The Association Between Helicobacter Pylori and Perforated Gastroduodenal Ulcer

Background Although the role of Helicobacter pylori (H. pylori) is well known in peptic ulcer disease (PUD) etiology, its role in perforated peptic ulcer (PPU) is not well established. This study aimed to assess the role of H. pylori infection in patients with PPU and to compare it with its prevalence in patients with PUD. Methodology This prospective analytical study was conducted for two years. The study patients were classified into two groups: group I consisted of patients (n = 48) operated for PPU and group II were patients (n = 48) with PUD diagnosed by endoscopy. The study excluded patients with any previous anti-H. pylori treatment, gastric malignancy, conservative management of sealed PPU, and those with a diameter of perforation less than the diameter of endoscopic biopsy forceps. Blood samples were taken for H. pylori serology IgG (ELISA) test. The mucosal biopsy samples from both the groups were tested with a rapid urease test and modified Giemsa stain examination to detect H. pylori. Results The prevalence of H. pylori infection were significantly less in patients with PPU than with PUD: by rapid urease: 12.5% vs. 31.2%, p: 0.002; modified Giemsa stain: 10.4% vs. 31.2%, p: 0.012; and IgG serology: 50 % vs. 68.7%, p: 0.012, respectively. Alcohol and tobacco were significant risk factors (p: 0.002 vs. p: 0.002 respectively). However, nonsteroidal anti-inflammatory drugs (NSAIDs) use was not a significant risk factor for PPU (p: 0.083). Conclusion H. pylori infection was not significantly associated with PPU. Some other factors like alcohol intake and tobacco were also involved in perforation. We can conclude that H. pylori infection is not a risk factor for PPU.