Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5302
Peer-review started: March 24, 2020
First decision: April 25, 2020
Revised: June 23, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: September 21, 2020
The incidence of peptic ulcer disease (PUD) has decreased during the last few decades. However, complicated PUD has not decreased likewise. Perforation is the complication that accounts for most deaths associated with PUD, and it remains a surgical emergency. Perforated peptic ulcer (PPU) has a high short-term mortality.
With the discovery of the role of Helicobacter pylori in PUD, it is important to investigate trends and changes in demography in patients with PPU. This will provide more precise characteristics regarding these patients, which in turn might contribute towards more rapid diagnostics and treatment.
The aim of this study was to investigate changes in demography and the effect on treatment, complications, and short- and long-term mortality in patients admitted to our hospital with PPU over four decades.
All patients who were admitted to our hospital with PPU from 1978-2017 were retrospectively identified and included. We retrieved their medical records and reviewed them to obtain data concerning patient characteristics, treatment and complications.
The median age increased from 63 to 72 years from the first to the last decade. The incidence rate increased with increasing age, although we observed a decline in incidence rate in recent decades. Comorbidity increased significantly over the 40 years of the study. The median time from debut of symptoms to operation increased from 8 to 17 h from the first to the last decade. One or more complications occurred in 39 %. Both short- and long-term mortality were associated with American Society of Anaesthesiologists (ASA) score.
Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.
This study has shown a demographic shift among patients with PPU. Future research should assess a better understanding of the association of increasing age, comorbidity and other risk factors with PPU. Clinical trials might serve to reduce the high number of complications in these patients.