It also inhibits the healing of duodenal Histone Methyltransferase antagonist ulcers [21, 26]. The rate of H. pylori infection in patients with perforated peptic ulcers ranges from 50%-80% and H. pylori infection, as a risk factor for perforated buy Target Selective Inhibitor Library PUD, appears to be more relevant

in younger patients. This is in contrast to elderly patients, where NSAIDs may play a more significant etiologic role [27]. Determination of Helicobacter Pylori was not performed in our study due to lack of reagents. Use of NSAID is an important cause of perforated peptic ulcer in the West. In our series, NSAID use as an offending cause could be attributable in only 10.7% patients. NSAID inhibit prostaglandin synthesis so further reducing gastric mucosal blood flow [27]. In agreement with other studies [3, 24], more than sixty percent of patients Tipifarnib mouse had no past history suggestive of peptic ulcer disease and those with a known history of PUD were not on regular treatment.

This is in sharp contrast to Nuhu et al in Nigeria who reported that 71% of cases had previous history of peptic ulcer disease [21]. It has been reported that in many developing countries, the diagnosis of PUD is first made in many instances after perforation [28]. The present study confirms this observation because more than sixty percent of the patients with perforation were not diagnosed previously as cases of PUD and therefore were not on treatment. Patients with no previous diagnosis of peptic ulcer have a higher risk of PUD perforation than patients with a known history of ulcer disease. This may be because preventative measures are more likely to have been taken in patients with a known history of ulcer. Furthermore, these patients are perhaps more likely to seek treatment earlier. In this study, most of patients had either primary or no formal education and more than three quarter of them were unemployed. Similar occupational pattern was reported by others [21, 22]. This observation has an implication on accessibility to health

care facilities Dimethyl sulfoxide and awareness of the disease. It has been reported that the interval between perforation and initiation of treatment is a better predictor of outcome. In the present study most of patients presented late more than 24 hours from the start of symptoms. This is in agreement with other studies in most developing countries [3, 21–23, 28]. Late presentation in our study may be attributed to lack of accessibility to health care facilities and lack of awareness of the disease. Hospital treatment is expensive and the patients may seek care only when the pain is unbearable. Patients may take medications in the pre-hospital period with hope that the symptom will abate. It is also possible that some clinicians managing the patients initially may not have considered perforation as a possible diagnosis.