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According to our previous investigations (published results in 8 papers) the incidence of a life-threatening complication of ulcer disease, perforation, has increased abruptly since 1991 in Estonia and exceeds significantly respective figures for developed countries. Also, the incidence of H. pylori in our perforated peptic ulcer (PPU) patients (96 - 97%) is significantly higher compared with that observed in other countries. Previous research results show that Estonian PPU patients have not received adequate contemporary conservative treatment, and our prospective investigation demonstrated that the mere adoption of triple treatment schemes used worldwide did not result in the expected postoperative H. pylori eradication in PPU patients. The large proportion of PPU patients and the existence of a team of researches with excellent expertise in Estonia allows to conduct unique investigations which would present also great theoretical and practical interest worldwide. Therefore it is our aim to find a suitable effective postoperative eradication scheme for PPU patients. For this, methods of comprehensive surgical investigation and treatment as well as histological, bacteriological and molecular techniques will be applied. In the case of a positive H.pylori finding, PPU patients will undergo a peroral eradication course lasting 7-14 days. We will combine different antibiotics with proton pump inhibitors, varying at the same time also the start and duration of treatment as well as the administration of drugs under direct medical supervision. The results of the treatment will be assessed 2 months and 1 year after eradication using endoscopy, self-estimation of the patients` condition and investigation of the collected gastric biopsies. In the assessment of the effectiveness of the treatment combinations it will be established which pathogenic mechanisms occur in PPU patients as well as how treatment results are associated with the virulence of different H. pylori strains (determined by PCR methods) and with sensitivity to the antibiotics used. On the basis of the follow-up of PPU patients who were enrolled earlier in a study in 1997-2000, it is planned to assess the long term results of five years depending on the operative technique and on the success of H. pylori eradication. The investigation would allow to find treatment tactics for PPU, suitable in our conditions. Postoperative preventive ulcer recurrence treatment would guarantee patients` better life quality in the future as well as result in an economic effect via reduction in the need for repeat hospitalisations. The results would serve as a basis of the development of optimal effective treatment guidelines for PPU. Two postgraduate students are participating in research. |