Perforated Peptic Ulcer Treated by Simple Closure and Helicobacter Pylori Eradication

Abstract

Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19-96 years) were operated on between 1996 and 2002, and treated by simple closure followed by Hp eradication and NSAID avoidance. The data were prospectively collected in a database. Hp infection was diagnosed in 68 patients (73.9%). Thirty-four patients (37%) consumed nonsteroidal anti-inflammatory drugs (NSAIDs), and 23 (25%) had both Hp infection and NSAID antecedents. The perforation was gastric in 4 cases and pre-pyloric, pyloric or duodenal in 88. There were postoperative complications in 24 patients (26%) and 4 patients died (4.3%). Hp eradication was shown in 46 patients. There was clinical ulcer recurrence in 4 (4.3%); in 3 of them recurrence manifested as re-perforation, all in gastric locations. Overall relapse and re-perforation 1-year crude rates were 6.1% and 4.1%, respectively. Crude rates for non-gastric ulcer recurrence were 0 at 1 year and 2.6% at 2 years and for non-gastric ulcer re-perforation rates were 0 at 1 and 2 years. This therapeutic strategy is associated with a low rate of recurrence and no re-perforations in case of duodenal, pyloric, or pre-pyloric perforated ulcers, but it is not acceptable for perforated gastric ulcers.

Seven Cases of Gastric Perforation in Roux-en-Y Gastric Bypass Patients: What Lessons Can We Learn?

“…H. pylori presence is not routinely screened preoperatively at most centers, although an increasing number of centers are beginning to do so. Efficacy and safety of eradication of H. pylori in treatment of perforated ulcers is still being examined [19]. Each of the patients discussed in previous case studies was treated empirically against H. pylori after development of ulcer perforation.…”

Results of surgical treatment of perforated peptic ulcer

“…Other authors found more common occurrence of H. pylori infection in patients with perforated duodenal ulcer, pyloric ulcer, and ulcer of the pyloric part of the stomach treated by suturing of the perforation and bacteria eradication than in subjects from the control group free of PUD (73.9% vs. 59.4%). The difference was not statistically significant [22,23]. They concluded that this slight difference did not support the thesis of H. pylori's role in the pathogenesis of PPU but the results obtained demonstrated that simple suturing of the perforated ulcer involved a low percentage of PUD relapses (2.6% during a 2-year follow-up) provided that H. pylori eradication was performed and NSAIDs were not used [22].…”

“…The difference was not statistically significant [22,23]. They concluded that this slight difference did not support the thesis of H. pylori's role in the pathogenesis of PPU but the results obtained demonstrated that simple suturing of the perforated ulcer involved a low percentage of PUD relapses (2.6% during a 2-year follow-up) provided that H. pylori eradication was performed and NSAIDs were not used [22].…”

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

“…Rostom, et al 22 , over wide review, concluded that any PPI drug was effective in reducing the incidence of peptic ulcer disease on chronic NSAID users; however, only misoprostol reduced the risk of complications like bleeding and perforation.…”