No abstract available.
Drug Therapy* ; Humans ; Peptic Ulcer*

Despite the generally declining trend in the incidence of peptic ulcers, peptic ulcer bleeding remains a prevalent and clinically significant condition. Additionally, despite the development of therapeutic endoscopy and acid-suppressive therapy, the overall mortality associated with peptic ulcer bleeding has remained at about 6% to 14%. Management of acute peptic ulcer bleeding requires prompt resuscitation, risk assessment, early endoscopic evaluation, and early initiation of pharmacotherapy. Advances in therapeutic endoscopic techniques and antisecretory therapies in the past few decades have reduced the incidence of recurrent bleeding and the mortality rate associated with this disease. Strategies to prevent recurrence have been defined for various causes of peptic ulcer bleeding. This article reviews the current diagnosis and management of acute peptic ulcer bleeding.
Diagnosis* ; Disease Management ; Drug Therapy ; Endoscopy ; Hemorrhage* ; Incidence ; Mortality ; Peptic Ulcer Hemorrhage ; Peptic Ulcer* ; Recurrence ; Resuscitation ; Risk Assessment

OBJECTIVETo evaluate the efficacy and safety of acupuncture at Zhongwan (CV 12) for treatment of peptic ulcer.

METHODSTwo hundred and seventy-six cases enrolled were randomly divided into an acupuncture group and a control group, 138 cases in the acupuncture group were treated with deep needling at Zhongwan (CV 12) with a long needle, and 138 cases in the control group were treated with climetidine. The therapeutic effects were evaluated by clinical symptoms and gastroscopy. They were investigated for 6 weeks.

RESULTSThe acupuncture group was better than the control group in rapid alleviation of stomachache and improvement of appetite (P < 0.05). The total effective rate was 90.6% in the acupuncture group and 88.4% in the control group with no significant difference (P > 0.05). The symptoms improved significantly in the two groups (P < 0.01), but with no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in the therapeutic effect of gastroscopy (P > 0.05).

CONCLUSIONAcupuncture at Zhongwan (CV 12) has a reliable therapeutic effect on peptic ulcer.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer ; therapy

OBJECTIVETo explore the acupoints selection rules on peptic ulcer treated with acupuncture and moxibustion,so as to provide references for acupoints clinical selecting.

METHODSLiterature on clinical report and clinical study for peptic ulcer treated with acupuncture and moxibustion was retrieved in CNKI, WANFANG, VIP, CBM, PubMed, Web of Science and other databases from January 1, 2003 to August 31, 2014,and acupoints selecting rules were summarized according to syndromes and symptoms.

RESULTSOne hundred and ten articles were acquired, and acupoints the first to the fifth used were Zhongwan (CV 12), Zusanli (ST 36), Weishu (BL 21), Pishu (BL 20) and Neiguan (PC 6). The main acupoints were Zhongwan (CV 12) and Zusanli (ST 36). As to acupoints mainly selected in accordance with different syndromes: (1)Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6) were matched for the syndrome of deficiency cold in the spleen and the stomach. (2) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Geshu (BL 17) were combined for the syndrome of qi stagnation and blood stasis. (3) Weishu (BL, 21), Pishu (BL 20), Qimen (LR 14) for the syndrome of qi stagnation induced by liver depression. (4) Neiguan (PC 6) and Taichong (LR 3) for the syndrome of liver qi invading the stomach. (5) Weishu (BL 21) and Pishu (BL 20) for the syndrome of weakness of the spleen and the stomach. (6) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Gongsun (SP 4) for the syndrome of cold in the stomach. (7) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), San yinjiao (SP 6) for the syndrome of yin deficiency in the stomach. (8) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Yinlingquan (SP 9), Ganshu (BL 18) for the syndrome of phlegm and dampness stagnation. As for acupoints majorly selected according to different symptoms, (1) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Taichong (LR 3) were combined for acid regurgitation. (2) Weishu (BL 21), Neiguan (PC 6), Tianshu (ST 25), Gongsun (SP 4) were selected for abdominal distension. (3) Weishu (BL 21), Neiguan (PC 6), Liangqiu (ST 34), Gongsun (SP 4) for unbearable stomach pain. (4) Weishu (BL 21), Pishu (BL 20), Neiguan (PC 6), Qihai (CV 6), Gongsun (SP 4) for lacking in strength.

CONCLUSIONWe treating peptic ulcer with acupuncture and moxibustion mainly choose Zhongwan (CV 12) and Zusanli (ST 36), and attach importance to acupoints selection based on syndrome and symptom differentiation.

Acupuncture Points ; Acupuncture Therapy ; Databases, Bibliographic ; Humans ; Moxibustion ; Peptic Ulcer ; therapy

Acute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitor (PPI) remains the mainstay of treatment with potent acid suppression. Maintenance of the intragastric pH level above 6 by the administration of PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of PPI after intravenous bolus injection. A high dose intravenous PPI is effective in reducing the risk of rebleeding, the need for surgery and repeated endoscopy. However, data regarding non-high dose intravenous PPIs are limited. In the future, novel PPIs and potassium-competitove acid blocker are in the area of interest. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for non-variceal upper gastrointestinal bleeding.
Endoscopy ; Hemolysis ; Hemorrhage* ; Hemostasis ; Hydrogen-Ion Concentration ; Incidence ; Infusions, Intravenous ; Mortality ; Pepsin A ; Peptic Ulcer ; Proton Therapy

Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pyori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pyori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pyori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.
Anti-Ulcer Agents/therapeutic use ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/diagnosis ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Hemostasis, Endoscopic ; Humans ; Misoprostol/therapeutic use ; Peptic Ulcer/surgery/*therapy ; Peptic Ulcer Hemorrhage/surgery/*therapy ; Proton Pump Inhibitors/therapeutic use

BACKGROUND: Since the international guideline of Helicobacter pylori eradication therapy was introduced into Korea, many reports about eradication outcomes have been documented. These data were published mostly from referred university hospital. However, in Korea, majority of patients has been treated with H.pylori eradication regimen in primary care setting. This study was performed to investigate the eradication rate of H. pylori in primary care office of Seoul, Korea. METHODS: Total 173 patients with H.pylori-positive gastroscopy results received eradication regimen-mainly one week PPI based triple therapy-from January 1998 to March 2003. Four weeks after completion of medication, urea breath test, biopsy and CLO test were performed to detect H.pylori. RESULTS: Total eradication rate was 87.9%. The eradication rate of male and female were 90.3% and 84.3%, respectively (p>0.05). The eradication rate of patients older than younger than 60 was 81.5% vs 89.0%, respectively (p>0.05). There was no statistical significance in annual eradication rate. In eradication rate, there was no significant difference among PPI regimen (omeprazole, rabeprazole, pantoprazole). Whether endoscopic diagnosis is gastric ulcer or duodenal ulcer, there was no statistical difference in eradication rate between them. In the same way, there was also no statistical difference between peptic ulcer and H.pylori associated gastritis. CONCLUSION: The current eradication rate of H. pylori in primary care setting of Korea was 87.9%. H.pylori eradication rate in primary care setting was not much different from that in referred hospital in Korea, but it was lower than that reported by controlled trials of 1995 (initial times of introduction of international guide line into Korea). So far, the results have been acceptable, but there still remains to be investigated in PPI-based triple therapy as H.pylori eradication in primary care setting in the future of Korea.
Biopsy ; Breath Tests ; Diagnosis ; Drug Therapy ; Duodenal Ulcer ; Female ; Gastritis ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Male ; Peptic Ulcer ; Primary Health Care* ; Rabeprazole ; Seoul ; Stomach Ulcer ; Urea

The development and introduction into clinical practice of proton pump inhibitors (PPIs) have influenced the management of acid-peptic disorders dramatically. PPIs inhibit the gastric hydrogen/potassium adenosine triphosphatase selectively and irreversibly which is the final step in acid secretion. PPIs are currently the most effective form of therapy in acid-peptic diseases. All PPIs are potent, effective and generally safe, but little different in equivalent doses. PPIs undergo hepatic metabolism by cytochrome P450 (CYP) system. Polymorphism of CYP2C19 influences the pharmacokinetics and pharmacodynamics of PPIs. Doses and dosing schemes of PPIs based on CYP2C19 genotype status is expected to increase the efficacy in clinical outcome. The major indication of PPIs are acid-related diseases such as peptic ulcers and their complications, gastroesophageal reflux diseases, Zollinger-Ellison syndrome and eradication of Helicobacter pylori with antibiotics and dyspepsia. The potency and cost-effectiveness of PPIs have extended their clinical uses. However, their widespread and long-term use may limit the therapeutic benefit between efficacy and clinical problems such as acid rebound hypersecretion, enhanced oxyntic gastritis, problems with carcinoids in rodents and long-term concern for gastric cancer development. Further studies are needed to minimize the side effects and to maximize the therapeutic effects of PPIs.
Animals ; Anti-Ulcer Agents/*therapeutic use ; Gastroesophageal Reflux/*drug therapy ; Helicobacter Infections/*drug therapy ; Humans ; Peptic Ulcer/*drug therapy ; Proton Pumps/*antagonists & inhibitors

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother's serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination.
Blood Transfusion ; Endoscopy, Gastrointestinal ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Infant, Newborn ; Peptic Ulcer Hemorrhage/*diagnosis/drug therapy/therapy ; Stomach Ulcer/*complications

BACKGROUND/AIMS: The Rockall risk assessment score was developed to predict the risk of rebleeding and death in patients with upper GI hemorrhage. The validity of this score, however, was not established in Korea. We tried to assess the reliability of the Rockall score to predict outcomes in patients with bleeding peptic ulcer. METHODS: Medical records of 175 patients with benign peptic ulcer bleeding treated in Samsung Medical Center from January 2000 to May 2003 were retrospectively analyzed. They were classified into three groups: no rebleeding rebleeding, and death and mean Rockall score was compared. Forrest classification was also compared with the Rockall score regarding the clinical usefulness of predicting poor outcomes in patients with bleeding peptic ulcer. RESUTLS: One hundred forty five patients did not show rebleeding, with mean Rockall score of 3.5 (SD=1.5). On the other hand, rebleeding occurred in 25 patients and the mean score was 6.4 (SD=1.44). There were 13 deaths with mean score of 7.0 (SD=1.08). The differences between the three groups were significant (p<0.001). In multivariate analysis, Rockall score was a independent risk factor of rebleeding and mortality (odds ratio, OR=2.73 and OR=8.74). CONCLUSIONS: The Rockall scoring system is useful to predict poor outcome such as rebleeding and death in patients with bleeding peptic ulcer.
Comparative Study ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage/*classification/mortality/therapy ; Recurrence ; Risk Factors ; Survival Rate