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)

아스피린 및 항응고제 복용 환자에서 소화성궤양 출혈의 치료

양효준 ( Hyo-joon Yang ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.5

Antiplatelet and anticoagulation agents are increasingly prescribed for secondary prophylaxis in patients with cardiovascular and cerebrovascular diseases. These drugs are associated with an increased risk of gastrointestinal bleeding, including peptic ulcer bleeding. It is difficult to decide when to restart the agents after peptic ulcer bleeding in these patients because the risk of rebleeding and thromboembolism should be balanced. The Korean College of Helicobacter and Upper Gastrointestinal Research revised the guidelines for drug-induced peptic ulcers as evidence-based guidelines using a de novo process. This paper introduces new recommendations on the resumption of antiplatelet and anticoagulation agents after peptic ulcer bleeding based on the revised guidelines for drug-induced peptic ulcers. (Korean J Gastroenterol 2020;76:242-245)

Original Article : Characteristics of Hemorrhagic Peptic Ulcers in Patients Receiving Antithrombotic/Nonsteroidal Antiinflammatory

( Drug Therapy ),( Kazuhiko Nakamura ),( Kazuya Akahoshi ),( Toshiaki Ochiai ),( Keishi Komori ),( Kazuhiro Haraguchi ),( Munehiro Tanaka ),( Norimoto Nakamura ),( Yoshimasa Tanaka ),( Kana Kakigao ) The Editorial Office of Gut and Liver 2012 Gut and Liver Vol.6 No.4

Background/Aims: Antithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated. Methods: We investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were categorized as the antithrombotic therapy (AT) group (n=213). The patients who were not treated with antithrombotics/NSAIDs were categorized as the control (C) group (n=263). The clinical characteristics were compared between the groups. Results: The patients in the AT group were significantly older than those in the C group (p<0.0001). The hemoglobin levels before/without transfusion were significantly lower in the AT group (8.24±2.41 g/dL) than in the C group (9.44±2.95 g/dL) (p<0.0001). After adjusting for age, the difference in the hemoglobin levels between the two groups remained significant (p=0.0334). The transfusion rates were significantly higher in the AT group than in the C group (p=0.0002). However, the outcome of endoscopic hemostasis was similar in the AT and C groups. Conclusions: Patients with hemorrhagic peptic ulcers receiving antithrombotic/NSAID therapies were exposed to a greater risk of severe bleeding that required transfusion but were still treatable by endoscopy. (Gut Liver 2012;6:423-426)

소화성 궤양 출혈의 내시경 치료

최연화,박준철 대한상부위장관ㆍ헬리코박터학회 2018 Korean Journal of Helicobacter Upper Gastrointesti Vol.18 No.4

Peptic ulcer bleeding is a common complication of peptic ulcer disease and the most common cause of upper gastrointestinal bleeding. Despite advances in drug usage and endoscopic modalities, no significant improvement is observed in the mortality rate of bleeding ulcers. The purpose of this review is to discuss various endoscopic hemostatic methods to treat peptic ulcer bleeding. Endoscopic hemostatic techniques can be classified into injection, mechanical, electrocoagulation, hemostatic powder, and endoscopic Doppler-guided hemostatic therapies (the last mentioned being a newly developed technique). Endoscopic hemostasis can be performed as mono or combination therapy using the aforementioned methods. Endoscopic hemostasis is the most important treatment for patients with peptic ulcer bleeding. Endoscopists should consider the treatment approach for peptic ulcer bleeding based on patient characteristics, the size and shape of the lesion, the endoscopist’s expertise, and the resources and circumstances at each hospital. Follow-up studies are needed to evaluate the efficacy of newly developed hemostatic powder therapy and endoscopic Doppler-guided hemostasis. (Korean J Helicobacter Up Gastrointest Res 2018;18:235-241)

Management of Non-Variceal Upper Gastrointestinal Bleeding

김승영,현종진,정성우,이상우 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Upper gastrointestinal bleeding (UGIB) is a critical condition that demands a quick and effective medical management. Non-variceal UGIB, especially peptic ulcer bleeding is the most significant cause. Appropriate assessment and treatment have a major influence on the prognosis of patients with UGIB. Initial fluids resuscitation and/or transfusion of red blood cells are necessary in patients with clinical evidence of intravascular volume depletion. Endoscopy is essential for diagnosis and treatment of UGIB, and should be provided within 24 hours after presentation of UGIB. Pre-endoscopic use of intravenous proton pump inhibitor (PPI) can downstage endoscopic signs of hemorrhage. Post-endoscopic use of high-dose intravenous PPI can reduce the risk of rebleeding and further interventions such as repeated endoscopy and surgery. Eradication of Helicobacter pylori and withdrawal of non-steroidal anti-inflammatory drugs are recommended to prevent recurrent bleeding.

