Peptic ulcer (PU) is one of the most common gastrointestinal diseases worldwide. With advances in medical technology, the global disease burden of PU has been effectively controlled. However, the most recent evidence regarding the global burden of PU remains limited.

Using publicly available data from the Global Burden of Disease (GBD) study from 1990 to 2021, we analyzed the characteristics of the global burden of PU, including trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). We employed Joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis, and autoregressive integrated moving average (ARIMA) modeling to evaluate changes and influencing factors for each indicator.

The global number of PU cases increased from 2,570,413 in 1990 (95% CI: 2,161,831-2,997,880) to 2,854,370 in 2021 (95% CI: 2,438,231-3,264,252), representing a cumulative growth of 11.05%. However, the age-standardized incidence rate (ASIR) decreased from 57.14 (95% CI: 48.61-66.73) per 100,000 population in 1990 to 34.10 (95% CI: 29.13-38.97) per 100,000 population in 2021. The global number of deaths due to PU decreased from 273,872 in 1990 (95% CI: 247,312-299,718) to 230,217 in 2021 (95% CI: 193,005-270,858). Significant gender differences were observed, with the disease burden consistently higher in males than in females. After controlling for period and cohort effects, the onset of PU tended to occur at younger ages, and the number of cases declined across most age groups from 1990 to 2021. The highest incidence of PU was concentrated in individuals aged 90 years and older. In terms of future trends, the global incidence of PU is projected to continue decreasing over the next 15 years. The global prevalence is expected to improve, while PU-related mortality is likely to plateau without significant increases or decreases.

The global burden of PU has declined significantly over the past three decades. However, elderly individuals and males remain at higher risk and require continued attention in prevention and management efforts.

This research aimed to determine the feasibility and accuracy of CLR and clinical features to formulate a prediction model for Peptic Ulcer (PU)-induced Upper Gastrointestinal Bleeding (UGIB).

The clinical data of 146 PU patients were prospectively collected, and patients were divided into the UGIB group (n = 48) and the non-UGIB group (n = 98). The factors affecting UGIB were analyzed using multifactorial logistic regression and collinearity analysis. The prediction model of UGIB was constructed, the predictive value of which was analyzed using the Receiver Operating Characteristic Curve (ROC) and Area Under the Curve (AUC), while the accuracy was analyzed using the calibration curve and Hosmer Lemeshow goodness-of-fit tests, and the application value was assessed using decision curve analysis (DCA).

Statistical significance was observed between the two groups regarding HP infection, ulcer diameter, ulcer stage, use of nonsteroidal anti-inflammatory drugs, Neutrophil, LYM, NEUT/LYM Ratio (NLR), CRP, and CLR. HP infection, ulcer stage, use of NSAIDs, NLR, and CLR were independent risk factors for UGIB, and PCT was a non-independent risk factor. The AUC for this model was 0.921. The calibration curve of the model matched the actual curve. The model achieved a better fitting effect in predicting UGIB (χ2 = 8.5069, df = 8, p = 0.3856) and had a better clinical application value.

A predictive model for PU-induced UGIB, based on CLR and clinical features, can assist in developing clinical treatment plans to prevent UGIB.

Dipeptidyl peptidase-4 inhibitors (DPP-4is) are widely used in Japan; however, their incretin activity raise concerns about gastrointestinal adverse events (GAEs). Therefore, we aimed to investigate GAEs symptoms commonly associated with DPP-4is and associated symptomatic treatment, to enable community pharmacists in charge of pharmaceutical management of outpatient prescriptions in Japan to strengthen patient intervention strategies. Therefore, we conducted a prescription sequence symmetry analysis (PSSA) using a prescription claims database (2018-2022) of a domestic chain pharmacy to evaluate the association between DPP-4is and GAEs. Adjusted sequence ratios (ASRs), a safety index, were calculated based on three treatment groups: prokinetic agents (dopamine D2 receptor blockers and serotonin 5-HT4 receptor agonists), gastric acid suppressants (histamine H2 receptor blockers and proton pump inhibitors), and laxatives, and the order in which DPP-4is were prescribed. The ASR was calculated for 90, 180, and 360 days, and subgroup analyses were performed for prokinetic agents and gastric acid suppressants groups based on their mechanism of action. ASR values > 1 indicated significant association with DPP-4is. PSSA results showed DPP-4is association across all observation periods for prokinetic agents and laxatives, but not for gastric acid suppressants. Subgroup analyses indicated a similar trend, suggesting that DPP-4is are associated with nausea and constipation owing to functional impairment rather than gastric acid secretion. Additionally, prescription data confirmed the possibility of adding gastrointestinal medications, which could cause a potential prescribing cascade, after prescribing DPP-4is. These findings highlight the importance of strengthening follow-up between patient visits to facilitate the early detection of GAEs caused by DPP-4is, and carefully considering the risks and benefits of symptomatic treatment.

Peptic ulcer disease (PUD) constitutes a significant global health concern, particularly in women of childbearing age (WCBA), who face elevated risks of severe pregnancy-associated complications. This investigation aimed to map the temporal dynamics and forecast the future incidence of PUD in this demographic to inform targeted prevention and control initiatives.

This analysis drew on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, extracting data on PUD incidence and mortality across seven age groups (15-49 years) in WCBA. Age-standardized incidence and mortality rates were calculated using the direct method of age standardization. Temporal trends from 1992 to 2021 were analyzed using joinpoint regression. The study further employed age-period-cohort analysis to discriminate the effects of these variables on incidence and mortality, and frontier analysis to evaluate potential reductions in burden by country based on developmental status. Nordpred modeling was used to project epidemiological trends up to 2044.

In 2021, the global age-standardized incidence rates (ASIR) and death rates (ASDR) for PUD among WCBA were 24.18 per 100,000 (95% CI: 14.72-36.38) and 0.54 per 100,000 (95% CI: 0.42-0.66), respectively. The highest incidence rates were observed in Oceania, while the greatest mortality rates were recorded in South Asia. Over the period from 1992 to 2021, global age-standardized mortality rates showed a significant decline. Conversely, after an initial drop, age-standardized incidence rates began to rise, with considerable regional and country-specific variation. This increase was particularly marked in regions with high Socio-demographic Index (SDI). Frontier analyses indicate that countries or regions in the middle SDI quintiles possess significant untapped potential to enhance both access to and quality of healthcare. Despite predictions of declining age-standardized incidence and mortality rates, total case numbers are expected to continue rising modestly through 2044.

The study underscores substantial global disparities in PUD trends in WCBA, with increasing case numbers and regional inequalities. The findings highlight the need for focused attention on high SDI regions and older WCBA cohorts to refine disease management and prevention strategies, aiding in the mitigation of PUD's public health impact.

Hemostatic powders have been rapidly developed and used to treat GI bleeding. We aimed to investigate the noninferiority of the newly developed hemostatic powder (CEGP-003; CGBio, Seongnam, South Korea) compared with conventional endoscopic treatments for nonvariceal upper GI bleeding (NVUGIB).

This prospective, multicenter, randomized, open-label, controlled trial was conducted at 4 referral institutions. We enrolled consecutive patients who underwent emergency endoscopy for NVUGIB. The patients were randomly assigned to either the CEGP-003 group or the conventional treatment group. In the CEGP-003 group, the hemostatic powder was applied as a spray. Conventional endoscopic treatments included electrical coagulation and use of hemostatic clips.

