Tamotsu Matsuhashi1, Sho Fukuda1, Yasuhiko Abe2, Tatsuya Mikami3, Tetsuya Tatsuta4, Takuto Hikichi5, Jun Nakamura5, Yusuke Onozato6, Waku Hatta7, Atsushi Masamune7, Motoki Ohyauchi8, Hirotaka Ito8, Norihiro Hanabata9, Yasumitsu Araki9, Takumi Yanagita10, Hidemichi Imamura10, Tsuyotoshi Tsuji11, Kae Sugawara11, Youhei Horikawa12, Shuichi Ohara13, Yutaka Kondo13, Takahiro Dohmen14, Katsunori Iijima1. 1. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan. 2. Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan. 3. Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan. 4. Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan. 5. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan. 6. Department of Gastroenterology, Faculty of Medicine, Yamagata University Hospital, Yamagata, Japan. 7. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan. 8. Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan. 9. Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan. 10. Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan. 11. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 12. Department of Gastroenterology, Hiraka General Hospital, Akita, Japan. 13. Department of Gastroenterology, Tohoku Rosai Hospital, Miyagi, Japan. 14. Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan.
Abstract
BACKGROUND: Although post-bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). METHODS: Data on duodenal ulcers with evidence of endoscopically-active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in-hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. RESULTS: Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically-confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in-hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in-hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. CONCLUSION: This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.
BACKGROUND: Although post-bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). METHODS: Data on duodenal ulcers with evidence of endoscopically-active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in-hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. RESULTS: Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically-confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in-hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in-hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. CONCLUSION: This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.