Eradication of Helicobacter pylori Prevents Recurrence of Ulcer After Simple Closure of Duodenal Ulcer Perforation

Ng, Enders K.; Lam, Y. H.; Sung, Joseph J.Y.; Yung, Man Yee; To, KF; Chan, Annie On On; Lee, Danny W.H.; Law, Bonita Ka Bo; Lau, James Y.; Ling, T. K. W.; Lau, W. Y.; Chung, Sai Ho

doi:10.1097/00000658-200002000-00001

Cited by 171 publications

(102 citation statements)

References 29 publications

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“…In Europe and the United States, the incidence of duodenal ulcer constitutes a significant percentage compared with the other peptic ulcers and a lot of evidence that recurrence could be inhibited by eradicating duodenal ulcer has been stored [42,43]. However, there was a moment when a question was raised as to whether eradication was truly effective for inhibiting recurrence of gastric ulcer or not [44].…”

Section: Prevention Of Ulcer Recurrencementioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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Section: Prevention Of Ulcer Recurrencementioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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“…The exclusive focus on male subjects in this series is a fact not found in other parallel studies or related series, although there is wide predominance of cases in men [1][2][3]6,7 . This can be explained by the short period of data collection associated with greater exposure to risk factors, such as smoking and alcoholism.…”

Section: Results Results Results Resultsmentioning

confidence: 88%

Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada

Casali¹,

Franzon

Kruel

et al. 2012

Rev. Col. Bras. Cir.

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OBJETIVO: Analisar o perfil epidemiológico de pacientes com úlcera péptica gastroduodenal perfurada e verificar se a presença do H. pylori nas secreções peritoneais e intraluminais desses pacientes pode ser avaliada pelo teste rápido da urease. MÉTODOS: Realizou-se estudo prospectivo, transversal, descritivo, com dados de pacientes atendidos em um hospital de abrangência regional, em portadores de úlcera péptica perfurada. Coletou-se, no transoperatório, amostras de líquido peritoneal (na proximidade da perfuração) e da secreção intraluminal, sendo encaminhadas para cultura e teste rápido de urease. RESULTADOS: Quatorze pacientes foram analisados. A média etária foi 41,06 anos, todos homens, brancos (71,4%), tabagistas (57,2%), IMC < 30 (85,7%), com história prévia de dispepsia (78,6%). Sorologia para H. pylori foi positiva em 84,6% dos casos. O teste rápido da urease foi positivo em 78,6% das amostras do tubo digestivo e em 42,8% das amostras da cavidade peritoneal; 41,6% foram positivos em ambos os locais, 50% somente na cavidade digestiva e 8,4% exclusivamente na cavidade peritoneal. Dos 11 pacientes com sorologia positiva para H. pylori 100% apresentaram positividade em pelo menos um dos sítios pesquisados. CONCLUSÃO: Verificou-se que a incidência foi menor que a esperada. Há associação significativa entre a infecção pelo H. pylori e a ocorrência de perfuração. A presença deste patógeno pode ser avaliada tanto pela sorologia quanto pela realização do teste rápido da urease do fluido coletado na cavidade peritoneal e na luz gástrica/duodenal.

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“…But, the effect of H. pylori eradication in complications of this disease, like perforation, is still a matter of research. From the year of 1995 on, several publications demonstrated that the simple closure of perforated ulcers, plus the eradication of H. pylori, diminishes relapse rates significantly, inducing this strategy as treatment for this complication 1,3,7,12,15,16,18,19,20,21,24,28 . Historically, Sebastian, et al 24 were the first to suggest association between H. pylori …”

Section: Discussionmentioning

confidence: 99%

“…Rodriguez-Sanjuan, et al 21 also removed those patients, as they presented with a higher rate of ulcer re-perforation. These authors also contraindicate closure of gastric ulcers of locations other than those, for the relapse rate is too high.…”

Section: Discussionmentioning

confidence: 99%

“…Ng, et al 20 reported a 38% relapse rate for the patients treated with an omeprazole monotherapy against a 4,8% rate for eradicated patients with a 12 months follow-up period. Rodriguez-Sanjuan, et al 21 related a 6,1% relapse rate for eradicated patients, with a 22 months follow-up period. This author, however, performed upper endoscopies on patients according to surgeon's criterion.…”

Section: Discussionmentioning

confidence: 99%

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Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

Dalcin¹,

Abaid²,

Almeida³

et al. 2009

ABCD, arq. bras. cir. dig.

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BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done. AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori. METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months. RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients. CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

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Eradication of Helicobacter pylori Prevents Recurrence of Ulcer After Simple Closure of Duodenal Ulcer Perforation

Abstract: Eradication of H. pylori prevents ulcer recurrence in patients with H. pylori-associated perforated duodenal ulcers. Immediate acid-reduction surgery in the presence of generalized peritonitis is unnecessary.

Cited by 171 publications

References 29 publications

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

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