Distribution of Age of Patients in Two Group:
Current study reveals that gastric perforation was taken place in lower age group (Table 1 and Fig 1), with mean age is 34.7 years, and gastric carcinoma was taken place in higher age group people, with mean age is 50.8 years.
Distribution of two groups according to the Sex of the Patients:
Distribution of male and female is equal in two groups, and male is affected more than female, the male and female ratio is almost 2:1(Table 1), which is not statistically significant.
Distribution of two groups according to the Religion of the Patients:
Current study reveals that(Table 1), most of the patients suffering from gastric cancer and perforated ulcer were Hindu (73% in case of gastric cancer and 71% in case of perforation). The findings are not statistically significant. The religion of the people lived in the service area of the hospital is Hindu, and it is probably influenced the result. Very few previous studies were evaluated about that fact, so it is an unique finding of the currentstudy.
Distribution of two groups according to the Occupation of the Patients:
Current study reveals that(Table 1), the patients, who were laborer by occupation was the most affected individuals in both groups, though gastric cancer and peptic perforation is not a said occupational hazard of laborers but it was in the higher note due to the poor food habits, food timing, and hygiene. The second most common affected patients were housewives, and it was a known fact that Indian especially Bengali housewives didn’t maintain healthy food timing, probably due to the enormous work pressure on them. Irregular meal time leads to H.Pylori infection and also gastritis, gastric ulcer and gastric carcinoma7.
Distribution of two groups according to the Literacy Rates, Marital Status and Residency of the Patients:
We analyzed that(Table 1),, most of the affected persons in two groups were literate. The findings were not statistically significant. Married persons were the commonest sufferer in two groups. Urban residents (64.4%) were more sufferer of the gastriccarcinoma, where rural population was more suffered from the peptic perforation. The observation is statistically significant.Married people, especially women skipped their meal and invited the H. Pylori infection as well as gastritis, and resultant cancer and perforation. 7 B. Smith et al8 conducted a study on Morocco, and they found a large number of patients suffering from gastric carcinoma were belongs from the urban population. They suggested that, the excess availability of processed foods, environmental pollution in urban area, made people prone to the gastric cancer.
Distribution of Peptic Perforation Patients according to the Site of Perforation (N = 45)
The study reveals that, 66.7% cases of perforation taken place in duodenum, and rest of the cases in stomach (Figure 2) K. Byacodi et al9 observed the similar result, though frequency of duodenal perforation (53.4%) was bit lower than current study.
Distribution of two groups according to the presence of Co- morbidities
Co-morbidities associated with patients of gastric carcinoma and pepticperforation causes increase morbidity, mortality and long hospital stay, and increasespostoperative complications. Current study reveals(Table 2), that 77.8% patient presented with peptic perforation and 53.3% patients presented with gastric carcinoma had no co- morbidities. The incidence is lower in Perforation Group patients, due to the lower age group of the patients. The most co- morbidities associated with two groups were the cardio-diabetic diseases. The findings are not statistically significant. M. Unver et al 10 found, respiratory diseases were the most common co-morbidities present with peptic perforation patients.W.Wang et al11 found 23% patients of gastric carcinoma had no co-morbidies. The frequency was much lower in comparison with the findings of currentstudy, but the most common co-morbidity was cardio-diabetic diseases.
Distribution of two groups According to the Use of NSAIDs
Current study analyzed(Figure 4A), that, 22% patients of Carcinoma Group and 13% patients ofPerforationGrouphad the historyofNSAIDsconsumption.Thefindingsarenot statisticallysignificant.A.Soll et al12 found almost 48% of peptic perforation patients took long standing NSAIDs. They also suggested that the frequency was higher with the high age group. M. Drini et al13 and R. Russel et al14 also found the higher frequency of use of NSAIDs in patients of peptic perforation. The findings were clearly opposes the finding of current study.W. Wang et al15 found lower frequency of use of NSAIDs in patients with gastric cancer, which supports the finding of our study. X. Huang et al16 also found the inverse correlations. The study findings strongly support the finding of current study.
Distribution of two groups according to the History of Alcohol Consumption
Frequency of Alcohol consumption was high in both the groups in the current study (Figure 4B). 60% patients of carcinoma group and 57% patients of perforation group had history of alcohol consumption. The findings are not statisticallysignificant.
Distribution of two groups according to the History of Smoking
Frequency of smoking was also high in both the group of patients(Figure 4C),. 71.10% patients of carcinoma group had positive history of smoking and 62.20% patients of perforation group had positive history. The findings were not statistically significant. We also analyzed that frequency of gastric carcinoma and peptic perforation was similar, when patient taken alcohol and smoking in combination.
Distribution of two groups according to the food habit
We analyzed the possible association of frequency of spicy food per week in two groups using a bar diagram (Figure 6). As depicted in the figure, the frequency was higher in gastric carcinoma group (44.4% thrice weekly and 13.3% more than that) than peptic perforation group (55.60% twice a week). Although, the difference was not statisticallysignificant.YH Chen et al17 Suggested in their meta analysis that there was positive co- relations between spicy food and gastric carcinoma. Yusefi et al18 suggested spicy food is one of the prime risk factors for gastric carcinoma. X. J. Cheng et al19 observed salt and salt-preserved foods as well as smoked foods, processed, grilled (broiled) and barbecued (charbroiled) animal meets are probably causes of gastric cancer.
A. S. B. Albaqawi et al20 conducted a study on Arar, Saudi Arabia, and they found 57% patients suffering from peptic perforation had history of taking spicy food twice or more than twice a week, which strongly supports the current study, though the frequency was much lower in the current study. M. N. Satynarayana21 observed high frequency association of capsaicin intake and peptic perforation. Capsaicin is a base product of spicy and streetfoods.
Distribution of two groups according to the result of Rapid Urease Test
Current study reveals (Figure 7), that rapid urease test, indicator of H. Pylori infection, was positive in 64.5% patients of carcinoma and 82% patients of peptic perforation. Though the differences were not statistically significant, but the high frequency association proves that H. Pylori is a great risk factor both for peptic perforation and gastric cancer. The result was supported by large number of previous studies.Plenty of study suggested the fact that, H. Pylori is a causative organism of the gastric cancer.22V. Herrera et al,23 also supported the findings of currentstudy.N. Uemura et al24found somehow different result in their study, only 2.9% H. Pylori infected patient developed gastric cancer. The findings are strongly opposes the current studyfinding.
Perez et al25,also had similar findings and strongly support the view of the current study, that the Helicobacter Pylori infection had strong relation with peptic perforation and eradication of which can prevent gastric cancer, as well as peptic perforation.
To conclude, out 90 patients, 45 patients of Gastric carcinoma and 45 patients of peptic perforation was selected after applying proper inclusion and exclusion criteria.Among the two groups, gastric carcinoma found in higher age group; where peptic perforation found in lower age group; male and female ratio is 2:1 in both groups of patient. Hindu patients were prevalent in both the groups. Laborer and housewives were mostly affected in bothcases.
Gastric carcinoma and peptic perforation found in high frequency in married persons. Urban residents were more sufferer of gastric carcinoma, vice versa in peptic perforation.Duodenal ulcer is the commonest site for perforations. Most patients in two groups had no previous co-morbid condition.Use of NSAIDs was found in high frequency in both groups. Most of the patients were chronic alcoholic and chronic smoker, and most of them had history of taking spicy foods more than twice in a week.H. Pylori found in high frequency in both group of patients, and it was higher in peptic perforation, which establish the association of H. Pylori with the gastric carcinoma and peptic perforation.