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Study of Incidence of Peptic Ulcer Perforation in Young Adults Section Medicine Original Article Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study 1MS(General Surgery), Principal Specialist, Government Bangur Hospital, Pali, Rajasthan, India. 2Assistant Professor (General Medicine), Government Bangur Hospital, Pali, Rajasthan, Dinesh Kumar Sarda1, Praveen Kumar Garg2* India. ABSTRACT DOI:10.21276/iabcr.2018.4.1.34 Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Received: 15.11.17 Accepted: 28.11.17 Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the department of Surgery Government Bangur Hospital, Pali, Rajasthan, India. Structured performa was prepared to obtained details of patients and ethical clearance from *Correspondence the institute was also taken prior to the study. Results: 76% of patients in our study were males and 24% were females with male and female ratio Dr. Praveen Kumar Garg, 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases Assistant Professor (General had positive family history and the incidence was in the patients who consumed non-vegetarian Medicine), Government Bangur (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were Hospital, Pali, Rajasthan, India. abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and Copyright: © the author(s) and publisher. chest infection (28%). IABCR is an official publication of Ibn Sina Academy of Medieval Medicine & Sciences, Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting registered in 2001 under Indian Trusts Act, 1882. This is an open access article distributed under younger adults with male preponderance. It is associated with unwanted health and economic issues. the terms of the Creative Commons Attribution Therefore, earlier management is only the way to minimize complications and mortality. Non-commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the Key words: CCT, IOP, Primary open angle glaucoma, Ocular hypertension original work is properly cited. INTRODUCTION_____________________ Peptic ulcer disease (PUD) is the ulceration in NSAIDS abuse, hyper-gastrinemia etc.[2] gastrointestinal tract caused by acidity that results in mucosal Risk factors or etiological factors of PUD may be Helicobacter erosion, extreme pain and discomfort. The erosion must be pylori infection, stress, family history, spicy diet, age, gender, ≥0.5cm and occurs due to imbalance between digestive smoking, alcohol consumption or tumors that results in secretion in stomach and duodenum. Acidity, spicy food and excess acid production. The common symptoms of PUD stress however are not the mere causes of peptic ulcer as include nausea, vomiting, heart burn, burning pain in most ulcers also occur due to Helicobactor pylori infection.[1] stomach while in severe cases vomiting of blood, black stool Stomach and duodenum consists of mucosal lining that or severe pain in stomach can be observed.[1] protects them from digestive secretions. Peptic ulcers can be Peptic ulcer disease, though incidence has decreased in categorized as gastric or duodenal ulcer (more common). recent years with the advent of anti-bacterial therapy and Another type of PUD also has been described namely proton pump inhibitors, is still a common health problem idiopathic PUD which is defined as the ulcer without definite worldwide.[3] About 4 million people are affected in the world causes. Eg. Helicobactor pylori infection, family history, every year with peptic ulcer.[4] In India, it is more prevalent in Access this article online How to cite this article: Sarda DK, Garg PK. Study of Incidence of Peptic Ulcer Website: Quick Response code Perforation in Young Adults: A Hospital Based Study. Int Arch BioMed Clin Res. 2018;4(1):120-123. www.iabcr.org DOI: 10.21276/iabcr.2018.4.1.34 Source of Support: Nil, Conflict of Interest: None International Archives of BioMedical and Clinical Research {120} Jan – Mar 2018 | Vol 4| Issue 1 www.iabcr.org Sarda DK and Garg PK: Incidence of Peptic Ulcer Perforation in Young Adults southern part and about 10-20% patients encounter Table 1: Gender wise distribution of patients complications of which 2-14% cases are reported with Gender N(%) Ratio [5] Male 57 (76%) perforations. The common site of perforation is prepyloric, 3.16:1 pyloric and duodenal region.[6] Inspite of recent advances in Female 18 (24%) the diagnosis and management of peptic ulcer, the rate of perforation is still increasing and has become one of the Table 2: Age wise distribution of patients major health challenges especially in younger individuals.