Helicobacter Pylori Is Not the Predominant Etiology for Peptic Ulcers Requiring Operation

Abstract

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009. Emphasis was placed on individual etiologic factors for PUD. There were 128 patients (52% male, 81% white) who underwent emergency operation including: simple patch closure (n = 61, 48%); gastric resection (n = 22, 17%); gastric resection with vagotomy (n = 21,16%); vagotomy and pyloroplasty (n = 18,14%); or other procedures (n = 6, 5%). Complications necessitating operation were perforation (n = 79, 62%); bleeding (n = 29, 23%); obstruction (n = 12, 9%); and intractability (n = 8, 6%). Perioperative mortality was 12.5 per cent. Risk factors for PUD included tobacco use (50%), alcohol abuse (34%), and steroids (21%). Nonsteroidal anti-inflammatory use was confirmed in 68 (53%) patients. Of the 128 patients, 82 (64%) were tested for Helicobacter pylori, 33 (40%) of which were positive and 49 (60%) negative. Helicobacter pylori, thus, was the confirmed ulcer etiology in only 26 per cent of cases. Unlike contemporary series of medically treated PUD, Helicobacter pylori may not be the predominant etiologic factor in patients who experience complications requiring surgery. A “traditional” surgical approach with liberal use of vagotomy, not antibiotic triple therapy, may well be the preferred treatment consideration in such cases.

Assessment of recent epidemiological trends in peptic ulcer perforation patients in an eastern indian tertiary hospital

“…Zelickson MS et al found that NSAID use was confirmed in 68 (53%) patients of the 128 patients they studied. 19 Konturek SJ et al 20 claimed that NSAID alone was used by 6.2%-12.7% of ulcer patients out of 5967 patients. Other Studies by Gisbert JP et al 15 and Henry et al 16 suggested strong association of PPU with the use of NSAID.…”

Predictive Factors of Surgery in Peptic Stenosis of the Bulb

“…Table evolves in two phases, sthenique with violent postprandial pain relieved by vomiting, then asthenique with decrease or disappearance pain and vomiting, becoming more widely spaced but more abundant and containing ingested food sometimes several days previously. The frequency of infection with Helicobacter pylori is high in our series (55%) as well as in the European series [7] compared to American series [8] [9]. Unlike our study where PPI therapy had allowed the treatment of stenosis in 23.75% of cases, approximately 90% of the Western USB were treated successfully by a triple therapy [10] [11].…”

A Prospective Clinicoendoscopic Follow-up Study in Young Patients with Peptic Ulcer Perforation at a Tertiary Institute in Central India

“…Ghosh et al 14 found 28.4% patients taking NSAIDs and 3.9% patients taking NSAIDs and steroids in combination. Other studies by Zelickson et al 19 and Konturek et al 20 demonstrated 53% and 12.7% use of NSAIDs, respectively, by their study population. In the present study, 10 (17.5%) patients were having drug-induced perforation out of which two patients had active ulcer at 6 months.…”