Peptic Ulcer Perforation before and after the Introduction of H2-Receptor Blockers and Proton Pump Inhibitors

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Abstract
Background: The aim of this retrospective study was to compare patients treated for perforated peptic ulcer before and after the introduction of the H2-receptor antagonists and proton pump inhibitors (PPI) with regard to their medical history, clinical features, methods of diagnosis and treatment, complications, and mortality. Methods and Results: During the study period 1974 to 1992 we found a significant reduction in the incidence of peptic ulcer perforation (P < 0.001). Patients admitted during the later period of the study were older and more seriously ill. The incidence of perforation among men decreased, but that among women was stable, thus changing the sex ratio towards a female preponderance at the end of the study period. After the introduction of PPI the relative number of gastric perforations decreased compared with the number of perforations in the duodenum. A relatively higher proportion of patients with gastric perforations was taking acetylsalicylic acid or non-steroid, anti-inflammatory drugs at the time of admission compared with patients with duodenal perforation. Simple suture of the perforation was the operative procedure used in 80% of the patients. Conclusions: Even though patients were increasingly older and more ill, neither the mortality nor the rate of postoperative complications changed during the study period.