Rantanen Tuomo K, Sihvo Eero I T, Räsänen Jari V, Hynninen Marja, Salo Jarmo A
Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
Digestion. 2015;91(4):272-6. doi: 10.1159/000381307. Epub 2015 Apr 15.
This study aimed at defining the mortality and the nature of fatal complications that arise out of esophageal ulcer for one clearly defined geographical area.
In this national, population-based study, the occurrence of fatal esophageal ulcer or ulcer requiring hospital treatment between January 1987 and December 2000 was assessed by the use of Finland's administrative databases. Medical records provided etiology of fatal ulcer and agonal symptoms.
Due to an esophageal ulcer, 2,242 patients received treatment in Finnish hospitals, at an annual frequency of 3.2/100,000. Ulcer with hemorrhage (53.5%), perforation (38.4%), or aspiration pneumonia (2.3%) was the cause of death in 86 patients for an annual mortality of 0.12/100,000. Based on the number of ulcers treated, 3.8% cases ended fatally. Gastroesophageal reflux disease (GERD) seemed to be the etiologic factor for ulcer in 68 (79.0%) patients. The most common agonal symptoms were hematemesis (41.8%), abdominal pain (25.6%), melaena (22.1%), and dyspnea (17.4%). Twenty (23.3%) patients were found dead at home.
The rarity of the disease, related disorders, and the diversity of symptoms make the complicated esophageal ulcer a diagnostic challenge. Effective monitored treatment for severe GERD may be an important step to prevent fatal outcome.
本研究旨在明确一个特定地理区域内食管溃疡所致的死亡率及致命并发症的性质。
在这项基于全国人口的研究中，通过芬兰的行政数据库评估了1987年1月至2000年12月期间致命性食管溃疡或需住院治疗的溃疡的发生情况。医疗记录提供了致命溃疡的病因及濒死症状。
在芬兰医院，2242例患者因食管溃疡接受治疗，年发生率为3.2/10万。86例患者因伴有出血（53.5%）、穿孔（38.4%）或吸入性肺炎（2.3%）的溃疡死亡，年死亡率为0.12/10万。基于接受治疗的溃疡数量，3.8%的病例最终死亡。胃食管反流病（GERD）似乎是68例（79.0%）患者溃疡的病因。最常见的濒死症状是呕血（41.8%）、腹痛（25.6%）、黑便（22.1%）和呼吸困难（17.4%）。20例（23.3%）患者在家中死亡。
该疾病的罕见性、相关病症及症状的多样性使得复杂性食管溃疡成为一项诊断挑战。对严重GERD进行有效的监测治疗可能是预防致命结局的重要一步。
