Risk factors, Helicobacter pylori and a role for laparoscopic treatment of perforated peptic ulcer?

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use. Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared. Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them. Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

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Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

International Surgery ◽

10.9738/intsurg-d-15-00180.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 578-584

Author(s):

Fatih Ciftci ◽

Fazilet Erözgen

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Postoperative Period ◽

Perforated Peptic Ulcer ◽

Apache Ii ◽

Morbidity And Mortality ◽

Apache Ii Score ◽

Peptic Ulcers ◽

Presentation Time ◽

Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

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Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i4.10 ◽

2020 ◽

Vol 30 (4) ◽

Author(s):

Nebyou Seyoum ◽

Daba Ethicha ◽

Zelalem Assefa ◽

Berhanu Nega

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Addis Ababa ◽

Previous History ◽

Perforated Peptic Ulcer ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Delayed Presentation ◽

Cross Sectional ◽

Female Ratio

Background: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting.Methods: A two years (January 1, 2016 - December 30, 2018) retrospective cross- sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa,Ethiopia.Results: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was <10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(2-30)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP <90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate.Conclusions: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.

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Prevalence of Helicobacter Pylori Infection in Patient’s of Perforated Peptic Ulcer

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i4.225 ◽

2017 ◽

Vol 05 (04) ◽

pp. 21163-21168

Author(s):

Dr Gajendra Saxena ◽

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Perforated Peptic Ulcer ◽

Helicobacter Pylori Infection

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Helicobacter pylori and perforated peptic ulcer. Prevalence of the infection and role of non-steroidal anti-inflammatory drugs

Digestive and Liver Disease ◽

10.1016/j.dld.2003.10.011 ◽

2004 ◽

Vol 36 (2) ◽

pp. 116-120 ◽

Cited By ~ 31

Author(s):

J Gisbert

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Perforated Peptic Ulcer ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Prevalence and risk factors of Helicobacter pylori infections in the patients suffering from acid-peptic disease at tertiary care center, Gujarat, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183903 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1250

Author(s):

Anjali K. Kukreja ◽

Himani B. Pandya ◽

Santosh Kumar

Keyword(s):

Risk Factors ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Abdominal Pain ◽

Prevalence Rate ◽

Tertiary Care ◽

Chili Pepper ◽

Care Hospital ◽

Spicy Food ◽

H Pylori

Background: Helicobacter pylori (H. pylori) infection is a medical encumber especially in the developing countries, ranging from acute inflammation to malignancy. The study is intended to explore the prevalence of H. pylori infection and also to compute its associated risk factors.Methods: Sixty two (n=62) symptomatic patients attending the tertiary care hospital, were included in the study. Two antral biopsies collected from each patient were subjected to rapid urease test and Gram staining. IgG antibodies were detected by rapid test based on the principle of Immunochromatography. To evaluate the risk factors, various determinants were asked to each patient in the form of questionnaire. Statistical analysis was done using Fisher exact test. P value < 0.05 was considered significant.Results: Prevalence rate of H. pylori infection was 24.19 % (15/62). More than half (53%) of the infected patients had complained of persistent burning abdominal pain. Prevalence rate was found highest in the patients suffering from peptic ulcer disease (66.6%, P=0.0237). Consumption of unfiltered water (P=0.007, Odd Ratio (OR)-1.06), eating spicy food, meat, fish and chili pepper (P=0.052, OR-1.01) was found the major risk factors. Addictive habits of either smoking/alcohol/tobacco (P=0.904) were not associated with infection.Conclusions: Prevalence of H. pylori infection was found low comparatively and was mainly associated with symptom of persistent burning abdominal pain and peptic ulcer. Use of unfiltered water, spicy food, chili pepper and meat undoubtedly increase the risk of acquiring H. pylori infection. Addictive habits were not significantly associated with infection.

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