The study of relation between hepatogenic peptic ulcer and portal hypertension,transmitter metabolic disturbance,hepatic insufficiency and infection;and the therapeutic principles of complications of peptic ulcer are described.Twenty four of 58 patients with hepatogenic peptic ulcer were examined by color Doppler ultrasound.Portal venous flow volume (24 cases) was 1060.9±96ml/min.Portal venous pressure(8 cases)was 3.77±2.51kPa tested during operation.Histamine concentration (8 cases) was 0.70±0.31μmol/L in peripheral blood.The gastrin contents of 9cases tested 3cm,5cm away from the ulcer were 2195.6±1043.89ng/L and 2140.3±978.5ng/L respectively. H pylori positive rate was 80% in 58 cases.The therapeutic results were satisfactory with no death.The results suggest that pathogenesis of hepatogenic peptic ulcer is closely related to these factors foresaid.The treatment is nonsurgical and massive hemorrhage or perforation once occurs,surgical treatment is necessary.
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.
ObjectiveTo discuss the etiological factors and risk factors for peptic ulcer hemorrhage with negative Helicobacter pylori (HP). MethodsA total of 182 patients with peptic ulcer treated in our hospital from January 2010 to December 2012 were chosen in our study. There were 85 cases of hemorrhage among them, with 50 HP positive and 35 HP negative ones. The other 97 patients were without hemorrhage. Etiological factors and correlated risk factors for peptic ulcer hemorrhage with HP negative were analyzed. ResultsHP negative rate of the hemorrhage group was 41.2%, while that rate of the non-hemorrhage group was 14.4%, and the difference was significant (P<0.05). The patients with peptic ulcer hemorrhage with negative HP had correlations with age, sex, wine drinking, taking non-steroidal anti-inflammatory medicine and so on. ConclusionPeptic hemorrhage is easily complicated with peptic ulcer with negative HP, and it is intimately correlated with patients' age, sex, wine drinking history, and taking non-steroidal anti-inflammatory medicine, etc.
ObjectiveTo evaluate whether laparoscopic repair for perforated peptic ulcer o ers elderly patients an improved outcome compared with conventional open surgery. MethodsFrom May 2008 to December 2013, clinical data of 163 elderly patients ( ≥ 60 years) who underwent laparoscopic or open repair of perforated peptic ulcer disease were analyzed retrospectively in our hospital. Ninety-one patients received laparoscopic repair and 72 received conventional open repair. The primary end points that were evaluated were total operative time, searching time, nasogastric tube utilization, intravenous fluid requirement, total time of abdominal drainage and urinary catheter usage, time taken to return to normal gastrointestinal motility, percentage of intravenous/intramuscular opiate use, off-bed time, and total in-patient hospital stay. The second end points were morbidity. ResultsThere was a significant diTherence in total operative time in patients who had undergone laparoscopic repair and open repair [(67.9±3.6) minutes vs. (97.8±5.2) minutes]. There was a significant decrease in the time that the nasogastric tube (2.1 days vs. 3.1 days), urinary catheter (2.3 days vs. 3.7 days) and abdominal drain (2.2 days vs. 3.8 days) were required during the postoperative period. Patients who had undergone laparoscopic repair also required less intravenous fluids (2.4 days vs. 4.1 days) and returned to normal gastrointestinal motility [(32.1±1.5) hours vs. (58.4±4.8) hours] and off-bed time significantly earlier than those who had undergone open repair (2.1 days vs. 3.5 days). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (4.7% vs. 45.6%). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (4.1 days vs. 5.3 days). Moreover, morbidity of laparoscopic repair was much lower than open repair (3.3% vs. 16.7%). ConclusionLaparoscopic repair is a viable and safe surgical option for elderly patients with perforated peptic ulcer disease and should be considered for all patients.
ObjectiveTo investigate the health status of elderly peptic ulcer patients in Haikou city and its influencing factors. MethodsSeventy-eight elderly peptic ulcer patients treated in the Department of Gastroenterology, Haikou Hospital between February 2012 and December 2014 were chosen to be the observation group, and at the same time, another 78 healthy elderly people examined in the same hospital were designated as the control group. The general information and health status of the study subjects were investigated for correlation analysis. ResultsThe health status, physical function, body pain, life quality and mental health scores in the observation group were significantly lower than those in the control group (P<0.05). Univariate analysis showed that age, smoking, high-salt diet, body mass index (BMI) were significantly associated with the incidence of peptic ulcer (P<0.05). Multivariate logistic regression analysis showed that age, smoking, high-salt diet, BMI were all independent risk factors for peptic ulcer occurrence (P<0.05). ConclusionThe health status of elderly peptic ulcer patients in Haikou city is relatively low. Age, smoking, high-salt diet and BMI are the major independent risk factors for the occurrence of peptic ulcer. We need to actively strengthen symptomatic prevention and intervention.
ObjectiveTo estimate the level and evolving pattern of peptic ulcer disease (PUD) burden from 1990 to 2019. MethodsThe related data of PUD from 1990 to 2019 were obtained from GBD 2019 database. The corresponding age-standardized rate, annual percentage change, average annual percentage change were calculated and analyzed by Excel and R software. ResultsThe global standardized prevalence of PUD was 99.4/100 000 (95%CI 83.9 to 117.5) in 2019, and decreased from 143.4/100 000 (95%CI 120.5 to 170.2) in 1990. The standardized disability-adjusted disease years (DALYs) rate was 74.4 (95%CI 69.0 to 81.9) in 2019. The estimated annual percentage change (EAPC) from 1990 to 2019 was −3.47% (95%CI −3.58 to −3.37), indicating that the standardized DALYs rate was declining. The prevalence and DALYs of PUD increased with age. The standardized DALYs rate was higher in males than in females in the same age group. Sociodemographic index (SDI) was negatively correlated with the standardized prevalence of PUD (R=−0.45, P<2.2e−16) and the standardized DALYs rate (R=−0.79, P<2.2e−16). ConclusionThe worldwide burden of PUD declined from 1990 to 2019, but the decline had begun to slow or pause in countries with better economic development levels.