Peptic ulcer: H.pylori infection in patients who have had peptic ulcer surgery was common.

Clinical bottom line (level 2a)

  1. Around half of patients who had a partial gastrectomy developed H. pylori infections post-operatively.
  2. About 85% of patients who had a vagotomy developed H.pylori infections post-operatively.
Danesh et al: British Medical Journal 1998; 316: 746-747
Expires October 2002

The study

Systematic review of all studies of
  • Patients: H.pylori infection and peptic ulcers
  • Intervention: surgery: partial gastrectomy or vagotomy
  • Outcome: persistent H. pylori infection


    • Articles found in ?all languages using databases, 1966 to 1997 (search terms: uncertain ) and reference lists and gastroenterology journals

    Selection criteria: if studies contained information on the indication for surgery and the type of surgery
    Appraisal criteria: not detailed
    Articles excluded if:
    • unrepresentative patients
    • unable to extract data


    36 studies found involving1236 patients.
    Studies were only heterogeneous for the type of surgery performed.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    H. pylori infection following partial gastrectomy ? 292/580 50.3%
    (46.3% to 54.4%)
    H. pylori infection following vagotomy ? 542/656 83%
    (80% to 86%)

    Comments

    1. Helicobacter reinfection rates are largely variable among different populations.
    2. Patients were tested on average 10 years after surgery, allowing plenty of time for reinfection.
    3. Lack of information about the search and appraisal techniques used in this systematic review make these results less certain.

    Citation

    1. Danesh J, Appleby P, Peto R, et al: How often does surgery for peptic ulceration eradicate Helicobacter pylori? Systematic review of 36 studies. British Medical Journal 1998; 316: 746-747
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer: Zoltan Bodnar

    Clinical Question.
    Patient H. pylori infection and peptic ulcer
    Intervention or Exposure surgery
    Outcome persistent H. pylori infection