Peptic ulcer disease (PUD) affects ~4 million people globally. Peptic ulcer perforation (PUP) is a serious complication of PUD associated with high mortality and morbidity. Hence, a high index of clinical suspicion is crucial in diagnosing such cases. Here, we present a case of a 19-year-old male who presented with 4 days of severe abdominal pain, fever, and vomiting. On examination, signs of acute abdomen were evident, and an erect chest X-ray confirmed free air under the diaphragm. The patient underwent an emergency midline laparotomy, during which 1000 ml of purulent fluid was evacuated. A perforation measuring 8 × 8 mm2 was repaired using the falciform ligament due to the unavailability of adequate healthy omentum. His postoperative recovery was uneventful. This case report underscores the importance of considering the falciform ligament as a viable and effective alternative for the closure of PUP when the omentum is unavailable.

UNASSIGNED: There are limited contemporary population-based data on Helicobacter pylori epidemiology and outcomes in the United States. Our primary aim was to create a validated cohort of veterans with H pylori testing or treatment using Veterans Health Administration data.
UNASSIGNED: Using Veterans Health Administration structured and unstructured data, we developed and validated 4 algorithms for H pylori infection (3 algorithms) and treatment status (1 algorithm). During the development phase, we iteratively modified each algorithm based on a manual review of random sets of electronic health records (reference standard). The a priori validation goal was to achieve a one-sided 95% confidence lower bound (LB) for positive predictive value (PPV) and/or negative predictive value (NPV) >90%. We applied the Bonferroni correction when both PPV and NPV were relevant.
UNASSIGNED: For H pylori infection, we achieved 99.0% PPV (LB = 94.6%) and 100% NPV (LB = 96.4%) for discriminating H pylori positive vs negative status using structured (ie, laboratory tests) and 95% PPV (LB = 90.3%) and 97.9% NPV (LB = 93.9%) using unstructured (ie, histopathology reports) data. Diagnostic codes achieved 98% PPV (LB = 93.0%) for H pylori diagnosis. The treatment algorithm was composed of multiple antimicrobial combinations and overall achieved ≥98% PPV (LB = 93.0%) for H pylori treatment, except for amoxicillin/levofloxacin (PPV<60%). Application of these algorithms yielded nearly 1.2 million veterans with H pylori testing and/or treatment between 1999 and 2018.
UNASSIGNED: We assembled a validated national cohort of veterans who were tested or treated for H pylori infection. This cohort can be used for evaluating H pylori epidemiology and treatment patterns, as well as complications of chronic infection.

Peptic ulcer disease refers to a break in the gastric or duodenal mucosal wall extending into the muscular mucosa. Although peptic ulcer disease commonly presents with dyspepsia, about 70% of patients initially present asymptomatically. A perforated peptic ulcer is a life-threatening complication of peptic ulcer disease that has high morbidity and mortality and requires emergent surgery. To prevent complications of peptic ulcer disease, an extensive history, physical examination, and appropriate imaging are required for appropriate management. In addition, the use of appropriate imaging and diagnostic modalities, such as an oral contrast computerized tomography of the abdomen, may lead to emergent treatment if complications arise. We present a unique case of a contained perforated duodenal ulcer within a fistula tract (Ulcère Perforé-Bouché) and diagnostic tools yielding detection and treatment of an Ulcère Perforé-Bouché. Abdominal x-rays may be inadequate the detect Ulcère Perforé-Bouché. However, an oral contract computerized tomography of the abdomen may have greater detection capabilities to diagnose cases of Ulcère Perforé-Bouché.

The impact of peptic ulcer disease (PUD) and Helicobacter pylori (H. pylori) eradication therapy on dementia risk in high H. pylori prevalence populations remains uncertain. This study investigates the relationship between PUD, H. pylori eradication, and dementia risk, including Alzheimer\'s disease (AD), in an elderly South Korean cohort, considering age and eradication timing. Data from the Korean National Health Insurance Service (2002-2015) for individuals aged 55-79 were analyzed. Participants were divided based on PUD and H. pylori therapy status. Propensity score matching was used to evaluate dementia incidence and hazard ratios over 5 and 10 years, alongside the timing of eradication therapy. PUD is linked to higher dementia risk at 5 and 10 years, more for overall dementia than AD, with eradication status not significantly altering the risk. Age-specific analysis showed increased AD risk in the 60s and 70s age groups. Late eradication therapy is correlated with a higher dementia risk. PUD is a risk factor for dementia in elderly South Koreans, particularly with delayed H. pylori therapy. The findings emphasize timely H. pylori management and its potential role in neurodegenerative disease prevention.

