Surgical therapy of peptic ulcers in the 21st century: more common than you think.
BACKGROUND
The frequency of surgery for peptic ulcer disease (PUD) has decreased dramatically during the last 3 decades. The purpose of this study was to characterize the Veteran patients undergoing surgery for peptic ulcer disease in a modern series and to examine the effect of H. pylori status on surgical outcome and recurrence of PUD.


METHODS
An Institutional Review Board-approved retrospective review of all patients undergoing operations for peptic ulcer disease during a 66-month period at a single Veterans Administration medical center was performed. Patient records were examined for demographics, medication use, Helicobacter pylori status, operative details, and surgical outcomes.


RESULTS
From January 1999 to July 2004, 43 of 128 upper gastrointestinal operations were performed for PUD. Thirty-five operations (81%) were performed for bleeding or perforated ulcers, and 26 (60%) patients had no history of PUD. The mean age was 60 years, and 66% of patients were American Society of Anesthesiologists (ASA) class 3 or 4; 47% were Helicobacter pylori positive, and 54% used nonsteroidal anti-inflammatory (NSAID) medication. Hospital mortality was 23%. By univariate analysis, emergent surgery, higher ASA status, H. pylori status, and absence of a history of ulcer disease were risk factors for mortality (P <.05). Only 36% underwent definitive ulcer surgery. With a median follow-up of 18 months, there has been only 1 single recurrence (3%).


CONCLUSIONS
PUD still accounts for 33% of all gastroduodenal surgery performed in a Veterans Administration medical center. The majority of these operations are emergent operations in high-risk patients. In this era of effective acid suppression and H. pylori treatment, definitive ulcer surgery in the emergent setting may not be necessary.
Sarosi
George A
GA
Department of Surgery, North Texas Veterans Administration Medical Center, 4500 S Lancaster Rd., Dallas, TX 75216, USA. george.sarosi@utsouthwestern.edu
Jaiswal
Kshama R
KR
Nwariaku
Fiemu E
FE
Asolati
Massiamo
M
Fleming
Jason B
JB
Anthony
Thomas
T
D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality / Q000639:trends*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010437:Peptic Ulcer / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs