Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

  • Tamotsu Matsuhashi
    Department of Gastroenterology Akita University Graduate School of Medicine Akita Japan
  • Sho Fukuda
    Department of Gastroenterology Akita University Graduate School of Medicine Akita Japan
  • Yasuhiko Abe
    Division of Endoscopy Yamagata University Hospital Yamagata Japan
  • Tatsuya Mikami
    Division of Endoscopy Hirosaki University Hospital Aomori Japan
  • Tetsuya Tatsuta
    Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
  • Takuto Hikichi
    Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
  • Jun Nakamura
    Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
  • Yusuke Onozato
    Department of Gastroenterology Faculty of Medicine Yamagata University Hospital Yamagata Japan
  • Waku Hatta
    Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
  • Atsushi Masamune
    Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
  • Motoki Ohyauchi
    Department of Gastroenterology Osaki Citizen Hospital Miyagi Japan
  • Hirotaka Ito
    Department of Gastroenterology Osaki Citizen Hospital Miyagi Japan
  • Norihiro Hanabata
    Department of Gastroenterology Aomori Prefectural Central Hospital Aomori Japan
  • Yasumitsu Araki
    Department of Gastroenterology Aomori Prefectural Central Hospital Aomori Japan
  • Takumi Yanagita
    Department of Gastroenterology Ohta Nishinouchi Hospital Fukushima Japan
  • Hidemichi Imamura
    Department of Gastroenterology Ohta Nishinouchi Hospital Fukushima Japan
  • Tsuyotoshi Tsuji
    Department of Gastroenterology Akita City Hospital Akita Japan
  • Kae Sugawara
    Department of Gastroenterology Akita City Hospital Akita Japan
  • Youhei Horikawa
    Department of Gastroenterology Hiraka General Hospital Akita Japan
  • Shuichi Ohara
    Department of Gastroenterology Tohoku Rosai Hospital Miyagi Japan
  • Yutaka Kondo
    Department of Gastroenterology Tohoku Rosai Hospital Miyagi Japan
  • Takahiro Dohmen
    Department of Gastroenterology Yuri Kumiai General Hospital Akita Japan
  • Katsunori Iijima
    Department of Gastroenterology Akita University Graduate School of Medicine Akita Japan

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<jats:sec><jats:title>Background</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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% [<jats:italic>P <</jats:italic> 0.0001] and 14.6% vs. 5.1% [<jats:italic>P =</jats:italic> 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>

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