Perforated peptic ulcer: how to improve outcome?

Abstract

Despite the introduction of histamine H2-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring. To improve the outcome of these patients, it is necessary to investigate the reasons behind this high mortality rate. In this review we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evident status. Only a few randomized, controlled trials have been published. The mortality rate and the extent of postoperative complications are fairly high but the reasons for this have not been thoroughly explained, even though a number of risk factors have been identified. Some of these risk factors can be explained by the septic state of the patient on admission. In order to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment.

• Authors: Morten Hylander Møller, Sven Adamsen, Morten Wøjdemann, Ann Merete Møller
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 44 Issue 1 Pg. 15-22 ( 2009) ISSN: 1502-7708 [Electronic] England
• PMID: 18752147 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Proton Pump Inhibitors

Topics

• Anti-Inflammatory Agents, Non-Steroidal (adverse effects)
• Clinical Trials as Topic
• Denmark (epidemiology)
• Duodenal Ulcer (complications, diagnosis, etiology, mortality, therapy)
• Evidence-Based Medicine
• Gastrectomy
• Helicobacter Infections (complications)
• Helicobacter pylori (isolation & purification)
• Humans
• Incidence
• Meta-Analysis as Topic
• Peptic Ulcer Perforation (diagnosis, etiology, mortality, therapy)
• Prevalence
• Proton Pump Inhibitors
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Smoking (adverse effects)
• Stomach Ulcer (complications, diagnosis, etiology, mortality, therapy)
• Survival Rate