Ulcers http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012 Thu, 10 Apr 2014 08:22:15 +0000 http://www.hindawi.com/journals/ulcers/2014/326065/ The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality. Margot Peetsalu, Ülle Kirsimägi, and Ants Peetsalu Copyright © 2014 Margot Peetsalu et al. All rights reserved. Urease Inhibitory Activity of Aerial Parts of Artemisia scoparia: Exploration in an In Vitro Study Thu, 16 Jan 2014 07:38:16 +0000 http://www.hindawi.com/journals/ulcers/2014/184736/ Artimisia scoparia has been used in the treatment of different disorders including ulcers. The current study was therefore designed to investigate the aerial parts of  Artemisia scoparia (crude extract, total sterol and flavonoidal contents, and aqueous fraction) for its urease inhibitory potential. The crude of the plant evoked marked attenuation on urease activity, when tested in various concentrations with IC50 values of 4.06 mg/ml. The inhibitory potential was further augmented in the aqueous fraction (IC50: 2.30 mg/ml) of the plant. When the total sterol and flavonoidal contents were challenged against urease, both showed concentration dependent activity; the latter showed maximum potency with IC50 values of 8.04 and 2.10 mg/ml, respectively. In short, the aerial parts of the plant demonstrated marked antagonism on urease and thus our study validated the traditional use of Artemisia scoparia in the treatment of ulcer. Murad Ali Khan, Haroon Khan, Shafiq Ahmad Tariq, and Samreen Pervez Copyright © 2014 Murad Ali Khan et al. All rights reserved. Antiulcerogenic Activity of 1-Hydroxy-3,7,8-trimethoxyxanthone Isolated from the Methanol Extract of Anthocleista vogelii PLANCH. in Rats Thu, 02 Jan 2014 13:07:26 +0000 http://www.hindawi.com/journals/ulcers/2014/172096/ Anthocleista vogelii (Loganiaceae) PLANCH. is used in Cameroonian ethnomedicine for the treatment of stomach ache and for curing fever and is used as purgative. Further investigations have shown that the stem bark of this plant possesses potent antiulcer properties. We have investigated the cytoprotective and antisecretory actions of 1-hydroxy-3,7,8-trimethoxyxanthone (AV), the xanthone obtained from the methanol extract of the stem bark. Oral administration of AV at the doses of 1, 2, and 5 mg/kg prevented in a dose-dependent manner ulcers induced by HCl/ethanol (60.90 to 93.22%), Indometacin (46.86 to 89.68%), and pylorus ligation (0.00 to 70.69%). AV reduced pylorus-ligated gastric acid secretion from 134.17 mEq/l in the controls to 118.55, 121.50, and 96.93 mEq/l, respectively, for the 1, 2, and 5 mg/kg doses and increased mucus secretion significantly in a dose-dependent manner in all experimental models. The cytoprotective and antisecretory properties of AV could thus be due to its ability to strengthen gastric mucosal defences through enhanced gastric mucus production. Gilbert Ateufack, Télesphore B. Nguelefack, Hippolyte K. Wabo, Pierre Tane, and Albert Kamanyi Copyright © 2014 Gilbert Ateufack et al. All rights reserved. Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers Mon, 16 Dec 2013 09:59:51 +0000 http://www.hindawi.com/journals/ulcers/2013/734859/ Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE) of the great saphenous vein (GSV) in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04%) and 4 in group II (40%), . The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, . Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity. Alvaro Delgado-Beltran Copyright © 2013 Alvaro Delgado-Beltran. All rights reserved. Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria Sun, 08 Sep 2013 10:39:24 +0000 http://www.hindawi.com/journals/ulcers/2013/820468/ Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend. Akaninyene Asuquo Otu, Victor Aniedi Umoh, Okon Ekwere Essien, Ofem Egbe Enang, Henry Ohem Okpa, and Patrick Ntui Mbu Copyright © 2013 Akaninyene Asuquo Otu et al. All rights reserved. Chronic Ulcers: Updating Epidemiology, Physiopathology, and Therapies Thu, 01 Aug 2013 10:51:39 +0000 http://www.hindawi.com/journals/ulcers/2013/964826/ Marco A. C. Frade and Pranab K. Das Copyright © 2013 Marco A. C. Frade and Pranab K. Das. All rights reserved. In Vivo Models Used for Evaluation of Potential Antigastroduodenal Ulcer Agents Tue, 25 Jun 2013 16:56:34 +0000 http://www.hindawi.com/journals/ulcers/2013/796405/ Peptic ulcer is among the most serious gastrointestinal diseases in the world. Several orthodox drugs are employed