The Effect of the Eradication of Helicobacter pylori Infection on Hemorrhage Because of Duodenal Ulcer

Abstract

The cost of a recurrently bleeding duodenal ulcer (DU) is very high, both from a human and an economic point-of-view. Helicobacter pylori infection plays an important role in the pathogenesis of DU disease and its complications, such as bleeding. Cure of H. pylori infection is recommended in patients with DU and its complications, although in the latter case, the most efficient management is not yet a defined issue. In particular, acid secretion inhibitors may not contribute to long-term cure. Our aims were to ascertain whether the recurrence of bleeding because of DU could be prevented by H. pylori eradication and whether long-term inhibition of gastric acid output is needed to prevent recurrence. Eighty-four patients (65 men; mean age, 55.1 years), who had bled because of recurrent DU, were followed after the cure of H. pylori infection. None of the patients were on therapy with nonsteroidal antiinflammatory drugs. Successful cure of H. pylori was determined by gastroscopy, histology, and serology performed at 3, 6, 12, 24, and 48 months after the eradication treatment. A 13C urea breath test was performed when the results of serology were unclear and also at recurrence of DU or bleeding. After the antibiotic treatment, 46 patients stopped all medications, whereas 38 continued long-term therapy with histamine type 2 receptor antagonists. During a mean follow-up period of 47.2 months (range, 37-65 months), recurrence of DU at endoscopy was observed in three patients in each group (p = 0.56), but none bled again. We conclude that H. pylori eradication prevents DU recurrence and rebleeding, that reinfection rate by H. pylori after cure was nil at 4 years, and that long-term inhibition of acid secretion may not improve outcome after cure of H. pylori, even in patients whose DU was complicated by hemorrhage.

Helicobacter pylori eradication therapy vs. antisecretory non‐eradication therapy for the prevention of recurrent bleeding from peptic ulcer

“…Two recent randomized studies have directly compared (after anti-H. pylori therapy had been prescribed and eradication confirmed) long-term maintenance antisecretory therapy vs. no treatment, and reported no differences in re-bleeding rates during a mean followup period of up to 47 months. 26,27 Furthermore, the protective effect of H. pylori eradication seems to be maintained, at least in the medium term, as rebleeding rates of 0% have been reported even after 24 months. [27][28][29][30] Nevertheless, as shown by the present meta-analysis, the prescription of H. pylori eradication therapy does not always prevent the recurrence of bleeding, and several explanations can be suggested.…”

“…26,27 Furthermore, the protective effect of H. pylori eradication seems to be maintained, at least in the medium term, as rebleeding rates of 0% have been reported even after 24 months. [27][28][29][30] Nevertheless, as shown by the present meta-analysis, the prescription of H. pylori eradication therapy does not always prevent the recurrence of bleeding, and several explanations can be suggested. Firstly, as antibiotic regimens are not 100% effective in the treatment of H. pylori infection, eradication failures may explain some of the re-bleeding episodes.…”

III Conferencia Española de Consenso sobre la infección por Helicobacter pylori

“…Consecuentemente, debe evaluarse la presencia de infección por H. pylori en todos los pacientes con hemorragia digestiva por úlcera péptica y prescribirse tratamiento erradicador a aquellos que estén infectados. Una vez confirmada la erradicación no es preciso administrar tratamiento de mantenimiento con antisecretores 310 111 12 0 (0%) 111 0 Graham et al 311 13 12 0 (0%) 13 0 Horvat et al 312 43 12 1 (2,3%) 43 2,3 Jaspersen et al 313 24 12 0 (0%) 24 0 Jaspersen et al 314 29 12 1 (3,4%) 29 3,4 Krizman et al 315 33 17 0 (0%) 47 0 Labenz et al 316 42 17 0 (0%) 59 0 Lai et al 317 41 53 2 (4,9%) 177 3,4 Liu et al 318 26 56 0 (0%) 121 0 Macri et al 319 21 48 0 (0%) 84 0 Pellicano et al 320 46 47 0 (0%) 180 0 Riemann et al 321 42 19 2 (4,8%) 66 3 Rokkas et al 322 13 12 0 (0%) 13 0 Santander et al 323 84 12 2 (2,4%) 84 2,4 Sung et al 324 108 12 0 (0%) 108 0 Vcev et al 325 36 12 0 (0%) 36 0 Vergara et al 326 93 27 0 (0%) 209 0 Total 1.106 1.913 0,88…”

Current therapy for nonvariceal upper gastrointestinal bleeding

“…They further recommend that patients with known peptic ulcer disease who require continued NSAID therapy should be maintained on a proton pump inhibitor [20]. Several studies have shown the efficacy of therapy for H. pylori in preventing future bleeding episodes in patients with bleeding peptic ulcer with proven H. pylori infection [29,31,36,44].…”