Between November 2019 and June 2022, 218 patients were enrolled (CEGP-003 group, 108; conventional group, 110). Initial hemostasis was achieved in 104 of 108 patients (96.3%) in the CEGP-003 group and 101 of 110 patients (91.8%) in the conventional treatment group. The CEGP-003 group exhibited a significantly higher recurrent bleeding rate than the conventional treatment group. Multivariate analysis showed that age, duodenum and middle one-third of the stomach, and CEGP-003 use as the initial hemostatic treatment were independent risk factors for recurrent bleeding. No adverse events were associated with CEGP-003.

CEGP-003 demonstrates promise as an initial endoscopic therapy for NVUGIB. However, close monitoring is warranted because of the risk of recurrent bleeding. (Clinical trial registration number: KCT0004655.).

To investigate the risk factors for rebleeding in patients with IIb peptic ulcer bleeding (PUB) treated endoscopically and to develop a nomogram model.

A retrospective analysis was conducted on 287 patients with grade IIb PUB who underwent endoscopic treatment at Beijing Pinggu Hospital from January 2019 to December 2023. The patients were divided into a modelling cohort (n=201) and a validation cohort (n=86) in a 7:3 ratio. The modelling cohort consisted of a non-bleeding (NB) group (n=176) and a re-bleeding (RB) group (n=25), while the validation cohort included an NB group (n=75) and an RB group (n=11). Logistic regression was used to analyze and identify the risk factors for rebleeding after endoscopic treatment in class IIb PUB patients. Based on the results of Logistic regression, a nomogram model was developed, and receiver operating characteristic (ROC) curve and calibration curve were performed to evaluate its accuracy.

Ulcer site, ulcer diameter, Helicobacter pylori (Hp) infection, D-dimer (D-D), prothrombin time (PT), albumin (ALB), and prostaglandin E2 (PGE2) were associated with rebleeding after endoscopic treatment in grade IIb PUB patients (all P<0.05). Logistic regression analysis identified Hp infection (OR=9.723, P=0.007), D-D (OR=1.013, P=0.047), PT (OR=2.242, P=0.013), ALB (OR=0.899, P=0.036), and PGE2 (OR=0.987, P=0.042) as independent risk factors for rebleeding. The area under the ROC curve for the nomogram model constructed based on these factors was 0.875 (95% CI: 0.788-0.962).

This study successfully identified key independent risk factors for rebleeding after endoscopic treatment in grade IIb PUB patients, providing clinicians with a scientific decision-making tool to reduce rebleeding risk and improve treatment outcomes.

Electroacupuncture (EA) is a promising treatment for gastrointestinal disorders, yet the efficacy of different acupoint combinations remains mechanistically undefined. We evaluated the therapeutic effects of different acupoint combinations on mucosal inflammatory injury induced in a rat model of gastric ulcer (GU) and dissected its molecular mechanisms through transcriptomic profiling.

A GU rat model was established using hypothermic restrained water immersion stress. EA therapy was administered to the He-Mu (ST36-CV12), Shu-Mu (BL21-CV12), and Yuan-Luo (ST42- ST40) acupoint combinations for 5 days. EA therapeutic effects were evaluated by coat score, fecal moisture percentage, pain threshold, body mass, organ index, histopathological changes, serum level of oxidative stress, and inflammatory cytokine levels in gastric tissue. A transcriptome analysis identified the related differentially expressed genes (DEGs) and central signaling pathway. Real-time quantitative PCR and Western blot were performed to verify the mRNA and protein expression levels of the main genes in the central pathway.

EA using different acupoint combinations differentially alleviated gastric mucosal injury in GU rats, with the He-Mu group exhibiting superior tissue damage alleviation, as well as inflammation and oxidative stress reductions. A Venn diagram transcriptome analysis revealed a shared central pathway among the three groups, corresponding to focal adhesion. Quantitative validation confirmed that the mRNA, protein, and phosphorylated protein expression of FAK, VCL, and EGFR-the core signal transduction factors of the focal adhesion pathway activated in gastric tissue after EA treatment-were upregulated, consistent with their therapeutic efficacy.

Our results demonstrated that the He-Mu acupoint combination exhibited superior therapeutic efficacy among the three acupoint combinations. EA using different acupoint combinations improved gastric mucosal injury to varying degrees, and was related to the focal adhesion pathway. The FAK, VCL, and EGFR are promising targets, and further studies are needed to elucidate their functional consequences in GU.

Gastrointestinal bleeding is a serious adverse event of coronary artery bypass grafting and lacks tailored risk assessment tools for personalized prevention.

This study aims to develop and validate predictive models to assess the risk of gastrointestinal bleeding after coronary artery bypass grafting (GIBCG) and to guide personalized prevention.

Participants were recruited from 4 medical centers, including a prospective cohort and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. From an initial cohort of 18,938 patients, 16,440 were included in the final analysis after applying the exclusion criteria. Thirty combinations of machine learning algorithms were compared, and the optimal model was selected based on integrated performance metrics, including the area under the receiver operating characteristic curve (AUROC) and the Brier score. This model was then developed into a web-based risk prediction calculator. The Shapley Additive Explanations method was used to provide both global and local explanations for the predictions.

The model was developed using data from 3 centers and a prospective cohort (n=13,399) and validated on the Drum Tower cohort (n=2745) and the MIMIC cohort (n=296). The optimal model, based on 15 easily accessible admission features, demonstrated an AUROC of 0.8482 (95% CI 0.8328-0.8618) in the derivation cohort. In external validation, the AUROC was 0.8513 (95% CI 0.8221-0.8782) for the Drum Tower cohort and 0.7811 (95% CI 0.7275-0.8343) for the MIMIC cohort. The analysis indicated that high-risk patients identified by the model had a significantly increased mortality risk (odds ratio 2.98, 95% CI 1.784-4.978; P<.001). For these high-risk populations, preoperative use of proton pump inhibitors was an independent protective factor against the occurrence of GIBCG. By contrast, dual antiplatelet therapy and oral anticoagulants were identified as independent risk factors. However, in low-risk populations, the use of proton pump inhibitors (χ21=0.13, P=.72), dual antiplatelet therapy (χ21=0.38, P=.54), and oral anticoagulants (χ21=0.15, P=.69) were not significantly associated with the occurrence of GIBCG.

Our machine learning model accurately identified patients at high risk of GIBCG, who had a poor prognosis. This approach can aid in early risk stratification and personalized prevention.

Chinese Clinical Registry Center ChiCTR2400086050; http://www.chictr.org.cn/showproj.html?proj=226129.

