Bleeding Giant Gastric Ulcer

Abstract

Background: A consecutive series of 269 cases of bleeding gastric ulcer were studied prospectively from 1979 to 1993 inclusive. Method: Fifty‐five (21%) had a giant gastric ulcer with a diameter of 3 cm or more. These cases were compared with those with ulcers less than 3 cm in diameter in terms of clinical details, prognostic factors, urgent operation and outcome. Results: Death occurred in 13 cases (5%), urgent surgery was performed in 75 cases (29%) and there were 11 postoperative deaths (15%) within a month of surgery. The patient details in the two groups matched in terms of age, sex distribution, ulcer history, previous complication and recent ingestion of analgesics. Clinical comparison showed that giant ulcer had a poorer prognosis with a higher mortality (10 vs 3%, P < 0.01), urgent surgery rate (65 vs 12%, P < 0.01) and operative mortality (23 vs 11%, difference not significant). Study of risk factors in patients with giant ulcer revealed significantly more with concurrent illness, shock, anaemia and endoscopic stigmata of recent haemorrhage. Conclusion: More severe bleeding and poorer general condition in the giant ulcer group stresses the importance of early diagnosis and accurate resuscitation in these patients. Survival depends on optimal condition and prompt and timely surgery.

Mucosal concentration of basic fibroblast growth factor in the healing process in human giant gastric ulcers

“…We defined giant ulcers as gastric ulcers that were larger than, or equal to, 3 cm in diameter. [1][2][3][4][5][6] Patients with gastric ulcers smaller than 3 cm in diameter were included in the study as controls. Patients only received lansoprazole and the use of other ulcer-healing agents was not permitted.…”

“…Patients with giant gastric ulcers are reported to be more unwell and older than patients with non-giant ulcers. [1][2][3][4][5] Their condition is often complicated by more aggressive diseases, anorexia and weight loss, resulting in emergency admission to hospital. 6 Consequently, it is suggested that giant gastric ulcers could be caused by a loss of mucosal integrity and disorders in the healing process resulting from catastrophic physical conditions such as hypoxia, malnutrition or a reduction in the synthesis of prostaglandins and growth factors.…”

“…Giant gastric ulcers are uncommon and the pathophysiological mechanism leading to their formation is not well characterized. Patients with giant gastric ulcers are reported to be more unwell and older than patients with non‐giant ulcers 1–5 . Their condition is often complicated by more aggressive diseases, anorexia and weight loss, resulting in emergency admission to hospital 6 .…”

The role of endoscopy in the management of patients with peptic ulcer disease

“…28 These patients often have more aggressive disease, with a higher incidence of bleeding, higher mortality rates (10% vs 3%), and greater need for urgent surgery (65% vs 12%) compared with patients with smaller ulcers. 29 Giant duodenal ulcers (O2 cm) also have a higher incidence of complications including bleeding, penetration, and perforation. 30,31 Upper endoscopy is important for the diagnosis of giant gastric ulcers because barium contrast studies may occasionally miss these ulcers due to their large, shallow craters.…”

“…[27][28][29] With the current widespread use of antisecretory therapy, giant ulcers are rarely encountered, and no series were reported in the past decade. Patients with giant ulcers tend to be older and may present with atypical symptoms including anorexia and weight loss.…”