*Edited by Isam Jaber Al-Zwaini and Ban Adbul-Hameed Majeed Albadri*

Epilepsy is the most common neurological disorder globally, affecting approximately 50 million people of all ages. It is one of the oldest diseases described in literature from remote ancient civilizations 2000-3000 years ago. Despite its long history and wide spread, epilepsy is still surrounded by myth and prejudice, which can only be overcome with great difficulty. The term *epilepsy* is derived from the Greek verb *epilambanein*, which by itself means to be seized and to be overwhelmed by surprise or attack. Therefore, epilepsy is a condition of getting over, seized, or attacked. The twelve very interesting chapters of this book cover various aspects of epileptology from the history and milestones of epilepsy as a disease entity, to the most recent advances in understanding and diagnosing epilepsy.

ISBN 978-1-78923-867-9

Epilepsy - Advances in Diagnosis and Therapy

Published in London, UK © 2019 IntechOpen © Dewang Gupta / unsplash


**5. Conclusions**

Preliminary findings show that postoperative CBT is e ffective as an add-on treatment to DBS in patients with therapy-resistent OCD. Further studies are necessary to establish the place of CBT after DBS. These studies should have larger sample sizes and designs that are adequate to quantify the added effects of both CBT as well as pharmacotherapy. In order to let patients benefit optimally from the experience and expertise of behavioral therapists working in DBS clinics, novel ways of administering CBT, such as administered by telephone, videoconferencing or online, should also be studied.

**Supplementary Materials:** The following are available online at http://www.mdpi.com/2077-0383/9/8/2383/s1, Table S1: Quality ratings of the included studies according to the Evidence Project risk of bias tool (Kennedy 2019).

**Author Contributions:** Conceptualization, A.F.G.L.; methodology, A.F.G.L.; formal analysis, M.G.; writing—original draft preparation, M.G.; writing—review and editing, T.B.v.d.V., K.S., L.A., M.P.; supervision, A.F.G.L. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.


**3. Complications of peptic ulcer**

The more frequent complication of peptic ulcer disease (PUD) is the bleeding (hemorrhage), followed by perforation and obstruction [13]. Some differences in the frequency among various complications can be found in the geographic distribution, due to amount of NSAIDs and ASA use, diffusion of *H. pylori* infection, lifestyles of the community. In fact the risk factors for complication occurrence in PUD, as hemorrhage or perforation, are the therapeutic use of NSAIDs or ASA, often as incorrect automedication, and untreated *H. pylori* infection.

#### **3.1 Risk factors for peptic ulcer complications**

In most cases peptic ulcer hemorrhage is connected with the use of NSAIDs and ASA. The risk degree is dose-dependent: the therapeutic employment of high

#### *Introductory Chapter: Complications of Gastroduodenal Ulcers DOI: http://dx.doi.org/10.5772/intechopen.101478*

dose is a greater risk factor for bleeding, compared with the use of medium or low dose of drugs [14]. The bleeding risk by NSAIDs is also drug-specific, for example, higher for Ketoralac and certainly higher for the synchronous use of aspirin and NSAIDs. Moreover these drugs play a real, concrete role in the occurrence of peptic ulcer perforation [15]. Likewise the presence of *H. pylori* infection is associated with the event of peptic ulcer complications as hemorrhage, but its role and mode of action are debatable in the development of the complication [16]. There are some hypotheses, sometimes conflicting, on the *H. pylori* actions: it was reported that the eradication of *H. pylori* infection reduces the bleeding complication; possible independent action or synergic interaction on peptic ulcer hemorrhage has been described; finally protective effect of *H. pylori* in the occurrence of hemorrhage was also communicated [17]. In some studies there is evidence of the absence of association between *H. pylori* infection and ulcer perforation [18]. Other risk factors for the development of the gastroduodenal ulcer complications, in particular bleeding, are the age over 60 years, associated use of corticosteroid and anticoagulants with NSAIDs, the presence of major comorbidities [19]. We could hypothesize a major incidence of peptic ulcer complications as bleeding or perforation in the patients with long history of ulcer disease without correct treatment, but there are not the studies comparing the incidence of complications before and after the wordwide introduction in the therapy of proton pump inhibitors and the eradication of *H. pylori* infection [16]. The pathological features of the peptic ulcer are an important factor that can modify the risk of complications: chronic ulcers, the penetrating character, and the great size of the lesions. The penetration into the gastroduodenal wall up to serosa, with sclerotic tissue, and erosive action on the blood vessels (sometimes of great size as gastroduodenal artery) are the pathological characteristics of bleeding and perforated peptic ulcers. All the complications of peptic ulcers require the preliminary therapeutic management: suspend ingestion of food, drinks, drugs; start the fluid resuscitation, immediate suspension, if previously foreseen in therapy, of ASA, NSAIDs, and also anticoagulant if possible, administer acid suppressive therapy with intravenous proton pump inhibitor (PPI), treatment of *H. pylori* infection, if certainly present [20]. The treatment of *H. pylori* infection actually decreases recurrent ulcers and the incidence of the complications. Consequently the therapeutic procedures for the eradication of the *H. pylori* infection (PPI, antibiotics per os, because the efficacy of antibiotics e.v. has not certainly demonstrated) have a fundamental role in the prevention of the complications and recurrences of the peptic ulcer disease [21].