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Elena Pallari - One of the best experts on this subject based on the ideXlab platform.

  • medical versus surgical treatment for refractory or Recurrent Peptic Ulcer
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Kurinchi Selvan Gurusamy, Elena Pallari
    Abstract:

    Background Refractory Peptic Ulcers are Ulcers in the stomach or duodenum that do not heal after eight to 12 weeks of medical treatment or those that are associated with complications despite medical treatment. Recurrent Peptic Ulcers are Peptic Ulcers that recur after healing of the Ulcer. Given the number of deaths due to Peptic Ulcer-related complications and the long-term complications of medical treatment (increased incidence of fracture), it is unclear whether medical or surgical intervention is the better treatment option in people with Recurrent or refractory Peptic Ulcers. Objectives To assess the benefits and harms of medical versus surgical treatment for people with Recurrent or refractory Peptic Ulcer. Search methods We searched the specialised register of the Cochrane Upper GI and Pancreatic Diseases group, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015 to identify randomised trials and non-randomised studies, using search strategies. We also searched the references of included studies to identify further studies. Selection criteria We considered randomised controlled trials and non-randomised studies comparing medical treatment with surgical treatment in people with refractory or Recurrent Peptic Ulcer, irrespective of language, blinding, or publication status for inclusion in the review. Data collection and analysis Two review authors independently identified trials and extracted data. We planned to calculate the risk ratio, mean difference, standardised mean difference, or hazard ratio with 95% confidence intervals using both fixed-effect and random-effects models with Review Manager 5 based on intention-to-treat analysis. Main results We included only one non-randomised study published 30 years ago in the review. This study included 77 participants who had gastric Ulcer and in whom medical therapy (histamine H2 receptor blockers, antacids, and diet) had failed after an average duration of treatment of 29 months. The authors do not state whether these were Recurrent or refractory Ulcers. It appears that the participants did not have previous complications such as bleeding or perforation. Of the 77 included participants, 37 participants continued to have medical therapy while 40 participants received surgical therapy (antrectomy with or without vagotomy; subtotal gastrectomy with or without vagotomy; vagotomy; pyloroplasty and suture of the Ulcer; suture or closure of Ulcer without vagotomy or excision of the Ulcer; proximal gastric or parietal cell vagotomy alone; suture or closure of the Ulcer with proximal gastric or parietal cell vagotomy). Whether to use medical or surgical treatment was determined by participant's or treating physician's preference. The study authors reported that two participants in the medical treatment group (2 out of 37; 5.4%) had gastric cancer, which was identified by repeated biopsy. They did not report the proportion of participants who had gastric cancer in the surgical treatment group. They also did not report the implications of the delayed diagnosis of gastric cancer in the medical treatment group. They did not report any other outcomes of interest for this review (that is health-related quality of life (using any validated scale), adverse events and serious adverse events, Peptic Ulcer bleeding, Peptic Ulcer perforation, abdominal pain, and long-term mortality). Authors' conclusions We found no studies that provide the relative benefits and harms of medical versus surgical treatment for Recurrent or refractory Peptic Ulcers. Studies that evaluate the natural history of Recurrent and refractory Peptic Ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with Recurrent or refractory Peptic Ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complications and gastric cancer (in gastric Ulcers only) in Recurrent and refractory Peptic Ulcers. In addition to complications related to treatment and disease, health-related quality of life and loss of productivity should also be measured.

  • The Cochrane Library - Medical versus surgical treatment for refractory or Recurrent Peptic Ulcer
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Kurinchi Selvan Gurusamy, Elena Pallari
    Abstract:

