DENSITY OF HELICOBACTER-PYLORI INFECTION IN PATIENTS WITH PEPTIC-ULCER PERFORATION

Background: A lack of change in prevalence of severe ulcer complicatio ns requiring emergency operation has been reported, despite the common use of histamine-2 (H-2)-receptor antagonists and proton pump inhibit ors. This may be attributable to use of ulcerogenic drugs or Helicobac ter pylori (HP) infection, or both. In this study, HP infection was ev aluated semiquantitatively in patients with peptic ulcer who required surgery, and the severity of histologic change was investigated. Metho ds: We reviewed a total of 113 consecutive patients (98 men and 15 wom en) operated on for perforation, hemorrhage, or stenosis of gastroduod enal ulcer between January 1986 and December 1995. Detection of HP was carried out by immunohistochemical staining. We graded the density of HP infection according to the number of individual HP bacteria counte d in a highly magnified visual field (x 1,000 of light microscopy). Th e grade of HP infection was defined as follows: (0) = 0; (1+) = 1-9; ( 2+) = 10-29; (3+) = 30-99; (4+) greater than or equal to 100. The seve rity of gastritis was evaluated by histologic examination using the cr iteria of Rauws. Results: Although the number of operations for gastro duodenal ulcer declined significantly, the rate of emergency operation for gastroduodenal ulcer increased from 60% to 90%, with the result t hat the frequency of operations for perforation or bleeding remained v irtually constant and that for stenosis significantly decreased. HP in fection was more prevalent in perforated ulcer (92%) than hemorrhagic ulcer (55%) or stenotic ulcer (45%). The grades of HP infection were 3 .0 +/- 0.14 (mean +/- SEM) in perforated ulcer, 2.3 +/- 0.34 in hemorr hagic ulcer, and 2.5 +/- 0.22 in stenotic ulcer. Perforated ulcer was associated with significantly more severe HI) infection and gastritis changes than hemorrhagic ulcer or stenotic ulcer. Conclusions: This st udy indicates that patients with perforated ulcer were infected with H P more severely than those with hemorrhagic ulcer or stenotic ulcer at the time of surgery. A close relationship was observed between the pe rforated ulcer and the density of HP infection determined semiquantita tively using immunohistochemical stain. (C) 1998 by the American Colle ge of Surgeons.