Endoscopic treatment for bleeding peptic ulcers: randomised comparison of adrenaline injection and adrenaline injection + Nd:YAG laser photocoagulation

Article Abstract:

Peptic ulcer is a condition in which the destructive effects of the highly acidic secretions of the stomach overcome the protective effects of the mucosa (lining) of the stomach and intestines, resulting in the formation of lesions that can cause serious bleeding if blood vessels are injured by the ulcerative process. Mortality resulting from peptic ulcer bleeding occurs almost exclusively among patients over the age of 60 who suffer complications of surgery for recurrent or continued gastrointestinal bleeding. Several endoscopic methods, or nonsurgical procedures in which flexible mechanical devices are introduced through the esophagus to the stomach, have been developed to reduce the necessity for high-risk emergency surgery and consequent risk of mortality. To evaluate the comparative efficacy of gastric adrenaline injections (which cause constriction of the affected blood vessels, reducing bleeding) and adrenaline injections plus photocoagulation by laser beam (stanching the ulcer-induced hemorrhage by exposing the affected blood vessels to laser light), a study was carried out involving 42 patients suffering from peptic ulcer-induced bleeding. Patients were divided into two groups, well matched on variables relevant to ulcer severity. One group received endoscopically administered injections of adrenaline; the other group received identical injections of adrenaline in addition to photocoagulation therapy with Nd:YAG laser light. Because previous studies had shown that Nd:YAG laser treatment alone has a beneficial effect, it was not considered to be ethically justifiable to include an untreated control group. Control of bleeding was achieved to a similar extent in both groups; 76 percent of patients receiving adrenaline injections showed cessation of bleeding, whereas 86 percent of the patients receiving combined therapy showed successfully controlled bleeding. There were no deaths or serious complications in either group. Hence the simpler, less expensive treatment (adrenaline injection) appears to be as effective as Nd:YAG laser treatment in the control of peptic ulcer-related hemorrhage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Stomach diseases, Nd-YAG lasers

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Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer

Article Abstract:

Peptic ulcer is a condition characterized by erosion of the inner lining of the gastrointestinal tract, characterized by pain, nausea, vomiting, gastrointestinal bleeding, and sometimes perforation of the wall of the gastrointestinal tract. This condition is caused by an imbalance between the protective effects of the gastrointestinal mucosa and the destructive effects of hydrochloric acid secreted by the stomach. In cases of mild or moderately severe peptic ulcer, the prognosis with drug treatment is excellent. In severe cases, extensive bleeding can be life-threatening, and must be dealt with immediately. One strategy for stanching peptic ulcer hemorrhage is coagulation therapy in which blood clotting is induced using light (photocoagulation), laser energy, heat, or electricity. These procedures are expensive and require highly experienced operators. Another approach is sclerotherapy in which compounds are injected that block the vessels supplying blood to the hemorrhaging area. Sclerotherapy is limited to the most severe cases of peptic ulcer as less invasive therapies yield good results for less severe cases. To further evaluate the utility of this procedure, 109 patients suffering from severe ulcer-induced hemorrhage of the gastrointestinal tract were randomly assigned to one of three treatment groups. Two groups received injections into the affected gastrointestinal blood vessels using adrenaline (a vasoconstrictive neurohormone) or ethanolamine (a compound that causes occlusion of blood vessels); the third group received no sclerotherapy. The treated groups had a significantly reduced rate of rebleeding following therapy compared with untreated patients (12.5 percent vs. 47 percent). When sclerotherapy was used to control rebleeding in the previously untreated group, the incidence of surgical intervention to repair hemorrhage was greatly reduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Gastroscopy, Sclerotherapy

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Duodenal ulcer is associated with low dietary linoleic acid intake

Article Abstract:

Many factors contribute to the development of duodenal ulcer, an inflammatory condition of the first segment of the small intestine, including stress, smoking, and drug treatments. The likelihood of developing an ulcer is thought to be influenced by food and fluid intake, but the exact nature of the effects of different foods is poorly understood. It has been suggested that the decrease seen in the incidence and severity of duodenal ulcer in Western society over the past 30 years may reflect an increase in the dietary levels of an essential fatty acid (one that is not synthesized by the body and must be supplied in the diet), linoleic acid, may be an important factor. The relative amount of linoleic acid in body fat has been shown to be a good indicator of the amount of linoleic acid in the diet. This was used to estimate dietary intake of this fatty acid in 35 men being treated for duodenal ulcer and in 35 healthy control subjects. The percentage of linoleic acid was significantly lower in the ulcer group than in the healthy group, at 10 and 12 percent, respectively. This difference was found in both smokers and nonsmokers. To prove the causal effects of linoleic acid intake on ulcer prevention, a longitudinal study is needed in which dietary levels of this fatty acid are altered and the incidence of ulcer development recorded. The effects of dietary linoleic acid on ulcer formation may be mediated by linoleic acid's effects on prostaglandins, a class of endogenous compounds that are important regulators of gastric acid secretion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Risk factors, Physiological aspects, Ulcers, Linoleic acids, Linoleic acid, Duodenal ulcer

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