Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors

Surgical Management of Upper Gastrointestinal Bleeding

The use of surgery in managing upper gastrointestinal (GI) bleeding has rapidly diminished secondary to advances in our understanding of the pathologies that underlie upper GI bleeding, pharmaceutical treatments for peptic ulcer disease, and endoscopic procedures used to gain hemostasis. A surgeon must work collaboratively with gastroenterologist and interventional radiologist to determine when, and what kind of, surgery is appropriate for the patient with upper GI bleeding.

Posterior Gastric Perforation with an Opening in Transverse Mesocolon: A Rare Case Report

Posterior gastric perforation is a very rare finding, difficult to diagnose due to the insidious onset of upper abdominal symptoms, and no air under the diaphragm on X-ray. Posterior gastric perforation which opens into transverse mesocolon is even rarer. This is a case report done to entail such a rare case, with only two cases reported in the past. We present the case of a 21-year-old female with pain in the epigastric region spreading to involve the whole abdomen, fever, vomiting, and anorexia. In our case, radiological findings revealed pneumoperitoneum. Intraoperatively, a tract was identified between the posterior wall of the stomach and transverse mesocolon. Tract was excised and primary repair was done using the Graham patch method.

Statewide Analysis of Peptic Ulcer Disease: As Hospitalizations Decrease, Procedural Volume Remains Steady

Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy in the 1980s. The authors’ clinical experience at a tertiary center, however, has been that procedures to treat PUD complications have not declined. This study tested the hypothesis that despite decreases in PUD hospitalizations, the volume of procedures for PUD complications has remained consistent. The study population included all inpatient encounters in the state of Maryland from 2009 to 2014 with a primary ICD-9 diagnosis code for PUD. Data on annual patient volume, demographics, anatomic location, procedures, complications, and outcomes were collected, and PUD prevalence rates were calculated. The study population consisted of the state's entire population, not a sample; statistical analysis was not applied. Hospitalizations for PUD declined from 2,502 in 2009 to 2,101 in 2014, whereas the percentage of hospitalizations with procedures increased from 27.1 to 31.5 per cent. Endoscopy was performed in 19.8 per cent of hospitalizations, operation in 9.4 per cent, and angiography in 1.3 per cent. Of 13,974 inpatient encounters, 30 per cent had at least one inhospital complication. Overall inpatient mortality was 2.2 per cent. PUD hospitalizations are declining in Maryland, mirroring national trends. A subset of patients continue to need urgent procedures for PUD complications, including nearly 10 per cent needing operation. Inpatient mortality among patients admitted for PUD was 2.2 per cent, congruent with other studies. Despite the efficacy of modern medical therapy, these data underscore the importance of teaching surgical residents the cognitive and operative skills necessary to manage PUD complications.

Massive gastric dilation caused by gastric outlet obstruction in the setting of peptic ulcer disease-A case report

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Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery.

Background

The prevalence of Peptic Ulcer Disease has decreased as did its elective surgical treatment, however its complications continue to occur.

Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

Case summary

In this report, we present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation. A subtotal gastrectomy with a Billroth II reconstruction was performed.

Discussion

Usually non-operative management is tried first, with medical therapy and endoscopic dilation. Emergent surgery is rarely needed, but in this patient, despite trying to optimize his condition first, the ulcer perforation precipitated surgical management.

Conclusion

Although Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer Disease and usually non-operative treatment is tried first, surgery may be necessary.

Disparities in peptic ulcer disease: A nationwide study

BACKGROUND

While advances in diagnosis and treatment of peptic ulcer disease have led to a decrease in hospital admissions the socioeconomic distribution of these benefits is unknown.

METHODS

We designed a retrospective cohort study using the National Inpatient Sample from 2012 to 2013 including all patients that were admitted for peptic ulcer disease. We compared the types of ulcer related complications, the rates of intervention and the outcomes based on race and insurance status.

RESULTS

Of 42,046 patients admitted for peptic ulcer disease 80.25% had an ulcer related complication. Black patients had the lowest rates of bleeding and highest rates of perforation and were less likely to undergo surgery for their complication but mortality was not different from white patients. Uninsured patients also had lower rates of bleeding and higher rates of perforation and they were at increased risk for death.

CONCLUSIONS

Unlike other surgical conditions insurance status, not race, predicts mortality in peptic ulcer disease.