This review emphasizes the exemplary safety and efficacy of rebamipide in the treatment of gastric ulcers and other mucosa-related disorders, positioning it as a viable candidate for inclusion in treatment guidelines across India and globally. An in-depth literature review of rebamipide was carried out on PubMed and Google Scholar. Rebamipide has a multifaceted mechanism of action, including prostaglandin synthesis, scavenging free radicals, and enhancing mucin production, leading to enhanced mucosal protection and ulcer healing. Rebamipide serves as a highly effective and safe treatment option for gastric ulcers and gastroesophageal reflux disease. The efficacy of this drug in treating ulcers often surpasses that of routinely used agents such as pantoprazole, sucralfate, misoprostol, famotidine, lansoprazole, and esomeprazole. This superiority of rebamipide can be attributed to the low rate of adverse events associated with it and its mild side effects, contributing to its widespread adoption across Southeast Asia and Russia. This popularity extends to its application beyond gastrointestinal ailments. Notably, it has been successfully employed in the treatment of ophthalmological, oncological, and bone regeneration-related issues. Rebamipide's exemplary safety and efficacy in treating gastric ulcers and other mucosa-related disorders support its potential for inclusion in treatment guidelines, not only in India but also globally.

Gastrectomy is often performed for perforated gastric cancer in patients receiving treatment with curative intent. However, gastrectomy is not a curative procedure, precludes oral intake, and may hinder palliative chemotherapy in patients with metastatic disease. The present study assessed the feasibility of a "stomach-preserving strategy" comprising peritoneal lavage and repair surgery for the management of gastric cancer perforation in patients with distant metastasis.

We retrospectively reviewed the medical records of patients with gastric cancer who underwent surgical treatment at our hospital from 2013 to 2021. The clinical courses of patients who had undergone peritoneal lavage and repair surgery for perforated gastric cancer with distant metastasis were reviewed to evaluate postoperative outcomes.

During the study period, 3,862 patients underwent radical gastrectomy. Additionally, nine patients with stage IV gastric cancer with distant metastasis prior to treatment underwent emergency surgery due to gastric perforation. Of the nine patients that underwent emergency surgery, seven patients underwent peritoneal lavage and repair surgery and two underwent peritoneal lavage only. No cases of secondary leakage were observed. Seven patients (78%) had a good postoperative course including the resumption of meals and continuation of chemotherapy. The remaining two died of sepsis. The median overall survival time was five months from surgery and 12 months from the initiation of palliative chemotherapy.

A "stomach-preserving strategy" for the management of perforated gastric cancer is safe in patients with stage IV gastric cancer with distant metastasis and allows continuation of oral intake and palliative chemotherapy.

Laparoscopic surgery is increasingly performed for peptic ulcer perforation, but its application in patients with severe scoliosis remains controversial due to anatomical challenges and respiratory dysfunction. We report a case of a patient with severe scoliosis who developed respiratory failure from a perforated peptic ulcer and underwent emergency laparoscopic surgery.

A 51-year-old man was transferred to the hospital by ambulance for sudden abdominal pain. Localized tenderness was observed in the upper right quadrant. Upon admission, hypoxia developed with a PaO2 of 66.7 mmHg under oxygen therapy. Abdominal contrast-enhanced computed tomography (CT) imaging revealed a perforated peptic ulcer with free gas and ascites. Emergency laparoscopic surgery was performed safely using a customized port position.

Patients with scoliosis are prone to respiratory dysfunction, increasing their risk of life-threatening complications from peptic ulcer perforation. Early treatment is crucial in such cases. Meticulous perioperative management, appropriate port placement, and close communication with the anesthesiologist were key factors enabling emergency surgery in this high-risk patient, even if preoperative examinations could not be sufficiently conducted. Port insertion from the lower abdomen helped overcome anatomical limitations.

Emergency laparoscopic surgery can be a viable option for patients with severe scoliosis and perforated peptic ulcers. Prompt decision-making, seamless perioperative management with the anesthesiologist, and tailored port placement to avoid intra-abdominal interference are essential for safe and effective procedures.

Gastric ulcers (GUs) are superficial diffuse lesions of the gastric mucosa that are characterised by being vulnerable to infection, difficult to cure and liable to recur. Bletilla ochracea Schltr. (BO) has the effects of astringent hemostasis, muscle growth and pain relief. We examined the effects of BO on acute GUs and their potential mechanisms from the perspectives of inflammation, oxidative stress and gut microbiota. Results indicated that BO alleviated pathological injury to the gastric mucosa and markedly alleviated oxidative stress and inflammation. In addition, BO significantly upregulated the levels of Nrf2, HO-1, NQO1 protein, and downregulated the levels of NF-κB p65, TLR4 protein. Moreover, BO significantly increased promoting the nuclear transfer of Nrf2 and markedly reduced the nuclear translocation of NF-κB p65. Furthermore, BO effectively modulated gut microbiota by increasing the diversity of species and relative abundance. Our study provided evidence that BO alleviated ethanol-induced acute GUs by activating the Nrf2/HO-1 and inhibiting the NF-κB p65/TLR4 signalling pathway, regulating dysbiosis of gut microbiota.

Helicobacter pylori (HP) infection is prevalent worldwide and contributes to various gastrointestinal diseases. Eradication therapy is crucial in managing HP infection, but antibiotic resistance has led to refractory cases, complicating treatment outcomes and increasing the risk of adverse events. This study aimed to evaluate the effectiveness of a multidisciplinary approach, termed HP Multidisciplinary Team (MDT) Clinic, in improving eradication rates and safety in patients with refractory HP infection.

Between November 2020 and November 2023, 153 patients with refractory HP infection were included, with 51 patients in the non-HP-MDT group and 102 patients in the HP-MDT group. The HP-MDT clinic provided personalized treatment plans, patient education, and follow-up. Genetic testing was conducted in selected cases to assess resistance patterns.

Patients attending the HP-MDT clinic showed significantly higher eradication rates compared with those in the non-HP-MDT group (80.39% vs 50.98%, P < 0.001). Logistic regression analysis confirmed that HP-MDT clinic attendance was independently associated with higher eradication rates (odds ratio: 4.43, 95% CI: 2.02 to 9.71, P < 0.001). Genetic testing revealed high rates of antibiotic resistance, particularly to clarithromycin (10/11, 90.91%) and metronidazole (11/11, 100%). Despite resistance, the HP-MDT approach achieved a high eradication rate of 92.31%. Adverse drug reactions occurred in 12.75% of patients in the HP-MDT group, predominantly mild gastrointestinal symptoms.

The HP-MDT clinic, integrating medical, pharmaceutical, and nursing expertise, significantly improved eradication rates and safety in patients with refractory HP infection. Personalized treatment plans, patient education, and genetic testing contributed to successful outcomes with minimal adverse events.

To investigate the diagnostic utility of aldehyde dehydrogenase 1 (ALDH1) and gastrin 17 (G-17) levels in the gastric juice of patients with gastric cancer and to track changes in the levels of these markers in the gastric juice of these patients.

126 individuals were diagnosed via gastroscopy. This trial includes gastric mucosal histology and gastroscopy performed at Hefei Second People's Hospital between March 2023 and March 2024. On the basis of the results of gastroscopy and gastric mucosal histology, all the participants were categorized into three groups: 30 patients with gastric cancer (GC), 34 patients with gastric ulcer (GU) and 62 patients with gastritis. Thirty patients with chronic nonatrophic gastritis were chosen from the physical examination center, and thirty-two patients with chronic atrophic gastritis (CAG) composed the gastritis group. As the control group, they were chosen at the physical testing center. An enzyme-related immunosorbent assay (ELISA) was used to quantify the levels of G-17 and ALDH1 in each group. A correlation study was performed on the levels of ALDH1 and G-17 in the gastric juice. By using binomial logistic regression analysis, the impact of G-17 and ALDH1 in gastric juice on the incidence of gastric cancer was examined. To illustrate the predictive usefulness of G-17 and ALDH1 in gastric juice for GC diagnosis, a receiver operating characteristic (ROC) curve was generated.

