Post-Bulbar Duodenal Ulcer with Particular Reference to its Hemorrhagic Tendency

Swarts, Jerome M.; Rice, Marion L.

doi:10.1016/s0016-5085(54)80124-7

Cited by 16 publications

(6 citation statements)

References 8 publications

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“…Considerable numbers of studies on PBDUs were performed from the 1950s to 1980s, demonstrating that PBDUs are relatively rare, accounting for 5-10% of overall DUs. [12][13][14][15][16][17][18][19][20][21][22] Since then, few studies have addressed this issue collectively, although there have been some case reports. 30,31 In addition, in some of these studies they were diagnosed in selected patient groups, such as patients who had received surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Considerable numbers of studies on PBDUs were performed from the 1950s to 1980s, demonstrating that PBDUs are relatively rare, accounting for 5–10% of overall DUs 12–22 . Since then, few studies have addressed this issue collectively, although there have been some case reports 30,31 .…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, PBDUs are thought to occur much less frequently in comparison to ulcers of the duodenal bulb, accounting for 5–10% of overall DUs and to possess a greater bleeding tendency in comparison to other ordinary DUs 12–15 . However, the majority of these studies were performed in the 1950s to 1980s, and in all of these studies, the diagnosis of PBDU was made without endoscopy, based on autopsy, surgical findings, and roentgenography 12–22 . In addition, no studies have focused on the nature of endoscopic treatment or its outcomes in patients with bleeding PBDUs.…”

Section: Introductionmentioning

confidence: 99%

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Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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Background Although post‐bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). Methods Data on duodenal ulcers with evidence of endoscopically‐active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in‐hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. Results Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically‐confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in‐hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in‐hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. Conclusion This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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“…In this series postbulbar ulcers did not develop this complication more commonly than the bulhar ulcers studied, but in most other series it is much more common. Swarts and Rice (1954), in a series of 18 patients, reported that 72% experienced bleeding at some time in their clinical course.…”

Section: Discussionmentioning

confidence: 99%

“…Ranisdell ( 1957) advises an initial conservative approach, but stresses the fact that the clinician must be aware of the high incidence of complications occurring with this form of ulceration. Most other authors, however, feel that postbulbar ulcers should be treated surgically without a medical trial (Swarts and Rice, 1954;Cooke and Hutton, 1958: Eergner and Gold, 1964: Pattison and Stellar, 1966. They believe that postbulbar ulceration is a more severe form of peptic ulcer, responding poorly to medical treatment and associated with a high incidence of hzmorrhage.…”

Section: Discussionmentioning

confidence: 99%

Postbulbar Duodenal Ulcer

Ritchie

1976

Australian and New Zealand Journal of Surgery

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I'ostbulbar dimdenal ulceration is not common, but when present is dificult to diagnose and treat. Between January 1965 and Septentber 1971, 1,080 patients with duodenal ulcers were trcatcd surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain w a s the most common indication for surgery. I n six pnticnts it was clinically indistinguishable f r o m biliary pain, giving rise to diagnostic dificulty. Twelve patients (29%) presented with hamorrhage, a percentage similar to thc 25% of billbar ulcers presriiting with this complication over the period of this study. T h i s is contrary t1J thc finding i n most other series, that postbulbar ulceration is more frequently complicated h! hemorrhage thnn is bulbar ulceration. Perf oration and stenosis are uncomnaon complications. I'ostbulbar idceration is easily overlooked in conventional barium stndies. Only onr-third of the patients subjected to barium meal X-ray rxamination had their ulcers identified in the first study. In n further third the presence of an ulcer wns suspected, and t!ic remainder required multiple investigations f o r undiagnosed symptoms before the contliiion was demonstrated. Duodenoscopy was not perforined in a suficient number of patients for its wiliic to bc trs.wssed, but other reports indicate that it should bc a valuable n z n~~~x u v r e . 7 . 1 1~ tcrhi:ical difficulties and potcntial hazards o f Pdlya gustrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.

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Portal Hypertension From Postbulbar Duodenal Ulcer

Strandness¹

1963

Arch Surg

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Post-Bulbar Duodenal Ulcer with Particular Reference to its Hemorrhagic Tendency

Cited by 16 publications

References 8 publications

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Postbulbar Duodenal Ulcer

Portal Hypertension From Postbulbar Duodenal Ulcer

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