Search Results (95)

Background and Objectives: Perforated gastro-duodenal ulcers (PGDUs) are life-threatening surgical emergencies with high morbidity and mortality. This study aimed to evaluate surgical strategies, outcomes, and prognostic factors in patients treated for PGDUs in a tertiary Eastern European center. Materials and Methods: We conducted a retrospective cross-sectional analysis of 156 patients admitted with PGDUs between 2020 and 2024. Data on demographics, risk factors, ulcer location, type of surgical approach, operative details, hospital stay, and mortality were collected. Statistical analysis included chi-square, Mann–Whitney U, and multivariate logistic regression. Results: The mean age was 57.6 ± 15.9 years (range 18–91), with men accounting for 64.7% of cases. Alcohol use was significantly associated with male sex (p = 0.012), while NSAID use was equally distributed. Open surgery was the mainstay of treatment (85.9%), with laparoscopy performed in 12.8% and conversion in 1.9%. Median hospital stay was shorter after laparoscopic repair (7.5 vs. 9 days, p = 0.039. On multivariate analysis, both age and comorbidity burden were independent predictors of mortality (p < 0.01). Conclusions: PGDU management in Eastern Europe remains dominated by open surgery. Laparoscopy, though underutilized, is associated with shorter recovery. Age is the strongest determinant of mortality, highlighting the need for early risk stratification, wider adoption of minimally invasive techniques, and preventive measures targeting modifiable risk factors. Full article

Background and aim: The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined. Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings. Methods: This retrospective study included 38,392 adults (≥18 years) who tested positive for FIT between 2016 and 2022 across eight medical centers in Israel. Of them, 1560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included the detection of neoplastic and precancerous lesions, with the rates of adenoma and polyp detection calculated. Gastroscopy findings, including gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy, were analyzed and compared between patients with normal and abnormal colonoscopy results. Results: Among 38,392 FIT-positive adults, 1560 underwent bidirectional endoscopy; of these, 632 (40.5%) had normal and 928 (59.5%) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.5% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 15% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Gastric ulcers were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group. Conclusions: Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare. Full article

Background: Prior research has reported increased expression of duodenal chromogranin-A (CgA), secreted by enteroendocrine cells (EECs), in association with pancreatic fibrosis. However, it remains unknown whether serum CgA levels are also elevated, and whether there is a different distribution pattern of EECs in pancreatic fibrosis and other dyspeptic causes. Aims: This study had three main objectives. First, to compare the serum CgA level between patients with pancreatic fibrosis and those with other dyspeptic conditions. Second, to analyze the distribution pattern of duodenal EECs. Third, to evaluate whether biopsy results varied depending on the specific location within the duodenum. Serum CgA levels were categorized into low and high groups based on a cutoff value of 50 ng/mL. Methods: This cross-sectional prospective case series included 15 patients, with 4 patients in the low CgA group and 11 in the high CgA group. Each participant underwent a serum CgA test, transabdominal ultrasonography, pancreatic elastography, and upper gastrointestinal endoscopy. During endoscopy, a single gastric biopsy and three duodenal biopsies from different locations were obtained. Results: Patients in the high CgA group were generally older (52–68 years) than those in the low CgA group (37–55 years), with a statistically significant difference (p < 0.01). The high CgA group exhibited a clustered and centralized pattern of EECs, whereas the low CgA group showed a more discrete pattern with fewer EECs (p < 0.01). All duodenal ulcer cases were found in the low CgA group, while three cases of pancreatic fibrosis and one case of chronic pancreatitis were identified in the high CgA group. In the high CgA group, five cases of functional dyspepsia showed a band-like EEC distribution pattern, whereas cases with pancreatic fibrosis demonstrated a more uniformly scattered EEC distribution (p < 0.01). Consistency among intra-individual duodenal biopsy results was high across different biopsy sites. Conclusions: Elevated serum CgA (>50 ng/mL) and specific duodenal EEC distribution patterns may serve as potential diagnostic indicators for pancreatic fibrosis or chronic pancreatitis. These characteristics could help differentiate these conditions from functional dyspepsia. Full article

