[Indications to surgical treatment of patients with peptic ulcer disease]

The aim of this investigation is to study the influence of eradication of Helicobacter pylori (Hp) on the results of conservative treatment of patients with ulcer. The results of treatment of 216 patients with peptic ulcer disease (I gr.--152 patients with noncomplicated peptic ulcer disease and II gr.--64 patients with complications of disease) were analyzed. To diagnose Hp infection (13)C-UBT and RUT of biopsy material were used. I gr.--patients received antibacterial treatment. In II gr.: in presence of absolute indications--surgical method was used (16 patients) with additional antibacterial treatment of Hp infection after surgery and in relative indications to surgery (48 patients)--antibacterial treatment was used initially. 1 month after conservative treatment (in part of patients--1 year after Hp eradication also) (13)C-UBT were used to control Hp eradication, as endoscopy--to control ulcer healing. In I gr.: all 152 patients (97,4% of investigated, early nontreated patients with noncomplicated ulcers) were Hp positive; in II gr.--62 from 64 (96,9%). In I gr.: efficiency of primary course of eradication therapy was 91,4% and came to 99,3% after repeated treatment (in II gr.--89,1% and 100% respectively). In I gr.--in 1 patient, the resistance to antibacterial treatment was revealed and eradication of Hp infection and ulcer healing were not achieved. In II gr.--epithelization and scarring of ulcer was revealed by control endoscopy in all cases except one case of prepyloric callous ulcer (Hp was eradicated in all of them). Thus, in complicated cases of peptic ulcer disease, only in presence of absolute indications, surgery is necessity. In presence of relative indications to surgery Hp eradication therapy is indicate initially. Only in cases of resistant to treatment ulcers, as ulcers nonhealing or recurring after Hp was eradicated, must be a relative indications to surgical treatment.