Abstract
Background/Aims: The incidence of uncomplicated peptic ulcer has decreased in recent years. It is unclear what the impact of this has been on the epidemiology of peptic ulcer complications. This systematic review aimed to determine the incidence, recurrence and mortality of complicated peptic ulcer and the risk factors associated with these events. Methods: Systematic PubMed searches. Results: Overall, 93 studies were identified. Annual incidence estimates of peptic ulcer hemorrhage and perforation were 19.4–57.0 and 3.8–14 per 100,000 individuals, respectively. The average 7-day recurrence of hemorrhage was 13.9% (95% CI: 8.4–19.4), and the average long-term recurrence of perforation was 12.2% (95% CI: 2.5–21.9). Risk factors for peptic ulcer complications and their recurrence included nonsteroidal anti-inflammatory drug and/or acetylsalicylic acid use, Helicobacter pylori infection and ulcer size ≧1 cm. Proton pump inhibitor use reduced the risk of peptic ulcer hemorrhage. Average 30-day mortality was 8.6% (95% CI: 5.8–11.4) after hemorrhage and 23.5% (95% CI: 15.5–31.0) after perforation. Older age, comorbidity, shock and delayed treatment were associated with increased mortality. Conclusions: Complicated peptic ulcer remains a substantial healthcare problem which places patients at a high risk of recurrent complications and death.
Journal Section:
Review
References
1.
Xia B, Xia HH, Ma CW, Wong KW, Fung FM, Hui CK, Chan CK, Chan AO, Lai KC, Yuen MF, Wong BC: Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician-referred uninvestigated dyspeptic patients in Hong Kong. Aliment Pharmacol Ther 2005;22:243–249.
[PubMed]
2.
Wong SN, Sollano JD, Chan MM, Carpio RE, Tady CS, Ismael AE, Judan-Ruiz EA, Ang VN, Go JT, Lim VY, Perez JY, Alvarez SZ: Changing trends in peptic ulcer prevalence in a tertiary care setting in the Philippines: a seven-year study. J Gastroenterol Hepatol 2005;20:628–632.
[PubMed]
3.
Lassen A, Hallas J, Schaffalitzky de Muckadell OB: Complicated and uncomplicated peptic ulcers in a Danish county 1993–2002: a population-based cohort study. Am J Gastroenterol 2006;101:945–953.
[PubMed]
4.
Everhart JE: Recent developments in the epidemiology of Helicobacter pylori. Gastroenterol Clin North Am 2000;29:559–578.
[PubMed]
5.
McCarthy DM: Prevention and treatment of gastrointestinal symptoms and complications due to NSAIDs. Best Pract Res Clin Gastroenterol 2001;15:755–773.
[PubMed]
6.
Schiffmann L, Kahrau S, Berger G, Buhr HJ: Colon perforation in an adolescent after short-term diclofenac intake. ANZ J Surg 2005;75:726–727.
[PubMed]
7.
Sonnenberg A, Everhart JE: Health impact of peptic ulcer in the United States. Am J Gastroenterol 1997;92:614–620.
[PubMed]
8.
de Leest H, van Dieten H, van Tulder M, Lems WF, Dijkmans BA, Boers M: Costs of treating bleeding and perforated peptic ulcers in the Netherlands. J Rheumatol 2004;31:788–791.
[PubMed]
9.
Higham J, Kang JY, Majeed A: Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 2002;50:460–464.
[PubMed]
10.
Paimela H, Paimela L, Myllykangas-Luosujarvi R, Kivilaakso E: Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scand J Gastroenterol 2002;37:399–403.
[PubMed]
11.
Bardhan KD, Williamson M, Royston C, Lyon C: Admission rates for peptic ulcer in the Trent region, UK, 1972–2000. Changing pattern, a changing disease? Dig Liver Dis 2004;36:577–588.
[PubMed]
12.
Soplepmann J, Peetsalu A, Peetsalu M, Tein A, Juhola M: Peptic ulcer haemorrhage in Tartu County, Estonia: epidemiology and mortality risk factors. Scand J Gastroenterol 1997;32:1195–1200.
