[Treatment of perforated gastroduodenal ulcer by simple suture followed by Helicobacter pylori eradication].

AIMS OF THE STUDY: To determine the prevalence of Helicobacter pylori (HP) infection in Vietnam in case of perforated gastro-duodenal ulcer and to evaluate efficiency of medical treatment to obtain eradication of HP and ulcer healing. PATIENTS AND METHODS: One hundred and eleven patients with perforated gastro-duodenal ulcer underwent surgical suture. HP infection was diagnosed by urease test and pathologic examination of peroperative antral biopsies, and by postoperative detection of HP-specific immunoglobulins G. HP infection was defined by positivity of at least one test. Medical treatment included omeprazole, clarithromycin, and amoxicillin for 7 days followed by omeprazole for 3 weeks for duodenal ulcer and 5 weeks for gastric ulcer. Follow-up endoscopy with biopsies was performed 4 to 6 weeks after treatment cessation.
RESULTS: Among 111 patients, 107 (96%) were infected by HP. The 4 patients non-infected by HP were treated by omeprazole alone and excluded from the study. Ulcer healed in 99 patients (93%). HP eradication was obtained in 102 patients (95%). The 8 patients with a non-healed ulcer and the 5 patients in whom HP eradication was not obtained at the first endoscopic control received additional medical treatment. Ultimately HP eradication and ulcer healing were obtained in all cases.
CONCLUSION: In a country in which prevalence of HP infection is high, acid-reduction surgery is unnecessary in case of perforated gastro-duodenal ulcer treated by simple surgical closure.