Eradication of Helicobacter pylori for prevention of ulcer recurrence after simple closure of perforated peptic ulcer: A meta-analysis of randomized controlled trials

Abstract

BackgroundEradication of Helicobacter pylori has become part of the standard therapy for peptic ulcer. However, the role of H pylori eradication in perforation of peptic ulcers remains controversial. It is unclear whether eradication of the bacterium confers prolonged ulcer remission after simple repair of perforated peptic ulcer. MethodsA systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of H pylori eradication on prevention of ulcer recurrence after simple closure of perforated peptic ulcers. The primary outcome to evaluate these effects was the incidence of postoperative ulcers; the secondary outcome was the rate of H pylori elimination. ResultsThe meta-analysis included five randomized controlled trials and 401 patients. A high prevalence of H pylori infection occurred in patients with perforated peptic ulcers. Eradication of H pylori significantly reduced the incidence of ulcer recurrence at 8 wk (risk ratio 2.97; 95% confidence interval: 1.06–8.29) and 1 y (risk ratio 1.49; 95% confidence interval: 1.10–2.03) postoperation. The rate of H pylori eradication was significantly higher in the treatment group than in the nontreatment group. ConclusionsEradication therapy should be provided to patients with H pylori infection after simple closure of perforated gastroduodenal ulcers.