[1] Age (years) N(%) Thus, the objective of our study was to determine the 10-20 6 (8%) prevalence of perforated peptic ulcer based on age, gender, 20-30 23 (30.7%) family history, dietary habits and also to study the associated 30-40 18 (24%) risk factors, clinical presentations, perforation site, surgical 40-50 15 (20%) management and complications. 50-60 7 (9.3%) >60 6 (8%) METHODS__________________________ This cross-sectional study was conducted in the department of surgery Government Bangur Hospital, Pali, Rajasthan Table 3: Table showing family history of patients (India) with involvement of 75 patients, History N(%) Inclusion criteria Present 47 (62.7%) Absent 28 (37.3%) • Patient with peptic ulcer perforation (both gastric and duodenal) • Patients without malignancy Exclusion criteria Table 4: Distribution of patients according to risk factors • Patients without the abdominal pain Risk factors N(%) • Patients who were not willing to participate Non-vegetarian diet 63 (84%) Spicy food 46 (61.3%) A detailed history of patient was taken in a structured Oily food 52 (69.3%) proforma that included informations regarding age, gender, Smokers 48 (64%) clinical presentation, site of perforation, management and Tobacco 23 (30.6%) complications. Each patients was followed for upto 30 days. Alcohol 33 (44%) Ethical clearance was obtained from the institute prior to the NSAIDS 34 (46.6) % study. RESULTS___________________________ Table 5: Distribution of patients based on clinical presentation The results of our study showed that of 75 cases of Symptoms N(%) perforated peptic ulcer 76% were males and 24% were Abdominal pain 75 (100%) females with male: female ratio 3.16:1. The incidence of Abdominal tenderness 64 (85.3%) perforation was high in the age group of 20-30 (30.7%) years Abdominal rigidity 71 (94.6%) followed by that in 30-40 years (24%). About 62.7% of Abdominal distension 55 (73.3%) patients included had positive family history of PUD while Rebound tenderness 67 (89.3%) 37.3% did not. 84.8%, 61.4% and 69.5% of patients had Nausea/ vomiting 48 (64%) High temperature/fever 40 (53.3%) vegetarian, spicy and oily diets respectively while 64.7%, Gas under diaphragm 60 (80%) 31.7% and 43.25% of the patients consumed cigarette, Dyspepsia 56 (74.6%) tobacco and alcohol. About 45.145 of the patients were on NSAIDS abuse. Abdominal pain, abdominal tenderness, abdominal rigidity Table 6: Time of presentation of patients after onset of and distension were presented by 100%, 85.3%, 94.6%and symptoms 73.3% of patients respectively while nausea/vomiting, fever, Time N(%) rebound tenderness, gas beneath diaphragm and dyspepsia Within 24 hours 27 (36%) were observed in 64%, 53.3%,89.85%, 80%, and 74.6% of cases respectively. Between 24-48 hours 28 (37.3%) About 36% of patients were admitted to hospital within 24 More than 48 hours 20 (26.7%) hours of symptom onset while 37.3% and 26.7% were admitted between 24-48 hours and after 48 hours respectively. The most common ulceration site was Table 7: Site of ulceration duodenum 62.7% followed by stomach 34.7%. 2.6% of Site N(%) patients showed perforation in both the sites. Gastric 26 (34.7%) Most of the perforated ulcer was treated by closure with Duodenal 47 (62.7%) omental patch (81.3%). 16% required two layered sutures Both 2 (2.6%) and gastro-jejunostomy was done in 2.7% of cases. The complications post-surgery frequently observed were wound Table 8: Surgical management infection (30.6%) and chest infection (28%) followed by Management N(%) peritonitis (9.3%), septicaemia (8%), fever (4%) and residual Closure with omental patch 61 (81.3%) abscess (2.6%). About 2.6% of patients died post-surgery. Gastro jejunostomy 2 (2.7%) Two layered closure 12 (16%) International Archives of BioMedical and Clinical Research {121} Jan – Mar 2018 | Vol 4| Issue 1 www.iabcr.org Sarda DK and Garg PK: Incidence of Peptic Ulcer Perforation in Young Adults Table 9: Post-surgical complications prostaglandin synthesis in stomach that may lead to ulcer Complications N(%) formation. This fact has been confirmed by the study of SL Wound infection 23 (30.6%) Malhotra et al on the etiological factors of peptic ulcer.[17] Chest infection 21 (28%) The clinical sign shown by patients were abdominal pain Septicemia 6 (8%) (100%), abdominal tenderness (85.3%), rigidity (94.6%), Residual abscess 2 (2.6%) distension (73.3%), nausea or vomiting (64%), fever/high Fever 3 (4%) temperature (53.3%) and gas under diaphragm (80%). Peritonitis 7 (9.3%) According to Everett et al [8], the most frequent complaint was Death 2 (2.6%) abrupt agonizing and disabling pain in abdomen.
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