Peptic Ulcer Mortality Research Articles

Laparoscopic surgery and mortality in perforated peptic ulcer (correlation and regression

Aim of the study is to evaluate the relationship between the number of laparoscopic operations and mortality in patients with perforated peptic ulcer. Materials and methods: The functional relationships between the number of performed laparoscopic operations and the levels of hospital and postoperative mortality were studied based on the analysis of the results of surgical treatment of patients with a perforated ulcer in 2018. Results: An analysis of the functional relationships between the number of laparoscopic operations performed and mortality was carried out based on the results of primary statistical information (2 189 patients with a perforated ulcer). Strong direct correlations have been established, which can be most reliably described within the framework of polynomial regression models (r2 = 0.917 and r2 = 0.889). Conclusion: An assessment of trends in the reduction in hospital and postoperative mortality with an increase in number of laparoscopic operations will be determined only with standardized approaches to the usage of minimally invasive technologies in all areas of the Russian Federation.

S990 A Two-Decade Analysis of Peptic Ulcer Mortality in the U.S (1999-2020)

S990 A Two-Decade Analysis of Peptic Ulcer Mortality in the U.S (1999-2020)

POMPP Score and Boey Score: To Predict Mortality in Peptic Ulcer Perforation

Introduction: Peptic ulcer is an insult to the mucosa of the upper digestive tract. Helicobacter pylori infection, long term use of non-steroidal anti-inflammatory drugs or steroids, excessive alcohol ingestion and smoking are common etiological factors. A number of scoring systems for prediction of outcomes in perforated peptic ulcer patients have been developed such as Predictive score of mortality in perforated peptic ulcer score and Boey score.
 Aims: To evaluate Predictive score of mortality in perforated peptic ulcer score and Boey Score in predicting accuracy of mortality in patients with peptic ulcer perforation.
 Methods: A hospital based study was conducted from June 2021 to May 2022 in the department of Surgery, Nepalgunj Medical College, Kohalpur. The Predictive score of mortality in perforated peptic ulcer and Boey score were recorded after history taking, physical examination, basic pre-operative investigations and radiological imaging. The patients were classified into high risk and low risk categories based on scores and followed up to predict the mortality within 30 days post operatively.
 Results: 80 patients were included in the study. 53 were male and 27 female. Peptic ulcer perforation was seen more in age groups of 45 to 60 years. In Boey score 8 patients out of 27 high risk patients died whereas in Predictive score of mortality in perforated peptic ulcer score 8 patients died out of 12 high risk patients. When compared, predictive score of mortality in perforated peptic ulcer was found to be more accurate than Boey score (p-<0.05) score.
 Conclusion: Predictive score of mortality in perforated peptic ulcer is easy to use and more accurate in predicting mortality in peptic ulcer perforation than Boey score.

A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers

Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases. Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period. Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p -value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p -value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p -value of 0.047. Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.

Evaluation of Boey scoring in predicting morbidity and mortality in peptic ulcer perforation peritonitis

Among abdominal emergencies, perforations of peptic ulcer are third most common in frequency, after acute appendicitis and acute intestinal obstruction. The prevalence of peptic ulcer disease ranges from 5 to 15% in the western population. Perforation being the most dreaded complication, occurring in about 2–10% of peptic ulcer cases. Inspite of better understanding of the disease, effective resuscitation and prompt surgery under modern anaesthesia techniques, there is still high mortality and morbidity in perforated peptic ulcer with mortality rate ranging from 5% to 15%. Prompt recognition of the condition and early surgery are very important to reduce the mortality. In our study, we stratified the patients with perforated peptic ulcer peritonitis according to Boey score and found a significant relationship between increasing Boey score with higher rates of post-operative morbidity and mortality. The study also demonstrated that using a simple clinical scoring system in surgical emergency room proves critical to reduce the chances of morbidity and mortality among patients with perforated peptic ulcer peritonitis.

