PEPTIC-ULCER PERFORATION BEFORE AND AFTER THE INTRODUCTION OF H-2-RECEPTOR BLOCKERS AND PROTON PUMP INHIBITORS

Background: The aim of this retrospective study was to compare patient s treated for perforated peptic ulcer before and after the introductio n of the H-2-receptor antagonists and proton pump inhibitors (PPI) wit h regard to their medical history, clinical features, methods of diagn osis and treatment, complications, and mortality. Methods and Results: During the study period 1974 to 1992 we found a significant reduction in the incidence of peptic ulcer perforation (P < 0.001). Patients ad mitted during the later period of the study were older and more seriou sly ill. The incidence of perforation among men decreased, but that am ong women was stable, thus changing the sex ratio towards a female pre ponderance at the end of the study period. After the introduction of P PI the relative number of gastric perforations decreased compared with the number of perforations in the duodenum. A relatively higher propo rtion of patients with gastric perforations was taking acetylsalicylic acid or non-steroid, anti-inflammatory drugs at the time of admission compared with patients with duodenal perforation. Simple suture of th e perforation was the operative procedure used in 80% of the patients. Conclusions: Even though patients were increasingly older and more il l, neither the mortality nor the rate of postoperative complications c hanged during the study period.