Predictive Factors of Surgery in Peptic Stenosis of the Bulb

Mohamed Ben Mabrouk¹, Aida Ben Slama Trabelsi², Mehdi Ksiaa², Waad Farhat¹, Ali Jmaa², Ali Ben Ali¹

¹Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia.
²Department of Gastroenterology, Sahloul Hospital, Sousse, Tunisia.

DOI: 10.4236/ojgas.2015.59021                

Abstract

The bulb ulcer stenosis, becoming exceptional in developed countries, remains frequent in our country despite the use of the antisecretory. The purpose of our study was to study epidemiological, diagnostic, and evolutionary complication particularities, and to find potential predictive factors of resistance of ulcer stenosis of the bulb to the pump inhibitors Proton through a recent series. This is a retrospective and descriptive study involving 105 patients, treated for ulcer stenosis of the bulb between January 2007 and December 2012. All our patients had received inhibitors of Proton pump, parenterally for 7 days. They were divided into 2 groups according to their response to treatment: the first group (G1) was sensitive and the second (G2) was resistant. All patients of the G2 were operated. We had compared the two groups. There was no statistically significant difference concerning age, sex, blood group and smoking between the two groups. In univariate study, the age of the epigastralgies was greater than or equal to 9 years; the clapotage fasting, dilation and gastric atony, objectified by the oesogastroduodenal transit were significantly associated with the failure of medical treatment. Only gastric atony and seniority of the disease over 9 years were independent risk factors of resistance to the Proton pump inhibitors in multivariate study.

Keywords

Bulbar Ulcer, Stenosis, Surgery, Proton Pump Inhibitors

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Milosavljevic, T., Kostic-Milosavljevic, M., Jovanovic, I. and Krstic, M. (2011) Complications of Peptic Ulcer Disease. Digital Distribution, 29, 491-493. http://dx.doi.org/10.1159/000331517
[2]	Vaira, D., Menegatti, M. and Miglioli, M. (1997) What Is the Role of Helicobacter Pylori in Complicated Ulcer Disease? Gastroenterology, 113, S78-S84. http://dx.doi.org/10.1016/S0016-5085(97)80017-0
[3]	Ellis, H. (1987) Pyloric Stenosis Complicating Duodenal Ul-ceration. World Journal of Surgery, 11, 315-318.
[4]	Fadil, A., Moumen, M., Bellakhdar, A. and El Fares, F. (1992) Pyloroduodenalstenosis of Ulcer Origin. Apropos of 260 Cases. Journal de Chirurgie (Paris), 129, 27-30.
[5]	Ben Mahmoud, N., Hajji, L., Ghozzi, M., Elloumi, M., Siai, K. and Azzouz, M.M. (2010) Dilatation endoscopique des sténoses ulcéreuses bulbaires: rEsultats et facteurs prédictifs de son efficacité: Etude.de 45 cas. SNFGE, Abstract.
[6]	Yenon, K., Koffi, E. and Kouassi, J.C. (1999) La sténose ulcéreuse pyloro-duodénale: Aspects diagnostiques et thérapeutiques. A propos de 38 cas. Médecine d’Afrique Noire, 46, 119-122.
[7]	Mirodzhov, G.K., Kadyrov, D.M., Rashidov, F.K., Ishankulova, D.M., Shamsuddinov, Sh.N. and Bulbulov, K.B. (2004) Anti-Helicobacter Therapy for Duodenal Peptic Ulcer Complicated by Pyloroduodenal Stenosis. Kliniceskaia Meditsina (Moskva), 82, 51-54.
[8]	Gibson, J.B., Behrman, S.W., Fabian, T.C. and Britt, L.G. (2000) Gastric Outlet Obstruction Resulting from Peptic Ulcer Disease Requiring Surgical Intervention Is Infrequently Associated with Helicobacter Pylori Infection. Journal of the American College of Surgeons, 191, 32-37. http://dx.doi.org/10.1016/S1072-7515(00)00298-2
[9]	Zelickson, M.S., Bronder, C.M., Johnson, B.L., Camunas, J.A., Smith, D.E., Rawlinson, D., Von, S., Stone, H.H. and Taylor, S.M. (2011) Helicobacter Pylori Is Not the Predominant Etiology for Peptic Ulcers Requiring Operation. The American Surgeon, 77, 1054-1060.
[10]	Brandimarte, G., Tursi, A., Di Cesare, L. and Gasbarrini, G. (1999) Antimicrobial Treatment for Peptic Stenosis: A Prospective Study. European Journal of Gastroenterology and Hepatology, 11, 731-734. http://dx.doi.org/10.1097/00042737-199907000-00009
[11]	Taskin, V., Gurer, I., Ozyilkan, E., Sare, M. and Hilmioglu, F. (2000) Effect of Helicobacter Pylori Eradication on Peptic Ulcer Disease Complicated with Outlet Obstruction. Helicobacter, 5, 38-40. http://dx.doi.org/10.1046/j.1523-5378.2000.00005.x
[12]	Shabbir, J., Durrani, S., Ridgway, P.F. and Mealy, K. (2006) Proton Pump Inhibition Is a Feasible Primary Alternative to Surgery and Balloon Dilatation in Adult Peptic Pyloric Stenosis (APS): Report of Six Consecutive Cases. Annals of the Royal College of Surgeons of England, 88, 174-175. http://dx.doi.org/10.1308/003588406x94959
[13]	Jamieson, G.G. (2000) Current Status of Indications for Surgery in Peptic Ulcer Disease. World Journal of Surgery, 24, 256-258. http://dx.doi.org/10.1007/s002689910041
[14]	Marquez, M., Ducons, J.A., Lanas, A., Martinez, T. and Sainz, R. (1989) Prevalence of Peptic Ulcer in Smokers and Non Smokers in Aragon. Revista Espanola de las Enfermedades Del Aparato Digestivo, 75, 566-571.
[15]	Menon, S. (2008) Benign Pyloro-Duodenal Stenosis. Gastrointestinal Endoscopy, 67, 578-579. http://dx.doi.org/10.1016/j.gie.2007.09.051