The gastric juice of the gastric cancer group had higher levels of ALDH1 and G-17 than did the gastric juice of the gastritis group and GU group (P < 0.05). The levels of ALDH1 and G-17 in gastric juice of gastric ulcer group were higher than those of atrophic gastritis group and control group (P < 0.05). The levels of ALDH1 and G-17 in gastric juice of atrophic gastritis group were statistically significant compared with those of control group (P < 0.05). The development of gastric cancer was significantly influenced by elevated levels of ALDH1 and G-17 in gastric juice (OR= 1.095, 1.018; both P <0.05); the AUCs for the combined diagnosis of gastric cancer and elevated levels of G-17 and ALDH1 in gastric juice were 0.792, 0.757, and 0.695, respectively.

The development of gastric cancer is influenced by increased levels of ALDH1 and G-17 in gastric juice. The diagnosis of gastric cancer may be made more accurately by combining the two gastric fluid markers, which can be found in gastric juice.

Poor sleep has been associated with diseases including cardiovascular, obesity and mental disorders. However, there is limited information on the correlation between sleep duration and quality with peptic ulcer disease (PUD). This study aimed to investigate the impact of sleep duration and quality on the incidence of PUD in a large Taiwanese population follow-up study. The study participants were recruited from the Taiwan Biobank. Sleep duration, sleep quality, and the presence of PUD were assessed using self-reported questionnaires. The participants were categorized into three groups based on sleep duration: < 7 hours/day, 7 hours/day, and > 7 hours/day. Sleep quality was divided into five levels: very poor, poor, normal, good and very good. The association between sleep duration and quality with incident PUD was analyzed using multiple logistic regression after controlling for confounders. We collected data from 22,561 participants (excluding those with pre-existing PUD, missing basic information, or lacking sleep data). Over an average follow-up period of 43 months, multivariable analysis showed that sleep duration > 7 hours/day (vs. < 7 hours/day; hazard ratio [HR], 0.771; 95% confidence interval [CI], 0.668 to 0.890; p < 0.001) was significantly associated with incident PUD. Further, sleep duration (per 1 hour/day; HR, 0.933; 95% CI, 0.889 to 0.979; p = 0.005) was also significantly associated with incident PUD. Those with poor sleep quality (vs. very poor quality; HR, 0.649; 95% CI, 0.491 to 0.858; p = 0.002), normal sleep quality (vs. very poor quality; HR, 0.611; 95% CI, 0.469 to 0.795; p < 0.001), good sleep quality (vs. very poor quality; HR, 0.507; 95% CI, 0.382 to 0.671; p < 0.001), and very good sleep quality (vs. very poor quality; HR, 0.493; 95% CI, 0.367 to 0.662; p < 0.001) were significantly associated with incident PUD. We found that longer sleep duration and better sleep quality were independent protective factors for PUD. Future research should explore the underlying mechanisms and verify whether improving sleep can directly reduce the incidence of PUD.

To explore the current research status and trends of potassium-competitive acid blockers (P-CABs) in the treatment of acid related diseases (ARDs) using bibliometric analysis.

We collected publications related to P-CAB in the treatment of acid-related diseases in the Web of Science (WOS) Core Collection from the establishment of the database to 30 June 2024. We evaluated the publication volume and citation status over the years using the WOS platform, and visualized the authors, countries, institutions, keywords, and citations of the publications using CiteSpace and VOSviewer.

This study included a total of 455 articles. The number of publications and citations related to research has been increasing year by year. The results show that the scholars with the highest number of publications mainly come from South Korea and Japan. Scholars such as Geun Seog Song, Bongtae Kim, and Nobuhiro Inatomi produced many works in related fields. The most popular drug in this field was vonoprazan, and research on this drug mainly focused on the effectiveness and safety evaluation of ARDs such as Helicobacter pylori infection, gastroesophageal reflux disease, peptic ulcers, etc. Researchers were concerned about the evaluation of treatment regimens and efficacy comparison between P-CABs and traditional proton pump inhibitors (PPIs) in the treatment of ARDs. At the same time, researchers are also closely monitoring the potential adverse reactions and long-term adverse outcomes of clinical application of P-CABs for ARDs.

The clinical application of P-CABs, represented by vonoprazan, in ARDs is receiving widespread attention from researchers. The exploration of the application of this type of drug in ARDs is constantly expanding, and it is a research field with great clinical value and research potential.

Gastric ulcer (GU) is a common digestive system disease. Acupuncture, as one of the external treatments of traditional Chinese medicine (TCM), has the characteristics of multi-target, multi-pathway and multi-level action in the treatment of GU. The relationship between meridian points and Zang-fu is an important part of the theory of TCM, which is crucial for the diagnosis and treatment of diseases. There is an external and internal link between acupoints and Zang-fu. The pathological reaction of Zang-fu can manifest as acupoint sensitization, while stimulation of acupoints can play a therapeutic role in the internal Zang-fu. Therefore, the acupoint has the functions of reflecting and treating diseases. This review explores the tender points on the body surface of patients with GU and the rules of acupoint selection. In addition, Zusanli (ST36), as one of the most used acupoints of the stomach meridian, was selected to show the mechanisms behind acupoint stimulation in the treatment of GU in greater detail, specifically in the well-studied model of the stress GU (SGU). Hence, the mechanisms of acupuncture at ST36 and points commonly used in combination with ST36 to treat SGU are discussed further. Treatment effects can be achieved through anti-inflammatory and antioxidant activities, gastric mucosal injury repair, and interaction with the brain-gut axis. In summary, this review provides evidence for a comprehensive understanding of the phenomena and mechanism of acupoint functions for GU. Please cite this article as: He M, Lim XY, Li J, Li L, Zhang T. Mechanisms of acupuncture at Zusanli (ST36) and its combinational acupoints for stress gastric ulcer based on the correlation between Zang-fu and acupoints. J Integr Med. 2025; 23(1): 1-11.

The treatments and outcomes of pediatric gastroduodenal perforations have rarely been described.

We retrospectively identified 515 patients aged 28 days to 17 years who were hospitalized for gastroduodenal perforation between July 2010 and March 2021 using a nationwide inpatient database. We compared characteristics, treatments, and outcomes for pediatric gastroduodenal perforation between children aged <7 years (n = 38) and ≥7 years (n = 477).

Children aged <7 years had a higher prevalence of females, comorbidities, and gastric perforation than those aged ≥7 years. Compared to children aged ≥7 years, children aged <7 years were more likely to receive surgical treatment (79% vs. 55%), open surgery (58% vs. 19%), and supportive treatment such as mechanical ventilation (39% vs. 2.5%), treatment for disseminated intravascular coagulation (13% vs. 1.3%), catecholamines (32% vs. 2.7%), blood transfusion (37% vs. 2.1%), and intensive care unit admission (47% vs. 7.1%). Children aged <7 years had higher in-hospital mortality (5.3% vs. 0.4%) and morbidity (18% vs. 4.8%) than those aged ≥7 years.