for the treatment of the disease. Although these drugs are effective, they produce many adverse effects thus limiting their use. In recent years, there has been a growing interest in alternative therapies, especially those from plants due to their perceived relative lower side effects, ease of accessibility, and affordability. Plant medicines with ethnomedicinal use in peptic ulcer management need to be screened for their effectiveness and possible isolation of lead compounds. This requires use of appropriate animal models of various ulcers. The limited number of antiulcer models for drug development against gastric and duodenal ulcer studies has hindered the progress of targeted therapy in this field. It is, therefore, necessary to review the literature on experimental models used to screen agents with potential antigastroduodenal ulcer activity and explain their biochemical basis in order to facilitate their use in the development of new preventive and curative antiulcer drugs. Clinical trials can then be carried out on agents/drugs that show promise. In this paper, current in vivo animal models of ulcers and the pathophysiological mechanisms underlying their induction, their limitations, as well as the challenges associated with their use have been discussed. Michael Buenor Adinortey, Charles Ansah, Isaac Galyuon, and Alexander Nyarko Copyright © 2013 Michael Buenor Adinortey et al. All rights reserved. What Is New in the Understanding of Non Healing Wounds Epidemiology, Pathophysiology, and Therapies Sun, 12 May 2013 11:56:40 +0000 http://www.hindawi.com/journals/ulcers/2013/625934/ Chronic wounds are a growing socioeconomic problem in the western world. Knowledge on recalcitrant wounds relies on in vitro studies or clinical observations, and there is emerging evidence on the clinical impact of bacterial biofilm on skin healing. Chronic wounds are locked in the inflammatory state of wound healing, and there are multiple explanations for this arrest with the theory of exaggerated proteolysis as the most commonly accepted. Previously, there has not been enough focus on the different etiologies of chronic wounds compared to acute, healing wounds. There is an urgent need to group chronic wounds by its cause when searching for possible diagnostic or therapeutic targets. Good wound management should therefore consist of recognition of basic wound etiology, irrigation, and debridement in order to reduce microbial and necrotic load, frequently changed dressings, and appropriate antimicrobial and antibiofilm strategies based on precise diagnosis. Representative sampling is required for diagnosis and antimicrobial treatment of wounds. The present review aims at describing the impact of biofilm infections on wounds in relation to diagnosing, treatment strategies, including experimentally adjuvant approaches and animal models. H. Trøstrup, T. Bjarnsholt, K. Kirketerp-Møller, N. Høiby, and C. Moser Copyright © 2013 H. Trøstrup et al. All rights reserved. Accumulation of Mast Cells in the Lesions and Effects of Antiallergic Drugs on the Patients with Inflammatory Bowel Disease Thu, 09 May 2013 14:36:01 +0000 http://www.hindawi.com/journals/ulcers/2013/714807/ The pathomechanism of inflammatory bowel disease (IBD) has not yet been fully demonstrated. However, it is well known that mast cells are present in the gastrointestinal tract, suggesting that mast cells may take part in it. So, we investigated the number of mast cells in IBD, such as ulcerative colitis (UC) and eosinophilic colitis, and showed that the number of mast cells was increased in the inflammatory lesions. We also presented a case of UC which was treated successfully with an antiallergic drug, tranilast. Furthermore, possible new approaches to treating the disease with immunomodulators including suplatast are introduced. However, our investigations were performed with a limited number of patients with IBD, and additional further studies are required to confirm the findings. Motohiro Kurosawa and Hiroichi Nagai Copyright © 2013 Motohiro Kurosawa and Hiroichi Nagai. All rights reserved. