Bleeding gastroduodenal ulcers in patients without Helicobacter pylori infection and without exposure to non-steroidal anti-inflammatory drugs

Background/Aim. A high risk of bleeding in Helicobacter pylori (H.pylori)-negative, non-steroidal anti-inflammatory drugs (NSAID)-negative ulcers highlights the clinical importance of analysis of the changing trends of peptic ulcer disease. The aim of the study was to investigate the risk factors for ulcer bleeding in patients with non-H. pylori infection, and with no NSAIDs use. Methods. A prospective study included patients with endoscopically diagnosed ulcer disease. The patients were without H. pylori infection (verified by pathohistology and serology) and without exposure to NSAIDs and proton pump inhibitors (PPI) within 4 weeks before endoscopy. After endoscopy the patients were divided into 2 groups: the study group of 48 patients with bleeding ulcer and the control group of 47 patients with ulcer, but with no bleeding. Prior to endoscopy they had completed a questionnaire about demographics, risk factors and habits. The platelet function, von Willebrand factor (vWF) and blood groups were determined. Histopathological analysis of biopsy samples were performed with a modified Sydney system. The influence of bile reflux was analyzed by Bile reflux index (BRI). Results. Age, gender, tobacco and alcohol use did not affect the bleeding rate. The risk of bleeding did not depend on concomitant diseases (p = 0.509) and exposure to stress (p = 0.944). Aspirin was used by 16/48 (33.3%) patients with bleeding ulcer, as opposed to 7/47 (14.9%) patients who did not bleed (p = 0.036). Abnormal platelet function had 12/48 (25.0%) patients who bled, as opposed to 2/47 (4.3%) patients who did not bleed (p = 0.004). Patients with BRI < 14 bled in 79.2%, and did not bleed in 57.4% of the cases (p = 0.023). There was no statistical difference between groups in regards to blood groups and range of vWF. Antrum atrophy was found in 14/48 (29.2%) patients with bleeding ulcer and in only 5/47 (10.6%) patients who had ulcer without bleeding (p = 0.024). Conclusion. Abnormal platelet function, aspirin use and antrum atrophy were the risk factors for ulcer bleeding in non-H. pylori, non- NSAIDs ulcer disease

Preoperative misdiagnosed gastrointestinal stromal tumor surgical “transferred” into gastric duplication cyst

Introduction. Gastrointestinal duplications are rare congenital anomalies, especially in the adult population which can occur along the entire gastrointestinal tract. The rarest among them are gastric duplications, making up 2–8% of all gastrointestinal duplications. Unusual embryonic malformations can be found even in the adult population and should always be considered in the differential diagnosis of thoraco-abdominal tumors. Unclear findings during preoperative diagnostic procedures are the reason for presenting the case. Case report. We present a 33 years old female, with tumorous lesion in the stomach wall, which had the endoscopic ultrasound features of gastrointestinal stromal tumor. During surgery, it was determined that the lesion was actually a cystic formation with gelatin content and histological examination confirmed the diagnosis of gastric duplication cyst. Conclusion. Preoperative diagnosis of gastric duplication cyst has always been a challenge for clinicians, since its morphological appearance may vary. That is the reason why these anomalies are often misdiagnosed as solid tumorous lesions by imaging methods and even by the most superior ones, and set up the surgery as a part of diagnostic algorithm