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Helicobacter pylori is the most common cause of gastroduodenal diseases. The concept that cagA-positive H. pylori is a risk factor for gastric cancer appears to be true only for H. pylori strains from Western countries. Other virulent genes may have a synergistic interaction with cagA during pathogenesis. This study aims to investigate H. pylori cagA, vacA, and iceA prevalence, genotypes, and their association to clinical outcomes in Vietnamese patients. The cagA status and vacA and iceA genotypes were determined using the PCR technique on DNA extracted from gastric biopsies of 141 patients with gastroduodenal diseases. After performing molecular analysis for cagA, vacA, and iceA genes, samples with mixed H. pylori strains, positivity, or negativity for both cagA and cagPAI-empty site, or unidentified genotypes were excluded. Finally, 107 samples were examined. The presence of the cagA, vacA, and iceA genes were detected in 77.6%, 100%, and 80.4% of cases, respectively. Notably, cagA( +) with EPIYA-ABD, vacA s1i1m1, vacA s1i1m2, iceA1, and iceA2 accounted for 73.8%, 44.9%, 33.6%, 48.6%, and 31.8% of cases, respectively. Four iceA2 subtypes (24-aa, 59-aa, 94-aa, and 129-aa variants) were found, with the 59-aa variant the most prevalent (70.6%). The cagA( +)/vacAs1i1m1/iceA1 and cagA( +)/vacAs1i1m2/iceA1 combinations were found in 26.2% and 25.1% of cases, respectively. A multivariable logistic regression analysis was performed, after adjusting for age and gender, with the gastritis group was used as a reference control. Statistically significant associations were found between the vacA s1i1m2 genotype, the iceA1 variant, and the cagA( +)/vacAs1i1m2/iceA1 combination and gastric cancer; the adjusted ORs were estimated as 18.02 (95% CI: 3.39-95.81), 4.09 (95% CI: 1.1-15.08), and 16.19 (95% CI: 3.42-76.66), respectively. Interestingly, for the first time, our study found that vacA s1i1m2, but not vacA s1i1m1, was a risk factor for gastric cancer. This study illustrates the genetic diversity of the H. pylori cagA, vacA, and iceA genes across geographical regions and contributes to understanding the importance of these genotypes for clinical outcomes.
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Antígenos Bacterianos , Proteínas Bacterianas , Genotipo , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Proteínas Bacterianas/genética , Helicobacter pylori/genética , Helicobacter pylori/aislamiento & purificación , Helicobacter pylori/clasificación , Helicobacter pylori/patogenicidad , Vietnam/epidemiología , Antígenos Bacterianos/genética , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/epidemiología , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Adulto , Proteínas de la Membrana Bacteriana Externa/genética , Anciano , Adulto Joven , Prevalencia , Factores de Virulencia/genéticaRESUMEN
Mauritia flexuosa, known as buriti in Brazil, is a widespread palm tree in Amazonia. It has many ethnobotanical uses, including food, oil, and medicine. The oil obtained from buriti's fruit pulp has high levels of monounsaturated fatty acids, carotenoids, and tocopherols, and is used in the food, cosmetic, and pharmaceutical industries for its antioxidant properties. Many biological activities have been reported for buriti oil, such as antioxidant, antimicrobial, chemopreventive, and immunomodulatory. Due to its high content of bioactive compounds, buriti oil is considered a functional ingredient with possible benefits in preventing oxidative stress and chronic diseases, particularly in the gastrointestinal tract. Peptic ulcer disease is a multifactorial disorder, involving lesions in the stomach and duodenum mucosa, which has a complex healing process. In this context, some nutrients and bioactive compounds help the maintenance of gastrointestinal mucosal integrity and function, such as carotenoids, tocopherols, and unsaturated fatty acids, which makes buriti oil an interesting candidate to be used in the prevention and management of gastrointestinal diseases. This study aimed to evaluate the gastroprotective and antiulcer effects of buriti oil and its possible mechanisms of action. Buriti oil reduced the ulcerative area and lipid peroxidation induced by ethanol. The gastroprotective activity of buriti oil partially depends on nitric oxide and sulfhydryl compounds. In acetic acid-induced gastric ulcers, buriti oil accelerated healing and stimulated the formation of new gastric glands. These results demonstrated the potential of buriti oil as a functional ingredient to promote health benefits in the gastrointestinal tract.
