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The number of patients being treated surgically for gastroduodenal disease has decreased over the past five decades as a result of focus on medical treatment. However, perforated and bleeding peptic ulcer disease (PUD) continues to represent a significant percentage of patients who require emergency surgery. The aim of this study was to characterize these critically ill surgical patients treated for gastroduodenal disease in our hospital. A retrospective, single-center, consecutive cohort study of all patients identified from the hospital National Surgical Quality Improvement Program database who were admitted to our institution requiring emergent surgical intervention over the past two years was conducted. Of 423 patients, 33 (7.8%) had operative procedures for complications of PUD, of which 19 patients (57.6%) had perforation; nine patients (27.3%) had hemorrhage; one patient (3.0%) had both perforation and hemorrhage; two patients (6.1%) had distal gastrectomies for ulcers refractory to medical management alone, and two patients (6.1%) had gastrectomies for malignant gastric neoplasms. There is a significant population of patients who present with life-threatening complications of PUD, despite the decline in PUD worldwide. These patients are critically ill and require careful and diligent management for good outcomes.
Peptic ulcer disease (PUD), which accounts for the bulk of gastroduodenal disease, affects approximately four million patients in the world every year.1 Despite this, since the advent of H2 blockers, proton pump inhibitors (PPIs), sucralfate, and the antibiotic therapy for Helicobacter pylori, the incidence of elective gastric surgery has nearly disappeared. since 2 to 14 per cent will experience either a perforation, with a mortality as high as 40 per cent, or a bleed, with a similar mortality rate, emergency surgery for these patients is a continuing challenge.
In addition, the management of these conditions can be controversial because of the focus on medical treatment. Guidelines, such as those of the Japanese society of Gastroenterology, do exist to help guide treatment.2 Although perforations may proceed directly to the operating room, bleeding is usually first addressed endoscopically. The aim of this study is to investigate the incidence of surgically treated gastroduodenal disease in our hospital and highlight the continued need for vigilance and surgical intervention...