Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study

Abstract

Objective: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU).Materials and methods: Design: a nationwide cohort study with prospective and consecutive data collection. Population: all patients treated for PUB and PPU at Danish hospitals between 2003 and 2014. Data: demographic and clinical data reported to the Danish Clinical Registry of Emergency Surgery. Outcome measures: 90- and 30-d mortality and re-intervention. Statistics: the crude and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis.Results: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30–1.67); p < 0.001, OR 1.60 (1.43–1.77); p < 0.001, and OR 1.86 (1.68–2.06); p < 0.001, respectively. There was no difference in outcomes between gastric and duodenal ulcers (DUs) in PPU patients: adjusted OR 0.99 (0.84–1.16); p = 0.698, OR 0.93 (0.78 to 1.10); p = 0.409, and OR 0.97 (0.80–1.19); p = 0.799, respectively.Conclusions: DU site is a significant predictor of death and re-intervention in patients with PUB, as compared to GU site. This does not seem to be the case for patients with PPU.