소화성 궤양의 합병증과 대책

방창석,백광호 대한상부위장관ㆍ헬리코박터학회 2014 Korean Journal of Helicobacter Upper Gastrointesti Vol.14 No.1

Despite the improvement of medical managements of peptic ulcer and decline of Helicobacter pylori infection, complications of peptic ulcer are still prevalent in clinical practice. This is because of the increased use of ulcerogenic medications such as aspirin or non-steroidal anti-inflammatory drug (NSAID) in elderly patients. Peptic ulcer complications include bleeding, perforation, penetration and gastric outlet obstruction. These complications need to be managed by multidisciplinary approaches such as combination of endoscopic treatment, radiologic embolization, or surgical treatments. In addition to using proton pump inhibitors, H. pylori eradication and discontinuing ulcerogenic medications are essential in the prevention of recurrence. Although uncommon, non-H. pylori, non-NSAID ulcers should be suspected as a potential cause in recurrent cases of peptic ulcer complications.

소화성 궤양의 약물치료

오정환 대한상부위장관ㆍ헬리코박터학회 2014 Korean Journal of Helicobacter Upper Gastrointesti Vol.14 No.1

Peptic ulcer disease is one of the most commonly encountered diseases. Despite the decrease of Helicobacter pylori infection, the use of aspirin and non-steroidal anti-inflammatory drugs has increased in recent years. Peptic ulcer bleeding is a common emergency associated with high mortality. As an adjunct to endoscopic treatment, acid suppression with proton pump inhibitors (PPIs) is important in the management of peptic ulcer bleeding. A high dose intravenous PPI is effective in reducing rebleeding and the need for surgery. However, data about non-high dose intravenous PPIs are limited. In addition, novel PPIs are focused in this review, since progress has been made regarding new PPIs.

Factors Associated with Rebleeding in Patients with Peptic Ulcer Bleeding: Analysis of the Korean Peptic Ulcer Bleeding (K-PUB) Study

( Joon Sung Kim ),( Byung-wook Kim ),( Sung Min Park ),( Ki-nam Shim ),( Seong Woo Jeon ),( Sang-wook Kim ),( Yong Chan Lee ),( Hee Seok Moon ),( Si Hyung Lee ),( Woon Tae Jung ),( Jin Il Kim ),( Kyou 대한소화기학회 2018 Gut and Liver Vol.12 No.3

Background/Aims: Rebleeding is associated with mortality in patients with peptic ulcer bleeding (PUB), and risk stratification is important for the management of these patients. The purpose of our study was to examine the risk factors associated with rebleeding in patients with PUB. Methods: The Korean Peptic Ulcer Bleeding registry is a large prospectively collected database of patients with PUB who were hospitalized between 2014 and 2015 at 28 medical centers in Korea. We examined the basic characteristics and clinical outcomes of patients in this registry. Univariate and multivariate analyses were performed to identify the factors associated with rebleeding. Results: In total, 904 patients with PUB were registered, and 897 patients were analyzed. Rebleeding occurred in 7.1% of the patients (64), and the 30-day mortality was 1.0% (nine patients). According to the multivariate analysis, the risk factors for rebleeding were the presence of co-morbidities, use of multiple drugs, albumin levels, and hematemesis/hematochezia as initial presentations. Conclusions: The presence of co-morbidities, use of multiple drugs, albumin levels, and initial presentations with hematemesis/hematochezia can be indicators of rebleeding in patients with PUB. The wide use of proton pump inhibitors and prompt endoscopic interventions may explain the low incidence of rebleeding and low mortality rates in Korea. (Gut Liver 2018;12:271-277)

의학강좌 : 소화성 궤양 출혈의 진단과 치료

성재규 ( Jae Kyu Sung ) 대한내과학회 2015 대한내과학회지 Vol.88 No.2

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. (Korean J Med 2015;88:156-160)

단일 2차 종합병원에서 출혈성 소화성궤양 환자의 임상 양상과 빅데이터 분석을 위한 조작적 정의에 관한 연구

이재원 ( Jae Won Lee ),김현기 ( Hyun Ki Kim ),우용식 ( Yong Sik Woo ),장재훈 ( Jaehoon Jahng ),진영란 ( Young Ran Jin ),박종헌 ( Jong Heon Park ),김용성 ( Yong Sung Kim ),정훈용 ( Hwoon Yong Jung ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.2

Background/Aims: Peptic ulcer bleeding (PUB) is the most common cause of upper gastrointestinal bleeding in Korea but there has been no research done using big data. This study evaluates the optimal operational definition (OD) for big data research by analyzing clinical characteristics of PUB. Methods: We reviewed the clinical characteristics of 92 patients with PUB confirmed on endoscopy in Wonkwang University Sanbon Hospital (January 2013 to December 2014). We calculated sensitivity and positive predictive value (PPV) to detect confirmed PUB patients using ODs developed by combining clinical features of patients with PUB. Results: The mean patient age was 63 years. Men had higher prevalence of PUB than women. Bleeding gastric ulcer was proportionately common in the age range of 40s to 60s in men, while a significantly higher rate of bleeding occurred in women older than 70s. The rate of drug-induced ulcer was 28.2%, whereas the prevalence of Helicobacter pylori was 47.8%. Among the hospitalized patients with diagnostic code of PUB, we ruled out patients with endoscopic removal of gastric adenoma or peritonitis, and selected patients who had been administered intravenous proton pump inhibitor. The sensitivity in this setting was 82.6%, and PPV was 88.4%. Conclusions: PUB was more common in older patients, and there was a clear gender difference in gastric ulcer bleeding by age. With a proper OD using PUB diagnostic codes, we can identify true patients with sufficiently high sensitivity and PPV. (Korean J Gastroenterol 2016,68:77-86)