Giant Gastric Ulcers

Abstract

Traditional therapy for giant gastric ulcers (greater than 3 cm) has been gastric resection because of a presumed high risk of hemorrhage and recurrence. To determine the validity of this approach and decide whether the need for resection has been altered by the introduction of H2-blockers, the records of 10,054 gastroduodenal endoscopies performed between 1971 and 1984 were reviewed. Forty-nine patients with giant gastric ulcers were identified. Five patients had malignant ulcers. Ten patients underwent gastric resection as initial therapy. Thirty-four patients were initially treated without surgery and were divided into Group I (no H2-blockers; 9 patients) and Group II (H2-blockers; 25 patients). Medical therapy was successful in three of nine patients (33%) in Group I and in 20 of 25 patients (80%) in Group II. Of 11 patients who failed medical therapy (7 intractability, 3 recurrence, and 1 fatal hemorrhage), 10 underwent subsequent gastric resection. Of the 20 patients treated surgically (10 initial and 10 medical failures), none were readmitted for recurrent ulcer disease. These data suggest that medical therapy of benign giant gastric ulcers is often effective and not associated with an excessive incidence of complications, as believed. Successful healing of these ulcers is greatly enhanced when H2-blockers are employed. Thus, the presence of an uncomplicated benign giant gastric ulcer is not an absolute indication for gastric resection.

Giant gastric and duodenal ulcers: A population‐based study with a comparison to nongiant ulcers

“…Lastly, the proportion of giant ulcers found at autopsy among non-surgically treated subjects who died of ulcer disease was greater than the percentage among subjects operated on during life, suggesting perhaps that the giant ulcers more often led to death. Thus, giant ulcers in this series, in contrast to those studied by Barragry et al [13], still seemed to represent a severe form of ulcer disease.…”

“…Among these recent cases, only 3 patients, or 6% of all those undergoing surgery for giant ulcers, had actually been on such therapy. Nonetheless, others have reported that giant ulcers respond promptly to medical treatment [13][14][15][16], and they should be so treated, provided no complications of the ulcer are present. If, however, ulcer healing is delayed, the increased risk of life-threatening bleeding from an unhealed giant ulcer clearly adds to the indications for operation.…”

Management of Giant Gastric Ulcer Perforation: Report of a Case and Review of the Literature

“…Giant gastric ulcer (GGU) has been defined as an ulcer >3 cm in diameter or large enough to occupy at least one wall [1, 2]. The incidence of GGU in the pre-H2 receptor antagonist (H2RA) era varied between 12 and 24% of all gastric ulcers [2, 3].…”

Unusual Complicated Gastric Ulcers

“…We have found lesions where radiology examination was suggestive o a gastric diverticulum or a gastric fundus tumoral process (Figures 3 and 4). We hav found such ulcers after immunosuppressant therapies with mycophenolate-mofeti administered post-heart transplant [10][11][12][13][14].…”