Risk Factors for Acute Perforated Duodenal Ulcers in Erbil Governorate-Kurdistan, Iraq


  • Abdulqadir Maghded Zangana Department of surgery, College of Medicine, Hawler Medical University
  • Sherwan Ahmed Garota Department of Surgery, College of Medicine, Hawler Medical University




peptic ulcer perforated duodenal Ulcer, risk factors


Background and objective: Acute perforations of duodenal ulcers continue as one of the real emergencies of surgery which require immediate attention and prompt operation. The aim of this study was to evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in Erbil governorate. Design: Retrospective study. The cases were selected on the basis of structured protocol. Setting: The study was performed on 124 patients with perforated duodenal ulcer attending the emergency departments of the three major hospitals in Erbil city (Erbil emergency hospital, Hawler teaching hospital and Hawler private hospital) Erbil governorate located in Iraqi Kurdistan over a period of 4 years.

Methods: The study was performed on 124 patients with perforated duodenal ulcer over a four year period (Jun. 2000- Jun. 2004). A number of probable risk factors for perforation of the duodenal ulcer were studied. Asymptomatic patients who perforated were studied as a separate group.

Results: one hundred twenty four patients with duodenal ulcer perforation were studied, 111 male and 13 female (male to female ratio 8.5:1) about 60% of patients were within their 4th and 5th decade of age. Patients residing in the rural areas had a lower incidence of perforation (39%) than that living in the urban areas (61%). seventy four patients (59.6%) were asymptomatic before they developed the perforation. Sixty six patients (53.2% of the total number) developed the perforation during Ramadan fasting months (four out of the total 48 months), sixty five percent of the cases were smokers. Stress and smoking played a significant rule in the occurrence of perforation in 83% of cases.

Conclusion: Stress, smoking and fasting played a major rule as a risk factor in the occurrence of duodenal ulcer perforation. A high incidence of perforation occurs during the months of Ramadan fasting, especially those without or on irregular treatment. The incidence of asymptomatic patients who were fasting and under stress, who then perforated was high.


Metrics Loading ...


Sakr AH. Fasting in Islam. Journal of the American Diabetic Association, 1975, 67:17–21.

Al-Kaabi S et al. Effect of Ramadan fasting on peptic ulcer disease. Indian journal of gastroenterology, 2004, 23:35–6.

Gumaa KA et al. The effects of fasting in Ramadan. I. Serum uric acid and lipid concentrations. British journal of nutrition, 1978, 40:573–81.

Al-Marri MA et al. Does peptic ulcer perforation occur more frequently in Ramadan? Paper presented at the First International Congress on Health and Ramadan, 19–22 January, 1994, Casablanca.

Donderici O et al. Effect of Ramadan on peptic ulcer complications. Scandinavian journal of gastroenterology, 1994, 29:603–6.

Abu Farsakh NA. Risk factors for duodenal ulcer disease. Saudi medical journal, 2002, 23:168–72.

Metzger J et al. Prevalence of Helicobacter pylori infection in peptic ulcer perforations. Swiss medical weekly, 2001, 131:99–103.

Christensen A, Bousefield R, Christiansen J. Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2 receptor antagonist. Ann Surg 1988, 207: 46.

Taylor H. Aspiration treatment of perforated duodenal ulcers. Lancet 1951, 1:7-12.

Bodner B, Harrington ME, Kim I. Multifactorial analysis of mortality and morbidity in perforated peptic ulcer disease. Surg Gynaecol Obstet 1990, 171:315-21.

Jain A; et al. Risk factors for duodenal ulcer in north India. Trop Gastroenterol 1999 Jan-Mar; 20 (1) : 36-9

Voutilainen M; et al. Impact of non-steroidal anti-inflammatory drug and aspirin use on the prevalence of dyspepsia and uncomplicated peptic ulcer disease. Scand J Gastroenterol. 2001 Aug; 36(8): 817-21

Bjorkman DJ. Current status of non-steroidal anti-inflammatory drug (NSAID) use in the United States: risk factors and frequency of complications. Am J Med. 1999 Dec 13; 107(6a): 3S-8S; discussion 8S-10S

. Ahmed ME, Al Knawy BA, Al Wabel AH, Foli AK. Duodenal ulcer and helicobacter pylori infection at high altitude: experience from southern Saudi Arabia.Can J Gastroentorlogy, 1997; 11: 313-316.

Abu Farsak H, Niazy A. Risk Factors for duodenal ulcer disease. Saudi Med J, 2002; 23 (2): 168 - 172.

Aldoori VVH, et al. A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men. Epidemiology 1997; 8: 420-424.

Elta GH, et al. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia and normal controls. Am J Gastroenterol 1990; 85: 1339-1342.

Eastwood GL. Is smoking still important in the pathogenesis of peptic ulcer disease? J clin Gastroenterology 1997; 25 Suppl 1-7




How to Cite

Zangana, A. M., & Garota, S. A. (2009). Risk Factors for Acute Perforated Duodenal Ulcers in Erbil Governorate-Kurdistan, Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 13(1), 1–5. https://doi.org/10.15218/zjms.2009.001



Original Articles