ORiginal Article : Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

( Shen Shong Chang ),( Hsiao Yun Hu ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.3

Background/Aims: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB. (Gut Liver 2015;9:346-352)

종합건강검진 수진자의 소화성궤양

정훈용,민영일 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1

1990년 7월 1일부터 1995년 6원 30일까지 5년간 건강검진을 위하여 본원 종합건강증진센터에 내원한 사람 중 위내시경 검사를 시행받은 44,213명을 대상으로 소화성 궤양의 발견 빈도와 연령별 및 성별 분포를 고찰하여 다음과 같은 결과를 얻었다. 1. 44,213명 중 4,477예(10.1%)에서 소화성궤양의 소견을 보였는데, 양성위궤양 소견만 보였던 예는 2.2%, 십이지장 궤양은 7.2%, 그리고 위, 십이지장혼재궤양은 0.7%였다. 2. 성별로 분석하였을 때, 남자는 13.2%, 여자는 4.6%의 빈도를 보였다. 3. 연령특이적 소화성궤양의 빈도는 10대, 20대, 30대, 40대, 50대, 60대, 70대가 각각 5.8%, 8.0%, 8.8%, 10.7%, 10.7%, 10.2%, 및 12.9%였으며, 십이지장궤양은 연령에 따른 빈도의 차이가 없었으나, 위궤양의 경우에는 연령에 따라 빈도가 점차 증가하는 경향을 보였다. 4. 위궤양은 65.3%가 활동성 혹은 치유기의 궤양이었으나, 십이지장궤양은 70%가 반흔기의 궤양이었다. Background Peptic ulcer is very common but frequently asymptomatic disease. The aim of this study is to investigate the prevalence of the peptic ulcer in Korean general health examinee. Methods A tota1 of 44,213 general health examinee received gastroscopy at General Health Promotion Center at Asan Medical Center between July 1990 and June 1995 were analyzed. Results Of 44,213, 4,477 (10.1%) had peptic ulcer: 963 (2.2%) gastric ulcer, 3,196 (7.2%) duodenal ulcer. Sex-specific prevalence of peptic ulcer was 13.2% in male and 4.6% in female. Age-specific prevalence in the 2nd, 3rd, 4th, 5th, 6th, 7th, and 8th decades was 5.8%, 8.0%, 8.8%, 10.7%, 10.7%, 10.2%, and 12.9%, respectively. According to ulcer stages by Sakada, 835 (18.7%) were in active, 990 (22.1%) in healing, and 2,652 (59.2%) in scar stage. The prevalence of peptic ulcers having ulcer crater was 4.1% of 44,213 examinee. Sixty-five percent of gastric ulcers was in active or healing stage, while 70% of duodenal ulcers was in scar stage. Conclusion The prevalence of peptic ulcer in Korean general health examinee was 10.1%, and that of peptic ulcer in active or healing stage was 4.1%.

소화성궤양 환자의 성격 및 심리적특성 - MMPI 와 Spielberger 불안척도를 중심으로 -

이병호(Byung Ho Lee),현진해(Jin Hai Hyun) 대한내과학회 1989 대한내과학회지 Vol.36 No.5

N/A The aim of this study was to evaluate personality patterns and psychological characteristics of peptic ulcer patients and patients with functional dyspepsia by MMPI and Spielberger's Anxiety Test. The peptic ulcer diseases were categorized gastric ulcer, duodenal ulcer, and recurrent duodenal ulcer. The group with functional dyspepsia consisted of patients with upper gastrointestinal symptoms, including postprandial abdominal distension, nausea, cramping pain, and belching without evidence of a peptic ulcer or other organic gastrointestinal disorder. The results are as follows: 1) The mean age of the gastric ulcer group was higher than that of the other groups. But there was no significant mean age difference between the functional dyspepsia, duodenal ulcer, and recurrent ulcer groups. 2) In the basic MMPI scales, the functional dyspepsia group showed the tendency of neuroticism (higher mean score of the D, Hy, and Pt scales than those of the peptic ulcer groups) and psychopathy (higher mean score of the Pd and Mf scales than those of peptic ulcer groups), compared to the peptic ulcer groups. But the duodenal ulcer group showed a significantly higher mean score on the Pa scale than the other groups. 3) In the extended MMPI scales, the peptic ulcer group revealed a higher mean score of the BO, CI, and Im scales than those of the functional dyspesia group. 4) The functional dyspepsia group showed a higher mean score of Spielberger's state and trait anxiety scale than those of the peptic ulcer groups. 5) There was no significant difference between the gastric ulcer and duodenal ulcer groups in the mean score of the MMPI scales and Spielberger's Anxiety scales except the L scale.

