Does Ramadan Fasting Increase duodenal ulcer perforation?

In Ramadan, healthy adult Muslims are obliged to fast. Prolonged fasting increase gastric acid and pepsin levels, which promote the risk of duodenal ulcer perforation (DUP). Effects of Ramadan fasting on DUP have not been thoroughly studied yet, and the limited number of studies investigating the impact of Ramadan fasting on DUP yielded discrepant results. This study aimed to evaluate DUP frequency during Ramadan 2011-2015 and compare it with other months.
This cross-sectional study was performed in 82 patients undergoing surgery due to DUP during July 2011-September 2015. The demographics, history of addiction, use of nonsteroidal and antiinflammatory drugs, previous history of acid peptic disease, as well as complications and outcomes of treatment were recorded and analyzed, and the obtained results were compared between Ramadan and other lunar months.
The majority of patients were male (86.6%, 71 patients), with a mean age of 43.9±16.5 years (age range: 20-75 years). Male to female ratio was 6:1. Cases with less than 30 years of age were less frequent (22%, 18 patients). DUP was more frequent during Rajab with nine cases (11%), while during Ramadan, six cases were reported, the difference between Ramadan and other months regarding the incidence of DUP was not significant (P=0.7). Risk factors such as smoking (60%) and addiction (44%; especially to crystal and crack) were noted. Consumption of nonsteroidal antiinflammatory drugs in 20 (24%) patients, and use of antacids in 17 (25%) patients. Distribution of DUP in different blood types was as follows: O=41%, A=28%, B=23%, AB=5%, and O-=3%; moreover, post-operative Helicobacter pylori antibody was present in 67% of the patients.
Ramadan fasting did not escalate DUP incidence, and those with DUP risk factors can fast with the use of antacids.