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Antioxidantes , Arecaceae , Aceites de Plantas , Antioxidantes/farmacología , Promoción de la Salud , Estructura Molecular , Carotenoides/farmacología , Tocoferoles/farmacologíaRESUMEN
Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage
Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.
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Humanos , Úlcera Péptica Perforada , Complicaciones Posoperatorias , Epiplón , Factores de RiesgoRESUMEN
Brasiliensic acid (Bras) is a chromanone isolated from Calophyllum brasiliense Cambèss. bark extracts with confirmed potential activity on gastric ulcer and Helicobacter pylori infection. This study aimed to investigate the in vitro and in vivo toxicity of Bras and molecular docking studies on its interactions with the H. pylori virulence factors and selected gastric cancer-related proteins. Cytotoxicity was evaluated by alamarBlue© assay, genotoxicity by micronucleus and comet assays, and on cell cycle by flow cytometry, using Chinese hamster epithelial ovary cells. Bras was not cytotoxic to CHO-K1 cells, and caused no chromosomal aberrations, nor altered DNA integrity. Furthermore, Bras inhibited damages to DNA by H2O2 at 1.16 µM. No cell cycle arrest was observed, but apoptosis accounted for 31.2% of the cell death observed in the CHO-K1 at 24 h incubation of the IC50. Oral acute toxicity by Hippocratic screening test in mice showed no relevant behavioral change/mortality seen up to 1,000 mg/kg. The molecular docking approach indicated potential interactions between Bras and the various targets for peptic ulcer and gastric cancer, notably CagA virulence factor of H. pylori and VEGFR-2. In conclusion, Bras is apparently safe and an optimization for Bras can be considered for gastric ulcer and cancer.Communicated by Ramaswamy H. Sarma.
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RESUMEN La úlcera péptica es menos frecuente en las embarazadas que en las mujeres no gestantes. Aunque rara vez se perfora durante el embarazo y aún menos frecuentemente durante el puerperio, está asociada con mayor riesgo de muerte materna. El uso de analgésicos no esteroideos y la infección por Helicobacter pylori están relacionados con su patogénesis. Debido a sus características clínicas durante el embarazo, la sepsis puerperal e íleo paralítico pueden retrasar el diagnóstico. Luego del parto, signos clínicos como taquicardia de reciente aparición, dolor abdominal y el aumento de la distensión deben sugerir el diagnóstico. Dado que las complicaciones pueden provocar morbilidad y mortalidad significativas durante el puerperio, la detección precoz y el tratamiento rápido son imperativos. El tratamiento de la úlcera péptica perforada durante el puerperio es el mismo que el de una situación quirúrgica abdominal urgente. Una reparación satisfactoria con parche omental suele sellar el defecto y evitar nuevas perforaciones. Se presenta un caso de úlcera péptica perforada durante el puerperio.
ABSTRACT Peptic ulcer is less frequent in pregnant women than in non-pregnant women. Although it rarely perforates during pregnancy and even less frequently during the puerperium, it is associated with an increased risk of maternal death. The use of nonsteroidal analgesic and Helicobacter pylori infection are related to its pathogenesis. Due to its clinical features during pregnancy, puerperal sepsis and paralytic ileus may delay diagnosis. After delivery, clinical signs such as new-onset tachycardia, abdominal pain, and increased distension should suggest the diagnosis. Since complications can cause significant morbidity and mortality during the puerperium, early detection and prompt treatment are imperative. Treatment of perforated peptic ulcer during the puerperium is the same as for an urgent abdominal surgical situation. Successful repair with omental patching usually seals the defect and prevents additional perforations. A case of perforated peptic ulcer during the puerperium is presented.
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BACKGROUND: Peptic ulcer disease (PUD) is a common disease worldwide, especially in developing countries. China, Brazil, and India are among the world's fastest-growing emerging economies. This study aimed to assess long-term trends in PUD mortality and explore the effects of age, period, and cohort in China, Brazil, and India. METHODS: We collected data from the 2019 Global Burden of Disease Study and used an age-period-cohort (APC) model to estimate the effects of age, period, and cohort. We also obtained net drift, local drift, longitudinal age curve, and period/cohort rate ratios using the APC model. RESULTS: Between 1990 and 2019, the age-standardized mortality rates (ASMRs) of PUD and PUD attributable to smoking showed a downward trend in all countries and both sexes. The local drift values for both sexes of all ages were below zero, and there were obvious sex differences in net drifts between China and India. India had a more pronounced upward trend in the age effects than other countries. The period and cohort effects had a similar declining trend in all countries and both sexes. CONCLUSIONS: China, Brazil, and India had an inspiring decrease in the ASMRs of PUD and PUD attributable to smoking and to period and cohort effects during 1990-2019. The decreasing rates of Helicobacter pylori infection and the implementation of tobacco-restricting policies may have contributed to this decrease.
