Clinical characteristics of peptic ulcer perforation in Korea

Table 1 Baseline characteristics of enrolled population n (%)

Variables	Total	Gastric ulcer	Duodenal ulcer	P value
	(n = 396)	(n = 173)	(n = 223)
Sex (men)	337 (85.1)	145 (83.8)	192 (86.1)	0.57
Age	50.6 ± 18.3	51.4 ± 19.0	50.1 ± 17.8	0.49
BMI (kg/m2)	21.7 ± 2.9	21.5 ± 2.9	21.9 ± 3.0	0.14
Alcohol consumption	187 (47.2)	76 (43.9)	111 (49.8)	0.27
Current smoking	221 (55.8)	98 (56.6)	123 (55.2)	0.84
Previous ulcer history	54 (13.6)	27 (15.6)	27 (12.1)	0.38
Comorbidity	123 (31.1)	61 (35.3)	62 (27.8)	0.13
Cardiovascular disease	83 (67.5)	38 (62.3)	45 (72.6)	0.22
DM	41 (33.3)	18 (29.5)	23 (37.1)	0.45
Chronic liver disease	13 (10.6)	8 (13.1)	5 (8.1)	0.40
Cerebrovascular disease	11 (8.9)	4 (6.6)	7 (11.3)	0.36
Malignancy	9 (7.3)	6 (9.8)	3 (4.8)	0.24
Chronic kidney injury	6 (4.9)	4 (6.6)	2 (3.2)	0.33
Pulmonary disease	4 (3.3)	3 (4.9)	1 (1.6)	0.30
Infectious disease	3 (2.4)	2 (3.3)	1 (1.6)	0.49
Current medication
NSAIDs	44 (11.2)	20 (11.7)	24 (10.8)	0.87
Steroid	8 (2.0)	5 (2.9)	3 (1.3)	0.23
Proton pump inhibitor	19 (4.8)	11 (6.4)	8 (3.6)	0.24
H2-blocker	12 (3.0)	5 (2.9)	7 (3.1)	> 0.99
Presentation				0.39
Abdominal pain	365 (92.2)	155 (89.6)	210 (94.2)
Melena/hematemesis	16 (4.0)	9 (5.2)	7 (3.1)
Shock	5 (1.3)	2 (1.2)	3 (1.3)
Epigastric soreness	6 (1.5)	4 (2.3)	2 (0.9)
Nausea/vomiting	4 (1.0)	3 (1.7)	1 (0.4)
Laboratory findings
White blood count (x103/uL)	13.4 ± 7.8	12.9 ± 5.3	13.8 ± 9.4	0.24
Hemoglobin (g/dL)	13.7 ± 6.0	13.7 ± 8.8	13.7 ± 2.2	0.95
Serum Creatinine (mg/dL)	1.02 ± 0.7	1.01 ± 0.7	1.03 ± 0.6	0.87
C-reactive protein (mg/L)	93.7 ± 89.0	88.9 ± 86.0	97.2 ± 91.1	0.39
Anatomical findings
Location
Stomach	173 (43.7)
Body		11 (6.4)
Antrum		62 (35.8)
Pylorus		100 (57.8)
Duodenum	223 (56.3)
Bulb			218 (97.8)
2nd portion			5 (2.2)
Size				0.82
≥ 1 cm	126 (37.6)	58 (38.4)	68 (37.0)
< 1 cm	209 (62.4)	93 (61.6)	116 (63.0)
H. pylori test
Positivity H. pylori test	78/174 (44.8)	30/72 (41.7)	48/102 (47.1)	0.48
Rapid urease test	60 (76.9)	26 (86.7)	34 (70.8)
Urea breath test	5 (6.4)	2 (6.7)	3 (6.2)
Serology test	13 (16.7)	2 (6.7)	11 (22.9)
Operation	388 (98.0)	170 (98.3)	218 (97.8)	0.51
Primary closure and/or omentopexy	307 (79.5)	139 (81.7)	168 (77.8)
Pyloroplasty and/or vagotomy	43 (11.1)	15 (8.8)	28 (13.0)
Total/subtotal gastrectomy or antrectomy	36 (9.3)	16 (9.5)	20 (9.2)
Others (Whipple’s operation, drainage)	2 (0.5)	0 (0.0)	2 (0.9)
Medical treatment	8 (2.0)	3 (1.7)	5 (2.2)	0.09
Clinical course
Hospital stay	13.1 ± 9.4	13.4 ± 10.4	12.8 ± 8.7	0.54
Complication	36 (9.1)	21 (12.1)	15 (6.7)	0.08
In hospital mortality	3 (0.8)	2 (1.2)	1 (0.4)	0.58

PPU: Perforated peptic ulcer; BMI: Body mass index; DM: Diabetes mellitus; NSAIDs: Non-steroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori.

