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Persistence of Helicobacter pylori infection in patients with peptic ulcer perforation
Helena Andreson1, Toomas Sillakivi, Margot Peetsalu
1Department of Microbiology, University of Tartu, Tartu, Estonia. Helena.Andreson@ut.ee
Objective:
In patients with perforated peptic ulcer (PPU) the convergence between the high eradication rate of Helicobacter pylori infection and low rates of ulcer relapse after treatment has been associated with reinfection by non-virulent strains. The objective of this study was to evaluate the persistence of infection by virulent H. pylori strains and ulcer recurrence in 33 patients with PPU one year after surgery and antimicrobial treatment.
Material And Methods:
The histological evaluation and molecular detection of H. pylori cagA and ureA genes, vacA allelic types and the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses of the glmM gene products from antral mucosa specimens were performed initially, 2-5 months and 1 year after therapy.
Results:
The density of H. pylori colonization was temporarily decreased (p<0.05) 2-5 months after therapy. After one year, complete eradication was achieved in only 7 patients (23%) at histological examination and recurrent ulcers were found in 3/33 (9%) patients. The vacA s1a allelic type of cagA-positive strains persisted in 19/33 (58%) PPU patients with identical PCR-RFLP fingerprints in 8/9 (89%) of the patients.
Conclusions:
In PPU patients with a low eradication rate of H. pylori infection after surgical and antimicrobial treatment, the frequent recrudescence of the infection is mostly caused by the persisting virulent strains of the cagA and vacA s1a subtypes. In the 1-year follow-up period the recurrent ulceration can be postponed just by the lowered colonization density of H. pylori after eradicative therapy.
Insights
Perforated peptic ulcer patients often experience Helicobacter pylori (H. pylori) recrudescence from virulent strains after treatment. This study found low eradication rates and persistent infection, leading to potential ulcer recurrence.
Area of Science:
- Gastroenterology
- Microbiology
- Surgery
Background:
- Perforated peptic ulcer (PPU) treatment aims for H. pylori eradication to prevent relapse.
- Reinfection with non-virulent strains was previously thought to explain low relapse rates.
- This study investigates the persistence of virulent H. pylori strains after PPU treatment.
Purpose of the Study:
- To evaluate the persistence of virulent H. pylori strains.
- To assess ulcer recurrence one year after PPU surgery and antimicrobial treatment.
Main Methods:
- Histological evaluation and molecular detection of H. pylori genes (cagA, ureA, vacA).
- Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the glmM gene.
- Specimens collected initially, 2-5 months, and 1 year post-therapy.
Main Results:
- H. pylori density decreased temporarily post-therapy (p<0.05).
- Complete eradication achieved in only 23% of patients after one year.
- Recurrent ulcers found in 9% of patients; virulent cagA-positive strains (vacA s1a) persisted in 58%.
Conclusions:
- Low H. pylori eradication rates in PPU patients are linked to persistent virulent strains (cagA, vacA s1a).
- Recurrent ulceration may be delayed by reduced H. pylori colonization density post-treatment.
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