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Association of Vagotomy and Decreased Risk of Subsequent Ischemic Stroke in Complicated Peptic Ulcer Patients: an Asian Population Study

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Abstract

Objectives

The primary management of peptic ulcers is medical treatment. Persistent exacerbation of a peptic ulcer may lead to complications (perforation and/or bleeding). There has been a trend toward the use of a less invasive surgical simple suture, simple local suture or non-operative (endoscopic/angiography) hemostasis rather than acid-reducing vagotomy (i.e., vagus nerve severance) for treating complicated peptic ulcers. Other studies have shown the relationship between high vagus nerve activity and survival in cancer patients via reduced levels of inflammation, indicating the essential role of the vagus nerve. We were interested in the role of the vagus nerve and attempted to assess the long-term systemic effects after vagus nerve severance. Complicated peptic ulcer patients who underwent truncal vagotomy may represent an appropriate study population for investigating the association between vagus nerve severance and long-term effects. Therefore, we assessed the risks of subsequent ischemic stroke using different treatment methods in complicated peptic ulcer patients who underwent simple suture/hemostasis or truncal vagotomy/pyloroplasty.

Methods

We selected 299,742 peptic ulcer patients without a history of stroke and Helicobacter pylori infection and an additional 299,742 matched controls without ulcer, stroke, and Helicobacter pylori infection from the National Health Insurance database. The controls were frequency matched for age, gender, Charlson comorbidity index (CCI) score, hypertension, hyperlipidemia history, and index year. Then, we measured the incidence of overall ischemic stroke in the two cohorts. The hazard ratio (HR) and the 95% confidence intervals (CIs) were estimated by Cox proportional hazard regression.

Results

Compared to the controls, peptic ulcer patients had a 1.86-fold higher risk of ischemic stroke. There were similar results in gender, age, CCI, hypertension, and hyperlipidemia stratified analyses. In complicated peptic ulcer patients, those who received truncal vagotomy and pyloroplasty had a lower risk of ischemic stroke than patients who received simple suture/hemostasis (HR = 0.70, 95% CI = 0.60–0.81).

Conclusions

Our findings suggest that patients with peptic ulcers have an elevated risk of subsequent ischemic stroke. Moreover, there were associations between vagotomy and a decreased risk of subsequent ischemic stroke in complicated peptic ulcer patients.

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Acknowledgements

This study was supported, in part, by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004); the China Medical University Hospital; the Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037); the NRPB Stroke Clinical Trial Consortium (MOST 105-2325-B-039-003); the Tseng-Lien Lin Foundation, Taichung, Taiwan; the Taiwan Brain Disease Foundation, Taipei, Taiwan; and the Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

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Author notes

  1. Chu-Wen Fang and Chun-Hung Tseng have contributed equally to this study.

Authors and Affiliations

  1. Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

    Chu-Wen Fang

  2. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Chun-Hung Tseng, Shih-Chi Wu & William Tzu-Liang Chen

  3. Department of Neurology, China Medical University Hospital, Taichung, Taiwan

    Chun-Hung Tseng

  4. Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, 404, Taichung, Taiwan

    Shih-Chi Wu

  5. Department of Surgery, China Medical University Hospital, Taichung, Taiwan

    William Tzu-Liang Chen

  6. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo

Authors
  1. Chu-Wen Fang
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Contributions

Wu SC, and Fang CW and Tseng CH conceived and designed the study and wrote the initial draft of the manuscript; Chen WT participated in the study design and conception; Muo CH performed the data analysis and interpretation and was involved in writing the initial draft of manuscript; and Wu SC performed the data analysis and interpretation as well as manuscript drafting and revision.

Corresponding author

Correspondence to Shih-Chi Wu.

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Conflicts of interest

The authors declare no conflicts of interest related to this study.

Disclosure

This study used the National Health Insurance Research Database established by the National Health Research Institutes with the authorization of the Bureau of National Health Insurance, Ministry of Health and Welfare of Taiwan. The interpretations and the conclusions contained herein do not represent the opinion of the aforementioned agencies and institutions.

Additional information

Guarantor of the article: Shih-Chi Wu.

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Fang, CW., Tseng, CH., Wu, SC. et al. Association of Vagotomy and Decreased Risk of Subsequent Ischemic Stroke in Complicated Peptic Ulcer Patients: an Asian Population Study. World J Surg 41, 3171–3179 (2017). https://doi.org/10.1007/s00268-017-4127-z

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  • DOI: https://doi.org/10.1007/s00268-017-4127-z

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