eMedicine Specialties > Pediatrics: Surgery > General Surgery

Peptic Ulcer: Surgical Perspective: Follow-up

Author: Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Contributor Information and Disclosures

Updated: Jul 19, 2006

Outcome and Prognosis

With the advent of H2 blocker and proton pump inhibitor therapy, the frequency of postoperative complications, such as recurrent bleeding episodes or persistent pain, has diminished. Eradication of H pylori achieves cure rates of peptic ulcer disease in as many as 90% of children. Most secondary ulcers heal after the offending agent (eg, NSAIDs, steroids) is discontinued and treatments with acid-reducing agents (eg, H2 blockers, proton pump inhibitors) and mucosal protective agents (eg, sucralfate) are instituted.

Future and Controversies

With advances in medical treatment and endoscopic technology, operative treatment for peptic ulcer disease in infants and children will become rare. Furthermore, the operative trend should be toward more conservative procedures because the option of completely suppressing gastric acid production exists and effective treatments to eradicate H pylori are available.

Whether a patient is better off with (1) a vagotomy and pyloroplasty and the potential for dumping syndrome or chronic diarrhea or with (2) a lesser procedure followed by H pylori therapy and long-term use of proton pump inhibitors is unknown. At this time, no solid data exist to resolve this question. Although a highly selective vagotomy would address the problem of gastric emptying, this is a technically demanding and time-consuming procedure, which may not be the best choice in an emergency.

 


More on Peptic Ulcer: Surgical Perspective

Overview: Peptic Ulcer: Surgical Perspective
Workup: Peptic Ulcer: Surgical Perspective
Treatment: Peptic Ulcer: Surgical Perspective
Follow-up: Peptic Ulcer: Surgical Perspective
References
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Further Reading

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Keywords

peptic ulcer, gastric necrosis, gastric necrosis in neonates, erosive gastritis, chronic gastritis, gastric perforation, peptic stricture with gastric outlet obstruction, duodenal perforation, bleeding duodenal ulcer, Helicobacter pylori, H pylori, Dieulafoy lesion, Dieulafoy disease, Zollinger-Ellison syndrome, peptic ulcer disease, peptic ulcer surgery, gastrointestinal bleeding, vagotomy, pyloroplasty, gastric ulcer, primary peptic ulcer, secondary peptic ulcer, hemorrhagic ulcer

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Contributor Information and Disclosures

Author

Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Carlos A Angel, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, British Association of Paediatric Surgeons, Children's Oncology Group, International Children's Continence Society, International Pediatric Endosurgery Group, New York Academy of Sciences, Society of Critical Care Medicine, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Robert K Minkes, MD, PhD, Staff Pediatric Surgeon, Houston Pediatric Surgeons, Texas Children's Hospital
Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Andre Hebra, MD, Clinical Associate Professor, Department of Surgery, University of South Florida School of Medicine; Director, Minimally Invasive Pediatric Surgery Program, Chief of Surgery, All Children's Hospital
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Pediatric Oncology Group, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP, Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University Children's Medical Center
Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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