Perforated peptic ulcer: How to improve outcome?

TY - JOUR

T1 - Perforated peptic ulcer: How to improve outcome?

AU - Møller, Morten Hylander

AU - Adamsen, Sven

AU - Wøjdemann, Morten

AU - Møller, Ann Merete

N1 - Keywords: Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Denmark; Duodenal Ulcer; Evidence-Based Medicine; Gastrectomy; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Meta-Analysis as Topic; Peptic Ulcer Perforation; Prevalence; Proton Pumps; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Smoking; Stomach Ulcer; Survival Rate

PY - 2008

Y1 - 2008

N2 - Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring. To improve the outcome of these patients, it is necessary to investigate the reasons behind this high mortality rate. In this review we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published. The mortality rate and the extent of postoperative complications are fairly high but the reasons for this have not been thoroughly explained, even though a number of risk factors have been identified. Some of these risk factors can be explained by the septic state of the patient on admission. In order to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27

AB - Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring. To improve the outcome of these patients, it is necessary to investigate the reasons behind this high mortality rate. In this review we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published. The mortality rate and the extent of postoperative complications are fairly high but the reasons for this have not been thoroughly explained, even though a number of risk factors have been identified. Some of these risk factors can be explained by the septic state of the patient on admission. In order to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27

U2 - 10.1080/00365520802307997

DO - 10.1080/00365520802307997

M3 - Journal article

C2 - 18752147

SN - 0036-5521

VL - 44

SP - 15

EP - 22

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 1

ER -