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management Mon, 22 Apr 2013 11:16:44 +0000 http://www.hindawi.com/journals/ulcers/2013/413604/ Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress. The condition affects 1% of the adult population and 3.6% of people older than 65 years. Leg ulcers are debilitating and greatly reduce patients' quality of life. The common causes are venous disease, arterial disease, and neuropathy. Less common causes are metabolic disorders, hematological disorders, and infective diseases. As many factors lead to chronic lower leg ulceration, an interdisciplinary approach to the systematic assessment of the patient is required, in order to ascertain the pathogenesis, definitive diagnosis, and optimal treatment. A correct diagnosis is essential to avoid inappropriate treatment that may cause deterioration of the wound, delay wound healing, or harm the patient. The researchers are inventing newer modalities of treatments for patients with chronic leg ulceration, so that they can have better quality life and reduction in personal financial burden. Shubhangi Vinayak Agale Copyright © 2013 Shubhangi Vinayak Agale. All rights reserved. Antioxidant Capacity, Cytoprotection, and Healing Actions of the Leaf Aqueous Extract of Ocimum suave in Rats Subjected to Chronic and Cold-Restraint Stress Ulcers Sun, 31 Mar 2013 08:46:53 +0000 http://www.hindawi.com/journals/ulcers/2013/150780/ We evaluated the qualitative chemical composition and tested the antiulcer actions on cold/restraint stress ulcers, the healing effect on chronic acetic acid-induced gastric ulcers, and the in vivo and in vitro antioxidant capacity of Ocimum suave extract. Triterpenes, flavonoids, sugars, phenols, sterols, and multiple bonds were among the phytochemicals detected. The extract (250–500 mg/kg) dose-dependently inhibited the formation of gastric ulcers induced by cold/restraint stress (52.30%–83.10%). The prophylactic actions were associated with significant increases in gastric mucus production. There was significant histological healing of chronic ulcers following 14-day treatment with O. suave extract (250–500 mg/kg). We also evaluated the efficacy of O. suave extract in cold/restraint-induced oxidative stress in rat stomach tissue. O. suave (500 mg/kg) ameliorated the decreased levels of reduced glutathione from 0.85 (control group) to 2.08 nmol/g tissue. The levels of SOD and catalase were also improved in rats treated with O. suave extract. The extract had a high phenol content (899.87 mg phenol/g catechin equivalent), in vitro DPPH radical scavenging activity (89.29%), and FRAP (antioxidant capacity) (212.64 mg/g catechin equivalent). The cytoprotective and ulcer healing effects of the extract are attributed to enhanced mucus production and the antioxidant properties which may likely be associated with the high presence of flavonoids and polyphenols. Paul V. Tan, C. Mezui, G. E. Enow-Orock, and G. Agbor Copyright © 2013 Paul V. Tan et al. All rights reserved. Screening for Osteomyelitis Using Thermography in Patients with Diabetic Foot Sun, 31 Mar 2013 08:22:04 +0000 http://www.hindawi.com/journals/ulcers/2013/284294/ One of the most serious complications of diabetic foot (DF) is osteomyelitis, and early detection is important. To assess the validity of thermography to screen for osteomyelitis, we investigated thermographic findings in patients with both DF and osteomyelitis. The subjects were 18 diabetic patients with 20 occurrences of DF who visited a dermatology department at a hospital in Tokyo and underwent evaluation by magnetic resonance imaging (MRI) and thermography between June 2010 and July 2012. Osteomyelitis was identified by MRI. Thermographs were taken of the wounds and legs after bed rest of more than 15 minutes. Two wound management researchers evaluated the range of increased skin temperature. There were three types of distribution of increased skin temperature: the periwound, ankle, and knee patterns. Fisher’s exact test revealed that the ankle pattern was significantly more common in the group with osteomyelitis than in the group without osteomyelitis (). The positive predictive value was 100%, and the negative predictive value was 71.4%. Our results suggest that an area of increased skin temperature extending to the ankle can be a sign of osteomyelitis. Thermography might therefore be useful for screening for osteomyelitis in patients with DF. Makoto Oe, Rie Roselyne Yotsu, Hiromi Sanada, Takashi Nagase, and Takeshi Tamaki Copyright © 2013 Makoto Oe et al. All rights reserved. Chronic Nonhealing Wounds: Could Leg Ulcers Be Hereditary? Sun, 10 Mar 2013 14:14:20 +0000 http://www.hindawi.com/journals/ulcers/2013/219257/ Background. A number of well-known acquired and putative inherited etiological factors contribute to the development of venous leg