Persistence of Helicobacter pylori infection in patients with peptic ulcer perforation.
OBJECTIVE
In patients with perforated peptic ulcer (PPU) the convergence between the high eradication rate of Helicobacter pylori infection and low rates of ulcer relapse after treatment has been associated with reinfection by non-virulent strains. The objective of this study was to evaluate the persistence of infection by virulent H. pylori strains and ulcer recurrence in 33 patients with PPU one year after surgery and antimicrobial treatment.


METHODS
The histological evaluation and molecular detection of H. pylori cagA and ureA genes, vacA allelic types and the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses of the glmM gene products from antral mucosa specimens were performed initially, 2-5 months and 1 year after therapy.


RESULTS
The density of H. pylori colonization was temporarily decreased (p<0.05) 2-5 months after therapy. After one year, complete eradication was achieved in only 7 patients (23%) at histological examination and recurrent ulcers were found in 3/33 (9%) patients. The vacA s1a allelic type of cagA-positive strains persisted in 19/33 (58%) PPU patients with identical PCR-RFLP fingerprints in 8/9 (89%) of the patients.


CONCLUSIONS
In PPU patients with a low eradication rate of H. pylori infection after surgical and antimicrobial treatment, the frequent recrudescence of the infection is mostly caused by the persisting virulent strains of the cagA and vacA s1a subtypes. In the 1-year follow-up period the recurrent ulceration can be postponed just by the lowered colonization density of H. pylori after eradicative therapy.
Andreson
Helena
H
Department of Microbiology, University of Tartu, Tartu, Estonia. Helena.Andreson@ut.ee
Sillakivi
Toomas
T
Peetsalu
Margot
M
Peetsalu
Ants
A
Mikelsaar
Marika
M
D000328:Adult; D000483:Alleles; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000150:complications / Q000382:microbiology*; D004957:Estonia; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011706:Pyloric Antrum / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications / Q000382:microbiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial