Trends in Perforated Peptic Ulcer: Incidence, Etiology, Treatment, and Prognosis

Abstract

After increasing steeply at the beginning of the twentieth century, ulcer perforation incidence during the last decades has declined in the young and in men, and it has risen among the elderly and in women. These changes can be attributed to a cohort phenomenon: Ulcer perforation risk is particularly common in the cohorts born after the turn of the twentieth century and is less common in previous and succeeding birth cohorts. A decline in total incidence is expected with the death of the high risk cohorts. Most ulcer perforations among subjects < 75 years of age can be attributed to smoking. Subjects with a history of ulcer perforation therefore have poorer long-term survival than the general population, most pronounced for younger generations. About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. Ulcer perforation was frequently treated by gastric resection in former days, whereas suture, being the first method introduced in 1887, is the method of choice today. The introduction of antibiotics improved the prognosis of ulcer perforation surgery greatly. Postoperative lethality decreased until 1950 but has remained stable since then. Lethality is higher in the elderly and is higher after gastric than after duodenal perforation. The delay before surgical treatment is a strong determinant for lethality, complication rates, and hospital costs. Treatment delay seems to have increased during the last

Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

“…Heart and renal disease were excluded from the Charlson Index when stratified by this variable. tor for both peptic ulcer complications (18). Unfortunately, it was not possible to obtain valid information on the duration from symptom onset to initiation of treatment in this study.…”

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

“…Sweeney, et al 27 reported mortality rates of 3-18%, considering age, perforation time and comorbidities.…”

Prevalence of Helicobacter Pylori Infection in Patient’s of Perforated Peptic Ulcer

“…19 Although Incidence of perforated gastroduodenal peptic ulcer has reduced to 50% over the last 6 years due to the increased use of proton pump inhibitors 20 yet peptic ulcer when perforate still carries high mortality, delay in surgical management is considered a major determinant. 21 The sensitivity and specificity of serology assay varies from 52-94.5%, and 60-97.2% respectively. 22 The biopsy-based methods, on the other hand have a low sensitivity (83%), but a high specificity (100%).…”