Togetherness Reminded by the Earthquake: Relationship Between Stress and Peptic Ulcer Perforation

Öz

Background: Severe stress is one of the leading causes of peptic ulcer perforations. Peptic ulcer perfora-tion is a clinical condition that can be fatal if not treated urgently. This study aimed to investigate the effects of social stress caused by the earthquakes in Kahramanmaraş on peptic ulcer perforation. Materials and Methods: A retrospective evaluation was conducted on 66 peptic ulcer perforation cases operated on in three major centers in Şanlıurfa, considering two large earthquakes that occurred on February 6, 2023, and by comparing the 6-month periods before and after the earthquakes. Patients were assessed in terms of age, gender, diagnostic method, perforation site, surgical technique, operation time, length of hospital stay, and mortality. Our study also evaluated laboratory parameters such as white blood cell (WBC) count, hemoglobin, urea, creatinine, and albumin levels. Results: In the 6 months prior to the earthquakes, 21 patients underwent surgery for peptic ulcer perfo-ration, whereas 45 patients were operated on for the same reason in the 6 months following the earthquakes; there were two deaths in each group. The number of patients operated on after the earthquakes was significantly higher than the number of patients operated on before the earthquakes. Furthermore, the two groups were also compared in terms of demographic data and laboratory findings; no significant differences between the two groups were observed regarding these parameters. Conclusions: Stress plays a remarkable role in the development of peptic ulcer perforation. In stressful situations that affect the general population, such as earthquakes, it is essential to assess stress tenden-cies and dyspeptic complaints in patients presenting to the hospital. Patients with positive findings should undergo endoscopy if necessary, followed by appropriate gastric treatment.

Anahtar Kelimeler

• Earthquake-related stress
• peptic ulcer
• peptic ulcer perforation

Depremin Hatırlattığı Bir Birliktelik: Stres-Peptik Ülser Perforasyonu İlişkisi

Öz

Amaç: Şiddetli stres, peptik ülser perforasyonlarının önde gelen nedenlerinden biridir. Peptik ülser perforasyonu ise acil müdahale edilmezse mortal seyredebilen bir klinik tablodur. Bu çalışmada Kahramanmaraş'ta meydana gelen depremlerin neden olduğu sosyal stresin peptik ülser perforasyonu üzerindeki etkilerinin araştırılması amaçlanmıştır. Materyal ve Metod: 6 Şubat 2023'te meydana gelen 2 büyük deprem baz alınarak, depremden önceki ve sonraki 6 aylık dönemlerde Şanlıurfa'da perforasyon vakalarının kabul edildiği üç büyük merkezde ameli-yat edilen 66 peptik ülser perforasyon vakası retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, tanı yöntemi, perforasyon yeri, cerrahi teknik, ameliyat süresi, hastanede kalış süresi ve mortalite açısın-dan değerlendirildi. Çalışmaya ayrıca beyaz kan hücresi (WBC), hemoglobin, üre, kreatinin ve albümin düzeyleri gibi laboratuvar parametreleri de dahil edildi. Bulgular: Depremden önceki 6 ayda 21 hasta peptik ülser perforasyonu nedeniyle ameliyat edilirken, depremden sonraki 6 ay aynı nedenle 45 hasta ameliyat edildi. Her grupta ikişer ölüm gerçekleşti. Depremden sonra ameliyat edilen hasta sayısı, depremden önce ameliyat edilen hasta sayısından anlamlı olarak daha fazlaydı. İki grup, demografik veriler ve laboratuar bulgular açısından da karşılaştırıldı. Karşılaştırılan bu parametreler açısından iki grup arasında anlamlı farklılık mevcut değildi. Sonuç: Stres, peptik ülser perforasyonu gelişiminde önemli bir role sahiptir. Deprem gibi toplumun genelini etkileyen stres durumlarında, hastaneye başvuran hastalarda stres eğilimi ve dispeptik şikayetler mutlaka sorgulanmalıdır. Pozitif bulguları olan hastalar gerekirse endoskopiye alınmalı ve sonrasında uygun mide tedavisi düzenlenmelidir.

Anahtar Kelimeler

• Depremle ilişkili stres
• peptik ülser
• peptik ülser perforasyonu

Kaynakça

1. 1. Russell AL, Tasker JG, Lucion AB, Fiedler J, Munhoz CD, Wu TJ, et al. Factors promoting vulnerability to dysregulated stress reactivity and stress-related disease. J Neuroendo-crinol. 2018; 30(10):e12641.
2. 2. Bures J. Gastric and duodenal ulcers--etiopathogenesis, diagnosis, and therapy at the milestone of the 20th century. Vnitr Lek. 2004; 50(1):91-3.
3. 3. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017; 390(10094):613-24.
4. 4. Moller MH, Vester-Andersen M, Thomsen RW. Long-term mortality following peptic ulcer perforation in the PULP tri-al. A nationwide follow-up study. Scand J Gastroenterol. 2013; 48(2):168-75.
5. 5. Surapaneni S, Rajkumar S, Reddy AVB. The Perforation-Operation time Interval; An Important Mortality Indicator in Peptic Ulcer Perforation. J Clin Diagn Res. 2013; 7(5):880-2.
6. 6. Behrman SW. Management of complicated peptic ulcer disease. Archives of Surgery. 2005; 140(2):201-8.
7. 7. Thorsen K, Glomsaker TB, von Meer A, Søreide K, Søreide JA. Trends in diagnosis and surgical management of pa-tients with perforated peptic ulcer. J Gastrointest Surg. 2011; 15(8):1329-35.
8. 8. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated pep-tic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011; 84(2):102- 13.

9. 9. Soreide K, Thorsen K, Soreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014; 101(1):51-64.
10. 10. Wysocki A, Budzyński P, Kulawik J, Drożdż W. Changes in the localization of perforated peptic ulcer and its relation to gender and age of the patients throughout the last 45 years. World J Surg. 2011; 35(4):811-6.
11. 11. Thorsen K, Soreide JA, Kvaloy JT, Glomsaker T, Soreide K. Epidemiology of perforated peptic ulcer: age and gender adjusted analysis of incidence and mortality. World J Gas-troenterol. 2013; 19(3):347-54.
12. 12. Jamal MH, Karam A, Alsharqawi N, Buhamra A, AlBader I, Al-Abbad J, et al. Laparoscopy in acute care surgery: repair of perforated duodenal ulcer. Med Princ Pract. 2019; 2(5):442-8.
13. 13. Cirocchi R, Soreide K, Di Saverio S, Rossi E, Arezzo A, Zago M, et al. Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduode-nal ulcers. J Trauma Acute Care Surg. 2018; 85(2):417-25.
14. 14. Siu WT, Chau CH, Law BK, Tang CN, Ha PY, Li MK. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg. 2004; 91(4):481-4.
15. 15. Bhandari V, Gunasekaran G, Naik D, Paruthy SB, Choudhry L, Garg P. A comparative study between figure of eight sutur-ing technique and omentopexy in closure of peptic ulcer perforation: a prospective study on 60 patients with APACHE II score ≤10. Int Surg J. 2015; 2(1):31-7.