In pediatric gastroduodenal perforation, children aged <7 years were more likely to have comorbidities, undergo surgical and supportive treatments, and demonstrate poor outcomes than those aged ≥7 years.

Insulin resistance (IR) is an independent predictor of atrial fibrillation (AF), but the specific utility of the triglyceride-glucose (TyG) index as a predictive marker for the incidence of AF in the acute coronary syndrome (ACS) population has not yet been explored.

To explore the correlation between TyG index and the risk of AF in ACS patients and to establish a predictive model.

A retrospective study was conducted on 613 ACS patients admitted to the Department of Cardiovascular Medicine at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2022 to September 2024. Patients were divided into four groups based on quartiles of TyG index. Patients were further divided into two groups based on the occurrence of AF: the AF group and the non-AF group. Patient information was collected through the hospital's HIS system. Variable selection was completed using LASSO regression algorithms. Multivariate logistic bidirectional stepwise regression analysis was used to explore the correlation between the TyG index and the risk of AF in ACS patients and to construct a regression model. Three different models were constructed by adjusting for confounding factors and restricted cubic spline plots were drawn to validate the significance of the TyG index combined with AF further. The predictive value of the LASSO-multivariate logistic bidirectional stepwise regression model and the TyG index alone for predicting AF in ACS patients was analyzed using the receiver operating characteristic curve.

The LASSO-multivariate logistic bidirectional stepwise regression algorithm showed that coronary heart disease (CHD), valvular heart disease (VHD), TyG, age (AGE), and diastolic blood pressure (DBP) were risk factors for AF in ACS. The restricted cubic spline model demonstrated a significant linear relationship between a higher TyG index and an increased risk of AF in the ACS patient population. The area under the curve (AUC) for predicting AF in ACS patients using the TyG index and the LASSO-multivariate logistic bidirectional stepwise regression model was 0.65(95%CI = 0.58 ~ 0.73) and 0.71(95%CI = 0.65 ~ 0.77) respectively. Additionally, the correlation between the TyG index and AF was consistent across different subgroups.

In ACS patients, the TyG index is a stable and independent predictor of AF, with specific clinical value in identifying the occurrence of AF in this population.

To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes.

Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12-24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints.

The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12-24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24-48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24-48 h (late) (OR: 3.133, 95%Cl: 1.127-8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay.

Early endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding.

NSAID-induced gastropathy is a health burden that requires effective intervention. Among various prevention options, Gardenia jasminoides fruit extract (GJE) has demonstrated gastroprotective effects through anti-inflammatory pathways with a wide safety margin. However, the detailed molecular mechanisms of GJE regarding mucoprotective and anti-inflammatory effects remained to be explored. Therefore, we investigated the effects of GJE on NSAID-induced gastric injury in rats, focusing on the expression of the protective factors: prostaglandin E2 (PGE2) and mucin 5AC (MUC5AC), and the aggravating factors: inducible nitric oxide synthase (iNOS) and nuclear factor-κB (NF-κB).

Twenty-four male Sprague-Dawley rats were assigned to three experimental groups (n = 8/group): the control group, the NSAIDs group receiving indomethacin to induce gastric ulcers, and the NSAIDs with GJE pretreatment (NSAIDs + GJE) group. After a two-day experimental period, the stomachs were collected for histopathological examination, immunohistochemical staining, and protein expression analysis in gastric tissue lysates.

The NSAIDs group exhibited severe neutrophil infiltration with ulcers upon gastric histopathological examination. Pretreatment with GJE attenuated NSAID-induced gastropathy, as evidenced by reduced neutrophil infiltration and decreased ulceration. Immunohistochemical staining and Western blotting demonstrated reduced expressions of PGE2 and MUC5AC, while the expressions of iNOS and NF-κB were increased following NSAID administration. In comparison to the NSAIDs group, the NSAIDs + GJE group exhibited higher expressions of PGE2 and MUC5AC and lower expressions of iNOS and NF-κB, providing evidence of the gastroprotective effects of GJE.

Pretreatment with GJE alleviated NSAID-induced gastric ulcers by increasing the expression of PGE2 and MUC5AC and decreasing the expression of iNOS and NF-κB. This study contributes to the understanding of the mechanisms by which GJE attenuates NSAID-induced gastropathy. Further studies are required to validate the effect of GJE in clinical settings.

Antibiotic resistance of Helicobacter pylori is increasing worldwide, lowering its efficacy in eradication therapy and posing a serious threat to human health. This study evaluated H. pylori resistance to antibiotics in the southeast region of China and explored factors related to eradication failure guided by antimicrobial susceptibility testing (AST).

In this retrospective study, patients who tested positive underwent gastroscopy, and H. pylori infection was confirmed by histological staining and H. pylori culture. We determined the rate of H. pylori antibiotic resistance, success rate of AST-guided eradication therapy, and risk factors associated with treatment failure.

Among the 210 enrolled patients, 188 (89.5%) had successful cultures, and 183 (87.1%) underwent AST. The most common antibiotic resistance was to metronidazole and clarithromycin (89.6%), followed by levofloxacin (68.3%), and amoxicillin (14.2%). Furazolidone (3.0%) and tetracycline (0.5%) showed relatively low resistance rates. There were no statistically significant differences in the rates of resistance to MET, LEV, or AMX between naive and non-naive patients. However, CLA resistance rates in non-naive patients were significantly higher than those in naive patients. The overall success rate of AST-guided therapy was high and showed no significant difference between first-line and rescue therapy. Sex, age, prior therapy, and proton pump inhibitors (PPIs) or potassium-competitive acid blockers (P-CABs) use were not significantly associated with an increased risk of eradication failure in AST-guided therapy.

Peptic ulcers are a prevalent and often chronic condition within the digestive system, frequently prone to recurrence. This study aims to evaluate the clinical effects of Anweiyang capsule combined with Pinellia Heart-Draining Decoction on Helicobacter pylori eradication, ulcer healing rates, and improvement of Traditional Chinese Medicine (TCM) syndromes in patients with peptic ulcers. A total of 100 patients were randomly assigned to an observation group (n = 50), receiving the herbal combination, and a control group (n = 50), receiving standard Western medical treatment. The total effective rate was significantly (P < 0.05) higher in the observation group (96%) compared to the control group (80%). After 4 weeks of treatment, serum procalcitonin (PCT) and C-reactive protein (CRP) levels decreased, while prostaglandin E2 (PGE2) levels increased in both groups; however, the observation group exhibited better results (P < 0.05). The observation group achieved a H. pylori eradication rate of 94% and an ulcer healing rate of 82%, compared to 64% and 56% in the control group, respectively. Improvement in TCM syndrome scores was more significant in the observation group (P < 0.05). Moreover, the incidence of adverse reactions was significantly (P < 0.05) lower in the observation group (4%) compared to the control group (18%). In conclusion, Anweiyang capsule combined with Pinellia Heart-Draining Decoction significantly enhances the eradication rate of H. pylori and the ulcer healing rate without substantially increasing the risk of adverse reactions, demonstrating its safety and reliability for patients.

