Subject(s)
Duodenum/pathology , Foreign-Body Reaction/etiology , Gastrectomy/adverse effects , Gastrointestinal Hemorrhage/etiology , Insect Proteins/adverse effects , Sutures/adverse effects , Adolescent , Adult , Aged , Duodenal Ulcer/complications , Duodenal Ulcer/surgery , Fatal Outcome , Female , Fibrosis , Gastrectomy/methods , Gastric Mucosa/pathology , Gastrointestinal Hemorrhage/therapy , Gastroscopy , Humans , Male , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Hemorrhage/surgery , Silk , Stomach Neoplasms/surgery , Treatment OutcomeABSTRACT
OBJECTIVES: Giant gastric and duodenal ulcers (>2-3 cm in greatest dimension) are reported to have higher rates of complication and mortality and to be associated with increasing age, renal failure, and use of nonsteroidal antiinflammatory drugs (NSAIDs). This study investigated the outcome and associations of gastric and duodenal ulcers >2.5 cm compared to ulcers of lesser size. METHODS: Records from all patients with gastric and duodenal ulcers >0.5 cm diagnosed by upper endoscopy between January 1994 and September 1995 were studied for evidence of concurrent use of aspirin, NSAIDs, methamphetamine, and cocaine, as well as for transfusion requirements, length of hospital stay, mortality, surgery, rebleeding, Helicobacter pylori infection, and malignancy. RESULTS: A logistic regression analysis of the 220 patients identified revealed that recent methamphetamine and/or cocaine use was significantly predictive of giant ulcer formation (p = 0.0002) with an odds ratio of 9.66. Also significant was younger age (p = 0.026) and aspirin or NSAID use (p = 0.046). H. pylori infection was significant only for giant gastric ulcers (p = 0.031). Ulcer size did not predict mortality, rate of rebleeding, requirement for surgery, transfusion requirements, or length of hospital stay. However, giant gastric ulcers were significantly more likely to be malignant (p = 0.002). CONCLUSIONS: Giant gastric and duodenal ulcers were strongly associated with stimulant abuse. They were also associated with younger age and use of aspirin or NSAIDs. Additionally, giant gastric ulcers were associated with malignancy and H. pylori infection. Ulcer size did not predict rate of complications or outcome.
Subject(s)
Cocaine/adverse effects , Methamphetamine/adverse effects , Peptic Ulcer/chemically induced , Adolescent , Adult , Aged , Aged, 80 and over , Aging/physiology , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Child , Endoscopy , Female , Humans , Male , Middle Aged , Peptic Ulcer/pathology , PrognosisABSTRACT
We describe a case of colonic pseudo-obstruction occurring in a pregnant patient whose preterm labor was being treated with intravenous magnesium and nifedipine. Sequential colonoscopies were required to manage the recurrent colonic dilations prior to delivery of healthy twins. There was no recurrence after delivery and discontinuation of the tocolytics.
