Giant peptic ulcers in patients with chronic renal failure

The clinical characteristics and outcome of patients with peptic ulcer disease (PUD) in association with chronic renal insufficiency were compared with those of patients who had PUD without renal impairment. The number of patients hospitalized with PUD was 150, which represented 1.3% of all hospital admissions to Kingsbrook Jewish Medical Center over the two-year period August 1986 to August 1988. The incidence of PUD among the patients with end-stage renal disease was 2.6%. Mortality was significantly higher in patients with serum creatinine greater than 264 mumol/L (Group A) than in patients with serum creatinine less than 264 mumol/L (Group B) (p = 0.02). A striking finding was the presence of giant (greater than 2 cm in width) gastric and duodenal ulcers and ulcers of the second portion of the duodenum in both groups. The difference in number of giant ulcers in Group A and Group B was statistically significant (p less than 0.001). Moreover, the patients in Group A had a higher incidence of upper gastrointestinal bleeding and mortality than those in Group B. Group A patients also had a greater need for surgery than Group B patients. Both groups were predominantly elderly with a mean age greater than 65 years, which may have contributed to the increased incidence of complications and mortality.