A randomized trial of nonoperative treatment for perforated peptic ulcer

Article Abstract:

The authors constructed a prospective study to determine if surgery could be avoided in some patients with perforated peptic ulcers. The study compared the clinical outcome of patients treated conservatively (without surgery) to those who underwent an emergency surgery for repair of a presumed perforated peptic ulcer. During a 13 month period, 83 patients were studied: 40 in the conservative treatment group were given intravenous fluids, received a stomach drain inserted into the stomach via the nose (nasogastric tube), and got intravenous administration of antibiotics. Eleven of these patients (28 percent) did not improve after 12 hours and required an operation. Of these patients, three were found to have gastrointestinal cancer. The 43 surgical patients were explored and their perforations were repaired. One of the primary surgical patients was also found to have cancer of the stomach. Overall, the mortality rates of the two groups were similar (two deaths in each group), and did not differ significantly with regard to infection, cardiac or renal failure. However, the hospital stay in the conservatively treated group was 35 percent longer. Patients over the age of 70 years were less likely to respond to non-surgical treatment. The authors conclude that in patients with perforated peptic ulcer, an initial period of nonoperative treatment and careful observation may be safely allowed, except in patients over 70 years old, and that such nonoperative treatment can eliminate the need for emergency surgery for more than 70 percent of the patients.

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Treatment of peptic ulcers caused by Helicobacter pylori

Article Abstract:

Surprising results from studies on peptic ulcer disease indicate that it often results from infection and can be cured. The three main causes of peptic ulcer disease are infection with the bacterium Helicobacter pylori, use of nonsteroidal anti-inflammatory drugs (NSAID) and diseases such as Zollinger-Ellison syndrome in which there is hypersecretion of acid. In cases due to Helicobacter pylori infection, acid contributes to the ulcer development but does not appear to be a cause. A recent study found that eradicating the bacterium with antibiotics can dramatically reduce the recurrence rate of ulcers. This suggests that the first step in treating a peptic ulcer should be to determine if the bacterium is present, and if so, antibiotics should be started. Patients with peptic ulcers who show signs of Helicobacter pylori infection and who are taking NSAIDs should discontinue NSAID use only if antibiotics fail to cure the ulcer.

Editorial, Complications and side effects

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The treatment of Helicobacter pylori infection in the management of peptic ulcer disease

Article Abstract:

Stomach ulcers caused by Helicobacter (H.) pylori infection may be effectively treated with a combination of antibacterial drugs. Several studies suggest that stomach ulcers are often caused by H. pylori, though infection does not always lead to ulcers. Diagnosis of H. pylori infection can be made from biopsies of the stomach lining, blood tests for antibodies to the bacterium, or breath tests after ingestion of urea. Treatment involving a combination of two or more antibacterial drugs is usually necessary to eliminate the bacteria. Drugs that may be used include antibiotics such as amoxicillin, metronidazole, tetracycline, bismuth, and inhibitors of acid secretion such as omeprazole. The preferred drug regimen involves bismuth, metronidazole, and tetracycline. Once the infection has been eliminated, recurrence of stomach ulcers is unlikely.

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