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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis made at the polyclinics and at the gastroenterology clinic were studied and compared. There were 2515 patients admitted to or discharged from hospital with a diagnosis of peptic ulcer. In gastric ulcer (630 patients), the erroneous diagnoses accounted for 24.8 +/- 1.1% including 7.7 +/- 0.7% of cases undiagnosed at the polyclinics and 17.0 +/- 1.0% of cases with an overdiagnosis. In duodenal ulcer, the respective figures were 15.1 +/- 0.6, 5.7 +/- 0.4 and 9.3 +/- 0.5%. The level of gastric ulcer diagnosis was lower than that of duodenal ulcer (p less than 0.01), the rate of overdiagnoses in both cases was, respectively 2.2- and 1.6-fold higher than that of underdiagnoses. The erroneous diagnoses mostly fall within faulty ulcer localization, chronic gastritis, chronic duodenitis, and chronic biliary diseases. Three groups of factors were distinguished among the causes of errors in the diagnosis of peptic ulcer: underestimation by the physicians of the pathomorphism and changed symptomatology; erroneous assessment of the disease history and examination data; not taking into sufficient account of the disease course determined by the sex, age and polymorbidity of the today's patient. The causes of errors were not infrequently found to go together.
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PMID:[Errors in the diagnosis of peptic ulcer]. 205 3

Despite extensive research, the etiology of peptic ulcer disease remains unclear. Given the multiple processes that control acid and pepsin secretion and defense and repair of the gastroduodenal mucosa, it is likely that the cause of ulceration differs between individuals. Acid and pepsin appear to be necessary but not sufficient ingredients in the ulcerative process. It is clear that the majority of gastric ulcers and a substantial number of duodenal ulcers do not have increased gastric acid secretion. Recent research has focused more on protection and repair of the stomach and duodenum. NSAIDs cause a significant number of gastric and duodenal ulcers; this is probably due to inhibition of prostaglandin production with loss of its protective effects. In the absence of NSAIDs and gastrinoma, it appears that most gastric ulcers and all duodenal ulcers occur in the setting of H. pylori infection. Evidence is mounting in support of H. pylori as a necessary ingredient in the ulcerative process, similar to acid and pepsin. It is not known whether the bacteria or the accompanying inflammation is the more important factor in the pathophysiology. Although the pathophysiology of gastric ulcer and duodenal ulcer is similar, there are clearly differences between the two groups. Duodenal ulcer is typified by H. pylori infection and duodenitis and in many cases impaired duodenal bicarbonate secretion in the face of moderate increases in acid and peptic activity. These facts suggest the following process: increased peptic activity coupled with decreased duodenal buffering capacity may lead to increased mucosal injury and result in gastric metaplasia. In the presence of antral H. pylori, the gastric metaplasia can become colonized and inflamed. The inflammation or the infection itself then disrupts the process of mucosal defense or regeneration resulting in ulceration. A cycle of further injury and increased inflammation with loss of the framework for regeneration may then cause a chronic ulcer. Gastric ulcer often occurs with decreased acid-peptic activity, suggesting that mucosal defensive impairments are more important. The combination of inflammation, protective deficiencies, and moderate amounts of acid and pepsin may be enough to induce ulceration. Many questions remain in understanding the pathophysiology of peptic ulcer disease. The physiology and pathophysiology of mucosal regeneration and the mechanisms by which H. pylori and inflammation disrupt normal gastroduodenal function will be fruitful areas of future investigation.
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PMID:Peptic ulcer pathophysiology. 207 87

While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22-76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart. In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%). In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 4:1, in patients with other cardiac diseases it was 2:1, respectively (p less than 0.001). Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p less than 0.001). 51 patients on acetylsalicylic acid (160 mg/die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects. The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively which are known to have a high mortality.
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PMID:[Frequency of pathological changes of the upper gastrointestinal tract in patients awaiting heart surgery]. 208 20