    Background Refractory Peptic Ulcers are Ulcers in the stomach or duodenum that do not heal after eight to 12 weeks of medical treatment or those that are associated with complications despite medical treatment. Recurrent Peptic Ulcers are Peptic Ulcers that recur after healing of the Ulcer. Given the number of deaths due to Peptic Ulcer-related complications and the long-term complications of medical treatment (increased incidence of fracture), it is unclear whether medical or surgical intervention is the better treatment option in people with Recurrent or refractory Peptic Ulcers. Objectives To assess the benefits and harms of medical versus surgical treatment for people with Recurrent or refractory Peptic Ulcer. Search methods We searched the specialised register of the Cochrane Upper GI and Pancreatic Diseases group, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015 to identify randomised trials and non-randomised studies, using search strategies. We also searched the references of included studies to identify further studies. Selection criteria We considered randomised controlled trials and non-randomised studies comparing medical treatment with surgical treatment in people with refractory or Recurrent Peptic Ulcer, irrespective of language, blinding, or publication status for inclusion in the review. Data collection and analysis Two review authors independently identified trials and extracted data. We planned to calculate the risk ratio, mean difference, standardised mean difference, or hazard ratio with 95% confidence intervals using both fixed-effect and random-effects models with Review Manager 5 based on intention-to-treat analysis. Main results We included only one non-randomised study published 30 years ago in the review. This study included 77 participants who had gastric Ulcer and in whom medical therapy (histamine H2 receptor blockers, antacids, and diet) had failed after an average duration of treatment of 29 months. The authors do not state whether these were Recurrent or refractory Ulcers. It appears that the participants did not have previous complications such as bleeding or perforation. Of the 77 included participants, 37 participants continued to have medical therapy while 40 participants received surgical therapy (antrectomy with or without vagotomy; subtotal gastrectomy with or without vagotomy; vagotomy; pyloroplasty and suture of the Ulcer; suture or closure of Ulcer without vagotomy or excision of the Ulcer; proximal gastric or parietal cell vagotomy alone; suture or closure of the Ulcer with proximal gastric or parietal cell vagotomy). Whether to use medical or surgical treatment was determined by participant's or treating physician's preference. The study authors reported that two participants in the medical treatment group (2 out of 37; 5.4%) had gastric cancer, which was identified by repeated biopsy. They did not report the proportion of participants who had gastric cancer in the surgical treatment group. They also did not report the implications of the delayed diagnosis of gastric cancer in the medical treatment group. They did not report any other outcomes of interest for this review (that is health-related quality of life (using any validated scale), adverse events and serious adverse events, Peptic Ulcer bleeding, Peptic Ulcer perforation, abdominal pain, and long-term mortality). Authors' conclusions We found no studies that provide the relative benefits and harms of medical versus surgical treatment for Recurrent or refractory Peptic Ulcers. Studies that evaluate the natural history of Recurrent and refractory Peptic Ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with Recurrent or refractory Peptic Ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complications and gastric cancer (in gastric Ulcers only) in Recurrent and refractory Peptic Ulcers. In addition to complications related to treatment and disease, health-related quality of life and loss of productivity should also be measured.

Kurinchi Selvan Gurusamy - One of the best experts on this subject based on the ideXlab platform.

  • medical versus surgical treatment for refractory or Recurrent Peptic Ulcer
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Kurinchi Selvan Gurusamy, Elena Pallari
    Abstract:

    Background Refractory Peptic Ulcers are Ulcers in the stomach or duodenum that do not heal after eight to 12 weeks of medical treatment or those that are associated with complications despite medical treatment. Recurrent Peptic Ulcers are Peptic Ulcers that recur after healing of the Ulcer. Given the number of deaths due to Peptic Ulcer-related complications and the long-term complications of medical treatment (increased incidence of fracture), it is unclear whether medical or surgical intervention is the better treatment option in people with Recurrent or refractory Peptic Ulcers. Objectives To assess the benefits and harms of medical versus surgical treatment for people with Recurrent or refractory Peptic Ulcer. Search methods We searched the specialised register of the Cochrane Upper GI and Pancreatic Diseases group, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015 to identify randomised trials and non-randomised studies, using search strategies. We also searched the references of included studies to identify further studies. Selection criteria We considered randomised controlled trials and non-randomised studies comparing medical treatment with surgical treatment in people with refractory or Recurrent Peptic Ulcer, irrespective of language, blinding, or publication status for inclusion in the review. Data collection and analysis Two review authors independently identified trials and extracted data. We planned to calculate the risk ratio, mean difference, standardised mean difference, or hazard ratio with 95% confidence intervals using both fixed-effect and random-effects models with Review Manager 5 based on intention-to-treat analysis. Main results We included only one non-randomised study published 30 years ago in the review. This study included 77 participants who had gastric Ulcer and in whom medical therapy (histamine H2 receptor blockers, antacids, and diet) had failed after an average duration of treatment of 29 months. The authors do not state whether these were Recurrent or refractory Ulcers. It appears that the participants did not have previous complications such as bleeding or perforation. Of the 77 included participants, 37 participants continued to have medical therapy while 40 participants received surgical therapy (antrectomy with or without vagotomy; subtotal gastrectomy with or without vagotomy; vagotomy; pyloroplasty and suture of the Ulcer; suture or closure of Ulcer without vagotomy or excision of the Ulcer; proximal gastric or parietal cell vagotomy alone; suture or closure of the Ulcer with proximal gastric or parietal cell vagotomy). Whether to use medical or surgical treatment was determined by participant's or treating physician's preference. The study authors reported that two participants in the medical treatment group (2 out of 37; 5.4%) had gastric cancer, which was identified by repeated biopsy. They did not report the proportion of participants who had gastric cancer in the surgical treatment group. They also did not report the implications of the delayed diagnosis of gastric cancer in the medical treatment group. They did not report any other outcomes of interest for this review (that is health-related quality of life (using any validated scale), adverse events and serious adverse events, Peptic Ulcer bleeding, Peptic Ulcer perforation, abdominal pain, and long-term mortality). Authors' conclusions We found no studies that provide the relative benefits and harms of medical versus surgical treatment for Recurrent or refractory Peptic Ulcers. Studies that evaluate the natural history of Recurrent and refractory Peptic Ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with Recurrent or refractory Peptic Ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complications and gastric cancer (in gastric Ulcers only) in Recurrent and refractory Peptic Ulcers. In addition to complications related to treatment and disease, health-related quality of life and loss of productivity should also be measured.