[PubMed]
13.
Langman MJ: Ulcer complications associated with anti-inflammatory drug use. What is the extent of the disease burden? Pharmacoepidemiol Drug Saf 2001;10:13–19.
[PubMed]
14.
Canoy DS, Hart AR, Todd CJ: Epidemiology of duodenal ulcer perforation: a study on hospital admissions in Norfolk, United Kingdom. Dig Liver Dis 2002;34:322–327.
[PubMed]
15.
van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, Tytgat GN: Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494–1499.
[PubMed]
16.
Thomopoulos KC, Vagenas KA, Vagianos CE, Margaritis VG, Blikas AP, Katsakoulis EC, Nikolopoulou VN: Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol 2004;16:177–182.
[PubMed]
17.
Bobrzynski A, Beben P, Budzynski A, Bielanski W, Plonka M, Konturek S: Incidence of complications of peptic ulcers in patients with Helicobacter pylori (Hp) infection and/or NSAID use in the era of Hp eradication. Med Sci Monit 2002;8:CR554–CR557.
18.
Andersen IB, Jorgensen T, Bonnevie O, Gronbaek M, Sorensen TI: Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study. Epidemiology 2000;11:434–439.
[PubMed]
19.
Gisbert JP, Legido J, Garcia-Sanz I, Pajares JM: Helicobacter pylori and perforated peptic ulcer prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Dig Liver Dis 2004;36:116–120.
[PubMed]
20.
Schnitzer TJ, Burmester GR, Mysler E, Hochberg MC, Doherty M, Ehrsam E, Gitton X, Krammer G, Mellein B, Matchaba P, Gimona A, Hawkey CJ: Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. Lancet 2004;364:665–674.
[PubMed]
21.
Imhof M, Ohmann C, Hartwig A, Thon KP, Hengels KJ, Roher HD: Which peptic ulcers bleed? Results of a case-control study. Scand J Gastroenterol 1997;32:131–138.
[PubMed]
22.
Kuyvenhoven JP, Veenendaal RA, Vandenbroucke JP: Peptic ulcer bleeding: interaction between non-steroidal anti-inflammatory drugs, Helicobacter pylori infection, and the ABO blood group system. Scand J Gastroenterol 1999;34:1082–1086.
[PubMed]
23.
Santolaria S, Lanas A, Benito R, Perez-Aisa M, Montoro M, Sainz R: Helicobacter pylori infection is a protective factor for bleeding gastric ulcers but not for bleeding duodenal ulcers in NSAID users. Aliment Pharmacol Ther 1999;13:1511–1518.
[PubMed]
24.
Hsu PI, Lai KH, Tseng HH, Lin CK, Lo GH, Cheng JS, Chan HH, Chen GC, Jou HS, Peng NJ, Ger LP, Chen W, Hsu PN: Risk factors for presentation with bleeding in patients with Helicobacter pylori-related peptic ulcer diseases. J Clin Gastroenterol 2000;30:386–391.
[PubMed]
25.
Ng TM, Fock KM, Khor JL, Teo EK, Sim CS, Tan AL, Machin D: Non-steroidal anti-inflammatory drugs, Helicobacter pylori and bleeding gastric ulcer. Aliment Pharmacol Ther 2000;14:203–209.
[PubMed]
26.
Okan A, Tankurt E, Aslan BU, Akpinar H, Simsek I, Gonen O: Relationship between non-steroidal anti-inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: a case-control study. J Gastroenterol Hepatol 2003;18:18–25.
[PubMed]
27.
Gisbert JP, Gonzalez L, de Pedro A, Valbuena M, Prieto B, Llorca I, Briz R, Khorrami S, Garcia-Gravalos R, Pajares JM: Helicobacter pylori and bleeding duodenal ulcer: prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol 2001;36:717–724.
[PubMed]
28.