Table 2 Comparison of clinical characteristics between patients with perforated peptic ulcer who were tested for Helicobacter pylori infection or not n (%)

Variables	Total (n = 396)			Gastric ulcer (n = 173)			Duodenal ulcer (n = 223)
	Patients who were testedfor H. pylori infection(n = 174)	Patients who were not tested for H. pylori infection(n = 222)	P value	Patients who were testedfor H. pylori infection(n = 72)	Patients who were not tested for H. pylori infection(n = 101)	P value	Patients who were testedfor H. pylori infection(n = 102)	Patients who were not tested for H. pylori infection(n = 121)	P value
Sex (men)	151 (86.8)	186 (83.8)	0.480	60 (83.3)	85 (84.2)	> 0.99	91 (89.2)	101 (83.5)	0.25
Age (yr)	47.6 ± 16.8	53.0 ± 19.1	0.003	47.5 ± 18.3	54.1± 19.1	0.02	47.6 ± 15.7	52.2 ± 19.1	0.05
< 60	133 (76.4)	142 (64.0)	0.008	56 (77.8)	61 (60.4)	0.02	77 (75.5)	81 (66.9)	0.18
≥ 60	41 (23.6)	80 (36.0)		16 (22.2)	40 (39.6)		25 (24.5)	40 (33.1)
BMI (kg/m2)	22.0 ± 3.1	21.5 ± 2.8	0.150	21.5 ± 3.1	21.4 ± 2.7	0.83	22.3 ± 3.0	21.6 ± 3.00	0.10
Alcohol drinking	87 (50.0)	100 (45.0)	0.360	33 (45.8)	43 (42.6)	0.76	54 (52.9)	57 (47.1)	0.42
Current smoking	97 (55.7)	124 (55.9)	> 0.99	39 (54.2)	59 (58.4)	0.64	58 (56.9)	65 (53.7)	0.69
Both alcohol consumption and smoking	69 (39.7)	85 (38.3)	0.840	24 (33.3)	36 (35.6)	0.87	45 (44.1)	49 (40.5)	0.59
Previous ulcer history	30 (17.2)	24 (10.8)	0.08	14 (19.4)	13 (12.9)	0.29	16 (15.7)	11 (9.1)	0.15
Comorbidity	44 (25.3)	79 (35.6)	0.03	21 (29.2)	40 (39.6)	0.2	23 (22.5)	39 (32.2)	0.13
HTN	27 (61.4)	55 (69.6)	0.43	14 (66.7)	24 (60.0)	0.78	13 (56.5)	31 (79.5)	0.08
DM	13 (29.5)	28 (35.4)	0.55	5 (23.8)	13 (32.5)	0.56	8 (34.8)	15 (38.5)	> 0.99
Cardiovascular disease	6 (13.6)	15 (19.0)	0.62	3 (14.3)	7 (17.5)	0.53	3 (13.0)	8 (20.5)	0.35
Chronic liver disease	5 (11.4)	8 (10.1)	0.53	1 (4.8)	7 (17.5)	0.24	4 (17.4)	1 (2.6)	0.06
Malignancy	0 (0.0)	9 (11.4)	0.02	0 (0.0)	6 (15.0)	0.07	0 (0.0)	3 (7.7)	0.24
Chronic kidney injury	3 (6.8)	3 (3.8)	0.17	2 (9.5)	2 (5.0)	0.43	1 (4.3)	1 (2.6)	0.61
Pulmonary disease	0 (0.0)	4 (5.1)	0.37	0 (0.0)	3 (7.5)	0.28	0 (0.0)	1 (2.6)	0.63
Infectious disease	1 (2.3)	2 (2.5)	0.71	1 (4.8)	1 (2.5)	0.57	0 (0.0)	1 (2.6)	0.63
Current medication
NSAIDs	21 (12.1)	23 (10.4)	0.63	9 (12.7)	11 (11.0)	0.81	12 (11.8)	12 (9.9)	0.67
Steroid	2 (1.2)	6 (2.7)	0.24	1 (1.4)	4 (4.0)	0.31	1 (1.0)	2 (1.7)	0.56
Proton pump inhibitor	7 (4.0)	12 (5.4)	0.64	3 (4.2)	8 (7.9)	0.26	4 (3.9)	4 (3.3)	0.54
H2-blocker	4 (2.3)	8 (3.6)	0.56	3 (4.2)	2 (2.0)	0.34	1 (1.0)	6 (5.0)	0.09

PPU: Perforated peptic ulcer; BMI: Body mass index; HTN: Hypertension; DM: Diabetes mellitus; NSAIDs: Non-steroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori.

Table 3 Comparison of clinical characteristics of perforated peptic ulcer according to age n (%)

