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Gastroduodenal
The scars of time: the disappearance of surgery for pyloric stenosis
  1. R Hall *1,
  2. C Royston2,
  3. K D Bardhan2
  1. 1York Peptic Ulcer Research Trust, York, UK
  2. 2Rotherham General Hospital, Rotherham, UK

Abstract

Introduction The changing pattern of both elective and emergency operations for peptic ulcer disease (PUD) has been well described but less is known about operations for pyloric stenosis (PS).

Methods Data registration was started by the York surgeon, the late Arthur HC Visick. After his death his successors formed the York Peptic Ulcer Research Trust to continue data collection. The database was maintained after 1971 by Robert Hall who continues as its archivist. All patients undergoing emergency or elective definitive operations for PUD (i.e. with the intent of cure), were entered into the database. The first registered operation was in 1929 and the last in 1997. We examined the pattern of the 4248 definitive operations for PUD and the subset of 475 with PS. Early registrations were sparse hence data before 1940 are amalgamated.

Results See Table 1. PS was found in 475/4248 (11%). Operation numbers steadily rose until 1974, declining rapidly thereafter until hardly any were carried out in the last decade. 2. Those born 1900-1909 had by far the highest proportion of PUD operations both overall and with PS, peaking in 1950-59. Later cohorts showed a similar pattern but with progressively lower peaks.

Table 1

PTU-083 Operation period versus birth cohort

Discussion 1. The decline in operation rates preceded the introduction of H2-receptor antagonists (H2RA) in November 1976, thus indicating it was independent of medical treatment. 2. By the time H2RA emerged those with severe disease had been operated upon and many of those born early in the 20th Century no longer survived. Thus this powerful new medical treatment was required by a decreasing PUD population who may have had milder disease. 3. We suggest that the falling numbers coming to operation even before the introduction of H2RA indicate a natural decline in the severity of PUD. The effect of H2RA has added to this.

Conclusion Operation for PS has largely vanished in parallel with the decline in elective PUD operation. This dramatic reduction owes as much to a spontaneously changing natural history as it does to the evolution of modern medical therapy.

  • peptic ulcer disease
  • pyloric stenosis
  • surgery

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Footnotes

  • Competing interests None.

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