Eradication of Helicobacter pylori for the prevention of peptic ulcer rebleeding
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Sirs, We read with interest the article by Manuel et al.1 examining whether the decreased prevalence of Helicobacter pylori and increased use of eradication regimens have affected the prevalence of peptic ulcer (PU)-related hospitalizations. The authors conducted a retrospective analysis of hospital discharges of PU patients in the US over the last decade, and concluded that, despite a decreasing prevalence of H. pylori and the increasing use of successful H. pylori eradication regimens, the prevalence of PU and its complications (mainly upper gastrointestinal haemorrhage) have not changed.
The authors suggest that, in the US, other aetiologies, including nonsteroidal anti-inflammatory drugs (NSAIDs), may be playing a larger role than once thought. Recently, we evaluated the effect of H. pylori eradication on ulcer bleeding recurrence in a prospective, long-term study including 422 patients with a total of 906 patient-years of follow-up and concluded that PU rebleeding does not occur in patients with complicated ulcers after H. pylori eradication.2 We have just updated the results of this study, now including 565 patients with PU bleeding (70% duodenal ulcer, 25% gastric ulcer, and 5% pyloric ulcer) followed up for at least 12 months (with a total of 1465 patient-years of follow-up). Several eradication therapies were used (patients with therapy failure received a second or third course).
Eradication was confirmed by 13C-urea breath test, and patients with eradication success did not receive maintenance anti-ulcer therapy. Recurrence of bleeding occurred in three patients, giving an incidence as low as 0.2% per patient-year of follow-up. Rebleeding was demonstrated in two patients at 1 year (which occurred after NSAID use in both cases), and in one patient at 2 years (which occurred after H. pylori reinfection).
These results indicate, in accordance with the suggestion by Manuel et al.,1 that although PU rebleeding may not occur in patients with complicated ulcers after H. pylori eradication, NSAID intake (or H. pylori reinfection) may cause rebleeding in H. pylori-eradicated patients.
Acknowledgement
Personal and funding interests: None.
