Prevalence and the outcome of peptic ulcer disease- A retrospective study

  • Md. Ahsanul Haque Lecturer, Department of Anatomy, MD, MSc (Gastroenterology), Army Medical College Jashore, Jashore Cantonment, Bangladesh
  • Raj Mohon Hira Professor and Head, Department of Anatomy, Army Medical College Jashore, Jashore Cantonment, Bangladesh
  • Sharna Moin Associate professor, Department of Anatomy, Army Medical College Jashore, Jashore Cantonment, Bangladesh
  • Syed Didarul Haque Associate Professor, Department of Pharmacology, Gazi Medical College, Khulna, Bangladesh
  • Md. Jahangir Hossain Medicine Specialist, 250 Bed Hospital, Jashore, Bangladesh
  • Md. Jasim Uddin Child Specialist, 250 Bed Hospital, Jashore, Bangladesh
  • Alomgir Kabir Chest specialist, 250 Bed Sador Hospital, Jashore, Bangladesh
Keywords: Peptic Ulcers, Gastroscopy, Proton pump Inhibitors

Abstract

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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References

Zelickson MS, Bronder CM, Johnson BL, Camunas JA, Smith DE, Rawlinson D, Von S, Stone HH, Taylor SM. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. Am Surg. 2011; 77:1054–1060.

Malik AA, Wani KA, Dar LA, Wani MA, Wani RA, Parray FQ. Mannheim Peritonitis Index and APACHE II--prediction of outcome in patients with peritonitis. Ulus Travma Acil Cerrahi Derg 2010; 16: 27-32.

Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27:161–169.

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102–113.

Bas G, Eryilmaz R, Okan I, Sahin M. Risk factors of morbidity and mortality in patients with perforated peptic ulcer. Acta Chir Belg. 2008;108:424–427.

Vaira D, Menegatti M, Miglioli M. What is the role of Helicobacter pylori in complicated ulcer disease? Gastroenterology. 1997; 113:S78–S84.

Higham J, Kang JY, Majeed A (2002) Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 50: 460-464.

Svanes C, Salvesen H, Bjerke Larssen T, Svanes K, Soreide O (1990) Trends in and value and consequences of radiologic imaging of perforated gastroduodenal ulcer. A 50-year experience. Scand J Gastroenterol 25: 257- 262.

Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22–26.

Hermansson M, Staël von Holstein C, Zilling T. Surgical approach and prognostic factors after peptic ulcer perforation. Eur J Surg. 1999;165:566–572.

Rajesh V, Chandra SS, Smile SR. Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol. 2003;24:148–150.

Buck DL, Møller MH. Influence of body mass index on mortality after surgery for perforated peptic ulcer. Br J Surg. 2014;101:993–999. [PubMed] [Google Scholar]

Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101:e51–e64. [PubMed] [Google Scholar

Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51-58.

Najm WI. Peptic Ulcer Disease. Primary Care. 2011;38(3):383-94.

Koçer B, Sürmeli S, Solak C, Ünal B, Bozkurt B, Yıldırım O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 2007; 22: 565-570.

Prabu V, Shivani A. An Overview of History Pathogenesis and Treatment of Perforated Peptic Ulcer Disease with Evaluation of Prognostic Scoring in Adults. Ann Med Health Sci Res. 2014;4(1):22-9.

Van Der, Hulst R, Tytgat G. Helicobacter pylori and Peptic Ulcer Disease. Scandinavian Journal of Gastroenterology.1996;31(sup220):10-8.

Arici C, Dinckan A, Erdogan O, Bozan H, Colak T. Peptikülserperforasyonu: Ameliyatmortalitesineetkieden risk faktörlerininanalizi. Ulusal Travma Derg 2002; 8: 142-146.Lemaitre J, Founas WE, Simoens C, Ngongang C, Smets D, Costa PM. Surgical management of acute perforation of peptic ulcers. A single-centre experience. ActaChirBelg 2005; 105: 588-591.

Imhof M, Epstein S, Ohmann C, Röher HD. Duration of survival after peptic ulcer perforation. World J Surg 2008; 32: 408- 412.

Makela JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg 2002; 168: 446-451.

Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer 2012; 12: 26-35.

Thorsen K, Glomsaker TB, Meer AV, Søreide K, Søreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg 2011; 15: 1329-1335.

Li CH, Chang WH, Shih SC, Lin SC, Bair MJ. Perforated peptic ulcer in southeastern Taiwan. J Gastroenterol Hepatol 2010; 25: 1530-1536.

Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today indication, technique and outcome. Langen-becks Arch Surg 2000; 385: 84-96

Arici C, Dinckan A, Erdogan O, Bozan H, Colak T. Peptikülserperforasyonu: Ameliyatmortalitesineetkieden risk faktörlerininanalizi. Ulusal Travma Derg 2002; 8: 142-146.

Broderick TJ, Matthews JB. Vagotomy and Drainage. In: Yeo CJ, Dempsey DT, Klein AS, Pemberton JH, Peters JH. Shackelford’s Surgery of the Alimentary Tract. Sixth edition, Philadelphia, Saunders, 2007. pp. 811-826.

Müslümanoglu M, Özmen V, Yol S, Ekiz F. Peptikülsercerrahisindelaparoskopikyaklaşım. T Klin Tıp Bilimleri 1994; 14: 111-114.

Paimela H, Oksala NKJ, Kivilaakso E. Surgery for peptic ulcer today. A study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg 2004; 21: 185-191.

Chou NH, Mok KT, Chang HT, Liu SI, Tsai CC, Wang BW, et al. Risk factors of mortality in perforated peptic ulcer. Eur J Surg 2000; 166: 149-153.

Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, et al. Perforated peptic ulcer: main factors of morbidity and mortality. World J Surg 2003; 27: 782-787

Testini M, Portincasa P, Piccini G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol 2003; 9: 2338-2340.

Chan WH, Wong WK, Khin LW, Soo KC. Adverse operative risk factors for perforated peptic ulcer. Ann Acad Med 2000; 29: 164- 167.

CITATION
DOI: 10.26838/MEDRECH.2022.9.6.625
Published: 2022-11-08
How to Cite
1.
Haque MA, Hira RM, Moin S, Haque SD, Hossain MJ, Uddin MJ, Kabir A. Prevalence and the outcome of peptic ulcer disease- A retrospective study. Med. res. chronicles [Internet]. 2022Nov.8 [cited 2022Nov.27];9(6):370-7. Available from: https://medrech.com/index.php/medrech/article/view/607
Section
Original Research Article