Summary
Helicobacter pylori (H. pylori) infection is associated with peptic ulcer disease and gastric cancer. The eradication
of H. pylori is of special interest in patients with congenital bleeding disorders, for whom treatment
of gastrointestinal hemorrhage with factor concentrates is costly. The prevalence
of H. pylori varies between different populations and identification of high-risk subgroups may
allow for more targeted screening and eradication of the infection. We performed a
5-year retrospective study of gastrointestinal bleeding, combined with screening and
treatment for H. pylori and a long-term prospective follow-up in 168 Swedish and 23 Estonian patients with
hemophilia or von Willebrand disease. The prevalence of seropositivity was lower in
Sweden than in Estonia (28 versus 48%, p = 0.03), lower in native Swedes than in non-Nordic
immigrants to Sweden (20 versus 76%, p = 0.0001) and lower in patients less than 40
years of age than older patients (16 versus 38%, p = 0.002). The incidence of gastrointestinal
hemorrhages among the 35 Swedish patients with active H. pylori infection, confirmed by a urea breath test, was 6.0 per 100 patient-years before
eradication therapy versus 1.7 during the prospective followup. A negative urea breath
test one month after therapy always remained negative after one year. Screening, followed
by treatment of all infected patients, yielded a reduction of direct costs over a
5-year period of 130 US-$ per screened patient. We conclude that screening and eradication
therapy for infection with H. pylori in patients with congenital bleeding disorders is an effective and economic strategy.
Keywords
Hemophilia - von Willebrand Disease - gastrointestinal hemorrhage - Helicobacter pylori
- urea breath test - health economy
