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The Impact of Ulcerogenic Drugs on Surgery for the Treatment of Peptic Ulcer Disease

The Impact of Ulcerogenic Drugs on Surgery for the Treatment of Peptic Ulcer Disease Abstract • To investigate the impact of ulcerogenic drugs on surgery for the treatment of peptic ulcer disease, we reviewed 150 surgical cases. Ulcerogenic drug use (steroids and/or nonsteroidal anti-inflammatory agents, including aspirin) increased from 15% between 1972 and 1977 to 37% between 1983 and 1988. While there was no correlation between ulcerogenic drug use and hemorrhage, obstruction, or intractable pain, 16 (52%) of the 31 perforations and 26 (38%) of the 69 emergency operations were associated with use of ulcerogenic drugs. The overall mortality rate was 11%. Death was correlated with age greater than 65 years and emergency operation, but not with ulcerogenic drug use or other variables. Of 12 patients with histories of peptic ulcer disease who were treated with ulcerogenic drugs without concomitant antiulcer prophylaxis, 11 (92%) required emergency operation to treat perforation or massive hemorrhage. Standard antiulcer medications or misoprostol should be prescribed to elderly patients and to those with histories of ulcers who require ulcerogenic drug therapy. (Arch Surg. 1991;126:609-612) References 1. Langman MJS. Epidemiologic evidence on the association between peptic ulceration and antiinflammatory drug use . Gastroenterology . 1989;96:640-646. 2. Graham DY, Smith JL. Gastroduodenal complications of chronic NSAID therapy . Am J Gastroenterol . 1988;83:1081-1084. 3. Green SB, Gail MH, Byar DP. Steroids and peptic ulcer . N Engl J Med . 1976;294:473-476.Crossref 4. Messer J, Sacks HS, Reitman D, Chalmers TC. Corticosteroids do cause peptic ulcer disease . Gastroenterology . 1982;82:1130. 5. Stabile BE, Passaro E Jr. Duodenal ulcer: a disease in evolution . Curr Probl Surg . 1984;21:6-17.Crossref 6. McConnell DB, Baba GC, Deveney CW. Changes in surgical treatment of peptic ulcer disease within a Veterans Hospital in the 1970s and the 1980s . Arch Surg . 1989;124:1164-1167.Crossref 7. Walt R, Katschinski B, Logan R, Ashley J, Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom . Lancet . 1986;2:489-492.Crossref 8. Fries JF, Miller SR, Spitz PW, Williams CA, Herbert HB, Bloch DA. Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use . Gastroenterology . 1989;96:647-655. 9. Collier DStJ, Pain JA. Non-steroidal anti-inflammatory drugs and peptic ulcer perforation . Gut . 1985;26:359-363.Crossref 10. Guess HA, West R, Strand LM, et al. Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983 . J Clin Epidemiol . 1988; 41:35-45.Crossref 11. Horowitz J, Kukora JS, Ritchie WP Jr. All perforated ulcers are not alike . Ann Surg . 1989;209:693-697.Crossref 12. Kekki M, Samloff IM, Ihamaki T, Varis K, Siurala M. Age and sex-related behavior of gastric acid secretion at the population level . Scand J Gastroenterol . 1982;17:737-743.Crossref 13. Farinati F, Cardin F, DiMario F, et al. Gastric ulcer and stomach aging: pathophysiology and clinical implications . Gerontology . 1988;34:297-303.Crossref 14. Majumdar AP, Moshier JA, Arlow FL, Luk GD. Biochemical changes in the gastric mucosa after injury in young and aged rats . Biochim Biophys Acta . 1989;21:35-40.Crossref 15. Maitra RS, Edgerton EA, Majumdar AP. Gastric secretion during aging in pyloric-ligated rats and effects of pentagastrin . Exp Gerontol . 1988;23: 463-472.Crossref 16. Kim SW, Parekh D, Townsend CM Jr, Thompson JC. Effects of aging on duodenal bicarbonate secretion . Ann Surg . 