCA and CYP2C19 ultra-rapid metabolizer genotypes are also associated with PUD. PMID:26470920

  5. Faecal mucus degrading glycosidases in ulcerative colitis and Crohn's disease.

    PubMed

    Rhodes, J M; Gallimore, R; Elias, E; Allan, R N; Kennedy, J F

    1985-08-01

    Because the normal faecal flora includes bacteria which can produce mucus-digesting glycosidases, it follows that increased digestion of colonic mucus by these bacterial enzymes could be important in the pathogenesis of ulcerative colitis. Faecal activities of potential mucus-degrading glycosidases have therefore been assayed in samples from patients with inflammatory bowel disease and normal controls. The enzymes alpha-D-galactosidase, beta-D-galactosidase, beta-NAc-D-glucosaminidase alpha-L-fucosidase and neuraminidase were assayed. Considerable glycosidase activity was present in most faecal samples. Similar activities of all the enzymes assayed were found in faeces from patients with ulcerative colitis, Crohn's disease and normal controls and there was no significant correlation with disease activity. These results imply that relapse of ulcerative colitis is not initiated by increased degradation of colonic mucus by faecal glycosidases but do not exclude a role for bacterial mucus degradation in the pathogenesis of ulcerative colitis.

  6. Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome

    PubMed Central

    Machado, Norman Oneil

    2016-01-01

    AIM: To study the etiopathogenesis, management and outcome of duodenal injury post laparoscopic cholecystectomy (LC). METHODS: A Medline search was carried out for all articles in English, on duodenal injury post LC, using the search word duodenal injury and LC. The cross references in these articles were further searched, for potential articles on duodenal injury, which when found was studied. Inclusion criteria included, case reports, case series, and reviews. Articles even with lack of details with some of the parameters studied, were also analyzed. The study period included all the cases published till January 2015. The data extracted were demographic details, the nature and day of presentation, potential cause for duodenal injury, site of duodenal injury, investigations, management and outcome. The model (fixed or random effect) for meta analyses was selected, based on Q and I2 statistics. STATA software was used to draw the forest plot and to compute the overall estimate and the 95%CI for the time of detection of injury and its outcome on mortality. The association between time of detection of injury and mortality was estimated using χ2 test with Yate’s correction. Based on Kaplan Meier survival curve concept, the cumulative survival probabilities at various days of injury was estimated. RESULTS: Literature review detected 74 cases of duodenal injury, post LC. The mean age of the patients was 58 years (23-80 years) with 46% of them being males. The cause of injury was due to cautery (46%), dissection (39%) and due to retraction (14%). The injury was noted on table in 46% of the cases. The common site of injury was to the 2nd part of the duodenum with 46% above the papilla and 15% below papilla and in 31% to the 1st part of duodenum. Duodenorapphy (primary closure) was the predominant surgical intervention in 63% with 21% of these being carried out laparoscopically. Other procedures included, percutaneous drainage, tube duodenostomy, gastric resection

  7. Total Robotic Biliopancreatic Diversion with Duodenal Switch Technique.

    PubMed

    Antanavicius, Gintaras; Mohammed, Ricardo; Van Houtte, Olivier

    2016-12-31

    The use of robotic bariatric surgery has increased significantly since its advent in 1999. Its utility and safety has been demonstrated in the literature for all bariatric procedures, including most recently the biliopancreatic diversion with duodenal switch (BPDDS). The robotic-assisted biliopancreatic diversion with duodenal switch (RBPDDS) was first described by Sudan et al. in 2007 with the use of the robot primarily for the duodeno-ileal anastomosis, then in 2015, the same authors described 59 cases of totally RBPDDS using the robot for the most of the operation, but still utilizing laparoscopic staplers. Robotic staplers were introduced recently and it became possible to utilize robot throughout the entire procedure without relying on stapling performed by an assistant. Described here is the technique of a total RBPDDS utilizing robotic staplers.

  8. An Unusual Cause of Duodenal Obstruction: Persimmon Phytobezoar.

    PubMed

    Fan, Shengxian; Wang, Jing; Li, Yousheng

    2016-12-01

    Duodenal phytobezoar, an unusual cause of acute duodenal obstruction, is rarely seen. The most common cause of this type of bezoar is persimmon. It frequently arises from underlying gastrointestinal tract pathologies (gastric surgery, etc.). Here, we report the case of a 66-year-old man who had undergone distal gastrectomy with Billroth I reconstruction for gastric cancer and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. The abdominal computed tomography scan showed a large-sized mass in the horizontal portion of the duodenum. On following endoscopic examination, a large phytobezoar was revealed in the duodenum. He was treated with endoscopic fragmentation combined with nasogastric Coca-Cola. The patient tolerated the procedure well and resumed a normal oral diet 3 days later.

  9. Duodenal gossypiboma: a case report and literature review.

    PubMed

    Velasco-Mata, Stephany; Díaz-Gómez, Marialy; Cova-Bianco, Tamarys; Hopp-Mora, Evelyn; Rodriguez-Rojas, Roselin; Chirinos-Malave, Yeirama; Carreiro-Rodriguez, Manuel

    2015-09-01

    Gossypiboma is a retained surgical cotton matrix material in the body after a surgical procedure. Cases are rarely reported due to medico-legal concerns. Although infrequent, it causes serious morbidity and even mortality if left undiagnosed. We present the case of a trans-mural migration of gossypiboma and a review of the literature. Gossypiboma's trans-duodenal migration is a rare complication of retained gauzes. Cases reported in the literature were easy to diagnose based on clinical grounds and endoscopic studies.

  10. [Perforated duodenal diverticula. Case report and treatment options].

    PubMed

    Guardado-Bermúdez, Fernando; Ardisson-Zamora, Fernando Josafat; Rojas-González, Juan Daniel; Medina-Benítez, Alberto; Corona-Suárez, Fernando

    2013-01-01

    Antecedentes: los divertículos duodenales los describió por primera vez Chromel en 1710. El divertículo duodenal es el segundo sitio más frecuente de divertículos en el tubo digestivo, el diagnóstico se limita a los casos con complicaciones y síntomas. Los divertículos duodenales se localizan en 10- 67% en la segunda porción del duodeno. Su hallazgo en la mayoría de los casos es incidental. Cerca de 90% de los pacientes cursan asintomáticos y sólo se manifiestan cuando sobrevienen las complicaciones, como la hemorragia digestiva y la perforación. Caso clínico: paciente femenina de 78 años de edad, que acudió al hospital debido a disnea de medianos esfuerzos y epigastralgia moderada, distensión abdominal, constipación y dificultad para canalizar gases. La laparotomía identificó un divertículo duodenal con perforación en su cúpula de 5 mm que dio pie a la realización de la diverticulectomía. Conclusiones: el diagnóstico de divertículo duodenal, como etiología de abdomen agudo, debe contemplarse en cualquier diagnóstico diferencial con cuadro de abdomen agudo, apoyados siempre en la imagenología y endoscopia. El tratamiento quirúrgico del divertículo duodenal, en especial su resección, sigue siendo la recomendación dirigida a la menor morbilidad y mejor recuperación.