NSAID is inversely associated with asymptomatic gastric ulcer: Local health examination data from the Korean National Health Insurance Corporation

Kim, Hee Man,Cho, Jae Hee,Choi, Jin Yi,Chun, Song Wook,Kim, Yu Jin,Cho, Hyeon Geun,Song, Si Young,Han, Ki Jun Informa Healthcare 2013 Scandinavian journal of gastroenterology Vol.48 No.12

<P><B><I>Background.</I></B> Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. <B><I>Aim.</I></B> We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. <B><I>Methods.</I></B> The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. <B><I>Results.</I></B> From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, <I>p</I> = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. <B><I>Conclusion.</I></B> NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.</P>

소화궤양의 임상적 고찰 : 내시경으로 진찰된 5,785예를 中心으로 Acute and Chronic Effect of smoking

강동훈,현진해 대한내과학회 1990 대한내과학회지 Vol.38 No.5

A clinical analysis was performed of 5,785 patients with peptic ulcer who were diagnosed by gastroduodenoscopy at Korea University Haehwa Hospital from March 1977 to March 1989. 1) There were no seasonal variations in the 5,785 peptic ulcer patient, but the frequency of gastric ulcer somewhat decreased in winter, duodenal ulcer and combined ulcer. 2) We observed a peak incidence of peptic ulcer in the 40-49 age group, gastric ulcer in the 40~49 age group, duodenal ulcer in the 30~39 age group, and combined ulcer in the 50~59 age group. The ratio of male to female was 2.5:1 in peptic ulcer, 2.7:1 in gastric ulcer, 2. 3:1 in duodenal ulcer and 3.8:1 in combined ulcer. 3) There was an incrased incidence of blood group 0 in the 5,785 peptic ulcer patients. 4) Of the 5,785 cases with peptic ulcer, 1,946 cases(33.6%) were gastric ulcer, 3,302 cases(57.1%) were duodenal and 537 cases(9.3%) were combined ulcer. The ratio of duodenal ulcer to gastric ulcer was 1.5:1 5) The frequency of multiple ulcer was 36.3% in stomach, and 28.6% in duodenum. 6) The most prevalent site of gastric ulcer was lesser curvature of angle. The most favorable site of duodenal ulcer was bulb(96.8%). And in bulb ulcer, anterier wall was involved most commonly. 7) Complications of peptic ulcer were, in frequency of order, hemorrhage(6.4%), pyloric stenosis(2.1%), and perforation(0.1%). 8) The most common symtom was epigastric pain. There were somewhat difference between gastric ulcer, duodenal ulcer, combined ulcer in character, duration and onset of the chief symptom, and other dyspeptic symptoms.

한국 노인 환자에서 소화성궤양의 임상적 특징

유기동 ( Ki Dong Yu ),김나영 ( Na Young Kim ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwang ),김진욱 ( Jin Wook Kim ),이동호 ( Dong Ho Lee ),정숙향 ( Soo Hyang Jeong ),이광혁 ( Kwang Hyuck Lee ),이형석 ( Hyung Suk Lee ),곽경 대한내과학회 2006 대한내과학회지 Vol.71 No.5