Background: Helicobacter pylori infection is widely prevalent across the globe and is a major etiological agent of various gastric pathologies. This bacterium colonizes the human stomach, where it induces a range of mucosal abnormalities observable upon clinical examination. Accordingly, the present study aimed to assess the prevalence and clinical implications of H. pylori infection among patients undergoing endoscopic evaluation. Method: A cross-sectional study was conducted from January to May 2019 at endoscopy service-providing health institutions. Sociodemographic and clinical data were collected. Gastric biopsies were collected during endoscopic procedures and immediately inoculated into brain–heart infusion broth and plated out. Then, phenotypic bacterial identification was done. The collected data have been analyzed using SPSS version 23. A logistic regression model was used for association determination. Result: Among the 135 individuals enrolled in the study, 59.3% are male, and 40.7% are female, with a mean age of 45 years. H. pylori is isolated in 17.8% of participants (24/135). Notably, the majority of these isolates 71% (17/24) are from male participants, while 29% (7/24) are from females. A statistically significant association is identified between H. pylori infection and both high salt intake [AOR = 3.3; 95% CI: 1.5–10.8; p = 0.04] and the presence of duodenal ulcers [AOR = 3.8; 95% CI: 1.2–11.9; p = 0.02]. The highest prevalence of H. pylori is observed among patients diagnosed with atrophic pangastritis. Conclusions: The prevalence of H. pylori among the study participants is comparatively low. However, a significant association was observed between H. pylori infection and both high dietary salt intake and the presence of duodenal ulcers. Full article

Background/Objectives: Understanding the diagnostic landscape is essential prior to developing artificial intelligence (AI)-based diagnostic strategies for automating the diagnosis of duodenal biopsies. This study aims to (1) determine the frequencies of different diagnoses seen in endoscopic duodenal biopsies in a large, tertiary referral centre; (2) identify key words on histopathology request forms that could indicate that a biopsy may contain a serious pathology and should not be diagnosed by an AI system; and (3) investigate the proportion of cases described as showing “intraepithelial lymphocytosis” that might be coeliac disease. Methods: To achieve this, we audited 18 months’ worth of duodenal biopsy reports in our centre. Results: A total of 6245 duodenal biopsies were identified, of which 73.76% were normal and at least 8.84% fell within the spectrum of coeliac disease. Additionally, 6.47% were classified as showing non-specific inflammation, 1.86% were adenomas, 0.45% were carcinomas, 0.06% were neuroendocrine tumours, 0.10% were lymphomas, and 0.03% were cases of flat dysplasia, giving a total of 0.64% of dysplastic or malignant diagnoses. Rarer diagnoses included ulceration, Helicobacter pylori infection, giardiasis, lymphangiectasia, transplant rejection, and lymphoma. Furthermore, 227 biopsies (3.63%) showed isolated intraepithelial lymphocytosis, of which 33 cases (14.5%) gave an overall clinicopathological picture of coeliac disease. Conclusions: We present the first long-term audit of all endoscopic duodenal biopsies received by the histopathology department of a tertiary-care facility. The results indicate that a fully automated diagnostic histopathology reporting system able to identify normal duodenal biopsies and biopsies within the spectrum of coeliac disease-associated enteropathy could decrease pathologists’ endoscopic duodenal biopsy workload by up to 80%. Full article

