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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical practice in the treatment of peptic ulceration in Denmark is illustrated by means of a questionnaire. The percentage of replies was 96. The investigation reveals that the predominant method of elective surgery for duodenal ulceration is still proximal gastric vagotomy rather than vagotomy+antrectomy. In elective surgery for prepyloric ulcer, vagotomy+antrectomy is employed most frequently and for elective operation for gastric ulcer partial gastric resection. In operative interventions for complications of ulceration such as haemorrhage and perforation, the operative strategy appears to be determined by the difficult current possibilities for training in ulcer surgery to a not inconsiderable extent, rather than to be based on a rational scientific basis as the definitive intervention here is replaced to a great extent by minor interventions such as simple undersewing of a bleeding gastric ulcer followed by H2-blocker treatment and simple closure of a perforated duodenal ulcer.
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PMID:[Surgical interventions in ulcer diseases in Denmark. A questionnaire study]. 135

Since the advent of H2-receptor antagonists, elective ulcer surgery is rare. The need for operation for complications of peptic ulcer disease, however, remains unchanged. Highly selective vagotomy is the elective operation of choice for duodenal ulcer worldwide. It has few side effects and a mortality that approaches 0%. Unfortunately, ulcers recur in 10% to 15% of patients, a much higher recurrence rate than that seen with vagotomy and antrectomy (less than 1%). The latter operation, however, is associated with significant side effects, such as dumping syndrome and diarrhea, and a higher operative mortality. The elective operation of choice for gastric ulcer is antrectomy. Recent prospective trials show that highly selective vagotomy should be performed routinely at the time of closure of perforated duodenal ulcer. Neither morbidity nor mortality is increased with the procedure, and the 40% to 60% ulcer recurrence rate with closure alone is reduced to 2% to 8%.
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PMID:Surgical management of peptic ulcer disease. 139 8

Hydrogen clearance was used to assess blood flow in fundal and antral gastric mucosa as well as in the lobule of the auricle in 127 patients with ulcer (99 duodenal and 28 gastric ulcer cases), 34 patients with gastric, duodenal, pancreatic and biliary ++non-ulcer lesions against 20 healthy subjects. The findings underwent analysis in relation to the disease form and phase, baseline characteristics of the mucosa (morphological, functional and bacteriological) and changes in them in response to pentagastrin (6 micrograms/kg), alupent (0.0075 mg/kg), clofelin (0.0015 mg/kg) administration. For ulcer involving the body of the stomach and sutured perforated duodenal ulcer, fundal and antral mucosa blood flow showed a decrease by 1/3, the lowest values presenting in the active disease phase. Diminution in gastric mucosa blood flow correlated with gravity of its gastritic lesion and was not directly related to its Campylobacter contamination. Pentagastrin stimulated blood flow in fundic mucosa and led to its 30% increase whereas the flow intensity remained unaffected in the antral mucosa and skin (lobule of the auricle). Acid production in response to pentagastrin introduction rose 3.5-fold, pepsin 2.1-fold. Alupent and clofelin do not affect blood flow causing a 30-50% increase and decrease in acid and pepsin production, respectively. Separate neurohumoral regulation of gastric mucosa blood flow and secretory activity of the latter permits differential correction of each of the impaired functions.
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PMID:[Characteristics of blood flow in the gastric mucosa in relation to its structure and function in patients with peptic ulcer]. 194 70

Seventy-four patients, admitted in emergency for acute perforation of a duodenal or gastric ulcer were reviewed retrospectively: 40 patients with one or several risk factor such as shock, old perforation, severe chronic illness or advanced age and 34 other patients without any risk factor. In this selected population, the surgical treatment, initially performed in 44 cases, consisted of suturing the perforation and draining the peritoneal cavity in all cases but four in which it was associated with a vagotomy (2 cases) or a distal gastrectomy (2 cases). Thirty younger patients admitted without shock, within 6 hours following the onset of the perforation were initially treated by digestive aspiration alone: this medical treatment was successful in 15 patients but required a subsequent laparotomy in the other cases. The overall postoperative mortality is 18% but is zero in the group of patients in whom a medical therapy was initially performed. Long-term follow-up shows that 70% of the patients with a perforated duodenal ulcer and without any anti-inflammatory drug past history at the time of the perforation are free from any symptom. A strategy for the management of perforated duodenal and gastric ulcers, applicable to a non-selected population, is proposed in reference to the surgical literature.
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PMID:[The treatment of perforated gastro-duodenal ulcer]. 223 33

Determination was made of in situ gastric pH during early morning in fasting state (basal pH) by using wired glass electrodes, and results obtained were analyzed. Analysis of the pattern of variation in intragastric pH at night revealed no substantial difference between normal subjects and patients with peptic ulcer but a tendency to be lower in the latter group. It was also shown that sleeping waves appeared in the electroencephalogram in association with the increase in intragastric pH during sleep at night. The basal pH value was 5.4 +/- 2.1 in patients with gastric cancer, 3.0 +/- 2.2 in those with gastritis, 2.4 +/- 1.9 in those with gastric ulcer, 1.7 +/- 0.2 in normal subjects and 1.3 +/- 0.6 in patients with duodenal ulcer. In gastric ulcer patients more anal site of ulcer lesion was associated with lower mean age of the patients and higher incidence of intestinal metaplastic gastritis of the antral or non-metaplastic type. In patients who underwent partial gastrectomy for peptic ulcer, the pH value in the remnant stomach tended to become higher with the lapse of time in all cases, being constant at about 3 months postoperatively. The decrease in gastric acidity at 12 months after operation was incomplete in patients who underwent emergency gastrectomy for perforated duodenal ulcer but satisfactory in those who underwent selective vatotomy and anterectomy as elective operations.
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PMID:A study of intragastric pH in patients with peptic ulcer--with special reference to the clinical significance of basal pH value. 732 83