Lanas A, García Rodríguez LA, Arroyo MT, Gomollón F, Feu F, González-Pérez A, Zapata E, Bástida G, Rodrigo L, Santolaria S, Güell M, de Argila CM, Quintero E, Borda F, Piqué JM: Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut 2006;55:1731–1738.
[PubMed]
29.
Zapata-Colindres JC, Zepeda-Gomez S, Montano-Loza A, Vazquez-Ballesteros E, de Jesus Villalobos J, Valdovinos-Andraca F: The association of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in peptic ulcer disease. Can J Gastroenterol 2006;20:277–280.
[PubMed]
30.
Lanas A, García Rodríguez LA, Arroyo MT, Bujanda L, Gomollón F, Forné M, Aleman S, Nicolas D, Feu F, González-Pérez A, Borda A, Castro M, Poveda MJ, Arenas J: Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol 2007;102:507–515.
[PubMed]
31.
Labenz J, Peitz U, Köhl H, Kaiser J, Malfertheiner P, Hackelsberger A, Börsch G: Helicobacter pylori increases the risk of peptic ulcer bleeding: a case-control study. Ital J Gastroenterol Hepatol 1999;31:110–115.
[PubMed]
32.
Castillo-Rojas G, Ballesteros MA, Ponce de León S, Morales-Espinosa R, Cravioto A, López-Vidal Y: Bleeding peptic ulcers and presence of Helicobacter pylori by various tests: a case-control study. Eur J Gastroenterol Hepatol 2002;14:1113–1118.
[PubMed]
33.
Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sainz R: Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 2002;16:779–786.
[PubMed]
34.
Vergara M, Casellas F, Saperas E, de Torres I, Lopez J, Borruel N, Armengol JR, Malagelada JR: Helicobacter pylori eradication prevents recurrence from peptic ulcer haemorrhage. Eur J Gastroenterol Hepatol 2000;12:733–737.
[PubMed]
35.
Gralnek IM, Jensen DM, Gornbein J, Kovacs TO, Jutabha R, Freeman ML, King J, Jensen ME, Cheng S, Machicado GA, Smith JA, Randall GM, Sue M: Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials. Am J Gastroenterol 1998;93:2047–2056.
[PubMed]
36.
Cheng HC, Chuang SA, Kao YH, Kao AW, Chuang CH, Sheu BS: Increased risk of rebleeding of peptic ulcer bleeding in patients with comorbid illness receiving omeprazole infusion. Hepatogastroenterology 2003;50:2270–2273.
[PubMed]
37.
Bini EJ, Cohen J: Endoscopic treatment compared with medical therapy for the prevention of recurrent ulcer hemorrhage in patients with adherent clots. Gastrointest Endosc 2003;58:707–714.
[PubMed]
38.
Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, Kwok SP: Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial. Gut 2003;52:1403–1407.
[PubMed]
39.
Hermansson M, Stael von Holstein C, Zilling T: Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors. Scand J Gastroenterol 1997;32:523–529.
[PubMed]
40.
Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Akahoshi K, Ayukawa K, Wada H, Tanoue K, Sugimachi K: The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology 2001;48:156–162.
[PubMed]
41.
Evans JP, Smith R: Predicting poor outcome in perforated peptic ulcer disease. ANZ J Surg 1997;67:792–795.
42.
Sharma SS, Mamtani MR, Sharma MS, Kulkarni H: A prospective cohort study of postoperative complications in the management of perforated peptic ulcer. BMC Surg 2006;6:8.
[PubMed]
43.
Cebollero-Santamaria F, Smith J, Gioe S, Van Frank T, Mc Call R, Airhart J, Perrillo R: Selective outpatient management of upper gastrointestinal bleeding in the elderly. Am J Gastroenterol 1999;94:1242–1247.
[PubMed]
44.
Godil A, DeGuzman L, Schilling RC 3rd, Khan SA, Chen YK: Recent nonsteroidal anti-inflammatory drug use increases the risk of early recurrence of bleeding in patients presenting with bleeding ulcer. Gastrointest Endosc 2000;51:146–151.
[PubMed]
45.