  11. Healing with basic fibroblast growth factor is associated with reduced indomethacin induced relapse in a human model of gastric ulceration.

    PubMed Central

    Hull, M A; Knifton, A; Filipowicz, B; Brough, J L; Vautier, G; Hawkey, C J

    1997-01-01

    BACKGROUND: Acid stable basic fibroblast growth factor (bFGF) promotes angiogenesis and healing of gastric ulcers in rats and reduces subsequent non-steroidal anti-inflammatory drug (NSAID) induced relapse. AIMS: To test in a double blind, placebo controlled, three way crossover study whether bFGF promotes healing and reduces subsequent relapse in a human model of gastric ulceration. SUBJECTS: Twelve healthy volunteers. METHODS: Subjects took aspirin 900 mg twice daily (days 1-3) with bFGF 0.1 mg twice daily or cimetidine 400 mg twice daily or placebo (days 1-14) and then indomethacin 50 mg thrice daily (days 15-21). Endoscopy was performed on days 1, 4, 8, 15, and 22 during each treatment period. Eight antral biopsy specimens were taken on day 1 and the number of unhealed biopsy induced mini-ulcers and NSAID induced erosions counted during subsequent endoscopies. RESULTS: Basic FGF and cimetidine were protective against aspirin and indomethacin induced duodenal (but not gastric) injury compared with placebo. There was significant relapse of biopsy induced mini-ulcers after indomethacin only in the placebo group (0 (0-0) before v 1 (0-4.5) after; p > 0.05). TGP-580 was detected in serum of one volunteer. CONCLUSIONS: Healing with bFGF (and cimetidine) was associated with reduced NSAID induced ulcer relapse in this model of gastric ulceration. PMID:9071932

  12. Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

    PubMed Central

    Lim, Joo Hyun; Kim, Sang Gyun; Song, Ji Hyun; Hwang, Jae Jin; Lee, Dong Ho; Han, Jae Pil; Hong, Su Jin; Kim, Ji Hyun; Jeon, Seong Woo; Kim, Gwang Ha; Shim, Ki-Nam; Shin, Woon Geon; Kim, Tae Ho; Kim, Sun Moon; Chung, Il-Kwon; Kim, Hyun-Soo; Kim, Heung Up; Lee, Joongyub; Kim, Jae Gyu

    2017-01-01

    Background/Aims The resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease. Methods Between 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed. Results The overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655). Conclusions Levofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies. PMID:27609487

  13. Helicobacter Pylori Infection and Serum Pepsinogen I Concentration in Peptic Ulcer Patients: Effect of Bacterial Eradication

    PubMed Central

    Park, Sill Moo; Park, Joongwon; Chang, Sae Kyung; Yoo, Byung Chul; Kim, Ho Jung

    1996-01-01

    Objectives: In order to test the hypothesis that H. pylori infections in the gastric antrum increase pepsinogen I release, fasting serum pepsinogen I concentrations were compared in peptic ulcer patients with and without H. pylori infection. A randomized prospective study was performed to determine whether the increased serum pepsinogen I concentrations associated with H. pylori infection respond to treatment that eradicates H. pylori. Methods: Fasting serum pepsinogen I concentrations were measured by RIA in 736 patients with endoscopically and histologically confirmed benign peptic ulcer with and without H. pylori infection. Out of 511 patients with H. pylori infection, 110 patients (group 1) were randomly selected and were treated with metronidazole and tripotassium dicitrato bismuthate combined with ranitidine and antacid, and 97 patients (group 2) were treated only with ranitidine and antacid. The third group, 54 patients free of H. pylori infection, was designed to evaluate the influence of H2-receptor antagonist and antacid on the change of pepsinogen I. Fasting pepsinogen I concentration and H. pylori status were compared before and after the treatment. Results: Patients infected by H. pylori (gastric ulcer 208, duodenal ulcer 303; total 511) had significantly higher fasting serum pepsinogen I concentrations than H. pylori negative patients (gastric ulcer 110, duodenal ulcer 115: total 225). Mean pepsinogen I level of the former was 124.3±46.9 and that of the latter was 77.9±25.8 ng/ml. (p<0.0001) The difference in serum pepsinogen I concentrations according to the location of ulcer crater was significant only in non-infected subjects e.g., mean pepsinogen I level H. pylori-negative gastric ulcer was significantly lower than that of H. pylori-negative duodenal ulcer patients. H. pylori was eradicated in all the patients who had received antibacterial therapy for 4 weeks and serum pepsinogen I concentrations were significantly decreased from 129.8+43.0 to

  14. [Chronic Duodenitis and Celiac Disease: a path between the nonspecific and the early stages of Marsh].

    PubMed

    Passera, Andrea Helena; Passera, Mario Luis; Higa, Antonio Luis; Nuñez, Maria; Armando, Lucas; Barzón, Silvia

    2015-01-01

    Given the advances in diagnosis for CD, some patients are detected with symptoms and signs of food intolerance, which have positive antibodies and autoantibodies for coeliac disease, whom present proximal bowel biopsies with chronic nonspecific duodenitis and are not associated with stages 0 and 1 Marsh. On the other hand, patients with bloating, abdominal pain, pondostatural delay, negative antibodies for CD, and chronic nonspecific duodenitis in whom removing cow's milk or gluten, the symptoms remit. There are also celiac patients with biopsies before diagnosis, with chronic nonspecific duodenitis. In this paper, we summarize three brothers with different degrees of chronic duodenitis, one with chronic nonspecific duodenitis, and two with histopathological sings of coeliac disease. It is an invitation to think that chronic nonspecific duodenitis in some patients may be an earlier manifestation of celiac disease.

  15. Radiographical evaluation of ulcerative colitis

    PubMed Central

    Deepak, Parakkal; Bruining, David H.

