Chowdhary S K, Bhasin D K, Panigrahi D, Malik A K, Kataria R N, Behra A, Roy P, Singh K
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Trop Gastroenterol. 1998 Jan-Mar;19(1):19-21.
Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia.
The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori.
While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis.
Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.
穿孔是十二指肠溃疡最常见的并发症。95%的十二指肠溃疡患者中可检测到幽门螺杆菌。然而，关于十二指肠溃疡穿孔患者中幽门螺杆菌感染率的报道较少。因此，我们比较了十二指肠溃疡穿孔患者与并发十二指肠溃疡及非溃疡性消化不良患者的幽门螺杆菌感染率。
本研究纳入45例患者（并发十二指肠溃疡15例、十二指肠溃疡穿孔15例、非溃疡性消化不良15例）。十二指肠溃疡穿孔患者在手术中取胃窦部组织进行活检，非溃疡性消化不良患者则通过内镜取胃窦部组织活检。幽门螺杆菌阳性的标准为：i）培养出幽门螺杆菌；ii）快速尿素酶试验（RUT）与吉姆萨染色联合检测，或RUT与革兰氏染色联合检测，结果显示幽门螺杆菌呈阳性。
并发十二指肠溃疡的15例患者中有9例幽门螺杆菌阳性，非溃疡性消化不良的15例患者中有7例幽门螺杆菌阳性，而十二指肠溃疡穿孔患者中无一例幽门螺杆菌检测呈阳性（p < 0.000）。所有十二指肠溃疡穿孔患者均有组织学胃炎（幽门螺杆菌阴性）。并发十二指肠溃疡的15例患者中有14例（9例幽门螺杆菌阳性，5例幽门螺杆菌阴性）以及非溃疡性消化不良的15例患者中有9例（7例幽门螺杆菌阳性）有组织学胃炎。
十二指肠溃疡穿孔患者不存在幽门螺杆菌感染。幽门螺杆菌阴性的十二指肠溃疡患者可能更易发生穿孔。
