Clnical and endoscopic manifestations of gastro-duodenal injuries in 178 patients caused by nonsteroidal anti-inflammatory drugs (NSAID) were compared with these of 84 patients without treatment of NSAID. We concluded that abnomal rate in gastro-duodenal endoscopy is 86.0 % in the group treated by NSAID. Gastric injury rate is 80.9 %, including 22.5% of gastric ulcer (p<0.01). Duodenal injury rate is 29.2 %. including 22.5% of duodenal ulcer (p<0.01). Clinical features: epigastric pain rate is 42.7%; abdominal distention is 11.8%. These symploms are useful in predicting gastrointestinal injuries. These lesions more likely severe if the patient have following factors: above 60 years old; alcoholism, smosking, using NSAIDs for long time, using high dose of the NSAIDs. There is not relation between endoscopic manifestations, type of rheumatic disease and HP infections.
Anti-Inflammatory Agents, Peptic Ulcer

Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs) are well-established causes of gastrointestinal mucosal damage, such as uncomplicated and complicated peptic ulcer diseases. Many epidemiologic studies suggest that H. pylori infection increases the risk of developing peptic ulcer complications among non-aspirin NSAID consumers. According to data from randomized clinical trials, H. pylori eradication may prevent NSAID-induced ulcers in non-aspirin NSAID-naive patients and long-term aspirin consumers with a history of ulcer complications. H. pylori eradication by itself is insufficient to prevent NSAID-induced peptic ulcers and complications among low-risk NSAID consumers. In patients receiving long-term non-aspirin NSAIDs with a history of ulcer complications, proton pump inhibitor is more effective in preventing ulcer recurrence and bleeding.
Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Helicobacter ; Helicobacter pylori ; Humans ; Peptic Ulcer ; Proton Pumps ; Recurrence ; Ulcer

BACKGROUND: The proportion of the aged (>60 years old) population is increasing in South Korea and it is expected to reach 30.8% in 2030. The aim of this study was to analyze the clinical characteristics of peptic ulcer disease in the aged population in South Korea. METHODS: A total of 134 patients (89 men and 45 woman) with peptic ulcers were investigated. The ulcers were diagnosed using esophagogastroduodenoscopy. The main symptom, the duration of the symptoms, the location of the ulcer, the presence of Helicobacter pylori as well as the history of Anti-Inflammatory Agents, Non-Steroidal (NSAID) use were analyzed. The parameters between the two age groups: under 60 years (n=73) and over 60 years (n=61), were compared. RESULTS: In the aged, the frequency of a Helicobacter pylori infection was lower. In a gastric ulcer (GU) in aged patients, the rate of Helicobacter pylori infection was less common than in younger GU patients. In aged duodenal ulcer (DU) patients, the rate of a Helicobacter pylori infection was similar to that of younger DU patients. Bleeding peptic ulcers were more common in NSAID-users than in nonusers. DU was less common in the aged group (29.5% vs. 47.9%, p=0.030) and the incidence of typical epigastric pain in the aged and young groups were similar (33.3% vs. 40.0%, p=0.439). The frequency of ulcer bleeding was not different (22.8% vs. 17.1%, p=0.425) between aged and young groups. However in the aged group, the NSAID users experienced more frequent ulcer bleeding than nonusers. The Helicobacter pylori (+) NSAID users are believed to have a higher tendency to bleed than the Helicobacter pylori (-) NSAID users but without statistical significance. Among the aged, 40% of the NSAID-nonusing peptic ulcer patients was Helicobacter pylori (-). The duration of symptoms was shorter in the aged. An atypical location of the aged and younger groups was similar (13.2% vs. 7.0%, p=0.352). CONCLUSION: In the aged gastric ulcer patients, factors other than NSAID and Helicobacter pylori are believed to play roles in the development of gastric uclers. However, in the aged duodenal ulcer patients, the role of Helicobacter pylori in the development of a duodenal ulcer was similar to that in the younger group. NSAID is believed to be an important risk factor in the bleeding of ulcers in aged patients. In addition, the Helicobacter pylori (+) NSAID users had more frequent bleeding than the Helicobacter pylori (-) NSAID users but without statistical significance.
Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Duodenal Ulcer ; Endoscopy, Digestive System ; Helicobacter pylori ; Hemorrhage ; Humans ; Incidence ; Korea* ; Male ; Morinda ; Peptic Ulcer* ; Risk Factors ; Stomach Ulcer ; Ulcer

