title: 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.
authors.affiliation: Greenville Hospital System University Medical Center, University of South Carolina, School of Medicine-Greenville, Greenville, South Carolina, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Zelickson
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Bronder
authors.forename: Brent L
authors.initials: BL
authors.lastname: Johnson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Camunas
authors.forename: Dane E
authors.initials: DE
authors.lastname: Smith
authors.forename: Dustin
authors.initials: D
authors.lastname: Rawlinson
authors.forename: Stephen
authors.initials: S
authors.lastname: Von
authors.forename: H Harlan
authors.initials: HH
authors.lastname: Stone
authors.forename: Spence M
authors.initials: SM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D004381:Duodenal Ulcer / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome