Coexistent Coccidioidomycosis of the Meninges and Pulmonary Cavitation Due to Coccidioides

A clinical study was undertaken to evaluate the effectiveness of concentrated cabbage juice in the treatment of peptic ulcers. Patients at San Quentin Prison with a diagnosed ulcer crater were treated in a double blind control experiment. They were given either concentrated cabbage juice or placebo facsimile. The evaluation of the merit of this treatment was based upon repeated x-ray examinations of the ulcer crater. A period of 22 days was allowed for ulcer crater healing time.The results of this experiment indicated concentrated cabbage juice to be effective in healing of peptic ulcer.     

RAPID HEALING OF PEPTIC ULCERS IN PATIENTS RECEIVING FRESH CABBAGE JUICE

Thirteen patients with peptic ulcer were treated with fresh cabbage juice, which, experiments have indicated, contains an antipeptic ulcer factor. This factor (vitamin U) prevents the development of histamin-induced peptic ulcers in guinea pigs.The average crater healing time for seven of these patients who had duodenal ulcer was only 10.4 days, while the average time as reported in the literature, in 62 patients treated by standard therapy, was 37 days.The average crater healing time for six patients with gastric ulcer treated with cabbage juice was only 7.3 days, compared with 42 days, as reported in the literature, for six patients treated by standard therapy.The rapid healing of peptic ulcers observed radiologically and gastroscopically in 13 patients treated with fresh cabbage juice indicates that the anti-peptic ulcer dietary factor may play an important role in the genesis of peptic ulcer in man.     

VITAMIN U THERAPY OF PEPTIC ULCER

Vitamin U, administered as raw cabbage juice to 100 patients with peptic ulcer, was apparently effective in promoting the rapid healing of uncomplicated peptic ulcers. The evidence of therapeutic benefit was (1) the rapid relief of the symptom, pain, without the use of any set plan of symptomatic treatment, and (2) ulcer crater healing time (determined roentgenographically) considerably shorter than in groups of cases, reported in the literature, in which “standard” types of diet and drug therapy were employed.     

Helicobacter pylori and peptic ulcer disease.

Medical therapy for duodenal or gastric ulcer disease has traditionally involved gastric acid antisecretory therapy for 4 to 8 weeks to promote initial healing and indefinitely to prevent recurrences of ulcer. The discovery of Helicobacter pylori in most patients with peptic ulcer disease has led to a change in this approach. Therapy designed to eradicate H pylori may facilitate ulcer healing with acid antisecretory agents and, more important, may greatly reduce the incidence of ulcer recurrence, obviating the need for maintenance antisecretory therapy. Regimens designed to eradicate H pylori are difficult to comply with, however, and are associated with adverse effects in some patients. In this article we review the diagnosis and treatment of H pylori infection in patients with peptic ulcer disease and make recommendations regarding the use of conventional ulcer therapies and therapies designed to eradicate H pylori.     

Effect of histamine H2-receptor antagonist therapy on the mutagenic activity of gastric juice

There is concern at present that treatment with histamine H2-receptor antagonists might promote the development of gastric cancer by producing conditions which favour intragastric formation of N-nitroso compounds. If H2-receptor antagonist therapy causes increased intragastric levels of N-nitroso compounds, an issue not yet resolved by analytical studies, corresponding changes in the mutagenic activity of gastric juice might be anticipated. In this study mutagenic activity and pH were measured in fasting gastric aspirate from 18 peptic ulcer patients before and during the final week of therapy with ranitidine (n = 10) or cimetidine (n = 8). Mutagenic activity was assessed using Salmonella typhimurium TA98 and TA100 in a modified pre-incubation "fluctuation" test. No significant change in mutagenic activity was detected after therapy. Of 15 patients found to have significant mutagenic activity in their fasting gastric juice before treatment, 14 remained mutagenic following treatment. Mutation frequencies (sum of positive wells in duplicate 96-well microtitre plates, mean +/- SD) for TA98 and TA100 were respectively, 20 +/- 34 and 100 +/- 64 before compared with 10 +/- 6 and 102 +/- 65 after therapy (p greater than 0.05). Changes in mutagenic activity were similar in both treatment groups and unrelated to duration of therapy, changes in gastric pH or ulcer healing. In vitro, neither cimetidine in aqueous solution, nor gastric juice preincubated with cimetidine showed significant mutagenic activity. These results provide no evidence that increased intragastric levels of genotoxic chemicals, such as N-nitroso compounds, occur during H2-receptor antagonist therapy.     

