CLINICAL OBSERVATION OF THE TEMPORAL ASSOCIATION BETWEEN CRACK COCAINE AND DUODENAL-ULCER PERFORATION

HYPOTHESIS: TO determine if a cause-effect relationship exists between crack cocaine use and duodenal ulcer perforation (DUP). PATIENTS AND METHODS: A retrospective study was conducted of all patients undergoin g emergency surgical management for peptic ulcer disease over a 6-year period at a large inner-city municipal teaching hospital. The hospita l records of 78 consecutive patients presenting with complications of peptic ulcer disease between April 1990 and April 1996 were reviewed. Group A (n = 24) consisted of patients with-confirmation of crack coca ine usage within 8 hours of clinical presentation; group B (n = 54) co nsisted of patients with no antecedent history of crack cocaine use. D emographic data, timing of drug use, clinical presentation, laboratory and radiographic findings, toxicology screening, operative findings, and postoperative course were compared between the two groups. RESULTS : Both groups revealed a similar gender distribution, tobacco use, pri or peptic ulcer symptoms, and laboratory findings, Group A patients we re younger (t test, P = 0.01) and more likely to present with perforat ion, whereas patients in group B presented with a combination of sympt oms (chi square, P = 0.03), Duodenal ulcer perforation was present in 75% of patients in group A compared with 46% of patients in group B (c hi square, P = 0.04). Group B patients had a significantly longer hosp ital stay compared with those in group A (t test, P = 0.01). Both crac k cocaine and alcohol are independent predictors of duodenal ulcer per foration, CONCLUSIONS: Patients with recent use of crack cocaine and/o r alcohol are more likely to present with duodenal perforations. Altho ugh a temporal association between crack cocaine use and duodenal ulce r perforation was demonstrated, this study does not confirm a cause-ef fect relationship. A prospective cohort study is needed to clarify the pathogenesis of this potential cause-effect relationship. (C) 1997 by Excerpta Medica, Inc.