Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-ain medical district, United Arab Emirates.
OBJECTIVE
To evaluate risk factors, morbidity and mortality rates of perforated peptic ulcer (PPU) and to investigate factors affecting postoperative complications of PPU.


BACKGROUND
The incidence of PPU has remained constant, simple closure with omental patch repair being the mainstay of treatment.


METHODS
One hundred and nineteen patients admitted to Al-Ain Hospital with PPU between January 2000 and March 2004 was studied retrospectively; two with deficient data were excluded from the analysis. Logistic regression was used to define factors affecting postoperative complications.


RESULTS
The mean age of patients was 35.3 years (range, 20-65). 45.7% of patients were Bangladeshi, and 85.3% originated from the Indian subcontinent. One patient, subsequently found to have a perforated gastric cancer, died. In 116 patients, 26 complications were recorded in 20 patients (17.2%). Common risk factors for perforation were smoking, history of peptic ulcer disease (PUD) and use of non-steroidal anti-inflammatory drugs (NSAIDs). A significantly increased risk of perforation was evident during the daytime fasting month of Ramadan. An increase in the acute physiology and chronic health evaluation (APACHE) II score (p = 0.047) and a reduced white blood cell count (0.04) were highly significant for the prediction of postoperative complications.


CONCLUSIONS
Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time.
Department of Surgery, Faculty of Medicine and Health Sciences, UAE University, UAE.
Fawaz Chikh
FC
Torab
Mohamed
M
Amer
Fikri M
FM
Abu-Zidan
Frank James
FJ
Branicki
D000328:Adult; D000368:Aged; D005260:Female; D006693:Holidays; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014479:United Arab Emirates / Q000453:epidemiology; D055815:Young Adult