Results of conservative treatment for perforated gastroduodenal ulcers in patients not eligible for surgical repair.

BACKGROUND Conservative treatment of perforated gastroduodenal ulcer has been shown to be associated with good results in patients whose general condition is good. However, its use in patients not eligible for surgical repair has not been supported. The aim of this study is to evaluate the results of conservative treatment in these patients in the era of proton pump inhibitor. MATERIAL AND METHODS In the period 1978-2004, 533 patients were admitted for perforated gastroduodenal ulcer. 503 patients underwent surgery, while 30 (median age 79 [42-98] years) were allocated to conservative treatment due to poor general condition. Conservative treatment consisted of nasogastric aspiration, antibiotics and antisecretory therapy (H2-blockers from 1978-1995, 11 patients, and proton pump inhibitors (PPI) from 1996, 19 patients). Endpoints were: hospital morbidity and mortality and hospital stay. RESULTS Overall morbidity and mortality were 33% and 30%. Median hospital stay was 11 days (range 0-32). General complications developed in 73% versus 16% of patients (p = 0.023) and mortality was 64% versus 11% (p = 0.008) for the H2-blocker and PPI groups respectively. On multivariate analysis mortality correlated with presence of shock at admission and type of antisecretory therapy. CONCLUSION In the era of PPI conservative treatment for perforated ulcer is possible with acceptable morbidity and mortality in patients not eligible for surgical repair. However, presence of shock at admission was associated with high mortality and, even in these patients, militates in favour of a surgical approach.