Prevalence of Helicobacter pylori infection in patients with gastric ulcer perforation admitted in a tertiary care centre

Muhammed Rashim P., S. Vineed


Background: Gastric ulcers are one of the most prevalent gastro intestinal diseases. Perforation of gastric ulcer is most common and dreaded complication of a gastric ulcer. Causes of gastric ulcer include Helicobacter Pylori, the NSAID, smoking and alcohol. Helicobacter Pylori infection is a curable cause of gastric ulcer. As prevalence of H. pylori differ in populations, prevalence of H. pylori in our population need to be assessed for determining treatment strategy for gastric ulcer.

Methods: Cross sectional study conducted in patients operated for perforation peritonitis and diagnosed to have gastric ulcer perforation in a tertiary care centre. Full thickness biopsy was taken from gastric ulcer perforation edge during the surgery for perforation peritonitis. The biopsy was stained with Giemsa stain and looked for the presence of H. pylori.

Results: Helicobacter pylori prevalence was 48.8% in our study. 8 females (out of 16) and 51 males (out of 105) had H. pylori positivity. 43 had history of smoking. Among them 20 were diagnosed to be having H. pylori positive. 26 persons had history of pan chewing. Among pan chewers 17 were H. pylori positive. Among 50 patients with history of alcoholism, 24 got H. pylori positivity. Among 40 patients with history of NSAIDs, 14 were positive for H. pylori.

Conclusions: Prevalence of Helicobacter pylori in gastric ulcer perforation in present study is 48.8%. Helicobacter Pylori eradication should be added in treatment protocols for perforated gastric ulcers.


Helicobacter pylori, Gastric ulcer perforations, Perforation peritonitis, Risk factors for peptic ulcer

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Rauws EA, Langenberg W, Houthoff HJ, Zanen HC, Tygat GN. Campylobacter pyloridis-associated chronic active antral gastritis. A prospective study of its prevalence and the effects of antibacterial and antiulcer treatment. Gastroenterol. 1988;94:33-40.

Gisbert JP, Legido J, García-Sanz I, Pajares JM. Helicobacter Pylori and perforated peptic ulcer prevalence of the infection and role of nonsteroidal and anti-inflammatory drugs. Dig Liver Dis. 2004;36:116-20.

Tokunaga Y, Hata K, Ryo J, Kitaoka A, Tokuka A, Ohsumi K, et al. Density of H.Pylori infection in patients with peptic ulcer perforation. J Am Coll Surg. 1998;186:659-63.

Sharma AK, Mittal S, Malvi SK:Association of H.pylori with peptic perforation in Chattisgarh region of India. Trop. Gastroenterol. 2000;21:42-3.

Arveen S, Jagdish S, Kadmbari D:Perforated peptic ulcer in South India:an institutional perspective. World J Surg. 2009;33(8):1600-4.

John B, Mathew BP, Vipin Chandran C. Prevalence of Helicobacter Pylori in peptic ulcer perforation. Int Surg J. 2017;4(10):3350-3.

Hussain AA, Abro AH, Siddiqui FG, Memon AA. Prevalence of Helicobacter Pylori infection in Patients with Perforated Peptic Ulcer. JLUMHS. 2012;11(3):172.

Dogra BB, Panchabhai S, Rejinthal S, Kalyan S, Priyadarshi S, Kandari A. Helicobacter Pylori in gastroduodenal perforation. Med J DY Patil Univ 2014;7:170-2.

Kamani F, Moghimi M, Marashi SA, Peyrovi H, Sheikhvatan M. Perforated peptic ulcer disease:mid-term outcome among Iranian population. Turk J Gastroenterol. 2010;21(2):125-8.

Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22(4):565-70.

Surapaneni S, Rajkumar S, Reddy VBA. Perforation-Operation time interval;an Important Mortality Indicator in Peptic Ulcer Perforation. Journal of Clinical and Diagnosticc Research, 2013;7(5):880-2.

Tas I, Ulger BV, Onder A, Kapan M, Bozdag Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulusal Cerrahi Derg. 2014;31(1):20-5.

Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models. Are existing models sufficient? A retrospective cohort study. Int J Surg. 2015;14:38-44.

Ogihara A, Kikuchi S, Hasegawa A, Kurosawa M, Miki K, Kaneko E, Mizukoshi H. Relationship between Helicobacter Pylori infection and smoking and drinking habits. J Gastroenterol Hepatolol. 2000;15(3):271-6.

Pillay KV, Htun M, Naing NN, Norsa’adah B. Helicobacter Pylori infection in peptic ulcer disease: the importance of smoking and ethnicity. Southeast Asian J Trop Med Public Health. 2007;38(6):1102-10

Brenner H, Rothenbacher D, Bode G, Adler G. Relation of smoking and alcohol and coffee consumption to active Helicobacter Pylori infection:cross sectional study. BMJ. 315:1489-92.

Parasher G, Eastwood G.L. Smoking and peptic ulcer in the Helicobacter Pylori era. Eur. J. Gatroenter. Hepatol. 2000;12:843-53.

Murray LJ, Lane AJ, Harvey IM. Inverse relationship between alcohol consumption and active Helicobacter Pylori infection. The Bristol Helicobacter project. Am J Gastroenterol. 2002;97:2750-5

Ullah A, Ullah S, Ullah A, Muzzafar-Ud-Din S, Khan M. Frequency of Helicobacter Pylori in patients presented with perforated peptic ulcer. JPMI. 2007:21(1):25-8.

Wadaani HA. Emergent laparoscopy in treatment of perforated peptic ulcer:a local experience from a tertiary centre in Saudi Arabia. World J. Emerg. Surg. 2013;8(10):1749-7922-8-10.