Background: Most patients with chronic peptic ulcer disease have helicobacter pylori (h.Pylori) infection. In the past, immediate acid reduction surgery has been strongly advocated for perforated peptic ulcer because of the high incidence of ulcer relapse after simple closure. Although H. Pylori eradication is now the standard treatment of uncomplicated and bleeding peptic ulcers, its role in perforation remains controversial.

Study aim: The aim of this randomized study, is to determine whether eradication of H. Pylori could reduce the risk of ulcer recurrence after simple closure of perforated duodenal ulcer or not

Patients and methods: Of 80 patients suffering from acute peptic ulcer perforation, 65 (81%) were shown to be infected by H. Pylori (CLO test). Sixty-five positive patents were randomized to receive a course of triple anti-helicobacter therapy or a 4-week course of omeprazole alone. Follow-up endoscopy was performed 8 weeks, 16 weeks (if the ulcer did not heal at 8 weeks), and 1 year after hospital discharge for surveillance of ulcer healing and determination of H. Pylori status. The endpoints zvere initial ulcer healing and ulcer relapse rate after 1 year.

Results: Of 58 patients who did undergo follow- up endoscopy, 31 of the 32 patients in the first group (anti- Helicobacter group) and 4 of the 26 patients in the second group (omeprazole alone group) had H. Pylori eradicated, initial ulcer healing rates were similar in the two groups (90.6% versus 88.4%). After 1 year, ulcer relapse was significantly less common in patients treated with anti-Helicobacter therapy than these who received omeprazole alone (6.2% versus 34.6%).

Conclusions: We have found a high prevalence of H. Pylori infection in patients with perforated peptic ulcer. An immediate and appropriate H. Pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to triple eradication protocol was excellent in hospital setting. Immediate acid- reduction surgery in the presence of generalized peritonitis is unnecessary.