Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?
BACKGROUND
A marginal ulcer developing after an initial operation for gastroduodenal ulcer is a serious threat to the patient, and a challenge to surgeons. Helicobacter pylori is the primary cause of peptic ulcer disease. However, its role in ulcer recurrence, especially of marginal ulcer (MU), after peptic ulcer surgery is unclear. This study aimed to determine any association between H. pylori infection and perforated MU by comparing the prevalence of H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) use in patients with perforated (PMU) and in those with nonperforated MU (NPMU).


METHODS
The study retrospectively evaluated the records of 16 patients with PMU who underwent surgical treatment and 24 patients with NPMU who underwent medical treatment in Atatürk University, School of Medicine, Department of General Surgery and Gastroenterology, between January 1995 and December 2004.


RESULTS
The rate of H. pylori in the PMU group was significantly higher than that of the NPMU group (P < 0.01). There was a significant relationship between NSAID consumption and PMU compared with NPMU patients (P < 0.01). There was also a significant relationship between NSAID consumption and H. pylori and PMU (P < 0.01).


CONCLUSIONS
Eradication of H. pylori after the first PMU operation especially in cases with impaired hemodynamics, severe peritoneal contamination, and/or a diameter smaller than 1 cm and avoiding the use of NSAIDs will surely reduce the risk of relapsing ulcers.
Aydinli
Bulent
B
Department of General Surgery, Medical Faculty, School of Medicine, Atatürk University, 25070, Erzurum, Turkey. bulentaydinli@gmail.com
Yilmaz
Omer
O
Ozturk
Gurkan
G
Yildigan
M Ilhan
MI
Gursan
Nesrin
N
Basoglu
Mahmut
M
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D017219:Gastric Outlet Obstruction / Q000473:pathology / Q000601:surgery; D016481:Helicobacter Infections / Q000473:pathology / Q000601:surgery*; D016480:Helicobacter pylori; D006801:Humans; D007583:Jejunum / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000473:pathology / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000473:pathology / Q000601:surgery*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D000658:Amoxicillin; D017291:Clarithromycin