García Rodríguez LA, Hernández-Díaz S: Risk of uncomplicated peptic ulcer among users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs. Am J Epidemiol 2004;159:23–31.
[PubMed]
46.
Hasselgren G, Carlsson J, Lind T, Schaffalitzky de Muckadell O, Lundell L: Risk factors for rebleeding and fatal outcome in elderly patients with acute peptic ulcer bleeding. Eur J Gastroenterol Hepatol 1998;10:667–672.
[PubMed]
47.
Chiu PW, Joeng HK, Choi CL, Kwong KH, Ng EK, Lam SH: Predictors of peptic ulcer rebleeding after scheduled second endoscopy: clinical or endoscopic factors? Endoscopy 2006;38:726–729.
[PubMed]
48.
Guglielmi A, Ruzzenente A, Sandri M, Kind R, Lombardo F, Rodella L, Catalano F, de Manzoni G, Cordiano C: Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy 2002;34:778–786.
[PubMed]
49.
Chung IK, Kim EJ, Lee MS, Kim HS, Park SH, Lee MH, Kim SJ, Cho MS, Hwang KY: Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers. Endoscopy 2001;33:969–975.
[PubMed]
50.
Chow LW, Gertsch P, Poon RT, Branicki FJ: Risk factors for rebleeding and death from peptic ulcer in the very elderly. Br J Surg 1998;85:121–124.
[PubMed]
51.
Al-Akeely MH, Alam MK, Al-Salamah SM, Abdu MA, Al-Teimi IN, Mohammed AA: Initial factors predicting rebleeding and death in bleeding peptic ulcer disease. Saudi Med J 2004;25:642–647.
[PubMed]
52.
García Rodríguez LA, Ruigómez A: Secondary prevention of upper gastrointestinal bleeding associated with maintenance acid-suppressing treatment in patients with peptic ulcer bleed. Epidemiology 1999;10:228–232.
[PubMed]
53.
Kim HS, Hwang KY, Chung IK, Park SH, Lee MH, Kim SJ, Hong SY: Tissue plasminogen activator and plasminogen activator inhibitor type 1 gene polymorphism in patients with gastric ulcer complicated with bleeding. J Korean Med Sci 2003;18:58–64.
[PubMed]
54.
Lin HJ, Tseng GY, Lo WC, Lee FY, Perng CL, Chang FY, Lee SD: Predictive factors for rebleeding in patients with peptic ulcer bleeding after multipolar electrocoagulation: a retrospective analysis. J Clin Gastroenterol 1998;26:113–116.
[PubMed]
55.
Kubba AK, Choudari C, Rajgopal C, Ghosh S, Palmer KR: Reduced long-term survival following major peptic ulcer haemorrhage. Br J Surg 1997;84:265–268.
[PubMed]
56.
Mose H, Larsen M, Riis A, Johnsen SP, Thomsen RW, Sorensen HT: Thirty-day mortality after peptic ulcer bleeding in hospitalized patients receiving low-dose aspirin at time of admission. Am J Geriatr Pharmacother 2006;4:244–250.
[PubMed]
57.
Chan WH, Wong WK, Khin LW, Soo KC: Adverse operative risk factors for perforated peptic ulcer. Ann Acad Med Singapore 2000;29:164–167.
[PubMed]
58.
Blomgren LG: Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 1997;21:412–415.
[PubMed]
59.
Kujath P, Schwandner O, Bruch HP: Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg 2002;387:298–302.
[PubMed]
60.
Rajesh V, Chandra SS, Smile SR: Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol 2003; 24:148–150.
[PubMed]
61.
Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, Dolapci M, Cengiz O: Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 2007;22:565–570.
[PubMed]
62.
Deus Fombellida J, Gil Romea I, Moreno Mirallas MJ, Urieta Carpi A: Risk factors in the surgical management of perforated duodeno-pyloric ulcer. Rev Esp Enferm Dig 1998;90:503–513.
[PubMed]
63.
