Published: 2021-03-26

H. pylori and peptic ulcer perforation: prevalence of infection and role in surgical outcome

Saad Anwar, Afzal Anees, Nishat Afroz, Sabiha Aziz


Background: Perforated peptic ulcer is one of the most common surgical emergencies. Despite a definite association of H. pylori with peptic ulcer disease, its association with peptic ulcer perforation is still doubtful. The aim of the present study was to know the prevalence of H. pylori infection and its role in surgical outcome of patients.

Methods: This prospective observational study was carried out at a tertiary care hospital of north India for a period of two years and included 136 consecutive patients of perforated peptic ulcer who underwent emergency laparotomy. H. pylori infection was tested on ulcer margin biopsy using rapid urease test kit and confirmed on histopathological examination.

Results: 136 consecutive patients of perforated peptic ulcer were included in this study with mean age of 42.43 years and sex ratio of 11.4:1. H. pylori infection was present in fifty four percent (54%) of patients. There was no relationship of H. pylori infection with morbidity and mortality of patients.

Conclusions: H. pylori infection should be assessed at the time of primary surgical management on biopsy specimen using rapid urease test and confirmed on histopathological examination. All positive patients should be subjected to H. pylori eradication therapy.


Helicobacter pylori, Peptic ulcer perforation, Perforated peptic ulcer, Prevalence

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Türkdoğan MK, Hekim H, Tuncer İ, Aksoy H. The epidemiological and endoscopic aspects of peptic ulcer disease in Van region. East J Med. 1999;4(1):6-9.

Montalvo-Javé EE, Corres-Sillas O, César Athié-Gutiérrez C. Factors associated with postoperative complications and mortality in perforated peptic ulcer. Cir Cir. 2011;79:128-35.

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

Gurleyik E. Changing trend in emergency surgery for perforated duodenal ulcer. J Coll Phys Surg Pak. 2003;13:708-10.

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.

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. Ann Surg. 2000;231:153-8.

Dogra BB, Panchabhai S, Rejinthal S, Kalyan S, Priyadarshi S, Kandar A. Helicobacter pylori in gastroduodenal perforation. Med J DY Patil Univ. 2014;7:170-2.

Chalya PL, Mabula JB, Koy M, McHembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: a tertiary hospital experience. World J Emerg Surg. 2011;6:31.

Gisbert JP, Legido J, Garcıa-Sanz I, Pajares JM. Helicobacter pylori and perforated peptic ulcer. Prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Digest Liver Dis. 2004;36(2):116-20.

Siu LK, Leung WK, Cheng AF, Sung JY, Ling TK, Ling JM, et al. Evaluation of a selective transport medium for gastric biopsy specimens to be cultured for Helicobacter pylori. J Clin Microbiol. 1998;36:3048-50.

Wang YK, Kuo FC, Liu CJ, Wu MC, Shih HY, Wang SSW, et al. Diagnosis of Helicobacter pylori infection: Current options and developments. World J Gastroenterol. 2015;21(40):11221-35.

Rotimi O, Cairns A, Gray S, Moayyedi P, Dixon MF. Histological identification of Helicobacter pylori: comparison of staining methods. J Clin Pathol. 2000;53:756-9.

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

Loffeld RJ, Stobberingh E, Flendrig JA, Arends JW. Helicobacter pylori in gastric biopsy specimens. Comparison of culture, Modified giemsa stain and immune histo-chemistry: a retrospective study. J Pathol. 1991;165:60-73.

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

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. 1998;19:19-21.

Tayal R, De A, Sundaravadanan S, Kumar M, Baveja S. Role of culture in cases of perforated peptic ulcers due to Helicobacter Pylori. Int J Sci Stud. 2015;3(3):24-7.