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Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these countries. This study describes surgical interventions for peptic ulcer disease in sub-Saharan Africa.

Materials and Methods

A systematic review was performed using PubMed, EMBASE, and African Index Medicus for studies describing surgical management of peptic ulcer disease in sub-Saharan Africa.

Results

From 55 published reports, 6594 patients underwent surgery for peptic ulcer disease. Most ulcers (86 %) were duodenal with the remainder gastric (14 %). Thirty-five percent of operations were performed for perforation, 7 % for bleeding, 30 % for obstruction, and 28 % for chronic disease. Common operations included vagotomy (60 %) and primary repair (31 %). The overall case fatality rate for peptic ulcer disease was 5.7 % and varied with indication for operation: 13.6 % for perforation, 11.5 % for bleeding, 0.5 % for obstruction, and 0.3 % for chronic disease.

Conclusion

Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.

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Abbreviations

CFR:

Case fatality rate

Co:

Cohort study

HICs:

High-income countries

LMICs:

Low- and middle-income countries

P:

Prospective

PUD:

Peptic ulcer disease

R:

Retrospective

SSA:

Sub-Saharan Africa

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Authors and Affiliations

  1. University Teaching Hospital–Kigali, 1024 Rue de la Paix, Kigali, Rwanda

    Jennifer Rickard

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA

    Jennifer Rickard

  3. Phillips Wangensteen Bldg, 11-145E, 516 Delaware St SE, Minneapolis, MN, 55455, USA

    Jennifer Rickard

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Correspondence to Jennifer Rickard.

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Rickard, J. Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data. J Gastrointest Surg 20, 840–850 (2016). https://doi.org/10.1007/s11605-015-3025-7

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