1990;212:332-338.Crossref 17. Kolbasa KP, Lancaster C, Olafsson AS, Gilbertson SK, Robert A. Indomethacin-induced gastric antral ulcers in hamsters . Gastroenterology . 1988;95:932-944. 18. Cryer B, Goldschmiedt M, Redfern JS, Feldman M. Comparison of salsalate and aspirin on mucosal injury and gastroduodenal mucosal prostaglandins . Gastroenterology . 1990;99:1616-1621. 19. Matthewson K, Pugh S, Northfield TC. Which peptic ulcer patients bleed? Gut . 1988;20:70-74.Crossref 20. Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration . Gut . 1987;28:527-532.Crossref 21. Butt JH, Barthel JS, Moore RA. Clinical spectrum of the upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Natural history, symptomatology, and significance . Am J Med . 1988;84( (suppl 2A) ):5-14.Crossref 22. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med . 1987;147:1054-1059.Crossref 23. Peoples JB. Peptic ulcer disease and the nonsteroidal anti-inflammatory drugs . Am Surg . 1985;51:358-362. 24. Somerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer . Lancet . 1986;1:462-464.Crossref 25. Roth SH, Bennett RE. Nonsteroidal anti-inflammatory drug gastropathy: recognition and response . Arch Intern Med . 1987;147:2093-2100.Crossref 26. Roth SH, Bennett RE, Mitchell CS, Hartman RJ. Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy . Arch Intern Med . 1987;147:1798-1801.Crossref 27. Lanza F, Peace K, Gustitus L, Rack MF, Dickson B. A blinded endoscopic comparative study of misoprostol versus sucralfate and placebo in the prevention of aspirin-induced gastric and duodenal ulceration . Am J Gastroenterol . 1988;83:143-146. 28. Stalnikowicz R, Goldin E, Fich A, et al. Indomethacin-induced gastroduodenal damage is not affected by cotreatment with ranitidine . J Clin Gastroenterol . 1989;11:178-182.Crossref 29. Stern AI, Ward F, Sievert W. Lack of gastric mucosal protection by sucralfate during long-term aspirin ingestion by humans . Am J Med . 1989;86( (suppl 6A) ):66-69.Crossref 30. McCarthy DM. Nonsteroidal antiinflammatory drug-induced ulcers: management by traditional therapies . Gastroenterology . 1989;96:662-674. 31. Graham DY. Prevention of gastroduodenal injury induced by chronic nonsteroidal antiinflammatory drug therapy . Gastroenterology . 1989;96: 675-681. 32. Jiranek GC, Kimmey MB, Saunders DR, Willson RA, Shanahan W, Silverstein FE. Misoprostol reduces gastroduodenal injury from one week of aspirin: an endoscopic study . Gastroenterology . 1989;96:656-661. 33. Graham DY, Agrawal NM, Roth SH. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial . Lancet . 1988;2:1277-1280.Crossref 34. Hawkey CJ, Rampton DS. Prostaglandins and the gastrointestinal mucosa: are they important in its function, disease, or treatment? Gastroenterology . 1985;89:1162-1188. 35. Lanza FL, Fakouhi D, Rubin A, et al. A double-blind placebo-controlled comparison of the efficacy and safety of 50,100, and 200 μg of misoprostol QID in the prevention of ibuprofen-induced gastric and duodenal mucosal lesions and symptoms . Am J Gastroenterol . 1989;84:633-636. 36. Nicholson PA. A multicenter international controlled comparison of two dosage regimens of misoprostol and cimetidine in the treatment of duodenal ulcer in out-patients . Dig Dis Sci . 1985;30:171S-177S.Crossref 37. Rachmilewicz D, Chapman JW, Nicholson PA. A multicenter international controlled comparison of two dosage regimens of misoprostol with cimetidine in treatment of gastric ulcers in outpatients . Dig Dis Sci . 1986;31: 75S-80S.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Impact of Ulcerogenic Drugs on Surgery for the Treatment of Peptic Ulcer Disease