Background: The incidence of peptic ulcer has decreased in the general population, but it has increased for the geriatric patients worldwide. The aim of the study is to determine the age-related characteristics of peptic ulcer patients. Methods: A total of 277 patients (195 men and 82 women), who were diagnosed with peptic ulcer from May 2003 to Dec 2004, were analyzed retrospectively. The clinical characteristics of peptic ulcer were compared between the two groups, that is, 138 elderly (= 65 yrs) and 139 non-elderly (= 50 yrs) patients. Results: Peptic ulcer in the elderly were located more atypically (high body and the greater curvature side of the mid and low body), the lesions were large and healed slowly. In the elderly group, 50.7% of the ulcers were gastric and 36.2% were duodenal. On the other hand, in the non-elderly group, 30.2% and 57.6% of the ulcers were gastric and duodenal, respectively. There was no difference of the main symptoms between the two groups. For endoscopically bleeding ulcer, the use of NSAID was statistically significant (p=0.006) only for the elderly group. The presence of Helicobacter pylori was less common in the elderly group than in the non-elderly (57.7% vs 77%, respectively, p=0.001). In the case of gastric ulcer, the rate of H. pylori infection was similar between the two groups (62.9% vs 73.8%, respectively, p=0.233). In contrast, in the case of duodenal ulcer, H. pylori infection was less common for the elderly patients than in the non-elderly patients (51% vs 77.5%, respectively, p=0.002). Conclusions: For the elderly patients with peptic ulcer in Korea, the role of H. pylori was relatively less important that it was for the non-eldery group. On the contrary, NSAID, aspirin and combined chronic illness seem to contribute to ulcer. Bleeding peptic ulcer was discovered in both groups with no significant difference in the occurrence rate.(Korean J Med 71:501-510, 2006)

소화성 궤양에 있어서 혈청 Pepsinogen I 의 의의에 관한 연구

이선희(Sun Hee Lee),이동필(Dong Pil Lee),신영민(Young Min Sin),황성윤(Sung Yoon Hwang),송근암(Kun Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang),문한규(Han Kyu Moon) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

Objectives: Peptic ulcer is heterogenous disease which has genetic or acquired etiologic factors and serum pepsinogen I (PG I) was reported as a marker of the genetic factor. In this study, the correlations of serum PG I level and natural course of peptic ulcer disease such as site, stage, recurrence and acquired factors such as smoking, H. pylori were evaluated. Methods: Fasting serum PG I levels were tested in 71 patients with peptic ulcer (Gastric ulcer 31, Duodenal ulcer 40) who had been confirmed by endoscopy, biopsy and 58 healthy control from January, 1991 to August, 1993 at Pusan National University Hospital. Serum PG I levels between ulcer and control group were compared and correlations of serum PG I level and natural course such as site, stage, complicaton, recurrence and acquired factors such as smoking, NSAID, H. pylori in ulcer group were observed. Results : 1) The patients with peptic ulcer showed significantly higher mean levels of serum PG I than those of the control group. Especially the mean levels of PG I of antral ulcer and duodenal ulcer were higher than ulcer of gastric body and angle. 2) The patients with active ulcer showed higher mean levels of serum PG I than healing stage ulcer. but there weas no statistical significance. 3) The patients with recurrence, smoking history, complications showed higher mean levels of PG I than those without recurrence, smoking history, complications. but there was no statistical significance. 4) The CLO test positive group of the duodenal ulcer patients showed higher mean levels of serum PG I than those of CLO test negative group. but there was no statistical significance. Conclusion: The above results suggest that serum pepsinogen I may be useful as a parameters of activity and recurrence and as a subclinical markers for acquired risk factors of the peptic ulcer.

단일기관에서 소화성 궤양을 진단 받은 투석 환자의 Helicobacter pylori 유병률

정철호 ( Chul Ho Chung ),김은정 ( Eun Jung Kim ),박무용 ( Moo Yong Park ),최수정 ( Soo Jeong Choi ),홍수진 ( Su Jin Hong ),김진국 ( Jin Kuk Kim ),황승덕 ( Seung Duk Hwang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2