Current Strategies in Ulcer Management with Special Reference to the Use of Antibiotics

Antibiotics, commonly amoxycillin, tetracycline, metronidazole and clarithromycin, are presently used in combination with anti-ulcer agents such as omeprazole, colloidal bismuth subcitrate, and sucralfate to treat Helicobacter pylori infection in patients with peptic ulcer, and compelling evidence has accumulated that eradication of the organism prevents duodenal ulcer relapse. The latest combination (MACH I) involved omeprazole, amoxycillin or metronidazole, and clarithromycin and claimed 90-96 percent success in H. pylori eradication. While the eradication rates of the bacteria are usually between 60-80 percent, the healing rates of duodenal ulcer using these regimens have been remarkably high, often over 90 percent, even with regimens that do not contain proton-pump inhibitors. Antibiotics alone, such as furazolidone and metronidazole, have been reported to heal peptic ulcer with various successes. In a recent double-blind placebo-controlled study, we showed that antibiotics alone, in the form of metronidazole, amoxycillin and clarithromycin, effectively healed 92.5 percent of patients with duodenal ulcer, and that the healing was largely accountable by clearance of H. pylori. Thus, the present day evidence indicates that both healing and prevention of relapse of peptic ulcer can be achieved by treatment of H. pylori. Metronidazole resistance is emerging rapidly, especially in Asia, and is likely to affect eradication success. At this point in time, the best regimen for peptic ulcer associated with H. pylori includes the use of a proton-pump inhibitor plus two antibiotics for one to two weeks.     

Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction

Background. At present, the prevalence of Helicobacter pylori ( H. pylori ) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up.
Patients and Methods. Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization.
Results. The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7–24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11.1%). The mean time to ulcer recurrence was 17 months (range, 10–24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients.
Conclusion. We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.     

A method of inducing chronic gastric and duodenal ulcer by electrocoagulation in rats

The described method includes electrocoagulation of the serous membrane of the stomach or duodenum by means of surgical diathermy. Under Nembutal general anaesthesia laparotomy was done and a ball-tip electrode was applied to the exposed anterior wall of the stomach or duodenal bulb. At the site of its contact with the serosa coagulation developed visible as a white spot approximately the size of the electrode tip. The ulcerogenic process triggered in this way developed within three days after the procedure. A deep ulcer in the mucosa developing during that time assumed in the second week the shape of a crater. From that time on ulcer healing began and progressed as evidenced by gradual diminution of its size. Complete healing of an untreated ulcer occurred in most animals after about five weeks. The extent of the ulcer niche was determined under a stereoscopic microscope calculating its area in mm2. A comparison of ulcer area in the animals treated with drugs inducing ulcer healing with this area in control rats made possible quantitative evaluation of the therapeutic effect.     

益生菌对幽门螺杆菌阳性消化性溃疡治疗有效性的Meta分析

目的 探讨益生菌+H.pylori标准疗法对消化性溃疡患者H.pylori感染的根除率与安全性。 方法 计算机检索2019年3月20日以前公开发表的中英文数据库文献(知网数据库、万方数据库、EMBASE数据库、MEDLINE数据库以及PubMed数据库等),借助RevMan 5.2软件分析与评价相关数据。 结果 检索符合条件研究文献共11篇。Meta分析证实,益生菌+H.pylori标准治疗方案可以有效提高H.pylori根除率(OR=2.94,P结论 益生菌+H.pylori标准疗法对消化性溃疡患者H.pylori感染的根除率以及溃疡愈合好转率均有提升,并显著降低不良反应发生率,具备临床推广价值。     

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.     

四联疗法和序贯疗法治疗服用非甾体类消炎药人群幽门螺杆菌感染的临 床对照研究

目的:对比四联疗法和序贯疗法对根除服用非甾体类消炎药(NSAID)人群幽门螺杆菌(Hp),改善其消化道不良症状及促进消化性溃疡愈合的临床效果。方法:对有消化不良症状的服用非甾体类消炎药物患者行胃镜检查、快速尿激酶及13C呼气试验检查,将155例幽门螺杆菌阳性合并有慢性胃炎或消化性溃疡患者作为研究对象,随机分为两组,A组采用四联疗法,B组采用序贯疗法。A组予雷贝拉唑+克拉霉素+阿莫西林+枸橼酸铋钾治疗10天;B组前5天予雷贝拉唑+阿莫西林,后5天予雷贝拉唑+克拉霉素+甲硝唑。治疗结束后,予雷贝拉唑和胃黏膜保护剂治疗8周。停药4周后,复查胃镜、13C呼气试验,观察和比较两组Hp根除率、消化不良症状缓解率及溃疡愈合率。结果:A、B两组Hp根除率分别为(ITT分析:86.7%和81.9%;PP分析:87.8%和84.3%);症状缓解率为(81.9%对79.2%);胃溃疡愈合率为(68.8%对66.7%),十二指肠球部溃疡的愈合率为(68.2%对70.0%),两组患者间Hp根除率、症状缓解率及溃疡愈合率比较均未见明显统计学差异(P>0.05)。四联疗法组和序贯疗法组不良反应的发生率分别为4.9%和4.3%。两组比较无明显差异(P>0.05)。结论:四联疗法和序贯疗法对长期服用非甾体类消炎药物人群的Hp根除疗效、消化不良症状的缓解及促进溃疡愈合的治疗作用均无明显差异。     

