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Peptic ulcer rebleeding rare after H. pylori eradication

NEW YORK (Reuters Health) – Patients with bleeding ulcers don’t need anti-ulcer maintenance therapy once Helicobacter pylori is eradicated, a new report from Spain indicates.

That’s because the rate of peptic ulcer rebleeding was less than 1% per patient-year after successful initial treatment.

“As peptic ulcer rebleeding virtually does not occur after curing the H. pylori infection, it seems unnecessary to continue antisecretory maintenance therapy in patients with a history of peptic ulcer bleeding and prior H. pylori eradication,” Dr. Javier P. Gisbert from Hospital Universitario de La Princesa in Madrid told Reuters Health by email.

Many believe maintenance antisecretory therapy may be prudent even after H. pylori eradication, the researchers noted in a May 22 online paper in The American Journal of Gastroenterology.

But in their multicenter prospective study of 1,000 patients, with 3,253 patient-years of follow-up, only 31 patients had recurrent H. pylori infection (27 at one year, three at two years, and one at five years).

The cumulative incidence was 3.1%, and the rate per patient-year was 0.95%.

Everyone in the study was followed for at least a year.

Bleeding recurred in three patients at one year and in another two at two years. Three of the five recurrences came after use of nonsteroidal antiinflammatory drugs (NSAIDs), and the other two after H. pylori reinfection.

The overall cumulative incidence of rebleeding was 0.5%, which translated into a per-patient-year incidence of 0.15%.

Among the 592 patients who were not taking NSAIDs at the time of their original bleeding event, there were only two recurrences (one after NSAID use, one after H. pylori reinfection), for an incidence rate of rebleeding of 0.11% per patient-year of follow-up.

“Successful eradication of H. pylori drastically changes the natural history of bleeding peptic ulcers, as rebleeding virtually does not occur after curing the infection,” Dr. Gisbert said. “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.”

“I would like to emphasize that although there is strong evidence that supports carefully testing for H. pylori infection in all patients with peptic ulcer bleeding and prescribing eradication therapy to those bearing the infection, compliance with this strategy seems be very limited in clinical practice,” Dr. Gisbert said.

“Thus, it is disappointing that relatively few patients admitted to hospital with peptic ulcer hemorrhage appear to be tested for the infection or treated when the infection is present,” he continued. “In summary, it seems evident that management of patients with previous peptic ulcer hemorrhage is only partly in accordance with evidence-based medicine.”

Dr. Gisbert added, “It remains to be demonstrated that the beneficial effects of H. pylori eradication are maintained in the future — I mean in the distant future, in the long-term — mainly because H. pylori reinfection could be a problem in the long-term management.”


Am J Gastroenterol 2012.