Imhof M, Schroders C, Ohmann C, Roher H: Impact of early operation on the mortality from bleeding peptic ulcer – ten years’ experience. Dig Surg 1998;15:308–314.
[PubMed]
64.
Sillakivi T, Lang A, Tein A, Peetsalu A: Evaluation of risk factors for mortality in surgically treated perforated peptic ulcer. Hepatogastroenterology 2000;47:1765–1768.
[PubMed]
65.
Imhof M, Epstein S, Ohmann C, Roher HD: Poor late prognosis of bleeding peptic ulcer. Langenbecks Arch Surg 2007;392:587–591.
[PubMed]
66.
Hasselgren G, Blomqvist A, Eriksson S, Henningsson A, Lundell L: Short and long term course of elderly patients with peptic ulcer bleeding – analysis of factors influencing fatal outcome. Eur J Surg 1998;164:685–691.
[PubMed]
67.
García Rodríguez LA, Ruigómez A, Hasselgren G, Wallander MA, Johansson S: Comparison of mortality from peptic ulcer bleed between patients with or without peptic ulcer antecedents. Epidemiology 1998;9:452–456.
[PubMed]
68.
Thomsen RW, Riis A, Christensen S, Norgaard M, Sorensen HT: Diabetes and 30-day mortality from peptic ulcer bleeding and perforation: a Danish population-based cohort study. Diabetes Care 2006;29:805–810.
[PubMed]
69.
Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, Vilaca H: Perforated peptic ulcer: main factors of morbidity and mortality. World J Surg 2003;27:782–787.
[PubMed]
70.
Chou NH, Mok KT, Chang HT, Liu SI, Tsai CC, Wang BW, Chen IS: Risk factors of mortality in perforated peptic ulcer. Eur J Surg 2000;166:149–153.
[PubMed]
71.
Madiba TE, Nair R, Mulaudzi TV, Thomson SR: Perforated gastric ulcer – reappraisal of surgical options. S Afr J Surg 2005;43:58–60.
[PubMed]
72.
Kang JY, Tinto A, Higham J, Majeed A: Peptic ulceration in general practice in England and Wales 1994–98: period prevalence and drug management. Aliment Pharmacol Ther 2002;16:1067–1074.
[PubMed]
73.
Singh G, Triadafilopoulos G: Epidemiology of NSAID-induced gastrointestinal complications. J Rheumatol Suppl 1999;56:18–24.
[PubMed]
74.
Hudson N, Balsitis M, Filipowicz F, Hawkey CJ: Effect of Helicobacter pylori colonisation on gastric mucosal eicosanoid synthesis in patients taking non-steroidal anti-inflammatory drugs. Gut 1993;34:748–751.
[PubMed]
75.
Konturek JW, Dembinski A, Konturek SJ, Stachura J, Domschke W: Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology 1998;114:245–255.
[PubMed]
76.
Laine L, Cominelli F, Sloane R, Casini-Raggi V, Marin-Sorensen M, Weinstein WM: Interaction of NSAIDs and Helicobacter pylori on gastrointestinal injury and prostaglandin production: a controlled double-blind trial. Aliment Pharmacol Ther 1995;9:127–135.
[PubMed]
77.
El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE: Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology 1997;113:15–24.
[PubMed]
78.
Huang JQ, Sridhar S, Hunt RH: Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 2002;359:14–22.
[PubMed]
79.
Cappell MS: A study of the syndrome of simultaneous acute upper gastrointestinal bleeding and myocardial infarction in 36 patients. Am J Gastroenterol 1995;90:1444–1449.
[PubMed]
80.
Ohmann C, Imhof M, Ruppert C, Janzik U, Vogt C, Frieling T, Becker K, Neumann F, Faust S, Heiler K, Haas K, Jurisch R, Wenzel EG, Normann S, Bachmann O, Delgadillo J, Seidel F, Franke C, Luthen R, Yang Q, Reinhold C: Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914–920.
[PubMed]
81.
