medwireNews: Outcomes of peptic ulcer bleeding tend to be better in people who test positive for Helicobacter pylori infection than in non-infected individuals, US researchers have found.
Outcomes were also more favorable in people who reported using non-steroidal anti-inflammatory drugs (NSAIDs), according to the study results published in the American Journal of Medicine.
Don Rockey (Medical University of South Carolina, Charleston) and colleagues retrospectively analyzed information on 575 patients who presented with acute upper gastrointestinal bleeding due to peptic ulcer disease over a 6-year period.
Patients were classified into four groups based on the presence or absence of H. pylori infection and the presence or absence of NSAID use.
Approximately half of the patients tested positive for H. pylori, 55% of whom reported using NSAIDS, as did 66% of those who tested negative. Men and non-White people were significantly more likely to be infected with H. pylori than were women and White individuals, note Rockey et al. Additionally, H. pylori-infected patients had significantly fewer comorbidities than those without the bacterium.
With regard to clinical outcomes, the median duration of hospital stay was longest for H. pylori-uninfected patients who reported no NSAID use, at 7 days, and shortest, at 3 days, for patients with H. pylori infection with or without NSAID use.
Similarly, rates of rebleeding within 30 days were highest in H. pylori uninfected NSAID-nonusers, at 18%, and lowest, at 4–6%, for H. pylori-infected patients.
Mortality at 30 days was similar among the four groups, with the most common cause of death being multi-organ dysfunction syndrome and respiratory/cardiac failure. Three deaths resulted from gastrointestinal bleeding, two of which were H. pylori-negative patients.
In regression analysis, H. pylori infection and female gender were associated with a reduced risk for bleeding, with adjusted odds ratios (ORs) of 0.393 and 0.282, respectively, while endoscopic therapy and combination therapy were associated with an increased bleeding risk.
“Patients with Helicobacter pylori can be started on standard-of-care triple antibiotic therapy to facilitate ulcer healing, thus decreasing recurrent ulcer complications,” Rockey et al conclude.
“Helicobacter pylori-negative ulcers are associated with poor outcomes regardless of use of NSAIDs and therefore, patients without Helicobacter pylori should be supported medically as appropriate to improve their underlying medical status, and should be treated as aggressively as possible with proton pump inhibitors.”
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