title: Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data.
abstract: BACKGROUND
  Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these countries. This study describes surgical interventions for peptic ulcer disease in sub-Saharan Africa.
  
  
  METHODS
  A systematic review was performed using PubMed, EMBASE, and African Index Medicus for studies describing surgical management of peptic ulcer disease in sub-Saharan Africa.
  
  
  RESULTS
  From 55 published reports, 6594 patients underwent surgery for peptic ulcer disease. Most ulcers (86%) were duodenal with the remainder gastric (14%). Thirty-five percent of operations were performed for perforation, 7% for bleeding, 30% for obstruction, and 28% for chronic disease. Common operations included vagotomy (60%) and primary repair (31%). The overall case fatality rate for peptic ulcer disease was 5.7% and varied with indication for operation: 13.6% for perforation, 11.5% for bleeding, 0.5% for obstruction, and 0.3% for chronic disease.
  
  
  CONCLUSIONS
  Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.
authors.affiliation: University Teaching Hospital-Kigali, 1024 Rue de la Paix, Kigali, Rwanda. jlr283@mail.harvard.edu.|Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA. jlr283@mail.harvard.edu.|, Phillips Wangensteen Bldg, 11-145E, 516 Delaware St SE, Minneapolis, MN, 55455, USA. jlr283@mail.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rickard
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D002908:Chronic Disease; D003906:Developing Countries / Q000706:statistics & numerical data*; D004381:Duodenal Ulcer / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications / Q000601:surgery*; D014628:Vagotomy
keywords: Africa South of the Sahara; Global health; Peptic ulcer