[Frontiers in Bioscience, 6, e119-128, October 1, 2001]


Kevin O. Clarke, Lawrence E. Harrison

Department of Surgery, Division of Surgical Oncology, UMDNJ-New Jersey Medical School, New Jersey, 185 S. Orange Avenue, MSB G588, Newark, NJ 07103


1. Abstract
2. Introduction
3. Surgery for Peptic ulcer disease
3.1. Bleeding peptic ulcer disease
3.1.1. Choice of Operation
3.2. Perforated Duodenal ulcers
3.2.1. Choice of Therapy
3.3 . Gastric outlet obstruction
3.4. Significance of H. pylori infection of the gastric remnant
4. Surgery for gastric malignancy
4.1. Gastric adenocarcinoma
4.1.1. Surgery for Staging
4.1.2. Surgery for Palliation
4.1.3. Surgery for Cure
4.2. Gastric MALT Lymphoma
4.2.1. Evaluation
4.2.2. Treatment
5. Perspective
6. References


Helicobacter pylori infection is the most common cause of peptic ulcer disease and is an etiologic factor in the development of gastric malignancies. Eradication of H. pylori heals most uncomplicated peptic ulcers, as well as preventing their relapse. In addition, H. pylori therapy has recently been used as a first line treatment for most low grade MALT lymphomas. Despite its efficacy, a small percentage of patients with peptic ulcer disease will require operative intervention and the indications for surgical intervention for the patient with peptic ulcer disease include; intractability, gastric outlet obstruction, acute perforation, and bleeding uncontrolled by endoscopic intervention. H. pylori has also been shown to be associated with an increased risk of gastric adenocarcinoma and surgical exploration may play a role in diagnosis, staging and treatment. Finally, the relationship between H. pylori infection and the development of gastric MALT lymphoma is well established. While treatment for H. pylori infection is indicated for low grade MALT lymphomas, surgical resection may be indicated for treatment failures, as well as for certain high grade lesions.