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Peptic Ulcer Haemorrhage in Estonia: Epidemiology, Prognostic Factors, Treatment and Outcome

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Peptic Ulcer Haemorrhage in Estonia: Epidemiology, Prognostic Factors, Treatment and Outcome DISSERTATIONES MEDICINAE UNIVERSITATIS TARTUENSIS 86 PEPTIC ULCER HAEMORRHAGE IN ESTONIA: EPIDEMIOLOGY, PROGNOSTIC FACTORS, TREATMENT AND OUTCOME JAAN SOPLEPMANN TARTU 2003 DISSERTATIONES MEDICINAE UNIVERSITATIS TARTUENSIS 86 DISSERTATIONES MEDICINAE UNIVERSITATIS TARTUENSIS 86 PEPTIC ULCER HAEMORRHAGE IN ESTONIA: EPIDEMIOLOGY, PROGNOSTIC FACTORS, TREATMENT AND OUTCOME JAAN SOPLEPMANN TARTU UNIVERSITY PRESS Department of Surgical Oncology, Clinic of Haematology and Oncology, Tartu University Clinics, Tartu, Estonia The dissertation was accepted for commencement of the degree of Doctor of Medical Sciences on August 25, 2003 by the Council of the Faculty of Me­ dicine, University of Tartu Opponents: Professor Jüri Männiste, MD, PhD, Dr Med, Nõmme Private Hospital, Tallinn, Estonia Assistant Professor Riina Salupere, MD, PhD, Department of Internal Medicine, University of Tartu, Tartu, Estonia Commencement: October 29, 2003 The publication of this dissertation is granted by the University of Tartu © Jaan Soplepman, 2003 Tartu Ülikooli Kirjastus www.tyk.ut.ee Tellimus nr. 518 Minu perele. Wereoksendamine. Kui see wiga ilmsiks tuleb, pane kohe lusika täis soola klaasi wee sekka ja joo ära. Joo peti-piima, see awitab. Wisa wereoksendamise juures on tarwis arsti abi otsida. J. M. Jaanus. Rahwa tohter. 1904. Lk. 62. CONTENTS LIST OF ORIGINAL PUBLICATIONS ................................................ 11 ABBREVIATIONS ...................................................................................... 12 1. INTRODUCTION..................................................................................... 13 2. REVIEW OF THE LITERATURE .......................................................... 15 2.1. Peptic ulcer disease ............................................................................ 15 2.2. Upper gastrointestinal haemorrhage ................................................. 15 2.3. Peptic ulcer haemorrhage.................................................................. 16 2.3.1. Pathophysiology...................................................................... 16 2.3.2. Epidemiology........................................................................... 16 Incidence and patient profile .................................................. 16 Predisposing factors................................................................ 17 2.4. Diagnosis ........................................................................................... 19 2.5. Prognostic factors for mortality ........................................................ 20 2.5.1. Clinical factors ........................................................................ 20 2.5.2. Endoscopic factors .................................................................. 20 2.6. Treatment ........................................................................................... 21 2.6.1. Resuscitation ............................................................................ 22 2.6.2. Medical therapy ...................................................................... 22 2.6.3. Endoscopic therapy................................................................. 23 2.6.4. Surgical treatment ................................................................... 24 Indications ............................................................................... 24 Methods ................................................................................... 25 2.6.5. Giant duodenal posterior wall ulcers ..................................... 25 2.7. Short-term outcome ........................................................................... 27 2.8. Long-term results ............................................................................... 27 3. AIMS OF THE STUDY ............................................................................ 29 4. PATIENTS AND METHODS ................................................................. 30 4.1. Patients................................................................................................. 31 4.2. Methods .............................................................................................. 32 4.2.1. D ata.......................................................................................... 32 4.2.2. Patient questionnaire............................................................... 32 4.2.3. Area of study ........................................................................... 32 4.2.4. Incidence.................................................................................. 33 4.2.5. Endoscopic diagnosing and follow-up examination.............. 