Tegoprazan represents a newly developed potassium-competitive acid blocker utilized for the treatment of acid-related disorders. The present study aimed to explore the therapeutic effectiveness of tegoprazan in Chinese individuals with duodenal ulcers (DU).

In the current multicenter, randomized, double-blind, double-dummy, parallel-group, non-inferiority, phase III clinical trial, individuals with DU underwent randomization 1:1 to be administered tegoprazan 50 mg or lansoprazole 30 mg once daily. The primary efficacy endpoint was the 6-week cumulative endoscopic ulcer healing rate. Secondary endpoints included 4-week endoscopic ulcer healing rate and relief of DU-related gastrointestinal symptoms at weeks 2, 4, and 6. Safety analysis encompassed adverse events (AEs) and laboratory indexes.

The 6-week cumulative endoscopic ulcer healing rates were 96.9% (188/194) and 99.0% (189/191) in the tegoprazan and lansoprazole groups, respectively, indicating a difference of -2.0% (95% confidence interval (CI) = -4.9 to 0.8) in the full analysis set (FAS). The corresponding healing rates were 98.4% (185/188) and 99.5% (183/184) in the per-protocol set, respectively, indicating a difference of -1.1% (95% CI = -3.1 to 1.0). The 4-week healing rates in the tegoprazan and lansoprazole groups were 89.2% (173/194) and 88.5% (169/191) in the FAS, respectively, with a difference of 0.7% (95% CI = -5.6 to 7.0). Treatment-related AEs, all mild-to-moderate, were reported in 38.2% (78/204) and 48.2% (94/195) of participants in the tegoprazan and lansoprazole groups, respectively.

Tegoprazan 50 mg once daily is effective and non-inferior to lansoprazole 30 mg once daily in Chinese patients with DU, showing a promising safety and tolerability profile.

NCT05010954.

Dendrobium officinale flos (DOF), a novel food raw material, is used in Chinese folk medicine to nourish the stomach. However, there is still no available study to evaluate the effects of DOF on animal models of acute gastric injury and its mechanism by modern pharmacological research.

Herein, we characterized the major components of an aqueous extract of DOF and assessed its potential ameliorative effects in a rat model of acute gastric mucosal injury. The DOF water extract showed significant protective effects on the gastric mucosa and exhibited excellent antioxidant and anti-inflammatory activities. Acute gastric injury rat models induced by ethanol (6 mL kg-1) were pretreated with different doses of DOF water extract (50-100 mg kg-1 day-1), and the biological effects of DOF extract in gastric tissues were evaluated. DOF extract alleviated the symptoms of ethanol-stimulated acute gastric mucosal injury, as evidenced by a significant reduction in gastric injury index and the degree of gastric pathological changes. Additionally, treatment with DOF extract upregulated mucin expression in the gastric mucosa, attenuated oxidative stress, decreased the release of inflammatory mediators (TNF-α, IL-6), suppressed the expression of key proinflammatory enzymes (COX-2 and iNOS), reduced the phosphorylation of p38 MAPK and p65 NF-κB and increased the level of PGE2 in gastric tissues.

DOF exerts protective effects against ethanol-induced acute gastric mucosal injury, mainly by inhibiting inflammation and oxidative stress. © 2024 Society of Chemical Industry.

In recent decades, immune checkpoint inhibitors (ICIs) have emerged as safer and less disruptive alternatives to conventional chemotherapy and radiotherapy for certain patients with tumours. ICIs serve a synergistic role alongside conventional therapies by manipulating the immune system to recognise and target tumour cells. However, excessive activation of the immune system can lead to immune-related adverse events including pneumonia, myocarditis and colitis, which pose serious and even fatal risks. In the present case series, three patients with a thoracic tumour with an ICI-induced peptic ulcer triggered by programmed cell death protein 1 antibodies (diagnosed by gastrointestinal endoscopy) are presented. These cases were successfully treated with corticosteroids. The diagnostic and treatment processes undertaken for these patients underscore the requirement to comprehensively understand the mechanism of ICI-induced peptic ulcer. Moreover, the relevant literature was also reviewed in the present study.

Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven effectiveness, the implementation of deprescribing in clinical practice remains inconsistent and varied, making it challenging to identify the most effective strategies. The goal is to provide a comprehensive outline of deprescribing interventions for PPI therapy implemented across various settings and by different healthcare professionals. Methods: The study is designed to be a systematic review of the published literature. PubMed, Embase, and Web of Science databases were searched from 1 January 1989 (the first PPI on the market) to 30 September 2024 for articles assessing PPI deprescribing in adult patients, focusing on the implementation rate (primary outcome) or effects on symptoms (secondary outcome). Results: After screening, 66 studies were included, predominantly pragmatic trials (N = 32) or randomized controlled trials (N = 25). We found a variety of interventions promoting PPI deprescription. Collaborative efforts involving multiple healthcare professionals, the use of algorithms for clinical decision-making, and patient involvement have proven to be key elements in the most effective strategies. Discontinuing therapy may not be advisable in cases of recurrent symptoms, suggesting that on-demand therapy could be a recommended approach. Deprescribing is particularly relevant for individuals with mild illnesses and symptoms, where tapering can effectively mitigate the rebound symptoms often associated with abrupt discontinuation. Conclusions: Given the current prevalence of inappropriate PPI prescribing, it is imperative to raise awareness among both physicians and patients about the importance of the deprescribing process, which should be tailored to the specific needs of each patient, considering his/her medical history, current health status, and personal preferences.

The fundamental goal of tissue engineering is to functionally restore or improve damaged tissues or organs. Here we address this in the small bowel using an in vivo xenograft preclinical acute damage model. We investigated the therapeutic capacity of human intestinal organoids (HIOs), which are generated from human pluripotent stem cells (hPSCs), to repair damaged small bowel. We hypothesized that the HIO's cellular complexity would allow it to sustain transmural engraftment. To test this, we developed a rodent injury model where, through luminal delivery, we demonstrated that fragmented HIOs engraft, proliferate, and persist throughout the bowel following repair. Not only was restitution of the mucosal layer observed, but significant incorporation was also observed in the muscularis and vascular endothelium. Further analysis characterized sustained cell type presence within the regenerated regions, retention of proximal regionalization, and the neo-epithelia's function. These findings demonstrate the therapeutic importance of mesenchyme for intestinal injury repair.

Duodenal ulcer (DU) causes various symptoms in children. The prevalence of Helicobacter pylori (Hp)-associated DU has been reducing in some regions, yet the updated trend in Taiwan is unknown. Risk factors of DU recurrence have not been comprehensively investigated in children.

This retrospective study included children diagnosed with DU to evaluate the demographics, symptoms, diagnostics, treatment, and outcomes. Specific populations (infant, surgery required) were sorted for subgroup analysis. Predictors of DU recurrence was analyzed in patients who received endoscopic follow-ups.

A total of 488 children were included. Most patients were male (72.5%), school-aged (11.3 ± 4.8 years old), and with varied underlying diseases in one-fifth. The annual incidences were around 3-5%, with a declining trend of case numbers and the Hp-positive proportion. Hp infection, concurrent gastric ulcer, perforation, and mortality were noted in 32.7%, 16%, 1.6%, and 1% of patients. Patients with or without Hp infection showed different clinical features but similar outcomes. The characteristics of subpopulations were depicted respectively. Male sex, lower Hb level, and perforation were independent risk factors associated with recurrence.

