Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer

Int J Surg. 2009 Apr;7(2):126-9. doi: 10.1016/j.ijsu.2008.12.001. Epub 2008 Dec 6.


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.

Patients and method: 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).

Conclusion: 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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Amoxicillin / therapeutic use
  • Anti-Infective Agents / therapeutic use*
  • Anti-Ulcer Agents / therapeutic use*
  • Drug Therapy, Combination
  • Duodenal Ulcer / microbiology
  • Duodenal Ulcer / surgery*
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / epidemiology
  • Helicobacter pylori*
  • Humans
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Omeprazole / therapeutic use
  • Peptic Ulcer Perforation / microbiology
  • Peptic Ulcer Perforation / surgery*
  • Prevalence
  • Secondary Prevention


  • Anti-Infective Agents
  • Anti-Ulcer Agents
  • Metronidazole
  • Amoxicillin
  • Omeprazole