1/9. Conservative treatment of stress ulcer bleeding: a new approach.Stress ulcer prophylaxis diminishes but does not eliminate the risk of severe bleeding from this complication. In 70-80% of the cases the source of bleeding is hemorrhagic gastritis. No controlled studies exist which have in particular investigated conservative therapy in patients with stress-induced hemorrhage. Even effective measures to suppress gastric acid secretion or to reduce splanchnic blood flow are ineffective in 10-40% of intensive care unit patients with stress-induced bleeding. In these cases total gastrectomy has so far often been the only therapeutic approach. We report our experience with a new approach in treating severe stress-induced hemorrhagic gastritis after ineffective primary treatment with H2-receptor antagonists, pirenzepine and somatostatin. Continuous gastric lavage with 5-10 l ice-cold Ringer's solution was used until complete cessation of bleeding, as evident from clear lavage. Repeated administration of 12 g sucralfate (60 ml) at 2-h intervals for 24 h through a gastric tube was used to prevent recurrence of bleeding and to promote healing. sucralfate was reduced on the 2nd and 3rd day to 20 ml 2-hourly and later to 10 ml 4-hourly. In four patients this treatment was used as an ultima ratio when the patients were already scheduled for total gastrectomy. A total of 23 patients were treated during a 7-year period; all of them responded successfully, and no patient required surgery.- - - - - - - - - - ranking = 1keywords = gastritis (Clic here for more details about this article) |
2/9. Abdominal complications after cardiac surgery in cardiopulmonary bypass.Gastrointestinal problems are an infrequent but serious consequence of cardiac surgery that includes cardiopulmonary bypass. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. Between July 1998 and August 2002, 1,552 patients (1,106 male and 446 female), mean age 56 years, underwent heart surgery with cardiopulmonary bypass. Among those 1,552 patients, 21 (1.35%) had gastrointestinal complications, mainly because of gastrointestinal bleeding due to gastritis and five of them required surgery. We present these five patients, three with intestinal ischemia, two with intestinal bleeding. There Hoffmeister-Finsterer operation, Rydygier resection, hemicolectomy, appendectomy with cecum sewing and sigmoid resection were performed. The mortality in this group was 60% (three of five), and the cause of death was multiorgan insufficiency. Conclusion: Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.- - - - - - - - - - ranking = 0.5keywords = gastritis (Clic here for more details about this article) |
3/9. Severe acute haemorrhagic gastritis controlled by hydrogen peroxide.A 92-year-old woman presented with severe acute haemorrhagic gastritis due to abuse of non-steroidal anti-inflammatory drugs (NSAIDs). She was treated with instillation of 150 ml 3% hydrogen peroxide (H2O2) every 2 h via a nasogastric tube. The copious amount of bright red blood through the nasogastric tube started to decline substantially after the first administration of H2O2 and continued to reveal clear material during the second and third instillation of H2O2. The total amount of H2O2 administered was 600 ml. No rebleeding and only a few flame-shaped intramucosal haemorrhages were observed on the following four consecutive daily endoscopic evaluations. These are promising observations which will have to be confirmed with respect to the safety and efficacy of H2O2 treatment by further controlled studies.- - - - - - - - - - ranking = 2.5keywords = gastritis (Clic here for more details about this article) |
4/9. Failure of ranitidine and omeprazole treatment in eosinophilic gastritis with ulceration.In a 32-year-old woman with an ulcer that had persisted for more than 13 months despite treatment with the H2 blocker ranitidine, the latter was replaced by the H K( )-ATPase inhibitor omeprazole. Treatment with omeprazole also failed to bring about healing of the ulceration which, at times, measured up to 10 cm in diameter. On account of a hemorrhage from the ulcer, a Billroth II resection of the stomach had to be performed. The histological work-up of the surgical specimen confirmed the tentative diagnosis of a secondary ulceration in underlying eosinophilic gastritis established on the basis of the work-up of biopsy material obtained from the ulcer. The reason for the failure of the lesion to respond to the H2 blocker or omeprazole in this case was a diffuse infiltration of the antral wall with eosinophilic granulocytes, and the resulting secondary persistent ischaemic ulceration.- - - - - - - - - - ranking = 2.5keywords = gastritis (Clic here for more details about this article) |
