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Tuesday, 26 November 2013

Gastric Ulcers- The Complications

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
II. Gastric ulcers
Gastric ulcer, a type of peptic ulcer is defined as a condition of a localized tissue erosion in the lining the stomach.
C. Complications
1. Death 
In a study of 701 patients with gastric ulcers admitted to hospital within the period 1955-64, 180 died within a five-year period calculated from the time of admission. Causes of death were established at autopsy in 66%, and otherwise were derived from death certificates. Mortality was significantly higher than expected in both men and women, particularly high in the first year after actual admission, but falling thereafter to about the same level as the expected mortality(16),
2. Peptic ulcer bleeding 
Peptic ulcer bleeding is a frequent and dramatic event with both a high mortality rate and a substantial cost for healthcare systems worldwide. It has been found that age is an independent predisposing factor for gastrointestinal bleeding, with the risk increasing significantly in individuals aged>65 years and increasing further in those aged>75 years. Indeed, bleeding incidence and mortality are distinctly higher in elderly patients, especially in those with co-morbidities(17)
3. Perforative hole
In the study of Diagnosis and the results of surgical treatment of perforated gastroduodenal ulcers, showed that the excellent and good long-term results after closure of a perforative hole were noted in 11.7% of the patients, after vagotomy–in 91.6% after gastric resection–in 88%(18).
4. Others
In the study to evaluate their relative risks of ulcer complications between 1984 and 1989, 62 patients with giant ulcers (greater than or equal to 3 cm) and to compare with 476 benign gastric ulcer patients, researchers at the Department of Pharmacology, Ataturk University, showed that giant ulcers are more prone to severe hemorrhage (44% versus 27%; chi 2 test: p less than 0.009) but not more prone to free perforation. Penetration into contiguous organs occurred more frequently with giant gastric ulcers (45% versus 10%; chi 2 test: p less than 0.0001). The risk of the presence of microscopic malignancy in the macroscopically benign-looking giant ulcer is significantly greater than in the nongiant type (13% versus 3%; Fisher’s exact test: p = 0.0013(19). Other study of 1470 patients over 65-year-old who were treated for various diseases, 50 had gastric ulcer and 10 had duodenal ulcer. About half the gastric ulcers were located in the body and fundus (n = 24, 48.0%). One third of the patients with gastric or duodenal ulcers had as their chief complaints hematemesis and hematochezia (n = 20, 33.3%), and a greater number had atypical gastrointestinal complaints (general malaise, fever etc, n = 25, 41.7%). Complications of gastric and duodenal ulcers were hematemesis and hematochezia (n = 20, 33.3%), and perforation (n = 2, 3.3%)(20).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157
(15) http://www.ncbi.nlm.nih.gov/pubmed/7495942
(16) http://www.ncbi.nlm.nih.gov/pubmed/1211040
(17) http://www.ncbi.nlm.nih.gov/pubmed/17896831
(18) http://www.ncbi.nlm.nih.gov/pubmed/1881067
(19) http://www.ncbi.nlm.nih.gov/pubmed/1636903
(20) http://www.ncbi.nlm.nih.gov/pubmed/9059054