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Operations for peptic ulcer disease: paradigm lost.

W H Schwesinger1, C P Page, K R Sirinek

  • 1Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-7842, U.S.A. schwesinger@uthscsa.edu

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|May 3, 2002
PubMed
Summary

Improved medical and endoscopic treatments have significantly reduced the need for surgery in peptic ulcer disease (PUD). Operative management for PUD, including emergency procedures, is now rarely necessary.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Health Services Research

Background:

  • Peptic ulcer disease (PUD) management has evolved with advancements in pharmacologic and endoscopic therapies.
  • The impact of these advancements on the surgical treatment of PUD requires evaluation.

Purpose of the Study:

  • To assess the changes in operative management of gastroduodenal ulcers over a 20-year period.
  • To compare trends in PUD surgery with gastric malignancy resections and other general surgical procedures.

Main Methods:

  • A retrospective review of a computerized surgical database from two training hospitals.
  • Analysis of PUD operations performed during four consecutive 5-year intervals from 1980 to 1999.
  • Comparison of operative rates for PUD (intractable, hemorrhage, perforation, obstruction) against gastric cancer surgeries.

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Main Results:

  • Total upper gastrointestinal operations for PUD decreased by 80% from 1980-1984 to 1994-1999.
  • Operations for intractable PUD saw the most significant decline, with reductions also noted for bleeding, obstruction, and perforation.
  • Surgical rates for gastric malignancy remained relatively stable during the study period.

Conclusions:

  • Pharmacologic and endoscopic treatments have substantially reduced the necessity for surgical intervention in PUD.
  • Elective surgery for PUD is now uncommon, and emergency operations are less frequent.
  • The declining trend in PUD surgery presents new challenges for surgical training and practice adaptation.