The role of helicobacter pylori infection in adults presenting with spontaneous gastroduodenal perforation at the University Teaching hospitals, Lusaka Zambia.

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Bwanga, Alick
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The University of Zambia
Gastroduodenal perforation contributes a significant proportion of surgical patients undergoing emergency laparotomy worldwide and is associated with high morbidity and mortality. It is well established that Helicobacter pylori (H. pylori) is the main cause of peptic ulcer disease. The prevalence of H. pylori infection in gastroduodenal perforation varies with geography, age, race, ethnicity and socioeconomic status. The correlation between H. pylori infection and gastroduodenal perforation is not well established. This study was set out to explore the role of H. pylori infection in adults presenting with spontaneous gastroduodenal perforations at the University Teaching Hospitals (UTH), Lusaka, Zambia. This was a cross-sectional study carried out in patients aged 18 years or above who presented to the surgical department of UTH with gastroduodenal perforation between June 2018 and March 2019. A total of 60 patients who had an acute perforation in the stomach and/or duodenum identifiable at laparotomy were enrolled. The perforation site was biopsied with 3 millimetre margins and sent for H. pylori histopathological examination. Simple closure of the perforation, omentopexy and peritoneal lavage were done. Post-operatively, stool was obtained for a rapid stool antigen test for H. pylori. The sociodemographic characteristics alongside relevant past medical and drug history were obtained using the questionnaire. Data was analysed using STATA version 13. Out of 60 patients, 48 were males, and 12 were females. The median age was 40 years (IQR, 31 – 52). Only 7 (12%) patients were positive for H. pylori and 53 (88%) patients were negative on histological examination of biopsies. There were 50 gastric perforations and 10 duodenal perforations. H. pylori infection had no significant statistical association with patient’s demographic characteristics, site and size of the perforation. Histological examination with Warthin-Starry silver stain was found to have superior sensitivity of 65% to stool antigen test (55%) in the detection of H. pylori infection. The prevalence of H. pylori infection in adults presenting with gastroduodenal perforation at UTH was found to be 12% and the histological examination was more sensitive than stool antigen test in the detection of the infection. Keywords: Gastroduodenal perforation, Helicobacter pylori, Peptic Ulcer Disease
Gastroduodenostomy. Gastroduodenostomy--Complications.