Endoscopy 2004; 36(1): 42-47
DOI: 10.1055/s-2004-814115
State of the Art Review
© Georg Thieme Verlag Stuttgart · New York

Ulcers and Gastritis

M.  P.  Dore1 , D.  Y.  Graham2
  • 1Institute of Clinical Medicine, University of Sassari, Sassari, Italy
  • 2Veterans' Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
Further Information

Publication History

Publication Date:
14 January 2004 (online)

Significant advances continue to be made in the area of gastritis and ulcer disease. Studies to identify the most appropriate use of capsule endoscopy have now confirmed that it is superior to other methods for identifying small-bowel mucosal pathology and sites of obscure gastrointestinal bleeding. It has increasingly been recognized that the complications of ulcer disease are secondary to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to interactions between NSAIDs and Helicobacter pylori. Effective prophylaxis for NSAID ulcers in H. pylori-negative individuals continues to be a challenge, as it has become clear that conclusions from studies focusing on ”endoscopic ulcers” in patients whose H. pylori status was unknown provided a false sense of security. The concept of multifocal atrophic gastritis has been challenged. The precursor lesion to gastric cancer now appears to be a sheet of pseudopyloric metaplasia advancing into the gastric body with islands of intestinal metaplasia embedded within it. Multifactorial models such as those proposed for understanding periodontal disease, including the organism, environmental factors, and host factors, appear particularly applicable to understanding the pathogenesis of H. pylori-associated gastric cancer.