Ramsoekh D, van Leerdam ME, Rauws EA, Tytgat GN: Outcome of peptic ulcer bleeding, nonsteroidal anti-inflammatory drug use, and Helicobacter pylori infection. Clin Gastroenterol Hepatol 2005;3:859–864.
[PubMed]
82.
Kang JY, Elders A, Majeed A, Maxwell JD, Bardhan KD: Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982–2002. Aliment Pharmacol Ther 2006;24:65–79.
[PubMed]
83.
Smalley WE, Ray WA, Daugherty JR, Griffin MR: No association between calcium channel blocker use and confirmed bleeding peptic ulcer disease. Am J Epidemiol 1998;148:350–354.
[PubMed]
84.
Klatsky AL, Tekawa I: Health problems and hospitalizations among Asian-American ethnic groups. Ethn Dis 2005;15:753–760.
[PubMed]
85.
Ng W, Wong WM, Chen WH, Tse HF, Lee PY, Lai KC, Li SW, Ng M, Lam KF, Cheng X, Lau CP: Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease. World J Gastroenterol 2006;12:2923–2927.
[PubMed]
86.
Lin HJ, Lo WC, Perng CL, Wang K, Lee FY: Can optimal acid suppression prevent rebleeding in peptic ulcer patients with a non-bleeding visible vessel: a preliminary report of a randomized comparative study. Hepatogastroenterology 1997;44:1495–1499.
[PubMed]
87.
Bardhan KD, Nayyar AK, Royston C: The outcome of bleeding duodenal ulcer in the era of H2 receptor antagonist therapy. QJM 1998;91:231–237.
[PubMed]
88.
Garrigan K, McIntosh C, Fraser AG: Bleeding peptic ulcers: audit of eradication treatment for H pylori. N Z Med J 1999;112:178–180.
[PubMed]
89.
Lai KC, Hui WM, Wong WM, Wong BC, Hu WH, Ching CK, Lam SK: Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage – a long-term randomized, controlled study. Am J Gastroenterol 2000;95:2225–2232.
[PubMed]
90.
Segal F, Prolla JC, Maguilnik I, Wolff FH: Clinical and endoscopic aspects in the evolution of patients with bleeding peptic ulcer – a cohort study. Arq Gastroenterol 2000;37:162–167.
[PubMed]
91.
Lanas A, Rodrigo L, Marquez JL, Bajador E, Perez-Roldan F, Cabrol J, Quintero E, Montoro M, Gomollón F, Santolaria S, Lorente S, Cucala M, Nuevo J: Low frequency of upper gastrointestinal complications in a cohort of high-risk patients taking low-dose aspirin or NSAIDS and omeprazole. Scand J Gastroenterol 2003;38:693–700.
[PubMed]
92.
Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L: Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol 2003;9:2338–2340.
[PubMed]
93.
Chan FK, Hung LC, Suen BY, Wong VW, Hui AJ, Wu JC, Leung WK, Lee YT, To KF, Chung SC, Sung JJ: Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology 2004;127:1038–1043.
[PubMed]
94.
Chan FK, Ching JY, Hung LC, Wong VW, Leung VK, Kung NN, Hui AJ, Wu JC, Leung WK, Lee VW, Lee KK, Lee YT, Lau JY, To KF, Chan HL, Chung SC, Sung JJ: Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005;352:238–244.
[PubMed]
95.
Horvat D, Vcev A, Soldo I, Timarac J, Dmitrovic B, Misevic T, Ivezic Z, Kraljik N: The results of Helicobacter pylori eradication on repeated bleeding in patients with stomach ulcer. Coll Antropol 2005;29:139–142.
[PubMed]
96.
Hung LC, Ching JY, Sung JJ, To KF, Hui AJ, Wong VW, Leong RW, Chan HL, Wu JC, Leung WK, Lee YT, Chung SC, Chan FK: Long-term outcome of Helicobacter pylori-negative idiopathic bleeding ulcers: a prospective cohort study. Gastroenterology 2005;128:1845–1850.
[PubMed]
97.
