Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation - Randomized controlled trial

Objective In this randomized trial, the authors sought to determine whether eradicati on of Helicobacter pylori could reduce the risk of ulcer recurrence after s imple closure of perforated duodenal ulcer. Background Data Immediate acid-reduction surgery has been strongly advocated for perforated duodenal ulcers because of the high incidence of ulcer relapse after simpl e patch repair. Although H. pylori eradication is now the standard treatmen t of uncomplicated and bleeding peptic ulcers, its role in perforation rema ins controversial. Recently a high prevalence of H. pylori infection has be en reported in patients with perforations of duodenal ulcer. it is unclear whether eradication of the bacterium confers prolonged ulcer remission afte r simple repair and hence obviates the need for an immediate definitive ope ration. Methods Of 129 patients with perforated duodenal ulcers, 104 (81%) were shown to be infected by H. pylori. Ninety-nine H. pylori-positive patients were random ized to receive either a course of quadruple anti-helicobacter therapy or a 4-week course of omeprazole alone. Follow-up endoscopy was performed 8 wee ks, 16 weeks (if the ulcer did not heal at 8 weeks), and I year after hospi tal discharge for surveillance of ulcer healing and determination of H. pyl ori status. The endpoints were initial ulcer healing and ulcer relapse rate after 1 year. Results Fifty-one patients were assigned to the anti-Helicobacter therapy and 48 to omeprazole alone. Nine patients did not undergo the first follow-up endosc opy. Of the 90 patients who did undergo follow-up endoscopy, 43 of the 44 p atients in the anti-Helicobacter group and 8 of the 46 in the omeprazole al one group had H. pylori eradicated; initial ulcer healing rates were simila r in the two groups (82% vs. 87%), After 1 year, ulcer relapse was signific antly less common in patients treated with anti-Helicobacter therapy than i n those who received omeprazole alone (4.8% vs. 38.1%). Conclusions Eradication of H, pylori prevents ulcer recurrence in patients with H, pylo ri-associated perforated duodenal ulcers. Immediate acid-reduction surgery in the presence of generalized peritonitis is unnecessary.