PERFORATED PEPTIC-ULCER OVER 56 YEARS - TIME TRENDS IN PATIENTS AND DISEASE CHARACTERISTICS

Perforated gastroduodenal ulcer was studied in 1483 patients in the Be rgen area during the years 1935-90 to discover time trends in age and sex, disease characteristics, treatment, and outcome. The male:female ratio fell from 10:1 to 1.5:1, median age increased from 41 to 62 year s. Most perforations were found in the duodenum in 1935-64, and in the pyloric and praepyloric area in 1965-90. There was a 10% occurrence o f gastric ulcers throughout the study period. Ulcer site was related t o age (more gastric and less duodenal perforations with increasing age ) and sex (more pyloric and less duodenal ulcers among women). There w ere twice as many perforations in the evening compared with the early morning. The diurnal variation was more pronounced for duodenal and py loric than for gastric and praepyloric perforations. Circadian and sea sonal variation of ulcer perforation did not change during the 56 year s studied. Treatment delay increased from median five hours to median nine hours. Infective complications and mortality fell with the introd uction of antibiotics around 1950. General complications has increased in recent years because of the increase of elderly patients. Among pa tients who died, the proportion with associated disease rose from 27 t o 85% during the study period.