Before the discovery of H. pylori, the therapy of peptic ulcer disease(PUD) was focused on the acid secretion. Although acid secretion is still important in the pathogenesis of PUD, eradication of H. pylori and therapy/prevention of NSAIDinduced disease is the mainstay of therapy these days. Multiple drugs have been evaluated in the therapy of H. pylori. No single agent is effective in eradicating the organism. Combination therapy for 10 to 14 days provides the greatest efficacy. The combination of two antibiotics among amoxicillin, metronidazole and clarithromycin plus either a PPI or bismuth compound(RBC: ranitidine bismuth citrate) has comparable success rates. Medical intervention for NSAIDrelated mucosal injury includes treatment of an active ulcer and prevention of future injury. Ideally the injurious agent should be stopped as the first step in the therapy of an active NSAIDinduced ulcer. If that is possible, then treatment with one of the acid inhibitory agents (H2 blockers, PPIs) is indicated. Cessation of NSAIDs is not always possible because of the patient's severe underlying disease. Only PPIs can heal GUs or DUs, independent of whether NSAIDs are discontinued. Prevention of NSAIDinduced ulceration can be accomplished by misoprostol (200 microgram qid) or a PPI. The use of COX2 specific inhibitor may also reduce injury to gastric mucosa. H. pylorinegative idiopathic peptic ulcer disease appears to be increasing. Antisecretory drugs remain the mainstay of treatment for promoting healing of idiopathic peptic ulceration. However, in the absence of H. pylori infection, antisecretory drugs are less effective in inhibiting gastric acidity. Managment of idiopathic PUD needs to be further de-fined and will require new clinical studies.
Amoxicillin ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Bismuth ; Clarithromycin ; Duodenal Ulcer ; Gastric Acid ; Gastric Mucosa ; Helicobacter pylori ; Metronidazole ; Misoprostol ; Peptic Ulcer* ; Ranitidine ; Stomach Ulcer ; Ulcer

PURPOSE: Despite modern medication, peptic ulcer, patients often require emergency surgery for complications of peptic ulcer disease, and the mortality due to a perforated peptic ulcer still remains high. This retrospective study was conducted to evaluate the risk factors associated with mortality in patients undergoing surgery for a perforated peptic ulcer. METHODS: Two hundred and four consecutive patients (mean age: 45.8 years; range: 15~0 years) who underwent emergency surgery for a perforated peptic ulcer at the National Medical Center, between January 1991 and December 2000, were reviewed. RESULTS: The overall mortality rate was 5.9%. A univariate analysis of multiple clinical variables revealed old age (> or =65 years), duration of symptoms (> or =24 hours), NSAIDs or steroid use, comorbid disease, shock on admission, low hemoglobin (<10 g/dl), higher BUN (> or =20 mg%), higher creatinine (> or =1.5 mg%), gastric ulcer and simple closure to be significantly associated with mortality. However, a multivariate analysis showed that shock on admission, comorbid disease and old age (> or =65 years) were independent predictors of mortality. CONCLUSION: Shock on admission, comorbid disease and old age should be considered as significant prognostic factors of emergency surgery for a perforated peptic ulcer, and a comorbid disease and age as non modifiable factors. For that reason, prompt resuscitation is considered as the most effective therapy for reducing the mortality due to peptic ulcer perforation.
Anti-Inflammatory Agents, Non-Steroidal ; Creatinine ; Emergencies* ; Humans ; Mortality* ; Multivariate Analysis ; Peptic Ulcer Perforation ; Peptic Ulcer* ; Resuscitation ; Retrospective Studies ; Risk Factors* ; Shock ; Stomach Ulcer

