Chapter 59 - Surgery for Peptic Ulcer Disease

Abstract

Gastroduodenal peptic ulcer disease (PUD) is a common problem with significant geographic variation in prevalence. In Western countries, the incidence of PUD has steadily declined and the prevalence is much higher in developing countries. Such variations are likely related to the prevalence of Helicobacter pylori, smoking, and the use of ulcerogenic drugs, such as nonsteroidal antiinflammatory drugs. The advent of histamine H2-receptor antagonists (H2 blockers) in the 1970s and the development of proton pump inhibitors (PPIs) in the late 1980s led to further acid reduction and faster, more efficient healing of active ulcer disease. The combined use of PPIs and endoscopic treatment has further decreased the need for emergency operation. PUD complications include bleeding, perforation, and gastric outlet obstruction. There has been a significant downward trend in the incidence of these complications. Complications of PUD also vary depending on the geographic location. Bleeding is the most common in the United States, and obstruction may be more common in other locations in the world. The goals of surgical procedures are to permit ulcer healing, prevent or treat ulcer complications, address the underlying ulcer etiology, and minimize postoperative digestive consequences.