Smoking History Is More Highly Associated with Perforated Peptic Ulcer Than the Rate of Helocobacter pylori Infection

Abstract

Introduction: Perforated peptic ulcer disease is a relatively common surgical emergency. We conducted a retrospective review of patients with perforated peptic ulcer disease in one institution to evaluate factors associated with ulcer perforation. Methods: A retrospective review of patients from April 2012 to March 2016 with perforated peptic ulcers was performed. Data collected from the medical records includes age, gender, BMI, operation, perforation site, Helicobacter pylori infection status, smoking history, steroid use, NSAID use, morbidity and mortality. Results: A total of 76 patients (62 men and 14 women) were included in this study. Perforation sites include the duodenal bulb (n=56), second portion of the duodenum (n=1), prepyloric area (n=4), gastric body (n=12), and gastric fundus (n=2). Of these, 69 underwent operation and seven were treated non-operatively. The prevalence of Helicobacter pylori infection was 70% in patients with duodenal perforation and 63% in patients with gastric perforation. The prevalence of smoking was 82% in duodenal perforations and 87% in gastric perforations. Steroid use was 2% in duodenal and 11% in gastric perforations. NSAID use was 9% in duodenal and 17% in gastric perforations. In patients with either duodenal or gastric perforation, the prevalence of a smoking history was higher than the rate of Helicobacter pylori infection. Conclusion: Perforated peptic ulcer disease is a common surgical emergency. Etiologic factors associated with perforation have been reported, including Helicobacter pylori infection and NSAID use. In the present study, smoking history is the predominant risk factor in patients with perforated peptic ulcer disease, among risk factors including Helicobacter pylori infection, NSAID use, and steroid use. This result is significant because Japan is known have a higher rate of Helicobacter pylori than in high income countries. Well-known risk factors including NSAID and steroid use were less associated with perforation in this study. Smoking history is the risk factor most highly associated with perforation.