Effect of Helicobacter pylori eradication on the ulcer recurrence rate after simple closure of perforated duodenal ulcer: retrospective and prospective randomized controlled studies

Background: The possible advantage of eradication of Helicobacter pylori in patients with perforated duodenal ulcer is unknown. This study was planned to assess the prevalence of H. pylori after simple closure of a perforated duodenal ulcer and to study the effect of H. pylori eradication on ulcer p ersistence and recurrence. Methods: Some 202 patients were followed prospectively for 2 years after si mple closure of a perforated duodenal ulcer (prospective group). A second g roup of 60 patients was reviewed 5 years or more after perforation closure (retrospective group). The prevalence of H. pylori in patients with perfora ted duodenal ulcer was compared with that in controls. Patients in the pros pective group were randomized to receive either ranitidine alone or quadrup le therapy (ranitidine, colloidal bismuth subcitrate, metronidazole and tet racycline) after operation. The incidence of H. pylori infection after the two treatments and the association with residual or recurrent ulcer were st udied. In the retrospective group long-term ulcer recurrence was correlated with H. pylori status. Results: The prevalence of H. pylori in patients with perforated duodenal u lcer was not significantly different from that in controls. At every interv al of follow-up in the prospective group and in the retrospective group the H. pylori infection rate was significantly higher in patients who had recu rrent or residual ulcers. Conclusion: Eradication of H. pylori after simple closure of a perforated d uodenal ulcer should reduce the incidence of residual and recurrent ulcers.