title: Perforated peptic ulcer.
abstract: Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can be managed non-operatively or with novel endoscopic approaches, but validation of such methods in trials is needed. Quality of care, sepsis care bundles, and postoperative monitoring need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research.
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: ksoreide@mac.com.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Thorsen
authors.affiliation: MRC Centre for Inflammation Research, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Ewen M
authors.initials: EM
authors.lastname: Harrison
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Juliane
authors.initials: J
authors.lastname: Bingener
authors.affiliation: Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten H
authors.initials: MH
authors.lastname: Møller
authors.affiliation: Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Michael
authors.initials: M
authors.lastname: Ohene-Yeboah
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Søreide
mesh_terms: D006801:Humans; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011182:Postoperative Care; D011379:Prognosis