Hp-positive DU seems to wane. Patients with male sex, lower Hb level, or perforation at diagnosis carried a higher risk of recurrence, which may warrant active surveillance and endoscopic follow-up.

Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.

Vonoprazan, a novel acid suppressant, has been employed in the treatment of peptic ulcer disease in recent years. However, the efficacy and safety of vonoprazan versus proton-pump inhibitors remains controversial. To address this gap, a systematic review and network meta-analysis were conducted to evaluate the efficacy and safety of vonoprazan in comparison with various proton-pump inhibitors.

Randomized controlled trials that met selection criteria in PubMed (Medline), EMBASE and the Cochrane Library were searched up to July 15, 2024. The primary outcome was ulcer healing rate. Secondary outcomes were treatment-emergent adverse events and drug-related adverse events. Effect size on outcomes is presented as odds ratios with 95% confidence intervals.

Thirty-five randomized controlled trials containing 9,544 participants were included. In terms of the healing rate at 2 weeks, lansoprazole 30 mg ranked first, followed by vonoprazan 20 mg and ilaprazole 10 mg. In terms of the healing rate at 4 weeks, pantoprazole 40 mg ranked first, with rabeprazole 10 mg and lansoprazole 30 mg ranking second and third, respectively. Regarding the healing rate at 8 weeks, lansoprazole 30 mg is demonstrated to be the most efficacious regimen. Moreover, subgroup analysis indicated that lansoprazole 30 mg is the optimal regimen in the treatment of artificial gastric ulcer at 4 and 8 weeks. Importantly, lansoprazole 30 mg has fewer adverse reactions and higher safety.

The optimal regimen for the treatment of peptic ulcer disease may be lansoprazole 30 mg at 2 and 8 weeks, while pantoprazole 40 mg has demonstrated superior performance at the 4-week when compared to vonoprazan 20 mg. Furthermore, lansoprazole 30 mg has shown to be superior in terms of safety outcomes. These findings, derived from a network meta-analysis, necessitate further research for validation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects but can lead to serious gastrointes complications. This report illustrates the management of an NSAID-induced penetrating gastric ulcer with subsequent postoperative hemorrhagic cholecystitis. A 68-year-old female with chronic NSAID use presented with epigastric pain and was diagnosed with a penetrating gastric ulcer extending into the retroperitoneum. The surgical management required a shift from a minimally invasive robotic-assisted approach to an open procedure due to unexpected intraoperative findings. The postoperative period was notable for the development of hemorrhagic cholecystitis that was managed with percutaneous transhepatic biliary drainage, highlighting the role of interventional radiology in complex postoperative care. NSAID use significantly increases gastrointestinal risks, leading to complications such as ulcers that may penetrate into adjacent structures, including the retroperitoneum. The management of penetrating gastric ulcers typically involves complex surgical procedures, highlighted in this scenario by the necessity for an antrectomy followed by a Billroth II reconstruction to address the extensive damage and restore gastrointestinal continuity, which is essential for patient recovery. In this case, the development of hemorrhagic cholecystitis postoperatively was effectively managed with a percutaneous transhepatic biliary drain, demonstrating the importance of interventional radiology in managing postoperative complications and the need for a multidisciplinary approach. This case report elucidates the management of NSAID-induced penetrating gastric ulcer that extended into the retroperitoneum, necessitating an antrectomy with Billroth II reconstruction. A gastric ulcer is generally classified as "large" if it exceeds 2 centimeters in diameter. These ulcers pose greater risks of complications such as perforation, penetration into adjacent organs, bleeding, and obstruction, necessitating more complex and comprehensive management strategies. The postoperative complication of hemorrhagic cholecystitis was effectively managed via interventional radiology, highlighting the critical role of minimally invasive techniques in addressing severe postoperative complications.

Peptic ulcer disease (PUD) and postprocedural artificial ulcers are common ulcer disease. For them, proton pump inhibitor (PPI) and potassium-competitive acid blocker (P-CAB) are commonly used in clinical practice. PPI requires acid, time, and multiple doses, but P-CAB has fewer limitations. We compared the efficacy, safety, and prevention of PPI and P-CAB in PUD or artificial ulcer.

We searched PubMed, ClinicalTrials.gov , Embase, Cochrane Library, and Web of Science databases for all studies. All eligible randomized controlled trials up to August 5, 2023, were included. Healing rates, shrinking rates, treatment-emergent adverse events rates, and recurrence rates were measured. Risk of bias, sensitivity analyses, and heterogeneity were also performed.

Twenty researches that were selected from 926 screening studies and in total 6,551 participants were included. The risk ratio (RR) of healing rate with P-CABs vs PPIs of PUD at 4 weeks was RR 1.01 (95% confidence interval 0.98-1.04). In addition, the healing rate distinction of artificial peptic ulcer was RR 1.04 (0.89-1.22), and the shrinking rate was mean difference 0.10 (-1.30-1.51). The result of treatment-emergent adverse event rate of PUD was RR 1.11 (0.91-1.35), and the delayed bleeding rate of artificial ulcer was RR 0.35 (0.16-0.80). The RR for recurrence rate of drug-related ulcers was 0.45 (0.25-0.81).

P-CAB is noninferior in healing artificial ulcer and PUD, also the incidence of treatment-emergent adverse events. But, there may be a statistical advantage in holding back delayed bleeding and preventing drug-induced ulcers. More standardized experiments are needed for further applications and more precise conclusions.

Fridericia chica is an Amazonian plant used to treat stomach disorders. However, the pharmacological activity of flavonoids in the extract has yet to be investigated. Therefore, we considered that a flavonoid-rich F. chica subfraction (FRS) has gastroprotective functions. For this, before the induction of gastric ulcers with ethanol or piroxicam, the rats received vehicle (water), omeprazole (30 mg/kg), or FRS (30 mg/kg), and the ulcer area was measured macro and microscopically, and the antisecretory action was investigated in pylorus-ligated rats. In addition, the roles of nitric oxide (NO) and nonprotein sulfhydryl compounds (NP-SH) in the gastroprotective effects of FRS were studied. FRS reduced ethanol- and piroxicam-induced ulcerations by 81% and 77%, respectively, as confirmed histologically. Antioxidant effects were observed for FRS through the maintenance of GSH and LPO levels, and the SOD and CAT activity similar to those found in the nonulcerated group. Moreover, FRS avoided the increase in MPO activity and TNF, IL-6, IL-4 and IL-10 levels. Moreover, mucin staining increased in ulcerated rats receiving FRS, and the pharmacological mechanism gastroprotective seems to involve the NO and NP-SH in addition to antisecretory actions. The chemical study by mass spectrometry confirmed the presence of flavonoids in FRS, and molecular docking studies have shown that these compounds interact with cyclooxygenase-1 and NO synthase. Furthermore, there was no indication that FRS had cytotoxic effects. Our results support the popular use of F. chica, and we conclude that the gastroprotection effect promoted by FRS can be attributed to the combined effect of the flavonoids.

