Prevalence and the outcome of peptic ulcer disease- A retrospective study
Introduction: Peptic ulcer disease (PUD) occurs due to an imbalance between stomach acid-pepsin and mucosal defense mechanisms. It affects 4 million people worldwide annually. About 10%-20% of patients with PUD will have complications and 2%-14% of the ulcers will perforate causing an acute illness. Objective: To assess the prevalence and the outcome of peptic ulcer disease. Materials and Methods: A retrospective study was conducted at the Department of Gastroenterology, Army Medical College Jashore, Jashore Cantonment, Bangladesh from January to June 2022. In total, 120 patients who underwent emergency surgery for perforated peptic ulcer were included in this study. The clinical Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, operative methods, post-operative complications, length of hospital stay, morbidity and mortality were collected retrospectively. Results: Out of 87 (72.5%) patients were male and 33 (27.5%) were female patients and the mean age was 60 years. The mean time for presentation to the hospital was 32 hours. While 29 (24.4%) of the patients had shock at presentation, 49 of them (40.8%) were identified to have at least one comorbid disease. It was identified that perforation was most frequent in the pre-pyloric region (86 patients, 71.6%). The length of hospital stay was longer in patients who developed morbidities. In the post-operative period, 46 patients (38.3%) developed morbidity. The most frequent morbidity was wound infection. 33 (27.5%) patients died. The most frequent reason for mortality was sepsis. In our study age over 60 years, presence of co-morbidities late time at presentation of more than 24 hrs. from the onset of symptoms, shock at presentation were noted as independent risk factors influencing morbidity and mortality. Conclusion: In spite of the developments in peptic ulcer disease treatment, peptic ulcer perforation remains a serious surgical problem. Patients above the age of 60, with a time to presentation longer than 24 hours, presence of shock at the time of presentation and concomitant diseases, are patients at high risk for post-operative morbidity and mortality, close monitoring of which can help reducing mortality and morbidity. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes.
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