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BACKGROUND: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. METHOD: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. RESULTS: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. CONCLUSIONS: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.
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Úlcera Duodenal , Neoplasias , Úlcera Péptica Perforada , Úlcera Gástrica , Humanos , Anciano , Úlcera Duodenal/complicaciones , Úlcera Duodenal/cirugía , Estudios Retrospectivos , Úlcera Péptica Perforada/complicaciones , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/complicaciones , Úlcera Gástrica/cirugía , Pronóstico , Úlcera Péptica Hemorrágica/complicaciones , Neoplasias/complicacionesRESUMEN
Introducción: La úlcera gástrica perforada es la complicación ulcerativa más frecuente después del sangrado y la más grave de todas. A medida que se desarrolla el proceso inflamatorio la lesión gástrica evoluciona pasando por los siguientes estadíos: gastritis superficial, gastritis atrófica crónica, metaplasia intestinal, displasia y finalmente cáncer. En este proceso de evolución natural de la enfermedad radica la importancia de realizar una biopsia durante el abordaje quirúrgico de la úlcera gástrica perforada. Objetivos: Determinar la prevalencia de neoplasia en úlceras gástrica perforada en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo 2015-2020. Materiales y métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal con datos retrospectivos. Resultados: Se incluyeron 50 pacientes sometidos a cirugía por úlcera gástrica perforada. El promedio de edad fue 67,1 ±17,1 años, el 60% correspondían al sexo masculino; en el 94% se realizó reavivamiento de bordes y en el 6% antrectomía. Con respecto al diagnóstico anatomopatológico, en el 90% se confirmó proceso infamatorio, la prevalencia de neoplasia fue del 6% y en el total de los pacientes postoperados por úlcera gástrica perforada se constató un 46% de mortalidad. Conclusión: La prevalencia de neoplasia fue mínima en los pacientes sometidos a cirugía por úlcera gástrica perforada. Se identificó un alto porcentaje de mortalidad en los pacientes postoperados por úlcera gástrica perforada. El promedio de edad fue 67,1 años y predominó el sexo masculino. El procedimiento quirúrgico más frecuente fue el reavivamiento de bordes y el diagnóstico anatomopatológico más prevalente fue proceso inflamatorio.
Introduction: Perforated gastric ulcer is the most frequent ulcerative complication after bleeding and the most serious of all; as inflammation progresses, gastric lesion evolves, beginning with superficial gastritis, then chronic atrophic gastritis, intestinal metaplasia, dysplasia, and finally cancer; hence the importance of performing a biopsy in the surgical approach of perforated gastric ulcer. Objectives: To determine the prevalence of neoplasia in perforated gastric ulcers in the General Surgery service of the Hospital Central del Instituto de Previsión Social in the period 2015-2020. Materials and methods: An observational descriptive cross-sectional study with retrospective data was carried out. Results: 50 patients who underwent surgery for perforated gastric ulcer were included. The average age was 67.1 ± 17.1 years, 60% were male; 94% underwent edge revival and 6% antrectomy. Regarding the anatomopathological diagnosis, 90% confirmed the inflammatory process, the prevalence of neoplasia was 6%, and in the total number of postoperative patients for perforated gastric ulcer, 46% mortality was confirmed. Conclusion: The average age was 67.1 years and the male sex predominated. The most frequent surgical procedure was edge revival and the most prevalent pathological diagnosis was inflammatory process. The prevalence of neoplasia was minimal in patients undergoing surgery for perforated gastric ulcer. A high percentage of mortality was identified in postoperative patients for perforated gastric ulcer.
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Úlcera Gástrica , Neoplasias , Cirugía General , BiopsiaRESUMEN
SUMMARY OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.
