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Perforated and bleeding peptic ulcer: WSES guidelines

1Emergency Surgery Department, Parma University Hospital, Parma, Italy.grid.411482.a 2General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.0000 0004 1756 8209grid.144189.1 3Scripps Memorial Hospital La Jolla, La Jolla, CA USA.0000 0004 0449 3295grid.415402.6 4General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy.0000 0004 1758 8744grid.414682.d 5Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.grid.411482.a 6Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.0000000417571846grid.7637.5 7Tan Tock Seng Hospital, Singapore, Singapore.grid.240988.f 8General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy.0000 0004 1757 2822grid.4708.b 9Royal Perth Hospital, Perth, Australia & The University of Western Australia, Crawley, Australia.0000 0004 0453 3875grid.416195.e 10Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.0000 0001 2193 6666grid.43519.3a Division of Surgery, ASL VT - Ospedale "Andosilla", Civita Castellana, Italy. 12Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.0000 0004 0383 8386grid.24029.3d 13Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy.0000000417571846grid.7637.5 Department of General Surgery, Albury Hospital, Albury, Australia. 15General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada.0000 0004 0469 2139grid.414959.4 16Helsinki University Hospital, Helsinki, Finland.0000 0000 9950 5666grid.15485.3d 17Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO USA.0000 0001 0369 638Xgrid.239638.5 18University of Pittsburgh, School of Medicine, UPMC - Presbyterian, Pittsburgh, PA USA.0000 0004 0462 9068grid.461860.d 19Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil.0000 0001 0723 2494grid.411087.b 20Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.0000 0001 2174 1754grid.7563.7 21Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA.0000000122986657grid.34477.33 22Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.0000 0001 0174 2901grid.414739.c 23Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA.0000 0004 0386 9924grid.32224.35 Letterkenny University Hospital, Donegal Clinical Research Academy Centre for Personalized Medicine, Donegal, Ireland. Department of Surgery, Macerata Hospital, Macerata, Italy. 26Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.0000 0000 9950 8111grid.413731.3

World journal of emergency surgery : WJES. 2020;15:3
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Abstract
Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine