Author(s): Devendra Chouhan1, Rajkumar Mathur2, Arvind Shukla3, Aarif Ansari4
To investigate the recent change in epidemiology of benign peptic perforation in young adults.
This is a prospective population-based single centre observational study of all patients diagnosed with benign perforated peptic ulcer; included were both gastric and duodenal ulcer patients admitted to Maharaja Yeshwantrao Hospital, Indore, between September 2013 and September 2015. Ulcers with a malignant neoplasia diagnosis verified by histology after biopsy, traumatic perforation, and perforation of age group >45 and <15 were excluded. Patient demographics, presentation patterns, and clinical data were retrieved from hospital records and surgical notes. Data collected by a working proforma in the form of a questionnaire having questions regarding their dietary habits, smoking, alcoholism, etc. from patients and their attendants both at the time of postoperative recovery in the wards.
In the study period, a total of 200 patients with PPU were identified; 169 were male patients and 31 were female patients. Maximum no. of patients were of age group 41-45 (61 cases, 30.5%), minimum below 20 years of age (7.5%). 164 patients (82%) were found to be non-vegetarian and 183 (91.5%) patients were having positive history of oily/spicy food. 106 (53%) patients were having positive history of smoking and 119 (59.5%) patients were having positive history of alcohol intake. History of NSAIDs abuse and drug abuse was not found to be significant. Duodenal to gastric perforation ratio found was 10:1. The overall mortality in our study is 14%. No significant difference in mortality was found between genders. However, for patients >40 years, the incidence increased over 4 times and mortality more than 12 times compared to younger age <20 years. After 1 month followup, out of 172 discharged patients, 145 (84%) patients came with symptoms resolved or having no complication. After 2 months followup, 158 (92%) patients came with symptoms resolved and 166 (96%) patients changed their dietary habits and lifestyle.
The incidence rate and mortality rate was stable. In our study, we found male preponderance, may be due to their lifestyle changes. Maximum number patients are found in age group 41-45 years. As in all previous studies, as age advances, incidence of peptic perforation also increases. Also, found strong relationship between consumption of oily or spicy food and non-vegetarian food with incidence of peptic perforation. Relation of peptic perforation with NSAIDs, smoking, and alcoholism follows same trends as in previous studies.