Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment

Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.     

Normalization of phospholipids concentration of the gastric mucosa was observed in patients with peptic ulcer after eradication of Helicobacter pylori

Background. Phospholipids concentration in the gastric mucosa decreased in patients with Helicobacter pylori infection. The aim of this study is to examine the effects of eradication of H. pylori on decreasing the phospholipids concentration in the gastric mucosa in patients with gastric or duodenal ulcer. Materials and Methods. Phospholipids (phosphatidylcholine, phosphatidylethanolamine, and sphingonomyeline) were measured in biopsy specimens from the antrum and corpus using thin‐layer chromatography. In H. pylori positive patients with gastric ulcer (n = 26) and duodenal ulcer (n = 13), and H. pylori negative controls (n = 20), the biopsy specimens were obtained before and 3 months after eradication. Eradication was performed using lansoprazole, amoxycillin, and clarithromycin. Results. Compared with the H. pylori negative control group, the concentrations of phosphatidylcholine and phosphatidylethanolamine decreased significantly in the gastric ulcer group in both antrum and corpus mucosa, and in the duodenal ulcer group in antrum mucosa. This decrease returned to the control level after eradication. Conclusions. This study demonstrates that the eradication of H. pylori in patients with peptic ulcer normalized the decrease of phosphatidylcholine and phosphatidylethanolamine in the gastric mucosa.     

脊髓高位横断诱发大鼠急性胃溃疡机制的研究

在颈七水平横断大鼠脊髓以诱发急性胃溃疡。结果表明:(1)脊髓横断动物的体温随环境温度而下降,体温的下降可能是诱发溃疡的重要原因之一;(2)注射肾上腺素可减轻溃疡和防止体温下降,且两者均呈剂-效关系;(3)切除肾上腺可使脊髓横断诱发的溃疡明显减轻,如补充注射地塞米松则可使之重新加重,但体温的下降在以上情况下均不受影响;(4)脊髓横断后胃粘膜泌酸和内分泌功能的改变可能与溃疡生成有关。     

A Review of Seasonal Periodicity in Peptic Ulcer Disease

Although several pathogenetic factors have been identified in recent years, the etiology of peptic ulcer disease is yet unknown. During the past few decades several investigators have reported seasonal patterns in peptic and duodenal ulcer disease. A review of the literature reveals vast differences between studies with respect to the type and number of patients selected, diagnostic techniques, the number of examinations and the interval of time between each as well as the method of data analysis. Nevertheless, there is solid evidence to conclude that peptic ulcer disease is lower during the summer than the other seasons of the year. Although many investigators have reported peptic ulcer disease to be more common in the spring and/or autumn, the evidence based on group studies thus far is not persuasive. On the other hand, initial findings on a small sample of patients studied by endoscopy at frequent intervals over at least a one-year period suggest that the season of peptic ulcer disease is a characteristic of each individual patient. Some experience recurrence of disease only in the spring while others experience such only in the autumn. Studies utilizing protocols which call for frequent endoscopic examination at regular (3-month or less) intervals for at least a one-year period are likely to clarify aspects of the seasonality of peptic ulcer disease.     

A Review of Seasonal Periodicity in Peptic Ulcer Disease

Although several pathogenetic factors have been identified in recent years, the etiology of peptic ulcer disease is yet unknown. During the past few decades several investigators have reported seasonal patterns in peptic and duodenal ulcer disease. A review of the literature reveals vast differences between studies with respect to the type and number of patients selected, diagnostic techniques, the number of examinations and the interval of time between each as well as the method of data analysis. Nevertheless, there is solid evidence to conclude that peptic ulcer disease is lower during the summer than the other seasons of the year. Although many investigators have reported peptic ulcer disease to be more common in the spring and/or autumn, the evidence based on group studies thus far is not persuasive. On the other hand, initial findings on a small sample of patients studied by endoscopy at frequent intervals over at least a one-year period suggest that the season of peptic ulcer disease is a characteristic of each individual patient. Some experience recurrence of disease only in the spring while others experience such only in the autumn. Studies utilizing protocols which call for frequent endoscopic examination at regular (3-month or less) intervals for at least a one-year period are likely to clarify aspects of the seasonality of peptic ulcer disease.     

