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