5/9. Chronic relapsing thrombotic thrombocytopenic purpura.A 58-year-old man had anemia and thrombocytopenia immediately after a myocardial infarction; recovery occurred spontaneously, but relapses followed intercurrent infection and abdominal surgery. The terminal relapse was precipitated by gastric ulcer with hemorrhagic gastritis; this episode was characterized by fluctuating neurologic symptoms including coma. autopsy studies confirmed the diagnosis of thrombotic thrombocytopenic purpura. This case shows that thrombotic thrombocytopenic purpura may occur de novo in adults as a relapsing syndrome with exacerbations precipitated by diverse events characterized by inflammation or tissue necrosis.- - - - - - - - - - ranking = 0.5keywords = gastritis (Clic here for more details about this article) |
6/9. prostaglandins, gastroduodenal ulcer and hemorrhagic gastritis.Today, we have effective and potent drugs such as H2-receptor antagonists for the treatment of peptic ulcers. cimetidine and ranitidine are antisecretory drugs which heal 67-90% of duodenal ulcers in 4 weeks. Certain prostaglandins (PGs) which also heal gastroduodenal ulcers and hemorrhagic gastritis not only diminish gastric acid secretion but also confer unique protective properties on the gastroduodenal mucosa. This phenomenon of 'cytoprotection' is supported by the experimental finding that PGs prevent gastroduodenal mucosal injury caused by absolute ethanol, HCl, NaOH and other irritating agents. Other PGs which do not reduce gastric acid secretion also heal human gastroduodenal ulcers. These special properties of PGs make them potentially beneficial for the treatment of gastric ulcer, and gastroduodenal ulcers accompanying use of nonsteroidal anti-inflammatory drugs as well as hemorrhagic gastritis which is particularly refractory to other therapeutic modalities.- - - - - - - - - - ranking = 3keywords = gastritis (Clic here for more details about this article) |
7/9. Severe upper gastrointestinal bleeding in healthy full-term neonates.Severe upper gastrointestinal bleeding is unusual in newborns, and is usually seen in sick premature infants. We report on three healthy full-term neonates who, after uneventful deliveries, presented with profuse bleeding in the first 48 h of life. Two infants had duodenal ulcers and one had diffuse hemorrhagic gastritis. All three patients responded to conservative medical therapy and have shown no recurrence of symptoms during a follow-up period of 1-4 yr.- - - - - - - - - - ranking = 0.5keywords = gastritis (Clic here for more details about this article) |
8/9. gastritis, duodenitis, and bleeding duodenal ulcer following mefenamic acid therapy.A 46-year-old woman developed hematemesis and melena two weeks after starting mefenamic acid therapy for osteoarthritis of the spine. Esophagogastroduodenoscopy, arteriography, and a laparotomy revealed antral gastritis, duodenitis, and an acute bleeding ulcer in the third portion of the duodenum. Although mefenamic acid has many of the pharmacologic and physicochemical properties of aspirin and produces gastrointestinal ulceration in animals when administered in large doses, the English literature reveals only one case of gastric ulceration and a single instance of upper-gastrointestinal tract hemorrhage associated with its use. This case warns that mefenamic acid may cause serious gastric and duodenal inflammation and ulceration more commonly than is presently suspected.- - - - - - - - - - ranking = 0.5keywords = gastritis (Clic here for more details about this article) |
9/9. Schonlein-Henoch vasculitis and chronic helicobacter pylori associated gastritis and duodenal ulcer: a case report.We describe the case of a child with Schonlein-Henoch purpura (SHP), bleeding duodenal ulcer and helicobacter pylori (H. pylori) associated gastritis. 5-year-old girl was hospitalized with typical symptoms of SHP. On the third day, the child has several episodes of hematemesis with bright red blood, accompanied by increased pain of the epigastric region. Gastroduodenal endoscopy revealed signs of atrophic gastritis in the antrum, duodenitis with diffuse petechiae, small erosions and bleeding ulcer. The gastric biopsy showed a moderately severe chronic gastritis with activity and H. pylori was detected. The therapy with ranitidine, metronidazole and amoxycillin was introduced for a period of 30 days. At follow-up 2 months later, clinical examination and routine laboratory tests were normal. A repeated endoscopy revealed no evidence of lesions and H. pylori negative gastric biopsy. In our case, the associated chronic antral gastritis and H. pylori infection may well have aggravated the gastrointestinal symptoms of SHP. We feel it would be useful to check for H. pylori in patients with gastrointestinal manifestations of SHP, such as bleeding and important epigastric pain.- - - - - - - - - - ranking = 4keywords = gastritis (Clic here for more details about this article) |