RISING FREQUENCY OF ULCER PERFORATION IN ELDERLY PEOPLE IN THE UNITED KINGDOM

doi:10.1016/S0140-6736(86)92940-5

The Lancet

Volume 327, Issue 8479, 1 March 1986, Pages 489-492

https://doi.org/10.1016/S0140-6736(86)92940-5 Get rights and content

Abstract

Peptic ulcer admission rates were known to be declining in England and Wales in younger men and women at least until 1977, but rates in elderly men were stable and rates in older women were increasing. Analysis of the most recently available data shows that these trends have continued in England and Wales and similar trends are seen in the elderly populations in Scotland. Reasons for the increasing susceptibility of elderly people, particularly older women, to peptic ulceration are not clear. However, altered smoking habits seem unlikely to explain the change, whereas increased use of non-steroidal anti-inflammatory drugs may account for part of it.

References (13)

D. Coggon et al.
20 years of hospital admission for peptic ulcer in England and Wales
Lancet
(1981)
M. Susser
Period effects, generation effects and age effects in peptic ulcer mortality
J Chron Dis
(1982)
A. Garner et al.
Effects of anti-inflammatory agents and prostaglandins on acid and bicarbonate secretions in the amphibian-isolated gastric mucosa
Gastroenterology
(1979)
Jh Kurata et al.
Inadequacy of the literature on the relationship between drugs, ulcers and gastrointestinal bleeding
Gastroenterology
(1982)
Kw Somerville et al.
Non steroidal anti-inflammatory drugs and bleeding peptic ulcer
Lancet
(1986)
D.St.J. Collier et al.
Non-steroidal anti-inflammatory drugs and peptic ulcer perforation
Gut
(1985)

There are more references available in the full text version of this article.

Cited by (310)