References

  • 1 Costamagna G, Shah S K, Riccioni M E. et al . A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease.  Gastroenterology. 2002;  123 999-1005
  • 2 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
  • 3 Scapa E, Jacob H, Lewkowicz S. et al . Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology.  Am J Gastroenterol. 2002;  97 2776-2779
  • 4 Mylonaki M, Fritscher-Ravens A, Swain P. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.  Gut. 2003;  52 1122-1126
  • 5 Saurin J C, Delvaux M, Gaudin J L. et al . Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy.  Endoscopy. 2003;  35 576-584
  • 6 Fireman Z, Mahajna E, Broide E. et al . Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy.  Gut. 2003;  52 390-392
  • 7 Liangpunsakul S, Chadalawada V, Rex D K. et al . Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis.  Am J Gastroenterol. 2003;  98 1295-1298
  • 8 Spiegel B M, Ofman J J, Woods K, Vakil N B. Minimizing recurrent peptic ulcer hemorrhage after endoscopic hemostasis: the cost-effectiveness of competing strategies.  Am J Gastroenterol. 2003;  98 86-97
  • 9 Brunner G, Luna P, Hartmann M, Wurst W. Optimizing the intragastric pH as a supportive therapy in upper GI bleeding.  Yale J Biol Med. 1996;  69 225-231
  • 10 Labenz J, Peitz U, Leusing C. et al . Efficacy of primed infusions with high dose ranitidine and omeprazole to maintain high intragastric pH in patients with peptic ulcer bleeding: a prospective randomised controlled study.  Gut. 1997;  40 36-41
  • 11 Sung J Y, Chan F K, Lau J WW. et al . The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcer with nonbleeding visible vessels or adherent clots: a randomized comparison.  Ann Intern Med. 2003;  139 237-243
  • 12 Huggins R M, Scates A C, Latour J K. Intravenous proton-pump inhibitors versus H2-antagonists for treatment of GI bleeding.  Ann Pharmacother. 2003;  37 433-437
  • 13 Lee K K, You J H, Wong I C. et al . Cost-effectiveness analysis of high-dose omeprazole infusion as adjuvant therapy to endoscopic treatment of bleeding peptic ulcer.  Gastrointest Endosc. 2003;  57 160-164
  • 14 Lau J Y, Sung J J, Lee K K. et al . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.  N Engl J Med. 2000;  343 310-316
  • 15 Sheu B S, Chi C H, Huang C C. et al . Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding.  Aliment Pharmacol Ther. 2002;  16 137-143
  • 16 van Leerdam M E, Vreeburg E M, Rauws E A. et al . Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000.  Am J Gastroenterol. 2003;  98 1494-1499
  • 17 Adamopoulos A, Efstathiou S, Tsioulos D. et al . Acute upper gastrointestinal bleeding: comparison between recent users and nonusers of nonsteroidal anti-inflammatory drugs.  Endoscopy. 2003;  35 327-332
  • 18 Malfertheiner P, Megraud F, O’Morain C. et al . Current concepts in the management of Helicobacter pylori infection: the Maastricht 2 - 2000 Consensus Report.  Aliment Pharmacol Ther. 2002;  16 167-180
  • 19 Graham D Y. NSAIDs, Helicobacter pylori, and Pandora’s box.  N Engl J Med. 2002;  347 2162-2164
  • 20 Chan F K, Hung L C, Suen B Y. et al . Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis.  N Engl J Med. 2002;  347 2104-2110
  • 21 Graham D Y. Critical effect of Helicobacter pylori infection on the effectiveness of omeprazole for prevention of gastric or duodenal ulcers among chronic NSAID users.  Helicobacter. 2002;  7 1-8
  • 22 Wallace J L, McKnight W, Del Soldato P. et al . Anti-thrombotic effects of a nitric oxide-releasing, gastric-sparing aspirin derivative.  J Clin Invest. 1995;  96 2711-2718
  • 23 Donnelly M T, Goddard A F, Filipowicz B. et al . Low-dose misoprostol for the prevention of low-dose aspirin-induced gastroduodenal injury.  Aliment Pharmacol Ther. 2000;  14 529-534
  • 24 Gisbert J P, Pajares J M. Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review.  Am J Gastroenterol. 2001;  96 2829-2838
  • 25 Parente F, Maconi G, Bianchi Porro G, Caselli M. Stool test with polyclonal antibodies for monitoring Helicobacter pylori eradication in adults: a critical reappraisal.  Scand J Gastroenterol. 2002;  37 747-749
  • 26 Koletzko S, Konstantopoulos N, Bosman D. et al . Evaluation of a novel monoclonal enzyme immunoassay for detection of Helicobacter pylori antigen in stool from children.  Gut. 2003;  52 804-806
  • 27 Gosciniak G, Przondo-Mordarska A, Iwanczak B, Blitek A. Helicobacter pylori antigens in stool specimens of gastritis children before and after treatment.  J Pediatr Gastroenterol Nutr. 2003;  36 376-380
  • 28 El-Zimaity H M, Ota H, Graham D Y. et al . Patterns of gastric atrophy in intestinal type gastric carcinoma.  Cancer. 2002;  94 1428-1436
  • 29 Sipponen P, Ranta P, Helske T. et al . Serum levels of amidated gastrin-17 and pepsinogen I in atrophic gastritis: an observational case-control study.  Scand J Gastroenterol. 2002;  37 785-791
  • 30 Whiting J L, Sigurdsson A, Rowlands D C. et al . The long term results of endoscopic surveillance of premalignant gastric lesions.  Gut. 2002;  50 378-381
  • 31 Moayyedi P, Feltbower R, Crocombe W. et al . The effectiveness of omeprazole, clarithromycin and tinidazole in eradicating Helicobacter pylori in a community screen and treat programme. Leeds Help Study Group.  Aliment Pharmacol Ther. 2000;  146 719-728
  • 32 Della M P, Lavagna A, Masoero G. et al . Effectiveness of Helicobacter pylori eradication treatments in a primary care setting in Italy.  Aliment Pharmacol Ther. 2002;  16 1269-1275
  • 33 Gene E, Calvet X, Azagra R, Gisbert J P. Triple vs. quadruple therapy for treating Helicobacter pylori infection: a meta-analysis.  Aliment Pharmacol Ther. 2003;  17 1137-1143
  • 34 Katelaris P H, Forbes G M, Talley N J, Crotty B. A randomized comparison of quadruple and triple therapies for Helicobacter pylori eradication: the QUADRATE Study.  Gastroenterology. 2002;  123 1763-1769
  • 35 Sapone A, Vaira D, Trespidi S. et al . The clinical role of cytochrome p450 genotypes in Helicobacter pylori management.  Am J Gastroenterol. 2003;  98 1010-1015
  • 36 Graham D Y, Hammoud F, El Zimaity H M. et al . Meta-analysis: proton pump inhibitor or H2-receptor antagonist for Helicobacter pylori eradication.  Aliment Pharmacol Ther. 2003;  17 1229-1236
  • 37 Miehlke S, Mannes G A, Lehn N. et al . An increasing dose of omeprazole combined with amoxicillin cures Helicobacter pylori infection more effectively.  Aliment Pharmacol Ther. 1997;  11 323-329
  • 38 Dore M P, Graham D Y, Mele R. et al . Colloidal bismuth subcitrate-based twice-a-day quadruple therapy as primary or salvage therapy for Helicobacter pylori infection.  Am J Gastroenterol. 2002;  97 857-860
  • 39 Gisbert J P, Calvet X, Bujanda L. et al . ”Rescue” therapy with rifabutin after multiple Helicobacter pylori treatment failures.  Helicobacter. 2003;  8 90-94
  • 40 Graham D Y, Opekun A R, Yamaoka Y. et al . Early events in proton pump inhibitor-associated exacerbation of corpus gastritis.  Aliment Pharmacol Ther. 2003;  17 193-200
  • 41 Graham D Y. Helicobacter pylori infection in the pathogenesis of duodenal ulcer and gastric cancer: a model.  Gastroenterology. 1997;  113 1983-1991
  • 42 Graham D Y. Campylobacter pylori and peptic ulcer disease.  Gastroenterology. 1989;  96 615-625
  • 43 Greenstein G, Hart T C. A critical assessment of interleukin-1 (IL-1) genotyping when used in a genetic susceptibility test for severe chronic periodontitis.  J Periodontol. 2002;  73 231-247
  • 44 Greenstein G, Hart T C. Clinical utility of a genetic susceptibility test for severe chronic periodontitis: a critical evaluation.  J Am Dent Assoc. 2002;  133 452-459
  • 45 El Omar E M, Rabkin C S, Gammon M D. et al . Increased risk of noncardia gastric cancer associated with proinflammatory cytokine gene polymorphisms.  Gastroenterology. 2003;  124 1193-1201
  • 46 El Omar E M, Carrington M, Chow W H. et al . Interleukin-1 polymorphisms associated with increased risk of gastric cancer.  Nature. 2000;  404 398-402
  • 47 El Omar E M, Carrington M, Chow W H. et al . The role of interleukin-1 polymorphisms in the pathogenesis of gastric cancer.  Nature. 2001;  412 99
  • 48 Furuta T, El Omar E M, Xiao F. et al . Interleukin-1β polymorphisms increase risk of hypochlorhydria and atrophic gasritis and reduce risk of duodenal ulcer recurrence in Japan.  Gastroenterology. 2002;  123 92-105
  • 49 Kornman K, Duff G, Reilly P. Re: A critical assessment of interleukin-1 (IL-1) genotyping when used in a genetic susceptibility test for severe chronic periodontitis. Greenstein G, Hart TC (2002; 73 : 231-247).  J Periodontol. 2002;  73 1553-1556

D. Y. Graham, M. D.

Veterans’ Affairs Medical Center

Room 3A-320 (111D) · 2002 Holcombe Boulevard · Houston, TX 77030 · USA

Fax: + 1-713-790-1040

Email: dgraham@bcm.tmc.edu