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Related Concept Videos

Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents01:24

Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents

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In the intricate landscape of the gastric lumen, excessive acid secretion disrupts the natural defense mechanisms, weakening the mucus-bicarbonate barrier. This vulnerability allows pepsin to infiltrate epithelial cells, digesting mucosal proteins and triggering erosion, leading to ulcer formation.
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
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Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy01:16

Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy

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Helicobacter pylori, a resilient gram-negative bacterium, can thrive in the stomach's harsh, acidic environment. Infection with H. pylori leads to a cascade of events within the stomach lining. One of the critical disruptions caused by this bacterium is the interference with somatostatin production, a hormone responsible for regulating acid secretion. This interference tips the balance, escalating acid secretion and diminishing bicarbonate levels. This imbalance compromises the defensive...
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Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors01:13

Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors

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Peptic ulcers, often induced by H. pylori infections or NSAID usage, arise from disruptions in the delicate balance of gastric acid production. Peptic ulcers stem from heightened gastric acid levels due to H. pylori infections or NSAID use. The protective mucus layer diminishes in the presence of these factors, allowing gastric acid to erode the stomach lining and form ulcers.
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
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Peptic Ulcer Disease IV: Management01:26

Peptic Ulcer Disease IV: Management

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Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
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Drugs for Peptic Ulcer Disease: Prostaglandin Analogs as Mucosal Protective Agents01:20

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The gastric mucosa produces prostaglandins E2 (PGE2) and prostacyclin (PGI2), crucial in maintaining gastric health. They exert cytoprotective effects, including increasing bicarbonate secretion, releasing protective mucin, reducing gastric acid output, and preventing harmful vasoconstriction. These effects are mediated through various receptors, such as EP1, EP2, EP3, and EP4.
Non-steroidal anti-inflammatory drugs (NSAIDs) can induce peptic ulcers by inhibiting cyclooxygenase, decreasing...
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Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids01:31

Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids

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In the complex environment of the gastric lumen, excessive acid secretion can lead to the formation or worsening of ulcers within the delicate mucosal layer. Antacids, such as sodium bicarbonate and calcium carbonate, provide relief by neutralizing this acid, transforming it into harmless salt and water. This neutralization process raises the gastric pH from a highly acidic level of 1 to a more basic 3-4, reducing the acidity within the stomach.
However, this neutralization reaction between...
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Related Experiment Video

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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
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Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer.

Galinos Barmparas1, Adel Alhaj Saleh2, Raymond Huang1

  • 1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Trauma Surgery & Acute Care Open
|June 3, 2021
PubMed
Summary
This summary is machine-generated.

Empiric antifungals (AF) are often used for perforated peptic ulcers (PPU), but this study found no benefit in preventing organ space infections (OSI). The use of empiric AF in PPU patients is unnecessary and should be reconsidered.

Keywords:
Candidafluconazoleinfectionspostoperative complications

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Area of Science:

  • Surgical infection control
  • Gastrointestinal surgery outcomes
  • Antifungal stewardship

Background:

  • Perforated peptic ulcer (PPU) management often includes empiric antifungals (AF).
  • Variability exists in AF use across institutions.
  • The association between empiric AF and organ space infection (OSI) in PPU is unclear.

Purpose of the Study:

  • To investigate the variation in empiric AF use for PPU.
  • To determine if empiric AF prevents OSI in PPU patients.
  • To assess the impact of empiric AF on Candida-related OSI.

Main Methods:

  • Secondary analysis of a multicenter case-control study (2011-2018).
  • Compared patients who received empiric AF within 24 hours of surgery versus those who did not.
  • Assessed OSI and Candida spp. OSI as primary and secondary outcomes, respectively.
  • Used logistic regression for adjusted analysis.

Main Results:

  • 43% of 554 PPU patients received empiric AF, with significant center variation (25%-68%).
  • Empiric AF use was not associated with a reduced incidence of OSI (aOR 1.04; p=0.86).
  • No significant difference in Candida-related OSI between groups (aOR 1.29; p=0.53).

Conclusions:

  • Empiric antifungals offer no significant clinical benefit in preventing OSI in PPU patients.
  • The use of empiric AF in this context is not supported by the evidence.
  • Antifungal stewardship should be considered for PPU management.