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."