Genetic and evolutionary implications in peptic ulcer disease

The evidence for a genetic component in peptic ulcer disease has been based on twin, family, and blood group studies. A polygenic model for the inheritance of peptic ulcers has been displaced by a genetic heterogeneity model based on several lines of evidence, some of the most powerful being recent work using subclinical markers. One marker in particular, an elevated level of serum pepsinogen I (PG I), a pepsin precursor produced by the gastric mucosa, secreted into the stomach lumen and also appearing in the bloodstream, has been found to be associated with a subgroup of duodenal ulcer patients. Segregation analysis of elevated serum PG I in duodenal ulcer sibships demonstrates familial aggregation consistent with autosomal dominant inheritance. Elevated PG I is also accompanied by gastric hyperacidity and presumably indicates those individuals with an increased mass of chief and parietal cells, and thus an increased capacity for peptic activity, an important element in the pathogenesis of ulcer disease. An evolutionary hypothesis based on selection for peptic activity and acidity is offered to explain several of the epidemiologic and genetic elements of this group of chronic diseases.     

胃溃疡对大鼠胃中HAP1表达的影响

建立冰乙酸性大鼠胃溃疡模型,采用ABC法进行免疫组织化学染色,观察并探讨胃溃疡对胃壁中HAP1(huntingtin as-soc iated protein 1,HAP1)表达的影响。结果溃疡组大鼠胃壁中HAP1阳性细胞数目及光密度与正常进食的大鼠相比显著增多。     

Protective and therapeutic effects of resveratrol on acetic acid-induced gastric ulcer

Sprague Dawley rats of both sexes were injected with either saline or RVT (10 mg/kg) either before or after acetic acid ulcer induction and decapitated 3, 5 or 10 days after ulcer. In the saline-treated ulcer groups, macroscopically evident ulcers were observed, while RVT-pretreated or RVT-treated groups had lower macroscopic ulcer scores. Likewise, the microscopic damage scores were lower for the RVT-administered groups. Gastric myeloperoxidase activity, malondialdehyde, collagen and tumour necrosis factor-alpha levels, as well as luminol- and lucigenin-enhanced chemiluminescence levels that were elevated in the saline-administered ulcer groups, were depressed with both RVT-pretreatment and RVT-treatment. Moreover, depleted glutathione levels in the ulcer groups were increased back to control levels by both pre- and post-treatments of RVT. Results demonstrate that resveratrol has both protective and therapeutic effects on oxidative gastric damage by suppressing pro-inflammatory cascades, including the activation of pro-inflammatory cytokines, accumulation of neutrophils and release of oxygen-derived free radicals.     

GABA对乙醇诱导型胃溃疡的影响及其机制分析

小白鼠脑室注射不同浓度GABA(2、4、6μmol)对乙醇诱导型胃溃疡有显著的促进作用,且有明显的剂量-效应关系。腹腔注射GABA(100μmol)则对乙醇诱导型胃溃疡没有影响;阿托品(s.c.0.2mg/kg)使溃疡明显加重,阿托品(s.c.0.2mg/kg)加GABA(i.c.v.4μmol)使溃疡比单独注射GABA时减轻41％;酚妥拉明(i.m.2.5mg/kg)对溃疡发生没有影响,酚妥拉明(i.m.2.5mg/kg)加GABA(i.c.v.4μmol)不改变单独注射GABA时的促溃疡效应。以上结果提示,外源性GABA通过中枢机制可加剧乙醇诱导型胃溃疡的发生;迷走神经可能在胃的自身保护机制中起重要调节作用,而交感神经可能无作用;中枢GABA并不通过交感神经,而可能通过迷走神经及其它途径加剧了乙醇诱导型胃溃疡的发生。     

消化性溃疡与幽门螺杆菌关系的内窥镜探查

目的:探讨幽门螺杆菌(Hp)与消化性溃疡(PU)的关系。方法:检测167例PU患者Hp阳性率,使用胃镜观察溃疡形态、大小和部位。结果:167例PU患者Hp阳性检出率为87.43%,胃溃直径大于1.5 cm者与,胃溃直径小于0.5cm,溃疡处于活动期者与愈合期和瘢痕期者,Hp阳性检出率有显著差异(P<0.05)。结论:Hp感染与溃疡的发生有密切关系,溃疡患者病情越重,Hp感染程度越高,但Hp阳性溃疡并不加重消化道出血现象发生。     

胃超声造影剂法对上消化道溃疡的诊断

目的：应用胃超声造影剂检测上消化溃疡。方法：采用“胃窗－８５超声造影剂化水量５００毫升口服后进行超声检查。结果：５６例超声检获胃溃疡２０例,十二指肠溃疡３６例。经手术病理,胃镜证实胃溃疡１７例,十二指肠溃疡３１例,Ｂ超误诊８例。Ｂ超诊断符合率分别赤８５％;８６％。结论：胃超声造影检查对上消化溃疡一定诊断价值     

