H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer

Abstract

Treatment of H. pylori infection is more effective than antisecretory non-eradicating therapy (with or without long-term maintenance antisecretory therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and eradication therapy should be prescribed to H. pylori-positive patients.

Proton pump inhibitors reduce the long‐term risk of recurrent upper gastrointestinal bleeding: an observational study

“…As reported recurrence rates for UGIB decline rapidly after the initial episode, the exclusion of events in the first 2 months following UGIB and the overall length of follow‐up meant that our incidence rates were in the lower part of the range estimated by previous studies (3–40%) 5–7 . Our results confirm those obtained by a previous observational study reporting an increased risk of recurrent UGIB among users of warfarin and a reduced risk with long‐term omeprazole therapy, 15 and are consistent with the use of PPIs in the acute management of UGIB 9 .…”

Proton pump inhibitors reduce the long‐term risk of recurrent upper gastrointestinal bleeding: an observational study

“…As reported recurrence rates for UGIB decline rapidly after the initial episode, the exclusion of events in the first 2 months following UGIB and the overall length of follow‐up meant that our incidence rates were in the lower part of the range estimated by previous studies (3–40%) 5–7 . Our results confirm those obtained by a previous observational study reporting an increased risk of recurrent UGIB among users of warfarin and a reduced risk with long‐term omeprazole therapy, 15 and are consistent with the use of PPIs in the acute management of UGIB 9 .…”

Effect of Helicobacter pylori Eradication Therapy on Risk of Hospitalization for a Major Ulcer Event

“…[20][21][22][23] However, we found that H. pylori eradication therapy compared with antisecretory therapy alone was associated with a significantly decreased risk of hospitalization for major ulcer events (adjusted HR 0.57, 95% CI 0.54-0.59, p<0.001). These findings were comparable to those of another meta-analysis, 18 which indicated that H. pylori eradication therapy was effective in preventing gastrointestinal ulcer rehospitalization compared with antisecretory therapy alone. With three studies (470 patients) included in that metaanalysis, the authors found that the mean percentage of rebleeding in the H. pylori eradication therapy group was 1.6%, and in the non-eradication therapy group with long-term maintenance antisecretory therapy was 5.6% (odds ratio 0.25, 95% CI 0.08-0.76).…”

Eradication of Helicobacter pylori for the Prevention of Peptic Ulcer Rebleeding

“…In this respect, a recent Cochrane systematic review and meta‐analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non‐eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta‐analysis [47].…”

“…Thus, follow-up periods in each study, measured in patientyears, and respective yearly bleeding (in patient-years −1 ), are also included in the Table. mean incidence of peptic ulcer rebleeding calculated from studies where H. pylori was eradicated and no maintenance antisecretory therapy was prescribed was only per patientyear of follow up (Table 1) . In this respect, a recent Cochrane systematic review and meta-analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non-eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta-analysis [47].…”

“…Two patients were lost to follow up at 1 year, one patient was lost at 2 years, and one more patient was lost at 3 years. Dropouts were considered as not having recurrent bleeding, as it is the most frequent outcome [12,13]. In addition, it seems to be exceptional that patients having recurrent bleeding are lost to follow up, as it is logical to assume that these patients will be finally included in the analysis.…”

Proton pump inhibitors reduce the long‐term risk of recurrent upper gastrointestinal bleeding: an observational study

“…As reported recurrence rates for UGIB decline rapidly after the initial episode, the exclusion of events in the first 2 months following UGIB and the overall length of follow‐up meant that our incidence rates were in the lower part of the range estimated by previous studies (3–40%) 5–7 . Our results confirm those obtained by a previous observational study reporting an increased risk of recurrent UGIB among users of warfarin and a reduced risk with long‐term omeprazole therapy, 15 and are consistent with the use of PPIs in the acute management of UGIB 9 .…”

Effect of Helicobacter pylori Eradication Therapy on Risk of Hospitalization for a Major Ulcer Event