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Objetivos: avaliar a relação entre doença do refluxo gastroesofágico e/ou úlcera péptica, e lesão de cárie e/ou doença periodontal. Métodos: O presente estudo foi realizado de acordo com as diretrizes do PRISMA (Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises) e foi registrado (CRD42023386741) na Plataforma Prospero (Registro Internacional Prospectivo de Revisões Sistemáticas, Universidade de York, York, Reino Unido). Para isso a pesquisa foi conduzida em quatro bases de dados (PubMed, WebOfScience, Embase e Scopus), além da literatura cinzenta, sem restrições sobre idioma ou data de publicação. Dos 1719 estudos selecionados, 165 foram submetidos à análise de texto. Dezesseis estudos foram elegíveis (15 transversais e um estudo caso-controle), e 7 estudos foram inseridos na meta-análise. Resultados: Pode-se verificar diferença nas médias entre doença do refluxo gastroesofágico e índice PMA (OR 1,00, 95% IC 0,60; 1,40), nessa meta-análise I2 = 53%. Também se observou diferença nas médias entre doença do refluxo gastroesofágico e índice OHI S (OR 1,22, 95% IC 0,50; 1,93), na metaanálise I2 = 84%. Não há associação entre DRGE e CPOD (DM = 0.53; 95% IC = - 1.39; 2.45), na meta-análise I2 = 84% e entre DRGE e % CPOD (DM = -0.87; 95% IC = -19.31; 17.56), na meta-análise I2 = 90%. Também não houve associação entre DRGE e IPV (DM = 0.23; 95% IC = -0.04; 0.51), na meta-análise I2 = 0%. Por último, não houve associação entre úlcera péptica e perda óssea (RC = 1.22; 95% IC = 0.43; 3.40), na meta-análise I2 = 90%. Conclusão: encontrou-se evidências sugestivas que indivíduos com doença do refluxo gastroesofágico e úlcera péptica apresentaram maior probabilidade de ter doença periodontal e lesão de cárie, em relação aos indivíduos sem esses comprometimentos sistêmicos.
Objectives: to evaluate the relationship between gastroesophageal reflux disease and/or peptic ulcer disease, and caries lesions and/or periodontal disease. Methods: The present study was carried out in accordance with the PRISMA (Key Items for Reporting Systematic Reviews and Meta-Analyses) guidelines and was registered (CRD42023386741) on the Prospero Platform (International Prospective Registry of Systematic Reviews, University of York, York, United Kingdom United). For this purpose, the research was conducted in four databases (PubMed, WebOfScience, Embase and Scopus), in addition to gray literature, without restrictions on language or publication date. Of the 1719 studies selected, 165 were subjected to text analysis. Sixteen studies were eligible (15 cross-sectional and one case-control study), and 7 studies were entered into the meta-analysis. Results: It was possible to verify a difference in the means between gastroesophageal reflux disease and PMA Index (OR 1.00, 95% CI 0.60; 1.40), in this meta-analysis I2 = 53%. There was also a difference in the means between Gastroesophageal Reflux Disease and OHI Index S (OR 1.22, 95% CI 0.50; 1.93), in this meta-analysis I2 = 84%. There is no association between GERD and DMFT (DM = 0.53; 95% CI = -1.39; 2.45), in this meta-analysis I2 = 84% and between GERD and % DMFT (DM = -0.87; 95% CI = -19.31; 17.56), in this metaanalysis I2 = 90%. There was also no association between GERD and IPV (MD = 0.23; 95% CI = -0.04; 0.51), in this meta-analysis I2 = 0%. Finally, there was no association between peptic ulcer disease and bone loss (OR = 1.22; 95% CI = 0.43; 3.40), in this meta-analysis I2 = 90%. Conclusion: according to the systematic review, individuals with gastroesophageal reflux disease and peptic ulcers were more likely to have periodontal disease and caries lesions, compared to individuals without these systemic impairments.
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Úlcera Péptica , Enfermedades Periodontales , Reflujo Gastroesofágico , Salud Bucal , Caries DentalRESUMEN
SUMMARY OBJECTIVE: The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score. METHODS: The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score. RESULTS: A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106). CONCLUSION: The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.
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El objetivo de este artículo de actualización tiene como objetivo hacer referencia acerca de la Ulcera péptica, una de las patologías muy frecuente en el sistema digestivo que afecta la mucosa gástrica o intestinal, cuya patogenia es multifactorial y cuyas complicaciones pueden ser graves, requiriendo un adecuado manejo y tratamiento hospitalario. Esta revisión hace referencia a los factores patogénicos más frecuentes, la fisiopatología, el abordaje clínico y su tratamiento, haciendo énfasis en la terapia farmacológica, en la que se hace una revisión sucinta y completa de todas sus propiedades farmacológicas.