Background and Objectives: Perforated peptic ulcers are a common surgical emergency and rank among the leading causes of acute peritonitis worldwide. Previous studies have suggested a seasonal pattern in the occurrence of symptomatic perforated peptic ulcers. With the advancement of modern medicine, including the widespread use of proton pump inhibitors, and the effects of climate change, this study aimed to assess potential seasonal variations in the incidence of peptic ulcer perforation in our region. Methods: This retrospective analysis included 104 adult patients (mean age: 61.5 ± 14.7 years) who underwent surgical treatment for peptic ulcer perforation between January 2021 and April 2024. Patients were analyzed by gender, age, risk factors (smoking and alcohol consumption), the location of the perforation (gastric or duodenal), and discharge outcome (survived or deceased). Additionally, cases were categorized by the month and season of the ulcer perforation. Results: Among the 104 patients (mean age 61.5 ± 14.7 years), 68 (65.4%) were male. Gastric and duodenal perforations were nearly equally observed (51% vs. 49%). A statistically significant difference in overall perforation rates by gender was observed (p = 0.009), though not between ulcer sites (p = 0.628 and p = 0.739). The highest number of perforations occurred in July (n = 12), while the lowest occurred in November (n = 4); however, no significant variation was found by month (p = 0.916) or season (p = 0.891), despite a predominance in spring. Comorbidities were present in 60% of patients. Smoking (33.6%) and alcohol use (22.1%) were common. Alcohol abuse was noted in 22.1% of patients and was significantly associated with both gastric (p < 0.001) and duodenal (p < 0.001) perforations, though not with the overall incidence (p = 0.284). Smoking, reported in 33.6% of patients, showed no significant association with the perforation site or overall incidence (p = 0.946). The combination of smoking and alcohol use favored gastric perforations, but without statistical significance (p = 0.157). Conclusions: Alcohol consumption appeared to increase the risk of ulcer perforation, while smoking did not demonstrate a statistically significant association. Although spring exhibited the highest observed incidence of peptic ulcer perforation, seasonal variation did not show a statistically significant difference overall. Full article

Background: Helicobacter pylori (H. pylori) is a prevalent bacterial pathogen implicated in different stomach and duodenal diseases, including chronic gastritis, gastric and duodenal ulcer, and stomach cancer. The COVID-19 pandemic has significantly influenced antibiotic prescription practices, potentially exacerbating antibiotic resistance in H. pylori. Objective: This study aims to investigate antibiotic prescription during the COVID-19 pandemic in Croatia and its possible impact on H. pylori antibiotic resistance, with a focus on Croatia. Methods: An extensive literature search was conducted to identify relevant studies from March 2020 to June 2024. The search strategy included terms related to COVID-19, antibiotic prescription, and Croatia. Studies were selected based on predefined eligibility criteria, focusing on observational research addressing antibiotic use during the pandemic. Results: The COVID-19 pandemic has led to significant fluctuations in community antibiotic consumption within the European Union/European Economic Area. In Croatia, antibiotic use in 2022 surpassed 2019 levels, driven by increased consumption of macrolides and other antibiotics. This surge, influenced by early pandemic treatment claims and penicillin shortages, contributed to rising antibiotic resistance in H. pylori. Resistance rates to clarithromycin and levofloxacin were notably high, driven by mutations in the 23S rRNA, gyrA, and gyrB genes. Discussion: The increased antibiotic use during the COVID-19 pandemic has highly likely complicated H. pylori eradication efforts, highlighting the necessity of judicious antibiotic use and robust antimicrobial stewardship. The pandemic underscored the need for new therapeutic strategies, optimized eradication regimens, and advanced diagnostic methods to manage bacterial infections effectively. Conclusions: The COVID-19 pandemic has significantly affected antibiotic use and resistance patterns, posing new challenges for H. pylori eradication. Addressing these challenges requires a multifaceted approach, including the development of new drugs and advanced diagnostics, coupled with sustained efforts in antimicrobial stewardship to combat emerging resistance threats. Full article

