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

Predictable factors in healing of 48 patients with gastric ulcer by PPI or H2-RA on 4 and 8 weeks of treatment were investigated. We evaluated the following factors such as patient's profile, local morphologic factors of gastric ulcer and suppression rate of 24 hr intragastric pH between healed and unhealed patients using single and multiple variable analysis. Results obtained from multiple variable analysis, the significant and independent factors of intractable gastric ulcers on the 4th week of treatment were ulcer size in over 20 mm and solitary ulcer. On the contrary, those of 8th week of treatment were shortage of holding time of intragastric pH over pH4 (less than 16.7 hrs) during treatment, the site of ulcer at lesser curvature of gastric angle and the shape of ulceration which showed mucosal overhanging. Considering with single and multiple variable analysis, we concluded that, in early phase, local shapes of the ulceration were important predictors in the healing of gastric ulcer, and the after that, the inhibition of intragastric acidity were significant factors in healing process of gastric ulcer.
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PMID:[Predictable factors in healing of gastric ulcer, comparative analysis of local morphologic factor of gastric ulcer and suppression of intragastric pH]. 773 28

A simple, safe and effective 1 week low dose triple therapy, omeprazole 20 mg u.i.d. clarithromycin 250 b.i.d. tinidazole 500 mg b.i.d. (OCT) was developed in response to the problems seen with standard triple and dual therapies. Standard triple therapy, bismuth and two antibiotics, in fact, is effective for the eradication of H. pylori but is of limited use, because of side effects and the patients low compliance. The combination of omeprazole plus one antibiotic, either amoxycillin or clarithromycin, has resulted in various rates of eradication in different geographical areas, most of them being inconsistent and low. The short term low dose triple therapy was therefore based on the rationale that measures aiming at reducing side effects and improving patient compliance with an appropriate combination of drugs would lead to a substantial improvement in the eradication rate. This regimen initially tested in H. pylori +ve patients with gastritis, is highly effective (> 90%) for long term eradication also in duodenal ulcer patients and in patients with gastric ulcer. Consistent results have been reproduced by several investigators with the same regime, whilst increasing dosages and duration of treatment does not seem to improve success rate. In alternative, omeprazole, clarithromycin, amoxicillin (OCA) has been also suggested to overcome the problem of metronidazole resistance, however recent studies seem to indicate that resistance to metronidazole does not seem to significantly influence outcome of OCT. In conclusion, also according to the recent Maastricht Consensus Report, the short term low dose triple therapy consisting of a PPI plus antibiotics--any two among clarithromycin, tinidazole/metronidazole and amoxycillin--currently represent the most effective approach to H. pylori eradication.
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PMID:Therapy of H. pylori infection. 944 54

The effects of trimebutine maleate (TM), a prokinetic drug, on gastrointestinal motility in patients with gastric ulcer were investigated. Twenty patients with active gastric ulcers were allocated to two groups; 10 patients received a proton pump inhibitor alone (PPI group), given orally, and 10 patients received oral TM in combination with a PPI (PPI + TM group), each for a period of 8 weeks. Electrogastrography (EGG) and gastric emptying were measured before and after the treatment period. During the active ulcer stage, tachygastria (more than 0.06 Hz) or bradygastria (less than 0.04 Hz) in the EGG frequency were observed in 9 patients either before or after meals. During the healed ulcer stage, tachygastria or bradygastria was observed in 4 of 10 patients in the PPI group, while in the PPI + TM group, 1 patient had tachygastria and none had bradygastria. Postprandial dip (PD) was observed in 3 of the 20 patients during the active stage, while after treatment, PD was observed in 3 patients in the PPI group and in 6 patients in the PPI + TM group, respectively. Gastric emptying in the PPI group did not show any change between before and after treatment, while that in the PPI + TM group improved significantly after treatment. These results suggest that TM may have an ameliorative effect on abnormal gastric motility in patients with gastric ulcer.
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PMID:Effects of trimebutine maleate on gastric motility in patients with gastric ulcer. 985 73

Three hundred thirty-three patient (116 gastric ulcer, 119 duodenal ulcer, 98 gastritis) who were successfully eradicated were enrolled in the study of H. pylori recurrence rate. H. pylori status was determined by histology, rapid urease test, 13C-urea breath test. The mean of the follow-up period was 13.3 months (2-56 months), and 15 patients showed negative to positive conversion of H. pylori. The recurrence rate was 4.4% for one year and 8.3% for two years using Kaplan-Meier analysis. Second eradication therapy after initial failure is another concern. Nineteen patients were assigned to receive an 1-week new triple therapy (clarithromycin, metronidazole and PPI), in whom a 2-week course of dual therapy (amoxicillin plus PPI) failed (group1). Another 15 patients in whom the 1-week new triple therapy failed were switched to the 2-week course of dual therapy plus ecabet sodium (group2). H. pylori was eradicated in 84.2% (16/19) of patients in group1 and 86.7% (13/15) in group2.
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PMID:[Recurrence rate of H. pylori after successful eradication and second eradication therapy after initial failure of treatment]. 1003 47

