Patients with H. pylori-negative Ulcers Experience More Frequent Rebleeding and Other Poor Outcomes

Research findings underscore the importance of testing peptic ulcer patients for H. pylori status.

The authors of “More Favorable Outcomes with Peptic Ulcer Bleeding Due to Helicobacter Pylori,” published in the American Journal of Medicine, examined Helicobacter pylori-positive and —negative patients with acute upper gastrointestinal bleeding due to ulcers to “determine whether the cause and biologic behavior of ulcers associated with acute upper gastrointestinal bleeding might lead to divergent patient outcomes.”

Out of a total cohort of 2,242 patients with upper gastrointestinal bleeding, researchers identified 228 patients with H. pylori-positive gastroduodenal ulcer disease and 216 patients with H. pylori-negative disease.

Patients with H. pylori-negative ulcers experienced “significantly more comorbid conditions” than their H. pylori-positive counterparts, as well as higher Charlson Index comorbidity scores (p=.003).

H. pylori-negative patients also had longer hospital stays (mean 11.4 days) than patients with H. pylori-positive ulcers (mean 6 days). They also had more rebleeding events within 30 days (11% vs. 5%).

Patients were also categorized according to NSAID use, with researchers reporting that rebleeding events were most frequent in patients without H. pylori and with no reported use of NSAIDS (18%).

The authors concluded that H. pylori-negative ulcer disease is “associated with poorer outcomes regardless of use of NSAIDs.” Patients with H. pylori-negative ulcers and no history of NSAID use in this study “had the worst outcomes and had more severe systemic disease.”

In an interview with Reuters Health, co-author Don Rockey, MD, chair of internal medicine at the Medical University of South Carolina in Charleston, said, “We really need to test all peptic ulcer patients aggressively” for H. pylori status because knowing this information “may be as critical as knowing whether patients use NSAIDs for predicting outcomes.”

“This should be standard in primary care,” he added.