Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality.

BACKGROUND/AIMS The incidence of uncomplicated peptic ulcer has decreased in recent years. It is unclear what the impact of this has been on the epidemiology of peptic ulcer complications. This systematic review aimed to determine the incidence, recurrence and mortality of complicated peptic ulcer and the risk factors associated with these events. METHODS Systematic PubMed searches. RESULTS Overall, 93 studies were identified. Annual incidence estimates of peptic ulcer hemorrhage and perforation were 19.4-57.0 and 3.8-14 per 100,000 individuals, respectively. The average 7-day recurrence of hemorrhage was 13.9% (95% CI: 8.4-19.4), and the average long-term recurrence of perforation was 12.2% (95% CI: 2.5-21.9). Risk factors for peptic ulcer complications and their recurrence included nonsteroidal anti-inflammatory drug and/or acetylsalicylic acid use, Helicobacter pylori infection and ulcer size ≥1 cm. Proton pump inhibitor use reduced the risk of peptic ulcer hemorrhage. Average 30-day mortality was 8.6% (95% CI: 5.8-11.4) after hemorrhage and 23.5% (95% CI: 15.5-31.0) after perforation. Older age, comorbidity, shock and delayed treatment were associated with increased mortality. CONCLUSIONS Complicated peptic ulcer remains a substantial healthcare problem which places patients at a high risk of recurrent complications and death.