title: Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer.
abstract: BACKGROUND
  This study was conducted to elucidate the prevalence of Helicobacter pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H. pylori prevent ulcer recurrence following simple repair of the perforation.
  
  
  METHODS
  Eighty-three patients with perforated duodenal ulcer (68 males); mean age was 47.8 years+/-7.2. Antral mucosal biopsies (to determine the status of HP by rapid urease test, culture and histological examination/staining) were obtained during laparotomy by passing a biopsy forceps through the perforation site. H. pylori positive patients who had undergone patch repair were randomized into the eradication group who received amoxicillin, metranidazole plus omperazole and the control group was given omeprazole alone. Follow-up endoscopy and antral biopsies were performed at 8 weeks, 16 weeks and 1 year to show ulcer healing and determine H. pylori state.
  
  
  RESULTS
  Of 77 patients in the study, 65 patients (84.8%) had H. pylori. These patients were randomly divided into the triple therapy group (34 patients) and the control group (31 patients). Eradication of H. pylori was significantly higher in the triple therapy group than the control group and initial ulcer healing was significantly better in the eradication group. After 1 year, ulcer recurrence was (6.1%) in the eradication group vs. (29.6%) in the control group (P=0.001).
  
  
  CONCLUSIONS
  H. pylori was present in a high proportion of patients with duodenal ulcer perforation. Eradication of H. pylori after simple closure of a perforated duodenal ulcer reduced the incidence of recurrent ulcer.
authors.affiliation: Mansoura University Hospital, General Surgery Department, Dep. 8, Egypt. elnakeebayman@yahoo.com
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Nakeeb
authors.forename: Amir
authors.initials: A
authors.lastname: Fikry
authors.forename: Tito M
authors.initials: TM
authors.lastname: Abd El-Hamed
authors.forename: El Yamani
authors.initials: el Y
authors.lastname: Fouda
authors.forename: Saleh
authors.initials: S
authors.lastname: El Awady
authors.forename: Tamer
authors.initials: T
authors.lastname: Youssef
authors.forename: Doaa
authors.initials: D
authors.lastname: Sherief
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000382:microbiology / Q000601:surgery*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010439:Peptic Ulcer Perforation / Q000382:microbiology / Q000601:surgery*; D015995:Prevalence; D055502:Secondary Prevention
chemical_list: D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D009853:Omeprazole