    2014-01-01

    Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis (UC). Imaging can be used non-invasively to determine the extent of involvement, severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease (IBD) manifestations. While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings, the use of computed tomography enterography (CTE) or magnetic resonance enterography (MRE) are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation. Additionally, CT colonography and MR colonography are emerging techniques with potential applications in UC. Ultrasonography, leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations. This plethora of radiological imaging options has become a vital component of UC assessments. PMID:24843072

  16. [Gastroduodenal mucosa sensitivity to estrogen in ulcers complicated by hemorrhage].

    PubMed

    Duzhiy, I D; Romanyuk, A M; Kharchenko, S V; Moskalenko, R A; Pyatykop, G I; Lyndin, M S

    2015-02-01

    Expression of alpha-receptors of estrogen (RE) in accordance to immunohistochemical (IHC) labeling in gastroduodenal mucosa cells was studied up in patients, suffering the ulcer disease and without it. In 4 patients (group I) a gastroduodenal mucosa affection was revealed, they were operated on for hemorrhage from gastroduodenal ulcers; in 3 patients (group II) gastroduodenal mucosa affection was not observed; in 4 patients (group III, control), a mammary gland cancer was diagnosed, a positive reaction on alpha-RE was noted. In groups I and II the biopsies were studied, obtained from pylorus and gastric fundus, as well as from duodenal ampula, and in a group III--obtained from the tumor. In a control group a positive labeling of nuclei was revealed in biopsies. In patients of groups I and II the alpha-RE expression by cellular nuclei was not revealed, but, the lots of positive IHC labeling of cytoplasm in glandular and stromal mucosal cells of the investigated gut were noted. Positive IHC labeling of cytoplasm for alpha-RE witnesses about sensitivity to them in norma and pathological processes. But, a trustworthy difference of alpha-RE expression by cellular nuclei was not noted. For confirmation or denial of this hypothesis further clinical and IHC investigations are needed.

  17. Cytochrome P450 1B1 expression in rat esophageal tumorigenesis promoted by gastric and duodenal reflux.

    PubMed

    Devlin, Andrea H; McIlroy, Marie; McKeen, Hayley D; Bonde, Pramode; Menezes, A A Carlos; Swarbrick, Christine J; Robson, Tracy; Hirst, David G; Campbell, F Charles; McGuigan, James A; McKeown, Stephanie R

    2009-02-01

    Cytochrome P450 1B1 (CYP1B1) mRNA is constitutively expressed in most normal extra-hepatic tissues; however the protein is not detectable in these tissues but is expressed in a wide variety of tumors. CYP1B1 is responsible for the activation of a number of carcinogens present in tobacco smoke and food. A surgical model of rat esophageal tumorigenesis, promoted by gastric or duodenal reflux was used to determine CYP1B1 expression in premalignant esophageal tissue. Immunohistochemistry was performed using a modified amplified fluorescein tyramide protocol. CYP1B1 was not observed in normal esophageal mucosa, submucosa, or muscularis mucosa. Animals exposed to gastric reflux developed mild hyperplasia. Varying degrees of hyperplasia were observed in the duodenal reflux group. All regions of hyperplasia showed moderate or strong CYP1B1 immunoreactivity. Duodenal reflux induced a small number of premalignant changes: immunoreactivity was absent from the epithelium of squamous dysplasia (0/10), Barrett's esophagus (0/7), and majority of dysplastic Barrett's esophagus (1/4). Moderate or strong immunoreactivity was observed in the majority (7/8) of squamous cell carcinomas (SCCs) in situ. Immunoreactivity was also observed in the lamina propria and submucosa in association with inflammation, regardless of the severity of inflammation. The expression of CYP1B1 in hyperplasia, SCCs in situ, or in association with inflammation may increase the production of carcinogenic metabolites, which may promote esophageal tumorigenesis.

  18. Ligation-assisted endoscopic submucosal resection with circumferential mucosal incision for duodenal carcinoid tumor.

    PubMed

    Harada, Hideaki; Suehiro, Satoshi; Shimizu, Takanori; Katsuyama, Yasushi; Hayasaka, Kenji; Ito, Hideto

    2015-09-14

    Here we present the case of a 64-year-old female with a duodenal carcinoid tumor treated by ligation-assisted endoscopic submucosal resection (ESMR-L) with circumferential mucosal incision (CMI). Band ligation was effective in resecting the duodenal carcinoid tumor after CMI, with an uneventful post-procedural course. Histopathological examination showed clear tumor margins at deeper tissue levels. Thus, in the present case, ESMR-L with CMI was useful for the treatment of duodenal carcinoid tumor.

  19. Association of Duodenal Atresia, Malrotation, and Atrial Septal Defect in a Down-Syndrome Patient

    PubMed Central

    Molinaro, F; Sica, M; Mariscoli, F; Bindi, E; Mazzei, O; Ferrara, F; Messina, M

    2016-01-01

    Duodenal atresia is the frequent cause of neonatal intestinal obstruction. The association between duodenal atresia, intestinal malrotation, cardiac anomalies and Down syndrome is infrequently reported. We present a prenatally suspected case of duodenal atresia which was associated with malrotation and atrial septal defect in a patient of Down syndrome. Duodenotomy and resection of web was performed in addition to Ladd’s procedure. Postoperative course remained uneventful. PMID:27170921

  20. Efficacy of Zinc Sulfate in Peptic Ulcer Disease: A Randomized Double-Blind Clinical Trial Study

    PubMed Central

    Parhizkar, Baran; Sheikhesmaeili, Farshad; Roshani, Mohammad; Nayebi, Morteza; Gharibi, Fardin

    2016-01-01

    Introduction Peptic ulcer is a common disease that affects millions of people worldwide. Considering its global prevalence finding new approach for treating is important. Aim The aim of this study was to investigate the effect of zinc sulfate on gastric and duodenal ulcer treatment. Materials and Methods This double-blind clinical trial study was done on 90 patients who were admitted to the gastrointestinal endoscopy clinic of Tohid hospital in Sanandaj, Iran. All patients were diagnosed with gastric and duodenal ulcers. They were randomly divided into two-intervention and control groups, using block randomization with block sizes of 4. Patients and researcher were unaware of the grouping. To assess the level of zinc, blood samples were taken. In case of positive Rapid Urease Test (RUT), triple therapy regimen including amoxicillin, clarithromycin and omeprazole was administered for two weeks. For intervention group in addition to "triple therapy", an oral dose of Zinc Sulfate 220mg capsules were administered daily, while the control group received placebo capsules. Results A total of 54.5% and 57% of the patients in the intervention and control groups had gastric ulcer respectively. The Rapid Urease Test (RUT) result of 72.7% of intervention group and 83.3% of control group was positive (p = 0.24). Serum zinc level of 20.9% of intervention group and 35.7% of control group was lower than the normal level (p = 0.13). The mean of serum zinc level of intervention group and control group were 81.9 and 78.9 mg dL respectively (p = 0.4). After intervention, peptic ulcer in 81.8% of the intervention group and 83.3% of the control groups were improved (p= 0.85). Response to treatment were higher in patients with normal zinc levels compared to patients with abnormal levels (77.5% vs. 22.5%, p=0.019). Conclusion A daily dose of 220mg zinc sulfate was not significantly effective on peptic ulcer. However, patients with normal zinc levels had better ulcer treatment. PMID