四联疗法治疗幽门螺杆菌阳性胃溃疡的疗效观察

目的：观察埃索美拉唑联合瑞巴派特、阿莫西林、克拉霉素治疗幽门螺杆菌阳性胃溃疡临床疗效。方法：60例确诊的Hp阳性胃溃疡患者随机分为对照组（30例）和治疗组（30例）,其中对照组患者给予奥美拉唑＋阿莫西林＋克拉霉素三联法治疗,实验组给予埃索美拉唑＋瑞巴派特＋阿莫西林＋克拉霉素四联法治疗。观察比较两组患者临床症状缓解情况,溃疡愈合率、Hp根除率及溃疡复发率。结果：①经过治疗,所有患者腹痛、腹胀、反酸、暧气等临床症状积分均显著降低（P〈0.01）,且治疗组下降程度大于对照组,两组间差异有统计学意义（P〈0.05）。②治疗组患者痊愈率为60.00%、总有效率为93.33%,明显高于对照组痊愈率（43.33%）和总有效率（80.00%）,两组间差异有统计学意义（P〈0.05）。③治疗组S2期获得率、溃疡愈合率和Hp根除率分别为93.33%、96.67%和93.33%,显著高于对照组60.00%的S2期获得率、70.00%的愈合率和83.33%的根除率（P〈0.01或0.05）。④随访1年后,治疗组患者溃疡复发率为11.54%,与对照组32.00%的复发率比较差异有显著性（P〈0.05）。结论：四联疗法治疗幽门螺杆菌阳性胃溃疡可有效缓解患者临床症状,提高溃疡愈合质量,根除Hp感染,减少复发,效果优于三联疗法。     

Critical effect of Helicobacter pylori infection on the effectiveness of omeprazole for prevention of gastric or duodenal ulcers among chronic NSAID users

Background. The recently reported OMNIUM and ASTRONAUT NSAID ulcer prevention trials using omeprazole to prevent endoscopic ulcer recurrence among chronic NSAID users suggested superiority over misoprostol or ranitidine. Aim. To test the hypothesis the results from the OMNIUM and ASTRONAUT studies would not be generalizible as ulcer healing and ulcer recurrence would differ in relation to Helicobacter pylori status. Methods. The data regarding H. pylori status were made available by AstraZenca allowing separate analysis of the outcome of those with NASID ulcers (i.e. without H. pylori infection) and those NSAID use was complicated with the presence of an active H. pylori infection. Results. Reanalysis confirmed that omeprazole was superior to placebo for the prevention of ulcer recurrence in chronic NSAID users. However, overall omeprazole was not significantly better than the subtherapeutic dose (400 µg/day) of misoprostol (14.5% vs. 19.6%, respectively, p = .93); 400 µg of misoprostol was actually superior to omeprazole for the prevention of gastric ulcers among those NSAID ulcers (8.2% vs. 16.6% for misoprostol and omeprazole, respectively; p < .05). Omeprazole was also not statistically different from misoprostol for gastric ulcer prevention in those whose NSAID use was complicated by an active H. pylori infection. Omeprazole was not significantly different from 300 mg of ranitidine for the prevention of NSAID gastric ulcers (14.6% vs. 11.6%, respectively, p = .56). Duodenal ulcers were over represented among H. pylori infected NSAID users and duodenal ulcer prevention was more sensitive to acid suppression than gastric ulcer. Conclusion. The OMNIUM and ASTRONAUT trials may have provided an unrealistic sense of security regarding the effectiveness of omeprazole for protection against ulcer recurrence in chronic NSAID users.     

Glutathione system of erythrocyte and plasma in peptic ulcer

A complex study of the blood glutathione system has been carried out for the first time in patients with peptic (gastric and duodenal) ulcer. In erythrocytes and blood plasma of patients with the complicated peptic ulcer and postgastroresection syndromes there was the increase of conjugated dienes (and in the second group the increase in antioxidant activity). Under these conditions the main change was the sharp and identical decrease in glutathione peroxidase activity. In patients with uncomplicated peptic ulcer there was sharp increase in erythrocite and plasma glutathione reductase activity and plasma GSH. In operated but basically healthy patients plasma glutathione peroxidase remained decreased but plasma GSH sharply increased. Evidently complicated peptic ulcer is characterized by decreased functioning of the glutathione system. Activation of this system and the decrease or disappearance of manifestations of oxidative stress are associated with a favorable course of this disease, especially at uncomplicated peptic ulcer. The revealed changes significantly differ from those observed in patients with viral hepatitis, blle excretory diseases and strokes.     

