Management of the complications of peptic ulcer disease

Management of complications of peptic ulcer disease, including hemorrhage, perforation, and obstruction, remain the responsibility of the general surgeon. Although flexible esophagogastro-duodenoscopy is essential for accurate diagnosis and may offer valuable therapeutic options for hemorrhage and obstruction, surgical intervention is essential in many cases, often in the most critically ill patients. Although our new understanding of the pathogenesis of H. pylori and current efforts to eradicate this organism may result in a decrease in the incidence of these complications, this effect has not yet materialized nor will it necessarily be a factor in complicated ulcer disease. Better understanding of the mechanisms by which H. pylori damages the gastrointestinal mucosa is needed. In the interim, the long- standing success of operations developed to decrease gastric acid secretion suggest that both acid and H. pylori are important causative factors in gastroduodenal injury. Although elective operations for ulcer disease are likely to become of historic interest, surgical procedures for treatment of complications will remain essential elements for the treatment of these conditions in critically ill patients. The surgical opportunity to treat ulcer diathesis definitively should continue to be used in that important setting.