  1. Venous Leg Ulcers.

    PubMed

    Vivas, Alejandra; Lev-Tov, Hadar; Kirsner, Robert S

    2016-08-02

    This issue provides a clinical overview of venous leg ulcers, focusing on prevention, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  2. Persistent nicorandil induced oral ulceration

    PubMed Central

    Healy, C M; Smyth, Y; Flint, S R

    2004-01-01

    Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required. PMID:15201264

  3. Consensus and Variable Region PCR Analysis of Helicobacter pylori 3′ Region of cagA Gene in Isolates from Individuals with or without Peptic Ulcer

    PubMed Central

    Rota, Cláudia Augustin; Pereira-Lima, Júlio C.; Blaya, Carolina; Nardi, Nance Beyer

    2001-01-01

    The clinical outcome of Helicobacter pylori infection may be associated with the cagA bacterial genotype. To investigate the cagA status of H. pylori-infected patients and the relationship between cagA and peptic ulcer disease, gastric biopsy specimens from 103 Caucasian patients in Brazil were analyzed by PCR. Since allelic variation in cagA exists and distinct H. pylori subgenotypes may circulate in different regions, PCR using primers for a variable 3′ region of the cagA gene according to a Japanese methodology and for a consensus cagA 3′ region used in Western methods was used for cagA detection. cagA was present in 53 (71%) of 75 H. pylori-positive cases when analyzed by the consensus region method and was associated with duodenal ulcer disease (P = 0.02), but not with gastric ulcer (P = 0.26), when compared to patients with duodenitis or gastritis. The variable region PCR method was able to detect 43 (57%) cagA-positive cases within the same group of H. pylori-positive patients and showed three subtypes of cagA (A, B/D, and C) that were not associated with clinical outcome. However, in 8 (18%) of the cases, more than one subtype was present, and an association between patients with multiple subtypes and disease outcome was observed when compared to patients with isolated subtypes (P = 0.048). cagA was a marker of H. pylori strains for duodenal ulcer disease in our population, and in spite of the differences in the 3′ region of the cagA gene, the Japanese methodology was able to detect the cagA status in most cases. The presence of multiple subgenotypes of cagA was associated with gastric ulcer. PMID:11158115

  4. Preduodenal portal vein in association with midgut malrotation and duodenal web-triple anomaly?

    PubMed

    Singal, Arbinder Kumar; Ramu, Chithra; Paul, Sarah; Matthai, John

    2009-02-01

    Preduodenal portal vein (PDPV) is a rare anomaly in which the portal vein passes anterior to the duodenum rather than posteriorly. Generally asymptomatic, PDPV may rarely cause duodenal obstruction or may coexist with other anomalies. We report a neonate who presented with duodenal obstruction and was found out to have 3 coexisting anomalies, each of which can lead to duodenal obstruction independently-PDPV, midgut malrotation, and duodenal web. A duodenoduodenostomy and a Ladd procedure were done, and the child recovered uneventfully. The mechanism of obstruction, interesting metabolic aberrations observed, outcome, and relevant literature are presented.

  5. Anatomical and neuropeptidergic properties of the duodenal neurons projecting to the gallbladder in the golden hamster.

    PubMed

    Seo, Je Hoon; Cho, Sa Sun; Lee, In Se; Lee, Heungshik S

    2002-10-01

    This study investigated the anatomical and neuropeptidergic properties of the duodenal neurons projecting to the gallbladder in the golden hamster. Fast blue (FB) was injected into the subserosa of the gallbladder in order to identify by retrograde tracing the duodenal neurons that project to the gallbladder. Subsequently, immunofluorescence microscopy was employed to see whether these duodenal neurons contained putative peptidergic neurotransmitters such as calcitonin gene-related peptide (CGRP), galanin (GAL) and vasoactive intestinal polypeptide (VIP). The FB-labeled cells were only found in the duodenal region adjacent to the major duodenal papilla where the biliary duct opens. On the other hand, there was no difference within this duodenal region in the numbers of FB-labeled cells between the mesenteric and antimesenteric portions, suggesting that these two portions of the duodenum equally contribute neuronal projections to the gallbladder. Double-immunofluorescence microscopy clearly demonstrated that a small population of FB-positive duodenal neurons contained putative neurotransmitters CGRP, GAL and VIP. Our data suggest that duodenal neurons around the major duodenal papilla in the golden hamster project to the gallbladder and exert their influence on the gallbladder via neuropeptides such as CGRP, GAL and VIP.

  6. Maintenance of Efficacy and Continuing Safety of Golimumab for Active Ulcerative Colitis: PURSUIT-SC Maintenance Study Extension Through 1 Year

    PubMed Central

    Gibson, Peter R; Feagan, Brian G; Sandborn, William J; Marano, Colleen; Strauss, Richard; Johanns, Jewel; Padgett, Lakshmi; Collins, Judith; Tarabar, Dino; Hebzda, Zbigniew; Rutgeerts, Paul; Reinisch, Walter

    2016-01-01

    Objectives: The safety and efficacy of subcutaneous golimumab through 2 years of maintenance therapy was evaluated in patients with moderate-to-severe ulcerative colitis (UC). Methods: Patients completing treatment through week 52 (placebo, golimumab 50, 100, every-4-weeks (q4w)) and evaluations at week 54 were eligible for this long-term extension (LTE) trial. Patients receiving placebo or golimumab 50 mg with worsening disease during the LTE could receive golimumab 100 mg. Efficacy assessments included the Mayo physician's global assessment (PGA) subscore, inflammatory bowel disease questionnaire (IBDQ), and corticosteroid use. Patients who were randomized to golimumab at PURSUIT-Maintenance baseline and continued receiving golimumab during the LTE were analyzed for efficacy (using intention-to-treat and “as observed” analyses; N=195) and safety (N=200). Patients treated with golimumab at any time from induction baseline through week 104 (N=1240) constituted the overall safety population. Results: Baseline demographics and disease characteristics of patients entering the LTE receiving golimumab were similar to those of all patients randomized to golimumab maintenance at baseline. At week 104, 80.5% (157/195) of patients had a PGA=0/1 (range weeks 56–104: 80.5–91.8%) and 56.4% (110/195) had a PGA=0 (weeks 56–104: range: 53.8–58.5%). Through week 104, 86% of patients maintained inactive or mild disease activity. Among 174 corticosteroid-free patients at week 54, 88.5% remained corticosteroid-free at week 104. At week 104, 62.2% (120/193) had an IBDQ score ≥170. Tuberculosis, opportunistic infection, and malignancy rates were low, and the overall safety profile was similar to that reported through week 54. Two non-melanoma skin cancers, one metastatic colon cancer, and two deaths (biventricular heart dysfunction, sepsis) occurred between weeks 54 and 104. Conclusion: Subcutaneous golimumab q4w through 2 years maintained clinical benefit and reduced

