Abstracts
1997 Digestive Disease Week

Helicobacter pylori status and endoscopy follow-up of patients having past history of perforated peptic ulcer.

KM Chu, R Poon, S Law, FJ Branicki, J Wong. Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong.

Background: It is uncertain whether recurrence of symptoms and/or ulcer disease in patients with past history of perforated peptic ulcer is related to Helicobacter pylori (HP).

Methods: 143 patients with complete record of follow-up since their past admission for perforated peptic ulcer were studied prospectively. None of them has received any eradication treatment for HP. History of recurrent pain or bleeding was documented. All patients underwent an upper gastrointestinal endoscopy. Endoscopic findings were noted. Three antral biopsies (or gastric biopsies in patient with previous gastrectomy) was taken for histological examination and rapid urease test.

Results: There were 116 males and 27 females with a mean age of 58.1 years (range, 15 to 90 years). The original sites of perforation were duodenal (N=124), prepyloric (N=9), and gastric (N=8). The operative procedures performed included omental patch repair (N=114), truncal vagotomy & pyloroplasty (N=17), Billroth II gastrectomy (N=4), Billroth I gastrectomy (N=2), Taylor's procedure & omental patch repair (N=2), truncal vagotomy, gastrojejunostomy & omental patch repair (N=1), and conservative management (N=3). Postoperatively, 57 patients (39.9%) had history of epigastric pain while 7 patients (4.9%) had history of ulcer bleeding. Endoscopy was performed at a mean period of 75.2 months from the previous operation. Positive endoscopic findings were present in 61 patients (42.7%). HP was positive in 63 patients (44.1%).

                            HP+          HP-               p
 Pain                        54           3
 No pain                     6            72            <0.00001
 Bleed                       6            1
 No bleed                    52           74             <0.05
 Positive endoscopy          55           6
 Negative endoscopy          6            66            <0.0001

Conclusions: H. pylori was related to the recurrence of symptoms and ulcer in patients with past history of perforated peptic ulcer.