Perforated and bleeding peptic ulcer: WSES guidelines
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(2020) 15:3
REVIEW
Open Access
Perforated and bleeding peptic ulcer: WSES guidelines Antonio Tarasconi1* , Federico Coccolini2, Walter L. Biffl3, Matteo Tomasoni4, Luca Ansaloni4, Edoardo Picetti5, Sarah Molfino6, Vishal Shelat7, Stefania Cimbanassi8, Dieter G. Weber9, Fikri M. Abu-Zidan10, Fabio C. Campanile11, Salomone Di Saverio12, Gian Luca Baiocchi6, Claudio Casella13, Michael D. Kelly14, Andrew W. Kirkpatrick15, Ari Leppaniemi16, Ernest E. Moore17, Andrew Peitzman18, Gustavo Pereira Fraga19, Marco Ceresoli20, Ronald V. Maier21, Imtaz Wani22, Vittoria Pattonieri1, Gennaro Perrone1, George Velmahos23, Michael Sugrue24, Massimo Sartelli25, Yoram Kluger26 and Fausto Catena1
Abstract Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5–10% and an incidence of 0.1–0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10–20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process. Keywords: Peptic ulcer, High-risk patients, Diagnosis, Non-operative management, Surgery, Antibiotics, Peritonitis, Pancreatitis, Intra-abdominal infection, Technique, Timing, Angiography, Embolization, Guidelines
* Correspondence: [email protected] 1 Emergency Surgery Department, Parma University Hospital, Parma, Italy Full list of author inf
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