  7. Systematic Review with Network Meta-Analysis: Comparative Efficacy of Biologics in the Treatment of Moderately to Severely Active Ulcerative Colitis

    PubMed Central

    Vickers, Adrian D.; Ainsworth, Claire; Mody, Reema; Bergman, Annika; Ling, Caroline S.; Medjedovic, Jasmina; Smyth, Michael

    2016-01-01

    Background Biological therapies are increasingly used to treat ulcerative colitis (UC). Aim To compare the efficacy of biologics in adults with moderately-to-severely active UC, stratified by prior exposure to anti-tumour necrosis factor (anti-TNF) therapy. Methods A systematic literature review was undertaken to identify studies of biologics approved for UC. Network meta-analysis was conducted for endpoints at induction and maintenance. Results Seven studies were included in the meta-analysis of induction treatment for anti-TNF therapy-naïve patients. All biologics were more effective than placebo in inducing clinical response, clinical remission, and mucosal healing. Infliximab demonstrated a statistically significant improvement over adalimumab in clinical response (odds ratio [OR] [95% credible interval (CrI)]: 2.19 [1.35–3.55]), clinical remission (OR [95% CrI]: 2.81 [1.49–5.49]), and mucosal healing (OR [95% CrI]: 2.23 [1.21–4.14]); there were no other significant differences between biologics for induction efficacy. Five studies were included in the meta-analysis of maintenance treatment, two studies rerandomised responder patients at end of induction, and three followed the same patients ‘straight through’. To account for design differences, the number of responders at end of induction was assumed to be equivalent to the number rerandomised. Vedolizumab showed significantly different durable clinical response from comparators (OR [95% CrI] infliximab 3.18 [1.14–9.20], golimumab 2.33 [1.04–5.41], and adalimumab 3.96 [1.67–9.84]). In anti-TNF therapy-experienced patients, only vedolizumab and adalimumab could be compared. At induction, no significant differences in efficacy were seen. During maintenance, vedolizumab showed significantly improved rates of mucosal healing versus adalimumab (OR [95% CrI]: 6.72 [1.36–41.0]). Conclusions This study expands the understanding of comparative efficacies of biologic treatments for UC, encompassing

  8. Prevalence of CagA and VacA antibodies in children with Helicobacter pylori-associated peptic ulcer compared to prevalence in pediatric patients with active or nonactive chronic gastritis.

    PubMed

    Alarcón, T; Martínez, M J; Urruzuno, P; Cilleruelo, M L; Madruga, D; Sebastian, M; Domingo, D; Sanz, J C; López-Brea, M

    2000-09-01

    VacA and CagA serological responses were detected in pediatric patients: 44 and 56%, respectively, in peptic ulcer (PU) patients, 33.3 and 44.4% in active chronic gastritis (ACG) patients, and 23.2 and 39.2% in non-ACG patients. Higher seroprevalence to CagA+VacA and to CagA+VacA+35-kDa antigen was found among PU patients. However, a low level of sensitivity and specificity was found for indirect detection of PU patients.

  9. Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)

    PubMed Central

    Devereaux, P J; Herlitz, Johan; Katelaris, Peter H; Lanas, Angel; Veldhuyzen van Zanten, Sander; Nauclér, Emma; Svedberg, Lars-Erik

    2011-01-01

    Objective To determine whether once-daily esomeprazole 40 mg or 20 mg compared with placebo reduces the incidence of peptic ulcers over 26 weeks of treatment in patients taking low-dose acetylsalicylic acid (ASA) and who are at risk for ulcer development. Design Multinational, randomised, blinded, parallel-group, placebo-controlled trial. Setting Cardiology, primary care and gastroenterology centres (n=240). Patients Helicobacter pylori-negative patients taking daily low-dose ASA (75–325 mg), who fulfilled one or more of the following criteria: age ≥18 years with history of uncomplicated peptic ulcer; age ≥60 years with either stable coronary artery disease, upper gastrointestinal symptoms and five or more gastric/duodenal erosions, or low-dose ASA treatment initiated within 1 month of randomisation; or age ≥65 years. All patients were ulcer-free at study entry. Interventions Once-daily, blinded treatment with esomeprazole 40 mg, 20 mg or placebo for 26 weeks. Main outcome measures The primary end point was the occurrence of endoscopy-confirmed peptic ulcer over 26 weeks. Results A total of 2426 patients (52% men; mean age 68 years) were randomised. After 26 weeks, esomeprazole 40 mg and 20 mg significantly reduced the cumulative proportion of patients developing peptic ulcers; 1.5% of esomeprazole 40 mg and 1.1% of esomeprazole 20 mg recipients, compared with 7.4% of placebo recipients, developed peptic ulcers (both p<0.0001 vs placebo). Esomeprazole was generally well tolerated. Conclusions Acid-suppressive treatment with once-daily esomeprazole 40 mg or 20 mg reduces the occurrence of peptic ulcers in patients at risk for ulcer development who are taking low-dose ASA. Clinical trial registration number ClinicalTrials.gov identifier: NCT00441727. PMID:21415072

  10. Colonic mucus, smoking and ulcerative colitis.

    PubMed

    Pullan, R D

    1996-03-01

    Human colonic mucosal protection is not fully understood but may in part rely on a layer of mucus gel adherent to the mucosa. Ulcerative colitis may occur if mucosal protection breaks down. Two studies are presented, both of which relate to the aetiology of ulcerative colitis. First, a layer of adherent mucus gel was demonstrated by a simple, reliable method. Measurements of mucus layer thickness were made in freshly resected colonic specimens and shown to increase from a mean of 107 microns on the right colon to 155 microns in the rectum. In ulcerative colitis the layer is significantly thinner or absent, whereas in Crohn's disease the colonic mucus layer is significantly thicker. Second, the relationship between smoking and colitis is explored by a double-blind, randomised and placebo-controlled trial of transdermal nicotine in active disease. Significant clinical benefit was seen, indicating nicotine may be both useful therapeutically and the component of tobacco smoke that acts to protect against colitis. Since smoking and nicotine have actions on mucosae and mucus in other organs, it is argued that there is a mucus deficiency in ulcerative colitis that smoking acts to reverse.

  11. Gastric ulcer localization: Potential use of in vivo labeling

    SciTech Connect

    Pera, A.; Rose, H.; Seavers, R.; Bekerman, C.; Pinsky, S.

    1984-01-01

    A previous work suggests that sucralfate labeled by binding to Tc-99m HSA permits the visualization of gastric ulcers. Potential problems with this technique are: 1) decreased binding of sucralfate to ulcer sites due to the labeling method of binding to exogenous protein (HSA); 2) overlying activity that may obscure identification of the ulcer. Because of these problems we have examined the possibility of direct in vivo Tc-99m labeling of sucralfate after it has already bound to the ulcer. In vitro studies were done to determine the binding of Tc-99m pertechnetate to sucralfate in the presence of tin in HCl solution at pHs comparable to those found in the stomach. Rapid and efficient labeling was achieved with 75-95% of the label bound to sucralfate at 30 minutes. In vivo studies were performed in rabbits with aspirin induced ulcers and in ulcer free human volunteers. The animal studies confirm that orally administered Tc-99m pertechnetate will bind to previously ingested sucralfate and that the labeled material will bind to the ulcers. Tc-99m pertechnetate was also shown to bind well to previously ingested sucralfate in humans. The results suggest that it is possible to label sucralfate in vivo. This method would offer the following advantages: 1) a simpler labeling procedure; 2) the potential of increased sensitivity by delaying the labeling until much of the sucralfate not bound to ulcer has passed, and thus decreasing the activity that remains in the stomach; and also by leaving the protein binding sites of the sucralfate free to interact with the ulcer since no exogenous protein is involved in labeling.

  12. [Peptic ulcer disease and stress].

    PubMed

    Herszényi, László; Juhász, Márk; Mihály, Emese; Tulassay, Zsolt

    2015-08-30

    The discovery that Helicobacter pylori infection is the major cause of peptic ulcer disease revolutionised our views on the etiology and treatment of the disease. This discovery has tempted many experts to conclude that psychological factors and, specifically, stress are unimportant. However, Helicobacter pylori infection alone does not explain fully the incidence and prevalence of peptic ulcer disease. It has been demonstrated that stress can cause peptic ulcer disease even in the absence of Helicobacter pylori infection, supporting a multicausal model of peptic ulcer etiology. Psychological stress among other risk factors can function as a cofactor with Helicobacter pylori infection.

  13. Hard to heal pressure ulcers (stage III-IV): efficacy of injected activated macrophage suspension (AMS) as compared with standard of care (SOC) treatment controlled trial.

    PubMed

    Zuloff-Shani, Adi; Adunsky, Abraham; Even-Zahav, Aviva; Semo, Haim; Orenstein, Arie; Tamir, Jeremy; Regev, Eli; Shinar, Eilat; Danon, David

    2010-01-01

    The objective of this study was to compare local injections of AMS with SOC treatments for stage III and IV pressure ulcers in elderly patients. It was designed as historically prospective 2-arms non-parallel open controlled trial, and conducted in a department of geriatric medicine and rehabilitation of a university affiliated tertiary hospital. We studied 100 consecutive elderly patients with a total of 216 stage III or IV pressure ulcers, 66 patients were assigned to the AMS group and had their wounds injected, while 38 patients were assigned to the SOC group. Primary outcome was rate of complete wound closure. Time to complete wound closure and 1-year mortality served as secondary outcomes. Statistical analyses were performed at both patient and wound levels. Percentage of completely closed wounds (wound level and patient level) were significantly better (p<0.001/p<0.001, respectively) in all patients in favor of AMS, as well as in the subset of diabetic patients (p<0.001/p<0.001). Similarly, AMS proved significantly better for the subset of those with leg ulcers and with baseline wounds ≤15 cm(2), compared with SOC. There were no statistically significant differences with regard to time to complete closure or 1-year mortality rates in the two groups. It is concluded that there is a significant difference in favor of stage III and IV wound closure rates by AMS, as compared with SOC treatments.

  14. [Treatment of peptic ulcer related to rheumatic diseases].

    PubMed

    Imaeda, Hiroyuki; Ishii, Hiromasa; Goto, Makoto

    2002-08-01

    Rheumatic diseases often have gastrointestinal(GI) manifestations, and may present as GI bleeding and perforation due to peptic ulcer associated with high mortality. Major causes of peptic ulcer related to rheumatic diseases are drugs such as nonsteroidal anti-inflammatory drug(NSAID) and corticosteroid, and vasculitis. The analgesic effects of NSAID often mask abdominal pain until they cause GI bleeding and perforation. Therefore, it is important to make early diagnosis of peptic ulcer with upper gastrointestinal endoscope. Fundamental treatment of NSAID induced peptic ulcer is to quit it, however it is difficult because of activity of rheumatic diseases. Also, most NSAID induced peptic ulcers heal by administration of proton pump inhibitor or misoprostol. Corticosteroid pulse therapy or administration of immunosuppressant agents is effective for vasculitis induced peptic ulcer, however it is difficult to make diagnosis of it. Development of NSAID with less side effects such as cyclooxygenase-2 selective inhibitors and establishment of diagnosis and treatment of peptic ulcer related to rheumatic diseases are expected.

  15. Calf muscle pump impairment and delayed healing of venous leg ulcers: air plethysmographic findings.

    PubMed

    Simka, Marian

    2007-08-01

    There is a need for a diagnostic tool to predict clinical outcome of venous leg ulcer patients, as the prognosis of healing based on clinical data alone has not appeared to be satisfactory. Air plethysmographic assessment of calf muscle pump was performed in the supine and upright position in 129 patients with active ulcers on their legs. All patients were managed in a specialized leg ulcer clinic. Results of air plethysmography were compared to clinical data and time of healing of ulcers. Muscle pump failure was found in 42.6% of extremities (supine position, 33.3%; upright, 22.5%; both, 12.4%). Patients with insufficient pump were older, and their ulcers were larger. Failure of pump was found more often in patients who began the treatment after long, unsuccessful, non-specialized care. Healing time of ulcers was prolonged in cases with insufficient pump. Regarding the subgroups with good clinical prognosis (patients with small ulcers or with a short history of ulceration), it was found that insufficiency of muscle pump correlated with delayed healing. It could be summarized that venous leg ulcers associated with calf muscle failure were larger, long-standing, and that their healing even after specialized treatment was delayed. Impaired muscle pump function revealed in plethysmographic examination can be a prognostic factor of delayed healing of leg ulcer. Ulcers with poor prognosis according to plethysmographic findings, and no quick recovery after standard management, should be considered for advanced therapies.