33 4.2.6. Definitions: ulcer location, operations and mortality ........... 33 4.2.7. Endoscopic therapy................................................................. 33 4.2.8. H. pylori infection................................................................... 33 4.2.9. Visick scale.............................................................................. 34 3 9 4.2.10. Operation methods ............................................................... 34 Duodenal resection with plasty after Helwing .................... 34 Antrectomy with reconstruction after Herfarth................... 34 4.2.11. Statistical methods ............................................................... 35 5. RESULTS ................................................................................................... 36 5.1. Epidemiology....................................................................................... 36 5.1.1. Upper gastrointestinal haemorrhage ....................................... 36 5.1.2. Peptic ulcer haemorrhage........................................................ 37 5.1.3. Predisposing factors ................................................................. 38 5.2. Prognostic factors ............................................................................... 39 5.3. Treatment and short-term outcome.................................................... 39 5.4. Long-term results in conservatively and operatively treated peptic ulcer haemorrhage patients ................................................................ 40 5.5. Long-term results in patients treated surgically for giant duodenal posterior wall ulcers complicated with haemorrhage....................... 41 6. DISCUSSION............................................................................................. 43 6.1. Epidemiology...................................................................................... 43 6.1.1. Upper gastrointestinal haemorrhage ....................................... 43 6.1.2. Peptic ulcer haemorrhage........................................................ 44 6.1.3. Predisposing factors ................................................................. 46 6.2. Prognostic factors ............................................................................... 47 6.3. Treatment and short-term outcome.................................................... 47 6.4. Long-term results in conservatively and operatively treated peptic ulcer haemorrhage patients ................................................................ 49 6.5. Long-term results in patients treated surgically for giant duodenal posterior wall ulcers complicated with haemorrhage....................... 50 7. CONCLUSIONS ........................................................................................ 53 8. REFERENCES ........................................................................................... 54 SUMMARY IN ESTONIAN.......................................................................... 64 ACKNOWLEDGEMENTS............................................................................ 68 PUBLICATIONS............................................................................................. 69 10 LIST OF ORIGINAL PUBLICATIONS This thesis is based on the publications below, which will be referred to in the following by their Roman numerals: I Soplepmann J, Peetsalu A, Peetsalu M, Väli T, Tein A. Endoscopic fin­ dings in upper gastrointestinal tract hemorrhage in Tartu University Sur­ gical Clinic: comparison of two periods, 1979-81 and 1989-91. Acta et Commentationes Universitatis Tartuensis 1994; 969: 16-25. II Vardja T, Peetsalu M, Soplepmann J, Peetsalu A. Natural history, results of surgery and the costs of treatment of duodenal ulcer disease. Estonian Physician 1995; 2: 113-116 (in Estonian, summary in English). III Soplepmann J, Udd M, Peetsalu A, Palmu A. Acute upper gastrointestinal haemorrhage in Central Finland province, Finland, and in Tartu County, Estonia. Annales Chirurgiae et Gynaecologiae 1997; 86: 222-228. IV Soplepmann J, Peetsalu A, Peetsalu M, Tein A, Juhola M. Peptic ulcer haemorrhage in Tartu County, Estonia: epidemiology and mortality risk factors. Scandinavian Journal of Gastroenterology 1997; 32: 1195-1200. V Soplepmann J, Peetsalu M, Tein A, Peetsalu A. Long-term results of peptic ulcer haemorrhage. European Journal of Trauma and Emergency Surgery 1999;22:177-179. VI Soplepmann J, Peetsalu M, Väli T, Peetsalu A. Long-term results of surgical treatment of giant duodenal posterior wall ulcers complicated with hemorrhage. Langenbeck's Archives of Surgery 2003 (submitted for pub­ lication). VII Soplepmann J, Peetsalu M, Sillakivi T, Tein A, Väli T, Peetsalu A. Changes in the treatment of peptic ulcer haemorrhage. Estonian Physician 2002; 81: 468-472 (in Estonian, summary in English). 11 ABBREVIATIONS AEV antrectomy with reconstruction after Herfarth,
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