Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2020; 26(35): 5302-5313
Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5302
Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years
Aydin Dadfar, Tom-Harald Edna
Aydin Dadfar, Tom-Harald Edna, Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway
Tom-Harald Edna, Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway
Author contributions: Dadfar A made substantial contributions to the conception and design of the study, acquisition, analysis, and interpretation of data, and drafting the article; Edna TH made substantial contributions to the conception and design of the study, acquisition, analysis, and interpretation of data, and drafting the article; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Levanger Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects (2018/2760 – 33974/2018).
Informed consent statement: Not necessary according to the Regional Committee for Medical and Health Research Ethics (REC), Helse Midt (2018/1510).
Conflict-of-interest statement: The authors declare the absence of conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Aydin Dadfar, MD, Surgeon, Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Kirkegata 2, Levanger 7600, Norway.
Received: March 24, 2020
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.