Peptic ulcer disease today

Abstract

Over the past few decades, since the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors, cyclo-oxygenase-2-selective anti-inflammatory drugs (coxibs), and eradication of Helicobacter pylori infection, the incidence of peptic ulcer disease and ulcer complications has decreased. There has, however, been an increase in ulcer bleeding, especially in elderly patients. At present, there are several management issues that need to be solved: how to manage H. pylori infection when eradication failure rates are high; how best to prevent ulcers developing and recurring in nonsteroidal anti-inflammatory drug (NSAID) and aspirin users; and how to treat non-NSAID, non-H. pylori-associated peptic ulcers. Looking for H. pylori infection, the overt or surreptitious use of NSAIDs and/or aspirin, and the possibility of an acid hypersecretory state are important diagnostic considerations that determine the therapeutic approach. Combined treatment with antisecretory therapy and antibiotics for 1-2 weeks is the first-line choice for H. pylori eradication therapy. For patients at risk of developing an ulcer or ulcer complications, it is important to choose carefully which anti-inflammatory drugs, nonselective NSAIDs or coxibs to use, based on a risk assessment of the patient, especially if the high-risk patient also requires aspirin. Testing for and eradicating H. pylori infection in patients is recommended before starting NSAID therapy, and for those currently taking NSAIDs, when there is a history of ulcers or ulcer complications. Understanding the pathophysiology and best treatment strategies for non-NSAID, non-H. pylori-associated peptic ulcers presents a challenge.

Molecular mechanisms in therapy of acid-related diseases

“…Frequent recurrence after healing has been a major component of the natural history of gastric ulcer and, without therapy, ulcers recur in 35-80 % of patients within 6-12 months of healing [62]. The major agents injurious to the upper gastrointestinal tract that are responsible for peptic ulcers are gastric acid, H. pylori infection, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).…”

“…Acid suppression therapy alone is associated with relatively high levels of recurrence. Thus the combination of bacterial eradication and elevation of pH provides the optimal treatment not only for ensuring ulcer cure, but also for abrogating the likelihood of the development of complications such as bleeding [62].…”

High prevalence of duodenal ulcer in a tertiary care hospital in the city of São Paulo, SP, Brazil

“…However, infection with more pathogenic H. pylori isolates with positive cagPAI genes (15,17) was previously shown as risk of ulcer disease outcome. Other factors were being between 40 and 60 years of age, being male, cigarette smoking, alcohol consumption, use of aspirin or NSAIDs, heavy social psychological stress, frequent mobility, irregular working hours, low socioeconomic status, higher acid output, and heredity (4,5,29) . The worldwide ulcer prevalence differs, with duodenal ulcers dominating in Western populations and gastric ulcers being more frequent in Asia, especially in Japan (29) .…”

“…Other factors were being between 40 and 60 years of age, being male, cigarette smoking, alcohol consumption, use of aspirin or NSAIDs, heavy social psychological stress, frequent mobility, irregular working hours, low socioeconomic status, higher acid output, and heredity (4,5,29) . The worldwide ulcer prevalence differs, with duodenal ulcers dominating in Western populations and gastric ulcers being more frequent in Asia, especially in Japan (29) . In the present study 33.4% of the patients had peptic ulcer disease, mainly, duodenal ulcer (26.5%) that was high in comparison to Southern Brazil (3.3%) (24) , Philippines (10.3%) (27) and Turkey (16.8%) (23) .…”

Anti-Ulcer Activity of Leguminosae Plants

“…Medications are used to relieve the pain, heal ulcerations and delay recurrence of ulcerations. These include antibiotics (33) , antacids and proton pump inhibitors (30) . Several drugs are available in the market for gastric ulcer therapy; however, most of these drugs are associated with unwanted side effects (23) .…”