High altitude area – A risk factor for gastric perforation?: A case series
2018, International Journal of Surgery Case Reports
Citation Excerpt :
PPU have seen a constant variation in epidemiology since last century, where the disease has noted a decreasing incidence after 1950 in men, however in women the incidence has seen a slight up-trend after 1950 [4,5]. The age group affected in various western literature has also seen a shift in trend from a disease of young initially to that of middle aged and elderly [4,6]. Data from Low and Middle income countries (LMIC’s), suggest that the median age at diagnosis of PPU has seen an increase of two decades i.e. from 30 to 40 s earlier to 60 s and above presently [7].
This is an original case series on soldiers evacuated from HAA(High Altitude Area) over last one year(Sept 2017–Aug 2018), of which 100% cases were found to have gastric antrum perforation. This is a deviation from the usual trend that is being noted in Indian subcontinent where duodenal perforations are commonest.
High altitude associated dyspepsia is a common phenomenon and some studies done in high altitude population have recorded high incidence of antral gastritis and mucosal atrophy on histo-pathological evaluation. This is also supported by high incidence of H. pylori infection. The presence of atrophic gastric mucosa associated with antral gastritis, when exposed to hypobaric hypoxemic conditions faced by soldiers posted to heights above 15,000 ft, may leads to increased intra-luminal pressure and ischemia which probably predisposes individuals for gastric antrum perforations.
This is a relatively untouched topic as we have not found studies onhigh altitude related gastric perforations and probably this is the first case series of its kind. The acknowledgement of this phenomenon may pave way for further studies for defining the role of high altitude in gastric perforations.
Laparoscopic versus open repair of perforated gastroduodenal ulcer: A National Surgical Quality Improvement Program analysis
2013, American Journal of Surgery
Citation Excerpt :
With advances in understanding of the pathogenesis of peptic ulcer disease and in its medical management, the prevalence of elective surgery for its treatment has decreased. Despite this, the need for urgent intervention for complications of ulcer disease has not seen a corresponding decrease but rather may actually be increasing.12–16 Even so, the nature of emergent ulcer surgery has fundamentally changed from gastric resections and various acid-reducing interventions to simple closure and peritoneal toilet followed by medical management for acid suppression and H pylori eradication.
Surgical repair of perforated gastroduodenal ulcers remains a common indication for emergent surgery. The aim of this study was to test the hypothesis that the laparoscopic approach (LA) would be associated with reduced length of stay compared to the open approach.
Patients with acute, perforated gastroduodenal ulcer were identified in the National Surgical Quality Improvement Program database, of whom 50 had the LA. One-to-one case/control matching on the basis of age, American Society of Anesthesiologists class, gender, and cardiac disease was evaluated for outcome analysis.
After matching, the 2 groups had similar characteristics. The rates of wound complications, organ space infections, prolonged ventilation, postoperative sepsis, return to the operating room, and mortality tended to be lower for the LA, although not significantly. Length of hospital stay was, however, significantly shorter for the LA by an average of 5.4 days.
The LA appears to be safe in mild to moderately ill patients with perforated peptic ulcer disease and is associated with reduced use of hospital resources.
Acute perforated peptic ulcer: On clinical experience in an urban tertiary hospital in south east Nigeria
2013, International Journal of Surgery
Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in our environment.
There is a paucity of published reports on acute perforated peptic ulcers in our environment. This study was conducted to evaluate the different pattern of risk factors clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer in our setting and to highlight the factors that continue to account for the high mortality and morbidity as seen here.
A retrospective study where data of seventy-six (76) patients managed for generalized peritonitis due to acute peptic ulcer perforation over a five year period (January 2006–December 2010) were retrieved from medical records of Enugu State University of Science and Technology Hospital (ESUTH). The patients' biodata, clinical and operative findings and treatment outcome were extracted and analysed, after institutional ethical approval was secured. All other cases of generalized peritonitis not traceable to acute peptic ulcer perforation were excluded from the study.
There were76 patients; 58 males and 18 females (M:F = 3.2:1) Their ages ranged from 20 to 80years with a mean of 39.5yr and SD ± 13.10years. Majority of the patients 49(64.4%) were 40years of age and below and only 24 (31.6%) had a previous history suggestive of chronic peptic ulcer disease. Twenty five (32.9%) patients presented within 24 h of onset of symptoms of perforation with a mortality of 8.0%. Slightly more than half of our patients 39(51.3%) presented between 24 and 48 h with mortality of 17.9%. Twelve patients (15.8%) presented between 48 and 72 h and the mortality in this group was 58.3%. The latter two groups accounted for most of the mortality in our series.
All perforations were anterior perforations within the first 2.5 cm of the duodenum and all had simple closure with pedicled omental patch and peritoneal toilet with copious volumes of warm normal saline.
Postoperatively all received Helicobacter pylori eradication therapy and proton pump inhibitors for at least two months.
Patient groups who presented early had low mortality rates, but patient groups who presented late had higher mortality rates. Overall mortality was 21%.
The design and methods of the aging successfully with pain study
2012, Contemporary Clinical Trials
Chronic low back pain (CLBP) is widespread among older adults (≥ 65 years) and is often treated inadequately. With a rapidly growing aging population, CLBP will increase and so will the demand for treatment. We believe that mind-body therapies can help to meet this demand. We present the methodology of a randomized, controlled clinical trial of 300 individuals with CLBP aged 65 years or older. The specific aims are, 1) to determine the effectiveness of a mindfulness meditation program in increasing function and reducing pain among older adults with CLBP, and 2) to evaluate the impact of mindfulness meditation on neuropsychological performance in older adults with CLBP. The intervention program is modeled on the Mindfulness-Based Stress Reduction Program (MBSR) and the control is adapted from the 10 Keys™ to Healthy Aging. We will measure self-reported and objectively measured physical function and include a variety of measures to assess pain intensity and pain interference and psychological function. Our primary hypothesis is that the MBSR program will be more effective than the 10 Keys™ program in increasing function and decreasing pain. The proposed study represents the first large, well-controlled, comprehensive examination of the effects of a mind-body program on older adults with chronic pain.
The Upper Gastrointestinal Tract
2010, Brocklehurst's Textbook of Geriatric Medicine and Gerontology
Trends in acute non-variceal bleeding in Israel in 1996-2007: A significant decrease in the rates of bleeding peptic ulcers
2010, Digestive and Liver Disease
A decrease in the incidence of hospital admissions for acute non-variceal upper GI bleeding (AUGIB) has been reported in regions with a low prevalence of Helicobacter pylori (HP) infection.
To investigate trends in hospital admissions for AUGIB in Israel, where the prevalence of HP infection is intermediate.
We have searched the National Hospital Discharge Database of the Israeli Ministry of Health, where all admissions to acute care hospitals for the period January 1, 1996 through December 31, 2007 are compiled. Using a validated strategy, we identified all admissions for AUGIB according to ICD-9-CM codes. Incidence rates were calculated and adjusted to reflect the age and gender distribution of the Israeli population.
The overall rates of hospital admissions for AUGIB decreased significantly from 29.3 to 16.8 cases/10⁵ population/year (p < 0.0001). The decreases were similar in both genders. This decrease was due to decreased rates of bleeding from duodenal ulcers (from 13.6 to 5 cases/10⁵ population/year) and gastric ulcers (from 4.3 to 2.4 cases/10⁵ population/year). The rates of bleeding from other causes remained unchanged. The rates of surgical interventions bleeding control decreased significantly (overall from 11 to 4%). The in-hospital mortality rate varied between 7.6 and 7%, did not change significantly in both genders but increased significantly with age during the study period.
A decline in the overall incidence of AUGIB during the study period was due to a significant decrease in the rate of bleeding peptic ulcers.

View all citing articles on Scopus

View full text

Occasional SurveyRISING FREQUENCY OF ULCER PERFORATION IN ELDERLY PEOPLE IN THE UNITED KINGDOM

Abstract

Lancet

J Chron Dis

Gastroenterology

Gastroenterology

Lancet

Non-steroidal anti-inflammatory drugs and peptic ulcer perforation

Gut

Occasional Survey
RISING FREQUENCY OF ULCER PERFORATION IN ELDERLY PEOPLE IN THE UNITED KINGDOM