title: Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study.
abstract: OBJECTIVE
  Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU).
  
  
  METHODS
  
  
  
  METHODS
  a nationwide cohort study with prospective and consecutive data collection.
  
  
  METHODS
  all patients treated for PUB and PPU at Danish hospitals between 2003 and 2014.
  
  
  METHODS
  demographic and clinical data reported to the Danish Clinical Registry of Emergency Surgery.
  
  
  METHODS
  90- and 30-d mortality and re-intervention.
  
  
  METHODS
  the crude and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis.
  
  
  RESULTS
  Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p < 0.001, OR 1.60 (1.43-1.77); p < 0.001, and OR 1.86 (1.68-2.06); p < 0.001, respectively. There was no difference in outcomes between gastric and duodenal ulcers (DUs) in PPU patients: adjusted OR 0.99 (0.84-1.16); p = 0.698, OR 0.93 (0.78 to 1.10); p = 0.409, and OR 0.97 (0.80-1.19); p = 0.799, respectively.
  
  
  CONCLUSIONS
  DU site is a significant predictor of death and re-intervention in patients with PUB, as compared to GU site. This does not seem to be the case for patients with PPU.
authors.affiliation: a Department of Gastroenterology, Surgical Unit , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Ida
authors.initials: I
authors.lastname: Lolle
authors.affiliation: b Department of Intensive Care 4131 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
authors.affiliation: a Department of Gastroenterology, Surgical Unit , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Steffen Jais
authors.initials: SJ
authors.lastname: Rosenstock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D003718:Denmark; D004386:Duodenum / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013270:Stomach / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Peptic ulcer bleeding; peptic ulcer disease; peptic ulcer perforation; prognosis