Are perforated gastroduodenal ulcers related to Helicobacter pylori infection?

The prevalence of Helicobacter pylori gastritis in 36 patients with a perforated ulcer undergoing endoscopy prior to or at least 2 months after perforation was 56%, intermediate between that of age and sex matched healthy blood donors (36%) who had measurement of circulating antibodies to Helicobacter pylori and of ulcer patients without perforation matched for age, sex and ulcer location (86%). In the 20 patients with Helicobacter pylori gastritis, 8 had a history of peptic ulcer and 7 of 9 patients with a follow-up of at least 12 months and no preventive treatment had a symptomatic relapse. The group of patients without infection included 6 young patients (< 40) who did not use non steroidal anti-inflammatory drugs and 10 older patients (> 60): 9 used non steroidal anti-inflammatory drugs and seven had a normal gastric mucosa on biopsy. One patient without Helicobacter pylori had a second perforation, the only relapse in this group. We conclude that patients with perforated ulcers are a heterogeneous group with a recurrent ulcer disease mainly in patients with Helicobacter pylori.