The objective of this update article aims to refer to peptic ulcer, one of the very common pathologies in the digestive system affecting the gastric or intestinal mucosa, whose pathogenesis is multifactorial and whose complications can be serious, requiring adequate management and hospital treatment. This review refers to the most frequent pathogenic factors, pathophysiology, clinical approach and their treatment, emphasizing pharmacological therapy, in which a succinct and complete review of all its pharmacological properties is made.
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Gastrointestinal diseases, such as peptic ulcers, are caused by a damage in the gastric mucosa provoked by several factors. This stomach injury is regulated by many inflammatory mediators and is commonly treated with proton-pump inhibitors, histamine H2 receptor blockers and antacids. However, various medicinal plants have demonstrated positive effects on gastric ulcer treatment, including plants of the Ceiba genus. The aim of this study was to evaluate the antiulcer and anti-inflammatory activities of the stem bark ethanolic extract of Ceiba speciosa (A. St.-Hil.) Ravenna. We performed a preliminary quantification of phenolic compounds by high-performance liquid chromatography-diode array detection (HPLC-DAD), followed by the prospection of other chemical groups through nuclear magnetic resonance (NMR) spectroscopy. A set of in vitro assays was used to evaluate the extract potential regarding its antioxidant activity (DPPH: 19.83 ± 0.34 µg/mL; TPC: 307.20 ± 6.20 mg GAE/g of extract), effects on cell viability and on the release of TNF-α in whole human blood. Additionally, in vivo assays were performed to evaluate the leukocyte accumulation and total protein quantification in carrageenan-induced air pouch, as well as the antiulcerogenic effect of the extract on an ethanol-induced ulcer in rats. The extract contains flavonoids and phenolic compounds, as well as sugars and quinic acid derivatives exhibiting potent antioxidant activity and low toxicity. The extract reduced the release of TNF-α in human blood and inhibited the activity of p38α (1.66 µg/mL), JAK3 (5.25 µg/mL), and JNK3 (8.34 µg/mL). Moreover, it reduced the leukocyte recruitment on the pouch exudate and the formation of edema, reverting the effects caused by carrageenan. The extract presented a significant prevention of ulcer formation and a higher reduction than the reference drug, Omeprazole. Therefore, C. speciosa extract has demonstrated relevant therapeutic potential for the treatment of gastric diseases, deserving the continuation of further studies to unveil the mechanisms of action of plant bioactive ingredients.
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Antiulcerosos , Ceiba , Extractos Vegetales , Úlcera Gástrica , Animales , Humanos , Ratas , Antiulcerosos/farmacología , Antioxidantes/farmacología , Carragenina/efectos adversos , Ceiba/química , Extractos Vegetales/química , Extractos Vegetales/farmacología , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/metabolismo , ÚlceraRESUMEN
Found in humid regions and waterways and popularly used to treat gastrointestinal problems among other applications, the present study evaluated the M. aquatica essential oil (OEMa) as a therapeutic alternative to treat gastrointestinal disorders. Produced by steam distillation, chemical composition of OEMa was determined by GC-MS analysis. The ethanol-induced ulcer and the dose-repeated acetylsalicylic acid (ASA)-induced gastrointestinal lesions models in rats evaluated, respectively, the prophylactic and curative effects of EOMa on peptic ulcers. The EOMa's effect on gastric secretion, gastric mucus and gastrointestinal motility were evaluated in in vivo models. The curative effect of EOMa on acute colitis was evaluated using the DSS-induced colitis model in mice. Obtained in 0.17% yield (w/w), with carvone (54.82 ± 1.39 g/100 g oil) as the main constituent, EOMa (at 75 mg/kg) showed potent gastroprotective effect (> 90%) mediated by non-protein sulfhydryl compounds (NPSH) and nitric oxide (NO) modulation alongside reduction in gastric secretion volume and total acidity. EOMa did not affect gastric mucus production and gastrointestinal motility. In dose-repeated ASA-induced gastrointestinal lesions model, EOMa (at 25 mg/kg) promoted the inflammatory process resolution both in gastric and duodenal walls by modulating NPSH, NO and myeloperoxidase levels. Despite delaying in 2 days the clinical symptoms worsening, EOMa (at 25 mg/kg) was not able to protect colon tissues from DSS-induced acute colitis as evidenced by macroscopic, biochemical, and histopathological parameters. This is the first report of Mentha aquatica essential oil as a promising herbal medicine for peptic ulcers treatment together with an adjuvant effect in IBD.
