Endoscopic follow-up of the perforated duodenal ulcer

Since the introduction of cimetidine, multiple studies have documented that H2 antagonists will heal over 95 per cent of duodenal ulcers with 6 to 8 weeks of therapy. Despite this overall decline, it has been shown that the rate of complications from duodenal ulcers, specifically perforation, has remained virtually unchanged. A retrospective look at the perforated duodenal ulcers admitted to the Medical College of Georgia between 1978 and 1984 revealed a total of 45 patients with 39 survivors. Eighty per cent of the 39 underwent follow-up endoscopy in a period of 4 to 12 weeks after perforation. Twenty-six of these patients had been treated with omental patch and an average of 7.5 weeks of cimetidine. Sixty-five per cent of those treated with omental patch and cimetidine continued to have active ulcer disease on endoscopic follow-up. Twenty-three per cent were asymptomatic despite active disease. Perforation appears to represent the severest form in the spectrum of duodenal ulcer disease. H2 antagonists have been shown to heal over 90 per cent of duodenal ulcers with 8 weeks of therapy. This study reveals them to be less effective with the perforated ulcer. It is recommended that patients treated with omental patch and cimetidine be followed closely with endoscopy and be considered for longer medical therapy.