Peptic ulcer disease (PUD) poses a significant global healthcare challenge, with an intricate interplay between stomach acid-pepsin levels and mucosal protective mechanisms. The emergence of Helicobacter pylori (H. pylori) as a major etiological factor revolutionized the therapeutic landscape, highlighting the importance of bacterial eradication in PUD management. Surgical intervention remains vital, particularly in cases of perforated peptic ulcers, despite a shift towards conservative approaches. Understanding the impact of H. pylori eradication on surgical outcomes is crucial for optimizing PUD management. This systematic review was conducted to assess how H. pylori eradication treatment impacts surgical results in patients with PUD. The criteria for inclusion involved research studies on individuals aged 18 years and older with a diagnosis of PUD that necessitated surgical treatment. Important results comprised eradication rates, complications after surgery, recurrence rates, and overall outcomes for patients. Two researchers independently screened and extracted data from electronic databases using a thorough search strategy. The evaluation of quality employed standardized instruments for randomized controlled trials and cohort studies. Nine research projects met the requirements for inclusion, offering information on the effectiveness of H. pylori elimination treatment on surgical results. Different rates of eradication were noted, with a notable number of patients experiencing postoperative complications. Recurrence of ulcers was a concern, despite treatment, emphasizing the complexity of PUD management. Studies have shown that eradication therapy is effective in certain patient groups, like young men with perforated peptic ulcers. Still, there are obstacles, especially for patients who test negative for H. pylori and experience recurring ulcers. The integration of H. pylori eradication with surgical intervention represents a holistic approach to PUD management. Although eradication therapy has the potential to enhance surgical results, difficulties remain, requiring personalized treatment approaches that consider patients\' unique characteristics and the cause of the disease. This research adds to the growing knowledge of PUD treatment, stressing the importance of proper management.

Peptic ulcer disease (PUD) affects approximately four million people worldwide. The most common etiologies of PUD are Helicobacter pylori (H. pylori) infections, chronic nonsteroidal anti-inflammatory drug (NSAID) use, and smoking. A rare cause of ulcer formation is documented in patients following Roux-en-Y gastric bypass (RYGB) procedures. Delayed treatment of these ulcers can further lead to ulcer perforation, erosion of the gastroduodenal artery (GDA), and fistula formation between the biliary structures and the gastrointestinal tract. Herein, we discuss the case of a 69-year-old female with an ulcer perforation 19 years after RYGB, resulting in an atypical ulcer erosion of the common bile duct without fistula formation.

BACKGROUND: Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are prevalent in Taiwan. Few studies have investigated the associations between obesity indices with GERD and PUD simultaneously. This study aimed to investigate the correlations among obesity indices with GERD and PUD in a large cohort of participants, around 120,000, in the Taiwan Biobank (TWB).
METHODS: A total of 121,583 participants (male: 43,698; female: 77,885; mean age 49.9 ± 11.0 years) were included to analyze the associations among obesity indices, including body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), abdominal volume index (AVI), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose index (TyG index), with GERD and PUD. Self-reported GERD and PUD were obtained by questionnaires. Multivariate logistic regression analysis was employed to analyze the relationship between obesity indices with GERD and PUD.
RESULTS: The prevalence of GERD and PUD was 13.7% and 14.6%, respectively. After multivariable analysis, high WHR (odds ratio [OR] = 1.009, p < 0.001), WHtR (OR = 1.005, p = 0.003), BRI (OR = 1.022, p = 0.005), AVI (OR = 1.013, p < 0.001), LAP (OR = 1.001, p < 0.001), TyG index (OR = 1.068, p < 0.001), and VAI (OR = 1.013, p = 0.002) were significantly associated with GERD, except BMI (p = 0.384). On the other hand, low BMI (OR = 0.984; p < 0.001) and AVI (OR = 0.994; p = 0.036) were significantly associated with PUD. However, the values of WHR (p = 0.151), WHtR (p = 0.304), BRI (p = 0.452), LAP (p = 0.799), VAI (p = 0.347), and TyG index (p = 0.642) were not.
CONCLUSIONS: This study found that high obesity indices are associated with GERD, but low obesity indices are associated with PUD in a large Taiwanese population study. Our findings may alert physicians to notice that different obesity index may be associated with different gastrointestinal disorder.

