Prevalence of Helicobacter pylori infection in peptic ulcer perforations

Helicobacter pylori (H. pylori) infection plays a crucial role in the pathogenesis of peptic ulcer disease. More than 95% of patients suffering from duodenal ulcers and about 70-80% of patients with gastric ulcers are H. pylori positive [1, 2]. While there are several reports in the literature [3–6] regarding prevalence of H. pylori infection in perforated peptic ulcers, there is a paucity of data from Europe [7, 8]. This study aimed at evaluating prospectively the prevalence of H. pylori infection in patients with acute perforated duodenal or gastric ulcers. In addition, we wanted to evaluate the success rate of H. pylori eradication in complicated peptic ulcer disease with a triple treatment regimen. We further analysed outcome, conversion rate, and reasons for conversion in patients with acute perforated peptic ulcers after laparoscopic or open ulcer repair. Laparoscopic perforated ulcer repair has recently been described by many authors [9–15] . Background: Most patients with chronic peptic ulcer disease have Helicobacter pylori (H. pylori) infection. In the past, immediate acid-reduction surgery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. Methods: In 47 consecutive patients (mean age = 64 years, range 27-91) suffering from acute peptic ulcer perforation the preoperative presence of H. pylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of H. pylori eradication with a triple regimen were prospectively studied. Results: Of these patients 73.3% were positive for H. pylori, regardless of the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Thirty-eight per cent underwent a simple laparoscopic repair. Conversion rate to laparotomy reached a high of 32%. The main reasons for conversion were the size of the ulcer, and/or diffuse peritonitis for a duration of over 12 hours with fibrous membranes difficult to remove laparoscopically. In the H. pylori positive patients, eradication was successful in 96% of the cases. Mortality and morbidity rates were greater in the laparoscopic group (p <0.05). Follow-up (median 43.5 months) revealed no need for reoperation for peptic ulcer disease and no mortality. Conclusion: We have found a high prevalence of H. pylori infection in patients with perforated peptic ulcers. An immediate and appropriate H. pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to a triple eradication protocol was excellent in the hospital setting.