Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: Is Helicobacter pylori infection a risk factor for hemorrhage?

Domon, Kaoru; Hirano, Naoki; Otsuka, Takafumi; Fujitsuka, Yoshinori; Takeuchi, Mio; Kikuchi, Yoshinori; Nakano, Shigeru; Igarashi, Yoshinori

doi:10.1111/j.1443-1661.2012.01245.x

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…In the present study, patients with PUB in the second-half group were older than those in the first-half group. In Japan, the birth rate is decreasing and average life expectancy is increasing, leading to a more elderly population (≥65 years) [16]. The rapid increase of the elderly population in recent years has been associated with the increased use of NSAIDs and antithrombotic agents.…”

Section: Discussionmentioning

confidence: 99%

Time Trends of the Impact of Helicobacter pylori Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

Nagasue¹,

Nakamura²,

Kochi³

et al. 2015

Digestion

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Background/Aims:Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The purpose of the present study was to elucidate the time trends of the impact of H. pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer bleeding (PUB) in Japanese patients. Methods: We retrospectively reviewed 719 patients who had received endoscopic hemostasis for PUB between 2002 and 2013. Subjects were divided into either the first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n = 356). The clinical characteristics of the patients, including the prevalence of H. pylori infection and use of NSAIDs and antithrombotic agents, were compared between the two groups. Results: Compared to the first-half group, patients in the second-half group were characterized by older age (proportion of the patients above 60 years old, 63.9 vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p < 0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant difference was observed regarding the use of antithrombotic agents between the two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and proportion of patients above 60 years old were significantly different between the two groups in a multivariate analysis. Conclusion: The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.

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Section: Discussionmentioning

confidence: 99%

Time Trends of the Impact of Helicobacter pylori Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

Nagasue¹,

Nakamura²,

Kochi³

et al. 2015

Digestion

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“…[16], L. A. García Rodríguez et al [17] и ряд других авторов -использованию лекарственных средств, обладающих ульцерогенным эффектом. По мнению К. Domon et al [18], образование дефектов может происходить под влиянием факторов патогенности и цитотоксической активности H. рylori.…”

Section: Introductionunclassified

Efficacy of the use of angiotensin converting enzyme inhibitors in the complex therapy of gastroduodenal erosions and ulcers in patients with unstable angina

Osadchij,

Bikova,

Dolgopolov

2024

ECG

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Purpose of the study. To find out the effectiveness of the use of angiotensin-converting enzyme (ACE) inhibitors in the complex therapy of erosive and ulcer lesions of the stomach and duodenum in unstable angina pectoris (UA). Materials and methods. A survey of 109 patients with UA with gastroduodenal erosions and ulcers was carried out, taking into account their clinical signs, endoscopic features and the parameters of gastric secretion. The patients were divided into two groups depending on the nature of the treatment of erosions and ulcers. The first group included 40 patients treated with standard therapy, and the second one included 69 patients who additionally received ACE inhibitor lisinopril at an average dose of 7.27±0.16 mg a day. Results. The therapy by lisinopril resulted in decreasing of pain and dyspeptic syndrome, especially in patients with acute erosions, compared with conventional treatment group. According to endoscopic examination, in patients treated with lisinopril, an acceleration of repair processes in the tissues of the gastroduodenal zone was observed. The depth and size of damages, a reduction in the period of persistence of microbleeding signs and inflammatory changes in the periulcerous zone were also less pronounced in lisinopril patient’s group. In patients with acute erosions a decrease in the number and size of erosive defects of the mucous membrane was observed. The study of the parameters of gastric secretion showed that gastroduodenal erosions and ulcers in UA revealed the activation of the acid-peptic factor and a decreasing in the production of gastromucoproteins. Increased production of pepsinogen and a sharply reduced formation of protective mucus was observed in patients after conventional treatment, despite some positive dynamics. Normalization in pepsinogen secretion with some inhibition of the production of mucopolysaccharides was observed in Lisinopril treated patients at the end of therapy. Acid production in both groups was reduced, which was associated with could be provoked by an uptake of antisecretory agents. Conclusion. The use of ACE inhibitor lisinopril in the complex therapy in patients with UA with gastroduodenal erosions and ulcers is pathogenetically justified and clinically effective. This combination helps to reduce the duration of clinical signs, accelerate the healing of defects and normalize the parameters of gastric secretion.

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Absence ofHelicobacter pyloriis not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

Lee

Noridah

Hassan

et al. 2014

PeerJ

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Aim. Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding.Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery.Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors.Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

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Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: Is Helicobacter pylori infection a risk factor for hemorrhage?

Cited by 3 publications

References 19 publications

Time Trends of the Impact of <b><i>Helicobacter pylori</i></b> Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

Time Trends of the Impact of <b><i>Helicobacter pylori</i></b> Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

Efficacy of the use of angiotensin converting enzyme inhibitors in the complex therapy of gastroduodenal erosions and ulcers in patients with unstable angina

Absence ofHelicobacter pyloriis not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

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