Summary
Various treatment policies and clinical disciplines compete for the treatment of bleeding peptic ulcer. In a prospective multicenter and interdisciplinary study performed during a 1-year period at ten hospitals in Düsseldorf, all patients admitted for peptic ulcer bleeding were recorded. The characteristics of patients admitted to surgical and to medical departments, the distribution of endoscopic treatment, indications for surgery, type of surgical procedures, and outcome were investigated. In the study period 387 bleeding peptic ulcers were recorded. Of these patients 82% were primarily admitted to medical and 18% to surgical departments. No differences in terms of severity of ulcer disease or bleeding activity were noted between the groups of medical and surgical patients. However, accompanying or underlying diseases were detected more often in patients admitted to medical departments. Endoscopy treatment was performed in the majority of patients with arterial spurting bleeding (88%) or a visible vessel (80%). Injection therapy with epinephrine or polidocanol was mainly used (78%). In 16% of cases the patients underwent operation; 44% of the patients primarily admitted to a surgical department were operated (medical departments, 10%). About half of the operated patients underwent emergency surgery; in the majority of cases resections were performed (gastric ulcer, 76%; duodenal ulcer, 56%). Overall mortality was 11 %, with no difference between surgical and medical patients. A high mortality was observed in the subgroup of patients with late recurrent bleeding (27%). It is concluded that for optimal treatment of peptic ulcer bleeding intensive cooperation between physicians and surgeons is necessary, and that agreed and evaluated treatment policies are needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- DÜSUK1:
-
Düsseldorf study of ulcer bleeding
- GI:
-
gastrointestinal
- SPV:
-
selective proximal vagotomy
- TV:
-
truncal vagotomy
- S:
-
surgery
- I:
-
internal medicine
- GP:
-
physicians in general practice
- Uni:
-
Heinrich-Heine-University, Düsseldorf
References
Arnold R (1984) Die Ulcusblutung — wann operative Blutstillung? Langenbecks Arch Chir 364:381–385
Bardhan JO, Cust G, Hinchliffe RFC, Williamson FM, Lyon C, Bose K (1989) Changing pattern of admissions and operations for duodenal ulcer. Br J Surg 76:230–236
Colin-Jones DG (1986) Endoscopy or radiology for upper gastrointestinal symptoms? Lancet 1:1022–1023
Colin-Jones DG, Cockel R, Schiller KFR (1978) Current endoscopic practice in the United Kingdom. Clin Gastroenterol 7:775–779
Cotter J (1990) Endoscopic treatment of bleeding peptic ulcers. Good in every situation? Endoscopy 22:201–202
Dronfield MW (1987) Special units for upper gastrointestinal bleeding. BMJ 294:1308–1309
Elashoff JD, Grossman MI (1980) Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978. Gastroenterology 78:280–285
Forrest JAH, Finlayson NDC, Shearman DJC (1974) Endoscopy in gastrointestinal bleeding. Lancet 11:394–397
Griffiths W, Neumann D, Welsh J (1979) The visible vessel as indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 300:1411–1413
Henry DA, Whyte I (1988) Endoscopic coagulation for gastrointestinal bleeding. N Engl J Med 318:186–187
Holman RAE, Davis M, Gough KR, Gartell P, Britton DC, Smith RB (1990) Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital. Gut 31:504–508
Hunt PS (1984) Surgical management of bleeding chronic peptic ulcer. Ann Surg 199:44–50
Imhof M, Stöltzing H, Kraemer M, Thon K (1989) Endoskopische Blutstillungsmaßnahmen im oberen Gastrointestinaltrakt. Akt Chir 24:185–193
Kohler B, Riemann JF (1989) Diagnose der gastrointestinalen Blutung. Dtsch Med Wochenschr 114:548–551
Kurata JH, Honda GD, Frankl H (1982) Hospitalization and mortality rates for peptic ulcers: a comparison of a large health maintenance organization and United States data. Gastroenterology 83:1008–1016
