A team from Rome, Italy, investigated the respective roles of Helicobacter pylori and acid secretion in bleeding duodenal ulcer.
A total of 99 duodenal ulcer patients were referred for evaluation of acid secretion. Of these, 7 had Zollinger-Ellison Syndrome and 14 had hypersecretory duodenal ulcer, defined by the coexistence of elevated basal acid output and pentagastrin acid output. 78 were duodenal ulcer patients with normal acid output.
All non-Zollinger-Ellison Syndrome patients were H. pylori-positive and cured of infection.
Patients were followed-up for a 36-month period, to assess the occurrence of bleeding episodes.
|After H. pylori eradication, gastric acid hypersecretion is not a risk for ulcer bleeding.
|Aliment Pharm Thera |
29 patients were known to have at least one bleeding episode in the 4 years before the study.
The researchers found that bleeding was more frequent in males and in patients on nonsteroidal anti-inflammatory drugs (NSAIDs).
The mean basal acid output was not higher among bleeders.
In the 21 patients (14 hypersecretory duodenal ulcer, 7 Zollinger-Ellison Syndrome) with basal acid output greater than 10 meg/h and pentagastrin acid output more than 44.5 meg/h, the risk of bleeding was higher, with an Odds Ratio of 6.5.
In the follow-up period, 3 out of 83 (3%) non-Zollinger-Ellison Syndrome patients had a H. pylori-negative duodenal ulcer with bleeding.
The risk of bleeding after H. pylori cure was not found to be higher in hypersecretory duodenal ulcer patients, nor among patients with previous bleeding episodes.
Dr G. Capurso, of the Medical School, Rome, said on behalf of fellow authors, "In H. pylori-positive duodenal ulcer patients, the coexistence of elevated basal acid output and pentagastrin acid output leads to a six-fold increase in the risk of bleeding."
"After H. pylori cure, gastric acid hypersecretion is not a risk factor for bleeding. However, duodenal ulcer recurrence with bleeding may occasionally occur in patients cured of H. pylori, even if acid output is normal," it was concluded.