In situ bioprinting has emerged as one of the most promising techniques for the sutureless tissue sealing of internal organs. However, most existing in situ bioprinting methods are limited by the complex and confined printing space inside the organs, harsh curing conditions for printable bioinks, and poor ability to suturelessly seal injured parts. The combination of in situ bioprinting and 4D printing is a promising technique for tissue repair. Herein, the in situ 4D printing of polyelectrolyte/magnetic composites by gastroscopy for sutureless internal tissue sealing is reported. Using gastric perforation as an example, a gelatin/sodium alginate/magnetic bioink is developed, which can be precisely located by a gastroscope with the assistance of an external magnetic field, solidified in gastric fluid, and firmly adhered to tissue surfaces. The solidified bioink along the defect can be attracted by an external magnetic field, resulting in sutureless sealing. A demonstration using a porcine stomach with an artificial perforation confirms the feasibility of sutureless sealing using 4D printing. Moreover, an in vivo investigation on gastric perforation in a rat model identifies the biocompatibility by H&E and CD68+ staining. This study provides a new orientation and concept for functionality-modified in situ 4D bioprinting.

Prolonged or excessive use of acid suppressants may increase the risk of Clostridioides difficile infection (CDI) by altering the intestinal microecosystem. Vonoprazan, a novel potassium-competitive acid blocker, exhibits a faster and more sustained acid-suppressive effect than proton pump inhibitors (PPIs). Therefore, vonoprazan may have a greater impact on the gut microbiota, potentially resulting in CDI.

This study aimed to explore the potential relationship between acid suppressants and CDI by the Japan Adverse Drug Event Report (JADER) and the FDA Adverse Event Reporting System (FAERS) databases.

A retrospective analysis of the JADER and FAERS databases was examined by disproportionality analysis.

We performed signal detection analyses of CDI induced by vonoprazan and PPIs using the JADER and FAERS databases. The association between acid suppressants and CDI was calculated using the reporting odds ratio (ROR) and corresponding 95% confidence interval (95% CI). When the lower limit of the 95% CI is exceeded by 1, the association is considered statistically significant.

In the JADER database, the ROR (95% CI) for vonoprazan and PPIs based on suspect drug reports was 15.84 (12.23-20.50) and 2.51 (1.92-3.28), respectively. In the FAERS database, the ROR (95% CI) for vonoprazan and PPIs based on primary and secondary suspect drug reports was 11.50 (6.36-20.82) and 1.42 (1.34-1.51), respectively. Subgroup analysis showed that elderly patients aged 60 years and older were more strongly associated with CDI. The ROR (95% CI) for vonoprazan and PPIs in patients aged 60 years and older in the JADER database was 15.35 (11.59-20.33) and 1.65 (1.14-2.39), respectively. Similarly, the ROR (95% CI) for vonoprazan and PPIs in the FAERS database was 12.56 (6.26-25.20) and 1.43 (1.31-1.57), respectively. Excluding the effect of Helicobacter pylori (H. pylori) infection, the use of acid suppressants was still associated with CDI.

While signal detection analysis based on the JADER and FAERS databases could not establish causality, our study demonstrated that both vonoprazan and PPIs were significantly associated with CDI. Vonoprazan showed a stronger association with CDI in both databases.

Gastric ulcers (GUs) have a high risk of clinical morbidity and recurrence, and further exploration is needed for the prevention, diagnosis, and treatment of the disease.

To investigated the effects of a diet plan on pepsinogen (PG) I, PG II, gastrin-17 (G-17) levels and nutritional status in patients with GUs.

A total of 100 patients with GUs treated between May 2022 and May 2023 were enrolled, with 47 patients in the control group receiving routine nursing and 53 patients in the experimental group receiving dietary nursing intervention based on a diet plan. The study compared the two groups in terms of nursing efficacy, adverse events (vomiting, acid reflux, and celialgia), time to symptom improvement (burning sensation, acid reflux, and celialgia), gastric function (PG I, PG II, and G-17 levels), and nutritional status [prealbumin (PA) and albumin (ALB) levels].

The experimental group showed a markedly higher total effective rate of nursing, a significantly lower incidence of adverse events, and a shorter time to symptom improvement than the control group. Additionally, the experimental group's post-intervention PG I, PG II, and G-17 levels were significantly lower than pre-intervention or control group levels, whereas PA and ALB levels were significantly higher.

The diet plan significantly reduced PG I, PG II, and G-17 levels in patients with GUs and significantly improved their nutritional status.

Annual prevalence estimates of peptic ulcer disease range between 0·12% and 1·5%. Peptic ulcer disease is usually attributable to Helicobacter pylori infection, intake of some medications (such as aspirin and non-steroidal anti-inflammatory medications), or being critically ill (stress-related), or it can be idiopathic. The clinical presentation is usually uncomplicated, with peptic ulcer disease management based on eradicating H pylori if present, the use of acid-suppressing medications-most often proton pump inhibitors (PPIs)-or addressing complications, such as with early endoscopy and high-dose PPIs for peptic ulcer bleeding. Special considerations apply to patients on antiplatelet and antithrombotic agents. H pylori treatment has evolved, with the choice of regimen dictated by local antibiotic resistance patterns. Indications for primary and secondary prophylaxis vary across societies; most suggest PPIs for patients at highest risk of developing a peptic ulcer, its complications, or its recurrence. Additional research areas include the use of potassium-competitive acid blockers and H pylori vaccination; the optimal approach for patients at risk of stress ulcer bleeding requires more robust determinations of optimal patient selection and treatment selection, if any. Appropriate continuation of PPI use outweighs most possible side-effects if given for approved indications, while de-prescribing should be trialled when a definitive indication is no longer present.

Guideline-directed medical therapy (GDMT) is important in heart failure management; however, polypharmacy itself may impact heart failure. Although measures against polypharmacy are needed, current discussion on unilateral drug tapering (including the drugs that should be tapered) is insufficient. In this study, we investigated the relationship between the number of prescribed GDMT drugs and prognosis in patients with heart failure.

In this single-centre retrospective study, 3,146 eligible patients with heart failure were included and divided into four groups based on the median number of prescribed GDMT drugs and the median number of drugs not included in the GDMT (ni-GDMT) at the time of hospital discharge. The definition of GDMT was based on various Japanese guidelines. The primary outcome was all-cause mortality within 3 years of hospital discharge.

A total of 252 deaths were observed during the 3-year follow-up period. Kaplan-Meier analysis revealed that groups with GDMT drug count ≥ 5 and ni-GDMT drug count < 4 had the lowest mortality, and those with GDMT drug count < 5 and ni-GDMT drug count ≥ 4 had the highest mortality (log-rank, P < 0.001). Cox regression analysis revealed a significant association between ni-GDMT drug count and all-cause mortality, even after adjustment for number of GDMT medications, age, male, left ventricular ejection function < 40%, hemoglobin, albumin levels, and estimated glomerular filtration rate [HR = 1.06 (95% CI: 1.01-1.11), P = 0.020]. Conversely, the GDMT drug count was not associated with increased mortality rates.

The ni-GDMT drug count was significantly associated with 3-year mortality in patients with heart failure. Conversely, the GDMT drug count did not worsen the prognosis. Polypharmacy measures should consider ni-GDMT drug quantity to improve the prognosis and outcomes in patients with heart failure.