Helicobacter pylori Status Affects Outcomes of Bleeding Peptic Ulcers

Summary and Comment |
September 24, 2013

Helicobacter pylori Status Affects Outcomes of Bleeding Peptic Ulcers

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

H. pylori–negative ulcers were associated with higher 30-day rebleeding and a longer hospitalization stay but not higher mortality.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

The major causes of peptic ulcers are Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs). Some data suggest that the clinical course may differ with the etiology of the ulcer.

In the current retrospective study, researchers evaluated 575 patients who presented with upper gastrointestinal bleeding (UGIB) from peptic ulcers at a single hospital in Texas. Of these patients, 444 received appropriate testing for H. pylori infection; half tested positive and half negative. Using demographic, clinical, and drug use data, researchers defined four groups based on status of H. pylori infection and prior use of NSAIDs.

Thirty-day mortality did not differ between the groups. H. pylori–positive patients had a lower 30-day rebleeding rate (5% vs. 11%; P=0.009) and a shorter mean hospital stay (6 days vs. 11 days; P<0.001) than H. pylori–negative patients. The highest rebleeding rate (18%) was in patients with idiopathic ulcers (negative for both H. pylori and NSAID use). The authors conclude that H. pylori–negative ulcers have poorer clinical outcomes than H. pylori–positive ulcers and that idiopathic ulcers have the worst outcomes. They advocate early H. pylori testing and treatment of all patients with bleeding peptic ulcers.

Comment

Study results vary on the effect of Helicobacter pylori infection on bleeding ulcer outcomes. As observed in this study, ulcers in H. pylori–positive patients are more likely to be duodenal and less likely to be multiple. The single-center source and the potential for confounding in this retrospective analysis limit the strength of its results. Although these findings do not change the clinical approach, they do emphasize the need to assess H. pylori status in the setting of acute upper gastrointestinal bleeding. High-dose acid suppression and endoscopic therapy (where indicated) remain the mainstays of treatment for severe nonvariceal UGIB.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

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