Homeostasis of the gastric mucosa and blood circulation. 2. Role of ischemia in disruption of the gastric mucosa

To date there is a lot of data of literature indicating that microcirculatory disorders play the main role in the development of gastric mucosal damages induced by stress, ethanol, nonsteroidal antiinflammatory drugs and tobacco smoke. Under stress gastric mucosal blood flow disorders may be caused by the actication of sympathetic nervous system. Ulcer healing is accompanied by the angiogenesis and by the increase of blood flow in the ulcer border and tissues surrounding the ulcer. Therefore now the main studies are concentrated on the search of defence-enhancing agent rather than drugs for antisecretory therapy. Therapeutic strategy suggests the use of some potential vasodilators such as NO donors, prostaglandin analogues, oxygen radical scavengers, endothelin, leukotrienes, platelet-activating factor antagonists and/or their synthesis inhibitors. At present, the therapeutic possibilities seem to be restricted and nothing indicates that stimulation of the defensive factor only, is more effective in the treatment of peptic ulcer than inhibition of aggressive factors. However we suggest that blood flow correction may be very important for the treatment of refractory ulcers or for prophylaxis of stress ulceration and peptic ulcer recurrence.     

Effect of intermittent normobaric hypoxia on gastric and duodenal mucosa in man]

Clinical and laboratory examinations of 11 patients with peptic ulcer have shown that combined treatment using sessions of intermittent normobaric hypoxytherapy (10% of oxygen in 90% of nitrogen, length of respiration is 7 min., respiration of free air 3 min., such 6 cycles for 1 hour) promotes healing of ulcers, decreases dyspepsic and astheno-neurotic symptoms of disease. The method can be recommended for treating the patients with peptic ulcer and for preventing seasonal acute attacks in patients with relapses of this disease.     

Incidence of peptic ulcer disease in Gothenburg, 1985.

OBJECTIVE--To determine the incidence and age distribution of peptic ulcer disease in adults in Gothenburg. DESIGN--Retrospective study of patients with symptoms over one year. SETTING--All gastroenterology and x ray departments. PATIENTS--Any patient found to have an active ulcer crater during 1985. MAIN OUTCOME MEASURES--Sex, age, past history of gastrointestinal ulcers, and smoking habit. RESULTS--In 1985, 1402 peptic ulcers were diagnosed in 1137 adults. Over half (403; 54%) of the ulcers in men and 393 (60%) ulcers in women were in patients aged over 60. All types of ulcer showed increasing incidence with age. The sex ratio of patients aged 40-50 with peptic ulcers was 1:1. Nearly half (109; 48%) of ulcers diagnosed for the first time in men and 129 (57%) of such ulcers in women were in patients aged over 60. Elderly men and women were also more likely to develop haemorrhage. CONCLUSIONS--In Gothenburg there is a surprisingly high incidence of peptic ulcer disease, which increases considerably with age, possibly explained by the availability of modern diagnostic techniques as 1121 (80%) ulcers had been diagnosed by gastroscopy. Compared with earlier studies there was no difference in the incidence between men and women aged 40-50.     

益生菌联合抗幽门螺杆菌治疗对消化性溃疡患者的疗效

目的 探讨益生菌联合抗幽门螺杆菌（H. pylori）治疗对消化性溃疡患者的疗效及其对患者肠道菌群的影响。方法 将120例经14C呼气试验（14C-UBT）检测确定为H. pylori感染阳性的消化性溃疡患者随机分为观察组和对照组,每组60例。其中,对照组采用四联疗法（奥美拉唑+阿莫西林+克拉霉素+铋剂）治疗,观察组采用四联疗法联合益生菌治疗;比较两组患者H. pylori根除情况、溃疡愈合质量及不良反应情况。治疗前后留取全部患者的新鲜粪便标本进行细菌培养,比较两组患者肠道菌群数量和肠道微生物定植抗力（B/E值）。结果 观察组患者H. pylori根除率和溃疡愈合率分别为88.3%、95.0%,显著高于对照组的70.0%和76.7%（P＜0.05）,不良反应率为3.3%,显著低于对照组的20.0%（P＜0.05）。与治疗前比,对照组患者治疗后肠道内产气荚膜梭菌、双歧杆菌及乳杆菌数量显著减少（P＜0.05）,肠杆菌、肠球菌及酵母菌数量显著增加（P＜0.05）,B/E值显著降低（P＜0.05）;观察组患者治疗后双歧杆菌和乳杆菌均显著增加（P＜0.05）,产气荚膜梭菌显著减少（P＜0.05）,肠杆菌、肠球菌及酵母菌无明显变化（P＞0.05）,B/E值显著升高（P＜0.05）。结论 常规抗H. pylori治疗易引起消化性溃疡患者肠道菌群紊乱,降低肠道定植抗力。益生菌联合治疗可有效改善患者肠道微生态,提高H. pylori根除率和溃疡愈合质量,减少不良反应。     

