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Dr Javier Gisbert and colleagues from Spain evaluated the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients. Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or 13C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by 13C-urea breath test 8 weeks after completing therapy. The team noted that patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test.  | | The incidence of rebleeding was less than 1% per patient-year of follow up | | American Journal of Gastroenterology |
NSAID use was not permitted during follow-up. The research team followed up 1000 patients for at least 12 months, with a total of 3,253 patient-years of follow-up. The participants' mean age was 56 years, 75% males, and 41% were previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in 3 patients at 1 year, and in 2 more patients at 2 years. The researchers noted that the cumulative incidence of rebleeding was less than 1% per patient-year of follow up. Dr Gisbert's team concludes, "Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication." "Maintenance anti-ulcer therapy is not necessary if eradication is achieved." "However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients."
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