Are patients with perforated peptic ulcers that are negative for H. pylori at a greater risk?

Rohit Rasane; Christopher Horn; Adrian Coleoglou Centeno; Nicholas Fiore; Marlon Torres; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; Grant Bochicchio

The link between Helicobacter pylori (H. pylori) infection and peptic ulceration is well known. However, in recent years studies have shown a decline of H. pylori related peptic ulcers. Emergence of the antibiotic era may be the reason for a decrease in H. Pylori associated peptic ulcers.

We hypothesize that H. pylori positive perforated peptic ulcer disease (PPUD) patients requiring surgical intervention have worse outcomes than patients who are negative.

Prospective data were collected on 106 patients having PPUD and tested for H. Pylori serum IgG test. Patients were divided into two groups; H. Pylori positive (HPP) and H. Pylori negative (HPN). Demographics, social history, medication history, esophagogastroduodenoscopy and admission blood reports were collected. Students T test was used for continuous variables and X² test was used for categorical variables.

We identified 79 patients who had H. Pylori serum IgG testing.  42(53%) tested positive and 37(47%) tested negative. HPN PPUD was more frequent in females (70%), Caucasians (84%) and patients with higher BMI 29±8.8. HPN group had a significantly longer length of stay (LOS) (20.2±13.8 vs 8.5±7.2 p=0.0001), ICU LOS (10.97±11.6 vs 1.9±4.6 p=0.0001), Ventilator days (4.54±6.7 vs 0.98±2.8 p=0.004), 30 day readmission (11; 68.7% vs 5; 31.3% p=0.049), ASA (3.11±0.85 vs 2.6±0.7 p=0.005), Charlson comorbidity index (4.8±2.7 vs 2.9±2.71 p=0.004) and a lower serum Albumin level (2.9±0.96 vs 3.86±0.9 p=0.0001). HPN PUD was associated with statistically significant higher risk of rebleed or ulceration (7, 88% vs 1, 12%, p=0.023) more than 6 months after the operation. No difference in the mortality was found between the groups.

In contrast to what we expected, HPN patients had clinically significantly worse outcomes than HPP patients. These findings may represent a difference in the baseline pathophysiology of the PUD process. Further investigation is warranted.