Comparison of POMPP Scoring System with PULP Score, Boey Score, and ASA Scoring Systems to Predict Mortality in Peptic Perforation

Perforated peptic ulcer represents the most frequent indication for emergency surgery for peptic ulcer disease. The mortality from perforated peptic ulcer remains up to 27%. We compare predictive score of mortality in perforated peptic ulcer (POMPP) scoring system with peptic ulcer perforation (PULP) score, Boey score, and American Society of Anesthesiologists (ASA) score to predict mortality. Hundred consecutive patients were operated for peptic perforation from May 2018 to May 2019 in our institute. For prediction of mortality, scoring was done by POMPP score, PULP score, Boey score, and ASA score. Comparative analysis of different score was done. Mean age was 40.7 years and male to female ratio was 32.3:1. Post-operative morbidity was 27% and mortality rate was 11%. Of the 10 patients of high POMPP score, 8 patients died (p value 0.000001) with accuracy of 80%. Receiver operating characteristic curve analysis showed that area under curve was 0.964 for POMPP score, 0.980 for PULP score, 0.960 for Boey score, and 0.906 for ASA score. The specificity of Boey score, POMPP score, and PULP score was 88.7%, 97.7%, and 100% respectively. Boey score had accuracy of 44.4% and PULP score had 100% accuracy in predicting mortality but it is complex with more number of components. POMPP score is based on objective data and its components are age and routinely measured values (blood urea nitrogen and serum albumin). It is simple and easily applicable scoring system for predicting mortality in peptic perforation peritonitis patients with accuracy of 80%.

PPIs for prevention and treatment of peptic ulcer

The incidence and mortality of peptic ulcer rose markedly during the 19th century,1 peaking in the generation born at the end of the century, and then steadily decreasing. In recent decades, the main ulcer aetiology has shifted in many countries from Helicobacter pylori to non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. Use of other drugs such as steroids, aldosterone antagonists, and selective serotonin reuptake inhibitors can contribute to gastroduodenal ulceration and its complications.2 This combination of factors explains why upper gastrointestinal bleeding remains the most common gastrointestinal emergency globally. [...]

Scoring system in outcome prediction of postoperative mortality and morbidity in perforated peptic ulcer

Scoring system in outcome prediction of postoperative mortality and morbidity in perforated peptic ulcer

Evaluation of mortality and morbidity in patients with secondary peritonitis using predictive score of mortality in perforated peptic ulcer

Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer.Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age &gt;65 years, BUN &gt;45mg/dl (Blood Urea Nitrogen) and Albumin &lt;1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality.Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to small bowel perforations (18% Ileal and 4 % Jejunal), 14 % due to trauma and 22 % due to miscellaneous causes. Morbidity is common after gastrointestinal perforation and it ranges from 17-63% whereas mortality ranges from 6-14%.Conclusions: POMPP score is easy and valid scoring system for peptic ulcer perforation. Early detection of high risk peptic perforation cases, allow other supportive treatment modality apart from surgery which can decrease the mortality. However, this score is not valid in perforation due to causes other than peptic ulcer.

Sa1478 Impact of Hemodialysis on Peptic Ulcer Bleeding-Study to Identify Risk Factors for Peptic Ulcer Rebleeding and Mortality-

Sa1478 Impact of Hemodialysis on Peptic Ulcer Bleeding-Study to Identify Risk Factors for Peptic Ulcer Rebleeding and Mortality-

Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality

To investigate the epidemiological trends in incidence and mortality of perforated peptic ulcer (PPU) in a well-defined Norwegian population. A retrospective, population-based, single-center, consecutive cohort study of all patients diagnosed with benign perforated peptic ulcer. Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010. Ulcers with a malignant neoplasia diagnosis, verified by histology after biopsy or resection, were excluded. Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes (K25.1, K25.2, K25.5, K25.6, K26.1, K26.2, K26.5, K26.6). Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures (e.g., JDA 60, JDA 61, JDH 70 and JDH 71) were performed to enable a complete identification of all patients. Patient demographics, presentation patterns and clinical data were retrieved from hospital records and surgical notes. Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. In the study period, a total of 172 patients with PPU were identified. The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year (95%CI: 5.6-7.6) and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year (95%CI: 0.7-1.6). A non-significant decline in adjusted incidence rate from 9.7 to 5.6 occurred during the decade. The standardized mortality ratio for the whole study period was 5.7 (95%CI: 3.9-8.2), while the total 30-d mortality was 16.3%. No difference in incidence or mortality was found between genders. However, for patients ≥ 60 years, the incidence increased over 10-fold, and mortality more than 50-fold, compared to younger ages. The admission rates outside office hours were high with almost two out of three (63%) admissions seen at evening/night time shifts and/or during weekends. The observed seasonal variations in admissions were not statistically significant. The adjusted incidence rate, seasonal distribution and mortality rate was stable. PPU frequently presents outside regular work-hours. Increase in incidence and mortality occurs with older age.

Fall in peptic ulcer mortality associated with increased consultant input, prompt surgery and use of high dependency care identified through peer-review audit

ObjectivesPatients with peptic ulceration continue to present to surgeons with complications of bleeding or perforation and to die under surgical care. This study sought to examine whether improved consultant input,...

