Emerging trends in peptic ulcer disease and damage control surgery in the H. pylori era

The prevalence of peptic ulcer disease (PUD) and the frequency of operation have been decreasing for decades. Immigration of patients harboring Helicobacter pylori may reverse these longstanding declines. The experience with a large public hospital population in an area of high immigration may portend future national trends. A 10-year retrospective study analyzed the changing demographics of PUD and the frequency and nature of surgical intervention. A total of 2,182 patients were diagnosed with PUD, 1,173 in the early period (1995-1999) and 1,009 in the recent period (2000-2004). The proportion of Hispanic patients increased from 39.3 per cent to 47.5 per cent (P = 0.017). The ratio of male to female patients decreased from 1.7:1 to 1.3:1 (P = 0.003). The PUD operation rate decreased from 6.7 per cent to 3.8 per cent (P = 0.004). Among operated patients, the frequency of H. pylori testing increased from 41.8 per cent to 81.6 per cent (P = 0.039). Acute perforation and bleeding necessitated the vast majority (87.2%) of operations. The use of acid-reducing operations declined from 50.6 per cent to 31.6 per cent in favor of nonacid-reducing "damage control" procedures. Contrary to historic trends, in the predominately immigrant public hospital patient population studied, 1) the incidence of PUD is decreasing only modestly, 2) male predominance is disappearing, 3) gastric ulcer (GU) is more prevalent than duodenal ulcer (DU), but DU requires operation more frequently than GU, and 4) there is a marked decrease in use of acid-reducing operations reflecting a new "damage control" surgical approach to acute PUD complications in the H. pylori era.