Acw Chan

The role of Helicobacter pylori in perforated duodenal ulcer: A prospective randomized treatment traal

BACKGROUND: Immediate definitive acid-reduction surgery has been advocated for patients with duodenal ulcer perforation because of the high incidence of ulcer recurrence. Whether H. pylori plays any role in the strong ulcer diathesis of these patients remains unclear. The aim of this study was to determine if H. pylori eradication prevented ulcer relapse in patients with ulcer perforation. METHOD: One hundred thirty patients with perforated duodenal ulcer had H. pylori status determined by rapid urease test, culture, and histology on antral biopsies obtained via intra-operative gastroscopy. With informed consent, ninety-one H. pylori-infected patients undergoing omental patch repair were randomized to receive either a 4-week course of Omeprazole (20mg per day) plus triple therapy (Bismuth 120mg, tetracycline 500mg, and metronidazole q.i.d, for 1 week) or Omeprazole alone. H. pylori eradication and ulcer healing were determined by follow-up endoscopy at 8-week, 16week (if unhealed on 8th week), and 1-year after the operation. Outcomes of patients were compared by intention to treat analysis using Chi square or Fisher Exact test when appropriate.