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Tuesday, 26 November 2013

Duodenal ulcers Treatments In conventional medicine perspective

Duodenal ulcers, a type of peptic ulcer is defined as a condition of a localized tissue erosion in the lining  the duodenum as a result of bacteria Helicobacter pylori (H pylori) in most cases. According to the study by Department of Research, University Hospital, Basel, fasting gastrin and pepsinogen-I and -II concentrations were significantly higher in H pylori positive compared with H pylori negative subjects. Neither age nor sex affected basal gastrin and pepsinogen concentrations in H pylori negative subjects. Fasting gastrin, pepsinogen-I and -II concentrations in serum samples were similar in H pylori positive persons with no symptoms and those with duodenal ulcers suggesting that similar mechanisms are involved in increasing plasma concentrations of these variables in both populations. Hypergastrinaemia and hyperpepsinogenaemia are therefore probably secondary to active H pylori.
F. Treatments
F.1. In conventional medicine perspective
1. Non invasive treatments
a. Low-dose triple therapy (omeprazole, clarithromycin and metronidazole)
In the study to test the hypothesis that 1-week low-dose triple therapy for H. pylori is sufficient for relief from dyspeptic symptoms and healing of duodenal ulcers.One-week, found that low-dose triple therapy consisting of omeprazole, clarithromycin and metronidazole is a highly effective and well-tolerated approach to the cure of H. pylori infection in patients with a duodenal ulcer. Our data suggest that continuation of antisecretory drug therapy beyond anti-H. pylori therapy is actually excessive regarding relief from dyspeptic symptoms and healing of duodenal ulcers(29).
b. Antibiotics
In the study to evaluate the primary objective of the present study was to evaluate the efficacy of 30 and 60 mg of lansoprazole administered in combination with two antibiotics for 7 or 10 days in eradicating Helicobacter pylori in duodenal ulcer patients, found that the double dose of lansoprazole optimizes H. pylori eradication rates. The highest eradication rates were obtained after 10 days of therapy. Additional studies should be carried out to determine the optimal duration of triple therapy for eradicating H. pylori(30).
c. Probiotics
A comparison of the clinical strains isolated from patients from St. Petersburg, Russia and patients from Dushanbe, Tajikistan showed that cagA gene was more prevalent in the strains from St. Petersburg. These findings demonstrate the necessity of implementation of molecular genetic identification of H. pylori in the clinical diagnostics practice reflecting the virulent genes profile of the strain. Addition of probiotics to the standard eradication therapy of H. pylori significantly improves the results of this therapy, according to the study by North-West State Medical University(31).
d. Endoscopy
In the article of The role of endoscopy in the management of patients with peptic ulcer disease, indicated that When a duodenal ulcer is detected either on endoscopy or a radiologic study, surveillance endoscopy has a low yield if symptoms resolve after a course of acid suppression together with eradication therapy for H Pylori (when present) and discontinuation of NSAIDs. More than 90% of duodenal ulcers heal with 4 weeks of proton pump inhibitor therapy.18,19 Surveillance endoscopy should be considered in patients with duodenal ulceration who experience persistent symptoms despite an appropriate course of therapy, specifically to rule out refractory peptic ulcers and ulcers with nonpeptic etiologies(32).
5. Etc.
2. Surgery
Surgery will always be the last resources in treating gastric ulcer, and only be performed if patients do not respond to medicines or endoscopy
a.Vagotomy
The aim of the surgery is to control the secretion of stomach acid by cutting of the vagus nerve.
b. Pyloroplasty
Pyloroplasty is a surgical procedure to widen the opening in the lower part of the stomach (pylorus), allowing stomach contents to empty more quickly into the intestine.
c. Partial gastrectomy
Partial gastrectomy is a surgical procedure in the removal part of the stomach.
 d. Gastrectomy
In the study to analyze outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease in regional hospital in Hong Kong, showed that emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication(33).
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Sources
 
 

(28) http://www.ncbi.nlm.nih.gov/pubmed/10759623
(29) http://www.ncbi.nlm.nih.gov/pubmed/9042978
(30) http://www.ncbi.nlm.nih.gov/pubmed/10891736
(31) http://www.ncbi.nlm.nih.gov/pubmed/22683837 
(32) http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/The%20role%20of%20endoscopy%20in%20the%20management%20of%20patientswith%
20peptic%20ulcer%20disease.pdf