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    Home > Active Ingredient News > Digestive System Information > The latest research progress of idiopathic peptic ulcer, a summary!

    The latest research progress of idiopathic peptic ulcer, a summary!

    • Last Update: 2021-06-22
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and recommend collections! Peptic ulcer (PUD) is a common clinical disease.
    The currently recognized causes are mainly Helicobacter pylori (Hp) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin
    .

    There are still many controversies about the incidence, clinical status and treatment of idiopathic ulcers
    .

    At the 2021 American Digestive Disease Week (DDW) conference, two scholars from the Chinese University of Hong Kong, China, brought us a report on idiopathic peptic ulcer
    .

    01 Epidemiology and diagnostic definition of idiopathic peptic ulcer: idiopathic peptic ulcer means no Hp infection, no history of taking NASIDs and/or aspirin in the past four weeks, and excluding other diseases that cause peptic ulcer such as Crohn’s disease, cytomegalovirus infection, lymphoma, Zollinger-Ellison syndrome and other gastroduodenal ulcers
    .

    Studies have reported that 11%-44% of peptic ulcers in the United States have nothing to do with Hp infection or NSAID drugs.
    Approximately 20% of peptic ulcer patients treated in major general hospitals in France have idiopathic peptic ulcers.
    Neither Hp infection nor NSAID are related
    .

    A meta-study analysis found that even if Hp infection is cured, 20% of ulcers will recur within 6 months
    .

    In the past 20 years, the prevalence of idiopathic peptic ulcers associated with non-NSAIDs or non-Hp infections has increased significantly
    .

    Is this an increase in the incidence in the real world, or is it a relative increase? Due to the decline of Hp infection rate and the popularization of sterilization therapy, the incidence of Hp infection-related ulcers has decreased, and the proportion of idiopathic ulcers will increase accordingly
    .

    It can be seen from previous reports that the number of idiopathic ulcers in Hong Kong increased from 4.
    1% in 1997 to 18.
    8% in 2000
    .

    Therefore, the incidence of idiopathic peptic ulcer may also be increasing
    .

    Since idiopathic peptic ulcer is a disease of exclusion diagnosis, there are some challenges in clinical diagnosis
    .

    (1) The false negative of Hp test causes the false negative of Hp: antibiotics, bismuth, proton pump inhibitor (PPI), high-dose H2 receptor blockers, bleeding in the stomach are recently or are being used
    .

    The use of antibiotics for a few days and 6 weeks after stopping the drug may lead to false negative results of the Hp puff test
    .

    Hp insufflation can only be performed after PPI treatment is stopped for at least 7-14 days
    .

    If there is bleeding in the stomach, the sensitivity of the Hp blow test can be reduced from 70% to 50%
    .

    (2) It is difficult to confirm that there is no history of taking NSAIDs or aspirin
    .

    (3) It is difficult to completely exclude peptic ulcers caused by some rare diseases
    .

    The pathogenesis of idiopathic peptic ulcer is largely unknown.
    It is still controversial whether the secretion of gastric acid is too much or too little
    .

    The weakened mucosal barrier function may be a more important mechanism than gastric acid secretion
    .

    02 Prognosis of Idiopathic Peptic Ulcer Bleeding In Hp-negative idiopathic peptic ulcer bleeding, the 1-year rebleeding rate is about 13.
    4% in the follow-up without acid suppression treatment
    .

    The rebleeding rate of Hp infection-related ulcer bleeding after Hp eradication is only 2.
    5%
    .

    In a prospective long-term follow-up (median follow-up up to 7 years) cohort study, the cumulative rebleeding rate of the idiopathic peptic ulcer bleeding group was about 42.
    3%, which was significantly higher than that of the Hp infection peptic ulcer bleeding group (11.
    2%)
    .

    In this study, the cumulative all-cause mortality of the idiopathic peptic ulcer bleeding group was 87.
    6%, while the cumulative death rate of the Hp infection peptic ulcer bleeding group was 37.
    3%
    .

    Therefore, the prognosis of patients with idiopathic peptic ulcer bleeding has a higher risk of rebleeding and death than patients with peptic ulcer bleeding caused by Hp infection
    .

    Current treatment guidelines recommend long-term PPI treatment for patients with Hp-negative idiopathic peptic ulcer bleeding
    .

    However, the guidelines do not clearly answer-whether H2 receptor antagonists can be used to replace PPI, and whether H2 receptor antagonists are less effective in preventing the recurrence of ulcer bleeding in such patients compared with PPI
    .

    In a randomized controlled double-blind trial, patients with a history of idiopathic ulcerative bleeding were recruited
    .

    After the ulcers of these patients healed, the researchers randomly assigned the patients 1:1 to the group receiving oral lansoprazole 30 mg/d or famotidine 40 mg/d for up to 24 months
    .

    The primary end point was repeated upper gastrointestinal bleeding within 24 months
    .

    In the lansoprazole group, the cumulative recurrence rate of upper gastrointestinal bleeding was 0.
    88% (95% CI 0.
    08%-4.
    37%); in the famotidine group, the cumulative recurrence rate of upper gastrointestinal bleeding was 2.
    63% ( 95%CI 0.
    71%-6.
    91%)
    .

    There was no significant difference in the rate of recurrent upper GI bleeding between the two groups
    .

    Lansoprazole and famotidine have the same efficacy in preventing the recurrence of ulcer bleeding, but the subtle difference in efficacy still cannot be denied
    .

    After PPI treatment, 4.
    4% of endoscopic ulcers recurred and the mortality rate was as high as 7%
    .

    Therefore, scholars believe that the effect of using PPI alone to suppress acid may still be unsatisfactory
    .

    Therefore, they conducted a prospective double-blind controlled trial to compare the prognosis of misoprostol combined with PPI and PPI alone in the treatment of patients with idiopathic peptic ulcer bleeding
    .

    After enrolling patients with idiopathic peptic ulcer bleeding and confirmed by endoscopy, they were randomly given misoprostol combined with PPI or PPI and placebo.
    After one year of follow-up, statistics showed that there was no difference in the recurrence rate of ulcerative bleeding.
    However, the combination of misoprostol and PPI is better than PPI alone in preventing symptomatic bleeding or decreased hemoglobin
    .

    The increase in idiopathic peptic ulcer is related to the widespread development of Hp eradication on the one hand, and the increase in incidence on the other
    .

    Therefore, while clinical gastroenterologists pay attention to Hp-positive peptic ulcers, they should also pay enough attention to Hp-negative ulcers, such as basic life and medication guidance, and how to follow up and review gastroscopy at the right time
    .

    Judging from the current clinical evidence, these patients may be more likely to cause serious complications such as bleeding if they cannot be treated properly
    .

     Expert profile Yan Yuling Postdoctoral in Gastroenterology, West China Hospital, Sichuan University, Doctor of Medicine
    .

    He is engaged in basic and clinical research on liver fibrosis and cirrhosis and portal hypertension, and has been funded by the Chinese Postdoctoral Postdoctoral Fund, and has published many SCI papers
    .

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