  16. [Caesarean section for ulcerative colitis].

    PubMed

    Unda-Franco, Eduardo; Ramírez-Avilés, Eva María; Moreno-de Gante, Leonardo; González, Quintín Héctor

    2011-02-01

    We present a case of a 35-year-old patient with diagnosis of ulcerative colitis that presented failure and complications associated with medical treatment; with a report of a colonoscopy and biopsy of pancolitis with severe activity. The patient was submitted to laparoscopic restorative total proctocolectomy with ileal "J" pouch anal anastomosis. Two months later the ileostomy was reversed. The patient received progesterone at the same time she was receiving immunosuppressive drugs. This was suspended two months after the second colon surgery. The patient did not require treatment with ovulation induction to achieve pregnancy. At the fourth month of gestation, the patient developed a perianal abscess, which was successfully drained. After multidisciplinary assessment in week 38 of gestation, it was decided to perform cesarean birth as a way to not affect the ileal pouch and the anastomosis of the digestive tract. At present time, the patient has had no further complications.

  17. The effects of aqueous extract of Aloe vera leaves on the gastric acid secretion and brain and intestinal water content following acetic acid- induced gastric ulcer in male rats

    PubMed Central

    Keshavarzi, Zakieh; Rezapour, Taha Mohammad; Vatanchian, Mehran; Zare Hesari, Mohammad; Nabizade Haghighi, Hadi; Izanlu, Mostafa; Sabaghian, Maryam; Shahveisi, Kaveh

    2014-01-01

    Objective: Gut–brain axis (GBA) is very important in creation and modulation of gastrointestinal problems. Aloe vera gel has gastroprotective properties. The purpose of this study was to evaluate the effect of aqueous extract of Aloe vera leaves on the gastric acid secretion and brain and intestinal water content following acetic acid gastric ulcer induction. Materials and Methods: Gastric ulcer was induced by injection of 20% acetic acid into the subserosal layer in male rats. Rats were randomly assigned into three groups: intact group, gastric ulcer group and Aloe vera group (treatment with Aloe vera following gastric ulcer induction). The acid levels and brain and intestinal water content of each sample were measured eight days after the gastric ulcer induction. Results: Gastric acid levels were significantly decreased in Aloe vera group when compared with gastric ulcer group (p<0.05). However, there were no differences in acid output between gastric ulcer and Aloe vera groups with intact group. After Aloe vera administration, the amount of brain water content had no difference with intact and gastric ulcer groups (p<0.05). The duodenal water content in Aloe vera group was significantly reduced compared with intact group (p<0.05) but gastric ulcer group had no significant difference with intact and Aloe vera group. Conclusions: The administration of Aloe vera has an inhibitory effect on the gastric acid output. PMID:25050311

  18. Duodenocutaneous fistula in rats as a model for "wound healing-therapy" in ulcer healing: the effect of pentadecapeptide BPC 157, L-nitro-arginine methyl ester and L-arginine.

    PubMed

    Skorjanec, S; Kokot, A; Drmic, D; Radic, B; Sever, M; Klicek, R; Kolenc, D; Zenko, A; Lovric Bencic, M; Belosic Halle, Z; Situm, A; Zivanovic Posilovic, G; Masnec, S; Suran, J; Aralica, G; Seiwerth, S; Sikiric, P

    2015-08-01

    While very rarely reported, duodenocutanenous fistula research might alter the duodenal ulcer disease background and therapy. Our research focused on rat duodenocutaneous fistulas, therapy, stable gastric pentadecapeptide BPC 157, an anti-ulcer peptide that healed other fistulas, nitric oxide synthase-substrate L-arginine, and nitric oxide synthase-inhibitor L-nitro-arginine methyl ester (L-NAME). The hypothesis was, duodenal ulcer-healing, like the skin ulcer, using the successful BPC 157, with nitric oxide-system involvement, the "wound healing-therapy", to heal the duodenal ulcer, the fistula-model that recently highlighted gastric and skin ulcer healing. Pressure in the lower esophageal and pyloric sphincters was simultaneously assessed. Duodenocutaneous fistula-rats received BPC 157 (10 μg/kg or 10 ng/kg, intraperitoneally or perorally (in drinking water)), L-NAME (5 mg/kg intraperitoneally), L-arginine (100 mg/kg intraperitoneally) alone and/or together, throughout 21 days. Duodenocutaneous fistula-rats maintained persistent defects, continuous fistula leakage, sphincter failure, mortality rate at 40% until the 4(th) day, all fully counteracted in all BPC 157-rats. The BPC 157-rats experienced rapidly improved complete presentation (maximal volume instilled already at 7(th) day). L-NAME further aggravated the duodenocutaneous fistula-course (mortality at 70% until the 4(th) day); L-arginine was beneficial (no mortality; however, maximal volume instilled not before 21(st) day). L-NAME-worsening was counteracted to the control level with the L-arginine effect, and vice versa, while BPC 157 annulled the L-NAME effects (L-NAME + L-arginine; L-NAME + BPC 157; L-NAME + L-arginine + BPC 157 brought below the level of the control). It is likely that duodenocutaneous fistulas, duodenal/skin defect simultaneous healing, reinstated sphincter function, are a new nitric oxide-system related phenomenon. In conclusion, resolving the duodenocutanenous fistulashealing

  19. The effects of food deprivation, nutritive and non-nutritive feeding and wheel running on gastric stress ulcers in rats.