ulcer (VLU). Aim. In this study we set out to perform a meta-analysis of putative genetic and acquired factors predisposing to VLU development. Methods. VLU patients () were divided into three subgroups in accordance with their acquired etiological factors. The frequencies of four genetic factors were determined: the R506Q (Leiden) mutation of the F5 gene, the G20210A mutation of the F2 (prothrombin) gene, the 2451 A/G SNP of the fibroblast growth factor receptor 2 (FGFR2) 3′ UTR, and the −308 G/A SNP of the tumor necrosis factor α (TNFA) promoter. Results. The −308 TNFA SNP exhibited a higher frequency among VLU patients without known acquired predisposing factor in their history, than among patients with thrombosis or soft tissue infection in their history (Fisher ). Conclusions. This study has demonstrated that the group of VLU patients is heterogeneous in their genetic predisposing factors. Further large-scale studies are needed to delineate the associations among genetic and acquired etiological factors with regard to VLU development and to integrate the consequences of the already known genetic factors to the management of VLU. Nikoletta Nagy, Gábor Szabad, Győző Szolnoky, Zsuzsanna Kiss-László, Éva Dósa-Rácz, Zsuzsanna Bata-Csörgő, Lajos Kemény, and Márta Széll Copyright © 2013 Nikoletta Nagy et al. All rights reserved. Chronic Ulcers in Thromboangiitis Obliterans (Buerger's Disease): Updating Epidemiology, Physiopathology, and Bosentan—A Novel Strategy of Therapy Sun, 24 Feb 2013 10:30:07 +0000 http://www.hindawi.com/journals/ulcers/2013/230780/ Thromboangiitis obliterans (TAO) or Buerger's disease is associated with both distal ulcers in the extremities and the possibility of amputation. The only treatment that has been shown to be effective in TAO is complete abstention from smoking. In spite of this, the disease progresses in up to 30 percent of cases and finally results in limb amputation. Only a few pharmacological and surgical options are available to date to improve healing ulcers in TAO. The efficacy of prostaglandin analogues is controversial. This paper summarizes the current evidence for medical treatment with bosentan in chronic ulcers in TAO patients. These available data up to date allow us to conclude that the beneficial effects of bosentan on improving endothelial function, inflammatory processes, and selective vasodilatation of damaged vessels result in a clinical enhancement regarding healing and preventive digital ulcers in such patients. In any case, these promising findings have to be confirmed with larger randomised trials. Ignacio López de Maturana, Javier Rodriguez, Carmen González, Silvia Bleda, Joaquin de Haro, and Francisco Acin Copyright © 2013 Ignacio López de Maturana et al. All rights reserved. Chronic Wounds, Biofilms and Use of Medicinal Larvae Thu, 14 Feb 2013 13:12:12 +0000 http://www.hindawi.com/journals/ulcers/2013/487024/ Chronic wounds are a significant health problem in the United States, with annual associated costs exceeding $20 billion annually. Traditional wound care consists of surgical debridement, manual irrigation, moisture retentive dressings, and topical and/or systemic antimicrobial therapy. However, despite progress in the science of wound healing, the prevalence and incidence of chronic wounds and their complications are escalating. The presence & complexity of bacterial biofilms in chronic wounds has recently been recognized as a key aspect of non-healing wounds. Bacterial biofilms are sessile colonies of polymicrobial organisms (bacteria, fungus, etc.) enclosed within a self-produced exopolymeric matrix that provides high levels of tolerance to host defenses, antibiotics and antiseptics. Thus, there is a need for alternative therapies to reduce biofilms in chronic wounds. In this report, we present initial findings from in vitro experiments which show that larval debridement therapy with disinfected blow fly larvae (Phaenicia sericata) reduced total CFUs (6-logs) of planktonic and mature biofilms of Pseudomonas aeruginosa or Staphylococcus aureus grown on dermal pig skin explants by 5-logs after 24 hours of exposure, and eliminated biofilms (no measurable CFUs) after 48 hours of exposure. Linda J. Cowan, Joyce K. Stechmiller, Priscilla Phillips, Qingping Yang, and Gregory Schultz Copyright © 2013 Linda J. Cowan et al. All rights reserved. Compression Stockings for Treating Venous Leg Ulcers Sun, 03 Feb 2013 08:46:51 +0000 http://www.hindawi.com/journals/ulcers/2013/686491/ Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle). Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI)) and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit). In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings. J. P. Benigni, A. L. Deman, and J. F. Uhl Copyright © 2013 J. P. Benigni et al. All rights reserved. The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding Tue, 27 Nov 2012 11:14:07 +0000 http://www.hindawi.com/journals/ulcers/2012/361425/ Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of proton-pump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment. Hisham AL Dhahab and Alan Barkun Copyright © 2012 Hisham AL Dhahab and Alan Barkun. All rights reserved. Ulcerative Lesions in Behcet's Disease Mon, 12 Nov 2012 14:49:14 +0000 http://www.hindawi.com/journals/ulcers/2012/146797/ Ulcerative lesions in Behcet’s disease (BD) are regarded as important manifestation for diagnosis. Various kinds of ulcerative lesions appear in patients with BD. They present as orogenital ulcers, necrotizing vasculitis and pyoderma gengrenosum. Gastrointestinal system involvement (Gis) in Behçet’s disease affects all areas from the esophagus to the anus. Most authors believe that the Gis manifestations of Behçet’s disease should be confined to aphthous ulcers, which can occur throughout the Gis tract. All patients with oro-genital and Gis ulcerations should be fully investigated to establish a definitive diagnosis and eliminate the possibility of an underlying BD. Ümit Türsen and Belma Türsen Copyright © 2012 Ümit Türsen and Belma Türsen. All rights reserved. Update on Peptic Ulcers in the Pediatric Age Mon, 05 Nov 2012 17:03:14 +0000 http://www.hindawi.com/journals/ulcers/2012/896509/ Background. Peptic ulcer disease (PUD) in children is reported worldwide, although it is relatively rare as compared with adults. Helicobacter pylori (HP) infection is a common cause of PUD in the pediatric age. Other risk factors include the use of nonsteroidal anti-inflammatory agents (NSAIDs), steroids, immunosuppressive drugs, and stressful events. Aim. To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. A MEDLINE search was performed indicating keywords as “Peptic Ulcer Disease,” “Epidemiology,” “Pediatric,” “Helicobacter pylori,” “Gastric ulcer,” “Bulbar Ulcer,” and “Upper Gastrointestinal Bleeding.” A selection of clinical trials, systematic reviews, and meta-analyses within the time period 2002–2012 was performed. Results. PUD in children is reported worldwide with an estimated frequency of 8.1% in Europe and of 17.4% in the US. When the underlying cause of PUD is addressed, the prognosis is excellent. Standard triple therapy, bismuth-based quadruple therapy, and the sequential therapy represent the current recommended treatments for HP related ulcers. NSAIDs related ulcers are treated by stopping the causative medications and by administration of proton-pump inhibitors or antisecretory drugs. Conclusions. PUD still represents a major concern in the paediatric age. A careful differential diagnosis and an adequate treatment constitute an excellent prognosis. Graziella Guariso and Marco Gasparetto Copyright © 2012 Graziella Guariso and Marco Gasparetto. All rights reserved. Stratification of Highest-Risk Patients with Chronic Skin Ulcers in a Stanford Retrospective Cohort Includes Diabetes, Need for Systemic Antibiotics, and Albumin Levels Tue, 09 Oct 2012 16:35:52 +0000 http://www.hindawi.com/journals/ulcers/2012/767861/ Chronic nonsurgical skin wounds such as venous stasis and diabetic ulcers have been associated with a number of comorbid conditions; however, the strength of these associations has not been compared. We utilized the Stanford Translational Research Integrated Database Environment (STRIDE) system to identify a cohort of 637 patients with chronic skin ulcers. Preliminary analysis () showed that 49.7% of the patients had a poor prognosis such as amputation or a nonhealing ulcer for at least a year. Factors significantly associated () with these outcomes included diabetes mellitus, chronic kidney disease, peripheral neuropathy, peripheral arterial disease, and need for systemic antibiotics. Patients with poor outcomes also tended to have lower hemoglobin levels (), higher WBC levels (), and lower albumin levels (). On multivariate analysis, however, only diabetes mellitus (OR 5.87, 1.36–25.3), need for systemic antibiotics (OR 3.88, 1.06–14.2), and albumin levels (0.20 per unit, 0.07–0.60) remained significant independent predictors of poor wound-healing outcomes. These data identify patients at the highest risk for poor wound-healing and who may benefit the most from more aggressive wound care and treatment. Omar Amir, Andy Liu, and Anne Lynn S. Chang Copyright © 2012 Omar Amir et al. All rights reserved. In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis Tue, 28 Aug 2012 14:22:10 +0000 http://www.hindawi.com/journals/ulcers/2012/196982/ Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival. Marcos Amorim, Alan N. Barkun, Martin Larocque, Karl Herba, Benoit DeVarennes, and Myriam Martel Copyright © 2012 Marcos Amorim et al. All rights reserved. Gastroprotective Efficacy of Coenzyme Q10 in Indomethacin-Induced Gastropathy: Other Potential Mechanisms Mon, 06 Feb 2012 14:36:27 +0000 http://www.hindawi.com/journals/ulcers/2012/957898/ Though recently the mitochondrial bioenergetic coenzyme (Co)Q10 has been shown to protect against indomethacin-induced gastric ulceration, yet the full mechanistic cassettes have not been investigated. Therefore, the current investigation assessed further gastroprotective mechanisms of CoQ10 using the indomethacin-induced gastropathy model. While CoQ10 was administered at 3 dose levels to male Wistar rats, the proton pump inhibitor, pantoprazole, was given at 4 dose levels ahead of pyloric ligation and indomethacin administration. Indomethacin evoked gastric ulcerations that were associated by decreased gastric mucosal nitric oxide and glutathione levels. The NSAID reduced gastric volume and mucin content, but increased titratable acidity, acid output, and peptic activity. CoQ10, especially at the higher dose levels, as well as pantoprazole pretreatments reverted almost all diversions induced by the NSAID to different extends. Moreover, preadministration with the nonselective nitric oxide synthase inhibitor, L-NAME, boosted ulcer formation that was associated by suppression of gastric mucosal nitric oxide in CoQ10 and pantoprazole-treated groups. The current investigation shows that CoQ10 guards against gastric ulceration via its partial inhibition of titratable acidity and peptic activity, as well as enhancement of mucin secretion due to both gastric mucosal nitric oxide and glutathione replenishment, especially at the higher dose levels. Asmaa M. Malash, Dalaal M. Abdallah, Azza M. Agha, and Sanna A. Kenawy Copyright © 2012 Asmaa M. Malash et al. All rights reserved. Cytoprotective Effect of Morinda tinctoria Roxb. against Surgical and Chemical Factor Induced Gastric and Duodenal Ulcers in Rats Sun, 25 Dec 2011 10:01:29 +0000 http://www.hindawi.com/journals/ulcers/2011/142719/ The present paper relates to the pharmacological validation of the antiulcer efficacy of ethanol leaf extract of Morinda tinctoria Roxb. (EEMT) against aspirin pyloric ligation-induced gastric ulcer model and cysteamine-induced duodenal ulcer in Wistar rats. Oral administration of EEMT at a dose of 200 and 400 mg/kg significantly prevented the occurrence of aspirin pyloric ligation and cysteamine-induced gastric and duodenal ulceration. The volume and acidity of gastric juice in pyloric ligated rats were significantly (𝑃<0.01) reduced by EEMT. There was a significant decrease in the number of ulcers, and its severity in both the models proved the ulcer protective activity of EEMT. Administration of extract at both dose levels has shown a significant increase in potassium and sodium ion concentration in the gastric juice of pylorus ligation group. On the basis of these observations, we concluded that EEMT possessing antiulcer activity may be due to the modulation of defensive factors by improvement in gastric cytoprotection. D. Sivaraman and P. Muralidharan Copyright © 2011 D. Sivaraman and P. Muralidharan. All rights reserved. Influence of Cord Blood Fraction (below 5 kDa) on Reparative Processes during Subchronic Ulcerative Gastropathy Mon, 05 Sep 2011 13:19:36 +0000 http://www.hindawi.com/journals/ulcers/2011/214124/ The low molecular fraction (below 5 kDa) was extracted from cord blood by ultrafiltration. It has been shown that the cord blood fraction possesses antiulcer activity on the model subchronic stomach ulcer. The cord blood fraction injections caused a significant reduction in the area of ulcer lesions and promoted recovery of microcirculation, thickness, and structure of gland layer, which was accompanied by a decrease in leucocytes infiltration