Impact of H2-receptor antagonists on the outcome of treatment of perforated duodenal ulcer

Abstract

One hundred and eighty-five patients were perforated duodenal ulcer were treated at one hospital over the 21-year period which straddled the introduction of H2-receptor antagonists. Of these 107 had simple closure, 58 simple closure with immediate H2-receptor antagonists and 20 immediate definitive surgery. The overall operative mortality rate was 5.4%. The rate of subsequent definitive surgery declined significantly in the years after the introduction of H2-receptor antagonists. Only a minority of those who came to subsequent definitive surgery had done so within the first year, the percentage rising from 16% at 1 year to 43.7% at 10 years. Of the patients treated by simple closure alone, 44.3% had subsequent definitive surgery compared with 24.1% having H2-receptor antagonists in addition, but this difference was not statistically significant using life table analysis. Review of the 104 patients available in 1989 showed no significant differences in symptoms between the treatment groups. The only preoperative predictor of subsequent definitive operation was non-steroidal anti-inflammatory drug consumption which showed a negative correlation. A 3-month history of dyspepsia before perforation did not predict the need for subsequent surgery. The symptomatic results in a different group of patients who had undergone highly selective vagotomy subsequent to a previous perforation were no different from patients treated by simple closure alone or with immediate prescription of H2-receptor antagonists. Bloating, however, was significantly more common after highly selective vagotomy. We believe that perforated duodenal ulcer should be treated by simple closure.(ABSTRACT TRUNCATED AT 250 WORDS)