Colonization of the human stomach with Helicobacter pylori strains producing active forms of the secreted toxin VacA is associated with an increased risk of peptic ulcer disease and gastric cancer, compared with colonization with strains producing hypoactive forms of VacA. Previous studies have shown that active s1m1 forms of VacA cause cell vacuolation and mitochondrial dysfunction. In this study, we sought to define the cellular metabolic consequences of VacA intoxication. Untargeted metabolomic analyses revealed that several hundred metabolites were significantly altered in VacA-treated gastroduodenal cells (AGS and AZ-521) compared with control cells. Pathway analysis suggested that VacA caused alterations in taurine and hypotaurine metabolism. Treatment of cells with the purified active s1m1 form of VacA, but not hypoactive s2m1 or Δ6-27 VacA-mutant proteins (defective in membrane channel formation), caused reductions in intracellular taurine and hypotaurine concentrations. Supplementation of the tissue culture medium with taurine or hypotaurine protected AZ-521 cells against VacA-induced cell death. Untargeted global metabolomics of VacA-treated AZ-521 cells or AGS cells in the presence or absence of extracellular taurine showed that taurine was the main intracellular metabolite significantly altered by extracellular taurine supplementation. These results indicate that VacA causes alterations in cellular taurine metabolism and that repletion of taurine is sufficient to attenuate VacA-induced cell death. We discuss these results in the context of previous literature showing the important role of taurine in cell physiology and the pathophysiology or treatment of multiple pathologic conditions, including gastric ulcers, cardiovascular disease, malignancy, inflammatory diseases, and other aging-related disorders.

Perforated peptic ulcers, though relatively rare, represent critical surgical emergencies with potentially life-threatening consequences. Their significance lies not only in their acute presentation but also in the diagnostic challenges they pose, particularly in patients with complex medical histories. Here we present a case of a 71-year-old female with a complex medical history, including insulin-dependent type 2 diabetes mellitus, hypertension, hyperlipidemia, hypothyroidism, dementia, diverticulitis, and chronic back pain, who initially were unresponsive and cyanotic. Despite challenges in diagnosis due to her medical complexity and opioid use, she was ultimately diagnosed with a perforated duodenal ulcer. Tragically, despite immediate surgical intervention, she succumbed to her illness, highlighting the complexities involved in managing perforated peptic ulcers, especially in patients with multiple chronic medical conditions. Peptic ulcer disease (PUD) can often remain asymptomatic, leading to delayed diagnosis and potentially life-threatening complications like perforation. Mortality rates associated with perforated peptic ulcers vary widely, ranging from 1.3% to 20%, with risk factors including nonsteroidal anti-inflammatory drug (NSAID) use, Helicobacter pylori infection, smoking, and corticosteroid use. Diagnosis necessitates a high index of suspicion, thorough clinical examination, and imaging modalities such as computed tomography (CT) scans with oral contrast. Treatment strategies range from nonoperative management with intravenous (IV) histamine H2-receptor blockers or proton pump inhibitors (PPIs) to surgical intervention, depending on the patient\'s hemodynamic stability. However, the case presented underscores the challenges in timely diagnosis and intervention, particularly in patients with complex medical histories, where symptoms may be masked or attributed to other comorbidities. Recent studies indicate a demographic shift toward older age and a higher prevalence among females, emphasizing the importance of increased awareness and vigilance among healthcare providers. Early recognition of symptoms, prompt investigation, and interdisciplinary collaboration are crucial in optimizing outcomes for patients presenting with perforated peptic ulcers, especially in the context of their underlying medical conditions.

BACKGROUND: Helicobacter pylori infection is prevalent worldwide and can lead to peptic ulcer disease (PUD) and gastric cancer. Effective diagnosis and treatment of H. pylori infection by gastroenterologists and family physicians is crucial. However, there are differing views on optimal diagnosis and treatment. The objective of this study is to understand the impressions of Canadian physicians regarding H. pylori diagnosis and treatment and whether impressions differ between gastroenterologists and family physicians. A second objective is to understand physician perspectives on rising antibiotic resistance and how that guides empiric management.
METHODS: A survey facilitated via REDCap was administered to Canadian gastroenterologists and family physicians. A total of 105 participants completed the survey, including 43 gastroenterologists and 62 family physicians. Gastroenterologists were recruited from across the country and family physicians were recruited from Manitoba.
RESULTS: For diagnosis of H. pylori, 67% of gastroenterologists reported endoscopic biopsies for histology assessment as most common and 73% of family physicians reported serology as their main diagnostic test. While nearly all gastroenterologists believed antibiotic resistance to be a problem, nearly one quarter of family physicians did not believe it was a problem.
CONCLUSIONS: There is variability in practices among both gastroenterologists and family physicians regarding diagnosis of H. pylori infection. There was consensus that local antibiotic resistance patterns should guide management. If known, the degree and patterns of antibiotic resistance could bring a more uniform consensus to H. pylori management. Greater education of physicians, especially family physicians regarding management of H pylori is needed.