Outcome of peptic ulcer bleeding, nonsteroidal anti-inflammatory drug use, and Helicobacter pylori infection

Clin Gastroenterol Hepatol. 2005 Sep;3(9):859-64. doi: 10.1016/s1542-3565(05)00402-7.

Abstract

Background & aims: NSAIDs and Helicobacter pylori are risk factors for the development of peptic ulcers. A prospective study was conducted to determine prevalence of NSAID use, H pylori infection, and outcome of peptic ulcer bleeding.

Methods: In 2000, data of all 361 patients presenting with peptic ulcer bleeding were prospectively collected in a defined geographical area, including 14 hospitals, and serving a catch area of 1.68 million persons. Follow-up data after a mean of 31 months were obtained from 211 patients.

Results: The overall incidence was 21.5 cases per 100,000 persons. Mean age of the group was 70.9 years, 55% were male, and 41% had severe or life-threatening comorbidity. NSAIDs were used by 52%, and in only 17% concomitant acid suppressive therapy was given. H pylori infection was tested in 64%. Of the patients tested for H pylori, 43% were positive. Twenty-three percent were H pylori negative and not using NSAIDs. Rebleeding during initial admission occurred in 19%. Mortality during initial admission was 14%. During follow-up mortality was high, 29%.

Conclusions: Half of all ulcer bleeding was associated with NSAID use. Only a minority of NSAID users used concomitant acid suppressive therapy. H pylori is not assessed systematically in all patients with ulcer bleeding. Almost a quarter of the ulcers were associated with neither H pylori infection nor NSAID use. Mortality, both during hospitalization and follow-up, was substantial.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Duodenal Ulcer / drug therapy
  • Duodenal Ulcer / microbiology
  • Female
  • Follow-Up Studies
  • Helicobacter Infections / complications*
  • Helicobacter Infections / drug therapy
  • Helicobacter Infections / epidemiology*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori*
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Patient Admission
  • Peptic Ulcer Hemorrhage / chemically induced
  • Peptic Ulcer Hemorrhage / drug therapy
  • Peptic Ulcer Hemorrhage / epidemiology
  • Peptic Ulcer Hemorrhage / etiology*
  • Peptic Ulcer Hemorrhage / microbiology
  • Prevalence
  • Prospective Studies
  • Proton Pump Inhibitors
  • Risk Factors
  • Stomach Ulcer / drug therapy
  • Stomach Ulcer / microbiology
  • Survival Analysis
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Proton Pump Inhibitors