Aassociation between Helicobacter pylori infection and perforated peptic ulcer in patients operated in Urmia Imam Khomeini teaching hospital

Perforation is one of the most serious and potentially fatal complications of peptic ulcer disease. Based on patient's clinical condition, the traditional treatment of peptic ulcers often involves a definitive wound procedure or simple closure of the perforation cavity. The purpose of this study was to investigate the association between serological and pathologic findings in Helicobacter pylori infection with perforated peptic ulcer in surgical patients at Urmia Imam Khomeini Medical Center. In a cross-sectional study, 80 patients with perforated peptic ulcer and 80 control subjects who underwent endoscopy due to uncomplicated peptic ulcer were entered this study at Imam Khomeini Medical Center of Urmia in 2017-2018. During the operation, a biopsy specimen was taken from the stomach wall and sent to the laboratory for pathologic and blood sent for serologic (IgM and IgG) examinations. Patients in the control group with uncomplicated peptic ulcers underwent a gastric biopsy during the endoscopy process; they were also examined for the same anti-H. pylori immunoglobulins. Data were analyzed statistically using SPSS-21 software. Of the 80 patients in the study group, 51 (63.8%) were male and 29 (36.2%) were female. In the control group, 42 (52.5%) were male and 38 (47.5%) were female. The mean age in the case and control groups were 51.83 ± 17.94 and 47.75 ± 12.89 years, respectively (p = 0.149). Fifty one (63.8%) of the case patients compared to 38 (47.5%) of control patients were IgM positive for H. pylori (p = 0.02). Regarding IgG, 41 (51.3%) of case patients were positive, while 55 (68.8%) of control patients were recorded as positive (p = 0.01). Our pathology results were positive for H. pylori in 66 (82.5%) of case patients compared to 48 (60%) of control patients, respectively (p = 0.001). Of 80 case patients, ulcers were detected to be prepyloric in 59 (73.8%) patients, body of stomach in 12 (16%) and duodenum ulcers in 5 (6.25%) patients. Statistically significant differences observed between case and control groups (p< 0.05) and our results suggest that closure of the perforated wound and eradication of H. pylori can be the first step in the treatment of perforated peptic ulcer disease and could prevent the recurrence of the disease. Further studies using large numbers of patients and their follow up is recommended.