Progress with proton pump inhibition.

The proton pump, a H+/K(+)-ATPase located on the secretory canalicular membrane of the parietal cell, forms the final pathway for gastric acid secretion. Omeprazole is concentrated in the secretory canaliculus, where it is converted to its active form, which binds covalently with the H+/K(+)-ATPase, thus inhibiting acid secretion arising from any stimulus. Meta-analysis has defined the primary determinants for peptic ulcer healing as the degree of acid suppression, the duration of suppression over 24 hours, and the length of treatment. The longer duration of acid suppression with omeprazole, particularly during the day, when food is ingested and H2-receptor antagonists are less effective, is reflected in the clinical superiority for symptom relief and ulcer healing and especially for the treatment of erosive esophagitis. Extensive clinical experience has proved omeprazole to be safe, and concerns over hypergastrinemia, ECL-cell hyperplasia, and carcinoid formation have not been substantiated in humans. Recent evidence has shown that omeprazole suppresses Helicobacter pylori and, in combination with antibiotics, can eradicate this organism in a substantial proportion of patients. This effect may result from enhancement of antibiotic bioavailability and optimizing host defense mechanisms.     

胆汁反流性胃炎134例临床分析

目的：探讨胆汁反流性胃炎的病因及其临床治疗效果。方法i回顾性性分析134例反流性胃炎患者的临床症状、胃镜检查、幽门螺杆菌（Hp）检测和治疗结果。结果：胆汁反流性胃炎的主要由胃切除手术、胆结石、胆囊炎、糖尿病、消化性溃疡、肝炎、肝硬化、消化道肿瘤和胰腺炎等诱发,但Hp感染率并不高,134例均在四周内治愈。结论：胆汁反流性胃炎是胆汁、胰液和肠液等反流入胃引起的胃黏膜损害造成,治疗上要以减少反流物的损害作用和改善胃肠动力为主。     

Comparison of the results of the treatment with pirenzepine combined with cimetidine and sucralfate of stomach ulcer resistant to cimetidine

Increased inhibition of gastric acid release through simultaneous blockade of H2-receptors and muscarine-receptors or administration of gastroprotective agent is theoretically justified in patients with peptic ulcer unresponsive to cimetidine. The study involved 70 patients with peptic ulcer previously treated with cimetidine in daily dose 1000 mg for 6 weeks without an effect. Patients were divided into two groups: group 1 treated with cimetidine plus pirenzepine, and group 2 given sucralfate in daily dose 4.0 g. Pirenzepine to patients of group 1 was given in a single dose of 50 mg before bedtime. Both groups were comparable in age, sex, disease onset, smoking, gastric acid secretion, and ulcer size. Healing was evaluated with endoscopic technique following 2 and weeks of therapy. Ulceration healed up within 2 weeks in 40% of patients treated with cimetidine combined with pirenzepine and in 31.4% patients treated with sucralfate. After 4 weeks, healing of ulceration was 71.4% and 68.6%, respectively. Large ulcers (over 1 cm in diameter) and previous partial gastrectomy did not affect healing rate. The obtained results suggest that administered therapies enable recovery in over 2/3 of patients with peptic ulcer unresponsive to a 6-week therapy with cimetidine alone.     

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     

尖顶羊肚菌菌丝体水提液对实验型胃溃疡的作用

研究尖顶羊肚菌菌丝体水提液对4种实验型胃溃疡模型的治疗作用。以大鼠幽门结扎致胃溃疡为模型,测定各组胃粘膜损伤指数、胃液分泌量和胃酸浓度;以大鼠乙酸烧灼、小鼠乙醇致胃粘膜损伤和小鼠水浸应激胃溃疡为模型,分别测定溃疡面积。结果表明尖顶羊肚菌菌丝体水提液可以不同程度抑制胃酸的分泌,减少胃液量,减少溃疡面积,促进溃疡面积的愈合,因此尖顶羊肚菌菌丝体水提液具有抗实验型胃溃疡的作用。