Bliss, David W.; Stabile, Bruce E.
Archives of Surgery , Volume 126 (5) – May 1, 1991
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References (40)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410290085017
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Abstract

Abstract • To investigate the impact of ulcerogenic drugs on surgery for the treatment of peptic ulcer disease, we reviewed 150 surgical cases. Ulcerogenic drug use (steroids and/or nonsteroidal anti-inflammatory agents, including aspirin) increased from 15% between 1972 and 1977 to 37% between 1983 and 1988. While there was no correlation between ulcerogenic drug use and hemorrhage, obstruction, or intractable pain, 16 (52%) of the 31 perforations and 26 (38%) of the 69 emergency operations were associated with use of ulcerogenic drugs. The overall mortality rate was 11%. Death was correlated with age greater than 65 years and emergency operation, but not with ulcerogenic drug use or other variables. Of 12 patients with histories of peptic ulcer disease who were treated with ulcerogenic drugs without concomitant antiulcer prophylaxis, 11 (92%) required emergency operation to treat perforation or massive hemorrhage. Standard antiulcer medications or misoprostol should be prescribed to elderly patients and to those with histories of ulcers who require ulcerogenic drug therapy. (Arch Surg. 1991;126:609-612) References 1. Langman MJS. Epidemiologic evidence on the association between peptic ulceration and antiinflammatory drug use . Gastroenterology . 1989;96:640-646. 2. Graham DY, Smith JL. Gastroduodenal complications of chronic NSAID therapy . Am J Gastroenterol . 1988;83:1081-1084. 3. Green SB, Gail MH, Byar DP. Steroids and peptic ulcer . N Engl J Med . 1976;294:473-476.Crossref 4. Messer J, Sacks HS, Reitman D, Chalmers TC. Corticosteroids do cause peptic ulcer disease . Gastroenterology . 1982;82:1130. 5. Stabile BE, Passaro E Jr. Duodenal ulcer: a disease in evolution . Curr Probl Surg . 1984;21:6-17.Crossref 6. McConnell DB, Baba GC, Deveney CW. Changes in surgical treatment of peptic ulcer disease within a Veterans Hospital in the 1970s and the 1980s . Arch Surg . 1989;124:1164-1167.Crossref 7. Walt R, Katschinski B, Logan R, Ashley J, Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom . Lancet . 1986;2:489-492.Crossref 8. Fries JF, Miller SR, Spitz PW, Williams CA, Herbert HB, Bloch DA. Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use . Gastroenterology . 1989;96:647-655. 9. Collier DStJ, Pain JA. Non-steroidal anti-inflammatory drugs and peptic ulcer perforation . Gut . 1985;26:359-363.Crossref 10. Guess HA, West R, Strand LM, et al. Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983 . J Clin Epidemiol . 1988; 41:35-45.Crossref 11. Horowitz J, Kukora JS, Ritchie WP Jr. All perforated ulcers are not alike . Ann Surg . 1989;209:693-697.Crossref 12. Kekki M, Samloff IM, Ihamaki T, Varis K, Siurala M. Age and sex-related behavior of gastric acid secretion at the population level . Scand J Gastroenterol . 1982;17:737-743.Crossref 13. Farinati F, Cardin F, DiMario F, et al. Gastric ulcer and stomach aging: pathophysiology and clinical implications . Gerontology . 1988;34:297-303.Crossref 14. Majumdar AP, Moshier JA, Arlow FL, Luk GD. Biochemical changes in the gastric mucosa after injury in young and aged rats . Biochim Biophys Acta . 1989;21:35-40.Crossref 15. Maitra RS, Edgerton EA, Majumdar AP. Gastric secretion during aging in pyloric-ligated rats and effects of pentagastrin . Exp Gerontol . 1988;23: 463-472.Crossref 16. Kim SW, Parekh D, Townsend CM Jr, Thompson JC. Effects of aging on duodenal bicarbonate secretion . Ann Surg . 1990;212:332-338.Crossref 17. Kolbasa KP, Lancaster C, Olafsson AS, Gilbertson SK, Robert A. Indomethacin-induced gastric antral ulcers in hamsters . Gastroenterology . 1988;95:932-944. 18. Cryer B, Goldschmiedt M, Redfern JS, Feldman M. Comparison of salsalate and aspirin on mucosal injury and gastroduodenal mucosal prostaglandins . Gastroenterology . 1990;99:1616-1621. 19. Matthewson K, Pugh S, Northfield TC. Which peptic ulcer patients bleed? Gut . 1988;20:70-74.Crossref 20. Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration . Gut . 1987;28:527-532.Crossref 21. Butt JH, Barthel JS, Moore RA. Clinical spectrum of the upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Natural history, symptomatology, and significance . Am J Med . 1988;84( (suppl 2A) ):5-14.Crossref 22. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med . 1987;147:1054-1059.Crossref 23. Peoples JB. Peptic ulcer disease and the nonsteroidal anti-inflammatory drugs . Am Surg . 1985;51:358-362. 24. Somerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer . Lancet . 1986;1:462-464.Crossref 25. Roth SH, Bennett RE. Nonsteroidal anti-inflammatory drug gastropathy: recognition and response . Arch Intern Med . 1987;147:2093-2100.Crossref 26. Roth SH, Bennett RE, Mitchell CS, Hartman RJ. Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy . Arch Intern Med . 1987;147:1798-1801.Crossref 27. Lanza F, Peace K, Gustitus L, Rack MF, Dickson B. A blinded endoscopic comparative study of misoprostol versus sucralfate and placebo in the prevention of aspirin-induced gastric and duodenal ulceration . Am J Gastroenterol . 1988;83:143-146. 28. Stalnikowicz R, Goldin E, Fich A, et al. Indomethacin-induced gastroduodenal damage is not affected by cotreatment with ranitidine . J Clin Gastroenterol . 1989;11:178-182.Crossref 29. Stern AI, Ward F, Sievert W. Lack of gastric mucosal protection by sucralfate during long-term aspirin ingestion by humans . Am J Med . 1989;86( (suppl 6A) ):66-69.Crossref 30. McCarthy DM. Nonsteroidal antiinflammatory drug-induced ulcers: management by traditional therapies . Gastroenterology . 1989;96:662-674. 31. Graham DY. Prevention of gastroduodenal injury induced by chronic nonsteroidal antiinflammatory drug therapy . Gastroenterology . 1989;96: 675-681. 32. Jiranek GC, Kimmey MB, Saunders DR, Willson RA, Shanahan W, Silverstein FE. Misoprostol reduces gastroduodenal injury from one week of aspirin: an endoscopic study . Gastroenterology . 1989;96:656-661. 33. Graham DY, Agrawal NM, Roth SH. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial . Lancet . 1988;2:1277-1280.Crossref 34. Hawkey CJ, Rampton DS. Prostaglandins and the gastrointestinal mucosa: are they important in its function, disease, or treatment? Gastroenterology . 1985;89:1162-1188. 35. Lanza FL, Fakouhi D, Rubin A, et al. A double-blind placebo-controlled comparison of the efficacy and safety of 50,100, and 200 μg of misoprostol QID in the prevention of ibuprofen-induced gastric and duodenal mucosal lesions and symptoms . Am J Gastroenterol . 1989;84:633-636. 36. Nicholson PA. A multicenter international controlled comparison of two dosage regimens of misoprostol and cimetidine in the treatment of duodenal ulcer in out-patients . Dig Dis Sci . 1985;30:171S-177S.Crossref 37. Rachmilewicz D, Chapman JW, Nicholson PA. A multicenter international controlled comparison of two dosage regimens of misoprostol with cimetidine in treatment of gastric ulcers in outpatients . Dig Dis Sci . 1986;31: 75S-80S.Crossref

Journal

Archives of Surgery – American Medical Association

Published: May 1, 1991

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