Management strategies of marginal ulcers

Marginal ulcer is caused by inadequate initial peptic ulcer surgical procedure. Since H2 receptor antagonists have become popular as a standard treatment for peptic ulcer in the past two decades, a retrospective analysis was done to evaluate whether the H2 receptor antagonists can also be used to treat marginal ulcer. Forty-five patients with pathologically proved marginal ulcer were collected from our hospital in records over the past 10 years. Medical treatment with H2 receptor antagonists was the primary treatment for those 45 patients. Only 7 marginal ulcers healed and without recurrence. Twenty-five ulcers healed but with repeated recurrence. Surgery was suggested to another ten repeated complicated recurrent ulcers and three persistent marginal ulceration. Three patients with persistent marginal ulcer underwent elective surgery and all of these recovered without recurrence. Six patients with recurrent bleeding ulcer underwent emergency operation, and all of them were died of surgical complications, except one patient who recovered without recurrence. Although H2 receptor antagonists have a high success rate to heal marginal ulcers, however, they also have a high recurrence rate. Surgical treatment should be strongly suggested for patients with repeated recurrent bleeding ulcer.