Abstract
The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality.
Highlights
Haemorrhage is the most frequent complication of peptic ulcer disease
Endoscopic treatment fails more often in the case of haemorrhage from giant peptic ulcers, duodenal posterior wall ulcers penetrating into the pancreas, compared with haemorrhage from giant gastric ulcers [6, 7]
In group I the proportion of giant ulcers in all prepyloric ulcers was significantly lower compared with group II, 14.6% (24/165) versus 32.6% (115/353) (P = 0.0001), and with group III, 14.6% versus 22.4% (92/411) (P = 0.02)
Summary
Haemorrhage is the most frequent complication of peptic ulcer disease. The problem connected with the diagnostics and treatment of PUH is the increasing proportion of elderly (≥65) patients frequently suffering from concomitant diseases. The most common cause of failure of endoscopic haemostasis is the difficulty to access the source of haemorrhage. This is due to extensive scarring and deformation in presence of giant peptic ulcer but usually not in presence of standard size peptic ulcer. Endoscopic treatment fails more often in the case of haemorrhage from giant peptic ulcers, duodenal posterior wall ulcers penetrating into the pancreas, compared with haemorrhage from giant gastric ulcers [6, 7]. There is only scanty information about prepyloric peptic ulcer haemorrhage as it is pathogenetically grouped under duodenal ulcer haemorrhage [9] or has not been classified in more detail [10,11,12,13]
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