Endoscopy 2003; 35(5): 393-396
DOI: 10.1055/s-2003-38775
Original Article

© Georg Thieme Verlag Stuttgart · New York

Helicobacter pylori Infection Does not Affect the Early Rebleeding Rate in Patients with Peptic Ulcer Bleeding after Successful Endoscopic Hemostasis: A Prospective Single-Center Trial

D.  Schilling 1 , A.  Demel 1 , T.  Nüsse 2 , E.  Weidmann 1 , J.  F.  Riemann 1
  • 1 Department of Internal Medicine C, Klinikum Ludwigshafen, Academic Medical Hospital of the University of Mainz, Ludwigshafen, Germany
  • 2 Department of Pathology, Klinikum Ludwigshafen, Academic Medical Hospital of the University of Mainz, Ludwigshafen, Germany
Further Information

Publication History

Submitted 29 April 2002

Accepted after Revision 11 November 2002

Publication Date:
17 April 2003 (online)

Background and Study Aims: Eradication of Helicobacter pylori infection can reduce the rebleeding rate of peptic ulcer bleeding in the long term. There are few data on the influence of H. pylori on the rebleeding rate in the acute phase of bleeding however. We therefore prospectively investigated the influence of H. pylori infection on the early rebleeding rate in patients who had undergone successful endoscopic hemostasis treatment for peptic ulcer bleeding.
Patients and Methods: Between January 1996 and November 2000 all patients with peptic ulcer bleeding were evaluated consecutively. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. Bleeding activity was assessed using the Forrest classification. After successful endoscopic hemostasis all patients received omeprazole 40 mg or pantoprazole 40 mg, intravenously, twice a day for 3 days. Rebleeding episodes were recorded over 21 days following primary hemostasis.

Results: 344 patients were enrolled into the study. The prevalence of H. pylori infection was 62.9 %. A total of 51 patients showed rebleeding (14.8 %), of whom 31 were H. pylori-positive (60 %). There was no statistically significant difference between the H. pylori-positive and -negative patients, however. The rebleeding rate did not differ between patients with H. pylori infection alone and patients also using nonsteroidal anti-inflammatory drugs. When stratifying patients according to activity of bleeding at index endoscopy, we were also unable to find any significant influence of H. pylori infection on the outcome of Forrest class I and IIa bleedings.
Conclusion: Based on our data, it can be concluded that H. pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis.

