Has the Incidence of Perforated Peptic Ulcer Decreased over the Last Decade? / with Invited Commentary

Abstract

Background: The therapeutic use of new drugs for inhibiting gastric secretion together with Helicobacter pylori antimicrobe therapy has given rise to controversy over the current incidence of perforated peptic ulcer (gastroduodenal peptic ulcer, GDPU). The aim of this study is to analyze the incidence of ulcer perforation over the last 12 years in our health area and the influence of new medical treatments. Material and Methods: Our series includes 246 patients operated on for perforated peptic ulcer during a 12-year period (January 1987 to December 1998) in our health area. The mean patient age was 55.2 ± 18.1 (16–93) years, and there was a predominance of males (199/246; 80.9%). The ulcer was located fundamentally in the pylorus (48.3%) and duodenal bulb (39.1%), and the most frequent surgical technique was bilateral truncal vagotomy associated with pyloroplasty (85.3%). Results: During the 1987–1992 period, 152 patients underwent surgery, whereas 94 patients were operated on between 1993 and 1998, which reveals a statistically significant difference (p < 0.001). Furthermore, if we divide the study into four 3-year periods (1987–1989, 1990–1992, 1993–1995 and 1996–1998), we see that there were 74 and 78 GDPUs in the first two periods, with no statistical differences between each other, and 48 and 46 cases in the last two periods, also with no statistical differences between each other, but statistically significant when compared to the first two periods. Conclusion: The incidence of perforated GDPU has dropped by half over the last 6 years due fundamentally to the use of proton pump inhibitors.