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OBJECTIVE: The aim of this study was to examine time trends in the incidence of peptic ulcer bleeding and risk factors in a defined geographical area in Norway. MATERIAL AND METHODS: Retrospective data were collected for 306 patients with bleeding peptic ulcers admitted to one hospital during the 1985-1986, 1995-1996, and 2007-2008 periods. RESULTS: The incidence in 1985-1986 was 52/100,000 and in 2007-2008 was 45/100,000. In the group aged 20-75 years, the incidence decreased by 54% from 54/100000 in 1985-1986 to 25/100000 in 2007-2008 (P = 0.001) and increased by 49% in the group aged >75 years from 272/100000 to 406/100000 (P = 0.0001). The use of aspirin or nonsteroidal anti-inflammatory steroid drugs (NSAIDs) was 31% in 1985-1986 and increased to 67% in 2007-2008 (P = 0.004). In patients using aspirin or NSAIDs, Helicobacter pylori was present in 73% in 1995-1996 and in 51% in 2007-2008. H. pylori infection declined from 84% to 52% between 1995-1996 and 2007-2008. CONCLUSIONS: The incidence rate of peptic ulcer bleeding did not change between 1985-1986 and 2007-2008, but decreased in the age group ≤75 years and increased in the age group >75 years. The use of low-dose aspirin and NSAIDs increased substantially over time, and H. pylori infection was still present in 51% of these patients in 2007-2008.
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OBJECTIVE: To test the effect of an ileocolic neosphincter-nipple valve anastomosis after ileocolic resection for Crohn's disease, on the clinical and surgical recurrence-free survival, in a long-term follow-up pilot study. BACKGROUND AND AIMS: Fifty-nine patients, with Crohn's disease were operated on with an ileocecal or ileocolic resection and a nipple valve between 1993 and 2007. METHODS: The nipple valve is constructed by everting the neoterminal ileum for a length of 4-5 cm and stabilized with 3 or 4 longitudinal stapler rows (N=36) or only in a basal zone (N=23). The nipple is telescoped with the tip pointed into the colon and the base of the nipple anastomosed to colon. Follow-up at regular intervals included clinical evaluation, Harvey-Bradshaw index, laboratory tests, colonoscopy and small bowel radiology when appropriate. RESULTS: The perioperative mortality was nil. Early postoperative complications were: wound infection (N=4), anastomotic leak (N=1), reoperated, nipple ischemia (N=1) reoperated, enterocutaneous fistula (N=1). Clinical recurrence in the neoterminal ileum was after 1, 3, 4 and 5 years: 11%, 20%, 23% and 24%. Eleven patients (19%) were reoperated for recurrence in the neoterminal ileum after median 96 months follow-up. The cumulative reoperation rate was after 1, 3, 4 and 5 years: 4%, 13%, 13% and 16%, respectively. CONCLUSION: The low clinical and surgical recurrence rate in the neoterminal ileum may suggest a protective effect of the neosphincter on postoperative recurrence of Crohn's disease. This result should be tested in a randomized controlled trial.
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OBJECTIVE: To assess the influence of resection margins and adjuvant chemoradiotherapy or chemotherapy on survival for patients with pancreatic cancer by meta-analysis of individual data from randomized controlled trials. DATA SOURCES: Structured MEDLINE search for published studies. STUDY SELECTION: A meta-analysis of published randomized controlled trials and individual data. DATA EXTRACTION: Individual data were obtained from 4 recently published trials (875 patients: 278 [32%] with R1 and 591 [68%] with R0 resections). DATA SYNTHESIS: Kaplan-Meier estimates of survival were compared using log-rank analyses. Pooled hazard ratios of the effects of chemoradiotherapy and chemotherapy treatments on the risk of death were calculated separately and across groups according to resection margins status. Six hundred ninety-eight patients (80%) had died, with a median follow-up of 44 months in the surviving patients. Resection margin involvement was not a significant factor for survival (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.94-1.29; log-rank chi(2) = 1.4; P = .24). The 2- and 5-year survival rates, respectively, were 33% and 16% for R0 patients and 29% and 15% for R1 patients. Chemoradiotherapy in R1 patients resulted in a 28% reduction in the risk of death (HR, 0.72; 95% CI, 0.47-1.10) compared with a 19% increased risk in R0 patients (HR, 1.19; 95% CI, 0.95-1.49). Chemotherapy in R1 patients had a 4% increased risk of death (HR, 1.04; 95% CI, 0.78-1.40) compared with a 35% reduction in risk in the R0 subgroup (HR, 0.65; 95% CI, 0.53-0.80). CONCLUSION: Adjuvant chemotherapy but not chemoradiotherapy should be the standard of care for patients with either R0 or R1 resections for pancreatic cancer.