BACKGROUND/AIMS: Bleeding still remains as one of the major medical problems in peptic ulcer diseases, despite of the advances in therapeutic options and endoscopic therapy. The aim of this study was to compare the clinical outcomes of bleeding peptic ulcer between two distinct periods in the past ten years. METHODS: We divided the among 10 years, we selected the two distinct periods; the first (1993~1995) and the second (2000~2002). The clinical and endoscopic characteristics in patients with bleeding peptic ulcer were compared between the two periods. We also analyzed the changes in the clinical outcomes as well. RESULTS: The age of patients during the second period was significantly older compare to the first period. In subgroup analysis, proportions of patients older than 60 years and of female patients were significantly higher in the second period. The percentage of the patients with co-morbid illness, such as diabetes mellitus, cardiovascular diseases, or users of non-steroidal anti-inflammatory drugs, was higher in the second period. Despite the decreasing the frequency of urgent surgery in the second period, there was no significant difference in the rate of re-bleeding and mortality between both periods. CONCLUSIONS: Despite the advances in therapeutic options in the second period, no significant difference was found in the prognosis of bleeding ulcer, compared to the first period. Old age, co-morbid illness, and increasing usage of NSAIDs has may contributed to this. Taken together, it might be more important to apply preventive measures to the patients who have risk factors for bleeding peptic ulcer.
Anti-Inflammatory Agents, Non-Steroidal ; Cardiovascular Diseases ; Diabetes Mellitus ; Female ; Hemorrhage* ; Humans ; Mortality ; Peptic Ulcer* ; Prognosis ; Risk Factors ; Ulcer

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed drugs, and they are known to be responsible for many cases of gastroduodenal ulcerations by inhibiting prostaglandin synthesis via blocking the cyclo-oxygenase production. Colonic side effects of these drugs are rare, but they are increasingly being reported to be due to the popularization of colonoscopy and the new formulations of drugs such as enteric coated pills or slow release pills. There is currently no consensus for making the clinical diagnosis and administering the proper therapy for drug-induced colonopathy in Korea. We experienced the patient who had multiple colonic ulcers after ingesting large amounts of aspirin and NSAIDs. In near future, we hope to determine the clinical and endoscopic features of drug associated colon injury.
Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Colon ; Colonoscopy ; Consensus ; Humans ; Korea ; Peptic Ulcer ; Prostaglandin-Endoperoxide Synthases ; Ulcer

Peptic ulcer disease complicated with gastric outlet obstruction is rare in children. Even though NSAIDs have been reported to cause various adverse events, they are still regarded as safe and, therefore, widely utilized in children. In the past, pediatric patients who were at risk of seizure due to high fever, were treated with dipyrone (Metamizole sodium) injection which inhibits cyclooxygenase-1 and inhibit prostaglandin, to weaken the gastro-duodenal defensive mechanism. A case of an infant with multiple esophagogatroduodenal ulcers and bleeding caused by NSAID complicated with gastric outlet obstruction is reported in this paper.
Anti-Inflammatory Agents, Non-Steroidal ; Child ; Cyclooxygenase 1 ; Dipyrone ; Fever ; Gastric Outlet Obstruction* ; Hemorrhage ; Humans ; Infant ; Peptic Ulcer* ; Seizures ; Ulcer

The eradication of Helicobacter pylori and the widespread use of effective antisecretory therapies, including proton pump inhibitors, have improved the management of peptic ulcer disease. However, in some patients, peptic ulcer disease is refractory to 8 to 12 weeks of standard antisecretory drug treatment. For refractory peptic ulcer disease, further evaluation of the risk factors and causes of refractory peptic ulcer disease, including patient risk factors and noncompliance (smoking, nonsteroidal anti-inflammatory drug use, and noncompliance with medical treatment), persistent H. pylori infection, and non-H. pylori-related factors (giant ulcer, gastrinoma, infections other than H. pylori, and malignancy), is essential. The treatment should focus on the cause of the refractory peptic ulcer disease, avoiding smoking and nonsteroidal anti-inflammatory drug, the treatment of persistent H. pylori, use of high-dose proton pump inhibitors, or surgical excision of gastrinomas. Surgery should be considered in patients who are at high risk for complications and recurrent peptic ulcer disease despite medical treatment. In this review, I describe the diagnosis and treatment of refractory peptic ulcer disease.
Anti-Inflammatory Agents, Non-Steroidal ; Diagnosis ; Gastrinoma ; Helicobacter pylori ; Humans ; Peptic Ulcer ; Proton Pump Inhibitors ; Risk Factors ; Smoke ; Smoking ; Ulcer

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.
Anti-Inflammatory Agents, Non-Steroidal ; Capsule Endoscopy ; Diagnosis ; Endoscopy ; Epidemiology ; Hemorrhage ; Peptic Ulcer ; Purpura ; Ulcer ; Upper Gastrointestinal Tract