A Prospective Study of Evaluation of Prognostic and Survival Factor in Peptic Ulcer Perforation in Bundelkhand Region With Reference To Prevalence of H. Pylori in Peptic Ulcer Perforation

Background: Peptic ulcer perforation (PUP) is a life-threatening surgical emergency, and Helicobacter pylori is central to its pathogenesis. Regional data from Bundelkhand are scarce. Aims and Objective: To determine H. pylori prevalence in PUP and identify factors associated with in-hospital survival. Materials and Methods: This prospective observational study included 154 adults with PUP at a tertiary centre in Jhansi (April 2025–March 2026). H. pylori was detected on ulcer-margin biopsy by Giemsa staining. Associations with in-hospital mortality were tested with Fisher's exact test (odds ratios, OR) and Firth's penalised multivariable logistic regression. Results: Mean age was 42.14 years and 80.52% were men. H. pylori was positive in 114 (74.03%). Smoking was the commonest risk factor (51.30%) and sepsis the commonest complication (28.57%). All underwent omental-patch repair. In-hospital mortality was 9.09% (14/154). On univariate analysis, age >60 years (OR 25.3), treatment delay >48 hours (OR 6.25), diabetes with hypertension (OR 25.4), NSAID use (OR 8.11), H. pylori-negative status (OR 14.0) and non-receipt of eradication therapy (OR 5.10) increased mortality. On multivariable analysis, only age >60 years remained independently associated with death (adjusted OR 13.1; p<0.001). Conclusion: PUP predominantly affected young and middle-aged men and was strongly associated with H. pylori. Advanced age was the only independent predictor of death; other factors clustered in the elderly, and the higher crude mortality among H. pylori-negative patients and those not receiving eradication therapy does not imply protection. Priorities are risk stratification of the elderly, reducing treatment delay and routine eradication therapy.