Gastroenterology

Gastroenterology

Volume 137, Issue 2, August 2009, Pages 525-531
Gastroenterology

Clinical—Alimentary Tract
High Incidence of Mortality and Recurrent Bleeding in Patients With Helicobacter pylori–Negative Idiopathic Bleeding Ulcers

https://doi.org/10.1053/j.gastro.2009.05.006Get rights and content

Background & Aims

The long-term prognosis of peptic ulcers associated with neither Helicobacter pylori nor nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown.

Methods

This 7-year prospective cohort study recruited patients with bleeding ulcers from January to December 2000. H pylori–negative idiopathic bleeding ulcers were defined as having tested negative for H pylori, having no exposure to aspirin or analgesics within 4 weeks before endoscopy, and having no other identifiable causative factors. After ulcers healed, patients were divided into 2 groups: patients with prior H pylori–negative idiopathic bleeding ulcers (H pylori–negative idiopathic ulcer cohort; n = 120) and those with H pylori–positive, NSAID-negative bleeding ulcers who received eradication therapy (H pylori ulcer cohort; n = 213). Both groups were followed for ≤7 years without gastroprotective therapy. The primary endpoints were recurrent ulcer bleeding and mortality.

Results

The 7-year cumulative incidence of recurrent ulcer bleeding was 42.3% (95% CI, 36.5%–48.1%) in the H pylori–negative idiopathic ulcer cohort and 11.2% (95% CI, 8.8%–13.6%) in the H pylori ulcer cohort (a difference of 31.1%; 95% CI, 27.7%–34.5%; P < .0001). Significantly more patients died in the H pylori–negative idiopathic ulcer cohort (87.6%; 95% CI, 83.0%–92.2%) than in the H pylori ulcer cohort (37.3%; 95% CI, 34.0%–40.6%) with a difference of 50.3% (95% CI, 49.0%–51.6%; P < .0001).

Conclusions

Patients with history of H pylori–negative idiopathic bleeding ulcers have a high risk of recurrent ulcer bleeding and mortality.

Section snippets

Study Population

This was a 7-year, single-center, prospective cohort study conducted at the Prince of Wales Hospital, which serves a local population of 1.2 million people in Hong Kong. We screened consecutive patients with a clinical diagnosis of upper gastrointestinal bleeding from January 2000 to December 2000. All patients provided informed written consent. Patients were excluded if they were in the intensive care unit, had terminal diseases, had malignancy, or had previous gastrectomy. The study was

Baseline Characteristics

From January 2000 to December 2000, 675 patients had bleeding ulcers confirmed by endoscopy. Thirty-seven patients (5.5%) were excluded: 14 patients had previous gastrectomy and 23 patients did not have biopsies for H pylori. One hundred twenty patients (18.8%) had H pylori–negative idiopathic bleeding ulcers. Three hundred five patients (47.8%) used low-dose aspirin, NSAIDs, over-the-counter analgesics, or traditional Chinese medicine. Three hundred thirty-three patients (52.2%) were nonusers.

Discussion

We set out to study the long-term clinical outcome of patients with H pylori–negative idiopathic bleeding ulcers and to compare them with those who had H pylori bleeding ulcers. In this 7-year prospective cohort study, we found that patients with a history of H pylori–negative idiopathic bleeding ulcers had an almost 4-fold increased risk of recurrent ulcer bleeding (42.3%) than did patients with prior H pylori bleeding ulcers (11.2%). Our findings indicated that patients with H pylori–negative

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Conflicts of interest The authors disclose the following: Dr Henry L.Y. Chan is a member of the advisory boards of Novartis and Schering-Plough. Dr Joseph J.Y. Sung received consulting fees from the National Health Research Institutes of Taipei, The Hong Kong Police Force, Lippincott Williams & Wilkins, and the Hong Kong College of Physicians and paid lecture fees by AstraZeneca Hong Kong Limited, GSK Pharmaceuticals International, and the American Society for Gastrointestinal Endoscopy. Dr Francis K.L. Chan received an independent research grant and a consulting fee from Pfizer and paid lecture fees by Pfizer, Takeda, and AstraZeneca.

All authors participated in patient recruitment and follow up. F.K.C. and J.Y.C. contributed to the design of the study; G.L.W., J.Y.C., K.A., Y.C., and L.C.H. were responsible for data collection, entry, and analysis; K.T. was responsible for the histologic assessment of the biopsy samples; G.L.W., V.W.W., A.J.H., and F.K.C. participated in the preparation of the report.

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