Plastic pollution is a growing concern. It can form smaller particles called microplastics (<5 mm). Microplastics can break down into even smaller pieces called nanoplastics (<1 μm). These minute particles can infiltrate human cells and tissues, with their health impacts still largely undetermined. On average, a liter of bottled water includes about 240,000 tiny pieces of plastic. The purpose of this study was to evaluate the association between the use of bottled plastic water (BW) and several health outcomes. Utilizing data from the Italian National Institute of Statistics’ “Aspects of Daily Life” survey (N = 45,597), we employed logistic regression to explore the correlation between BW consumption and the prevalence of various chronic diseases, including hypertension, gastric/duodenal ulcers, and kidney stones. Adjustments were made for covariates such as education, age, gender, and economic resources. Our analysis indicated a statistically significant association between BW consumption and increased risk of hypertension (Odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.00–1.11), diabetes (OR = 1.09, 95% CI 1.01–1.18), gastric/duodenal ulcers (OR = 1.21, 95% CI 1.07–1.38), and kidney stones (OR = 1.17, 95% CI 1.03–1.32). The consumption of BW is associated with heightened risk for certain health conditions. Policymakers and healthcare providers should consider implementing targeted prevention strategies and awareness campaigns. Full article

Background: (-)-Fenchone is a naturally occurring monoterpene found in the essential oils of Foeniculum vulgare Mill., Thuja occidentalis L., and Peumus boldus Molina. Pharmacological studies have reported its antinociceptive, antimicrobial, anti-inflammatory, antidiarrheal, and antioxidant activities. Methods: The preventive antiulcer effects of (-)-Fenchone were assessed through oral pretreatment in cysteamine-induced duodenal lesion models. Gastric healing, the underlying mechanisms, and toxicity after repeated doses were evaluated using the acetic acid-induced gastric ulcer rat model with oral treatment administered for 14 days. Results: In the cysteamine-induced duodenal ulcer model, fenchone (37.5–300 mg/kg) significantly decreased the ulcer area and prevented lesion formation. In the acetic acid-induced ulcer model, fenchone (150 mg/kg) reduced (p < 0.001) ulcerative injury. These effects were associated with increased levels of reduced glutathione (GSH), superoxide dismutase (SOD), interleukin (IL)-10, and transforming growth factor-beta (TGF-β). Furthermore, treatment with (-)-Fenchone (150 mg/kg) significantly reduced (p < 0.001) malondialdehyde (MDA), myeloperoxidase (MPO), interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and nuclear transcription factor kappa B (NF-κB). A 14-day oral toxicity investigation revealed no alterations in heart, liver, spleen, or kidney weight, nor in the biochemical and hematological parameters assessed. (-)-Fenchone protected animals from body weight loss while maintaining feed and water intake. Conclusion: (-)-Fenchone exhibits low toxicity, prevents duodenal ulcers, and enhances gastric healing activities. Antioxidant and immunomodulatory properties appear to be involved in its therapeutic effects. Full article

Background: Lung cancer, particularly small-cell lung carcinoma (SCLC), often presents with respiratory symptoms. However, atypical manifestations including jaundice and abdominal pain can obscure the diagnosis, leading to challenges in early detection and treatment. Case Presentation: A 49-year-old male, with a history of smoking and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), presented to the emergency department with a 3-day history of jaundice and a 3-week duration of mild abdominal pain. Initial investigations, including blood tests, showed hyperbilirubinemia and elevated lipase and amylase levels. An abdominal ultrasound was performed and revealed a hypoechoic, inhomogeneous mass in the head of the pancreas and multiple liver masses, suggesting a cephalo-pancreatic formation with liver metastasis. Further diagnostic procedures, including upper endoscopy and ERCP, followed by a TAP CT scan, identified a large mediastinal-pulmonary mass with invasion into major vessels and extensive metastasis. The immunohistochemical analysis of a duodenal ulcer biopsy confirmed a diagnosis of duodenal metastasis from a small-cell neuroendocrine lung carcinoma. Conclusion: Our case highlights that while rare, the possibility of metastatic spread should be included in the differential diagnosis when obstructive jaundice occurs in the context of high-risk factors for lung cancer. Full article

