Published: 2020-01-27

Endoscopic assessment and Helicobacter pylori status evaluation in operated cases of peptic ulcer perforation

Prashant Rao, Sarika Mayekar, Vishwajit Pawar, Mohan Achyut Joshi


Background: Helicobacter pylori’s role in delaying ulcer healing after surgical repair for peptic ulcer perforation causing ulcer persistence hasn’t been definitively established as it has been for uncomplicated ulcers.

Methods: Authors performed an endoscopy and H. pylori status evaluation in 30 patients at an average of 6.2 weeks after simple omental patch closure for perforated peptic ulcer.

Results: A positive H. pylori status was found in 12 patients (40%) of which 9 had active ulcers. None in the negative group had an active ulcer. H. pylori infection was the only factor found to be responsible for ulcer persistence after surgery.

Conclusions: A reasonable approach would thus be to perform an endoscopy 6 weeks after surgery to assess ulcer healing and H. pylori status. H. pylori eradication therapy should then be selectively initialled for patients with an active ulcer or positive H. pylori status.


Helicobacter pylori, Peptic ulcer perforation, Ulcer persistence, Ulcer recurrence

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Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983;321(8336):1273-5.

Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003;8(3):159-67.

Chowdhary SK, Bhasin DK, Panigrahi D, Malik AK, Kataria RN, Behra A, et al. Helicobacter pylori infection in patients with perforated duodenal ulcer. Trop Gastroenterol: Offici J Digest Dis Found. 1998;19(1):19-21.

Matsukura N, Onda M, Tokunaga A, Kato S, Yoshiyuki T, Hasegawa H, et al. Role of Helicobacter pylori infection in perforation of peptic ulcer: an age-and gender-matched case-control study. J Clin Gastroenterol. 1997;25:S235-9.

Kumar D, Sinha AN. Helicobacter pylori infection delays ulcer healing in patients operated on for perforated duodenal ulcer. Ind J Gastroenterol: Offici J Ind Soci Gastroenterol. 2002;21(1):19-22.

Chu KM, Kwok KF, Law SY, Tuen HH, Tung PH, Branicki FJ, et al. Helicobacter pylori status and endoscopy follow-up of patients having a history of perforated duodenal ulcer. Gastrointest Endosco. 1999;50(1):58-62.

Reinbach DH, Cruickshank G, McColl KE. Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection. Gut. 1993;34(10):1344-7.

Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Annal Surg. 2000;231(2):153.

Graham DY, Lew GM, Klein PD, Evans DG, Evans DJ, Saeed ZA, et al. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer: a randomized, controlled study. Annal Int Med. 1992;116(9):705-8.