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.