“…[20][21][22][23] However, we found that H. pylori eradication therapy compared with antisecretory therapy alone was associated with a significantly decreased risk of hospitalization for major ulcer events (adjusted HR 0.57, 95% CI 0.54-0.59, p<0.001). These findings were comparable to those of another meta-analysis, 18 which indicated that H. pylori eradication therapy was effective in preventing gastrointestinal ulcer rehospitalization compared with antisecretory therapy alone. With three studies (470 patients) included in that metaanalysis, the authors found that the mean percentage of rebleeding in the H. pylori eradication therapy group was 1.6%, and in the non-eradication therapy group with long-term maintenance antisecretory therapy was 5.6% (odds ratio 0.25, 95% CI 0.08-0.76).…”

Eradication of Helicobacter pylori for the Prevention of Peptic Ulcer Rebleeding

“…In this respect, a recent Cochrane systematic review and meta‐analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non‐eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta‐analysis [47].…”

“…Thus, follow-up periods in each study, measured in patientyears, and respective yearly bleeding (in patient-years −1 ), are also included in the Table. mean incidence of peptic ulcer rebleeding calculated from studies where H. pylori was eradicated and no maintenance antisecretory therapy was prescribed was only per patientyear of follow up (Table 1) . In this respect, a recent Cochrane systematic review and meta-analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non-eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta-analysis [47].…”

“…Two patients were lost to follow up at 1 year, one patient was lost at 2 years, and one more patient was lost at 3 years. Dropouts were considered as not having recurrent bleeding, as it is the most frequent outcome [12,13]. In addition, it seems to be exceptional that patients having recurrent bleeding are lost to follow up, as it is logical to assume that these patients will be finally included in the analysis.…”

Proton pump inhibitors reduce the long‐term risk of recurrent upper gastrointestinal bleeding: an observational study

“…As reported recurrence rates for UGIB decline rapidly after the initial episode, the exclusion of events in the first 2 months following UGIB and the overall length of follow‐up meant that our incidence rates were in the lower part of the range estimated by previous studies (3–40%) 5–7 . Our results confirm those obtained by a previous observational study reporting an increased risk of recurrent UGIB among users of warfarin and a reduced risk with long‐term omeprazole therapy, 15 and are consistent with the use of PPIs in the acute management of UGIB 9 .…”

Effect of Helicobacter pylori Eradication Therapy on Risk of Hospitalization for a Major Ulcer Event

“…[20][21][22][23] However, we found that H. pylori eradication therapy compared with antisecretory therapy alone was associated with a significantly decreased risk of hospitalization for major ulcer events (adjusted HR 0.57, 95% CI 0.54-0.59, p<0.001). These findings were comparable to those of another meta-analysis, 18 which indicated that H. pylori eradication therapy was effective in preventing gastrointestinal ulcer rehospitalization compared with antisecretory therapy alone. With three studies (470 patients) included in that metaanalysis, the authors found that the mean percentage of rebleeding in the H. pylori eradication therapy group was 1.6%, and in the non-eradication therapy group with long-term maintenance antisecretory therapy was 5.6% (odds ratio 0.25, 95% CI 0.08-0.76).…”

Eradication of Helicobacter pylori for the Prevention of Peptic Ulcer Rebleeding

“…In this respect, a recent Cochrane systematic review and meta‐analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non‐eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta‐analysis [47].…”

“…Thus, follow-up periods in each study, measured in patientyears, and respective yearly bleeding (in patient-years −1 ), are also included in the Table. mean incidence of peptic ulcer rebleeding calculated from studies where H. pylori was eradicated and no maintenance antisecretory therapy was prescribed was only per patientyear of follow up (Table 1) . In this respect, a recent Cochrane systematic review and meta-analysis concluded that rebleeding was less frequent after H. pylori eradication therapy than after non-eradication antisecretory therapy, with an odds ratio of about 0.20 [12,13]. This advantage is expressed by a number needed to treat with eradication therapy to prevent one episode of rebleeding of only 5 when compared with ulcer healing treatment alone, in agreement with the results of another meta-analysis [47].…”

“…Two patients were lost to follow up at 1 year, one patient was lost at 2 years, and one more patient was lost at 3 years. Dropouts were considered as not having recurrent bleeding, as it is the most frequent outcome [12,13]. In addition, it seems to be exceptional that patients having recurrent bleeding are lost to follow up, as it is logical to assume that these patients will be finally included in the analysis.…”