The frequency, symptoms, and complication rate of PUD seem to decrease during pregnancy. Yet clinicians often have to treat dyspepsia or pyrosis of undetermined origin during pregnancy because the frequency of pyrosis significantly increases during pregnancy, and clinicians reluctantly perform EGD during pregnancy for pyrosis to differentiate reliably between GERD and PUD. Dyspepsia or pyrosis during pregnancy is initially treated with dietary and lifestyle modifications. If the symptoms do not remit with these modifications, sucralfate or antacids, preferably magnesium-containing or aluminum-containing antacids, should be administered. Histamine2 receptor antagonists are recommended when symptoms are refractory to antacid or sucralfate therapy. Ranitidine seems to be a relatively safe H2 receptor antagonist. If symptoms continue despite H2 receptor antagonist therapy, the patient should be evaluated for possible EGD or PPI therapy. Pregnant women with hemodynamically significant upper gastrointestinal bleeding or other worrisome clinical findings should undergo EGD. Indications for surgery include ulcer perforation, ongoing active bleeding from an ulcer requiring transfusion of six or more units of packed erythrocytes, gastric outlet obstruction refractory to intense medical therapy, and a malignant gastric ulcer without evident metastases.
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PMID:Gastric and duodenal ulcers during pregnancy. 1263 19

Japanese guideline for the management of gastric ulcer prepared by a research group supported by government funding was published in 2003 as a concise book for use in general practice. Overall management strategy classified based on etiology of ulcer was shown as a flow chart. Recommendation of treatment strategy for NSAID ulcer with PPI, and for H. pylori-positive gastric ulcer with eradication therapy are in line with internationally acknowledged consensus. A number of so-called mucoprotective drugs most of which are available in Japanese market alone, however, were given low priority when choosing single regimen, and their use in combination with acid suppressant, the most popular ulcer regimens in Japan, was not recommended due to lack of reliable evidence. Though it will take some time for general physicians to widely adopt this guideline, it undoubtedly will serve for reasonable gastric ulcer management in Japan.
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PMID:[Japanese guideline for the management of gastric ulcer]. 1528 60

The efficacy of established Helicobacter pylori regimes needs to be reviewed. In view of drug resistance, side effects, and compliance and expense of therapy, treatment failure is increasing and second-line treatment strategies need to be developed. A simulation model suggested by the Cochrane review group showed that H. pylori eradication is cost-effective for duodenal and gastric ulcer long-term. The duration of eradication therapy continues to be controversial. In Europe and other parts of the world, 7-day triple regimes are used, whereas guidelines from the United States recommend 10-14 days of therapy. Antibiotic resistance is a major factor affecting the outcome of eradication therapy. New modified eradication regimes involve substitution of antibiotics used in conjunction with other drugs. The newer generation fluoroquinolones have shown some promise as part of an eradication regimen. Quadruple therapy (bismuth, proton pump inhibitor [PPI] and two antibiotics and sequential treatment [PPI with three antibiotics]) are promising first-line treatments. Novel agents have been tried, but with disappointing results. New drugs and administration forms have been reported but their efficacy needs confirmation.
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PMID:Treatment of Helicobacter pylori. 1617 70

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.
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PMID:[Is the successful eradication of Helicobacter pylori sufficient for the healing of peptic ulcer?]. 1657 72

H pylori is a global human pathogen and is the major cause of gastritis and the gastritis-associated diseases: gastric ulcer, duodenal ulcer, gastric cancer, and primary gastric B-cell lymphoma (MALToma). Although several reliable diagnostic tests are widely available, the ideal regimen for treating the infection re-mains to be established. The current first-line or legacy triple therapy regimens fail in 20% to 40% of patients. Causes of treatment failure include antibiotic resistance, poor compliance, short (7-10 days) duration of therapy, and drug-related side effects. Fourteen-day triple therapy has an approximately 12% better cure rate than does 7-day therapy; therefore, shorter durations can no longer be recommended. Recent studies confirmed older observations that the success rate of legacy triple regimens (PPI plus two antibiotics) can be improved if the duration is extended to 14 days or if a third antibiotic is given. Sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) requires further evaluation although the concept appears very promising and therapy should probably replace the legacy triple therapies. More studies are needed to examine doses, durations, and the need for sequential administration of the drugs, which extends the duration to 14 days. Nonetheless, sequential quadruple therapy probably should replace the legacy triple therapies. Classic quadruple therapy contains bismuth, a PPI, 1500 mg of metronidazole, and 1500 mg of tetracycline. It provides the highest average eradication rates and in many regions should be considered as the initial approach. Confirmation of eradication using noninvasive diagnostic tests, such as a urea breath test or stool antigen assay, is now the standard of care. The diagnosis of latent or symptomatic H pylori like the diagnosis of latent or symptomatic syphilis, always should prompt treatment. Because of decreasing cure rates, new and improved therapies are needed.
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PMID:Helicobacter pylori diagnosis and management. 1688 64

A 68-years-old Japanese woman was hospitalized emergently because of hemorrhagic gastric ulcer. For the hospitalization period, elevated levels of white blood cell count, eosinophilic leucocyte count, serum IgE and positive MPO-ANCA were recognized. With considering clinical course and these laboratory findings, we diagnosed Churg-Strauss syndrome (CSS). Steroid therapy in combination with cyclophosphamide was effective. CSS is a rare disease, but we should discriminate this disease when we encounter gastrointestinal bleeding of unknown etiology, especially PPI-resistant gastric ulcer.
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PMID:[A case of Churg-Strauss syndrome discovered with hematemesis]. 1714 25


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