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Surgical management of peptic ulcer disease

Ashley H Vernon, MD
Stephen J Ferzoco, MD
Stanley W Ashley, MD
Section Editors
David I Soybel, MD
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Wenliang Chen, MD, PhD


Peptic ulcer disease was once the most common indication for gastric surgery but now only infrequently requires operation. Over the last several decades, the development of potent antisecretory agents (H2 blockers and proton pump inhibitors) and the recognition that treatment for Helicobacter pylori infection can eliminate most ulcer recurrences have essentially eliminated the need for elective surgery [1,2]. However, complications related to peptic ulcer disease continue to occur and include bleeding, perforation, and gastric outlet obstruction. An understanding of surgical management remains important since surgery is the mainstay of emergency treatment of these life-threatening complications and for disease that is refractory to medical management. Also, there remain a significant number of patients who underwent surgery prior to the development of current standard medical therapies who continue to have issues related to their original operation.

The indications for surgery, general principles of ulcer surgery, and respective treatments for duodenal and gastric ulcers will be reviewed here. The technical aspects of gastrectomy and vagotomy and their complications are reviewed elsewhere. (See "Partial gastrectomy and gastrointestinal reconstruction" and "Total gastrectomy and gastrointestinal reconstruction" and "Vagotomy" and "Postgastrectomy complications".)


There has been a significant decline in the incidence of hospitalization for peptic ulcer disease (PUD) since 1990 [3,4]. In a study of the Nationwide Inpatient Sample (NIS), hospitalizations for PUD decreased 30 percent from 1993 to 2006, with the decline being greater for duodenal compared with gastric ulcers (37 versus 20 percent, respectively) [4]. These declines are attributed to better medical therapy, including proton pump inhibitors and regimens that eradicate Helicobacter pylori (H. pylori). The natural history and treatment of PUD are discussed elsewhere. (See "Peptic ulcer disease: Management".)

Because of the decrease in the hospitalization rate for PUD, surgeons-in-training now have less exposure to the overall management of PUD, including complications, as well as some of the more technically demanding procedures for treating PUD, such as highly selective vagotomy (parietal cell vagotomy) [5,6]. (See "Vagotomy", section on 'Highly selective vagotomy' and "Postgastrectomy duodenal leak".)


Elective surgery is uncommonly needed for peptic ulcer disease in current medical practice. Currently accepted indications, elective and emergent, for surgery in the management of peptic ulcer disease include bleeding, perforation, obstruction, intractable disease, and suspected malignancy [2].

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2017.
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