  • The Cochrane Library - Medical versus surgical treatment for refractory or Recurrent Peptic Ulcer
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Kurinchi Selvan Gurusamy, Elena Pallari
    Abstract:

    Background Refractory Peptic Ulcers are Ulcers in the stomach or duodenum that do not heal after eight to 12 weeks of medical treatment or those that are associated with complications despite medical treatment. Recurrent Peptic Ulcers are Peptic Ulcers that recur after healing of the Ulcer. Given the number of deaths due to Peptic Ulcer-related complications and the long-term complications of medical treatment (increased incidence of fracture), it is unclear whether medical or surgical intervention is the better treatment option in people with Recurrent or refractory Peptic Ulcers. Objectives To assess the benefits and harms of medical versus surgical treatment for people with Recurrent or refractory Peptic Ulcer. Search methods We searched the specialised register of the Cochrane Upper GI and Pancreatic Diseases group, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015 to identify randomised trials and non-randomised studies, using search strategies. We also searched the references of included studies to identify further studies. Selection criteria We considered randomised controlled trials and non-randomised studies comparing medical treatment with surgical treatment in people with refractory or Recurrent Peptic Ulcer, irrespective of language, blinding, or publication status for inclusion in the review. Data collection and analysis Two review authors independently identified trials and extracted data. We planned to calculate the risk ratio, mean difference, standardised mean difference, or hazard ratio with 95% confidence intervals using both fixed-effect and random-effects models with Review Manager 5 based on intention-to-treat analysis. Main results We included only one non-randomised study published 30 years ago in the review. This study included 77 participants who had gastric Ulcer and in whom medical therapy (histamine H2 receptor blockers, antacids, and diet) had failed after an average duration of treatment of 29 months. The authors do not state whether these were Recurrent or refractory Ulcers. It appears that the participants did not have previous complications such as bleeding or perforation. Of the 77 included participants, 37 participants continued to have medical therapy while 40 participants received surgical therapy (antrectomy with or without vagotomy; subtotal gastrectomy with or without vagotomy; vagotomy; pyloroplasty and suture of the Ulcer; suture or closure of Ulcer without vagotomy or excision of the Ulcer; proximal gastric or parietal cell vagotomy alone; suture or closure of the Ulcer with proximal gastric or parietal cell vagotomy). Whether to use medical or surgical treatment was determined by participant's or treating physician's preference. The study authors reported that two participants in the medical treatment group (2 out of 37; 5.4%) had gastric cancer, which was identified by repeated biopsy. They did not report the proportion of participants who had gastric cancer in the surgical treatment group. They also did not report the implications of the delayed diagnosis of gastric cancer in the medical treatment group. They did not report any other outcomes of interest for this review (that is health-related quality of life (using any validated scale), adverse events and serious adverse events, Peptic Ulcer bleeding, Peptic Ulcer perforation, abdominal pain, and long-term mortality). Authors' conclusions We found no studies that provide the relative benefits and harms of medical versus surgical treatment for Recurrent or refractory Peptic Ulcers. Studies that evaluate the natural history of Recurrent and refractory Peptic Ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with Recurrent or refractory Peptic Ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complications and gastric cancer (in gastric Ulcers only) in Recurrent and refractory Peptic Ulcers. In addition to complications related to treatment and disease, health-related quality of life and loss of productivity should also be measured.

