Prevalence of Helicobacter pylori infection in peptic ulcer perforations

Background: Most patients with chronic peptic ulcer disease have Helicobact er pylori (H. pylori) infection. In the past, immediate acid-reduction surg ery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing pr ocedures either bq 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) suff ering from acute peptic ulcer perforation the preoperative presence of H. p ylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of EI. pylori eradication with a tripl e 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 l aparotomy reached a high of 32%. The main reasons for conversion were the s ize of the ulcer, and/or diffuse peritonitis for a duration of over 12 hour s with fibrous membranes difficult to remove laparoscopically. In the H. py lori positive patients, eradication was successful in 96% of the cases. Mor tality and morbidity rates were greater in the laparoscopic group (p < 0.05 ). Follow-up (median 43.5 months) revealed no need for reoperation for pept ic ulcer disease and no mortality. Conclusion: We have found a high prevalence of H. pylori infection in patie nts with perforated peptic ulcers. An immediate and appropriate H. pylori e radication therapy for perforated peptic ulcers reduces the relapse rate af ter simple closure. Response rate to a triple eradication protocol was exce llent in the hospital setting.