We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy when compared to those done for chronic uncomplicated ulcer or perforated duodenal ulcer. Of these 30 patients, 22 had a compromise of either gastric acidity or motility at the time of operation. These two factors appear to be most significant in controlling the organisms which reach the stomach from swallowed saliva or by reflux through the pylorus. The organisms most frequently causing infection after gastroduodenal operations are endogenous to the stomach and include aerobic enteric gram-negative bacilli and oral, penicillin-sensitive anaerobes. Exogenous bacteria such as Staphylococcus aureus are a less frequent cause of infection after these operations.
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PMID:Sepsis after gastroduodenal operations: relationship to gastric acid, motility, and endogenous microflora. 738 47

Experience is recorded with the operative treatment of 185 patients with perforated gastric and duodenal ulcer over the period 1981-1991. The period was divided in two: 1981-1985 and 1986-1991. During the first period were operated 89 patients: 58 with perforated duodenal ulcer and 31 with gastric ulcer. The method of choice during this period was suture of the perforation. During the second period were operated 96 patients: 90 with duodenal and 6 with gastric ulcer. Surgical approach was also individualized depending on the pathologic process, patient age and accompanying diseases. The following operative interventions were performed: "pure suture" of the ulcer--55 patients; gastric resection by Billroth I and II techniques--7 patients; different variants of vagotomy with drainage operation--34 patients. Analysis of the immediate results in 42 patients demonstrated that best results were obtained by vagotomy + drainage operations.
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PMID:[The modern aspects of the surgical treatment of the perforated gastric and duodenal ulcer with a view to the immediate results]. 841 55

Between 1988 and 1997 in 226 patients (169 males--75.2% and 57 females--24.8%) surgical treatment was performed due to duodenal ulcer perforation (205 cases--90.7%) or gastric ulcer perforation (21 cases--9.3%, including 3 cases of perforated gastric cancer). Mean age was 51.5 years (19-94 years). In perforated duodenal ulcer the main procedure was truncal vagotomy with pyloroplasty performed in 95.6%, and simple ulcer suture in 4.4%. In perforated gastric ulcer the main procedure was Billroth I (Rydygier) stomach resection performed in 76.18%, and simple ulcer suture in 23.82%. A group of patients who died in perioperative period (29 cases--12.8%) was selected and compared to a group of others regarding age, sex, smoking, alcohol abuse, time elapsing between first symptoms and surgical treatment, use of NSAIDs, location and size of perforation hole, type of surgical procedures. On that basis 4 risk factors of disease in perioperative period due to perforated ulcer surgery were appointed: 1. Age--mean age of patients who died was 67 years (vs. 48.9 years among successfully treated), perioperative mortality in patients over 60 years old was 35.4%, and in patients over 70 years old was 50%). 2. Presence of three or more coexisting diseases--54.54% risk of disease (vs. 2.5% in patients with less than three or without coexisting diseases). 3. Delay in surgical treatment over 24 hours--48.15% of diseases vs. 7.04% in patients undergoing surgery within the first 24 hours following perforation. 4. Septic shock--80% of diseases.
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PMID:[Perioperative mortality for perforated duodenal and gastric ulcer--analysis of 226 patients]. 1044 7

We describe the selective non-operative management of 34 patients who had an initial diagnosis of perforated duodenal ulcer made on acute presentation between 1984-1994 in our district surgical unit. Diagnosis of the condition was made on clinical grounds with the aid of an erect chest X-ray which demonstrated pneumoperitoneum in 28 patients (82 per cent). Six patients (18 per cent) who did not respond to non-operative treatment required surgical intervention; 3 patients had an unsealed duodenal ulcer perforation; 2 had a perforated benign gastric ulcer and 1 patient had acute gangrenous cholecystitis. The overall mortality and morbidity rate was 3 per cent and 35 per cent respectively. There were no documented reperforations over a mean follow-up period of 27 months. While these figures are acceptable and comparable with operative intervention for this condition, we do however stress the labour intensive methods and close clinical monitoring that is required to avoid morbid sequelae.
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PMID:Non-operative management of perforated duodenal ulcer. 1062 65

Metaplasia represents the process of transforming a well-differentiated adult tissue into another type of adult tissue. Pancreatic metaplasia of the gastric mucosa represents the process in which the normal mucosa of the stomach is replaced with pancreatic formations, which mimic the structure of pancreatic acini. We describe the case of a male patient aged 39 who was admitted for abdominal pain, vomiting, hematemesis, melena, pale teguments, intense perspiration and nausea. The patient underwent surgery for suturing a perforated duodenal ulcer five years prior to this episode (2002). A gastric ulcer complicated with superior digestive bleeding and a chronic duodenal ulcer complicated with partial stenosis and perivisceritis were found during surgery. Gastric wall fragments were harvested and underwent usual histological techniques and immunohistochemistry. We found an ulceration from the gastric mucosa to the submucosa, covered by fibrino-leukocytic detritus. In the mucosal chorion we found numerous round or oval shaped nested formations which occupied the lower two thirds of the chorion, to the muscularis mucosae. Some metaplasic acini contain cells variable in shape, color and immunophenotype. Surrounding the nested acini we found tubular formations, formed of cubic shaped cells, representing excretory canals which were continued by gastric glands or opened directly in the crypts of the gastric epithelium.
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PMID:Pancreatic metaplasia of gastric mucosa associated with gastroduodenal ulcer. 2049 57


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