  • Medical versus surgical treatment for refractory or Recurrent Peptic Ulcer
    WILEY-BLACKWELL, 2015
    Co-Authors: Kurinchi Selvan Gurusamy
    Abstract:

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of medical versus surgical treatment for people with Recurrent or refractory Peptic Ulcer

Francis K. L. Chan - One of the best experts on this subject based on the ideXlab platform.

  • Therapeutic Management of Recurrent Peptic Ulcer Disease
    Drugs, 2012
    Co-Authors: Raymond S. Tang, Francis K. L. Chan
    Abstract:

    The epidemiology of Peptic Ulcer disease (PUD) has undergone significant changes since the discovery of Helicobacter pylori . Various aetiologies contribute to Recurrent PUD. Ulcers related to untreated H. pylori infection tend to recur. Use of NSAIDs, low-dose aspirin and dual anti-platelet therapy have become important risk factors for Recurrent Ulcers and their complications as the proportion of H. pylori -related Ulcers declines. Recent data have shown that H. pylori -negative, NSAID-negative idiopathic Peptic Ulcers are on the rise and carry a higher risk of Recurrent Ulcer bleeding and mortality. Effective management of Recurrent PUD relies on identification and modification of treatable risk factors. Persistent H. pylori infection should be carefully ruled out. Choice of an effective H. pylori eradication regimen should be based on local antibacterial resistance patterns. For patients who need long-term NSAID therapy, the initial choice of an NSAID relates to a patient’s cardiovascular risk, and the need for therapy to decrease gastrointestinal (GI) complications is determined by the severity and number of GI risk factors. For patients on dual anti-platelet therapy, strategies to prevent Recurrent Ulcer disease and its complications centre on balancing the bleeding and thrombotic risks of individual patients. Long-term proton pump inhibitor maintenance therapy may be necessary to prevent Recurrent Ulcer bleeding for patients with Ulcer bleeding from H. pylori -negative, NSAID-negative Ulcers, and for patients who require NSAID or aspirin maintenance therapy.

Roy Soetikno - One of the best experts on this subject based on the ideXlab platform.

  • clipping over the scope for Recurrent Peptic Ulcer bleeding is cost effective as compared to standard therapy an initial assessment
    Gastrointestinal Endoscopy Clinics of North America, 2020
    Co-Authors: Alton W Russell, Ravishankar Asokkumar, Tonya Kaltenbach, Roy Soetikno
    Abstract:

    Clipping over the scope (C-OTS) is a novel closure technique used for the treatment of nonvariceal gastrointestinal bleeding, especially for high-risk lesions. C-OTS devices cost more than clipping through the scope and thermal devices. The high upfront cost of C-OTS may pose a barrier to its use and the cost-effectiveness of C-OTS for Peptic Ulcer disease bleeding is unknown. Cost-effectiveness studies of C-OTS for Peptic Ulcer bleeding as both first-line and second-line therapy can provide the current estimate of the conditions in which the use of C-OTS is cost-effective and give insights of the determinants to the cost-effectiveness of C-OTS.

H. Bauer - One of the best experts on this subject based on the ideXlab platform.

  • Video-assisted thoracoscopic truncal vagotomy.
    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 1997
    Co-Authors: Pablo Palma, H. Kistler, H. Bauer
    Abstract:

    Thoracoscopic truncal vagotomy was performed in three patients with Recurrent Ulcer after previous Billroth-II gastrectomy. The technique involved double-lumen endotracheal-endobronchial intubation and single-lung ventilation. No morbidity or mortality existed and the mean hospitalization was 7 days. To date, no Recurrent Ulceration has been detected in these patients. Thoracoscopic truncal vagotomy is considered to be a rapid, simple and safe approach and thus could play a preferential role in the management of patients with Recurrent Peptic Ulcer after previous gastrectomy.