peptic%20ulcer%20disease
PEPTIC ULCER DISEASE
Peptic ulcer disease is the presence of ulceration in the stomach and proximal duodenum commonly and in the lower esophagus, distal duodenum or jejunum infrequently. It is characterized by mucosal damage secondary to pepsin and gastric acid secretion.
It is the principal cause of upper gastrointestinal hemorrhage.
Appropriate therapy depends on the cause of peptic ulcer disease.

Surgical Intervention

  • Recommended in patients with more emergent complications (ie hemorrhage, perforation, gastric outlet obstruction), refractory disease and intractability, or rare causes of ulcer disease (eg gastrinoma, Zollinger-Ellison syndrome)
    • The most common indication for surgery is bleeding
      • Surgical hemostasis is recommended for patients with bleeding peptic ulcer after failure of repeated endoscopy or after initial endoscopy in patients with >2 cm ulcers, hypotension and/or unstable hemodynamic status
    • Peritonitis is a surgical emergency that needs patient resuscitation, laparotomy and peritoneal toilet, or omental patch placement
  • Indications for elective peptic ulcer surgery include resection of ulcers suspected to be malignant, failure to heal despite maximal medical therapy, intolerance or noncompliance with medical regimen, and relapse while on maximal medical therapy
  • Options for duodenal ulcer may include truncal vagotomy, selective vagotomy, highly selective vagotomy, partial gastrectomy
  • Options for gastric ulcer may include partial gastrectomy with gastroduodenal or gastrojejunal anastomosis
  • Options to relieve chronic obstruction may include vagotomy and pyroplasty, antrectomy, or gastroenterostomy
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