{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:15:51Z","timestamp":1788347751276,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Peptic ulcer disease (PUD) continues to be a health issue, mainly due to\n \n Helicobacter pylori<\/jats:italic>\n <\/jats:styled-content>\n (\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n ) infection and non\u2010steroidal anti\u2010inflammatory drugs (NSAIDs). Despite better treatment of\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n and use of proton pump inhibitors, the rate of reduction in PUD complications is slowing down. This may be predominantly because of increased NSAID and aspirin use, especially among older adults and those in higher socioeconomic regions. Understanding changing causes of perforated PUD is important for prevention and care.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective audit reviewed patients who underwent surgical repair for peptic ulcer perforations at tertiary hospitals in Western Australia from 2010 to 2018. The study assessed patient demographics, ulcer sites, risk factors (including NSAID\/aspirin use and\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n status), eradication, and follow\u2010up care to evaluate the relative impact of NSAID use and\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n infection on ulcer perforation.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A cause for perforated PUD was identified in 78% of 359 patients; 72% had a history of NSAID or aspirin use and 42% tested positive for\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n . More gastric than duodenal perforations were observed. Practices around\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n testing, eradication, and follow\u2010up varied. Malignant gastric perforation was rare.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n NSAID\/Aspirin use may be surpassing H. pylori as the main cause of perforated PUD in Western Australia, mirroring global patterns.\n \n H. pylori<\/jats:italic>\n <\/jats:styled-content>\n remains important but identifying NSAID use as a modifiable risk and standardising testing, eradication, and follow\u2010up\u2014including endoscopy\u2014are needed. These findings should guide clinical practice for post\u2010operative and preventive care.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70747","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:54:27Z","timestamp":1779256467000},"page":"1957-1962","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changing Aetiology of Perforated Peptic Ulcers: Rising Impact of Non\u2010Steroidal\u2010Anti\u2010Inflammatories in Western Australia"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4001-6130","authenticated-orcid":false,"given":"Vidya","family":"Willis","sequence":"first","affiliation":[{"name":"Division of Surgery Medical School, University of Western Australia Crawley Western Australia Australia"},{"name":"Department of General Surgery Fiona Stanley Hospital Murdoch Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamalee","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Murdoch Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Murdoch Western Australia Australia"},{"name":"University of Western Australia. Crawley Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J.","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Murdoch Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11938-020-00326-7"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v9.i1.1"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32404-7"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-022-02130-2"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.684162"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15732"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v4.i7.323"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00276-7"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000323958"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000997"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01084-24"},{"key":"e_1_2_12_13_1","volume-title":"Testing for Helicobactor pylori","author":"Lambert J.","year":"1997"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v28.i12.1187"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2013.02.010"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-021-01769-0"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2008.12.001"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200002000-00001"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2012.10.046"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpsurg.2019.100728"},{"issue":"4","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s10120-014-0433-4","article-title":"Follow\u2010Up Endoscopy for Benign\u2010Appearing Gastric Ulcers Has no Additive Value in Detecting Malignancy: It Is Time to Individualise Surveillance Endoscopy","volume":"18","author":"Gielisse E. 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