Purpose: Patients with chronic renal failure tend to have an increased incidence of peptic ulcer disease. Helicobacter pylori ( H. pylori) infection is generally found to be the major cause of peptic ulcer disease. There are a few studies about the association between H. pylori and peptic ulcer disease in dialysis patients. In this retrospective study, we investigated the relationship between H. pylori and peptic ulcer disease in dialysis patients. Methods: The participants enrolled in this study were hemodialysis (HD) or peritoneal dialysis (PD) patients in the period from February 2001 to March 2010, who had been diagnosed as having a peptic ulcer. The presence of H.pylori was identified by at least one of the following: the rapid urease test, the urea breath test or histologic findings. Results: A total of 132 patients (100 HD and 32 PD patients) were enrolled. The mean age and duration of dialysis were 56.5±14.8 years and 27.6±45.3 months, respectively. The prevalence of H. pyloripositive patients amongst those with peptic ulcer disease was 43.1% (57/132). H. pylori-positive prevalence was 48.1% (38/79) in gastric ulcer patients, and 33.3% (11/33) in duodenal ulcer patients, but this difference was not significant (p=0.21). There were no significant differences in age, causes of chronic renal failure or dialysis method between the H. pylori-positive and H. pylori-negative groups. However, the duration of dialysis was significantly longer in the H. pylori-negative group (16.6±34.1 vs. 36.0±50.8 months, p=0.01). Furthermore, as the duration of dialysis increased, the prevalence of H. pylori infection decreased (p=0.004). Conclusion: There was little association between H. pylori and peptic ulcer disease in dialysis patients. Long-term dialysis appeared to decrease the prevalence of H. pylori infection in peptic ulcer disease.

Risk factors for peptic ulcer disease in patients with end-stage renal disease receiving dialysis

( Minah Kim ),( Chang Seong Kim ),( Eun Hui Bae ),( Seong Kwon Ma ),( Soo Wan Kim ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1

Background: Compared to the general population, patients with end-stage renal disease have more gastrointestinal symptoms and a higher prevalence of peptic ulcer. Risk factors for peptic ulcer disease in patients with end-stage renal disease, however, remain poorly defined. This study aims to better identify those risk factors. Methods: We analyzed 577 patients with end-stage renal disease from 2004 to 2016. We excluded patients with lifethreatening conditions. All patients underwent upper endoscopy. We analyzed patient medical records, medication history, and endoscopic findings. Independent sample t test, chi-square test, Fisher’s exact test, and multiple logistic regression analysis were used in statistical analyses. Results: Of the 577 patients with end-stage renal disease, 174 had peptic ulcer disease (gastric or duodenal ulcer). Patients on hemodialysis had a higher prevalence of peptic ulcer disease than those on peritoneal dialysis. Patients with peptic ulcer disease had lower serum albumin level and higher blood urea nitrogen level than those without peptic ulcer disease. Positive scores on two or more nutritional indices (albumin, serum cholesterol, uric acid, and creatinine levels) were associated with peptic ulcer disease in end-stage renal disease. Conclusion: Hemodialysis, hypoalbuminemia, and multiple malnutrition indices were associated with the prevalence of peptic ulcer disease in patients with end-stage renal disease receiving dialysis.

Investigation of -308G>A and -1031T>C Polymorphisms in the TNFA Promoter Region in Polish Peptic Ulcer Patients

( Aleksandra Sałagacka ),( Marta Zebrowska ),( Agnieszka Jelen ),( Marek Mirowski ),( Ewa Balcerczak ) 대한소화기학회 2014 Gut and Liver Vol.8 No.6

Background/Aims: Tumor necrosis factor α (TNF-α) encoded by TNFA is a key mediator in inflammation, a precursor condition for peptic ulceration. Promoter polymorphisms of TNFA that influence its transcriptional activity and TNF-α production are known. TNFA-308G>A (rs1800629) and TNFA- 1031T>C (rs1799964), which are responsible for increased TNFA transcription, could influence the risk of peptic ulceration. This study aimed to investigate these polymorphisms and to evaluate their association with peptic ulcer disease and Helicobacter pylori infection in the Polish population. Methods: Gastric mucosa specimens obtained from 177 Polish peptic ulcer patients were used to conduct rapid urease tests and to assess the investigated polymorphisms by polymerase chain reaction-restriction fragment length polymorphism. Genotyping data were compared with the results obtained from healthy individuals of Polish origin. Results: There were no significant differences in genotype and allele frequency of the investigated polymorphisms between peptic ulcer patients and healthy individuals. No associations between the frequencies of particular genotypes and alleles for both single-nucleotide polymorphisms (SNPs) and the presence of H. pylori infection in peptic ulcer patients and in subgroups of men and women with peptic ulcer disease were found. Conclusions: The investigated SNPs are not risk factors for either peptic ulcer or H. pylori infection development in the Polish population. The results require verification in a larger cohort. (Gut Liver 2014;8:632-636)