PMID- 17629803
OWN - NLM
STAT- MEDLINE
DCOM- 20070809
LR  - 20221212
IS  - 1424-7860 (Print)
IS  - 0036-7672 (Linking)
VI  - 137
IP  - 23-24
DP  - 2007 Jun 16
TI  - Results of conservative treatment for perforated gastroduodenal ulcers in 
      patients not eligible for surgical repair.
PG  - 337-40
AB  - BACKGROUND: Conservative treatment of perforated gastroduodenal ulcer has been 
      shown to be associated with good results in patients whose general condition is 
      good. However, its use in patients not eligible for surgical repair has not been 
      supported. The aim of this study is to evaluate the results of conservative 
      treatment in these patients in the era of proton pump inhibitor. MATERIAL AND 
      METHODS: In the period 1978-2004, 533 patients were admitted for perforated 
      gastroduodenal ulcer. 503 patients underwent surgery, while 30 (median age 79 
      [42-98] years) were allocated to conservative treatment due to poor general 
      condition. Conservative treatment consisted of nasogastric aspiration, 
      antibiotics and antisecretory therapy (H2-blockers from 1978-1995, 11 patients, 
      and proton pump inhibitors (PPI) from 1996, 19 patients). Endpoints were: 
      hospital morbidity and mortality and hospital stay. RESULTS: Overall morbidity 
      and mortality were 33% and 30%. Median hospital stay was 11 days (range 0-32). 
      General complications developed in 73% versus 16% of patients (p = 0.023) and 
      mortality was 64% versus 11% (p = 0.008) for the H2-blocker and PPI groups 
      respectively. On multivariate analysis mortality correlated with presence of 
      shock at admission and type of antisecretory therapy. CONCLUSION: In the era of 
      PPI conservative treatment for perforated ulcer is possible with acceptable 
      morbidity and mortality in patients not eligible for surgical repair. However, 
      presence of shock at admission was associated with high mortality and, even in 
      these patients, militates in favour of a surgical approach.
FAU - Bucher, Pascal
AU  - Bucher P
AD  - Clinic of Visceral Surgery, Department of Surgery, Geneva University Hospital, 
      Geneva, Switzerland. Pascal.Bucher@hcuge.ch
FAU - Oulhaci, Wassila
AU  - Oulhaci W
FAU - Morel, Philippe
AU  - Morel P
FAU - Ris, Frederic
AU  - Ris F
FAU - Huber, Olivier
AU  - Huber O
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Intubation, Gastrointestinal
MH  - Length of Stay
MH  - Middle Aged
MH  - Peptic Ulcer/*complications/*drug therapy/mortality
MH  - Peptic Ulcer Perforation/*drug therapy/mortality
MH  - *Proton Pump Inhibitors
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2007/07/17 09:00
MHDA- 2007/08/10 09:00
CRDT- 2007/07/17 09:00
PHST- 2007/07/17 09:00 [pubmed]
PHST- 2007/08/10 09:00 [medline]
PHST- 2007/07/17 09:00 [entrez]
AID - smw-11796 [pii]
AID - 10.4414/smw.2007.11796 [doi]
PST - ppublish
SO  - Swiss Med Wkly. 2007 Jun 16;137(23-24):337-40. doi: 10.4414/smw.2007.11796.