A prospective study of 41 patients (24 male and 17 female) aged over 40 years with iron deficiency anemia and hookworm infection was performed by endoscopy and barium enema to determine the incidence of GI lesions. Alcohol ingestion, smoking, abdominal pain, anorexia, loss in weight, bowel habit change, analgesic consumption and stool occult blood test were analyzed for their positive predictive value of GI lesions. The mean age of the patients was 62.8 years (SD = 10.1). The mean hemoglobin was 5.99 gm.% (SD = 1.9). Twenty patients (48.8%) had GI lesions. The lesions included 10 erosive gastritis, 1 erosive duodenitis, 5 gastric ulcers, 2 duodenal ulcers, 1 carcinoma of stomach and 1 carcinoma of colon. Gastric ulcer, duodenal ulcer and carcinoma were regarded as significant lesions. Abdominal pain was found in 16 of the 20 patients with GI lesions and 8 of the 21 without GI lesion (Chi square with Yate's correction, x2 = 5.78 p = 0.02). Four of the 17 patients without pain had GI lesions but only one of these 4 (5.8%) had gastric ulcer. Abdominal pain had an 80% sensitivity and 62% specificity for the positive prediction of GI lesions based on the above findings. GI investigation is recommended for all patients with abdominal pain. In those without pain, treatment of hookworm and iron therapy with follow-up may be justified.
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PMID:Gastrointestinal lesions in patients over 40 years of age with iron deficiency anemia and hookworm infection. 209 22

Two hundred and four patients, mainly Arabs, attending for upper gastrointestinal endoscopy at the gastroenterology clinic in Mubarak Al-Kabeer Hospital, Kuwait, were examined for evidence of infection with Helicobacter pylori and associated inflammation. Biopsy specimens of antrum, body, and duodenum; gastric juice; and antral mucosal brushings were investigated by microbiological, cytological, and histopathological methods. Clinical conditions diagnosed at endoscopy included gastritis, gastric ulcer, duodenitis and duodenal ulcer, but half the patients had endoscopically normal gastric and duodenal mucosae. H pylori was detected by one or more of the procedures in at least one specimen from 197 (96.6%) of the patients. Histological and cytological analysis showed equal sensitivity, but bacteriological culture was less reliable. The proportion of positive cases was high, compared with other reported series, which may have been accounted for by the variety of diagnostic techniques used in this study, the selected population (all with gastrointestinal symptoms) or genetic or environmental predisposing factors peculiar to the sample population.
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PMID:Helicobacter pylori in dyspeptic patients in Kuwait. 226 85

To evaluate the role of Campylobacter pylori in different gastrointestinal disorders, serum IgG antibodies against C. pylori were determined in dyspeptic patients and in a control group of healthy children and adults. Twenty-eight percent of the dyspeptic patients with normal mucosa were seropositive. Among the patients with altered mucosa, the seroprevalence increased from duodenitis (48%) to gastritis (89%) and gastric or duodenal ulcer, gastric stump gastritis and carcinoma (100%, for each group, respectively). The C. pylori detection rate was lowest in patients with duodenitis alone (19%) and highest in patients with duodenal ulcers (95%). Therefore, C. pylori does not play an important role in patients with duodenitis alone. About 30% of patients with gastritis, active duodenal or gastric ulcer had antibody levels as low as the seroconverted dyspeptic patients but with normal gastroduodenal mucosa. C. pylori was not considered a causative factor for mucosal damage in these patients.
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PMID:The role of Campylobacter (Helicobacter) pylori in disorders of the gastrointestinal tract. 231 73

Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis and a major cause of death in such patients. The main sites of bleeding are esophageal varices, gastritis, and peptic ulcers. In order to determine the prevalence of either potential bleeding lesions or of other endoscopic findings in hemodynamically stable individuals with various etiologies of cirrhosis, 510 consecutive cirrhotic patients, evaluated for possible orthotopic liver transplantation (OLTx) underwent an upper gastrointestinal endoscopy for combined diagnostic and therapeutic purposes. The patients were divided into two main groups: 319 patients with parenchymal liver disease and 191 patients with cholestatic liver disease. Gastritis was found significantly more often in patients with parenchymal liver disease than in those with cholestatic liver disease (49.8% vs 30.9%; P less than 0.001). In contrast, the prevalence of esophagitis, esophageal and gastric varices, gastric ulcer, duodenal ulcer, and duodenitis was similar in both groups. Normal endoscopic findings were present in 5.0% of the parenchymal group and 11.5% of the cholestatic group (P less than 0.02). Ascites and encephalopathy were found significantly more often in subjects with parenchymal liver disease as compared to those with cholestatic liver disease. Portal hypertension and its degree, as assessed by the presence and size of esophageal varices, was similar in both groups, and in both groups there was a statistically significant qualitative trend of increasing prevalence of esophageal varices with increasing severity of disease as estimated using Pugh-Child's criteria.
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PMID:Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. 234 4

Endoscopic gastric antral biopsy specimens (133) from 92 dyspeptic patients with endoscopically evident gastritis (34; including one patient with dual pathology) gastric ulcer (13), duodenitis (17; including one patient with dual pathology) duodenal ulcer (29) and 41 subjects of non ulcer dyspepsia (NUD) with endoscopically normal upper gastrointestinal tract were examined for H. pylori by stained smear, various urease tests, culture and histopathology. Crushed tissue smear stained by Gram's method using carbol fuchsin counterstain proved to be the simplest and a reliable technique. Up to 4 h urease broth + ve test correlated well with smear and culture. Positive association of H. pylori with disease was considered when at least two of the above methods were suggestive. Significantly higher positivities were observed in gastritis (61.7%), gastric ulcer (84.6%), duodenitis (58.8%) and duodenal ulcer (82.8%) patients, as compared to NUD subjects (46.3%). Severe histopathological lesions were frequently associated with multiple bacteriological test positives.
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PMID:Evaluation of different methods for detection of Helicobacter pylori in patients with gastric disease. 234 21

The purpose of this paper is to study the use of upper gastrointestinal (Gl) fiberoptic endoscopy in children. Two hundred consecutive patients referred to one of the authors were reviewed. The indications for performing upper gastrointestinal endoscopy in these 200 patients were: (1) recurrent abdominal pain (46.5%), (2) persistent vomiting (14.5%), (3) haematemesis (14.5%), (4) acute abdominal pain (13%) and (5) other indications such as foreign body removal, failure to thrive and unexplained chest pain (11.5%). The endoscopy was performed with the Olympus P3 or Olympus XP-10 gastroscopes. The sedation used was a combination of intravenous pethidine (2mg/kg) and diazepam (0.5 mg/kg). Among the patients with recurrent abdominal pain, upper Gl endoscopy showed duodenal ulcer in 7 patients (7.5%), duodenitis in 4 (4.3%), oesophagitis in 4 (4.3%) and gastric ulcer in 2 (2.2%). The rest of the patients were normal (81.7%). With regard to persistent vomiting, 37.9% of the patients showed gastroesophageal reflux and 6.9% had a hiatus hernia. Of 29 patients examined endoscopically for upper Gl bleeding, no focus of bleeding was identified in 27.6%. The remaining 72.4% were bleeding from acute gastric erosion (27.6%), oesophagitis (17.2%), oesophageal varices (13.8%), duodenal ulcer (10.3%) and Mallory-Weiss tear (3.5%). The Majority of the patients with acute abdominal pain were normal endoscopically (61.5%). The two common abnormal findings were acute gastritis (27.0%) and acute duodenitis (11.5%). No major complications were encountered during the procedure in these 200 patients. It was concluded that upper Gl endoscopy is useful for defining upper Gl mucosal pathology. The procedure can be performed safely in children under sedation.
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PMID:Upper gastrointestinal endoscopy in children. 237 74

A clinical, endoscopic and histopathologic study on chronic nonspecific duodenitis was performed in 174 subjects, 124 patients (control patients, patients with gastric or duodenal ulcer and nonulcer dyspepsia) and 50 healthy volunteers without clinical history of gastro-intestinal disease. Chronic nonspecific duodenitis was found in 6 healthy volunteers (12%), 5 control patients (7%), one gastric ulcer patient (7%), all duodenal ulcer patients and in 15 patients with nonulcer dyspepsia (83%). Chronic non-specific duodenitis is a focal process affecting the duodenal bulb. It can be missed when only one biopsy is studied. Superficial gastric metaplasia was directly correlated to gastric acid secretion and was found in 32 healthy volunteers (64%), 23 control patients (34%), six gastric ulcer patients (43%), 20 duodenal ulcer patients (20%) and in 17 patients with nonulcer dyspepsia (94%). This study suggests that chronic nonspecific duodenitis is a stage of duodenal ulcer disease.
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PMID:Chronic nonspecific duodenitis. A multiple biopsy study of the duodenal bulb in health and disease. 261 62


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