    PubMed

    Yi, I; Stephan, F K

    1998-01-01

    Feeding and housing conditions that induce gastric lesions were investigated. Rats were housed in activity wheels or in hanging cages and exposed to food deprivation, ad lib cellulose or 6 g of cellulose per day for 5 days. Food-deprived rats in both housing conditions had ulcers in the rumen but many rats also had mucosal ulcers. Cellulose prevented rumenal ulcers but produced a tendency toward more severe mucosal ulcers. Ulcers in wheel-housed rats were somewhat larger but the difference was not significant. In a second experiment, rats were fed 6 g/day laboratory chow or 6 g/day chow + ad lib cellulose until b.wt. reached a preset criterion. On the average, about 10 days on the feeding regimen were required to induce ulcers in these groups. None of the rats had rumenal ulcers. Mucosal ulcers were reliably larger in rats that received cellulose in addition to 6 g of chow. There was no difference in ulcer area between wheel-housed and cage-housed rats. The results indicate that solid bulk, regardless of its caloric value or amount, protects the nonglandular stomach whereas noncaloric bulk tends to aggravate ulcers in the glandular stomach. A small amount of chow delays the rate of b.wt. loss and consequently ulcer formation. Furthermore, wheel running is not necessary to produce mucosal ulcers when food intake is insufficient to maintain b.wt. and b.wt. at sacrifice seems to be a good predictor of ulcer formation.

  20. [Peptic ulcer in children].

    PubMed

    Sawada, Atsushi

    2004-03-01

    H. pylori infection is the main cause of peptic ulcer in children. Japan pediatric H. pylori research meeting made the guideline for diagnosis and eradication therapy for H. pylori. This guideline showed the methods for diagnose and the eradication therapy for children with H. pylori infection. Many pediatric patients have been free from some abdominal symptoms after eradication therapy for H. pylori. However we need endoscopy for diagnose in spite of children. And recently new non-invasive diagnostic devices are developed and some species acquired tolerance for clarithromycin. Therefore we hope that a new guideline for children will be written soon.

  1. Refractory peptic ulcer disease.

    PubMed

    Napolitano, Lena

    2009-06-01

    Refractory PUD is a diagnostic and therapeutic challenge. Optimal management of severe or refractory PUD requires a multidisciplinary team approach, using primary care providers, gastroenterologists, and general surgeons. Medical management has become the cornerstone of therapy. Identification and eradication of H pylori infection combined with acid reduction regimens can heal ulceration and also prevent recurrence. Severe, intractable or recurrent PUD and associated complications mandates a careful and methodical evaluation and management strategy to determine the potential etiologies and necessary treatment (medical or surgical) required.

  2. Vedolizumab for the Treatment of Adults with Moderate-to-Severe Active Ulcerative Colitis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

    PubMed

    Essat, Munira; Tappenden, Paul; Ren, Shijie; Bessey, Alice; Archer, Rachel; Wong, Ruth; Lobo, Alan; Hoque, Sami

    2016-03-01

    As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of vedolizumab (Takeda UK) to submit evidence of the clinical effectiveness and cost effectiveness of vedolizumab for the treatment of patients with moderate-to-severe active ulcerative colitis (UC). The Evidence Review Group (ERG) produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from GEMINI 1, a Phase 3, multicentre, randomised, double-blinded, placebo-controlled study of the induction and maintenance of clinical response and remission by vedolizumab (MLN0002) in patients with moderate-to-severe active UC with an inadequate response to, loss of response to or intolerance of conventional therapy or anti-tumour necrosis factor (TNF)-α. The clinical evidence showed that vedolizumab performed significantly better than placebo in both the induction and maintenance phases. In the post hoc subgroup analyses in patients with or without prior anti-TNF-α therapy, vedolizumab performed better then placebo (p value not reported). In addition, a greater improvement in health-related quality of life was observed in patients treated with vedolizumab, and the frequency and types of adverse events were similar in the vedolizumab and placebo groups, but the evidence was limited to short-term follow-up. There were a number of limitations and uncertainties in the clinical evidence base, which warrants caution in its interpretation--in particular, the post hoc subgroup analyses and high dropout rates in the maintenance phase of GEMINI 1. The company also presented a network meta-analysis of vedolizumab versus other biologic therapies indicated for moderate-to-severe UC. However, the ERG considered that the results presented may have underestimated the uncertainty in treatment effects, since fixed

  3. [Non-surgical therapy for ulcerative colitis].

    PubMed

    Asakura, H; Suzuki, K; Honma, T

    1997-04-01

    Ulcerative colitis involving primarily the mucosa of the colon and rectum is a diffuse and nonspecific inflammatory disease. Immunocompetent cells infiltrating in the inflammed mucosa are mainly lymphocytes, macrophages and neutrophils. These activated cells produce proinflammatory cytokines such as IL-1, IL-6, IL-8 and TNF alpha and inflammatory activators such as PAF, leukotriene, prostaglandins, free radicals and proteases, resulting in acute on chronic states. Non-surgical therapy for ulcerative colitis includes basic medical therapy with sulfasulphapyridine, 5-ASA, corticosteroids and immune suppressive drugs as well as new therapies, which are leukocytapheresis, granulocytapheresis, anticytokine therapy with antiTNF alpha monoclonal antibody, IL-1ra and IL-10, intravenous treatment of massive immunoglobulins and transdermal nicotine therapy.

  4. Intraoperative methods to stage and localize pancreatic and duodenal tumors.

    PubMed

    Norton, J A

    1999-01-01

    Intraoperative methods to stage and localize tumors have dramatically improved. Advances include less invasive methods to obtain comparable results and precise localization of previously occult tumors. The use of new technology including laparoscopy and ultrasound has provided some of these advances, while improved operative techniques have provided others. Laparoscopy with ultrasound has allowed for improved staging of patients with pancreatic cancer and exclusion of patients who are not resectable for cure. We performed laparoscopy with ultrasound on 50 consecutive patients with adenocarcinoma of the pancreas or liver who appeared to have resectable tumors based on preoperative computed tomography. 22 patients (44%) were found to be unresectable because of tumor nodules on the liver and/or peritoneal surfaces or unsuspected distant nodal or liver metastases. The site of disease making the patient unresectable was confirmed by biopsy in each case. Of the 28 remaining patients in whom laparoscopic ultrasound predicted to be resectable for cure, 26 (93%) had all tumor removed. Thus laparoscopy with ultrasound was the best method to select patients for curative surgery. Intraoperative ultrasound (IOUS) has been a critical method to identify insulinomas that are not palpable. Nonpalpable tumors are most commonly in the pancreatic head. Because the pancreatic head is thick and insulinomas are small, of 9 pancreatic head insulinomas only 3 (33%) were palpable. However, IOUS precisely identified each (100%). Others have recommended blind distal pancreatectomy for individuals with insulinoma in whom no tumor can be identified. However, our data suggest that this procedure is contraindicated as these occult tumors are usually within the pancreatic head. Recent series suggest that previously missed gastrinomas are commonly in the duodenum. IOUS is not able to identify these tumors, but other methods can. Of 27 patients with 31 duodenal gastrinomas, palpation identified 19