Murray WR, Birnic GG (1987) Special units for upper gastrointestinal bleeding. BMJ 295:51–52
Ohmann C, Then K, Hengels KJ, Imhof M, and the DÜSUK study group (1992) Incidence and pattern of peptic ulcer bleeding in a defined geographical area. Scand J Gastroenterol 27:571–581
Petermann C, Jung M, Lorenz D (1987) Das blutende Gastroduodenal-Ulcus — Herausforderung für Endoskopie und Chirurgie. Langenbecks Arch Chir [Suppl] : 943–943
Röher H-D, Thon K (1984) Impact of early operation on the mortality from bleeding peptic ulcer. Dig Surg 1: 32–36
Sandbichler P, Pernthaler H, Öfner D, Königsrainer A, Schwab G, Aigner F (1989) Das peptische Ulkus mit nichtblutendem sichtbaren Gefäßburzel. Frühelektive Operation oder endoskopische Therapie? Wien Klin Wochenschr 101:736–738
Saperas E, Piqué JM, Ayuso RP, Bordas JM, Terés J, Pera C (1987) Conservative management of bleeding duodenal ulcer without a visible vessel: prospective randomized trial. Br J Surg 74:784–786
Siewert JR, Bumm R, Hölscher AH, Dittler HJ (1989) Obere gastrointestinale Ulkusblutung — Letalitätssenkung durch früh-elective chirurgische Therapie von Risikofaktoren. Dtsch Med Wochenschr 114:447–452
Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J (1981) 277 members of the ASGE: the National ASGE survey on upper gastrointestinal bleeding. 11. Clinical prognostic factors. Gastrointest Endosc 27:80–93
Storey DW, Bown SG, Swain CP, Salmon PR, Kirkham JS, Northfield TC (1981) Endoscopic prediction of recurrent bleeding in peptic ulcers. N Engl J Med 305:915–916
Swain CP (1991) Operative endoscopy in acute upper GIbleeding — indications, techniques, prognosis. Hepatogastroenterology 38:201–206
Then K, Stöltzing H, Ohmann C, Lorenz W, Röher H-D (1988) Decision-making and clinical problem solving in upper gastrointestinal bleeding. Theor Surg 2:185–198
Tilvis RS, Vuoristo M, Varis K (1987) Changed profile of peptic ulcer disease in hospital patients during 1969–1984 in Finland. Scand J Gastroenterol 22:1238–1244
Unger W, Herzog KH, Pätzold K, Bunk A (1989) Chirurgische Therapie des blutenden Ulcus gastroduodenale. Individual-adaptierte Indikationsstellung. Zentralbl Chir 114:1441–1450
Wheatley KE, Dykes PW (1990) Upper gastrointestinal bleeding — when to operate. Postgrad Med 66:926–931
Winkeltau G, Arlt G, Treutner K-H, Schubert T, Schumpelick V (1990) Endoscopic therapy and early elective operation as a therapeutic regression in ulcer bleeding. Hepatogastroenterology 37:121–123
Author information
Authors and Affiliations
Consortia
Additional information
DÜSUK Study Group: M. Heinrich, R. Spoek, H. Niedermeyer (Augusta Krankenhaus); J.-R. Delgadillo, M. MeyerAbich (Krankenhaus Benrath); R. Schroeder-Finckh, H.-Ch. Spiegelberg (Diakoniewerk Kaiserswerth); B. Pletschen, R. Jurisch (Dominikus Krankenhaus); T. Hallenscheidt, S. Heuer (Ev. Krankenhaus Dnsseldorf); U. Mairose, E. Franiel, S. El-Mohammed (Ev. Krankenhaus Wülfrath); B. Mayer, Ch. Ruppert (Krankenhaus Gerresheim); D. Rassek, M. Sporrer, U. Janzik (Marienhospital Düsseldorf); C. Löns, P. Plogmeier (St.-Vinzenz Krankenhaus); H. Stöltzing (Robert-Bosch-Krankenhaus Stuttgart); A. Hartwig, M. Heinzen, R. Hüning, U. Koch, R. Winkelströter (Heinrich-Heine-Universität Düsseldorf); M. Dudek, H. Ellermeier, M. Hinssen, W. Kihm, H. Kleybrink, H. Loerke, D. Potthoff, H. Preiß, F.P. Steinbacher (niedergelassene Internisten); W. Slesina (Abteilung and Poliklinik für Arbeits-und Sozialmedizin, Universität Köln)
Rights and permissions
About this article
Cite this article
Thong, K., Ohmann, C., Hengels, K.J. et al. Peptic ulcer bleeding: medical and surgical point of view. Clin Investig 70, 1061–1069 (1992). https://doi.org/10.1007/BF00184544
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00184544