and an increase in glycosaminoglycans synthesis. That resulted in a faster recovery of mucus membrane of stomach as compared with Actovegin. Application of the cord blood fraction in animals with stomach ulcer normalized the alkaline phosphatase activity and thiobarbituric acid-active product content. Gel-penetrating chromatography showed that the patterns of the low molecular substances from cord blood and Actovegin differed both qualitatively and quantitatively. Alexander Kirillovich Gulevsky, Yelena Sergeevna Abakumova, Natalya Nikolaevna Moiseyeva, and Yevgeniy Gennadievich Ivanov Copyright © 2011 Alexander Kirillovich Gulevsky et al. All rights reserved. The Human Gastric Pathogen Helicobacter pylori and Its Association with Gastric Cancer and Ulcer Disease Mon, 18 Jul 2011 18:22:59 +0000 http://www.hindawi.com/journals/ulcers/2011/340157/ With the momentous discovery in the 1980's that a bacterium, Helicobacter pylori, can cause peptic ulcer disease and gastric cancer, antibiotic therapies and prophylactic measures have been successful, only in part, in reducing the global burden of these diseases. To date, ~700,000 deaths worldwide are still attributable annually to gastric cancer alone. Here, we review H. pylori's contribution to the epidemiology and histopathology of both gastric cancer and peptic ulcer disease. Furthermore, we examine the host-pathogen relationship and H. pylori biology in context of these diseases, focusing on strain differences, virulence factors (CagA and VacA), immune activation and the challenges posed by resistance to existing therapies. We consider also the important role of host-genetic variants, for example, in inflammatory response genes, in determining infection outcome and the role of H. pylori in other pathologies—some accepted, for example, MALT lymphoma, and others more controversial, for example, idiopathic thrombocytic purpura. More recently, intriguing suggestions that H. pylori has protective effects in GERD and autoimmune diseases, such as asthma, have gained momentum. Therefore, we consider the basis for these suggestions and discuss the potential impact for future therapeutic rationales. Bianca Bauer and Thomas F. Meyer Copyright © 2011 Bianca Bauer and Thomas F. Meyer. All rights reserved. Novel Techniques in Endoscopy Are Useful in Evaluating Patients with Ulcerative Colitis Wed, 22 Jun 2011 15:02:07 +0000 http://www.hindawi.com/journals/ulcers/2011/398785/ Ulcerative colitis (UC), one of the most common forms of chronic inflammatory bowel disease, is characterized by exacerbations and remissions. Even when conventional colonoscopy suggests remission and a normal mucosal finding, microscopic or histological abnormalities may persist, and relapse may be imminent. Confocal microendoscopy allows histological diagnosis during the endoscopic examination. High-resolution video-magnifying colonoscopy with chromoscopy enables the observation of colorectal mucosal pit patterns and prediction of the probability of subsequent disease relapse in patients in remission. Endoscopic ultrasonography provides an immediate and accurate evaluation of the health status of the colonic wall without the need to wait for histological results and provides an indication of the efficacy of treatment. These novel endoscopic techniques are useful for the evaluation of disease activity and the efficacy of treatment in patients with UC and the prediction of relapse. Takafumi Ando, Osamu Watanabe, Yuji Nishio, Kazuhiro Ishiguro, Osamu Maeda, Masanao Nakamura, Ryoji Miyahara, Naoki Ohmiya, and Hidemi Goto Copyright © 2011 Takafumi Ando et al. All rights reserved. Use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial Tue, 24 May 2011 13:46:09 +0000 http://www.hindawi.com/journals/ulcers/2011/439425/ Recurrent aphthous stomatitis is a common disorder of the oral cavity, affecting mainly young people. It is characterized by small ulcers which can be very painful and generally heal spontaneously within 7–14 days. There is currently no therapy that can provide rapid healing. This study evaluated the efficacy and rapidity of response of a lozenge containing Lactobacillus brevis CD2. 