Asunto(s)
Antiulcerosos , Colitis , Mentha , Aceites Volátiles , Úlcera Péptica , Úlcera Gástrica , Ratas , Ratones , Animales , Aceites Volátiles/uso terapéutico , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/tratamiento farmacológico , Antiulcerosos/farmacología , Mucosa Gástrica , Ratas Wistar , Úlcera Péptica/tratamiento farmacológico , Extractos Vegetales/farmacología , Colitis/inducido químicamente , Colitis/tratamiento farmacológico , Colitis/patologíaRESUMEN
Resumen La infección por Helicobacter pylori se asocia con enfermedades gastroduodenales como gastritis crónica, úlcera péptica y adenocarcinoma gástrico. Actualmente se dispone de diferentes esquemas terapéuticos, sin embargo, el uso indiscriminado de antibióticos generó resistencia en este agente, razón para estudiar alternativas y reevaluar los criterios que determinan la selección de un esquema en específico. El objetivo de esta revisión fue describir los principios generales de tratamiento de acuerdo a guías de referencia y recomendaciones de autores independientes, y exponer el uso de la rifabutina como alternativa terapéutica. En la búsqueda bibliográfica se usaron los términos "Helicobacter pylori" AND "rifabutin", en las bases de datos PubMed, SciELO y el motor de búsqueda Google Scholar®. La evidencia actual sugiere que el uso de rifabutina como terapia de rescate es apropiado y seguro, y sería la alternativa ideal en casos de multirresistencia o difícil acceso a pruebas de susceptibilidad antibiótica. MÉD.UIS.2022;35(1): 31-42.
Abstract Helicobacter pylori infection is associated with gastroduodenal diseases such as chronic gastritis, peptic ulcer, and gastric adenocarcinoma. Nowadays, there are different therapeutic regimens, however, the indiscriminate use of antibiotics generated resistance in this agent, reason to study alternatives and reevaluate the criteria that determines the selection of a specific regimen. The aim of this review was to describe the general principles of treatment according to reference guidelines and recommendations of independent authors, and to present the use of rifabutin as a therapeutic alternative. The bibliographic search was performed using the terms "Helicobacter pylori" AND "rifabutin" in the databases PubMed, SciELO and the search engine Google Scholar®. Current evidence suggests that the use of rifabutin as rescue therapy is appropriate and safe, and would be an ideal alternative in cases of multidrug resistance or difficult access to antibiotic susceptibility tests. MÉD.UIS.2022;35(1): 31-42.
Asunto(s)
Humanos , Helicobacter pylori , Rifabutina , Úlcera Péptica , Neoplasias Gástricas , GastritisRESUMEN
RESUMEN Introducción: El tratamiento de la úlcera péptica duodenal (UPD) ha cambiado radicalmente en el transcurso de los últimos 50 años debido a la efectividad del tratamiento médico. Sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera duodenal; y dentro de éste la vagotomía. Objetivo: Describir el origen y evolución de la vagotomía altamente selectiva (VAS), y su papel en el tratamiento quirúrgico de la UPD. Material y métodos: Se revisó la bibliografía publicada durante los últimos 50 años relacionada con la VAS en el tratamiento quirúrgico de la UPD. La fuente de los datos utilizados fue obtenida de Clinical Key, Pubmed, Google, Scopus y Scielo, desde 1970 hasta 2020. Desarrollo: La VAS se aplicó por primera vez en el humano en 1967 por Holle y Hart. Posteriormente, Johnston y Wilkinson y Amdrup y Jensen en 1970, informan sus resultados, conservando el píloro. La única debilidad que se le atribuye a la VAS es una alta tasa de recurrencia de la úlcera; sin embargo, su mortalidad y morbilidad son mínimas, por lo que es la intervención de elección para la úlcera duodenal intratable o complicada. Conclusiones: Debido a la disminución en la necesidad del tratamiento quirúrgico, pocos cirujanos están entrenados y experimentados en esta operación técnicamente difícil; lo que ha sido el principal factor para las altas tasas de recurrencia. Sin embargo, consideramos que la VAS tiene vigencia actual en manos de cirujanos entrenados y experimentados.
