What has happened to perforated peptic ulcer?

Abstract

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965-82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965-70 to 59.0 years in 1977-82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.

Spectrum of perforation peritonitis in Kashmir: a prospective study at our tertiary care centre

“…2 It is common in a younger age group in the tropical countries (mean age in our study was 39.8 years) in comparison to the studies from West. [6][7][8] Male 69.9%, and female 30.1% were present in our series similar to other studies. 9 Perforation of the proximal part of the gastrointestinal tract were more common, 10 which is in contrast to the studies from western countries where perforations are common in the distal part.…”

Etiology and management of perforation peritonitis: perspective from developing world

“…Most commonly it affects the younger age group in the tropical countries (mean age in the present study group was 38.6 years) as compared to western world . [5][6][7] Most of the cases present late to the hospital with well-established generalized peritonitis having gross purulent or fecal contamination and varying degrees of septicemia. It is possible to make the diagnosis of peritonitis clinically in almost all the cases due to typical signs and symptoms.…”

Has the Incidence of Perforated Peptic Ulcer Decreased over the Last Decade? / with Invited Commentary

“…Various authors [2, 3, 9, 16]report a decrease in elective surgery for GDPU, which they relate to the widespread use of drugs such as anti-H 2 and proton pump inhibitors over the last two decades. These drugs are very efficient for curing ulcer outbreaks but do not prevent ulcer recurrence if treatment is discontinued [17].…”

“…Since then various studies have implicated Helicobacter pylori in the pathogenesis of the disease [5, 6, 7], and the Consensus Conference held by the National Institute of Health in 1994 recommended that all patients with GDPU and H. pylori infection should be treated with antimicrobe therapy [8]. However, in the same period of time it was reported that the number of surgical procedures performed in patients with complicated GDPU has remained unchanged [9, 10, 11, 12]. We recently reported a significant decrease in the need of surgery for peptic pyloric stenosis, which is probably due to the influence of treatment with proton pump inhibitors and H. pylori antimicrobe therapy [13].…”