Hospitalisation of and mortality from bleeding peptic ulcer in Sweden: a nationwide time‐trend analysis

Time-trend analyses of incidence and mortality in bleeding peptic ulcer show divergent results. To conduct a detailed national analysis of hospitalisation of and mortality from bleeding peptic ulcer in Sweden. Data from all hospitalisations at departments with primary responsibility for patients with bleeding ulcer in Sweden, with main diagnosis or co-diagnosis of bleeding ulcer from 1987 to 2005 were retrieved from the Hospital Discharge Register. A validation study was performed due to an uncertainty in diagnostic setting after the introduction of ICD-10 in 1997. Annual hospitalisation rates per 100 000 inhabitants in relation to gender, age and ulcer location were calculated as well as age-standardised 30-day mortality rates. Hospitalisations for bleeding ulcer decreased from 63.9 to 35.3 per 100 000 inhabitants per year during the study period. The decrease was greater among men (men: from 80.4 to 40.9; women: from 47.7 to 29.7) and in younger age groups. Bleeding gastric ulcer decreased in both genders, and bleeding duodenal ulcer decreased most among men, but was stable in a subgroup of elderly women. Median age increased from 70 to 76 years. Standardised 30-day mortality increased from 5.3% to 6.2%. The increased mortality was found in those aged more than 65 years and with duodenal ulcer disease, whereas mortality remained unchanged in those with bleeding gastric ulcer. Hospitalisation rates for bleeding peptic ulcer have markedly decreased in Sweden in all age groups. The 30-day mortality is low compared with other nationwide studies in the western world, but has increased among patients with duodenal ulcer disease.

Perforated peptic ulcer in southeastern Taiwan

No studies focus on the population with perforated peptic ulcer in southeastern Taiwan. The present study aimed to assess the differences between the different races and the risk factors related to mortality and morbidity in postoperative patients in southeastern Taiwan. The medical records of 237 patients were reviewed retrospectively. The following factors were analyzed: patient profiles, coexisting illnesses, diagnostic method, fever, preoperative shock, clinical data at emergency room, delay operation, site of perforation, operative method, positive ascites culture, species of microbes in ascites culture, postoperative complications, death and the length of hospital stay. Aborigines were significantly different from non-aborigines in the ratio of female cases and in the habits of alcohol drinking and betel nut chewing. There were also four significantly different variables between them: fever, hemoglobin value, site of perforation and operative method. Total postoperative complication rate was 41.3% and 39 patients (16.6%) died. In multivariate analysis, age > or = 65 years, lipase > upper normal limit and preoperative shock were independent predictors of mortality. Significant risk factors associated with morbidity were NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock. Aborigines were different from non-aborigines in several categories. In southeastern Taiwan, NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock were independent risk factors of morbidity, and age > or = 65 years, lipase > upper normal limit and preoperative shock were independent risk factors of mortality in postoperative perforated peptic ulcer. Lipase > upper normal limit is needed for further research on the influence on mortality.

Differences in the birth-cohort patterns of gastric cancer and peptic ulcer

AimThe aim of this epidemiological study was to follow the time trends of mortality from gastric cancer and compare them with those of gastric and duodenal ulcer.MethodsMortality data from Denmark,...

Mapping infectious diseases in Africa

<h3>Aim</h3> The aim of this epidemiological study was to follow the time trends of mortality from gastric cancer and compare them with those of gastric and duodenal ulcer. <h3>Methods</h3> Mortality data from Denmark, England &amp; Wales, Italy, Japan, Switzerland and the United States of the past 57–130 years were analysed. The age-specific death rates were plotted against the period of death as period-age contours and against the period of birth as cohort-age contours. <h3>Results</h3> The long-term time trends of gastric cancer mortality were found to rise among generations born during the 18th century until the first half of the 19th century and then decline in all subsequent generations. The rise and fall of gastric cancer preceded similar birth-cohort patterns of gastric and duodenal ulcer by about 10–30 years. With the exception of gastric cancer in the USA, similar birth-cohort phenomena were seen in all countries. In general, similar temporal patterns were also seen in men and women analysed separately. <h3>Conclusions</h3> The time trends of mortality from gastric cancer are shaped by an underlying birth-cohort pattern that resembles similar patterns of peptic ulcer mortality. The occurrence of birth-cohort phenomena in gastric cancer and peptic ulcer suggests that additional secular trends besides changes in the infection with <i>Helicobacter pylori</i> must have contributed to the peculiar long-term behaviour of these diagnoses.

