Incidence, types and complications of chronic gastric ulcer [a change in the indications of surgery]

Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation. Reviewing the incidence, types, complications and surgical indications for chronic gastric ulcer in Iraq and comparing it with other world reports. Retrospective study of the data base for 5166 patients with chronic peptic ulcer disease operated upon between 1965-2000. The incidence of chronic gastric ulcer, their age, sex, race, clinical presentation, diagnosis, types, size of ulcers and the indications of surgery during the period 1965-1980 [Group A] and 1981-2000 [Group B] were reviewed. Among the 5166 patients with peptic ulcer disease, 111 [2.15%] had chronic gastric ulcer.86 [77.5%] were male and 25 [22.5%] were females. 97 [87%] were Arabs and 14 [12.6%] were Kurds, a ratio: 8.1/1. Age ranges [mean] 19-79 [53.9] years. Duration of illness ranges [mean] 6 months to 9 years [4.2 years]. 68.5% of patients were among the low socioeconomic classes. 77.9% of males were smokers. Barium study showed the ulcer in the 89 patients examined. Malignancy was excluded by endoscopy and biopsy in 91 and frozen section biopsy during surgery in 49 patients. Types of ulcer were; Type I: 47 [42.3%], Type II: 44 [39.6%], Type III: 14 [12.6%] and Type IV 6 [5.4%] patients. The Size of ulcers was; < 2 cm 23 [20.7%], 2-4 cm 57 [51.4%] and > 4 cm 31 [27.9%] patients. Indications for surgery in Group A [67 patients] versus Group B [44 patients] were; dyspepsia 51 [67.1%] v 11 [25%], gastric outlet obstruction 9 [13.4%] v 18 [40.9%], bleeding 6 [9%] v 13 [29.5%] and perforation one [1.5%] v 2 [4.5%] patients. Surgical procedures were; vagotomy and drainage in 77 [69.4%] and B-I partial gastrectomy in 34 [30.6%] patients. 2 [1.8%] died post-operatively, 11 lost to follow after 6-9 months and 98 patients were followed for 5-32 years. Evidence of recurrent stomal ulcer in one patient. The incidence of chronic gastric ulcer in Iraq is low compared to chronic DU a ratio 1/45.5. Mean age 53.9 years. Male/female: 3.4/1 .Arabs/Kurds: 6.9/1. Coexistence of chronic duodenal ulcer with chronic gastric ulcer was 39.6%. The indications for surgery during the period 1965-1980 versus the period 1981-2000 were; elective in 51 [76%] v 11 [25%] and urgent or emergency in 16 [24%] v 33 [75%] patients. Operations were; vagotomy and drainage in 69.4% and resection in 30.6% of patients

Malignant gastrointestinal stromal tumors of the stomach

Stromal or mesenchymal neoplasms affecting the gastrointestinal [GI] tract are divided into two groups. The less common variety includes tumors that are identical to those that arise in the soft tissues throughout the rest of the body, including lipomas, schwannomas, hemangiomas. The second more common group consists of stromal tumors that are collectively referred to as gastrointestinal stromal tumors [GISTs]. They are most often located in the stomach and proximal small intestine. To compare the incidence, mode of presentation and management of malignant gastric GISTs of this study from Iraq with other world reports. Retrospective study of the medical records of 1037 patients with gastric malignancies operated upon between January 1970-December 2000 were reviewed. The incidence of GISTs, their age and sex, symptomatology, diagnostic procedures, surgical management and results will be presented. Among 1037 patients with gastric malignancies, 13 [1.25%] were malignant GISTs. 6 were males and 7 females. Age ranges from 19-67 [median 58 +/- 13 .2397 SD] years. Mode of presentation were; upper GI bleeding 8 [62%], dyspepsia 4[31%] and mass one [8%] patient. Duration of illness ranges from 2 days-8 years [median 3 months +/- 25.9207 SD]. Barium study revealed a tumor in 10 out of 11 patients. Endoscopy in 12 patients reported 4 nodular, 3 fungating and 3 ulcerative tumor and two normal. Ultrasound in 8 patients showed a mass in 7 [5 intraluminal, two extraluminal] and no tumor in one. Site of tumor were the; lesser curve 4[31%], antrum 3[23%], greater curve 2[15%], fundus 2[15%], body one [8%] and cardia one [8%] patient. Grossly the tumors were; fungating 5, nodular 2, ulcerative one, nodular-cystic 3 and nodular-ulcerative in 2. The tumor size vary from 5x3 - 17x12 [mean 9.69231 +/- 3.727793 SD x 7.69231 +/- 2.95479 SD] cm. Gastric resections were; upper 5, segmental 4, subtotal 2 and lower 2 patients. Chemotherapy and/or radiotherapy were given to advance or those with metastasis. Histopathology reported low-grade malignancy in 5 and high-grade in 8 patients. According unified 1997 TNM staging were; I 2, II 4, III 3 and IV 4 cases. Two-years survival was 69% [9 out of 13] and 5-years was 46% [6 out of 13]. Malignant GISTs constitute 1.25% of all gastric malignancies. No gender predilection found. Median age 50.3 years. Recurrent upper GI bleeding in 62% and dyspepsia in 31%. No specific symptoms but abdominal mass in 4 cases. Barium study, endoscopy and US were the diagnostic procedures. Tumors were; mostly intraluminal, fungating nodular and large [median 8x8 cm]. Resection was the treatment. 5 were low-grade and 8 high-grade malignancy. 2 and 5-years survival were 62% and 46% respectively