Document Detail

Impact of H2-receptor antagonists on the outcome of treatment of perforated duodenal ulcer.
MedLine Citation:
PMID:  1982317     Owner:  NLM     Status:  MEDLINE    
One hundred and eighty-five patients were perforated duodenal ulcer were treated at one hospital over the 21-year period which straddled the introduction of H2-receptor antagonists. Of these 107 had simple closure, 58 simple closure with immediate H2-receptor antagonists and 20 immediate definitive surgery. The overall operative mortality rate was 5.4%. The rate of subsequent definitive surgery declined significantly in the years after the introduction of H2-receptor antagonists. Only a minority of those who came to subsequent definitive surgery had done so within the first year, the percentage rising from 16% at 1 year to 43.7% at 10 years. Of the patients treated by simple closure alone, 44.3% had subsequent definitive surgery compared with 24.1% having H2-receptor antagonists in addition, but this difference was not statistically significant using life table analysis. Review of the 104 patients available in 1989 showed no significant differences in symptoms between the treatment groups. The only preoperative predictor of subsequent definitive operation was non-steroidal anti-inflammatory drug consumption which showed a negative correlation. A 3-month history of dyspepsia before perforation did not predict the need for subsequent surgery. The symptomatic results in a different group of patients who had undergone highly selective vagotomy subsequent to a previous perforation were no different from patients treated by simple closure alone or with immediate prescription of H2-receptor antagonists. Bloating, however, was significantly more common after highly selective vagotomy. We believe that perforated duodenal ulcer should be treated by simple closure.(ABSTRACT TRUNCATED AT 250 WORDS)
I M Macintyre; A Millar
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the Royal College of Surgeons of Edinburgh     Volume:  35     ISSN:  0035-8835     ISO Abbreviation:  J R Coll Surg Edinb     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-05-21     Completed Date:  1991-05-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7503110     Medline TA:  J R Coll Surg Edinb     Country:  SCOTLAND    
Other Details:
Languages:  eng     Pagination:  348-52     Citation Subset:  IM    
Surgical Review Office, Western General Hospital, Edinburgh, UK.
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MeSH Terms
Age Factors
Combined Modality Therapy
Duodenal Ulcer / drug therapy*,  mortality,  surgery
Histamine H2 Antagonists / therapeutic use*
Peptic Ulcer Perforation / drug therapy*,  mortality,  surgery
Time Factors
Reg. No./Substance:
0/Histamine H2 Antagonists

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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