Time Trends of Ulcer Mortality in Europe

The aim of the present study was to follow the time trends of ulcer disease in a representative sample of European countries and assess whether the most recent behavior of peptic ulcer still fits the overall pattern governed by an underlying birth-cohort phenomenon. Mortality data from 6 countries between 1921 and 2004 were analyzed, including Denmark, France, Germany, The Netherlands, Spain, and Switzerland. The age-specific death rates of gastric and duodenal ulcers from each individual country were plotted as period-age and cohort-age contours. The data from the past 50-80 years show striking similarities among the 6 European countries. In all countries alike, the risk of dying from gastric and duodenal ulcer increased among consecutive generations born during the second half of the 19th century until shortly before the turn of the century, and then decreased in all subsequent generations. The time trends of gastric ulcer preceded those of duodenal ulcer by 10-30 years. The increase in nonsteroidal anti-inflammatory drug consumption or introduction of potent antisecretory medications have not affected the long-term downward trends of ulcer mortality. The birth-cohort pattern has continued to influence the temporal variations of peptic ulcer until most recently. The unique shape of the birth-cohort patterns of gastric and duodenal ulcers and their identical appearance in countries with different health care systems and varying political and socioeconomic histories reflect the overriding influence of Helicobacter pylori infection.

A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

BackgroundWith dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer.MethodsIn a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods – logistic regression, Cox proportional hazards regression and Poisson regression, respectively – to examine the association of the predictors with these three domains.ResultsWe observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p < 0.001; and RR = 2.4, p = 0.002; respectively]. However, the rate of development of complications was influenced by a history suggestive of shock [relative hazards (RH) = 3.4, p = 0.002] and A- blood group (RH = 4.7, p = 0.04).ConclusionAbdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.

Evaluation of risk factors for mortality in perforated peptic ulcer in Ankara Numune Teaching Hospital, Ankara, Turkey

To assess the risk factor that influence mortality from perforated peptic ulcer. Retrospective study. Ankara Numune Teaching and Research Hospital, Ankara, Turkey. A total of 342 patients with perforated peptic ulcer disease were identified from April 1997 to January 2004. Data for the patients were extracted from the hospital records, operative notes and clinic charts. Age, sex, coexisting medical illness, use of non-steroidal anti-inflammatory drugs (NSAID) or steroids, preoperative shock, delay in treatment location of ulcer size, type of operation time, albumin concentration postoperative complications, postoperative hospitals stay and mortality results for all patients were obtained. Patients were aged from 17 to 80 years (mean 63 years, median 68 years) there were 210 males and 132 females. The mortality rate was 8.8% (30/342), and 62 patients had postoperative complications. Multivariate analysis showed that co-existing medical illness, preoperative shock, delay in treatment and low albumin concentrations were independent risk factors that significantly contributed to mortality. This study confirms co-existing medical illness, preoperative shock, delay in treatment and low albumin concentration as significant risk factors that increase mortality in patients with perforated peptic ulcers. These factors could serve as a guide to opine the risk and to improve the outcome in patients with perforated peptic ulcer. Mortality could be reduced by preventing delay in diagnosis and treatment for any co-existing medical illness and providing appropriate nutrition support.

Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery.

This study assessed the surgical concept and prognosis of perforated gastroduodenal ulcers. Data from 102 patients who underwent emergency surgery for peptic ulcer perforation were recorded prospectively. To evaluate morbidity and mortality ulcer perforation was classified into three types: type A, solitary peripyloric ulcer located anteriorly in which laparoscopic closure by suture with omentoplasty was treatment of choice and postoperative endoscopic biopsy was mandatory; type B, perforated ulcer with large defect in which excision and suture was necessary; type C, complicated perforated ulcer with destruction of proximal duodenum and penetration into adjacent organs in which resectional surgery was indicated. Morbidity and mortality were significantly lower in type A (9%, 4%, respectively) than types B (22%, 20%) and C (34%, 17%). Closure of type A perforation was managed laparoscopically in all cases. Billroth II resection was performed in 75% of type C cases. Age, ASA status, and time of surgery were independent prognostic factors by multivariate analysis, with increased mortality in patients older than 65 years, ASA III and IV, and surgery after 24 h following onset of symptoms. Prognosis of perforated ulcer disease is highly correlated with age, comorbid conditions (ASA status), and time of surgery. The proposed classification system helps to determine patients at risk of mortality.