Helicobacter pylori eradication prevents recurrence after simple closure of perforated duodenal ulcer.
OBJECTIVE
Evidence remains inconclusive as to whether eradication of Helicobacter pylori prevents ulcer relapse after simple closure of a perforated duodenal ulcer. This study was conducted to determine the effect of H. pylori eradication using a quadruple drug regimen along with a probiotic on ulcer recurrence after perforation closure.


METHODS
A total of 93 patients who had presented with perforated duodenal ulcer and had a simple closure of a duodenal perforation comprised the study group. Three months postoperatively, patients who were found to be positive for H. pylori infection (n = 60) were administered quadruple therapy consisting of omeprazole, clarithromycin, amoxicillin and colloidal bismuth subcitrate for 10 days along with the probiotic Lactobacillus sporogenes for 14 days. Diagnosis of H. pylori was carried out by urease test and histology. Patients were followed for 18 months. Recurrence of ulcer was analyzed for correlation with H. pylori status.


RESULTS
Of 60 patients who received H. pylori eradication therapy, 53 were available for subsequent follow up. H. pylori eradication was achieved in 43/53 (81.1%) patients. The ulcer recurrence in the eradicated group was 18.6% (8/43) compared to 70% (7/10) in the noneradicated group (P = 0.003).


CONCLUSIONS
Eradication of H. pylori significantly reduces the relapse of duodenal ulcer after simple closure of perforation. Anti H. pylori therapy must be recommended for all H. pylori positive patients after simple closure of a perforated duodenal ulcer.
Bose
Ashitha C
AC
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Kate
Vikram
V
Ananthakrishnan
Nilakantan
N
Parija
Subhash Chandra
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D004381:Duodenal Ulcer / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D012008:Recurrence