Background: During esophagogastroduodenoscopy performed with colonoscopy, gastric and duodenal erythema, erosions, and ulcerations are often observed. This investigation was designed to review the prevalence of gastroduodenal lesions in patients who have undergone wireless capsule endoscopy using standard bowel cleansing preparations, but no endoscopy or sedation. Methods: A retrospective analysis was conducted on patients referred for capsule endoscopy. Records and capsule reports were reviewed for the patient demographics, preparation prescribed, procedural indications, and gastroduodenal findings. The preparations studied included polyethylene glycol lavage (PEG), PEG plus bisacodyl (PEG + bis), bisacodyl (bis), oral sulfate solution (OSS), and no prep. Results: Among the 1236 records, 498 (40.3%) were men and 738 (59.7%) were women. The mean age was 56 years +/− 18 years SD. The percentage of patients with lesions after any bowel preparation was 52.7% for gastric lesions and 23.6% for duodenal lesions. The percentage of patients with gastroduodenal lesions was 58.3% with prep, compared to 38.2% without prep. These findings were statistically significant, with an RR of 1.53 [1.19–1.94] (p-value = 0.00004). This difference was more pronounced in the OSS group RR of 1.65 [1.29–2.1] and bisacodyl group RR of 1.64 [1.25–2.15] compared to the PEG group RR of 0.95 [0.7–1.3]. Conclusions: This study showed that patients undergoing wireless capsule endoscopy who received bowel preparations had a significant increase in gastric and duodenal lesions. Of the preparations studied, OSS was associated with a greater number of gastroduodenal lesions, while PEG was the least associated with lesions, with an occurrence similar to the non-prep group. The clinical significance of these lesions remains undetermined. Endoscopists should be aware that preparations are associated with gastroduodenal lesions to avoid the misinterpretation and misdiagnosis of these lesions. Full article

Cannabis is a plant that is cultivated worldwide, and its use is internationally regulated, but some countries have been regulating its medicinal, social, and industrial uses. This plant must have arrived in Peru during the Spanish conquest and remains widely cultivated illicitly or informally to this day. However, new regulations are currently being proposed to allow its legal commercialization for medicinal purposes. Cannabis contains specific metabolites known as cannabinoids, some of which have clinically demonstrated therapeutic effects. It is now possible to quantitatively measure the presence of these cannabinoids in dried inflorescences, thus allowing for description of the chemical profile or “chemotype” of cannabinoids in each sample. This study analyzed the chemotypes of eight samples of dried inflorescences from cannabis cultivars in four different regions of Peru, and based on the significant variation in the cannabinoid profiles, we suggest their therapeutic potential. The most important medical areas in which they could be used include the following: they can help manage chronic pain, they have antiemetic, anti-inflammatory, and antipruritic properties, are beneficial in treating duodenal ulcers, can be used in bronchodilators, in muscle relaxants, and in treating refractory epilepsy, have anxiolytic properties, reduce sebum, are effective on Methicillin-resistant Staphylococcus aureus, are proapoptotic in breast cancer, can be used to treat addiction and psychosis, and are effective on MRSA, in controlling psoriasis, and in treating glioblastoma, according to the properties of their concentrations of cannabidiol, cannabigerol, and Δ9-tetrahydrocannabinol, as reviewed in the literature. On the other hand, having obtained concentrations of THC, we were able to suggest the psychotropic capacity of said samples, one of which even fits within the legal category of “non-psychoactive cannabis” according to Peruvian regulations. Full article

