A Rare Case of Helicobacter pylori Mix Infections and Recurrence of Duodenal Ulcers

Abstract

Introduction: Since Helicobacter pylori (H. pylori) infection is a major cause of gastroduodenal ulcers, it is normal to expect successful eradication drastically reduces ulcer recurrence. Case Presentation: We present a case of a 45-year-old woman with no history duodenal ulcer in her family who was referred to the hospital with epigastric pain. A gastroduodenoscopy was then performed, and revealed two active duodenal ulcers, both measuring 10 mm in size. She was prescribed with 14 days H. pylori standard therapy, but no confirmation test concerning bacterial clearance was performed. Ten months later, she was admitted to the hospital again and complained about intense epigastric pain and vomiting. Gastroscopic findings showed a new 11 mm duodenal ulcer. However, because of positive rapid urease test (RUT), further microbiological analysis was prescribed. Strikingly, H. pylori mix infections was observed. With prescription of second-line therapy against H. pylori, after 4 weeks, positive 13C-urea breath test became negative and her duodenal ulcer was also completely cured. Conclusion: Our cases strongly suggest that frequency of H. pylori mix infections is not only considerable but also it can drastically affect the final outcome of clinical manifestations such as duodenal ulcer. Conclusively, current report insists that gastroenterologists should pay more attention to the possibility of presence of H. pylori mix infections in the management of patients with duodenal ulcers. Additionally, after an initial antibacterial treatment, an obligatory follow up system is recommended.