Cases reported "Peptic Ulcer"

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1/33. Understanding peptic ulcer disease pharmacotherapeutics.

    The implication that helicobacter pylori is responsible for peptic ulcer disease (PUD) has revolutionized the pharmacotherapeutic management of PUD. There has been a shift from long-term therapy with antacids and histamine2 (H2) antagonists to short-term therapy with triple antimicrobials with or without an antisecretory agent or a double antimicrobial therapy with an antisecretory agent. A case of PUD in a 53-year-old woman and its management with double antimicrobial agents and an antisecretory agent is discussed. research evidence suggests that a treatment regimen aimed at eradicating H. pylori without diagnostic testing enhances the ability to effectively manage suspected cases of PUD before complications arise and referrals to specialists are necessary. Discouraging the use of over-the-counter H2 antagonists, ruling out long-term use of nonsteroidal anti-inflammatory drugs before selecting the treatment regimen, and considering expected treatment compliance are important aspects of PUD management that emerged from this case.
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keywords = acid
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2/33. A particularly aggressive combined glucagonoma and gastrinoma syndrome.

    Duodeno-pancreatic biochemically polyfunctional endocrine tumour is a well known entity. Usually, only one hormone is responsible for the clinical features. We report a case of aggressive combined glucagonoma and gastrinoma tumour without metastases, causing respectively diabetic ketoacidosis and fulminant peptic ulcer, and death. Occasional patients can present with clinical features of both glucagonoma and gastrinoma. Diabetic patients exhibiting migratory skin lesions should be suspected of glucagonoma. In addition, a multidisciplinary approach to such patients including dermatologists, surgeons, radiologists and endoscopists is mandatory.
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keywords = acid
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3/33. Reversible pheripheral edema in female patients taking proton pump inhibitors for peptic acid diseases.

    Pheripheral edema was observed in five female patients after taking proton pump inhibitors omeprazole, lansoprazole, or pantoprazole for 7-15 days for peptic acid diseases in recommended standard doses. edema disappeared two to three days after stopping therapy but reappeared in all five patients after being reexposed to the drugs. In three of the patients drug kinetic investigations were performed and revealed a slow metabolizer status. During dose-finding studies for intravenous proton pump inhibitors omeprazole and pantoprazole, three of six young female volunteers receiving omeprazole and two young female volunteers receiving pantoprazole developed peripheral edema within 8 hr when high doses of the proton pump inhibitors were applied by continuous infusion together with large volumes of fluid. The edema disappeared within 24 hr after stopping the infusion therapy. serum hormone concentrations in these patients did not change during therapy, neither did the edema factor C1-esterase inhibitor. As a possible mechanism, a competitive inhibition at the receptor site of female hormones involved in water regulation is suspected.
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keywords = acid
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4/33. peptic ulcer in children with gastric tube interposition.

    An infrequent, but potentially serious, complication of gastric tube interposition is ulceration within the conduit. It is important, therefore, to recognize ulcer formation in its early stages by serial radiographs throughout the childhood years. While redundancy and partial obstruction with impaired drainage of the tube appear to be etiologic factors, distension of the transposed antrum may lead to hyperacidity and may play a role in ulcerogenesis. A course of dietary and antacid therapy may heal the ulcer, but surgical revision of the tube may prove necessary.
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keywords = acid
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5/33. gastric outlet obstruction as a consequence of a duodenal web masquerading as gastrinoma in an adult.

    We present the case of a 24-year-old man with recurrent peptic ulcers and hypergastrinemia, in whom a multidisciplinary investigation for gastrinoma revealed a duodenal web. The affected duodenal segment was excised, and a gastroduodenostomy with highly selective vagotomy was performed. Postoperative serum gastrin levels returned to the normal range over the next 6 weeks. Congenital duodenal anomalies are unusual causes of gastric outlet obstruction in adults. Chronic gastric outlet obstruction secondary to an adult duodenal web can induce neurohumoral changes in gastric function, which enhance both acid output and gastrin secretion. This case reminds clinicians to consider congenital anomalies in adults presenting with recurrent peptic ulcers and hypergastrinemia.
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keywords = acid
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6/33. An unusual case of massive gastric distension with catastrophic sequelae.

