Factors associated with peptic gastroduodenal ulcer perforations in adult patients at Muhimbili National Hospital

Peptic gastroduodenal ulcer disease results from an imbalance of acid secretion and mucosal defenses that resist acid digestion. Following developments in the medical treatment of peptic ulcer disease (PUD) in the last two decades, surgical intervention is currently confined to the treatment of complicated disease, namely, ulcer hemorrhage, perforation, penetration and obstruction. Simple closure or omental patch repair is the mainstay of treatment of perforated peptic ulcer (PPU), definitive surgery being rarely practiced, dependence now being on medical therapy to complete the healing process and prevent recurrence of the disease1, 2 The main objective of the study was to evaluate the sociodemographic characteristics, types and risk factors for perforated gastroduodenal disease at Muhimbili National Hospital, in Dar es Salaam. A case-control hospital based study with prospective data collection for one year, from April 2010 to March 2011. Cases were patients with gastroduodenal perforation enrolled following emergency laparotomy. Controls were gastroduodenal ulcer patients diagnosed by oesophagogastroduodenoscopy. The sociodemographic characteristics were age, sex, religion and area of residence. The risk factors evaluated included; cigarette smoking, alcohol consumption, use of nonsteroidal anti-inflammatory medications, stress, number of meals, serological status for Helicobacter pylori and human immunodeficiency virus. Cases had age range between 15 and 70 years, mean age of 33.8 years with male to female ratio of 9:1 and patients aged 20 – 39 years formed the majority of perforated gastroduodenal ulcer disease. It was found that controls had age range between 17 and 85 years, mean age of 46.9 years with male to female ratio of 2:1 and patients in the age group 40 – 59 formed a large proportion of gastroduodenal ulcer disease. The ratio of gastric to duodenal perforation was 2.5:1 among cases while the ratio of gastric to duodenal ulcers was 1:1 among controls. Age was associated with perforated gastroduodenal disease and Moslems were significantly more affected than Christians. Area of residence and sex were not associated with perforated gastroduodenal disease. Current cigarette smoking, current alcohol drinking as well as coexistence of stressful condition within six months period were strong risk factors for perforation. It was noted that patients who presented with epigastric pain were less likely to perforate than those without epigastric pain. The use of NSAIDs for at least one week and number of meals per day were not associated with perforation. Moreover, H. pylori and HIV seropositivity were not associated with gastroduodenal perforation. In our community perforated gastric ulcer was seen more often than perforated duodenal ulcer. Age and Moslem were the two sociodemographic characteristics strongly affected with gastroduodenal perforation. Recent histories of Cigarette smoking and alcohol consumption as well as psychological stress were the strong risk factors for perforation. However long standing history of epigastric pain was protective. There were no statistical associations for NSAIDs use, number of meals per day and seropositivity for H. pylori and HIV in relation to gastroduodenal perforation. The management of patients with peptic gastroduodenal ulcer disease should include counseling on risk factors and maintaining medications to prevent complications such as perforation.