GASTRIC MUCOSAL THICKNESS AS A PREDICTOR OF PPI THERAPY SUCCESS IN PEPTIC ULCER DISEASE
Main Article Content
Keywords
Gastric mucosal thickness, peptic ulcer disease, proton pump inhibitor, ulcer healing, endoscopy, inflammation, antral thickness.
Abstract
Background: Peptic ulcer disease remains a common clinical problem, and although proton pump inhibitors are effective for most patients, treatment response varies widely. This has led to growing interest in identifying simple, non-invasive markers that can help predict healing. Gastric mucosal thickness, which increases with inflammation and edema, may offer a practical way to anticipate how well a patient will respond to acid-suppressive therapy.
Methodology: This observational study included seventy-two adults with endoscopically confirmed peptic ulcers. Baseline clinical details, ulcer characteristics, and gastric mucosal thickness measured sonographically in the fasting stated were recorded. All patients received standard PPI therapy for four to eight weeks, depending on clinical assessment. Follow-up visits assessed symptom improvement and treatment adherence, and repeat endoscopy was performed to evaluate ulcer healing. Treatment success was defined by both symptom relief and complete endoscopic resolution.
Results: Patients with thinner antral mucosa at baseline showed higher rates of ulcer healing and symptom improvement. In contrast, those with mucosal thickness greater than 6 mm had a noticeably lower response to therapy. Larger ulcer size and the presence of wall edema were also more frequent in the failure group. ROC analysis indicated that mucosal thickness demonstrated good predictive accuracy for treatment outcome.
Conclusion: Gastric mucosal thickness appears to be a useful indicator of PPI therapy success in peptic ulcer disease. Measuring this simple parameter may help clinicians identify patients who need longer treatment or closer monitoring.
References
2. Kalapala, R., et al., Endoscopic full-thickness plication for the treatment of PPI-dependent GERD: results from a randomised, sham controlled trial. Gut, 2022. 71(4): p. 686-694.
3. Kim, G.H., Proton pump inhibitor-related gastric mucosal changes. Gut and liver, 2020. 15(5): p. 646.
4. Saleh, M., et al., Therapeutic approach of adipose-derived mesenchymal stem cells in refractory peptic ulcer. Stem Cell Research & Therapy, 2021. 12(1): p. 515.
5. Guevara, B. and A.G. Cogdill, Helicobacter pylori: a review of current diagnostic and management strategies. Digestive diseases and sciences, 2020. 65(7): p. 1917-1931.
6. Tarasconi, A., et al., Perforated and bleeding peptic ulcer: WSES guidelines. World journal of emergency surgery, 2020. 15(1): p. 3.
7. Lau, L.H. and J.J. Sung, Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes. Digestive Endoscopy, 2021. 33(1): p. 83-94.
8. Weledji, E.P., Acute upper gastrointestinal bleeding: a review. Surgery in Practice and Science, 2020. 1: p. 100004.
9. Wei, Y., et al., Zuojin Pill ameliorates inflammation in indomethacin-induced gastric injury via inhibition of MAPK pathway. Journal of Ethnopharmacology, 2021. 275: p. 114103.
10. Hewetson, M. and R. Tallon, Equine squamous gastric disease: prevalence, impact and management. Veterinary Medicine: Research and Reports, 2021: p. 381-399.
11. Cashin¹, P.A. and S. Chung, 16 Peptic ulcer disease. Textbook of Surgery, 2020: p. 133.
12. Danilo, C. and S. Leanza, A review on treatment of perforated peptic ulcer by minimally invasive techniques. Maedica, 2022. 17(3): p. 692.
13. Koga, Y., Microbiota in the stomach and application of probiotics to gastroduodenal diseases. World journal of gastroenterology, 2022. 28(47): p. 6702.
14. Marginean, C.M., et al., The importance of accurate early diagnosis and eradication in Helicobacter pylori infection: pictorial summary review in children and adults. Antibiotics, 2022. 12(1): p. 60.
15. Bornschein, J. and D.M. Pritchard, Myths and misconceptions in the management of Helicobacter pylori infection. Frontline Gastroenterology, 2022. 13(3): p. 245-253.
16. Zerbib, F., et al., ESNM/ANMS consensus paper: diagnosis and management of refractory gastro‐esophageal reflux disease. Neurogastroenterology & Motility, 2021. 33(4): p. e14075.
17. Fass, R., Gastroesophageal reflux disease. New England Journal of Medicine, 2022. 387(13): p. 1207-1216.
18. Wang, Z., R. Ren, and Y. Yang, Mucosa microbiome of gastric lesions: Fungi and bacteria interactions. Progress in Molecular Biology and Translational Science, 2020. 171: p. 195-213.
19. Mann, R., et al., Advanced endoscopic imaging and interventions in GERD: an update and future directions. Frontiers in Medicine, 2021. 8: p. 728696.
20. Robinson, K. and J.C. Atherton, The spectrum of Helicobacter-mediated diseases. Annual Review of Pathology: Mechanisms of Disease, 2021. 16(1): p. 123-144.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Afshan Abbas
Professor of Pharmacology, Sir Syed College of Medical Sciences (for Girls), Karachi, Pakistan
Nadeem AKhtar Korai
Associate Professor of Pharmacology, Gambat Medical College, Gambat, Pakistan
Abdullah Khilji
Associate Professor, Department of Anatomy, Khairpur Medical College, Khairpur Mirs, Pakistan
Sehrish Hussain
Demonstrator, Department of Anatomy, Khairpur Medical College, Khairpur Mirs, Pakistan
Maryam Waqar Panhwar
Demonstrator, Department of Anatomy, Khairpur Medical College, Khairpur Mirs, Pakistan
