Changing pattern of perforated PUD: Are NSAIDs to be blamed?

Abstract

Objective: This study aimed to determine if there is association between gastric perforation and non-steroidal anti-inflammatory drugs (NSAIDs) abuse in patients presenting with perforated peptic ulcer disease (PPUD).

Material and Methods: The data were collected retrospectively from May 2011 to May 2015 and then prospectively until December 2017. Sixty patients diagnosed with PPUD on exploratory laparotomy were evaluated. Data were analyzed using SPSS (version 21.0). P value ≤ 0.05 was considered significant.

Results: A total of 60 patients were operated on for PPUD during the study period. Forty-five (75.0%) patients gave significant history of NSAIDs use, of which nine (20.0%) had medical prescription, while others were over the counter medications. None of the patients was on ulcer prophylaxis including those who were on long term use and with prior dyspeptic symptoms. Five patients (11.1%) were on the recommended dose of the NSAIDs, thus patients in this series showed irrational use of NSAIDs. Forty-two (93.3%) patients had gastric perforation, while only three of the patients had duodenal perforation. The association between significant NSAIDs use and gastric perforation was found to be significant (p= 0.002). There was no difference in the site of perforation when patients who were on long term NSAIDs were compared with short term NSAIDs use (10.0 vs. 35.0) (p= 0.061). In addition, long term NSAIDs use (p= 0.041), ignorance of proper dose of the medication (p= 0.003), and gastric ulcer perforations (p= 0.011) were independent causes of mortality in the studied patients when age and duration of the presentations were matched.

Conclusion: NSAIDs use, including both long- and short-term use, was significant among patients with gastric perforation.

Cite this article as: Egwuonwu O, Chinedu O, Chianakwana G, Anyanwu S, Emegoakor C, Nzeako H. Changing pattern of perforated PUD: Are NSAIDs to be blamed? Turk J Surg 2019; 35 (2): 105-110

This study was approved by the ethical board of Nnamdi Azikiwe University Teaching Hospital.

Written informed consent was obtained from patients who participated in the prospective part of the study. The data from the retrospective patients were de-identified so no consent was needed.

Externally peer-reviewed.

Consept - O.E.; Design - C.O.; Supervision - G.C., S.A.; Resource - O.E.; Materials - C.E.; Data Collection and/or Processing - C.O., H.N.; Analysis and Interpretation - C.O.; Literature Search - C.O.; Writing - C.O.; Critical Reviews - G.C., S.A.

Authors do not have any conflict of interest.

The authors declared that this study has received no financial support.