30 patients were randomized to take 4 lozenges a day of active product or placebo for 7 days. Signs and symptoms as well as laboratory parameters in the saliva were assessed at the start of the study and after 7 days of treatment. The study demonstrated the efficacy and the rapidity of response of the Lactobacillus brevis CD2 lozenges in resolving the clinical signs and symptoms of aphthous stomatitis, with a significantly rapid improvement of pain. This is the first study confirming the efficacy of a probiotic product in this pathology. Vito Trinchieri, Stefano Di Carlo, Maurizio Bossu', and Antonella Polimeni Copyright © 2011 Vito Trinchieri et al. All rights reserved. Chronic Inflammation and Malignancy in Ulcerative Colitis Wed, 20 Apr 2011 10:50:33 +0000 http://www.hindawi.com/journals/ulcers/2011/714046/ Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) associated with multiple colonic and extraintestinal complications, the most severe being the development of colorectal cancer (CRC). Compared to the general population, there is an increased risk of CRC associated with UC. Although the pathogenesis of CRC in UC is unknown, most studies have linked it to long-standing inflammation as well as other risk factors such as duration of disease, extent of inflammation, family history of CRC, and coexisting conditions such as primary sclerosing cholangitis (PSC). UC is a life-long disease for which patients enter a vigilant screening program which includes surveillance colonoscopy to promote early detection of CRC yet some controversies exist regarding the cost effectiveness of surveillance colonoscopy and improving survival. Newer modalities such as chromoendoscopy, narrow band imaging, high definition colonoscopy, and confocal microscopy have aided in developing a more targeted approach for early detection of dysplasia in surveillance colonoscopy. This review focuses on the role of chronic colonic inflammation and dysplasia in development of UC-associated CRC and current methods of screening, detection, chemoprevention, and treatment of UC-associated CRC. Sai Sunkara, Garth Swanson, Christopher B. Forsyth, and Ali Keshavarzian Copyright © 2011 Sai Sunkara et al. All rights reserved. Cytokine Networks in Ulcerative Colitis Mon, 10 Jan 2011 16:05:58 +0000 http://www.hindawi.com/journals/ulcers/2011/391787/ Ulcerative colitis (UC) is a relapsing inflammatory bowel disease whose pathogenesis has yet to be defined completely. A genetic predisposition is needed to develop the colitis, but environmental factors are necessary to trigger an exaggerated and aberrant immune response, which stands at the basis of the mucosal healing. Cytokines, small cell-signaling protein molecules secreted by various types of cells including immune and glia cells, are the main mediators of the mucosal healing in IBD; ulcerative colitis is characterized by a Th2 atypical immune response, since, beside the classical proinflammatory cytokines, such as IL-1, IL-6, and TNF-α, in the pathogenesis of UC, we find a complex network in which the Th2 cytokines, IL-10 and IL-13, play a key role, but little IL-4 was found. Our aim was to review the literature to point out the state of the art in terms of cytokines because the knowledge of cytokine network in UC could lead to the discovery of new therapeutical targets. Giulia Roda, Margherita Marocchi, Alessandro Sartini, and Enrico Roda Copyright © 2011 Giulia Roda et al. All rights reserved. Short-and Long-Term Clinical Outcomes of Infliximab in Fulminant Ulcerative Colitis Mon, 03 Jan 2011 13:46:13 +0000 http://www.hindawi.com/journals/ulcers/2011/156407/ The aim was to characterize short- and long-term clinical outcomes of infliximab in fulminant ulcerative colitis. Patients with severe ulcerative colitis meeting the criteria of fulminant colitis after 3 days of glucocorticosteroid treatment were randomized to control or additional induction therapy of infliximab followed by an on demand/maintenance therapy of infliximab. Twenty six patients with fulminant colitis were equally randomized. At Day 7, ten patients in the control group and none in the infliximab group were in the need of colectomy (𝑃<.001). Due to superior effect of infliximab, patients in the control group were of ethical reasons transformed to infliximab treatment instead of performing colectomy. The probability to avoid colectomy was 0.66 with a median observation time of 52 months and a maximal of 91 months. The addition of azathioprine reduced the risk of late colectomy. We conclude that infliximab is effective in preventing early and late colectomy in fulminant colitis. J. Florholmen, G. Øverland, T. Olsen, R. Rismo, G. Cui, I. Christiansen, E. J. Paulssen, and R. Goll Copyright © 2011 J. Florholmen et al. All rights reserved.