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. The 5-year survival rate for liver cancer in the US has improved from 3% four decades ago to 20% now. Transarterial chemoembolization (TACE) is the treatment of choice for stage B/intermediate-stage HCC. Complications of TACE include hepatic encephalopathy, liver failure, post-embolization syndrome, duodenal ulcers, liver abscesses, acute cholecystitis, and injury to the biliary tract. This study evaluates the 30-day readmission rate and predictors of readmission among patients with HCC undergoing TACE. Methods: The 2016–2018 Healthcare Cost and Utilization Project (HCUP) database, which includes the National Readmission Database (NRD), was used. All adult patients with HCC who underwent TACE were identified using the International Classification of Diseases (ICD-10). The rate of 30-day readmissions after TACE and the associated diagnoses were identified. Logistic regression was used to obtain adjusted odds ratios for variables associated with 30-day readmission. Results: A total of 566 patients underwent TACE between 2016–2018. Sixty-five patients were excluded due to death and unavailability of 30-day readmission data. The procedure was performed in large (80.4%), metro-teaching hospitals (94.5%). Mean patient age was 65.1 ± 9.9 years, and 74% of patients were male. Among the 501 patients, 81 (16.2%) were readmitted within 30 days. The mean age for readmitted patients was 63.2 ± 11.0 and 69.1% were male. The mean length of stay at readmission was 5.5 ± 7.3 days. A total of 7.4% of patients had neurological disorders, 17.3% had weight loss, 30.9% had fluid and electrolyte imbalance, and 21.0% had hepatic encephalopathy. The most common primary diagnoses at 30-day readmission were liver cell carcinoma, sepsis, and liver failure. Univariate analysis for variables associated with 30-day readmission included hepatic encephalopathy (OR 3.45; 95% CI 1.8–6.62; p = 0.0002), underlying neurological disorders (OR 3.28; 95% CI 1.16–9.3; p = 0.03), weight loss (OR 2.82; 95% CI 1.42–5.61; p = 0.003), and Medicaid status (OR 1.74; 95% CI 1.05–2.88; p = 0.03). Multivariable analysis showed hepatic encephalopathy (OR 2.91; 95% CI 1.4, 6.04; p = 0.04) and weight loss (OR 2.37; 95% CI 1.13–4.96; p = 0.02) were associated with hospital readmission. Conclusions: Weight loss and hepatic encephalopathy were predictors for 30-day readmission after a TACE procedure for HCC. Full article

This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient’s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient’s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates. Full article

We reviewed gastric ulcer healing by dopamine considering several distinctive duodenal key points. Selye and Szabo describe the cysteamine-induced duodenal ulcer in rats as a duodenal stress ulcer in patients. Szabo’s cysteamine duodenal ulcer as the dopamine duodenal healing and cysteamine as a dopamine antagonist signifies the dopamine agonists anti-ulcer effect and dopamine antagonists ulcerogenic effect. From these viewpoints, we focused on dopamine and gastric ulcer healing. We mentioned antecedent studies on the dopamine presence in the stomach and gastric juice. Then we reviewed, in the timeline, therapy significance arising from the anti-ulcer potency of the various dopamine agonists, which is highly prevailing over the quite persistent beneficial evidence arising from the various dopamine antagonists. Meanwhile, the beneficial effects of several peptides (i.e., amylin, cholecystokinin, leptin, and stable gastric pentadecapeptide BPC 157, suggested as an acting mediator of the dopamine brain-gut axis) were included in the dopamine gastric ulcer story. We attempt to resolve dopamine agonists/antagonists issue with the dopamine significance in the stress (cysteamine as a prototype of the duodenal stress ulcer), and cytoprotection (cysteamine in small dose as a prototype of the cytoprotective agents; cysteamine duodenal ulcer in gastrectomized rats). Thereby, along with dopamine agonists’ beneficial effects, in special circumstances, dopamine antagonists having their own ulcerogenic effect may act as “mild stress (or)” or “small irritant” counteracting subsequent strong alcohol or stress procedure-induced severe lesions in this particular tissue. Finally, in the conclusion, as a new improvement in further therapy, we emphasized the advantages of the dopamine agents’ application in lower gastrointestinal tract therapy. Full article