Risk factors affecting morbidity and mortality in patients with perforated peptic ulcers in sub‐Saharan Africa: A systematic review

Abstract

Perforated peptic ulcer disease results from an imbalance between stomach acid pepsin and mucosal defense barriers, it affects millions of people worldwide with perforation being the second most medical emergency complication after bleeding. Despite the global data available, there is limited data summarizing the factors influencing the mortality and morbidity of peptic ulcers in Africa. This review aims to evaluate factors that influence morbidity and mortality in patients presenting with perforated peptic ulcers in Sub-Saharan Africa. A total of 25 cross-sectional studies conducted in Sub Sahara Africa were used to compile this review. The review focused on aspects such as the epidemiology, risk factors, and treatment of peptic ulcer disease from the Sub- Sahara African perspective. The total sample size of 1377 patients was calculated from the total reviewed articles. The mortality for most counties was ≥ 8 % while the morbidity rate was ≤ 48 % with most cases reported in men. Major risk factors influencing morbidity and mortality in Sub Sahara Africa are age > 60, presence of shock at admission, delay in treatment > 24 hours, and presence of concomitant diseases. Surgery remains the standard treatment of perforated peptic ulcers in Sub Sahara Africa with the most common postoperative complications that influence morbidity and mortality being septic shock and wound infections. Despite the presented data, more studies should be done in other Sub-Saharan African countries to provide more data for comparative analysis.