ABSTRACT Introduction: The treatment of duodenal peptic ulcer (DPU) has radically changed over the last 50 years due to success of medical treatment. However, surgery still has an important role in the treatment of duodenal ulcer; and with this, vagotomy. Objective: To describe the origin and evolution of highly selective vagotomy (HSV), as well as its role in the surgical treatment of DPU. Material and Methods: We reviewed the bibliography published during the last 50 years in relation to highly selective vagotomy (HSV). The data used were obtained from the search carried out in Clincal Key, Pumed, Google, Scopus and Scielo databases during the period 1970-2020. Development: Highly Selective Vagotomy was first performed in humans by Holle and Hart in 1967. Later, their results were informed by Johnston and Wilkinson and Amdrup and Jensen in 1970, preserving the pylorus. The only weakness attributed to HSV is a higher ulcer recurrence rate; however, mortality and morbidity are minimal, so it is the intervention of choice for intractable or complicated duodenal ulcers. Conclusions: Because of the decline in the need for surgical management, fewer surgeons are trained and and have enough experince to perform this technically challenging surgery, which has been the main factor associated with higher recurrence rates. However, we consider that HSV has a current relevance when it is performed by trained and experienced surgeons.
Asunto(s)
HumanosRESUMEN
La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.
Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.
A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.
Asunto(s)
Humanos , Hemorragia Gastrointestinal , Úlcera Péptica , Antiinflamatorios no Esteroideos , Endoscopía Gastrointestinal , Helicobacter pylori , Tracto Gastrointestinal , Servicio de Urgencia en Hospital , Esofagitis , Inhibidores de la Bomba de Protones , Síndrome de Mallory-Weiss , NeoplasiasRESUMEN
Helicobacter pylori is an organism associated with ulcer disease and gastric cancer. The latter is one of the most prevalent malignancies and currently the fourth major cause of cancer-related deaths globally. The pathogen infects about 50% of the world population, and currently, no treatment ensures its total elimination. There has been an increase in our understanding of the pathophysiology and pathogenesis mechanisms of H. pylori over the years. H. pylori can induce several genetic alterations, express numerous virulence factors, and trigger diverse adaptive mechanisms during its adherence and colonization. For successful colonization and infection establishment, several effector proteins/toxins are released by the organism. Evidence is also available reporting spiral to coccoid transition as a unique tactic H. pylori uses to survive in the host's gastrointestinal tract (GIT). Thus, the virulence and pathogenicity of H. pylori are under the control of complex interplay between the virulence factors, host, and environmental factors. Expounding the role of the various virulence factors in H. pylori pathogenesis and clinical outcomes is crucial for vaccine development and in providing and developing a more effective therapeutic intervention. Here we critically reflect on H. pylori infection and delineate what is currently known about the virulence and pathogenesis mechanisms of H. pylori.
Asunto(s)
Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Gastritis/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/genética , Humanos , Virulencia/genética , Factores de Virulencia/genéticaRESUMEN
Introdução: A crença de que o uso de Inibidores de Bomba de Prótons (IBPs) apresenta baixo risco de toxicidade, resultou em um aumento significativo na sua prescrição em nível mundial, esse fator juntamente com a baixa divulgação de orientações, têm contribuído para o aumento das indicações desnecessárias de inibidores de bomba de prótons em nível hospitalar, principalmente para profilaxia. Objetivo: Analisar a utilização dos inibidores de bomba de prótons em pacientes internados nas enfermarias de clínica médica de um Hospital Universitário, visando avaliar suas indicações, tempo de uso, efeitos adversos e impacto financeiro gerado pelo uso inadequado. Métodos: Foram analisados prontuários de pacientes que estiveram internados nas enfermarias de clínica médica do Hospital Municipal Universitário de Taubaté (HMUT) durante os meses de maio a julho de 2020. As indicações adequadas do uso de inibidores de bomba de prótons foram baseadas em diretrizes internacionais do American Journal of Gastroenterology e do American Society of Health-System Pharmacy. Resultados: Identificamos que 297 pacientes (79,6%) usaram inibidores de bomba de prótons em algum momento da internação. O uso desse medicamento foi adequadamente prescrito em 49,8% dos casos. Foi encontrado maior prevalência de pneumonia e diarreia nos pacientes que fizeram uso de inibidores de bomba de prótons a longo prazo. O custo anual associado as prescrições indevidas foram de R$24.736,40. Conclusão: Observamos alta prevalência de indicações incorretas dos inibidores de bomba de prótons em ambiente hospitalar, ocasionando gasto desnecessário e possíveis complicações. Faz-se necessário, portanto, elaboração de novos protocolos e maior rigidez nas indicações desses medicamentos no Hospital Municipal Universitário de Taubaté.
