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Changing Aetiology of Perforated Peptic Ulcers: Rising Impact of Non-Steroidal-Anti-Inflammatories in Western
Vidya Willis1,2, Tamalee Wilson2, David R Fletcher2,3
1Division of Surgery, Medical School, University of Western Australia, Crawley, Western Australia, Australia.
Background:
Peptic ulcer disease (PUD) continues to be a health issue, mainly due to Helicobacter pylori ( H. pylori ) infection and non-steroidal anti-inflammatory drugs (NSAIDs). Despite better treatment of H. pylori and use of proton pump inhibitors, the rate of reduction in PUD complications is slowing down. This may be predominantly because of increased NSAID and aspirin use, especially among older adults and those in higher socioeconomic regions. Understanding changing causes of perforated PUD is important for prevention and care.
Methods:
This retrospective audit reviewed patients who underwent surgical repair for peptic ulcer perforations at tertiary hospitals in Western Australia from 2010 to 2018. The study assessed patient demographics, ulcer sites, risk factors (including NSAID/aspirin use and H. pylori status), eradication, and follow-up care to evaluate the relative impact of NSAID use and H. pylori infection on ulcer perforation.
Results:
A cause for perforated PUD was identified in 78% of 359 patients; 72% had a history of NSAID or aspirin use and 42% tested positive for H. pylori . More gastric than duodenal perforations were observed. Practices around H. pylori testing, eradication, and follow-up varied. Malignant gastric perforation was rare.
Conclusion:
NSAID/Aspirin use may be surpassing H. pylori as the main cause of perforated PUD in Western Australia, mirroring global patterns. H. pylori remains important but identifying NSAID use as a modifiable risk and standardising testing, eradication, and follow-up-including endoscopy-are needed. These findings should guide clinical practice for post-operative and preventive care.
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