In a 6-year prospective study from 1972 to 1978 266 patients were admitted to a haematemesis and melaena unit with bleeding duodenal ulcer. There were 13 deaths, a mortality of 5 per cent. A comparison between the three consecutive 2-year periods of study showed an initial mortality of 6 per cent for the first 4 years falling to 2 per cent for the 93 admissions during the final 2 years of experience. Of the 120 patients treated surgically, 10 died in hospital, giving an operative mortality of 8 per cent. The trend in operative mortality was from 13 per cent for the initial 2-year period to 8 per cent for the second period and to 3 per cent for the final 2 years. The operative rate was consecutively 45, 50 and 34 per cent. There was 1 death in conservatively treated patients during each 2-year period of study. Three types of operation were performed: vagotomy, pyloroplasty and oversewing of the ulcer; Polya gastrectomy; and vagotomy and antrectomy. There was no difference in morbidity and mortality between these operations. At a mean follow-up of 3.1 years, 90 per cent of the patients had a good result from their operation. It is concluded that a prospective system of management with an active policy of early endoscopy, surgery and regular audit reduces the mortality from bleeding duodenal ulcer.

Elective surgery for treatment of hemorrhage from duodenal ulcer.

Bleeding duodenal ulcer: reduction in mortality with a planned approach.

Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.

Massive upper gastrointestinal hemorrhage in the elderly

The natural history of duodenal ulcer disease.

Physiologic approach to the surgical management of duodenal ulcer.

Bleeding peptic ulcer in the elderly is associated with use of non-steroidal, anti-inflammatory drugs (NSAIDs) and aspirin, presenting a therapeutic dilemma for the treatment of survivors. To determine the longterm morbidity of patients surviving bleeding peptic ulcer and their treatment, with particular reference to NSAID use, this study followed up 487 patients aged over 60 years, who survived an episode of bleeding peptic ulcer in Nottingham during 1986 to 1991. Information was gathered by evaluation of general practitioner and hospital records, scrutiny of death certificates, and postal questionnaire to surviving patients. Of 487 patients surviving a bleeding peptic ulcer, 345 were alive at the follow up, a mean 34.2 months after discharge. Of these 201 (58%) had taken NSAIDs before their ulcer bleed (104 non-aspirin NSAIDs, 77 aspirin, 20 both). Compared with non-users, the patients using NSAIDs at the time of presentation were significantly more likely subsequently to consult their general practitioner with locomotor symptoms (56% v 35%, p < 0.001) and receive further NSAIDs (34% v 13%, p < 0.001), but significantly less likely to consult their general practitioner for dyspepsia (31% v 54%, p < 0.001). Antiulcer drug use was widespread in both groups, with an overall point prevalence of 44%. Seventy five patients received NSAIDs during the follow up period (69% with coprescription of antiulcer drugs, usually H2 antagonists). Recurrent peptic ulcer, ulcer complications, and ulcer related deaths were uncommon. Antiulcer drug use was lower in those with ulcer recurrence compared with the point prevalence in those without (17% v 44%, p < 0.05). Patient questionnaire responses confirmed a high level of locomotor symptoms especially in patients previously admitted with NSAID associated ulcer bleeding. In conclusion, in patients surviving peptic ulcer bleeding, recurrent ulcer complications and death seem to be lower than reported by studies that preceded the advent of antiulcer drugs. It is suggested that this low incidence may be a consequence of their use. Granted the low level of recurrent ulceration and the high level of locomotor symptoms in patients studied, current treatment may unduly emphasise the importance of stopping NSAIDs in this group of patients.

https://gut.bmj.com/content/gutjnl/37/2/182.full.pdf

Morbidity and treatment in elderly patients surviving hospital admission with bleeding peptic ulcer.

Branch of medicine focused on the digestive system and its disorders

Elective surgery for treatment of hemorrhage from duodenal ulcer.

Citations

Bleeding duodenal ulcer: reduction in mortality with a planned approach.

Massive upper gastrointestinal hemorrhage in the elderly

The natural history of duodenal ulcer disease.

Physiologic approach to the surgical management of duodenal ulcer.

Morbidity and treatment in elderly patients surviving hospital admission with bleeding peptic ulcer.

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Hyperselective vagotodmy in the elective treatment of duodenal ulcer