    We report a case of massive gastric distension presenting with abdominal pain, shock and lower limb ischaemia. At laparotomy, gastric distension was found to be secondary to gastric outflow obstruction compounded by gas formation from antacid ingestion. Both the aorta and inferior vena cava were directly compressed by the distended stomach. This mode of presentation and combined aetiologies remain unreported. Gastric decompression resulted in profound cardiovascular compromise, multiorgan failure and eventually death.
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keywords = acid
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7/33. Severe and refractory peptic ulcer disease: the diagnostic dilemma: case report and comprehensive review.

    The recognition of helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general surgeons. Surgery is reserved for complications of the disease, refractory disease, or rare causes of ulcer disease such as gastrinoma and zollinger-ellison syndrome. In this report, we describe a case of intractable peptic ulcer disease that progressed to gastric outlet obstruction despite maximal medical therapy. We review the diagnostic studies utilized to evaluate the potential etiologies of peptic ulcer disease and the difficulty in diagnosing gastrinoma and Zollinger-Ellison in the setting of potent medical acid suppression therapy.
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ranking = 3786.9080109337
keywords = gastric acid, acid
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8/33. Hemolytic anemia associated with the use of omeprazole.

    omeprazole is the first drug designed to block the final step in the acid secretory process within the parietal cell. It has been shown to be extremely effective in the treatment of peptic ulcer disease, reflux esophagitis, and the zollinger-ellison syndrome. Although clinical experience with omeprazole is still limited, many controlled studies have established the short-term safety of this drug. We report the first case of a serious short-term adverse reaction with the use of omeprazole: hemolytic anemia. The patient developed weakness, lethargy, and shortness of breath 2 days after starting therapy with omeprazole. Two weeks after the initiation of therapy, her hematocrit had decreased from 44.1% to 20.4%, and she had a positive direct Coombs antiglobulin test and an elevated indirect bilirubin. After she discontinued the omeprazole, her hemoglobin and hematocrit gradually returned to normal. The mechanism by which omeprazole caused the patient's hemolytic anemia is uncertain, but physicians should be alerted to this possible adverse effect.
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keywords = acid
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9/33. Peptic (contact ulcer) granuloma of the larynx.

    review of published work and analysis of clinical data and pathology of four biopsy specimens from two patients with laryngeal contact granuloma showed that its peptic origin was derived from a gastro-oesophago-laryngeal reflux. It is proposed that the term "peptic granuloma" should be given to this phenomenon. This term is given further support on account of the spectacular recovery of the laryngeal lesion following antacid and antireflux treatment, rather than the traditional method of using vocal rest and speech therapy, assumed to be the best way of treating a result of mechanical irritation, the previously accepted cause of laryngeal contact granuloma.
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keywords = acid
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10/33. Marked basal gastric acid hypersecretion and peptic ulcer disease: medical management with a combination H2-histamine receptor antagonist and anticholinergic.

    Three children with peptic ulcer disease had recurrent symptoms unresponsive to cimetidine or ranitidine therapy alone. Acid secretory studies showed a marked basal acid hypersecretion, which was atropine-sensitive in two of three patients and was best suppressed by ranitidine in combination with an anticholinergic drug. Marked reduction in acid output following intravenous atropine suggested that the hypersecretion was under vagal, muscarinic control. However, in one patient, large doses of the selective m1-muscarinic antagonist pirenzepine were ineffective in suppressing basal acid hypersecretion. Given the efficacy and safety of drug therapy used in these children over a 3-year period, we conclude that medical management is an effective alternative to surgery for pediatric patients with refractory or recurrent peptic ulcer disease.
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ranking = 15146.632043735
keywords = gastric acid, acid
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