Introduction: The belief that the use of Proton Pump Inhibitors (PPIs) presents a low risk of toxicity, resulted in a significant increase in its prescription worldwide, this factor combined with the low disclosure of guidelines, have contributed to the increase in unnecessary indications of at the hospital level, especially for prophylaxis. Objective: To analyze the use of proton pump inhibitors in patients hospitalized in the medical clinic wards of a University Hospital, in order to evaluate their indications, time of use, adverse effects and financial impact generated by inadequate use. Methods: Medical records of patients who were admitted at the Municipal University Hospital of Taubaté during the months of May to July 2020 were analyzed. The appropriate indications for the use of proton pump inhibitors were based on the international guidelines of the American Journal of Gastroenterology and the American Society of Health-System Pharmacy. Results: We identified that 297 patients (79.6%) used proton pump inhibitors at some point in hospitalization. The use of this drug was adequately prescribed in 49.8% of the cases. A higher prevalence of pneumonia and diarrhea was found in patients who used proton pump inhibitors in the long term. The annual cost associated with undue prescriptions was R$24,736.40. Conclusion: We observed a high prevalence of incorrect indications of proton pump inhibitors s in the hospital environment, causing unnecessary expenses and possible complications. It is necessary, therefore, the elaboration of new protocols and greater rigidity in the indications of these drugs at the Municipal University Hospital of Taubaté.
Asunto(s)
Humanos , Úlcera Péptica Hemorrágica , Inhibidores de la Bomba de Protones/efectos adversos , Prescripción Inadecuada/efectos adversos , Antiulcerosos/administración & dosificación , Prescripciones de Medicamentos/estadística & datos numéricos , Costos y Análisis de Costo , Hospitalización , Pacientes InternosRESUMEN
Resumen La hemorragia digestiva alta (HDA) es una emergencia médico-quirúrgica común que debe ser tratada precozmente por su alta morbimortalidad. Corresponde a sangrado del esófago, estómago o del duodeno proximal, y se divide en etiología no variceal y variceal. Dentro de las no variceales destaca la úlcera péptica como la más frecuente, siendo esta producida por un desbalance entre factores protectores y agresivos. Por otro lado, en las hemorragias variceales destacan las várices gastroduodenales, las cuales son consecuencia del aumento de la presión portal. La incidencia de la HDA a nivel mundial varía entre 37 a 172 casos por cada 100.000 habitantes por año y la mortalidad entre un 5 y un 14% según diferentes estudios. Lamentablemente, no existen cifras nacionales fidedignas de incidencia y prevalencia. El médico debe conocer bien la presentación clínica y la fisiopatología para ser asertivo en la sospecha, diagnóstico y manejo de esta patología. En cuanto al tratamiento, el enfrentamiento se divide en el manejo de urgencias y luego endoscópico, puesto que la resucitación temprana intensiva puede reducir la morbimortalidad en pacientes con HDA. A continuación se hará una revisión actualizada enfocada en los aspectos más relevantes del manejo de esta patología. Se obtuvieron los datos de Pubmed y Scielo, específicamente la búsqueda de artículos originales y de revisiones sistemáticas con las palabras "hemorragia digestiva alta", "úlcera péptica", "várices esofágicas" y otras relacionadas. Los criterios usados fueron artículos preferentemente menores a 5 años de publicación en revistas científicas de alto índice de impacto.
Upper gastrointestinal bleeding (UHD) is a common medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to bleeding from the esophagus, stomach, or proximal duodenum, and is divided into non-variceal and variceal etiology. Among the non-variceal, the peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal hemorrhages gastroduodenal varices stand out, are a consequence of increased portal pressure. The incidence of HDA worldwide varies between 37 to 172 cases per 100,000 inhabitants per year and mortality between 5 to 14% according to different studies. Unfortunately, there are no reliable national statistics of incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology to be assertive in the suspicion, diagnosis, and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic, because early intensive resuscitation can reduce morbidity and mortality in patients with UHD. This is an updated review which will be focused on the most relevant aspects of the management of this pathology. Data were obtained from Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "upper gastrointestinal bleeding", "peptic ulcer", "esophageal varices" and other related words. The criteria used were articles preferably less than 5 years old in scientific journals with a high impact index.