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

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

Background:

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.

Hypothesis:

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

Methods:

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.

Results:

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.

Conclusions:

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.