Contribution of <i>Helicobacter pylori</i> infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti‐inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors

Venerito, Marino; Schneider, Cornelia; Costanzo, R; Breja, Radovan; Röhl, Friedrich-Wilhelm; Malfertheiner, Peter

doi:10.1111/apt.14652

Cited by 37 publications

(50 citation statements)

References 34 publications

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“…The finding of 195 (37%) positive H. pylori patients is therefore robust. In comparison, retrospective studies performed by Kim et al [20] and Venerito et al [33] reported that only one-third of patients were tested for H. pylori infection, and 30% and 44% were positive for H. pylori, respectively.…”

Section: Discussionmentioning

confidence: 90%

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Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Romstad

Detlie

Søberg

et al. 2020

Scandinavian Journal of Gastroenterology

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Objectives: Acute upper gastrointestinal bleeding is a well-recognized complication of peptic ulcers and erosions. The aim of this study was to assess the incidence rate and identify risk factors for this complication in southeastern Norway. Materials and methods: Between March 2015 and December 2017, a prospective observational study was conducted at two Norwegian hospitals with a total catchment area of approximately 800,000 inhabitants. Information regarding patient characteristics, comorbidities, drug use, H. pylori status and 30-day mortality was recorded. Results: A total of 543 adult patients were included. The incidence was 30/100,000 inhabitants per year. Altogether, 434 (80%) of the study patients used risk medication. Only 46 patients (8.5%) used proton pump inhibitors (PPIs) for more than 2 weeks before the bleeding episode. H. pylori testing was performed in 527 (97%) patients, of whom 195 (37%) were H. pylori-positive. The main comorbidity was cardiovascular disease. Gastric and duodenal ulcers were found in 183 (34%) and 275 (51%) patients, respectively. Simultaneous ulcerations at both locations were present in 58 (10%) patients, and 27 (5%) had only erosions. Overall, the 30-day mortality rate was 7.6%. Conclusions: The incidence of upper gastrointestinal bleeding due to peptic ulcers and erosions was found to be lower than previously demonstrated in comparable studies, but the overall mortality rate was unchanged. The consumption of risk medication was high, and only a few patients had used prophylactic PPIs. Concurrent H. pylori infection was present in only one-third of the patients. Clinical trial registration: Bleeding Ulcer and Erosions Study 'BLUE Study', ClinicalTrials.gov Identifier. NCT03367897.

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Section: Discussionmentioning

confidence: 90%

“…Retrospective studies in general reveal that testing for H. pylori is not well established in daily practice and often present missing data on H. pylori status [20,33,34].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Romstad

Detlie

Søberg

et al. 2020

Scandinavian Journal of Gastroenterology

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“…, and H. pylori infection (OR 4.7; 95% CI: 2-10.9) [3,4]. The risk of UGIB in patients with H. pylori infection is also doubled during therapy with non-aspirin antiplatelet agents when compared to ASA [5]. As regards age, a recent meta-analysis of 13 trialswith a median age of trial participants of 62 years (range, 53-74) -showed that aspirin use was associated with an increased risk of bleeding events compared with no aspirin (23.1 per 10, 000 participant-years with aspirin and 16.4 per 10,000 participant-years) with no aspirin -HR 1.43; absolute risk increase 0.47%) [6].…”

Section: Risk Factors Associated With Bleeding In Antiplatelet Usersmentioning

confidence: 99%

“…The risk factors associated with GI bleeding in VKAs anticoagulant users are: 1) age> 65 years (RR 2.5; 95% CI: 1.2-5.5); 2) a previous GI bleeding (RR 5.1; 95% CI: 1.9-13.5); 3) liver cirrhosis (RR 6.9; 95% CI: 2-24.5); and 4) presence of diverticulosis of the colon for the lower digestive tract [4,5]. The risk of UGIB is also increased by the concomitant use of lipid-lowering agents (RR 1.8; 95% CI: 1.4-2.4), NSAIDs (RR 8.7; 95% CI: 7.3-10.4), ASA (RR 6.9; 95% CI: 5.9-8.28), and COX-2 inhibitors (RR 5; 95% CI 1.2-8.9) [8].…”

Section: Risk Factors Associated With Bleeding In Vkas Usersmentioning

confidence: 99%

Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)

Abrignani

Gatta

Gabrielli³

et al. 2021

European Journal of Internal Medicine

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Aspirin and P2Y 12 receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Indeed, pharmacodynamic and pharmacokinetic studies suggested an interaction through hepatic CYP2C19 between PPIs and clopidogrel, which could translate into clinical inefficacy, leading to higher rates of cardiovascular events. The FDA and the EMA sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. In addition, whether the use of PPIs may affect the clinical efficacy of the new P2Y 12 receptor antagonists, ticagrelor and prasugrel, remains less known. According to current guidelines, PPIs in combination with antiplatelet treatment are recommended in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids or non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. Like vitamin K antagonists (VKAs), DOACs can determine gastrointestinal bleeding. Results from both randomized clinical trials and observational studies suggest that high-dose dabigatran (150 mg bid), rivaroxaban and high-dose edoxaban (60 mg daily) are

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“…75 H pylori can cause bleeding peptic ulcer alone but recent data have clarified the interactions with other risk factors. 76 H pylori infection appears to increase the risk of PUB, compared to non-bleeding peptic ulcer in patients also taking NSAIDs (OR: 2.91; 95% CI: 1.71-4.98) aspirin (OR: 2.23; 95% CI: 1.52-3.38) and non-aspirin anti-platelet agents (OR: 4.37; 95% CI: 1.28-14.99) but not in those taking corticosteroids, selective serotonin-reuptake inhibitors or anti-coagulants. These increased risks were not completely ameliorated by concurrent PPI use.…”

Section: Follow-up and Preventionmentioning

confidence: 99%

Advances in the Therapy of Bleeding Peptic Ulcer

Beales

2018

Clinical Medicine Insights: Therapeutics

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Peptic ulcer bleeding remains an important medical emergency. Important recent advances are reviewed. These include further support for a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/L. The Glasgow-Blatchford score remains the most useful assessment score for identifying the lowest risk patients suitable for outpatient management and predicting the need for intervention. Newer scores such as the AIMS65 and Progetto Nazionale Emorragia Digestive score (PNED) may be more accurate in predicting mortality. Pre-endoscopy erythromycin improves outcomes and is underused. A new disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Over-the-scope clips and haemostatic powders appear to have some role as endoscopic salvage therapies. Non-H. pylori, non-aspirin/non-steroidal anti-inflammatory drug (NSAID) ulcers contribute to an increasing percentage of bleeding peptic ulcers and are associated with a high rebleeding rate. The optimal management of these ulcers remains to be determined.

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Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti‐inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors

Cited by 37 publications

References 34 publications

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)

Advances in the Therapy of Bleeding Peptic Ulcer

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