A cross-sectional study of demographic profile and incidence of Helicobacter pylori in patients with duodenal ulcer perforation.

Abstract

Introduction: Duodenal ulcer Perforation (DUP) is a life-threatening complication of peptic ulcer disease, disproportionately burdening resource-limited regions. Helicobacter pylori (H. pylori) is a key etiology, yet data from Nepal are limited. This study evaluated demographics, risk factors, and H. pylori incidence in DUP patients at a Nepalese tertiary center.

Methods: A hospital-based prospective cross-sectional study (March 2024-April 2025) included 61 surgically managed DUP patients aged 18-70 years. Exclusion criteria: recent antibiotic/proton pump inhibitors use, gastric ulcers, or traumatic perforation. H. pylori was detected via histopathological analysis of perforation margin biopsies. Demographics, risk factors [smoking, alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, socioeconomic status (SES), food habits], and outcomes were analyzed using SPSS v28 (χ²/t-tests; P < 0.05 significant).

Results: The cohort (mean age 38.7 ± 17.6 years; 93% male) showed 65.57% H. pylori positivity. Smoking prevalence was 82% and significantly associated with H. pylori infection (OR = 4.50, 95% CI: 1.14-17.8; P = 0.024). Low SES (57% of patients) correlated strongly with H. pylori, whereas high or middle socioeconomic status had significantly lower odds of H. pylori infection (high/middle SES OR = 0.30, 95% CI: 0.10-0.89; P = 0.027). Alcohol use (59%) had a nonsignificant H. pylori association (OR = 2.78, 95% CI: 0.93-8.26; P = 0.063), while NSAIDs (8%) and steroids (7%) played minimal roles.

Conclusion: DUP in Nepal predominantly affects young males, with high H. pylori prevalence (65.57%) driven significantly by smoking and low SES. These findings highlight synergistic sociodemographic and biological risk factors in resource-limited South Asia, advocating for targeted H. pylori screening and prevention programs.