Incidence, Types and Complications of Chronic Gastric Ulcer (A Change in the Indications of Surgery)
Iraqi Postgraduate Medical Journal,
2008, Volume 7, Issue 4, Pages 277-284
Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation.
Reviewing the incidence, types, complications and surgical indications for chronic gastric ulcer in Iraq and comparing it with other world reports.
Retrospective study of the data base for 5166 patients with chronic peptic ulcer disease operated upon between 1965-2000. The incidence of chronic gastric ulcer, their age, sex, race, clinical presentation, diagnosis, types, size of ulcers and the indications of surgery during the period 1965-1980 (Group A) and 1981-2000 (Group B) were reviewed.
Among the 5166 patients with peptic ulcer disease,111(2.15%) had chronic gastric ulcer.86 (77.5%) were male and 25 (22.5%) were females. 97 (87%) were Arabs and 14 (12.6%) were Kurds, a ratio: 8.1/1. Age ranges (mean) 19-79 (53.9) years. Duration of illness ranges (mean) 6 months to 9 years ( 4.2 years). 68.5% of patients were among the low socioeconomic classes. 77.9% of males were smokers. Barium study showed the ulcer in the 89 patients examined. Malignancy was excluded by endoscopy and biopsy in 91 and frozen section biopsy during surgery in 49 patients. Types of ulcer were; Type I: 47 (42.3%), Type II: 44 (39.6%), Type III: 14 (12.6%) and Type IV 6 (5.4%) patients. The Size of ulcers was; < 2 cm 23 (20.7%), 2-4 cm 57 (51.4%) and > 4 cm 31 (27.9%) patients. Indications for surgery in Group A (67 patients) versus Group B (44 patients) were; dyspepsia 51 (67.1%) v 11 (25%), gastric outlet obstruction 9 (13.4%) v 18 (40.9%), bleeding 6 (9%) v 13 (29.5%) and perforation one (1.5%) v 2 (4.5%) patients. Surgical procedures were; vagotomy and drainage in 77 (69.4%) and B-I partial gastrectomy in 34 (30.6%) patients. 2 (1.8%) died post-operatively, 11 lost to follow after 6-9 months and 98 patients were followed for 5-32 years. Evidence of recurrent stomal ulcer in one patient.
The incidence of chronic gastric ulcer in Iraq is low compared to chronic DU a ratio 1/45.5. Mean age 53.9 years. Male/female: 3.4/1 .Arabs/Kurds: 6.9/1 . Coexistence of chronic duodenal ulcer with chronic gastric ulcer was 39.6%. The indications for surgery during the period 1965-1980 versus the period 1981-2000 were; elective in 51 (76%) v 11 (25%) and urgent or emergency in 16 (24%) v 33 (75%) patients. Operations were; vagotomy and drainage in 69.4% and resection in 30.6% of patients.
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