Cooper GS, Yuan Z, Rosenthal GE, Chak A, Rimm AA: Lack of gender and racial differences in surgery and mortality in hospitalized Medicare beneficiaries with bleeding peptic ulcer. J Gen Intern Med 1997;12:485–490.
[PubMed]
98.
Kapetanakis AM, Kyprizlis EP, Tsikrikas TS: Efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer. Hepatogastroenterology 1997;44:288–293.
[PubMed]
99.
Thomopoulos K, Katsakoulis E, Vagianos C, Mimidis K, Margaritis V, Nikolopoulou V: Causes and clinical outcome of acute upper gastrointestinal bleeding: a prospective analysis of 1534 cases. Int J Clin Pract 1998;52:547–550.
[PubMed]
100.
Lakhwani MN, Ismail AR, Barras CD, Tan WJ: Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia. Med J Malaysia 2000;55:498–505.
[PubMed]
101.
Ruigómez A, García Rodríguez LA, Hasselgren G, Johansson S, Wallander MA: Overall mortality among patients surviving an episode of peptic ulcer bleeding. J Epidemiol Community Health 2000;54:130–133.
[PubMed]
102.
Brock J, Sauaia A, Ahnen D, Marine W, Schluter W, Stevens BR, Scinto JD, Karp H, Bratzler D: Process of care and outcomes for elderly patients hospitalized with peptic ulcer disease: results from a quality improvement project. JAMA 2001;286:1985–1993.
[PubMed]
103.
Adamopoulos AB, Efstathiou SP, Tsioulos DI, Tzamouranis DG, Tsiakou AG, Tiniakos D, Mountokalakis TD: Bleeding duodenal ulcer: comparison between Helicobacter pylori positive and Helicobacter pylori negative bleeders. Dig Liver Dis 2004;36:13–20.
[PubMed]
104.
Duggan JM, Zinsmeister AR, Kelly KA, Melton LJ 3rd: Long-term survival among patients operated upon for peptic ulcer disease. J Gastroenterol Hepatol 1999;14:1074–1082.
[PubMed]
105.
Sillakivi T, Yang Q, Peetsalu A, Ohmann C: Perforated peptic ulcer: is there a difference between Eastern Europe and Germany? Copernicus Study Group and Acute Abdominal Pain Study Group. Langenbecks Arch Surg 2000;385:344–349.
[PubMed]
106.
Lee FY, Leung KL, Lai BS, Ng SS, Dexter S, Lau WY: Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg 2001;136:90–94.
[PubMed]
107.
Somboonpanya P: Surgery for perforated peptic ulcers at Prachomklao Hospital. J Med Assoc Thai 2002;85:1003–1007.
[PubMed]
108.
Rahuman MM, Saha AK, Rahim A: Experience of peptic ulcer perforation over a decade in a teaching hospital of southern Bangladesh. Ceylon Med J 2003;48:53–55.
[PubMed]
109.
Ozalp N, Zulfikaroglu B, Bilgic I, Koc M: Evaluation of risk factors for mortality in perforated peptic ulcer in Ankara Numune Teaching Hospital, Ankara, Turkey. East Afr Med J 2004;81:634–637.
[PubMed]
110.
Veliyev NA, Merrell RC: Differentiated approach to surgical treatment of patients with perforated duodenal ulcer. Chirurgia (Bucur) 2004;99:119–123.
[PubMed]
111.
Ersumo T, Y WM, Kotisso B: Perforated peptic ulcer in Tikur Anbessa Hospital: a review of 74 cases. Ethiop Med J 2005;43:9–13.
[PubMed]
112.
Lunevicius R, Morkevicius M: Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value. Langenbecks Arch Surg 2005;390:413–420.
[PubMed]
113.
Christensen S, Riis A, Norgaard M, Thomsen RW, Tonnesen EM, Larsson A, Sorensen HT: Perforated peptic ulcer: use of pre-admission oral glucocorticoids and 30-day mortality. Aliment Pharmacol Ther 2006;23:45–52.
[PubMed]
© 2011 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2011
You do not currently have access to this content.