References

  • 1 Wara P. Endoscopic prediction of major rebleeding: a prospective study of hemorrhage in bleeding ulcer.  Gastroenterology. 1998;  88 1209-1214
  • 2 Consensus Development Panel . Consenus statement on therapeutic endoscopy and bleeding ulcers.  Gastrointest Endosc. 1990;  36 62-65
  • 3 Jaramillo J L, Galvez C, Carmona C. et al . Prediction of further hemorrhage in bleeding peptic ulcer.  Am J Gastroenterol. 1994;  89 2135-2138
  • 4 Cook D J, Guyatt G H, Salena B J, Laine L A. Endoscopic therapy for non-variceal hemorrhage: a meta-analysis.  Gastroenterology. 1992;  102 139-148
  • 5 Chung S CS, Lau J Y, Sung J J. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding peptic ulcers.  BMJ. 1997;  314 1307-1311
  • 6 Green F W, Kaplan M M, Curtis L E, Levine P H. Effect of acid and pepsin on blood coagulation and platelet aggregation.  Gastroenterology. 1978;  74 38-43
  • 7 Cederberg C, Thomson A BR, Mahachai V. et al . Effect of intravenous and oral omeprazole on 24-hour intragastric acidity in duodenal ulcer patients.  Gastroenterology. 1992;  103 913-918
  • 8 Inoue M, Nakamura M. Studies of various administration methods for lansoprazole injections using 24-hour intragastric pH monitoring.  J Clin Gastroenterol. 1995;  20 17-21
  • 9 Aoki T. Intravenous administration of lansoprazole: a preliminary study of dose ranging and efficacy in upper gastrointestinal bleeding.  Aliment Pharmacol Ther. 1995;  9 51-57
  • 10 Labenz J, Tillenburg B, Peitz U. et al . Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer.  Gastroenterology. 1996;  110 947-950
  • 11 Verdu E F, Armstrong D, Fraser R. et al . Effect of helicobacter pylori status on intragastric pH during treatment with omeprazole.  GUT. 1995;  36 539-543
  • 12 Labenz J, Peitz U, Kohl H. et al . Helicobacter pylori increases the risk of peptic ulcer bleeding: a case-control study.  Ital J Gastroenterol. 1999;  31 110-115
  • 13 Rokkas T, Karameris A, Mavrogeorgis A. et al . Eradication of helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease.  Gastrointest Endosc. 1995;  41 1-4
  • 14 Jaspersen D, Koerner T, Schorr W. et al . Helicobacter pylori eradication reduces the rate of rebleeding in ulcer hemorrhage.  Gastrointest Endosc. 1995;  41 5-7
  • 15 Riemann J F, Schilling D, Schauwecker P. et al . Cure with omeprazole plus amoxicillin versus long-term ranitidine therapy in helicobacter pylori-associated peptic ulcer bleeding.  Gastrointest Endosc. 1997;  46 299-304
  • 16 Vergara M, Casellas F, Saperas E. et al . Helicobacter pylori eradication prevents recurrence from peptic ulcer hemorrhage.  Eur J Gastroenterol Hepatol. 2000;  12 733-737
  • 17 Lin H J, Tseng G Y, Hsieh Y H. et al . Will Helicobacter pylori affect short-term rebleeding rate in peptic ulcer bleeding patients after successful endoscopic therapy?.  Am J Gastroenterol. 1999;  94 3184-3188
  • 18 Forrest J A, Finlayson N D, Sherman D J. Endoscopy in gastrointestinal bleeding.  Lancet. 1974;  27 1164-1167
  • 19 Kohler B, Benz C, Maier M, Riemann J F. Acute ulcer bleeding: a prospective randomized trial to compare Doppler and Forrest classification in endoscopic diagnosis and therapy.  Dig Dis Sci. 1997;  42 1370-1374
  • 20 Dixon M F, Genta R M, Yardley P C, Coorea P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis. Houston 1994.  Am J Surg Pathol. 1996;  20 1161-1181
  • 21 Ell C, Hagenmüller F, Schmitt W. et al . Multicenter prospective study of the current status of treatment for bleeding ulcer in Germany.  Dtsch Med Wochenschr. 1995;  120 3-9
  • 22 Lau J YW, Sung J Y, Lee K KC. et al . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.  N Engl J Med. 2000;  343 310- 316
  • 23 Udd M, Miettinen P, Palmu A. et al . Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study.  Scand J Gastroenterol. 2001;  36 1332-1338
  • 24 Tu T C, Lee C L, Wu C H. et al . Comparison of invasive and non invasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers.  Gastrointest Endosc. 1999;  49 302-306
  • 25 Schilling D, Demel A, Nüsse T, Riemann J F. Diagnostic accuracy of rapid urease test for the diagnosis of Helicobacter pylori infection in patients with acute duodenal gastric or ulcer bleeding - a prospective evaluation of 96 patients.  Dig Liver Dis. 2002;  in press
  • 26 Adamek R J, Freitag M, Opferkuch W. et al . Intravenous omeprazole/amoxicillin and omeprazole pretreatment in Helicobacter pylori-positive acute peptic ulcer bleeding.  Scand J Gastroenterol. 1994;  29 880-883

D. Schilling, M.D.

Department of Internal Medicine C (Gastroenterology and Hepatology) · Klinikum der Stadt Ludwigshafen · Academic Medical Hospital of the University of Mainz

Bremerstrasse 79 · 67063 Ludwigshafen/Rhine · Germany

Fax: + 49-621-503-4114

Email: MedCLu@t-online.de

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