Variables	< 60 yr	≥ 60 yr	P value
	(n = 275)	(n = 121)
Sex (men)	260 (94.5)	77 (63.6)	< 0.001
BMI (kg/m2)	21.8 ± 2.7	21.5 ± 3.4	0.33
Alcohol consumption	154 (56.0)	33 (27.3)	< 0.001
Current smoking	172 (62.5)	49 (40.5)	< 0.001
Previous ulcer history	31 (11.3)	23 (19.0)	0.04
Comorbidity	41 (14.9)	82 (67.8)	< 0.001
Current medication
NSAIDs	8 (2.9)	36 (30.0)	< 0.001
Steroid	4 (1.5)	4 (3.3)	0.26
Proton pump inhibitor	9 (3.3)	10 (8.3)	0.04
H2-blocker	5 (1.8)	7 (5.8)	0.05
H. pylori test
Positivity H. pylori test	67/133 (50.4)	11/41 (26.8)	0.008
Rapid urease test	52 (77.6)	8 (72.7)
Urea breath test	4 (6.0)	1 (9.1)
Serology test	11 (16.8)	2 (18.2)
Anatomical findings
Location			0.490
Gastric ulcer	117 (42.5)	56 (46.3)
Duodenal ulcer	158 (57.5)	65 (53.7)
Size			< 0.001
≥ 1 cm	73 (31.1)	53 (53.0)
< 1 cm	162 (68.9)	47 (47.0)
Clinical course
Hospital stay	11.3 ± 7.7	17.0 ± 11.7	< 0.001
Complication	11 (4.0)	25 (20.7)	< 0.001
In hospital mortality	0 (0.0)	3 (2.5)	0.009

PPU: Perforated peptic ulcer; BMI: Body mass index; NSAIDs: Non-steroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori.

Table 4 Comparison of clinical characteristics of perforated peptic ulcer categorized by the Helicobacter pylori-infected, non-steroidal anti-inflammatory drugs user, and non-Helicobacter pylori, non-non-steroidal anti-inflammatory drugs group n (%)

Variables	Both H. pylori positive and NSAIDs user group (n = 5)	H. pylori positive group (n = 73)	NSAIDs user group (n = 16)	Non-H. pylori, Non-NSAIDs group (n = 80)	P value
Sex (men)	4 (80.0)	67 (91.8)	9 (56.2)	71 (88.8)	0.005
Age	57.6 ± 16.0	40.3 ± 15.2	69.5 ± 12.2	49.1 ± 14.6	< 0.001
BMI (kg/m2)	24.7 ± 4.1	21.6 ± 3.0	21.2 ± 4.3	22.2 ± 2.8	0.090
Alcohol consumption	3 (60.0)	33 (45.2)	4 (25.0)	47 (58.8)	0.060
Current smoking	3 (60.0)	36 (49.3)	6 (37.5)	52 (65.0)	0.090
Previous ulcer history	0 (0.0)	9 (12.3)	4 (25.0)	17 (21.2)	0.290
Comorbidity	2 (40.0)	11 (15.1)	12 (75.0)	19 (23.8)	< 0.001
Anatomical findings
Location					0.710
Gastric ulcer	1 (20.0)	29 (39.7)	8 (50.0)	34 (42.5)
Duodenal ulcer	4 (80.0)	44 (60.3)	8 (50.0)	46 (57.5)
Size					0.002
≥ 1 cm	3 (60.0)	15 (23.8)	8 (66.7)	33 (48.5)
< 1 cm	2 (40.0)	48 (76.2)	4 (33.3)	35 (51.5)
Clinical course
Hospital stay	10.6 ± 4.2	10.3 ± 4.5	12.8 ± 4.8	13.2 ± 9.9	0.120
Complication	0 (0.0)	1 (1.4)	1 (6.2)	6 (7.5)	0.240
In hospital mortality	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)

PPU: Perforated peptic ulcer; BMI: Body mass index; NSAIDs: Non-steroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori.

Table 5 Multivariate analysis for the risk factors of non-steroidal anti-inflammatory drugs-associated perforated peptic ulcer compared with ​non-Helicobacter pylori, non-non-steroidal anti-inflammatory drug associated perforated peptic ulcer

Variables	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Sex (men)	0.16 (0.05-0.55)	0.003
Age	1.12 (1.06-1.17)	< 0.001	1.09 (1.04-1.16)	0.001
BMI (kg/m2)	0.89 (0.74-1.07)	0.210
Alcohol consumption	0.23 (0.07-0.79)	0.020
Current smoking	0.32 (0.11-0.98)	0.050
Previous ulcer history	1.24 (0.35-4.32)	0.740
Comorbidity	9.63 (2.78-33.39)	< 0.001	4.11 (1.03-16.48)	0.050

All variables with P ≤ 0.2 by univariate analysis were analyzed by multivariate analysis. BMI: Body mass index.

Table 6 Multivariate analysis for the risk factors of non-Helicobacter pylori, non-non-steroidal anti-inflammatory drugs perforated peptic ulcer compared with solely Helicobacter pylori positive perforated peptic ulcer

Variables	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Sex (men)	0.71 (0.24-2.09)	0.530
Age	1.04 (1.02-1.07)	0.001	1.04 (1.02-1.07)	< 0.001
BMI (kg/m2)	1.09 (0.97-1.22)	0.160
Alcohol consumption	1.73 (0.91-3.28)	0.100	2.08 (1.05-4.13)	0.040
Current smoking	1.91 (1.00-3.66)	0.050
Previous ulcer history	1.92 (0.80-4.63)	0.150
Comorbidity	1.76 (0.77-4.00)	0.180

All variables with P ≤ 0.2 by univariate analysis were analyzed by multivariate analysis. BMI: Body mass index.