A possible role for inducible arginase isoform (AI) in the pathogenesis of chronic venous leg ulcer

Chronic venous ulcer (CVU) is a major cause of chronic wounds of lower extremities and presents a significant financial and resource burden to health care systems worldwide. Defects in the vasculature, matrix deposition, and re-epithelialization are the main histopathological changes believed to impede healing. Supplementation of the amino acid arginine that plays a crucial role in the interactions that occur during inflammation and wound healing was proven clinically to improve acute wound healing probably through enhancing activity of inducible arginase (AI) locally in the wounds. However, the possible mechanism of arginine action and the potential beneficial effects of AI/arginine in human chronic wounds remain unclear. In the present study, using biopsies, taken under local anesthesia, from adult patients (n = 12, mean age 55 years old) with CVUs in lower extremities, we investigated the correlation between AI distribution in CVUs and the histopathological changes, mainly proliferative and vascular changes. Our results show a distinct spatial distribution of AI along the ulcer in the epidermis and in the dermis with the highest level of expression being at the ulcer edge and the least expression towards the ulcer base. The AI cellular immunoreactivity, enzymatic activity, and protein levels were significantly increased towards the ulcer edge. Interestingly, a similar pattern of expression was encountered in the proliferative and the vascular changes with strong correlations between AI and the proliferative activity and vascular changes. Furthermore, AI cellular distribution was associated with increased proliferative activity, inflammation, and vascular changes. Our findings of differential expression of AI along the CVU base, edge, and nearby surrounding skin and its associations with increased proliferative activity and vascular changes provide further support to the AI implication in CVU pathogenesis. The presence of high levels of AI in the epidermis of chronic wounds may serve as a molecular marker of impaired healing and may provide future targets for therapeutic intervention.     

蛇伤性溃疡中西医结合高压氧治疗的体会

目的总结中西医结合高压氧治疗蛇伤性溃疡的临床疗效。方法对我院收治的27例蛇伤性溃疡患者在全身支持治疗、伤口局部清创、外用及湿敷中药治疗外,并给予高压氧治疗。结果 27例蛇伤性溃疡患者均治愈出院,治愈率100%。结论中西医结合高压氧治疗蛇伤性溃疡的疗效确切,值得临床借鉴及推广。     

中医药治疗胃溃疡的特色

胃溃疡是临床常见但十分棘手的消化系统疾病,主要临床表现为长期性、周期性、节律性上腹部疼痛。现代治疗多采用西医治疗,效果显著,但复发率高、不良反应较大。大量研究表明,祖国医学对治疗胃溃疡具有独特的优势,且在临床上取得了良好的疗效,尤其是大大降低了胃溃疡的复发率。关于中医药治疗胃溃疡的方式非常成熟且规范全面,主要包括辨证论治、专方加减、专药治疗、其他中医治法等,说明中医药治疗胃溃疡具有一定的特色及广阔的前景,同时也面临一些问题,需要医务人员共同思考并解决。现将中医药治疗胃溃疡的现状概述如下。     

颌下腺表皮生长因子促进大鼠胃粘膜损伤的愈合

用免疫组织化学方法观察到雄性大鼠颌下腺有非常丰富的表皮生长因子样免疫活性物质,并且主要位于导管细胞中,颌下腺摘除使血清尤其是胃液ＥＧＦ水平显著降低,直至手术后第２８天仍然维持在较低水平。利用颌下腺摘除术清内源性ＥＧＦ后,冰乙酸涂抹造成的慢性胃溃疡愈合速度较假手术大鼠明显减慢,而补充相应剂量的外源性ＥＧＦ可使颌下腺摘除大鼠的溃疡愈合速度恢复到与假手术组引当水平。上述结果显示,颌下腺及其分泌的ＥＧＦ对     

Management of recurrent apthous ulcer using Corticosteroids,Local anesthetics and nutritional supplements

Recurrent Aphthous ulcers are the most common oral lesions among dental patients. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. Therefore, it is of interest to report data on the management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Case sheets of 76 patients who underwent treatment for recurrent aphthous ulcer between June 2019 and March 2020 at the Saveetha Dental College, India were used in this analysis. Data was analyzed using Chi square test at a P value < 0.05 that is statistically significant. Results show that topical anaesthetics in population (49%) were more effective that corticosteroids. Thus, topical anaesthetics are recommended for recurrent aphthous ulcer.     

川木香对实验性胃溃疡形成的抑制作用研究

目的:研究川木香对实验性胃溃疡形成的抑制作用.方法:采用利血平型小鼠胃溃疡模型、醋酸型大鼠胃溃疡模型,以雷尼替丁为对照药物,观察动物溃疡指数和溃疡抑制率.结果:川木香单体提取物(去氢木香内酯)、醋酸乙酯提取物、乙醇提取物,抑制利血平型溃疡存在统计学差异(与模型对照组比较,P＜0.01);醋酸乙酯提取物,抑制醋酸型溃疡存在统计学差异(与模型对照组比较,P＜0.05),其中高剂量组作用存在统计学差异(与模型对照组比较,P＜0.01).结论:川木香具有抑制实验性胃溃疡的形成作用,醋酸乙酯提取物可以作为川木香抑制胃溃疡形成的有效部位.